bluuebunny/crossref_metadata_2025_split huggingface dataset:
CYSTOID MACULAR EDEMA AFTER FOUR-POINT SCLERAL FIXATION OF INTRAOCULAR LENS
Authors: Hauser David , Ben-David David , Masarwa Dua , Jaar Richard , Arow Majd , Haas Keren , Pokroy Russell 
Published: February 2021

Purpose:
To assess the incidence of cystoid macular edema (CME) associated with 4-point Gore-Tex suture intraocular lens (IOL) scleral fixation, before and after institution of routine intravitreal triamcinolone acetonide prophylaxis and long-term topical nonsteroidal anti-inflammatory drug usage.

Methods:
Consecutive patients were included after IOL implantation with concurrent pars plana vitrectomy for spontaneous IOL dislocation due to pseudoexfoliation syndrome. We compared short-term prophylactic nonsteroidal anti-inflammatory drugs only (Group A) to prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs (Group B).

Results:
Twenty-six eyes of 26 patients with pseudoexfoliation syndrome and spontaneous IOL dislocation were studied. Mean logMAR visual acuity improved from 1.27 ± 0.80 (20/375 Snellen equivalent) preoperatively to 0.46 ± 0.39 (Snellen 20/43) postoperatively (P < 0.001). Visual outcomes were similar for Groups A and B. In Group A, 10/16 eyes had CME, 4/16 had chronic CME longer than 6 months, and 1 longer than 12 months. In Group B, 1/10 had CME (which was both chronic and refractory).

Conclusion:
In eyes with pseudoexfoliation syndrome and spontaneous IOL dislocation, 4-point Gore-Tex suture IOL ab externo fixation yielded good visual outcomes, although CME was observed more than reported elsewhere. Prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs seem to reduce the risk of postoperative CME.
Exacerbation of Granular Corneal Dystrophy Type 2 After Small Incision Lenticule Extraction
Authors: Kwak Jay Jiyong , Yoon Sook Hyun , Seo Kyoung Yul , Kim Tae-im , Lee Hyung Keun , Stulting R. Doyle , Kim Eung Kweon 
Published: February 2021

Purpose:
To report the outcome of unilateral small incision lenticule extraction (SMILE) in a patient with granular corneal dystrophy type 2 (GCD2).

Methods:
Slit-lamp photography and Fourier domain optical coherence tomography were used to document the clinical course and appearance of the corneas in a patient with genetically determined GCD2 who underwent unilateral SMILE in the right eye.

Results:
Slit-lamp examination of a 23-year-old woman revealed 2 faint opacities at the surgical interface approximately 2 months after the SMILE procedure had been performed on her right eye. Nine and 3 typical GCD2 deposits located immediately beneath the Bowman layer were observed in the right and left corneas, respectively. Over time, the deposits at the interface increased in size, density, and number in the right eye. Fourier domain optical coherence tomography performed 33 months after the SMILE procedure revealed deposits at the SMILE interface that were distinct from those located immediately beneath the Bowman layer. The severity of disease exacerbation was less in this patient than what is typically observed in others who have undergone laser-assisted in situ keratomileusis or photorefractive keratectomy.

Conclusions:
SMILE is contraindicated in patients with GCD2, as are other corneal refractive surgical procedures. This case highlights the importance of genetic testing before the performance of refractive corneal procedures—especially for patients with corneal opacities on preoperative slit-lamp examination or a family history of corneal disease compatible with that of a corneal dystrophy.
Educational and Electronic-Based Tools to Mitigate the Risk of Transfusion Adverse Events
Authors: Ding Jennifer , Krey Rebecca , Malone Laura , Merrill VeRonika , Krouss Mona , O'Brien Jennifer , Fontaine Magali J. 
Published: February 2021

ABSTRACT
The transfusion of blood products is a widely used practice but comes with the risk of transfusion-associated adverse events and fatalities. The primary aim of this study was to evaluate if strict adherence to transfusion guidelines would lead to a decrease in the rate of transfusion reactions that occurred when blood products were given outside of established indications. Hospital-wide educational programs and dedicated electronic transfusion order sets were used to encourage adherence to guidelines. A secondary aim of this study was to evaluate if a decrease in the incidence of transfusion reactions also lead to a decrease in associated healthcare costs.
Improving Management of Type 2 Diabetes Mellitus in Hospitalized Adults: A Quality Initiative
Authors: Wahlberg Elizabeth A. , Muthukrishnan Preetika , Burnett Maria , Barrett Kaitlyn V. , Gilbert Matthew , Repp Allen B. 
Published: February 2021

ABSTRACT
The American Diabetes Association recommends scheduled basal and nutritional insulin doses as the preferred treatment for noncritically ill hospitalized patients with type 2 diabetes; however, the adoption of these practices remains suboptimal. We sought to understand current diabetes management practices and improve glycemic control in patients with type 2 diabetes on the Hospital Medicine Services at our academic medical center. We surveyed resident and attending physicians to understand barriers to guideline-based practice. We conducted educational sessions, developed pocket-card decision aids, encouraged discussion on rounds, and provided periodic performance feedback to attending physicians. Results of the barriers survey identified “fear of causing hypoglycemia” as the most common barrier to guideline-based practice. Compared with the preintervention 12-month period, these interventions were associated with doubling of the use of guideline-based insulin therapy regimens, a significant reduction in the rate of severe hyperglycemia days, and a nonsignificant reduction in the rate of hypoglycemia days over a 12-month period. These results demonstrate that a simple, low-cost intervention can be associated with an increase in guideline-concordant insulin ordering with improvement in glycemic outcomes for patients with type 2 diabetes.
Weather and COVID-19 Deaths During the Stay-at-Home Order in the United States
Authors: Karimi Seyed M. , Majbouri Mahdi , DuPré Natalie , White Kelsey B. , Little Bert B. , McKinney W. Paul 
Published: February 2021

Objective:
To estimate the association between weather and COVID-19 fatality rates during US stay-at-home orders.

Methods:
With a county-level longitudinal design, this study analyzed COVID-19 deaths from public health departments’ daily reports and considered exposure as the 18 to 22 day-period before death. Models included state-level social distancing measures, Census Bureau demographics, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2.5 concentrations, and U.V. light index.

Results:
A 1 °F increase in the minimum temperature was associated with 1.9% (95% CI, 0.2% to 3.6%) increase in deaths 20 days later. An ozone concentration increase of 1 ppb (part per billion) decreased daily deaths by 2.0% (95% CI, 0.1% to 3.6%); ozone levels below 38 ppb negatively correlated with deaths.

Conclusions:
Increased mobility may drive the observed association of minimum daily temperature on COVID-19 deaths.
Implementing New Working Practices Through a Structured Support Model for Systematic Work Environment Management
Authors: Molin Fredrik , Hellman Therese , Svartengren Magnus 
Published: February 2021

Objective:
To describe factors that facilitate and hinder implementation of a structured support model focusing on psychosocial work environment in Swedish municipalities.

Methods:
This qualitative study was conducted in six Swedish municipalities. In total, 63 semi-structured interviews and focus groups were conducted with key stakeholders in the municipalities during a 2-year period. The consolidated framework for implementation research (CFIR) was used for data analysis.

Results:
Findings suggest that the support model needs to have an easy enough structure to understand and use, and it must be immediately applicable for work groups and employees. An important factor for facilitating implementation was the support from first-line managers and upper management.

Conclusions:
Upper management need to be committed to the model and communicate clearly to lower levels of the implementing organization on the purpose and objectives of the model.
Developing a Curriculum on Transgender Health Care for Physician Assistant Students
Authors: Hart Bethany G. , Kindratt Tiffany B. , Vasudevan Anita , Garcia Antonio D. , Pagels Patti , Orcutt Venetia , Lau May C. 
Published: February 2021

Purpose
Our goal was to (1) evaluate physician assistant (PA) students' knowledge, skills, and attitudes toward transgender patients, (2) develop and deliver a lecture on transgender health care, and (3) determine changes in knowledge, skills, and attitudes postlecture.

Methods
A 32-item survey was developed and emailed to PA students. Students were then invited to a 2-hour lecture on transgender-specific psychosocial topics and clinical skills plus medical treatment for gender dysphoria. Lecture attendees retook the survey after 2 weeks.

Results
Initial mean self-assessment scores regarding clinical knowledge and skills were below 3 on a 7-point Likert scale. All measures improved following the lecture (p < .001 for all). Overall, 86.7% of students were interested in the addition of transgender health into their didactic curriculum.

Conclusions
Our results illustrate insufficient student competence in transgender medicine. Our proposed transgender curriculum may be a useful guide for educators wanting to integrate this topic into their instruction.
Does the Length of Student Physical Therapists' Clinical Educational Experiences Matter?
Authors: Wolden Mitch , Gusman Lori N. , Drevyn Elsa , Flom-Meland Cindy 
Published: February 2021

Introduction/Review of Literature.
Clinical educational experiences (CEEs) comprise approximately 30% of the total credit hours in the Doctor of Physical Therapy (DPT) curriculum and are essential to the clinical learning and performance of DPT students to achieve entry-level competence. There are no established standards in DPT education for the length and timing of CEEs to optimize students' clinical learning and performance. The purpose of our investigation was to assess the development of DPT students' clinical learning and performance at 3 DPT programs during 6-, 8-, 9-, and 16-week CEEs.

Methods.
An analysis of variance was conducted to assess the changes in DPT students' clinical learning and performance based on the following: (1) the length of CEEs, (2) the effect of the length and timing of CEEs, and (3) the length of the final CEEs.

Subjects.
Midterm and final evaluation Physical Therapist Clinical Performance Instrument data were analyzed from 707 DPT students' CEEs.

Results.
The average change in DPT students' clinical learning and performance during CEEs was as follows: 6 weeks = 3.13 (SD = 2.3), 8 weeks = 3.20 (SD = 2.6), 9-weeks = 3.30 (SD = 2.5), and 16 weeks = 2.56. Significant difference in DPT students' clinical learning occurred during the 8-week (P = .03; P = .04) and 9-week (P = .04; P = .01) CEEs compared with the early 6-week CEEs and 16-week CEEs, respectively.

Discussion and Conclusion.
The greatest change in DPT students' clinical learning and performance occurred during 8- and 9-week CEEs and between the first and third full-time CEEs. Given the increasing costs of DPT education and student debt, the length of CEEs required to meet CAPTE standards and program goals should be further investigated.
The redesign of an advanced practice registered nurse professional evaluation process and tool at a midwest academic medical center: A pilot project
Authors: Kamm Alaine M. , Howard-Ruben Josie A. , Carlson Elizabeth A. 
Published: February 2021

ABSTRACT

Background:
Inconsistency and a lack of clarity exist regarding the advanced practice registered nurse peer review process in hospitals throughout the country.

Local problem:
The current APRN peer review process in place for over a decade at an academic medical center has never been evaluated, and neither fulfills ongoing professional practice evaluation requirements nor meets the expectations of peer review.

Methods:
Pre–post intervention quality improvement project (Standards for Quality Improvement Reporting Excellence checklist).

Interventions:
Using current professional standards and guidelines that meet the requirements for ongoing professional practice evaluation and nursing peer review, a redesigned process and tool was created and piloted in three specialty groups of nurse practitioners (NPs) at the medical center. Satisfaction before and after the pilot survey was measured using a Likert-type scale, and results were compared and analyzed following the completion of the pilot survey.

Results:
The posttest measure revealed a statistically significant improvement in satisfaction with the redesigned professional evaluation tool compared with the prepilot peer review tool.

Conclusions:
The redesign project demonstrated that using current professional standards and guidelines, a comprehensive process and tool for professional evaluation and peer review is achievable across NP specialties.
Promoting adherence to bone-loading exercises in postmenopausal women with low bone mass
Authors: Waltman Nancy , Cole Melissa A. , Kupzyk Kevin A. , Lappe Joan M. , Mack Lynn R. , Bilek Laura D. 
Published: February 2021

ABSTRACT

Background:
We recently completed a parent study (Bone Loading Exercises versus Risedronate on Bone Health in Post-menopausal Women [NIH# R01NR015029]) examining bone-loading exercises to prevent bone loss in postmenopausal women with low bone mass. Forty-three million US women have low bone mass and increased risk for fractures. Bone-loading exercises (weight-bearing and resistance training) can preserve bone mass and decrease risk of fractures. However, multiple barriers prevent women from exercising and adherence rates are low.

Purpose:
This secondary analysis of the parent study (a) examined barriers specific to women participating in bone-loading exercises; (b) described effectiveness of self-efficacy strategies used in the parent study for increasing confidence in knowledge and reducing barriers; and (c) applied study findings and principles of self-efficacy and self-regulation in development of guidelines for promoting adherence to exercises.

Methods:
Seventy-two women were randomized to the exercise group and completed 12 months of exercises. Instruments for self-efficacy were completed at 2 weeks and barriers interference at 6 months. Percent adherence was measured as the number of exercise sessions attended divided by the number prescribed.

Results:
In the 12-month study, average adherence to exercises was 58.9%. Lower adherers reported lack of self-regulation skills such as “lack of time” as the most frequent barriers to exercise.

Implications for practice:
Guidelines developed included promotion of skills for self-regulation (such as regulation of time) as well as self-efficacy to improve adherence rates. Nurse practitioners may be the most motivated of all providers to use guidelines promoting exercise for women in their clinical practice.
The role of computed tomography scan in the diagnosis of COVID-19 pneumonia
Authors: Axiaq Ariana , Almohtadi Ahmad , Massias Samuel A. , Ngemoh Dorette , Harky Amer 
Published: February 2021

Purpose of review
To summarize current literature evidence on the role of computed tomography (CT) scan in the diagnosis and assessment of coronavirus disease 2019 (COVID-19) pneumonia.

Recent findings
Recent guidelines on the use of CT scans in COVID-19 vary between countries. However, the consensus is that it should not be used as the first line; a notion supported by the WHO. Currently, several investigations are being used including reverse transcription PCR testing, chest radiographs, and ultrasound scans, and CT scans. They are ideally performed later during the disease process as the sensitivity and specificity are highest by that time. Typical COVID-19 features on CT scans vary but include vascular enlargement, ground-glass opacities, and ground glass opacification together with consolidation.

Summary
Since COVID-19 was declared as a global pandemic, there was a push towards identifying appropriate diagnostic tests that are both reliable and effective. There is a general agreement that CT scans have a high sensitivity but low specificity in diagnosing COVID-19. However, the quality of available studies is not optimal, so this must always be interpreted with the clinical context in mind. Clinicians must aim to weigh up the practicalities and drawbacks of CT scans when considering their use for a patient. The ease and speed of use of CT scans must be balanced with their high radiation doses, and infection control considerations.
Intestinal failure in Finland: prevalence and characteristics of an adult patient population
Authors: Pohju Anne K. , Pakarinen Mikko P. , Sipponen Taina M. 
Published: February 2021

Objectives
Details of intestinal failure in the Finnish adult population are unknown. This study aimed to specify the intestinal failure prevalence and to clinically characterize the patient population in Finland.

Methods
All Finnish healthcare units with the potential of providing parenteral support received an electronic survey to report whether they had patient(s) aged ≥18 years on long-term (≥120 days) parenteral support due to intestinal failure. Patient details came from patient records. IBM SPSS v.25 was used to analyze descriptive statistics.

Results
Of the 74 patients, 52 were included after confirming parenteral support indication from the records. The adult intestinal failure prevalence for 2017 was 11.7 per million, 95% confidence interval: 8.9–15.3. Most patients were women (69%), and the median age was 62 (45–72) years. Short bowel syndrome was the most frequent intestinal failure mechanism (73%), and surgical complication the most frequent underlying diagnosis (29%). Of patients, 66% represented the clinical classification category parenteral nutrition 1 or parenteral nutrition 2. Median Charlson Comorbidity Index was one (0–2.8); hypertension (37%) and diabetes (23%) were the most frequent comorbidities. Patients received seven (3.5–7) parenteral support infusions weekly, and eight patients (15%) were on fluids and electrolytes only. The median duration of parenteral support was 27.5 (11.3–57.3) months. Ten patients ceased parenteral support during 2017 after a median of 20.0 (9.0–40.3) parenteral support months. Eight weaned off parenteral support, one ran out of catheter sites, and one died.

Conclusion
Prevalence and patient characteristics of adult intestinal failure in Finland are similar to those in other Western countries.
Geographic Variation of Statin Use Among US Nursing Home Residents With Life-limiting Illness
Authors: Mack Deborah S. , Baek Jonggyu , Tjia Jennifer , Lapane Kate L. 
Published: February 2021

Background:
Medically compromised nursing home residents continue to be prescribed statins, despite questionable benefits.

Objective:
To describe regional variation in statin use among residents with life-limiting illness.

Research Design:
Cross-sectional study using 2016 Minimum Data Set 3.0 assessments linked to Medicare administrative data and health service utilization area resource files.

Setting:
Nursing homes (n=14,147) within hospital referral regions (n=306) across the United States.

Subjects:
Long-stay residents (aged 65 y and older) with life-limiting illness (eg, serious illness, palliative care, or prognosis <6 mo to live) (n=361,170).

Measures:
Prevalent statin use was determined by Medicare Part D claims. Stratified by age (65–75, 76 y or older), multilevel logistic models provided odds ratios with 95% confidence intervals.

Results:
Statin use was prevalent (age 65–75 y: 46.0%, 76 y or more: 31.6%). For both age groups, nearly all resident-level variables evaluated were associated with any and high-intensity statin use and 3 facility-level variables (ie, higher proportions of Black residents, skilled nursing care provided, and average number of medications per resident) were associated with increased odds of statin use. Although in residents aged 65–75 years, no associations were observed, residents aged 76 years or older located in hospital referral regions (HRRs) with the highest health care utilization had higher odds of statin use than those in nursing homes in HRRs with the lowest health care utilization.

Conclusions:
Our findings suggest extensive geographic variation in US statin prescribing across HRRs, especially for those aged 76 years or older. This variation may reflect clinical uncertainty given the largely absent guidelines for statin use in nursing home residents.
Clinical relevance of incidental focal breast uptake on fluorine-18 fluorodeoxyglucose PET/computed tomography studies: an experience in a high-load center of Spain
Authors: Wakfie-Corieh Cristina Gamila , Rodríguez Rey Cristina , Ortega Candil Aida , Ferrando-Castagnetto Federico , Valhondo-Rama Raquel , Ruiz Tolón Mercedes , Pascual Martin Alejandro , Carreras Delgado José Luis 
Published: February 2021

Aim
We aimed to determine the frequency and clinical significance of breast incidental uptake (BIU) detected through fluorine-18 fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in a single, high-load center.

Patients and methods
In this retrospective study, we analyzed a total of 13 763 PET/CT studies performed from January 2017 to January 2020. After excluding 3148 scans, the maximum standardized uptake value (SUVmax) and maximum diameter (cm) of each BIU were measured. Clinical management, ultrasound/mammography and pathology reports were analyzed.

Results
We found BIU in 27 scans of 26 patients (0.3% of the studies). Mean age was 62.2 years and 88.5% were women; 84.6% underwent PET/CT for oncological indications. Ultrasound/mammography was consequently performed in 23 patients (88.5%), and histological correlations were available for Breast Imaging Reporting and Data System categories 4 and 5. Finally, lesions were benign in 14 patients (60.9%; two of them with low/intermediate risk of malignancy) and malignant in nine patients (39.1%). The remaining three patients had no ultrasound/mammography reports. Mean SUVmax of benign and malignant lesions were 2.6 ± 1.4 and 5.8 ± 3.5, respectively (P = 0.002). Considering a SUVmax cut-off value of 4.0, the sensitivity and specificity for differentiating benign vs. malignant lesions were 67 and 93%, respectively. Benign lesions were smaller than malignant in CT (maximum diameter:1.3 ± 0.5 cm vs. 2.0 ± 1.0 cm, P = 0.02).

Conclusion
Although BIU detected by 18F-FDG PET/CT is infrequently found, the risk of malignancy remains very high (39.1%). Both SUVmax and maximum diameter were greater in malignant than in benign lesions. An exhaustive study with ultrasound/mammography and selective histopathological correlation is mandatory after BIU findings, even in small lesions.