bluuebunny/crossref_metadata_2025_split huggingface dataset:
Video Consent for Colonoscopy Improves Knowledge Retention and Patient Satisfaction
Authors: Padival Ruthvik , Harris Kevin B. , Garber Ari , El-Khider Faris , Kichler Adam , Vargo John , Baggott Brian B. 
Published: July 2021

Background and Aim:Informed consent for endoscopy is variable across institutions and remains understudied in gastrointestinal endoscopy. This study aims to standardize informed consent for screening and diagnostic colonoscopies with a supplemental video tool that includes the key components of informed consent.Methods:A video tool was developed that incorporated the key components of informed consent for colonoscopy. In addition, a 7-question survey was developed to query patients on core aspects of informed consent and satisfaction with the informed consent process. Patients undergoing elective outpatient colonoscopy with conscious sedation were randomized to traditional consent or consent with the addition of a video tool. A pilot study determined the sample size. Traditional consent was standard of practice before the procedure. Patients in the video tool group watched the video tool in the preprocedure area followed by traditional consent. Both groups had the opportunity to address questions with the attending physician before the procedure. All patients were contacted 1 to 2 days following the colonoscopy to answer the question survey.Results:A total of 110 patients were eligible for participation, and 91 were included in the final data analysis. Subjects in the video tool group demonstrated significantly higher recall of key aspects of informed consent and higher satisfaction with the informed consent process versus the traditional consent group. The history of prior colonoscopy was similar between both groups. Mean endoscopy operation metrics were not negatively impacted by the inclusion of the video tool.Conclusion:Patients undergoing screening and diagnostic colonoscopies who received informed consent supplemented by a video tool had a higher recall of core aspects of informed consent and higher satisfaction with the process, with no impact on procedural times.
Unhealthy Eating, Psychopathology, and Nonalcoholic Fatty Liver Disease in Youth Presenting for Bariatric Surgery
Authors: Ley Sanita L. , Zeller Meg H. , Reiter‐Purtill Jennifer , Kleiner David E. , Dixon John , Xanthakos Stavra ,   Teen View Study Group and in collaboration with the Teen‐LABS Consortium
Published: July 2021

ABSTRACTObjectives:Little is known about the behavioral and psychosocial correlates of pediatric nonalcoholic fatty liver disease (NAFLD). Given diet contributes to the development and persistence of NAFLD, we examined (1) the prevalence of unhealthy eating behaviors (UEB), (2) whether these varied by NAFLD or nonalcoholic steatohepatitis (NASH) presence, and explored (3) the association of psychopathology with NAFLD.Methods:Before metabolic and bariatric surgery (MBS), adolescents (N = 159; Mage = 16.4; MBMI = 53.7 kg/m2, 73% girls, 62.3% white) self‐reported presence/absence of 10 UEB (Questionnaire on Eating and Weight Patterns‐Revised, Night Eating Questionnaire, Look AHEAD). NAFLD and NASH presence was assessed by intraoperative liver biopsy. Height/weight, blood pressure, and blood specimens were obtained. A medical comorbidity index was created (prediabetes/diabetes, dyslipidemia, elevated blood pressure). Psychopathology was assessed in a subgroup completing the Youth Self‐Report (N = 98).Results:Binge eating disorder symptomatology was associated with higher odds of NAFLD whereas frequent eating out was associated with lower odds of NAFLD. Among those with NAFLD frequent eating out was associated with higher odds of NASH while nocturnal eating was associated with lower odds of NASH. Separate models identified internalizing psychopathology as associated with higher odds of NAFLD after controlling for demographics, number of UEB, and medical comorbidities.Conclusions:Results suggest potential phenotypical differences between adolescents presenting for MBS with/without NAFLD, with implications for behavioral/psychosocial targets for screening and intervention. Replication should occur in a sample with greater gender and ethnic diversity to improve generalizability. Understanding differences in the context of surgical weight loss and comorbidity resolution is indicated.
A Quality Improvement Initiative to Improve Discharge Timeliness and Documentation
Authors: Larrow Annie , Chong Amy , Robison Treavor , Patel Aarti , Kuelbs Cynthia , Fisher Erin , Hershey Daniel , Pierce Heather 
Published: July 2021

Introduction:
Discharge communication is critical for the continuity of patient care. However, discharge summaries are often not available in time for follow-up visits, and the content is inconsistent. We aimed to decrease the average time to discharge summary completion by 25%, reduce deficiencies (information errors) by 50%, and increase discharge summary template use to >80% in 6 months.

Methods:
A pediatric interprofessional team used quality improvement methods to identify barriers and implement interventions, including discharge summary completion time expectation, electronic health record discharge summary template changes addressing gaps, and training. Notable changes to the template included embedded writing tips to guide writers and specific template choices for common diagnoses to standardize content. The primary outcome measure was the mean discharge summary completion time. Secondary measures were the percentage of discharge summaries with deficiencies and the rate of template use.

Results:
After interventions, the mean discharge summary completion time decreased by 70% (from 71.5 to 21.8 hours). Discharge summary deficiencies decreased 44% (from 4.5% to 2.5%), and template use increased from 62% to 97%.

Conclusion:
Quality improvement methods and a newly designed electronic health record-discharge summary template were used to dramatically improve discharge summary timeliness and standardize content to streamline continuity of care.
18F-Fluoroestradiol Tumor Uptake Is Influenced by Structural Components in Breast Cancer
Authors: Takahashi Mizuho , Maeda Hiroyuki , Tsujikawa Tetsuya , Kono Hiroko , Mori Tetsuya , Kiyono Yasushi , Okazawa Hidehiko , Noriki Sakon , Imamura Yoshiaki , Goi Takanori 
Published: July 2021

Purpose
Estrogen receptor (ER) is expressed in the majority of invasive breast cancer and is an important prognostic indicator. The tumor stroma also plays an important role in disease progression. This study evaluated the effect of stromal components on 16α-[18F]-fluoro-17β-estradiol (18F-FES) uptake in breast cancer and proposed a partial-volume correction method for 18F-FES PET based on histopathological analyses.

Patients and Methods
Fifteen patients with biopsy-confirmed breast cancer underwent preoperative 18F-FES PET. Estrogen receptor expression in biopsy specimens was assayed by immunohistochemistry, cellular components in surgical specimens were measured using hematoxylin-eosin staining, and nuclear components in surgical and biopsy specimens were measured using Azan-Mallory staining. The relationship between 18F-FES SUV of the primary tumor and histopathological findings including ER expression, the Allred score, ER-positive cellular component ratio, and ER-positive nuclear component ratio (NCR) was examined. The relationship between stroma-free 18F-FES SUV and ER expression was also examined.

Results

18F-FES uptake was not significantly positively correlated with ER expression (r = 0.44, P = 0.10). 18F-FES uptake was significantly correlated with the Allred score, ER-positive cellular component ratio, and ER-positive NCR in surgical specimens (ρ = 0.60, P = 0.02; r = 0.55, P = 0.03; and r = 0.65, P = 0.01, respectively). 18F-FES uptake was predominantly correlated with ER-positive NCR in biopsy specimens (r = 0.84, P < 0.001). Stroma-free 18F-FES SUV was significantly correlated with ER expression (r = 0.78, P < 0.01).

Conclusions

18F-FES PET predominantly demonstrates the level of ER expression in breast cancer cell nucleus. Although tumor 18F-FES uptake is affected by the degree of stromal components, the partial volume effect on the uptake can be corrected by stroma-volume fraction in Azan-Mallory staining.
Bone Marrow Metastases From Gastric Adenocarcinoma on 68Ga-FAPI-04 PET/CT
Authors: Huang Yilin , Cao Jianpeng , Peng Dengsai , Liu Huipan , Chen Yue 
Published: July 2021

Abstract
A 37-year-old woman complained of fatigue and dizziness for 4 days. Bone marrow biopsy findings were suggestive of digestive tract–derived metastases. 18F-FDG PET/CT revealed mild FDG avidity in the stomach and bone marrow, whereas 68Ga-FAPI-04 PET/CT showed strong FAPI uptake in the FDG-avid lesions. The patient was diagnosed with bone marrow metastases from gastric cancer by a bone marrow biopsy.
18F-FDG PET/CT and 68Ga-FAPI-4 PET/CT Findings of Bilateral Knee Osteoarthritis in a Patient With Uveal Malignant Melanoma
Authors: Erol Fenercioğlu Özge , Beyhan Ediz , Ergül Nurhan , Arslan Esra , Çermik Tevfik Fikret 
Published: July 2021

Abstract
We present the findings of 68Ga-FAPI-4 PET/CT and 18F-FDG PET/CT of a metastatic malignant melanoma patient with osteoarthritis. A 65-year-old woman with a history of metastatic uveal malignant melanoma was referred to 18F-FDG PET/CT for restaging after enucleation and chemotherapy. 18F-FDG PET/CT imaging showed high radiotracer uptake in liver metastases; additionally mild uptake due to osteoarthritis was observed in both knees. However, although 68Ga-FAPI-4 showed lower uptake in liver lesions, it showed a more prominent uptake in both knee joints compared with 18F-FDG.
Treatment Effects and Lip Profile Changes Following Surgical Mandibular Advancement Versus Premolar Extractions in Class II Div 1 Malocclusion: A Randomized Controlled Trial
Authors: Kochar Gagan Deep , Londhe Sanjay , Chopra Sukhbir Singh , Kohli Sarvraj , Kohli V.S. , Chakranarayan Ashish , Kambojh Ashish , Bhatt Sudarshan 
Published: July 2021

Abstract
No randomized controlled trial has compared the treatment outcome between surgical mandibular advancement and premolar extractions in class II malocclusion. This 2-arm parallel randomized controlled trial evaluated the treatment effects and lip profile changes in skeletal class II adult patients subjected to bilateral sagittal split ramus osteotomy for mandibular advancement and those treated with premolar extractions. Seventy skeletal class II patients were accessed and forty-six subjects who fulfilled inclusion criteria were distributed randomly into Group CG (patients: 23, mean age: 21.28 ± 2.69 years) and Group SG (patients: 23, mean age: 21.15 ± 2.64 years). Group CG was subjected to extraction of maxillary first premolars and mandibular second premolars followed by implant supported space closure and Group SG was managed by surgical mandibular advancement. Skeletal, dental, and soft-tissue changes were analyzed. The study was single-blinded (statistical analyzer). Groups were closely matched for baseline parameters. In the present trial there was no loss to follow-up. Though overjet and overbite were optimized in both the groups but significant improvement was seen in surgical cases. Group CG demonstrated statistically significant point “A” remodeling, dentoalveolar changes, and increase in nasolabial angle. Group SG exhibited significant sagittal and vertical skeletal improvement and lip position change. Surgical mandibular advancement was found to be a better treatment modality compared to premolars extraction for managing skeletal class II div 1 malocclusion as it permits greater improvement of the profile and skeletal relationship.
European Guideline on Craniofacial Microsomia: A Version for Patients and Families
Authors: Renkema Ruben W. , Spivack Olivia K.C. 
Published: July 2021

Abstract
A European guideline on craniofacial microsomia was developed within the European Reference Network for rare and/or complex craniofacial anomalies and ear, nose, and throat disorders and published in 2020. The guideline provides an overview of optimal care provisions for patients with craniofacial microsomia and recommendations for the improvement of care. This document seeks to provide a tailored overview of this guideline for patients and their families.
Midfacial Soft Tissue Changes After Reduction Malarplasty: A Computed Tomographic Study
Authors: Gao Jiaman , Wei Min , Yuan Jie , Yu Zheyuan , Duan Huichuan , Jiang Taoran , Cao Dejun , Xu Liang 
Published: July 2021

Background:
The reduction malarplasty has become one of the most popular esthetic surgeries among Asian women to improve facial contour. However, it is still controversial whether midfacial soft tissue changes after surgery, and more studies are needed.

Methods:
This retrospective observational study reviewed 30 patients who underwent L-shaped reduction malarplasty during January 2018 and August 2019. The preoperative and postoperative soft tissue thickness and the angle of nasolabial fold of the midfacial were assessed using photographs, three-dimensional skull computerized tomography images, and the Wrinkle Severity Rating Scale.

Results:
The postoperative average level of nasolabial fold angle was lower than that observed in preoperative conditions, with the difference being statistically significant (t = -10.262, P < 0.001). The postoperative fifth and sixth layers of soft tissue in the midface were significantly higher than those observed in preoperative tissues.

Conclusions:
Although L-shaped reduction malarplasty has evident effects on soft tissue changes of middle face, they are within acceptable ranges and do not affect patient satisfaction.
Evolving Trends in Unilateral Cleft Lip Repair Based on Continuous Certification by the American Board of Plastic Surgery
Authors: Shah Nikhil , Kearney Aaron M. , Zins James , Gosain Arun K. 
Published: July 2021

Background:
The American Board of Plastic Surgery (ABPS) began collecting data from unilateral cleft lip (UCL) corrections in 2011 as a component of the continuous certification process. We evaluated these data to understand practice patterns in UCL repair, in the United States, and whether these practice patterns had changed over the past 9 years.

Methods:
Tracer data for UCL correction were reviewed from its inception in October 2011 through 2016 and compared to UCL cases between 2017 and March 2020. Trends in practice patterns were evaluated against literature reviews meant to coincide with the ABPS continuous certification data.

Results:
A total of 520 cases were included from October 2011 to March 2020. Median age of UCL repair was 4 months and 66% of patients were male. Fifty-one percent of cases presented with a complete cleft lip. There was a decrease in postoperative adverse events when data from 2011 to 2016 was compared to 2017 to 2019 (P = 0.020). Revisions were the most common postoperative adverse event (2%). There was a decrease in nasoalveolar molding from 25% to 12% (P < 0.001) and 56% of total cases underwent a concurrent primary cleft rhinoplasty. The rate of gingivoperiosteoplasty at the time of primary cleft lip repair also fell (9% versus 1%; P < 0.001).

Conclusions:
This article reviews tracer data obtained by the ABPS for UCL repair. The American Board of Plastic Surgery tracer data provides a national, cleft lip-specific database with longer follow-up times than other large databases.
Design-Based Bone Marrow Biopsy Training
Authors: Brondfield Sam , Harmon Derek , Romero Dylan , Tai Jenny , Hsu Gerald 
Published: July 2021

Introduction
Hematology/oncology fellows must achieve bone marrow biopsy proficiency. However, opportunities for fellows to perform bone marrow biopsies on patients are highly dependent on clinical volume. An easily accessible and feasible system to practice these procedures repetitively has not been described. Other specialties use 3-dimensional (3D)–printed models to practice procedures, but hematology/oncology has not yet incorporated this novel medical education tool, which has the potential to provide such an accessible and feasible system for procedural practice.

Methods
We used design thinking to develop and pilot a bone marrow biopsy simulation using 3D-printed pelvis models. We printed and optimized 2 models through iterative prototyping. In July 2019, we conducted a 1-hour session with 9 fellows. After an anatomy review, fellows practiced biopsies using the models with faculty feedback. To evaluate feasibility, we reviewed session evaluations, measured fellow comfort, surveyed supervising attendings, and gathered fellow and attending feedback.

Results
Fellows rated the 3D session highly. Fellow comfort improved after orientation. Supervisors noted no difference between the 2019 fellows and prior years. Fellows praised the opportunity to rehearse mechanics, receive feedback, and internalize anatomy. Fellows suggested incorporating a female pelvis and more soft tissue. Attending feedback on the model aligned with fellow feedback. We implemented the session again in 2020 with adjustments based on feedback.

Conclusions
Three-dimensional printing represents an accessible and feasible educational tool. Three-dimensional–printed models provide opportunities for iterative practice, feedback, and anatomy visualization. Future iterations should continue to incorporate user feedback to optimize model utility.
Developing Consensus on Simulation Fellowship Requirements on the Path to Accreditation Council of Graduate Medical Education Accreditation
Authors: Tayeb Baraa , Dobiesz Valerie , Pozner Charles N. 
Published: July 2021

Introduction
Nonaccredited simulation fellowships have multiplied resulting in fellowship differences. Standardization of fellowship content and requirements is needed, especially if accreditation is to be achieved. Simulation fellowship criteria were developed using expert consensus and the Accreditation Council for Graduate Medical Education requirements to frame the supporting pillars for accreditation.

Methods
Core curricular components, subelements, and requirements for graduation were derived from a literature review and existing fellowship curricula. A modified Delphi process was performed to establish fellowship program content and requirements. A priori criteria for inclusion or exclusion were used during 3 iterative rounds. Experts could recommend items for inclusion.

Results
Fourteen publications and 71 curricula were reviewed with 7 core curriculum components and 44 subelements identified for subsequent expert panel review. All core components were included by consensus: application of teaching and debriefing, business and leadership, curriculum development, educational theory, operational support, research, and assessment and evaluation. Thirty-eight subelements reached consensus. Graduation requirements included a research or scholarly project and a minimum number of debriefing activities, evaluation activities, original simulation curricula, skill-based teaching activities, scenario-based activities, and interprofessional education activities. The maximum number of clinical hours per week was 16 to 20.

Conclusions
Using a modified Delphi process, experts reached consensus on core curriculum components, subelements, graduation requirements, and maximum number of clinical hours to establish Accreditation Council for Graduate Medical Education accreditation criteria for a simulation standardization of simulation fellowships for physicians. Further work is needed to define other parameters including program infrastructure and assessment.
Assessing Competence With a Task Trainer
Authors: Poeppelman Rachel Stork , Coles Mary T. , Heater Thomas , Vohsing Luke , Von Sadovszky Victoria , Lutmer Jeffrey E. , Maa Tensing 
Published: July 2021

Introduction
The purpose of this study was to develop a caregiver and healthcare provider assessment tool to evaluate essential tracheostomy skills using a simulated task trainer.

Methods
Three tracheostomy skill checklists were developed: closed suctioning, open suctioning, and tracheostomy change. Checklist items were developed based on institutional guidelines and a literature review. Items were revised based on iterative expert review and pilot testing. A total of 64 intensive care staff and 24 caregivers were evaluated using the checklists, of which 29 staff members and 4 caregivers were rated simultaneously by 2 raters to estimate interrater reliability. The relationships between checklist performance and staff demographics (experience and discipline) were calculated. A survey examining the selection of automatic fail items and minimum passing score was sent to 660 multidisciplinary staff members.

Results
Intraclass correlations were 0.93 for closed suctioning, 0.93 for open suctioning, and 0.76 for tracheostomy change. Staff performance only correlated with experience for the tracheostomy change checklist and was inconsistently associated with discipline (respiratory therapy vs nursing). A large, multidisciplinary survey with 132 of 660 respondents confirmed the selection of automatic fail items and minimum passing score. A total of 92.9% of the survey respondents agreed with a minimum passing score of 80%.

Conclusions
We developed 3 essential tracheostomy skill checklists with multiple sources of validity evidence to support their use in a simulation-based assessment of tracheostomy skills.
Effectiveness of a Simulation Curriculum on Clinical Application
Authors: Harwayne-Gidansky Ilana , Askin Gulce , Fein Daniel M. , McNamara Courtney , Duncan Ellen , Delaney Kristen , Greenberg Jacob , Mojica Michael , Clapper Timothy , Ching Kevin 
Published: July 2021

Introduction
The use of simulation to develop clinical reasoning and medical decision-making skills for common events is poorly established. Validated head trauma rules help identify children at low risk for clinically important traumatic brain injury and guide the need for neuroimaging. We predicted that interns trained using a high-fidelity, immersive simulation would understand and apply these rules better than those trained using a case-based discussion. Our primary outcomes were to determine the effectiveness of a single targeted intervention on an intern's ability to learn and apply the rules.

Methods
This was a prospective randomized controlled trial. Interns were randomized to participate in either a manikin-based simulation or a case discussion. Knowledge and application of the Pediatric Emergency Care Applied Research Network Head Trauma tool were assessed both under testing conditions using standardized vignettes and in clinical encounters. In both settings, interns completed a validated assessment tool to test their knowledge and application of the Pediatric Emergency Care Applied Research Network Head Trauma tool when assessing patients with head injury.

Results
Under testing conditions, both being in the simulation group and shorter time from training were independently associated with higher score under testing conditions using standardized vignettes (P = 0.038 and P < 0.001), but not with clinical encounters.

Conclusions
Interns exposed to manikin-based simulation training demonstrated performance competencies that are better than those in the case discussion group under testing conditions using standardized vignettes, but not in real clinical encounters. This study suggests that information delivery and comprehension may be improved through a single targeted simulation-based education.