bluuebunny/crossref_metadata_2025_split huggingface dataset:
Penggunaan Zat Pewarna Sintetis pada Sirup Yang Dijual di Pasar Modern Kota Makassar
Authors: Sunu Baharuddin 
Published: February 2021

Salah satu masalah keamanan pangan yang masih memerlukan pemecahan masalahnya yaitu penggunaan bahan tambahan pada bahan makanan untuk berbagai keperluan. Diantara beberapa Bahan Tambahan Makanan yang sangat sering digunakan salah satunya adalah pewarna makanan.Penelitian zat pewarna pada sirup dilakukan karena mengingat banyaknya zat pewarna yang digunakan sebagai bahan tambahan pangan baik yang diizinkan maupun yang tidak diizinkan. Menurut Permenkes RI No.722/Mennkes/Per/IX/1988 tentang Bahan Tambahan Makanan bahwa tidak semua zat pewarna yang digunakan merupakan zat pewarna yang diizinkan. Penelitian ini adalah penelitian yang bersifat deskriptif, yaitu untuk melihat gambaran jenis zat pewarna dan kadar zat pewarna pada minuman sirup yang dijual di pasar modern kota makassar.Hasil penelitian menunjukkan bahwa dari 5 yang diuji kualitatif positi mengandung bahan tambahan pangan yang diizinkan Permenkes RI. No.722/Menkes/Per/IX/1988. Dan Hasil uji secara kuantitatif dari 3 sampel yang diuji kadar zat pewarnanya 2 diantaranya tidak memenuhi syarat yaitu Sirup Kian Jaya 509 mg/L dan Sirup Oranges Marjan 389 mg/L. Dari hasil penelitian yang didapat maka dapat disimpulkan bahwa 5 sampel sirup telah memenuhi syarat pada uji kualitatif. Sedangkan dalam uji kuantitatif 3 sampel sirup yang telah diuji kadarnya 2 diantaranya tidak memenuhi syarat. Bagi konsumen sebaiknya tidak terlalu sering mengkomsumsi makanan dan minuman yang mengandung pewarna sintetis karena dapat berbahaya bagi kesehatan.
One of the food safety problems that still requires solving the problem is the use of additional ingredients in food ingredients for various purposes. Among some of the Additional Materials Food that is very often used, one of which is food coloring. The research on coloring substances in syrup is done because considering the number of coloring agents used as food additives both permitted and not permitted. According to RI Minister of Health Regulation No. 722 / Mennkes / Per / IX / 1988 concerning Food Additives that not all coloring agents used are permissible coloring agents. This research is research that isnature descriptive , i.e. for look picture type subst ance dye and grade substance dye on drinks syrup sold in the modern market town makassar. The results of the study showed that from 5 tested qualitative positives containing food additives which were allowed by Permenkes RI. No. 722 / Menkes / Per / IX / 1988. And the quantitative test results from 3 samples tested for the coloring agent 2 of them did not meet the requirements, namely Syrup Kian Jaya 509 mg / L and Oranges Syrup Marjan 389 mg/l. From the results research obtained then could concluded that 5 samples syrup has been meet terms on testqualitative. While in test quantitative 3 samples syrup that has been tested the levels are 2 of them not meet terms. For consumer should not too often consume food and beverages containing dye syntheticbecause could dangerous for healt.
Consultation Intervention Rates for the Otolaryngology Service: A Large Metropolitan Hospital Experience
Authors: Mors Matt , Bohr Colin , Fozo Michael , Shermetaro Carl 
Published: February 2021

CONTEXT The purpose of this study was to evaluate the types of consultations received by an otolaryngology service at a 772-bed large metropolitan, MI-based hospital. METHODS The authors performed a retrospective review of the specific types of consultations received during calendar year 2016. RESULTS A total of 518 consultations were reviewed and analyzed by the first and second authors (MM, CB). Consultations with low intervention rates included dysphagia (difficulty swallowing) (32.3%), dysphonia (difficulty speaking) (16%), otalgia (earache) (20.8%), hearing loss (13.3%), rule out vocal cord dysfunction (0%), and vertigo/dizziness (0%). Epistaxis (nosebleed) was the most frequent reason for consultations, and angioedema (lip or airway swelling) was the most common airway-related consultation. Notably, emergent or urgent surgery was only performed on 4.6% of sample patients. Several common consultation reasons (e.g., longer-term hearing loss evaluation and cerumen (“earwax”) removal) could have been deferred for clinic-based evaluation where audiograms and microscopes are more readily available. CONCLUSIONS These findings suggest areas for continuing education for primary care provider and resident education to place more appropriate hospital consultations. Annual resident lectures to prepare junior residents for the most common call scenarios (i.e., control epistaxis and incision and drainage of peritonsillar abscesses) could be helpful in this area. In addition, didactic lectures for primary care physicians on how to evaluate patients with dysphagia may be of value as this was a common consult for otolaryngologist referrals.
Osteopathic Orthopaedic Residency Selection Criteria: Program Directors’ Survey and Analysis
Authors: McDonald Michael , Khan Saad , Cabatu Clarence , Scott Fremont 
Published: February 2021

CONTEXT Orthopaedic Surgery has become one of the most competitive specialties. Each year the number of applicants is far greater than the number of available Orthopaedic residency training spots [1,2,3]. With medical schools expanding their class sizes and new medical schools opening out of proportion to the number of residency spots, the competition is becoming even more fierce [12]. There are several published articles on resident selection in allopathic orthopaedic programs [5-7]. However, there are currently no such published studies on osteopathic orthopaedic programs to our knowledge. With the AOA and ACGME merger, this topic is critical to both allopathic and osteopathic applicants alike. The goal of our study was to evaluate the resident selection criteria for osteopathic orthopaedic residency programs. METHODS A twenty-five-question survey was sent to all of the osteopathic orthopaedic programs in December of 2017. The most important selection factors were then calculated as a mean of all the responses and were ranked accordingly. RESULTS The survey was completed by 29 out of 41 program directors (71%). The most important factors in resident selection were performance during the student’s rotation at the program, formality/politeness and performance in the interview, and medical school board exam scores. CONCLUSIONS This study is the most comprehensive study to date on the osteopathic orthopaedic resident selection process. The results from this study will help future applicants, both MD and DO, to focus on the factors in resident selection. The results may also help programs evaluate their own selection process and make improvements.
An Evaluation of a Community Hospital’s Emergency Department Ultrasonography Processes for the Diagnosis of Acute Pediatric Appendicitis
Authors: Davis Tanner , Wisniewski Samuel J. , Suidinski Heidi , Betcher Joe 
Published: February 2021

CONTEXT Since the 1980s, the use of ultrasonography for suspected acute pediatric appendicitis has become increasingly common. Multiple studies have suggested that ultrasound of the appendix has consistently high sensitivity and specificity when the appendix can be clearly visualized. The authors’ primary objective for this study was to retrospectively evaluate their community-based healthcare system’s processes for detecting acute pediatric appendicitis using ultrasonography. METHODS This was a retrospective medical chart review study of data over a five-year 2014-2018 period at Mercy Health Muskegon in Muskegon, Michigan. All patients aged 3-18 years who had received an appendix ultrasound during this period were identified using the McKesson Radiology (MS) PACS-Lite computer program. Pediatric appendix ultrasound cases were collected and analyzed for sensitivity, specificity, positive predictive value, negative predictive value with 95% confidence intervals. Acute appendicitis cases had been confirmed based on pathology reports. Secondary measures including white blood cell, body mass index, and body temperature were also included in analyses. RESULTS In this sample, the overall sensitivity at detecting acute pediatric appendicitis using ultrasonography was relatively low at approximately 42% (95% CI: 21.1 - 66.0%). On the other hand, sample specificity was quite high at 97% (95% CI: 89.9 – 99.5%). The overall positive predictive value (PPV) was 80% (95% CI: 44.2-96.5%) and the negative predictive Value (NPV) was 86% (95% CI: 75.7-92.4%). The occurrence for false positives was 20% (95% CI: 3.5-55.8%). False negatives were 14% (95% CI: 7.6-24.3%). CONCLUSIONS The use of ultrasonography at the authors’ institution less often accurately identified cases of later-confirmed pediatric appendicitis compared to some earlier published studies. The authors concluded that this could be due to seeing a lower number of more complex/ambiguous cases of pediatric appendicitis or lack of hospital personnel’s pediatric-specific training and/or experience compared to specialty children’s hospitals. It is possible that imaging improvements could be achieved by either or a combination of: offering training sessions for general ultrasound technicians, offering training session for radiologists, and visiting pediatric physicians and ultrasound technicians. A valuable follow-up study would be to track anticipated improvements and lead to formulation of an acute pediatric appendicitis care protocol within the authors’ healthcare system.
A Novel ‘Train the Trainer’ Emergency Medicine Resident Point-of-Care Ultrasound Course: A Feasibility Study
Authors: Butki Nikolai , Long Jereme , Butki Andrew , Corser William 
Published: February 2021

CONTEXT A novel multi-site ‘train the trainer’ point-of-care ultrasound (POCUS) training course was designed to better meet the graduate medical education learning needs of a geographically dispersed consortium of 16 community-based Michigan emergency medicine (EM) residency programs. The specific aim of this study was to explore the feasibility of using volunteer EM physicians who were novices with ultrasound techniques as instructors for a POCUS course. Additionally, the authors evaluated the effectiveness and consistency of a POCUS course delivered over multiple sites to enhance EM residents’ ultrasound knowledge and skill acquisition. METHODS For the initial session, the lead instructor conducted a focused two-hour course with the novice instructors. A subsequent four-hour session was then repeated for EM residents whereby the aforementioned novice instructors provided the hands-on instruction. The residents were given 10-item pre- and 20-item post-course knowledge tests to gauge the effectiveness of the instruction model. After the course, a satisfaction survey was administered to the resident participants and a qualitative open-ended survey to the volunteer EM physicians who served as instructors. RESULTS Forty-two EM residents from 11 different residency programs attended at one of the three courses that were offered. After adjustments for size differences in the pre- and post-training tests, 35 (87.5%) of total sample resident learners’ scores proportionately increased from pre- to post-test scores, with five (11.9%) other residents maintaining their pre-course score levels and only two (4.8%) residents experienced a post-score decline. In addition, resident participants responded favorably to a post-course summary evaluation with an average response of 4.8 (0-5 Likert scale) demonstrating overall satisfaction with the course. In the separate qualitative survey given to instructors, comments consistently conveyed a perceived benefit for the volunteer EM physicians. CONCLUSIONS The evaluation of this novel model supports the feasibility of the ‘train the trainer’ program. It provides a proof of principle that train the trainer model can be implemented for POCUS training courses. Despite the small sample size, our results show an increase in the pre- to post-test scores among most participating residents. This model provides an additional option for EM residency program educators to consider when developing their POCUS training courses across multiple GME settings.
The Face of Clostriodes Difficile Infections in the Outpatient Setting
Authors: Wang Michael S , Faheem Samad , Mangio Joanna , Pham Kevin , Lloyd Daniel , Hatch-Vallier Brianna , Johnson Ewanah 
Published: February 2021

BACKGROUND It has long been well-established that Clostridiodes difficile infections (CDI) can cause severe morbidity and mortality. However, most of the literature to date has focused on hospital-diagnosed infections with less emphasis on clinic-based CDI cases. Guidelines from the 2010 IDSA/SHEA for CDI advocate for metronidazole as first-line therapy for mild to moderate CDI cases. However, the 2017 guidelines recommend oral vancomycin or fidaxomicin as first-line therapy due to their superior efficacy. Objective: The purpose of this study was to compare Clostriodes difficile infections in convenience samples of clinic vs. hospital patients. METHODS In 2019, a retrospective, case-controlled study was performed by the first six authors between 2015-2017 (i.e., prior to the 2017 IDSA/SHEA CDI guidelines) to compare ambulatory and hospital CDI treatment prescriptions. Analytic data included frequency of White blood cells (WBC) and creatinine collection, frequency of severe CDI cases, compliance with the 2010 guidelines, CDI recurrence, and mortality. RESULTS An eligible subgroup of N = 92 hospital patients at Spectrum Health Lakeland were more likely to have WBC (98.4% vs 32.6%, p<0.001) and creatinine (97.8 vs. 39.4, P < 0.001) drawn than 184 patients receiving clinic-based care. Hospital sampled patients were more likely to have severe CDI (46.7% vs 6.7%, p < 0.001). Mortality was less common in hospital patients (1.1% vs. 7.6%, p = 0.017) and the recurrence rates were similar. (21.2% inpatient vs. 28.3% outpatient, (p = 0.224). CONCLUSIONS Based on these results, assessment of CDI severity remains limited in the ambulatory population due to the lack of severity markers. It is unclear if this is due to lack of available laboratory resources or difference in clinical presentation. Of those sample patients who have available markers of severity, patients receiving clinic-based diagnoses were less likely assessed to have severe CDI. Keywords: Cloistriodes difficile infection, ambulatory, severity markers
Wilkie’s Weight Loss Wonder: A Case Series
Authors: Haidar Akhlema , Davies Alexandra , Hussain Afzal , Gregerson Samuel , Thammineni Dheeraj , Markus Johnathon 
Published: February 2021

INTRODUCTION Wilkie’s Syndrome, also known as Superior Mesenteric Artery Syndrome (SMAS), is a rare cause of bowel obstruction that can contribute to vague abdominal symptoms on clinical presentation. This syndrome occurs when the aortomesenteric angle decreases, compressing the third portion of the duodenum between the aorta and the superior mesenteric artery. An acute decrease in the mesenteric fat pad cushion between these two blood vessels is the primary etiology, although other causes (e.g., anatomical, postoperative, functional, and pubescent etiologies) have also been described. CASE PRESENTATION In the present cases, 2 females with a common history of recent weight loss presented to our institution with similar symptoms of abdominal pain, nausea and vomiting. Each patient was subsequently diagnosed with SMAS following imaging studies. Both patients experienced successful resolution of symptoms with conservative nutritional management. DISCUSSION Common presenting complaints of SMAS include nausea, vomiting, early satiety and postprandial pain. These symptoms overlap with other gastrointestinal disorders (i.e., mesenteric ischemia, intestinal volvulus, peptic ulcer disease) making diagnosis difficult. SMAS can be identified through imaging modalities including barium studies and computer tomography. First line therapies typically include conservative nutritional support and promotion of weight gain. If conservative therapies fail, various surgical procedures can be pursued. Delayed diagnosis can lead to further pathological sequelae, including duodenal compromise, ischemia and necrosis. As the syndrome progresses, success of conservative nutritional support is less likely, and surgical correction becomes increasingly necessary. CONCLUSION Therefore, a clinical goal for SMAS should include as swift a recognition and diagnosis as possible.
Does Peritraumatic Ketamine Reduce Symptoms of Post-Traumatic Stress Disorder?
Authors: Brodeur Jack , Mancine Ryley , Ley Alyse , Magen Jed 
Published: February 2021

INTRODUCTION Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are chronic diseases which can affect patients following a severe trauma. As these patients typically first present to the emergency department, it is critical for emergency physicians to remain updated on the use of ketamine or other anesthetic agents which may impede development or reduce symptoms which may impair normal functioning. The purpose of this clinical review was is to review the literature regarding how the use of peritraumatic ketamine could decrease the incidence of ASD and PTSD. In 2019, the authors completed a MEDLINE search was performed yielding 25 articles which were initially evaluated by the first and second authors. Four articles which met inclusion criteria are discussed in this manuscript. SUMMARY of EVIDENCE Although two earlier research groups have found that peritraumatic ketamine administration contributed to increased symptoms of PTSD (e g., reexperiencing, dissociation, avoidance, and hyperarousal), two later studies have indicated that ketamine had no effect on PTSD development. Additionally, one 2012 study group has suggested propofol use may alleviate PTSD symptoms at six months post-trauma. Another 2017 study team found that the number of surgical procedures was directly correlated with increased PTSD development. CONCLUSIONS Based on the literature to date, peritraumatic ketamine does not appear to influence the prevention nor development of ASD and subsequent PTSD. More research is needed to clarify the psychopharmacologic effects of ketamine when used in the management of reactions to acute trauma experiences. Based on the results of the two later works, future research is indicated considering whether propofol may contribute to PTSD development.
Billing Implications of Emergency Medicine Resident Physicians’ Laceration Length Estimates
Authors: Sherer Joseph , Caloia Roya , Corser William D. , Tishkowski Kevin 
Published: February 2021

CONTEXT Lacerations are a common occurrence in urgent care and emergency room settings. The types of lacerations repaired in these settings range from superficial and linear to deep and stellate. Healthcare professionals are required to describe these wounds in documentation and part of that description is length. In a busy clinical setting, many providers use a visual estimation of wound length for documentation. The purpose of this exploratory pilot study was to systematically examine the factors (e.g., sex, residency year, prior laceration training) associated with overall accuracy of five laceration length estimates made on a series of five identically-marked linear dummy torso sutured lacerations by a convenience sample of Emergency Medicine (EM) resident physicians. Before the study, the authors hypothesized that laceration estimates from later-year residents and/or those with more prior laceration training would be more accurate. METHODS The EM residents who attended a statewide educational session were encouraged to participate in the study by independently entering information concerning their a) personal characteristics, and b) five laceration length estimates from five dummy torso sutured lacerations onto hard copy forms during break and lunch periods of the daylong conference. The use of any types of measurement devices was prohibited. RESULTS A total non-probability convenience sample of 107 participants (93 EM resident physicians and 14 medical student attendees) from 14 different Michigan-based EM residency programs completed a 10-item survey during the educational conference. Results for both composite and individual actual-to-estimated (AE) laceration differences varied widely within the sample, with up to 58.9% of laceration over estimates hypothetically having resulted in overbilling of payers for the laceration repair. CONCLUSIONS The considerable range in laceration estimates obtained from these EM clinicians indicate the complexity of attempting to estimate lacerations without measuring devices, as well as the potential for over-billing under such conditions. Larger resident samples recording laceration length estimates, with testing of potential interaction effects on AE patterns, are needed in the future to provide additional evidence concerning this aspect of EM billing.
Examination of Resident Physician Quality Improvement/Patient Safety Project Confidence Levels from Multiple Programs
Authors: McGrail Carolyn , Urban Josie , Church Brandy , Corser William D. 
Published: February 2021

CONTEXT It is now increasingly recognized that physicians should be engaged in quality improvement/patient safety (QIPS) activities to make their patient care systems perform more reliably and safely. In order to ensure that our nation’s physicians embed this aspect of practice into their work, there also is a growing expectation for effective integration of QIPS training into graduate medical education. This exploratory pilot study was conducted to identify how residents’ personal and residency program characteristics might be related to their perceived confidence to develop and conduct prospective QIPS projects. METHODS A total non-probability convenience sample of 43 DO resident physicians from five residency programs (Family Medicine, Internal Medicine, Obstetrics and Gynecology, Pediatrics, and Psychiatry) at Authority Health were surveyed from 09/28/2015 to 01/06/2016 using online Survey Monkey software. A 38-item survey asked residents about their personal and residency program characteristics, as well as their current overall perceived confidence to develop and conduct QIPS projects. RESULTS Two model terms that proved non-significant during analyses were residents’ age category and year in residency training. In the final stepwise multinomial regression model, however, three covariates including: a) sex (p=0.045), b) being in a primary care residency program (p=0.038) and c) having had prior QIPS project experience (p=0.049) were each found to be statistically significant predictors of respondents’ perceived comfort level categories. Male residents and those who were in a primary care residency program (i.e., Family Medicine, Internal Medicine or Pediatrics), and/or reported having had prior QIPS project experience, reported significantly higher confidence levels. CONCLUSIONS Somewhat similar to earlier studies, these results suggest the need to incorporate QIPS education for resident trainees across the nation. Ideally, the findings from larger resident studies will enable GME leaders to develop and deliver evidence-based QIPS curricula that are better oriented to resident physicians’ personal characteristics and preferences.