bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Cervical Ectopic Pregnancies
Authors: Fowler Mary Louise , Wang Dongyu , Chia Victoria , Handal-Orefice Roxane , Latortue-Albino Paula , Mulekar Sujata , White Katharine , Perkins Rebecca 
Published: June 2021

OBJECTIVE:
To investigate published cases of cervical ectopic pregnancy between 2000 and 2018 and compare management strategies and treatment success rates based on initial patient characteristics.

METHODS:
PubMed, EMBASE, and Web of Science were searched to capture peer-reviewed citations published between 2000 and 2018. Cases reporting either β-hCG level, crown–rump length, or gestational sac diameter for each individual patient were included. Data regarding the article information, patient characteristics, treatment used, and outcomes were collected. Initial success was defined as resolution of the cervical ectopic pregnancy with the predefined treatment plan. Initial failure was defined as the requirement of additional unplanned interventions due to the predefined treatment plan not being successful. End success was defined as resolution of the cervical ectopic pregnancy without hysterectomy.

RESULTS:
A total of 204 articles from 44 countries comprising 454 cases were reviewed. The initial β-hCG level ranged from 9 to 286,500, with a median of 14,773, and gestational age ranged from 4 to 18 weeks, with an average of 7 4/7 weeks (±2 0/7 weeks). In looking at initial success, compared with methotrexate alone, dilation, and curettage (odds ratio [OR] 2.26; 95% CI 2.64–10.45), dilation and curettage combined with uterine artery embolization (OR 4.85; 95% CI 2.06–11.44) and uterine artery embolization (OR 5.17; 95% CI 1.14–23.53) were more effective options. More than half of patients (50.2%) required multiple interventions, and 41 (9%) resulted in hysterectomy.

CONCLUSIONS:
Management of cervical ectopic pregnancies should be guided by patient stability, β-hCG level, size of pregnancy, and fetal cardiac activity but may benefit from a planned multimodal approach.
Effects of a Resident's Reputation on Laparoscopic Skills Assessment
Authors: Tannenbaum Evan , Walker Melissa , Sullivan Heather , Huszti Ella , Farrugia Michele , Sobel Mara 
Published: June 2021

OBJECTIVE:
To quantify the effect of a resident's reputation on the assessment of their laparoscopic skills.

METHODS:
Faculty gynecologists were randomized to receive one of three hypothetical resident scenarios: a resident with high, average, or low surgical skills. All participants were then asked to view the same video of a resident performing a laparoscopic salpingo-oophorectomy that differed only by the resident description and provide an assessment using a modified OSATS (Objective Structured Assessment of Technical Skills) and a global assessment scale.

RESULTS:
From September 6, 2020, to October 20, 2020, a total of 43 faculty gynecologic surgeons were recruited to complete the study. Assessment scores on the modified OSATS (out of 20) and global assessment (out of 5) differed significantly according to resident description, where the high-performing resident scored highest (median scores of 15 and 4, respectively), followed by the average-performing resident (13 and 3), and finally, the low-performing resident (11 and 3) (P=.008 and .043, respectively).

CONCLUSION:
Faculty assessment of residents in gynecologic surgery is influenced by the assessor's knowledge of the resident's past performance. This knowledge introduces bias that artificially increases scores given to those residents with favorable reputations and decreases scores given to those with reputed surgical skill deficits. These data quantify the effect of such bias in the assessment of residents in the workplace and serve as an impetus to explore systems-level interventions to mitigate bias.
Adverse Birth Outcomes Associated With Prepregnancy and Prenatal Electronic Cigarette Use
Authors: Regan Annette K. , Bombard Jennifer M. , O’Hegarty Michelle M. , Smith Ruben A. , Tong Van T. 
Published: June 2021

OBJECTIVE:
To evaluate the risk of adverse birth outcomes among adults who use electronic cigarettes (e-cigarettes) before and during pregnancy.

METHODS:
Data from the 2016–2018 PRAMS (Pregnancy Risk Assessment Monitoring System) were used to assess the association between e-cigarette use during the 3 months before and last 3 months of pregnancy among 79,176 individuals with a recent live birth and the following birth outcomes: preterm birth, small for gestational age, and low birth weight (LBW). Adjusted prevalence ratios were generated using average marginal predictions from multivariable logistic regression models. Models were stratified by prenatal combustible cigarette smoking and frequency of e-cigarette use (daily or less than daily use).

RESULTS:
In the 3 months before pregnancy, 2.7% (95% CI 2.6–2.9%) of respondents used e-cigarettes; 1.1% (95% CI 1.0–1.2%) used e-cigarettes during the last 3 months of pregnancy. Electronic cigarette use before pregnancy was not associated with adverse birth outcomes. Electronic cigarette use during pregnancy was associated with increased prevalence of LBW compared with nonuse (8.1% vs 6.1%; adjusted prevalence ratio 1.33; 95% CI 1.06–1.66). Among respondents who did not also smoke combustible cigarettes during pregnancy (n=72,256), e-cigarette use was associated with higher prevalence of LBW (10.6%; adjusted prevalence ratio 1.88; 95% CI 1.38–2.57) and preterm birth (12.4%; adjusted prevalence ratio 1.69; 95% CI 1.20–2.39). When further stratified by frequency of e-cigarette use, associations were seen only for daily users.

CONCLUSION:
E-cigarette use during pregnancy, particularly when used daily by individuals who do not also smoke combustible cigarettes, is associated with adverse birth outcomes.
Pregnancy Risk by Frequency and Timing of Unprotected Intercourse Before Intrauterine Device Placement for Emergency Contraception
Authors: BakenRa Abena , Gero Alexandra , Sanders Jessica , Simmons Rebecca , Fay Kathryn , Turok David K. 
Published: June 2021

OBJECTIVE:
To assess pregnancy risk after intrauterine device (IUD) placement by the number and timing of unprotected intercourse episodes in the prior 14 days.

METHODS:
This was a secondary analysis of a randomized trial that compared the copper T380A IUD and levonorgestrel 52-mg intrauterine system for emergency contraception. At enrollment, participants had a negative urine pregnancy test result and reported the frequency and timing of any unprotected intercourse in the preceding 14 days. We assessed pregnancies 1 month after IUD placement and compared pregnancy risk by single or multiple unprotected intercourse episodes and by timing (5 or fewer days before IUD placement or 6 or more days before).

RESULTS:
Among the 655 participants, one pregnancy occurred in a patient who reported intercourse once 48 hours before IUD placement. Multiple unprotected intercourse episodes were reported by 286 participants (43.7%), and 95 participants (14.4%) reported at least one unprotected intercourse episode 6 or more days before IUD placement. No pregnancies occurred among those with multiple unprotected intercourse episodes (0%, 97.5% CI 0–1.3%) or with any unprotected intercourse episode 6–14 days before IUD placement (0.0%, 97.5% CI 0.0–3.8%). Pregnancy risk difference did not significantly differ by single compared with multiple unprotected intercourse episodes (0.3%, 95% CI −0.3% to 0.8%), nor by unprotected intercourse 5 or fewer days before IUD placement or 6 or more days before (0.2%, 95% CI −0.2% to 0.5%).

CONCLUSION:
With a negative urine pregnancy test result at IUD placement, 1-month pregnancy risk remains low, regardless of frequency or timing of unprotected intercourse in the prior 14 days.

Clinical Trial Registration:

ClinicalTrials.gov, NCT02175030.
Prospective Validation of the Preschool Confusion Assessment Method for the ICU to Screen for Delirium in Infants Less Than 6 Months Old
Authors: Canter Marguerite O. , Tanguturi Yasas C. , Ellen Wilson Jo , Williams Stacey R. , Exum Sylvia A. , Umrania Hiren M. , Betters Kristina A. , Raman Rameela , Ely E. Wesley , Pandharipande Pratik P. , Fuchs D. Catherine , Smith Heidi A. B. 
Published: June 2021

OBJECTIVES:
ICU delirium is a predictor of greater morbidity and higher mortality in the pediatric population. The diagnostic obstacles and validity of delirium monitoring among neonates and young infants have yet to be fully delineated. We sought to validate the Preschool Confusion Assessment Method for the ICU in neonates and young infants and determine delirium prevalence in this young population.

DESIGN:
Prospective cohort study to validate the Preschool Confusion Assessment Method for the ICU for the assessment of ICU delirium in neonates and young infants compared with the reference standard, Child and Adolescent Psychiatry.

SETTING:
Tertiary medical center PICU, including medical, surgical, and cardiac patients.

PARTICIPANTS:
Infants less than 6 months old admitted to the PICU regardless of admission diagnosis.

MEASUREMENTS AND MAIN RESULTS:
We enrolled 49 patients with a median age of 1.8 months (interquartile range, 0.7–4.1 mo), 82% requiring mechanical ventilation. Enrolled patients were assessed for delirium in blinded-fashion by the research team using the Preschool Confusion Assessment Method for the ICU and independently assessed by the psychiatry reference rater using Diagnostic and Statistical Manual of Mental Disorders-5 criteria. A total of 189 paired assessments were completed, and the Preschool Confusion Assessment Method for the ICU performed with a sensitivity of 95% (95% CI, 89–100%), specificity of 81% (68–90%), “negative and positive predictive values” of 97% (94–100%) and 69% (55–79%), respectively, compared with the reference rater. Delirium prevalence was 47%, with higher rates of 61% observed among neonates (< 1 mo old) and 39% among infants 1–6 months old.

CONCLUSIONS:
The Preschool Confusion Assessment Method for the ICU is a valid screening tool for delirium monitoring in infants less than 6 months old. Delirium screening was feasible in this population despite evolving neurocognition and arousal architecture. ICU delirium was prevalent among infants. The consequence of acute brain dysfunction during crucial neurocognitive development remains unclear. Future studies are necessary to determine the long-term impact of ICU delirium and strategies to reduce associated harm in critically ill infants.
Long-Term Functional Outcome and Quality of Life Following In-Hospital Cardiac Arrest—A Longitudinal Cohort Study
Authors: Pound Gemma M. , Jones Daryl , Eastwood Glenn M. , Paul Eldho , Hodgson Carol L. ,   The Australia and New Zealand Cardiac Arrest Outcome and Determinants of ECMO (ANZ-CODE) Investigators
Published: June 2021

Objectives:
To evaluate the functional outcome and health-related quality of life of in-hospital cardiac arrest survivors at 6 and 12 months.

Design:
A longitudinal cohort study.

Setting:
Seven metropolitan hospitals in Australia.

Patients:
Data were collected for hospitalized adults (≥ 18 yr) who experienced in-hospital cardiac arrest, defined as “a period of unresponsiveness, with no observed respiratory effort and the commencement of external cardiac compressions.”

Interventions:
None.

Measurements and Main Results:
Prior to hospital discharge, patients were approached for consent to participate in 6-month and 12-month telephone interviews. Outcomes included the modified Rankin Scale, Barthel Index, Euro-Quality of Life 5 Dimension 5 Level, return to work and hospital readmissions. Forty-eight patients (80%) consented to follow-up interviews. The mean age of participants was 67.2 (± 15.3) years, and 33 of 48 (68.8%) were male. Good functional outcome (modified Rankin Scale score ≤ 3) was reported by 31 of 37 participants (83.8%) at 6 months and 30 of 33 (90.9%) at 12 months. The median Euro-Quality of Life-5D index value was 0.73 (0.33–0.84) at 6 months and 0.76 (0.47–0.88) at 12 months. The median Euro-Quality of Life-Visual Analogue Scale score at 6 months was 70 (55–80) and 75 (50–87.5) at 12 months. Problems in all Euro-Quality of Life-5D-5 L dimension were reported frequently at both time points. Hospital readmission was reported by 23 of 37 patients (62.2%) at 6 months and 16 of 33 (48.5%) at 12 months. Less than half of previously working participants had returned to work by 12 months.

Conclusions:
The majority of in-hospital cardiac arrest survivors had a good functional outcome and health-related quality of life at 6 months, and this was largely unchanged at 12 months. Despite this, many reported problems with mobility, self-care, usual activities, pain, and anxiety/depression. Return to work rates was low, and hospital readmissions were common.
A Novel 29-Messenger RNA Host-Response Assay From Whole Blood Accurately Identifies Bacterial and Viral Infections in Patients Presenting to the Emergency Department With Suspected Infections: A Prospective Observational Study*
Authors: Bauer Wolfgang , Kappert Kai , Galtung Noa , Lehmann Dana , Wacker James , Cheng Henry K. , Liesenfeld Oliver , Buturovic Ljubomir , Luethy Roland , Sweeney Timothy E. , Tauber Rudolf , Somasundaram Rajan 
Published: June 2021

OBJECTIVES:
The rapid diagnosis of acute infections and sepsis remains a serious challenge. As a result of limitations in current diagnostics, guidelines recommend early antimicrobials for suspected sepsis patients to improve outcomes at a cost to antimicrobial stewardship. We aimed to develop and prospectively validate a new, 29-messenger RNA blood-based host-response classifier Inflammatix Bacterial Viral Non-Infected version 2 (IMX-BVN-2) to determine the likelihood of bacterial and viral infections.

DESIGN:
Prospective observational study.

SETTING:
Emergency Department, Campus Benjamin Franklin, Charité—Universitätsmedizin Berlin, Germany.

PATIENTS:
Three hundred twelve adult patients presenting to the emergency department with suspected acute infections or sepsis with at least one vital sign change.

INTERVENTIONS:
None (observational study only).

MEASUREMENTS AND MAIN RESULTS:
Gene expression levels from extracted whole blood RNA was quantified on a NanoString nCounter SPRINT (NanoString Technologies, Seattle, WA). Two predicted probability scores for the presence of bacterial and viral infection were calculated using the IMX-BVN-2 neural network classifier, which was trained on an independent development set. The IMX-BVN-2 bacterial score showed an area under the receiver operating curve for adjudicated bacterial versus ruled out bacterial infection of 0.90 (95% CI, 0.85–0.95) compared with 0.89 (95% CI, 0.84–0.94) for procalcitonin with procalcitonin being used in the adjudication. The IMX-BVN-2 viral score area under the receiver operating curve for adjudicated versus ruled out viral infection was 0.83 (95% CI, 0.77–0.89).

CONCLUSIONS:
IMX-BVN-2 demonstrated accuracy for detecting both viral infections and bacterial infections. This shows the potential of host-response tests as a novel and practical approach for determining the causes of infections, which could improve patient outcomes while upholding antimicrobial stewardship.
Incidence of the “Adrenaline Rush” and Vasovagal Response with Local Anesthetic Injection
Authors: Greene Bradley H. C. , Lalonde Donald H. , Seal Shane K. F. 
Published: June 2021

Background:
Many patients feel an “adrenaline rush” or a vasovagal reaction when injected with lidocaine and epinephrine during wide awake surgery. The incidence of these reactions is not well documented in the literature.

Methods:
In total, 387 patients were prospectively injected with lidocaine and epinephrine for minor procedures without sedation between July 1, 2019 and November 1, 2020. A concentration of epinephrine with 1:100,000 in 2% lidocaine was injected, with most patients getting less than 20 mL of volume.

Results:
Eight (2.2%) of the patients had adrenaline rush symptoms, which included nervousness, anxiety, tremors, shaky feelings, flushing, diaphoresis, light-headedness, tingling, and “heart racing.” Seven patients (1.8%) experienced vasovagal responses, which included nausea, a feeling of being unwell, faint, or lightheaded, or had circumoral pallor.

Conclusions:
Patients run a low risk of feeling an adrenaline rush or vasovagal reaction when injected with lidocaine and epinephrine. Routinely advising patients that the adrenaline rush can happen, and that this is not an allergic reaction can be helpful to allay fear of the unknown and to prevent false allergy beliefs. Injecting patients lying down may decrease the incidence of vasovagal reactions by increasing cerebral blood flow with the advantage of gravity.
Effect of COVID-19 on Geographic Distribution of the Integrated Plastic Surgery Match
Authors: Om Anjali , Losken Albert 
Published: June 2021

Background:
COVID-19 had significant impact on the 2021 integrated plastic surgery match, most notably through cancellation of away rotations and virtual interviews. While previous studies have analyzed geographic outcomes of the match in prior years, the effects of COVID-19 have not been determined. This study aims to contribute 2021 match data to determine the effects of COVID-19 on the geographic distribution of the integrated plastic surgery match.

Methods:
Official match results for each program were populated by searching official program institutional websites and social media pages. Trainees’ home medical institutions and current integrated plastic surgery residency programs were noted. Statistical analysis compared geographic distribution in COVID-19 affected (2021) and non-COVID-19 affected (2015-2020) match years.

Results:
Of 85 integrated plastic surgery programs, 80% (n = 68) of programs and 1,015 matched trainees were included in this study. The average percentage of institutional matches in COVID-19-affected match year was 25.12%, compared to 16.67% for non-COVID-19-affected match years (p = 0.0012). The odds ratio of matching at a home institution in 2021 compared to prior years was 1.68 (95% CI 1.11-2.53).

Conclusions:
Our study is consistent with previous studies that demonstrate strong match preferences for affiliated medical students but also adds that this trend may be amplified in the post-COVID-19 era. While multiple factors may be involved in geographic distributions of residency match outcomes, the results of this study suggest that COVID-19 restrictions on travel and exposure to outside programs may have contributed to an even higher percentage of matches within the same institution.
Management of Bacille Calmette-Guérin Lymphadenitis and Abscess in Immunocompetent Children
Authors: Villanueva Paola , Pittet Laure F. , Curtis Nigel 
Published: June 2021

Background:
There is no consensus on managing common adverse reactions to Bacille Calmette-Guérin (BCG) vaccination. We systematically reviewed the management of BCG-associated regional lymphadenitis and injection site abscess in immunocompetent individuals.

Methods:
Searches of Medline, Embase and PubMed were done until November 2020. Randomized controlled trials (RCTs) and cohort studies that compared management strategies for complications of intradermal BCG vaccination were included.

Results:
Of 1338 individual articles, 15 met inclusion criteria. Six RCTs, 4 prospective and 4 retrospective cohort studies compared management in 1022 children with BCG-associated lymphadenitis. For nonsuppurative lymphadenitis, no antimicrobial was found to significantly impact on time to resolution or prevention of suppuration. For suppurative lymphadenitis, there was some evidence that needle aspiration shortens time to resolution and prevents sinus tract formation. Surgical excision (mainly offered for persistent suppurative lymphadenitis) generally had favorable outcome. Two cohort studies (including 1 aforementioned) compared management strategies in up to 36 children with BCG injection site abscess; one showed no difference in outcome in children treated with antibiotics and the other reported complete resolution without treatment.

Conclusions:
Evidence does not support a role for antimicrobial therapy in the management of localized reactions to BCG vaccination in immunocompetent children. Needle aspiration may shorten the recovery period for BCG-associated suppurative lymphadenitis. BCG injection site abscess usually heals without treatment. However, studies are limited and cases are not well defined. Growing research into novel BCG applications provides opportunities to investigate optimal management strategies for adverse reactions in a prospective manner using active safety surveillance.
Psychometric Evaluation of the Korean Version of Control Attitudes Scale-Revised
Authors: Lee Kyoung Suk , Park Da-In 
Published: June 2021

Background
Heart failure (HF) is a chronic heart condition that requires patients to adapt to the disease and maintain a high degree of self-management. Patients with HF commonly feel loss of control, which has a negative effect on their compliance to self-care, health-related quality of life, and health outcomes. To promote self-care behavior and to develop healthy coping mechanisms, it is important to understand individual HF patients' perceived control, a self-generated belief that one has the ability to bring forth desired outcomes. Currently, there is no valid and reliable Korean instrument available in measuring perceived control among patients with HF.

Objective
The objective of this study was to cross-culturally translate, adapt, and evaluate psychometric properties of the Korean version of Control Attitudes Scale-Revised (KCAS-R) in Korean patients with HF.

Methods
The KCAS-R was developed using a translation/back-translation process and an examination of semantic and conceptual equivalence. Reliability was assessed using Cronbach α to determine internal consistency, and item-total and interitem correlations were assessed to test item homogeneity. The construct validity was examined using exploratory factor analysis, confirmatory factor analysis, and testing hypotheses for known associations with self-efficacy, self-care confidence, and self-care.

Results
A convenience sample of 138 patients with HF were included for the psychometric testing of an 8-item KCAS-R. The Cronbach α for internal consistency was 0.835, and the item-total correlation was acceptable. The construct validity revealed a 2-factor structure accounting for 63.23% of the total variance. The KCAS-R was associated with higher levels of self-efficacy, self-care confidence, and self-care. In addition, patients with higher perceived control had less depression and anxiety compared with those with lower levels of perceived control.

Conclusion
This study provided support for the satisfactory reliability and validity of the 8-item KCAS-R in measuring perceived control in Korean patients with HF.