bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining Key Elements for Effective Physical Therapist–Physical Therapist Assistant Working Relationships: A Qualitative Study
Authors: Hayward Lorna , Sellheim Debra O. , Scholl Jessica , Joyce Christopher 
Published: February 2021

Introduction.
Education of doctor of physical therapist (DPT) and physical therapist assistant (PTA) students about their roles and responsibilities for working collaboratively is required for entry-level clinical practice. Research maintains that DPTs graduate with inadequate knowledge regarding the roles, scope of work, utilization and supervision of PTAs. Study objectives were to uncover the characteristics that comprise an effective physical therapist (PT) - PTA working relationship from 3 perspectives; and identify pedagogy that might inform the relationship development.

Methods.
Using purposive sampling, we recruited PT and PTA clinician recipients of the APTA Outstanding PT-PTA team award; and DPT students and PTA students from 3 academic institutions. Qualitative case study with a phenomenological approach. Interview questions explored participant perceptions and experiences regarding: effective PT-PTA relationships; barriers and gaps in DPT and PTA educational preparation for intra-professional teaming; and educational strategies for addressing deficiencies in students' knowledge and skills.

Results.
Thirty-two semi-structured interviews were conducted. Four with PT and 5 with PTA Outstanding PT-PTA award recipients. Fifteen interviews were conducted with DPT students, eight were conducted with PTA students. Data resulted in 4 themes; communication, trust and respect, environment, and bonding. The themes described the PT-PTA relationship and included a triad (PT-PTA-patient) with the patient centrally located.

Discussion and Conclusion.
Respondents indicated that DPT and PTA programs should create curriculum that develops both cognitive and affective clinical skills pertaining to the PT-PTA relationship. Academic and clinical practice settings play an integral role in creating pedagogy and environments conducive to effective PT-PTA teaming. Role clarification may optimize health care performance, patient satisfaction, cost of care and reduce problems related to miscommunication.
Use of multifunctional electronic health records and burnout among primary care nurse practitioners
Authors: Abraham Cilgy M. , Zheng Katherine , Norful Allison A. , Ghaffari Affan , Liu Jianfang , Topaz Maxim , Poghosyan Lusine 
Published: February 2021

ABSTRACT

Background:
Prevalence of electronic health records (EHRs) has significantly increased, and EHRs are a known contributor to clinician burnout. However, it is unknown whether the use of multifunctional EHRs is associated with nurse practitioner (NP) burnout in primary care practices. This is a major gap in the literature because 69% of practicing NPs deliver primary care services to patients.

Purpose:
This study aimed to investigate whether the use of multifunctional EHRs is associated with primary care NP burnout.

Method:
This study is a secondary analysis of cross-sectional survey data collected from NPs in two states (Pennsylvania and New Jersey). Nurse practitioners completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Use of multifunctional EHRs was operationalized using two items—computerized capabilities and electronic reminder systems. Burnout was measured using a validated, single item asking NPs to self-report their feelings of burnout. A multilevel cox regression model was built to test for associations between the use of multifunctional EHRs and NP burnout.

Results:
Of 396 NPs included, 25.3% reported burnout. The use of multifunctional EHRs did not increase primary care NP burnout (risk ratio = 0.30, 95% confidence interval = 0.13–0.71, p = .01).

Implications for practice:
With 25.3% of NPs burned out, it is imperative to reduce NP burnout. However, computerized capabilities and electronic reminder systems did not contribute to feelings of NP burnout. Future research examining other EHR components is needed to understand which features of the EHR contribute to NP burnout.
Tubomanometry Measurement Success Rate in Clinical Practice
Authors: Lindfors Oskari H. , Oehlandt Heidi , Sinkkonen Saku T. 
Published: February 2021

Objectives:
Tubomanometry (TMM) is an objective method for investigating Eustachian tube (ET) function, but difficulties in technique and interpretation may reduce its usability. The objective of our study was to investigate common difficulties with TMM in different ET dysfunction (ETD) patient groups and at different pressures (30, 40, and 50 mbars) when first introducing TMM to otologic practice. Furthermore, we wanted to investigate whether it would be possible to perform TMM at only one pressure and obtain a representative result.

Methods:
A retrospective chart review of a 2-year cohort of 114 patients with a history of ETD treated at a tertiary referral center. Primary outcome was the success rate of TMM, secondary the reasons for unsuccessful measurements. Tertiary outcome was the correlation of TMM results at adjacent pressures.

Results:
TMM success rate was 91%, varying 81 to 94% in different ETD patient groups and 87 to 94% at different pressures. Unsuccessful measurements resulted from air-leaks from the external ear canal, abnormal ear canal pressure curves (R < 0) and at 50 mbar, difficulties in reaching sufficient nasopharyngeal pressure. TMM results were similar in 88% of cases at 30 and 40 mbars and in 86% of cases at 40 and 50 mbars.

Conclusions:
TMM success rate seems sufficiently high for clinical diagnostics, and most difficulties may be overcome with proper interpretation during the TMM measurement session, and thus repeating the measurements when necessary. Considering the diagnostic information that would be lost if using only a single, predefined pressure, we suggest using all three pressures.
Endoscopic Transcanal Push-Trough Myringoplasty for Different Types of Tympanic Membrane Perforations
Authors: Chen Yubin , Jiang Xiaoyu , Yang Luoying , Wang Jianyan , Li Peng 
Published: February 2021

Objective:
This study aims to explore the feasibility of endoscopic transcanal push-trough myringoplasty (ETPM) for all types of tympanic membrane perforations (TMPs), and compare the outcomes with those of endoscopic type 1 tympanoplasty (ETT) with meatal flap elevation.

Study Design:
A prospective, controlled study.

Methods:
In the present study, inpatients with TMPs were divided into two groups according to the manner of tympanic membrane repair: one group received ETPM without raising the meatal flap, and the other received ETT. The operation duration, postoperative healing rate, visual analogue scale (VAS) of pain, and complication rates were compared between these two groups.

Results:
Regardless of the size and location of the perforation, and its relationship with the malleus manubrium, myringoplasty can be completed using the ETPM method. The operation duration for different types of TMPs was shorter in the ETPM group than in the ETT group, and the difference was statistically significant (p<0.05). However, there was no statistical difference in the short-term healing rate (p>0.05) and pain VAS score (p>0.05) between these two groups. Furthermore, no intraoperative or postoperative complications occurred in both groups.

Conclusion:
ETPM without raising the meatal flap can be applied for all types of TMPs, regardless of how large the perforation is, or where it is located. This can shorten the operation duration, and has a high healing rate comparable to ETT and mild postoperative pain. Mastering some essential surgical skills under the endoscope would be helpful to ensure the success of the surgery.
Expert position statements: comparison of recommendations for the care of adults and youth with elevated lipoprotein(a)
Authors: Wilson Don P. , Koschinsky Marlys L. , Moriarty Patrick M. 
Published: February 2021

Purpose of review
Summarize recent recommendations on clinical management of adults and youth with elevated lipoprotein(a) [Lp(a)] who are at-risk of or affected by cardiovascular disease (CVD).

Recent findings
There is ample evidence to support elevated Lp(a) levels, present in approximately 20% of the general population, as a causal, independent risk factor for CVD and its role as a significant risk enhancer. Several guidelines and position statements have been published to assist in the identification, treatment and follow-up of adults with elevated levels of Lp(a). There is growing interest in Lp(a) screening and strategies to improve health behaviors starting in youth, although published recommendations for this population are limited. In addition to the well established increased risk of myocardial infarction, stroke and valvular aortic stenosis, data from the coronavirus pandemic suggest adults with elevated Lp(a) may have a particularly high-risk of cardiovascular complications. Lp(a)-specific-lowering therapies are currently in development. Despite their inability to lower Lp(a), use of statins have been shown to improve outcomes in primary and secondary prevention.

Summary
Considerable differences exist amongst published guidelines for adults on the use of Lp(a) in clinical practice, and recommendations for youth are limited. With increasing knowledge of Lp(a)'s role in CVD, including recent observations of COVID-19-related risk of cardiovascular complications, more harmonized and comprehensive guidelines for Lp(a) in clinical practice are required. This will facilitate clinical decision-making and help define best practices for identification and management of elevated Lp(a) in adults and youth.
Artificial Intelligence‐based Analytics for Diagnosis of Small Bowel Enteropathies and Black Box Feature Detection
Authors: Syed Sana , Ehsan Lubaina , Shrivastava Aman , Sengupta Saurav , Khan Marium , Kowsari Kamran , Guleria Shan , Sali Rasoul , Kant Karan , Kang Sung‐Jun , Sadiq Kamran , Iqbal Najeeha T. , Cheng Lin , Moskaluk Christopher A. , Kelly Paul , Amadi Beatrice C. , Asad Ali Syed , Moore Sean R. , Brown Donald E. 
Published: February 2021

ABSTRACTObjectives:Striking histopathological overlap between distinct but related conditions poses a disease diagnostic challenge. There is a major clinical need to develop computational methods enabling clinicians to translate heterogeneous biomedical images into accurate and quantitative diagnostics. This need is particularly salient with small bowel enteropathies; environmental enteropathy (EE) and celiac disease (CD). We built upon our preliminary analysis by developing an artificial intelligence (AI)‐based image analysis platform utilizing deep learning convolutional neural networks (CNNs) for these enteropathies.Methods:Data for the secondary analysis was obtained from three primary studies at different sites. The image analysis platform for EE and CD was developed using CNNs including one with multizoom architecture. Gradient‐weighted class activation mappings (Grad‐CAMs) were used to visualize the models’ decision‐making process for classifying each disease. A team of medical experts simultaneously reviewed the stain color normalized images done for bias reduction and Grad‐CAMs to confirm structural preservation and biomedical relevance, respectively.Results:Four hundred and sixty‐one high‐resolution biopsy images from 150 children were acquired. Median age (interquartile range) was 37.5 (19.0–121.5) months with a roughly equal sex distribution; 77 males (51.3%). ResNet50 and shallow CNN demonstrated 98% and 96% case‐detection accuracy, respectively, which increased to 98.3% with an ensemble. Grad‐CAMs demonstrated models’ ability to learn different microscopic morphological features for EE, CD, and controls.Conclusions:Our AI‐based image analysis platform demonstrated high classification accuracy for small bowel enteropathies which was capable of identifying biologically relevant microscopic features and emulating human pathologist decision‐making process. Grad‐CAMs illuminated the otherwise “black box” of deep learning in medicine, allowing for increased physician confidence in adopting these new technologies in clinical practice.
Evidence-Based Virtual Learning Experiences for the Clinical Nurse Leader Capstone
Authors: Hinic Katherine 
Published: February 2021

Background:
The global COVID-19 pandemic resulted in abrupt changes in the delivery of health care and nursing education, particularly in highly affected areas of the country.

Problem:
Many hospitals suspended nursing students' learning on-site due to concerns related to virus transmission and lack of clear guidance on safe and effective learning. This Model C Clinical Nurse Leader (CNL) direct entry MSN program needed to meet graduating students' capstone learning needs in a virtual format.

Approach:
A review of the literature along with CNL competencies and other American Association of Colleges of Nursing resources informed this evidence-based virtual capstone experience.

Outcomes:
Students achieved learning outcomes in a virtual format and reported high levels of satisfaction with learning activities.

Conclusions:
Virtual learning activities were essential at the height of the pandemic and may prove useful in other circumstances that limit clinical site availability. These activities can also complement in-person learning experiences.
Using Photo-Elicitation Interviews With Families of Children and Adolescents With Chronic Illness
Authors: Leite Ana Carolina A. B. , García-Vivar Cristina , Nascimento Lucila C. 
Published: February 2021

Background
Despite the increasing number of studies using photo-elicitation for data collection in qualitative research, there is a need to further explore its use among families of children and adolescents living with chronic illness.

Objective
The aim of this study was to discuss methodological and pragmatic considerations about the use of photo-elicitation interviews (PEIs) for data collection with families of children and adolescents living with chronic illness.

Methods
We discussed methodological aspects of using PEIs as reported in publications. A search of the literature was carried out to identify articles presenting information on methodological aspects of the use of PEIs in qualitative data collection, regardless of age group. In pursuit of complementing the evidence with pragmatic considerations of using PEIs, we illustrate with an example of a recent qualitative study of our own that aimed to understand the narratives about hope of families of children and adolescents living with chronic illness.

Results
We synthesized common aspects that need to be considered when using PEIs with different populations: ethical issues, cameras, guidance, and interviews. We also presented our experience of using the PEI technique to collect data from families. Because of our experience, we denominate our method as the “family photo-elicitation interview” (FPEI). Our method goes beyond the PEI technique because it integrates aspects of family nursing theories when conducting interviews with families. FPEIs strengthen family interaction and allow family members to share their perspectives.

Discussion
We present a new perspective of PEIs—the FPEI—in the pediatric context. Previous studies have not addressed considerations about using PEIs for families. We hope our results assist novice researchers in planning and implementing FPEIs in qualitative research. We recommend that researchers explore the use of FPEIs in other contexts, such as geriatrics or palliative care.
Longitudinal Moderated Mediation Analysis in Parallel Process Latent Growth Curve Modeling in Intervention Studies
Authors: Zhu Shijun , Sagherian Knar , Wang Yan , Nahm Eun-Shim , Friedmann Erika 
Published: February 2021

Background
Intervention studies are used widely in nursing research to explore the efficacy of intervention programs for changing targeted health outcomes. However, the analyses of such studies have focused predominantly on their main intervention effects; most studies ignore the mechanisms underlying how the intervention programs work partly because of lack of application details of the longitudinal mediation analysis techniques.

Objectives
The aim of this study was to illustrate an application of parallel process latent growth curve modeling (PP-LGCM) to examine longitudinal moderated mediation effects.

Methods
Longitudinal data from an online bone health intervention study were used to demonstrate the step-by-step application of PP-LGCM with Mplus statistical software.

Results
With modification indices, we were able to achieve adequate model fit for PP-LGCM in our data. The mediation effects of self-efficacy on the intervention effects on exercise were nonsignificant for the entire sample. However, the conditional indirect effect showed the mediation effects were moderated by age group.

Discussion
PP-LGCM provides an efficient way to analyze and explain the underlying mechanisms for the intervention effects in a trial, especially when the intervention program is guided by a theory.
A Peek Into the Future: How a Pandemic Resulted in the Creation of Models to Predict the Impact on Sexually Transmitted Infection(s) in New York State (Excluding New York City)
Authors: Joshi Manjiri , Yuan Yingchao , Miranda Wilson , Chung Rakkoo , Rajulu Deepa T. , Hart-Malloy Rachel 
Published: February 2021

Abstract
During the initial height of COVID-19 in New York State excluding New York City in March 2020, reports of sexually transmitted infections declined. Prediction models developed to estimate the incidence of early syphilis and gonorrhea during the COVID-19 pandemic were used to study impact on STI diagnoses/reporting and inform sexual health program planning.
Prevalence and Epidemiology of Mycoplasma genitalium in a Pacific-Region Military Population
Authors: Horseman Timothy S. , Crecelius Elena M. , Miller Mechelle A. , Lustik Michael B. , Lee Benjamin C. , Brazer Miriam L. , O'Neal Lindsey L. , Kim Dong M. , Fong Keith S.K. , Chang Tom W. 
Published: February 2021

Background

Mycoplasma genitalium is an important emerging sexually transmitted pathogen commonly causing urethritis in men, cervicitis, and pelvic inflammatory disease in women with potential of infertility. Accumulating evidence identifies the prevalence of M. genitalium similar to long recognized pathogens, Chlamydia trachomatis and Neisseria gonorrhoeae. The purpose of this study was to establish the prevalence and epidemiology of M. genitalium in a mid-Pacific military population.

Methods
A prospective analysis was conducted from routine specimens collected as standard of care for sexually transmitted infection (STI) testing at Tripler Army Medical Center on Oahu, HI. The prevalence of M. genitalium was determined using the Aptima M. genitalium assay, a transcription-mediated amplification test. A multivariate analysis was performed to assess the associations for this infection with other STIs and demographic factors.

Results
A total of 1876 specimens were tested in a 6-month period including 6 sample types from 1158 females and 718 males. Subject ages ranged from 18 to 76 years, with a median of 24 years (interquartile range, 21–29 years). The prevalence of M. genitalium was 8.8% overall (n = 165), 7.1% in females and 11.6% in males. Coinfection with M. genitalium occurred with another sexually-transmitted pathogen in 43 patients (18.3%), with C. trachomatis as the most common organism (n = 38).

Conclusions
These data contribute to the evidence base for M. genitalium and STI screening in an active-duty military.
Case Report: Alagille Syndrome Presenting with Angioid Streaks
Authors: Katsoulos Konstantinos F. , Kapsala Zoi , Livir-Rallatos Gerasimos 
Published: February 2021

SIGNIFICANCE
Alagille syndrome is rare genetic disease, which affects liver and heart function. Cases are frequently diagnosed late, and a complete ocular examination aids in the diagnosis. Although ophthalmic manifestations are usually benign, occasionally, sight-threatening complications occur.

PURPOSE
The case presented herein highlights a rare condition, which usually can be diagnosed by the ophthalmological findings. However, in this particular case report, the complication of angioid streaks and choroidal neovascularization is reported for the first time in Alagille syndrome.

CASE REPORT
Α 32-year-old woman diagnosed with Alagille syndrome presented with diminution of vision in the left eye. The cause was choroidal neovascularization related to angioid streaks. She was treated with intravitreal injections of ranibizumab but developed an extensive macular scar. A few years later, she developed the same complication in the right eye and was treated similarly.

CONCLUSIONS
Alagille syndrome has many ophthalmic manifestations, most of them benign with minimal threat to vision. Herein for the first time, we present a case of Alagille syndrome with angioid streak–related choroidal neovascularization, which resulted in severe vision loss.
Factors for Maintaining Abstinence at 2 and 6 Months After Alcohol Withdrawal
Authors: PAREAUD MARINE , GIRARD MURIELLE , NUBUKPO PHILIPPE 
Published: February 2021

Objectives:
Relapse rates in subjects with an alcohol use disorder who have undergone alcohol detoxification are high, and risk factors vary according to the studied population and the context in which withdrawal occurred. Subjects being treated in psychiatric settings require increased monitoring at the moment of detoxification and during follow-up. It is thus important to identify specific risk factors for relapse in such patients. The objective of this study was to determine factors associated with maintenance of abstinence 2 months after alcohol withdrawal (M2) and to characterize factors associated with later relapses 6 months after withdrawal (M6) among those who were abstainers at M2.

Methods:
We conducted an ancillary study of a specific psychiatric cohort of subjects with an alcohol use disorder who were followed after withdrawal, by analyzing clinical and biological data collected at M2 and M6.

Results:
The specific factors predictive of future relapse were age, intensity of craving, number of standard glasses consumed, psychiatric comorbidity (depression), and employment and family/marital status. Substance use (other than the use of tobacco) decreased the likelihood of abstinence at M2, whereas a depressive state at the time of alcohol withdrawal increased the likelihood of abstinence at M2. Consumption of other substances and a greater intensity of craving at the time of alcohol withdrawal decreased the likelihood of abstinence at M6.

Conclusions:
The results of this study highlight the importance of identifying craving, multiple substance use, and psychiatric comorbidities (depression) during comprehensive interviews in follow-up after alcohol withdrawal. In caring for patients after alcohol detoxification, priority should be given to factors that have been shown to enhance the beneficial effects of abstinence, such as mood enhancement.
Medical and Endoscopic Management of Crohn Disease
Authors: Deepak Parakkal , Ludwig Daniel R. , Fidler Jeff L. , Guglielmo Flavius F. , Bruining David H. 
Published: February 2021

Abstract
In this review, through a series of questions and answers, we explore the current approach to classifying patients with Crohn disease into low-risk (mild-moderate) and high-risk (moderate-severe) categories with the recommended treatment approaches per guidelines from the International Organization for the Study of Inflammatory Bowel Diseases, American Gastroenterological Association, the American College of Gastroenterology, and the European Crohn's and Colitis Organization detailed here. The development pipeline of potential therapies is also summarized. We also review key information from magnetic resonance enterography and pelvis imaging studies that the abdominal radiologist can communicate to a multidisciplinary treatment team that includes gastroenterologists and colorectal surgeons, with a goal of achieving optimal patient outcomes. Lastly, endoscopic and radiological treatment targets in a treat-to-target approach in Crohn disease are explored.