bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provider Perceptions of Virtual Care During the Coronavirus Disease 2019 Pandemic
Authors: Connolly Samantha L. , Gifford Allen L. , Miller Christopher J. , Bauer Mark S. , Lehmann Lisa S. , Charness Michael E. 
Published: April 2021

Background:
The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in virtual care (VC) across outpatient specialties, but little is known regarding provider acceptance of VC.

Objective:
The objective of this study was to assess provider perceptions of the quality, efficiency, and challenges of VC versus in-person care with masks.

Design:
This was a voluntary survey.

Participants:
Mental health (MH), primary care, medical specialty, and surgical specialty providers across the 8 VA New England Healthcare System medical centers.

Measures:
Provider ratings of: (1) quality and efficiency of VC (phone and video telehealth) compared with in-person care with masks; (2) challenges of VC; and (3) percentage of patients that providers are comfortable seeing via VC in the future.

Results:
The sample included 998 respondents (49.8% MH, 20.6% primary care, 20.4% medical specialty, 9.1% surgical specialty; 61% response rate). Most providers rated VC as equivalent to or higher in quality and efficiency compared with in-person care with masks. Quality ratings were significantly higher for video versus phone (χ2=61.4, P<0.0001), but efficiency ratings did not differ significantly. Ratings varied across specialties (highest in MH, lowest in SS; all χ2s>24.1, Ps<0.001). Inability to conduct a physical examination and patient technical difficulties were significant challenges. MH providers were comfortable seeing a larger proportion of patients virtually compared with the other specialties (all χ2s>12.2, Ps<0.01).

Conclusions:
Broad provider support for VC was stratified across specialties, with the highest ratings in MH and lowest ratings in SS. Findings will inform the improvement of VC processes and the planning of health care delivery during the COVID-19 pandemic and beyond.
18F-FDG PET/computed tomography scan in patients with suspicion of recurrent neuroendocrine carcinoma of the cervix
Authors: Jiang Yuanyuan , Hou Guozhu , Huo Li , Li Fang , Zhu Zhaohui , Cheng Wuying 
Published: April 2021

Objectives
The aim of this study was to investigate the value of [18F]fluoro-2-deoxy-D-glucose (18F-FDG) PET/computed tomography (CT) to detect recurrent cervical neuroendocrine carcinoma and its subsequent impact on patient management.

Methods
A total of 25 patients who had undergone 30 18F-FDG PET/CT studies for suspected recurrent cervical neuroendocrine carcinoma (18 small cells, 2 large cells, 1 atypical carcinoid, and 4 unclassified) were retrospectively analyzed. The findings of the PET/CT images were compared with the histopathologic results in 8 scans and with clinical follow-up in 22 scans.

Results
Of the 30 PET/CT studies, 63.3% (19/30) were positive for recurrence while 36.7% (11/30) were negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG PET/CT for detecting recurrent disease of cervical neuroendocrine carcinomas were 90.0, 90.0, 94.7, 81.8, and 90.0%, respectively. Metastasis to distant organs was the most common (89.4%), followed by lymph node recurrence (52.6%). Lungs were the most frequent site of distant metastasis (63.1%). 18F-FDG PET/CT findings led to the change of the management in 10 out of 25 patients (40%) by introducing the use of previously unplanned therapeutic procedures.

Conclusions

18F-FDG PET/CT is an efficient technique for detecting recurrent cervical neuroendocrine carcinoma, and may thus contribute to improving patient management.
Testing for and identification of Multisystem Inflammatory Syndrome in children in the pediatric emergency department
Authors: Patel Roshni , Patel Katie J. , Rocker Joshua 
Published: April 2021

Purpose of review
The current article summarizes updates on multisystem inflammatory syndrome in children (MIS-C) research and focuses on strategies to diagnose and manage these patients in the emergency department.

Recent findings
MIS-C is an inflammatory syndrome that occurs approximately 4-5 weeks after severe acute respiratory syndrome coronavirus 2 infection. It is associated with symptoms such as fever, shock, abdominal pain, rash, and conjunctivitis along with laboratory abnormalities such as elevated inflammatory markers, coagulation factors, and cytokines. Patients fall into the following three subcategories: first, classic or incomplete Kawasaki; second, cardiogenic or distributive shock; or third, an inflammatory response that does not initially meet criteria of the other subcategories. Immediate treatment largely focuses on supportive care through fluid resuscitation and pressor support; however, inpatient management may also include intravenous immunoglobulin, steroids, anticoagulation and at times anti-inflammatory biologics.

Summary
Overall fatality rate remains low and short-term research has demonstrated self-limited sequelae. Pediatricians should focus on the timely diagnosis and identification of this inflammatory disease via clinical findings and laboratory evidence to best treat these patients.
Future artificial intelligence tools and perspectives in medicine
Authors: Chaddad Ahmad , Katib Yousef , Hassan Lama 
Published: April 2021

Purpose of review
Artificial intelligence has become popular in medical applications, specifically as a clinical support tool for computer-aided diagnosis. These tools are typically employed on medical data (i.e., image, molecular data, clinical variables, etc.) and used the statistical and machine-learning methods to measure the model performance. In this review, we summarized and discussed the most recent radiomic pipeline used for clinical analysis.

Recent findings
Currently, limited management of cancers benefits from artificial intelligence, mostly related to a computer-aided diagnosis that avoids a biopsy analysis that presents additional risks and costs. Most artificial intelligence tools are based on imaging features, known as radiomic analysis that can be refined into predictive models in noninvasively acquired imaging data. This review explores the progress of artificial intelligence-based radiomic tools for clinical applications with a brief description of necessary technical steps. Explaining new radiomic approaches based on deep-learning techniques will explain how the new radiomic models (deep radiomic analysis) can benefit from deep convolutional neural networks and be applied on limited data sets.

Summary
To consider the radiomic algorithms, further investigations are recommended to involve deep learning in radiomic models with additional validation steps on various cancer types.
High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms and Improved Prognostic Stratification With the New World Health Organization 2019 Classification
Authors: Hayes Aimee R. , Furnace Myles , Shah Ruchir , Rundell Caroline , Muller Gregory , Dehbi Hakim-Moulay , Luong Tu Vinh , Toumpanakis Christos , Caplin Martyn E. , Krell Daniel , Thirlwell Christina , Mandair Dalvinder 
Published: May 2021

Objectives
There is a pressing need to develop clinical management pathways for grade 3 (G3) gastroenteropancreatic neuroendocrine neoplasms (GEP NEN).

Methods
We performed a retrospective study on patients with metastatic G3 GEP NEN. The relationship between baseline characteristics and progression-free survival and overall survival was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model.

Results
We included 142 patients (74 well-differentiated neuroendocrine tumors [WDNETs], 68 poorly differentiated neuroendocrine carcinomas [PDNECs]). Patients with WDNET had prolonged survival compared with PDNEC (median, 24 vs 15 months, P = 0.0001), which persisted in both pancreatic and nonpancreatic cohorts. Well-differentiated morphology, Ki-67 <50% and positive somatostatin receptor imaging were independently associated with prolonged survival. Of the subgroup treated with first-line platinum-based chemotherapy, response rates were favorable (partial response, 47%; stable disease, 30%); there was no significant difference in response rates nor progression-free survival between WDNET and PDNEC despite significantly prolonged overall survival in the WDNET cohort.

Conclusions
Our study corroborates the knowledge of 2 prognostically distinct subgroups within the World Health Organization 2019 G3 GEP NEN population, observed in both pancreatic and nonpancreatic gastrointestinal cohorts. Definitive management pathways are needed to reflect the differences between G3 WDNET and PDNEC.
Esophagitis Dissecans Superficialis in Children
Authors: Ebigbo Nonyelum , Park Jason Y. , Cheng Edaire , Gurram Bhaskar 
Published: May 2021

ABSTRACTObjectives:Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the superficial esophageal epithelium with variable clinical characteristics. Endoscopically, there is an appearance of superficial peeling of sheets of epithelium. Histologically there is 2‐toned epithelium with coagulative necrosis of the superficial epithelium. Currently, there is paucity of data regarding this condition in children.Methods:A 10‐year retrospective search of the pathology information system was performed for cases with a pathologic diagnosis of EDS in a tertiary care pediatric center. Demographic data, clinical history, endoscopic findings, and histopathologic reports were reviewed.Results:Thirteen patients (9 girls; ages 3–18 years), were identified with histologic findings of EDS. Esophageal food impaction, dysphagia, vomiting, and abdominal pain were the most common presenting symptoms. Sixty‐nine percentage of the patients had underlying comorbidities and 76% were on at least 1 medication chronically. Eosinophilic esophagitis (23%), inflammatory bowel disease (23%), and gastroesophageal reflux disease (GERD) (15%) were the most common associated diagnoses. Of the 13 patients, 5 had repeat endoscopies showing complete resolution of EDS with no complications.Conclusions:EDS is an under‐recognized entity that endoscopists should be familiar with. In our series, the most prevalent associations were with food impaction and eosinophilic esophagitis (EoE). Contact injury and/or inflammation may precede the development of EDS. Pediatric EDS appears to be an incidental finding without significant morbidity or mortality.
Attached to Virtual Dreams
Authors: Costanzo Antonino , Santoro Gianluca , Russo Santi , Cassarà Maria Silvia , Midolo Laura Rosa , Billieux Joël , Schimmenti Adriano 
Published: April 2021

Abstract
Maladaptive daydreaming describes excessive fantasy activity that interferes with an individual's life. Surprisingly, the precursors of maladaptive daydreaming and its role in excessive involvement in virtual worlds have been scarcely investigated. In the current study, we examined the relationships among attachment styles, maladaptive daydreaming, and problematic social media use (PSMU) in a sample of community-dwelling adults. Eight hundred seventy-seven participants between 18 and 68 years old were recruited via an online survey and asked to fill out self-reported measures on attachment styles, maladaptive daydreaming, and PSMU. Mediation analyses showed that maladaptive daydreaming is a significant mediator in the relationships between preoccupied and fearful attachment styles and PSMU, suggesting that maladaptive daydreaming partly explains the established link between insecure attachment styles and excessive use of social media. Individuals with PSMU fostered by maladaptive daydreaming may benefit from clinical interventions that promote the use of adaptive regulatory strategies to develop feelings of security and self-confidence that may serve to reduce the excessive involvement in social media.
Assisting Learners to Understand and Incorporate Functions of Clinical Judgment Into Nursing Practice
Authors: Sommer Sheryl K. , Johnson Janean D. , Clark Cynthia M. , Mills Christine M. 
Published: May 2021

Background
Mastering clinical judgment (CJ) skills is an essential competency for nurses in all health care environments.

Problem
Complexities of the health environment combined with the intricacies of nursing practice can pose potential risks to client safety.

Approach
Over a 2-year period, a 3-phased approach using (1) survey results from nurses in education and practice, (2) discussion forums, and (3) a series of think tanks that comprised nurse educators resulted in the development of the Guide for CJ.

Outcomes
The Guide for CJ provides nurse educators with an evidence-based resource to promote CJ skills in nursing students. The environmental and individual factors and expected nurse responses and behaviors contained in the Guide are well-aligned with the cognitive operations contained in the National Council of State Boards of Nursing Action Model.

Conclusions
Educators may use the Guide to support faculty development and operationalize CJ to develop a variety of learning strategies for use in multiple learning environments.
Creating Collaborative Relationships With Historically Black Colleges and Universities
Authors: Hudson Tamika , Steed Julia , Parker Shaunna , Johnson Rolanda , Norman Linda 
Published: May 2021

Background
The lack of a diverse nursing workforce and inclusive nursing student pipeline initiatives can impact existing health disparities in the United States.

Problem
Gaps in the representation of future Black nurses in schools of nursing provide missed opportunities for cultural congruence and awareness.

Approach
Developing collaborative relationships with historically Black colleges and universities (HBCUs) for recruitment is a mutually beneficial strategy. Undergraduate interns from 3 HBCUs attended a 6-week summer nursing immersion program at a graduate school of nursing on the campus of a predominately White institution. The aim was to provide awareness of the nursing profession and mentorship for further exploration into the profession.

Conclusions
The program managed by Black nurse faculty provides a recruitment strategy that serves as a framework to support the financial, emotional, and social needs of prospective Black nursing students.
Urban Sexual Health Clinic Patients With “Undetermined Risk” for HIV Are Less Likely to Receive Preexposure Prophylaxis
Authors: Platt Laura , Shebl Fatma M. , Qian Yiqi , Bunda Bridget , Ard Kevin L. , Bassett Ingrid V. 
Published: May 2021

Background
New diagnoses of HIV increasingly occur among people who fall outside traditional transmission risk categories. This group remains poorly defined, and HIV prevention efforts for this group lag behind efforts for patients in other risk groups.

Methods
We conducted a retrospective review of patient visits at sexual health clinics in Boston, MA, over a 14-month period. Patients were classified into Centers for Disease Control and Prevention–defined HIV transmission risk categories. We compared frequencies of sexually transmitted infections (STIs), HIV, preexposure prophylaxis (PrEP) indications, and PrEP prescriptions. Predictors of HIV or STI among patients in the undetermined risk category were assessed with logistic regression.

Results
There were 4723 clinic visits during the study period. Patients in the undetermined risk group constituted the largest proportion (55.8%), followed by men who have sex with men (MSM; 42.7%). The proportion of visits by patients in the undetermined risk group with an indication for PrEP was low (28.0%) compared with MSM (91.3%) and MSM who also inject drugs (93.8%); however, the absolute number was high (737). Among patients with an indication for PrEP, those in the undetermined risk group were least likely to receive a prescription. Behavioral risk factors were poorly predictive of STI or HIV among patients in the undetermined risk group.

Conclusions
Patients with undetermined risk for HIV constituted a large proportion of clinic visits and had a large volume of sexual health needs but rarely received PrEP when indicated. To end the HIV epidemic in the United States, prevention efforts must include people who fall outside traditional risk categories.
A Systematic Review of New Approaches to Sexually Transmitted Infection Screening Framed in the Capability, Opportunity, Motivation, and Behavior Model of Implementation Science
Authors: Footman Alison , Dagama Dorris , Smith Catherine Hogan , Van Der Pol Barbara 
Published: May 2021

Abstract
Chlamydia and gonorrhea are 2 of the most common bacterial sexually transmitted infections (STIs) worldwide. Rising chlamydia and gonorrhea rates along with increased closing of STI clinics has led many to seek STI testing in clinical settings such as urgent cares and walk-in clinics. However, with competing priorities, providing effective and efficient STI care can be difficult in these settings. This has left a growing need for the implementation of novel STI screening programs in other clinical settings. This review summarizes previous studies that have evaluated the clinical implementation of chlamydia and gonorrhea screening programs in these settings. Literature from January 2015 to February 2020 regarding the implementation or evaluation of STI screening programs in clinical settings was reviewed. Constructs from the Capability, Opportunity, Motivation, and Behavior model were used to organize results, as this model can aid in identifying specific strategies for behavior/process change interventions. We found that multiple STI screening programs have been implemented and evaluated in 5 different countries and multiple health care facilities including sexual health clinics, urgent cares, walk-in clinics, and university health clinics. When implementing new STI screening programs, sample-first, test-and-go services and molecular point-of-care (POC) testing approaches were found to be effective in increasing screening and reducing costs and time to treatment. At the health care systems level, these programs can help reduce STI screening costs and generate additional revenue for clinics. At the provider level, clear communication and guidance can help clinical and administrative staff in adopting new screening programs. Finally, at the patient level, new programs can reduce time to treatment and travel costs in visiting clinics multiple times for testing and treatment services.
Psychiatric Education for Pediatric Emergency Medicine Fellows
Authors: Rudloff James , Wurster Ovalle Victoria , Barzman Drew , Gonzalez-del-Rey Javier 
Published: May 2021

Objectives

The number of psychiatric encounters is steadily increasing across all pediatric emergency departments. Based on this growing national crisis, we hypothesized there is a lack of robust education in behavioral/mental health emergencies during pediatric emergency medicine (PEM) fellowship.

Methods
This was a cross-sectional survey of PEM fellowship directors. The survey was submitted to the Pediatric Emergency Medicine Program Director Survey Committee via REDCap to all 83 fellowship directors.

Results
Fifty-five (66%) PEM fellowship directors completed the survey from September 2019 to December 2019. Forty-three (78%) programs provide some type of didactic teaching, although only 7 (13%) programs offer more than 5 hours of didactics over 3 years of fellowship. Six (11%) programs offer electronic resources, 13 (24%) offer simulations in psychiatry, and only 4 (7%) programs require any type of psychiatry rotation. Forty-six (84%) programs do not currently use psychiatric emergencies as a competency for evaluating PEM fellows. Program directors felt significantly more confident in faculty than graduating fellows in the management of numerous diagnoses including agitation (P < 0.001), homicidal ideation (P = 0.044), neuroleptic malignant syndrome (P = 0.006), acute dystonia (P < 0.001), and heroin overdose (P = 0.022). Ninety-six percent felt online curricula would be helpful to address this knowledge gap.

Conclusions
Despite growing behavioral/mental health needs in the pediatric emergency department, there continues to be opportunity to improve psychiatric education during PEM fellowship. Program directors felt more confident in faculty than graduating fellows with several psychiatric diagnoses. Pediatric emergency medicine fellowship directors expressed a strong interest in online tools to assist in the education of PEM fellows.
Effect of Traditional Plus Virtual Reality Rehabilitation on Prognosis of Stroke Survivors
Authors: Fang Zongwei , Wu Tingting , Lv Meina , Chen Mingrong , Zeng Zhiwei , Qian Jiafen , Chen Wenjun , Jiang Shaojun , Zhang Jinhua 
Published: April 2021

Objective
Virtual reality technology has begun to be gradually applied to clinical stroke rehabilitation. The study aimed to evaluate the effect of traditional plus virtual reality rehabilitation on motor function recovery, balance, and activities of daily living in stroke patients.

Method
Studies published in English before October 2020 were retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. This study used RevMan 5.3 software for meta-analysis.

Result
A total of 21 randomized controlled trials were included, which enrolled 619 patients. Traditional plus virtual reality rehabilitation is better than traditional rehabilitation in upper limb motor function recovery measured by Fugl-Meyer Assessment–Upper Extremity (mean difference = 3.49, 95% confidence interval = 1.24 to 5.73, P = 0.002) and manual dexterity assessed by Box and Block Test (mean difference = 6.59, 95% confidence interval = 3.45 to 9.74, P < 0.0001). However, there is no significant difference from traditional rehabilitation in activities of daily living assessed by Functional Independence Measure (mean difference = 0.38, 95% confidence interval = −0.26 to 1.02, P = 0.25) and balance assessed by Berg Balance Scale (mean difference = 2.18, 95% confidence interval = −0.35 to 4.71, P = 0.09).

Conclusions
Traditional plus virtual reality rehabilitation therapy is an effective method to improve the upper limb motor function and manual dexterity of patients with limb disorders after stroke, and immersive virtual reality rehabilitation treatment may become a new option for rehabilitation after stroke.