bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes, Perceived Benefits, and Experiences of Engagement With Professional Competence Schemes for Doctors in Ireland: Findings From a National Survey
Authors: Hanlon Holly Rose , Prihodova Lucia , Hoey Hilary , Russell Thelma , Donegan Deirdre , O'Shaughnessy Ann 
Published: April 2021

Introduction:
This study aimed to assess the attitudes, perceived benefits, and experiences of engaging with a formal system of continuing professional development (CPD) in the form of Professional Competence Schemes (PCSs) among doctors in Ireland.

Methods:
The study utilized an anonymous online survey measure with both open-ended and Likert-scale questions. The measure examined general attitudes, perceived impact, and experiences of engagement with PCS. This study examines the scale items only. All 4350 doctors enrolled on a PCS were invited through email to complete the survey. One thousand four hundred eight doctors participated, indicating a response rate of 32%.

Results:
Descriptive and inferential statistics (analysis of variance and Kruskal–Wallis) were performed on the scale items using IBM SPSS statistics, with group comparisons examining differences in responses according to gender and current primary role. A majority (80%) of respondents had positive overall attitudes to PCS. Most participants reported that CPD positively impacts their practice across a wide range of areas, particularly patient care. Most participants reported positive experiences engaging with PCS, although a minority reported difficulties, including lack of time to participate in and record CPD activities, difficulties obtaining evidence of participation, and feeling that their CPD activities are not easily captured by the PCS system. Significant differences in responses according to role were found for overall attitudes (confidence interval = 95%, P < .00) and overall experiences of PCS (confidence interval = 95%, P < .00) with nonconsultant hospital doctors emerging as a particularly vulnerable group with less positive attitudes and experiences.

Discussion:
Across the board overall attitudes, perceived impact and experiences of PCS were positive, and indicate that doctors feel that PCS is a valuable and beneficial activity. However, a minority of respondents reported experiencing difficulties with engagement, and these areas of difficulty represent targets for future improvement.
Fostering Mindfulness in Continuing Pharmacy Education Using a Board Game: Initial Experiences and Perceptions
Authors: Pogge Elizabeth K. , Davis Lindsay E. 
Published: April 2021

Introduction:
Expansion of pharmacists' scope of practice creates a need to optimize learning within continuing professional development (CPD) that can simultaneously promote mindfulness and enhance clinical decision-making. An educational board game embracing the principles of situated learning was developed with the purpose of promoting clinical reasoning skills and mindfulness.

Methods:

Iter Vitae was used in a national pharmacy meeting CPD session. An evaluation was conducted by a voluntary survey to gather perceptions of game-based instruction.

Results:
Ninety of 115 session-attendees completed the anonymous survey. Participants strongly agreed that Iter Vitae is an effective learning tool of appropriate complexity for CPD sessions. Participant perceptions suggest that playing Iter Vitae may enhance clinical knowledge, foster critical thinking, and influence provider empathy. Open-ended responses revealed appreciation of collaborative learning within authentic case scenarios.

Discussion:
This game-based CPD session gave participants an opportunity to develop elements of mindful practice embedded within authentic case scenarios. Further research on game-based instruction is needed to determine its effects on knowledge and skill acquisition, retention, and impact on clinical practice.
An Active-Learning Quality Improvement Curriculum for Faculty in Hospital Medicine
Authors: Muthukrishnan Preetika , Burnett Maria , DeVoe Stephen G. , Kennedy Amanda G. , Pasanen Mark E. , Tompkins Bradley , Repp Allen B. 
Published: April 2021

Introduction:
Despite the growing importance of quality improvement (QI) training in medical education, there is a lack of faculty with expertise in QI at many academic medical centers. In this report, we describe the design, implementation, and evaluation of a QI training program for faculty in hospital medicine at an academic medical center aimed at increasing faculty capacity in QI.

Methods:
With input from an initial focus group of hospital medicine faculty, we developed a 12-session, active-learning curriculum incorporating core concepts in QI applied to a real-life QI problem. We used a survey instrument to assess changes in self-reported confidence, the Quality Improvement Knowledge Application Tool-Revised to assess changes in applied knowledge, and a second focus group to obtain qualitative feedback regarding the curriculum.

Results:
Self-reported confidence in numerous QI skills increased after completion of the curriculum; however, concurrent improvement in applied knowledge was not observed. Qualitatively, participants not only described improved understanding of QI methodology and greater confidence contributing to QI initiatives but also a sense they were not prepared to lead a QI project independently.

Discussion:
An active-learning faculty training program is feasible with limited resources and was associated with increased faculty confidence in QI skills.
The COVID-19 Online Learning Transition and the Plus/Delta Debriefing Model
Authors: Dzara Kristina , Heller Ayres , Kesselheim Jennifer 
Published: April 2021

Abstract:
As a result of the COVID-19 pandemic, the Harvard Medical School Master of Medical Sciences in Medical Education program implemented the Plus/Delta debriefing model to collect real-time learner feedback and facilitate continuous quality improvement within our assessment and program evaluation module, which rapidly transitioned online. The model is grounded in quality improvement methodology and encourages bidirectional rather than top–down feedback. Learners identified specifically what went well with each module session (Plus) and how to improve for the next time (Delta). After each session, narrative responses were reviewed, aggregated into meaningful categories, and implemented when possible. Implemented improvements focused on increasing session interactivity and enhancing communication. Learners pointed to the uniqueness of the model and applauded efforts to embed them in the cocreation process. Asking learners to debrief their experience—especially during a module which is iteratively redesigned week-by-week—can offer a realistic view of what is working and what needs further refinement. As we continue to navigate the COVID-19 pandemic, rapid, continuous educational quality improvement deserves renewed emphasis. Implementing the Plus/Delta debriefing model into longitudinal online teaching sessions is a translatable, easily replicable, and free method of receiving immediate and valuable learner feedback.
Ozone Attenuated H9c2 Cell Injury Induced by Doxorubicin
Authors: Xu Lingshan , Wang Chenhao , Zou Zhiqing , Wu Zhouquan 
Published: April 2021

Abstract:
Doxorubicin (DOX) is a commonly used drug in the treatment of cancers, whereas its application in the clinical stage is restricted because of side effects such as cardiomyocyte injury. Increasing studies indicated that ozone may protect cardiomyocytes from injuries. This study aimed to explore the effects of ozone on cardiotoxicity induced by DOX treatment. Rat heart myoblasts (H9c2) were treated with increasing concentrations of DOX (0.5, 1, 1.5, and 2 μM) to induce cell injury. 3-(4,5)-dimethylthiahiazo(-2)-3,5-diphenytetrazoliumromide assay and flow cytometry analysis were used to measure the viability and apoptosis of H9c2 cells. The mRNA and protein levels of proinflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-(IL)1β, and IL-6, matrix metalloproteinases (MMP-2 and MMP-9), and the key factors on the TLR4/NF-kB signaling (TLR4, p-p65, and p65) were measured by reverse transcription quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, and western blot. The result showed that DOX promoted apoptosis and increased the expression of TNF-α (by 3.65-fold changes), IL-1β (by 4.98-fold changes), IL-6 (by 3.44-fold changes), MMP-2 (by 1.98-fold changes), and MMP-9 (by 1.98-fold changes) levels in H9c2 cells. Moreover, the introduction of ozone reversed these changes in gene expression and suppressed the activation of the TLR4/NF-kB signaling, which indicated that ozone may exert protective effects on H9c2 heart myoblasts by relieving the cardiotoxicity induced by DOX. Our study provides theoretical basis for the significance of ozone in managing doxorubicin-induced H9c2 heart myoblast injury.
Adverse Events of Sacubitril/Valsartan: A Meta-analysis of Randomized Controlled Trials
Authors: Huang Yun , Zhang YuYu , Ma Lili , Zhou Hua , Fang Chongbo , Chen Chaolin 
Published: April 2021

Abstract:
This review aimed to summarize the adverse events (AEs) reported during the use of sacubitril/valsartan versus angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB). Studies containing safety outcomes or AEs during the use of sacubitril/valsartan versus ACEI/ARB were retrieved from the MEDLINE, Embase, and Cochrane Library databases and clinical trials. From the selected studies, the pooled risk ratios with 95% confidence intervals of dichotomous outcomes were assessed by a random or fixed effects model in our meta-analysis. Fourteen studies involving 20,261 patients were included in this review. No significant differences were found in total AEs between the sacubitril/valsartan and ACEI/ARB groups. Compared with ACEI/ARB, sacubitril/valsartan decreased the risk of death, discontinuation due to AEs, and renal dysfunction, whereas it increased the risk of hypotension. Specifically, sacubitril/valsartan decreased the risk of death compared with ACEI/ARB, whereas it increased the risk of hypotension for patients with heart failure and decreased the risk of discontinuation due to AEs in White patients. It also increased the risk of dizziness in Asians and decreased the risk of hyperkalemia and renal dysfunction, whereas it increased the risk of hypotension when the study duration was ≥48 weeks. The available evidence showed that sacubitril/valsartan was associated with fewer side effects than ACEI/ARB, except for hypotension. Study duration, race, and patients with primary diseases affected the AEs of sacubitril/valsartan.
Review of the Preanalytical Errors That Impact Therapeutic Drug Monitoring
Authors: Peck Palmer Octavia M. , Dasgupta Amitava 
Published: April 2021

Purpose:
Preanalytical errors comprise the majority of testing errors experienced by clinical laboratories and significantly impact the accuracy of therapeutic drug monitoring (TDM).

Methods:
Specific preanalytical factors in sample timing, collection, transport, processing, and storage that lead to errors in TDM were reviewed. We performed a literature search using several scientific databases including PubMed, ScienceDirect, Scopus, Web of Science, and ResearchGate for human studies published in the English language from January 1980 to February 2021, reporting on TDM and the preanalytical phase.

Results:
Blood collection errors (ie, wrong anticoagulant/clot activator used, via an intravenous line, incorrect time after dosing) delay testing, cause inaccurate results, and adversely impact patient care. Blood collected in lithium heparin tubes instead of heparin sodium tubes produce supertoxic lithium concentrations, which can compromise care. Specimens collected in serum separator gel tubes cause falsely decreased concentrations due to passive absorption into the gel when samples are not processed and analyzed quickly. Dried blood spots are popular for TDM as they are minimally invasive, allowing for self-sampling and direct shipping to a clinical laboratory using regular mail. However, blood collection techniques, such as trauma to the collection site, filter paper fragility, and hematocrit (Hct) bias, can adversely affect the accuracy of the results. Volumetric absorptive microsampling is a potential alternative to dried blood spot that offers fast, volume-fixed sampling, low pain tolerance, and is not susceptible to Hct concentrations.

Conclusions:
The identification of preanalytical factors that may negatively impact TDM is critical. Developing workflows that can standardize TDM practices, align appropriate timing and blood collection techniques, and specimen processing will eliminate errors.
Interactions of hypertension, obesity, left ventricular hypertrophy, and heart failure
Authors: daSilva-deAbreu Adrian , Alhafez Bader Aldeen , Lavie Carl J. , Milani Richard V. , Ventura Hector O. 
Published: April 2021

Purpose of review
Hypertension (HTN) and obesity are major risk factors for cardiac remodeling and dysfunction, leading to left ventricular hypertrophy (LVH) and heart failure (HF). In this review, we discuss the complex mechanisms and effects of HTN and obesity, and their treatments in LVH, ventricular function, and HF.

Recent findings
Obesity and HTN impact the heart through overlapping neurohormonal pathways. However, the relationship between obesity and cardiomyopathy is more complex, and additional metabolic and hemodynamic pathways seem to contribute to cardiac dysfunction in these patients. Weight loss and blood pressure (BP) control help to prevent and reverse at least some of the damage caused by obesity and HTN even beyond what would be expected from solely the hemodynamic changes.

Summary
Obesity and HTN cause maladaptive changes in the heart that can lead to LVH and HF. Weight loss and BP control help to, at least partially, reverse some of these changes and improve clinical outcomes in patients with HF.
Outcomes of Descemet-Stripping Endothelial Keratoplasty in 52 Eyes With Iridocorneal Endothelial Syndrome
Authors: Mohamed Ashik , Chaurasia Sunita , Senthil Sirisha , Choudhari Nikhil S. 
Published: April 2021

Purpose:
To evaluate the long-term outcomes of Descemet-stripping endothelial keratoplasty (DSEK) in 52 eyes with iridocorneal endothelial (ICE) syndrome.

Methods:
Retrospective study of 52 eyes of 52 patients who were diagnosed with ICE syndrome and underwent DSEK between January 2010 and December 2019 with a follow-up of at least 6 months.

Results:
The mean age was 48.8 ± 10.8 years. Female patients (n = 33) constituted 63.5%. The median duration of follow-up was 2.4 years (range, 0.5–9.1 yrs). The mean best-corrected visual acuity improved significantly after surgery and remained stable (∼20/50) through 5 years. The mean endothelial cell loss was 28%, 37.9%, 43.6%, and 56.9% at 6 months and at 1, 2, and 3 years, respectively. Graft rejection was noted in 5 eyes (9.6%). Postoperatively, increased intraocular pressure (IOP) was seen in 17 eyes (32.7%), and 10 eyes (19.2%) underwent glaucoma surgeries. Fourteen eyes (26.9%) had secondary graft failures. The estimates of graft success were 93.6% ± 3.6% at 1 year, 85.6% ± 5.5% at 2 years, 79.3% ± 6.7% at 3 years, 69.0% ± 8.9% at 4 years, and 59.1% ± 11.9% at 5 years. Postoperative increased IOP was found to be the only significant (P = 0.05) risk factor (hazard ratio 8.92) associated with graft failure. The clinical variant of ICE syndrome did not seem to influence the graft survival (P = 0.68).

Conclusions:
In this study, DSEK had a success rate of ∼60% at 5 years. Increased IOP post-DSEK is a significant risk factor for graft failure. Graft survival is not affected by the clinical variant of ICE syndrome.
Circumferential Assessment of Changes in Anterior Segment Characteristics and Baseline Predictors of Angle Widening After Laser Iridotomy in Caucasian Eyes
Authors: Tun Tin A. , Sawicki Andrzej , Wilkos-Kuc Agnieszka , Aung Tin , Zarnowski Tomasz 
Published: April 2021

Précis:
Laser peripheral iridotomy (LPI) widened the iridocorneal angle and flattened the iris circumferentially in Caucasian eyes and baseline refractive error, lens vault, and iris volume play a significant role in the angle widening.

Purpose:
The purpose of this study was to investigate circumferential angle widening and iris changes after LPI using swept-source optical coherence tomography (SS-OCT) in Caucasian eyes with the use of novel anterior segment parameters.

Materials and Methods:
A total of 130 eyes (68 primary angle-closure suspect, 34 primary angle closure, and 28 primary angle-closure glaucoma eyes) of 66 subjects underwent 360-degree SS-OCT (SS-1000 CASIA) angle imaging and gonioscopy in the dark before and 7, 30, 90 days after LPI. For each eye, 16 frames (11.25 degree apart) were selected for analysis from 128 cross-sectional images, and novel 2-dimensional and 3-dimensional anterior segment parameters namely angle opening distance area (AODA) and the trabecular-iris space volume (TISV) 750 µm from the scleral spur, as well as iris parameters such as iris thickness (IT750 and IT2000), iris curvature, and iris curvature area were measured for each image.

Results:
AODA and TISV were significantly increased and the iris curvature and iris curvature area were significantly decreased at days 7, 30, and 90 after LPI when compared with their baseline (all P<0.001) but there was no significant change in the IT750 and IT2000 (all P>0.05). The multivariable linear regression model showed a significant association of ΔAODA with refractive error (β=−0.23, P=0.013), lens vault (β=2.8, P=0.007), and iris volume (β=−0.11, P=0.027) after adjusting for age and sex.

Conclusions:
LPI widened the iridocorneal angle and flattened the iris circumferentially in Caucasian eyes in this study. Baseline refractive error, lens vault, and iris volume play a significant role in the circumferential angle widening by LPI.
Conversion Rate of Web-based Versus Non-web-based Patient Referral Sources in a Facial Plastic Surgery Practice
Authors: Abdolalizadeh Parya , Kashkouli Mohsen Bahmani , Gandomi-Mohammadabadi Alireza , Jafarpour Soheila , Karimi Nasser , Abri Aghdam Kaveh 
Published: April 2021

Purpose:
To compare the conversion rate (number of procedures/referrals) of web-based and non-web-based referrals to a facial plastic surgery practice (2012–2019).

Method:
Data on demographics, referral source, patient’s concern, and their facial procedures were recorded. Web-based referral sources include website and Instagram. Non-web-based counterparts were the word-of-mouth, medical professionals, and others (TV, radio, printed media). Patient concerns were either cosmetic or noncosmetic (functional). Patients who underwent facial cosmetic surgery and injections (botulinum toxin A, filler, fat) were categorized in the cosmetic procedure group. Patients with functional procedures with or without facial injections were categorized in the noncosmetic procedure group. The conversion rate was defined as the ratio of the number of referrals with different facial procedures to the total number of referrals.

Results:
Included were 19,965 patients, majority of whom (63.3%) had cosmetic concern. Total, cosmetic, and noncosmetic conversion rates were 30.1%, 27.7%, and 2.4% for the web-based and 24.1%, 19.8%, and 4.3% for the non-web-based referrals, respectively (0.3 < p < 0.4). Cosmetic conversion rate grew from 6.7% in referrals ≤20 to more than 23% in >20 years of age (p = 0.03). It was also significantly (p < 0.001) higher in the referrals with cosmetic (28.3%) than noncosmetic (12.1%) concern. Gender and year of practice did not have a significant effect on the conversion rates.

Conclusion:
Conversion rates were not significantly different between the web-based and non-web-based referrals. A significantly higher cosmetic conversion rate was observed for the referrals with cosmetic concern and older than 20 years.
Occupations Associated With Poor Cardiovascular Health in Women
Authors: Nriagu Bede N. , Ako Ako A. , Wang Conglong , De Roos Anneclaire J. , Wallace Robert , Allison Matthew A. , Seguin Rebecca A. , Michael Yvonne L. 
Published: April 2021

Introduction:Research on the effect of occupation on cardiovascular health (CVH) among older women is limited.Methods:Each of the seven American Heart Association's CVH metrics was scored as ideal (1) or non-ideal (0) and summed. Multivariable logistic regression was used to estimate the odds of poor overall CVH (CVH score of 0 to 2) comparing women employed in each of the top 20 occupational categories to those not employed in that category, adjusting for age, marital status, and race/ethnicity.Results:(1) Bookkeeping, accounting, and auditing clerks; (2) first-line supervisors of sales workers; (3) first-line supervisors of office and administrative support workers; and (4) nursing, psychiatric, and home health aides were more likely to have poor overall CVH compared to women who did not work in these occupations.Conclusions:Several commonly held occupations among women were associated with poor CVH.
Predicting occupational outcomes from neuropsychological test performance in older people with HIV
Authors: Brouillette Marie-Josée , Koski Lisa , Forcellino Laurence , Gasparri Joséphine , Brew Bruce J. , Fellows Lesley K. , Mayo Nancy E. , Cysique Lucette A. 
Published: April 2021

Objective:
The ability to work is amongst the top concerns of people living with well treated HIV. Cognitive impairment has been reported in many otherwise asymptomatic persons living with HIV and even mild impairment is associated with higher rates of occupational difficulties. There are several classification algorithms for HIV-associated neurocognitive disorder (HAND) as well as overall scoring methods available to summarize neuropsychological performance. We asked which method best explained work status and productivity.

Design:
Participants (N = 263) drawn from a longitudinal Canadian cohort underwent neuropsychological testing.

Methods
: Several classification algorithms were applied to establish a HAND diagnosis and two summary measures (NPZ and Global Deficit Score) were computed. Self-reported work status and productivity was assessed at each study visit (four visits, 9 months apart). The association of work status with each diagnostic classification and summary measure was estimated using logistic regression. For those working, the value on the productivity scale was regressed within individuals over time, and the slopes were regressed on each neuropsychological outcome.

Results:
The application of different classification algorithms to the neuropsychological data resulted in rates of impairment that ranged from 28.5 to 78.7%. Being classified as impaired by any method was associated with a higher rate of unemployment. None of the diagnostic classifications or summary methods predicted productivity, at time of testing or over the following 36 months.

Conclusion:
Neuropsychological diagnostic classifications and summary scores identified participants who were more likely to be unemployed, but none explained productivity. New methods of assessing cognition are required to inform optimal workforce engagement.