bluuebunny/crossref_metadata_2025_split huggingface dataset:
Convergent Validity of In-Person Assessment of Inpatients With Traumatic Brain Injury Using the Brief Test of Adult Cognition by Telephone (BTACT)
Authors: DiBlasio Christina A. , Novack Thomas A. , Cook Edwin W. , Dams-O'Connor Kristen , Kennedy Richard E. 
Published: March 2021

Objective:
To examine convergent validity of the Brief Test of Adult Cognition by Telephone (BTACT) by determining correlation with established neuropsychological tests, administered an average of 4.4 days apart, in an inpatient traumatic brain injury (TBI) population.

Setting:
Acute inpatient rehabilitation hospital.

Participants:
Fifty-five patients receiving inpatient rehabilitation for new-onset TBI (69.1% male; mean age = 37 years, SD = 14 years).

Design:
Cross-sectional, secondary data analysis.

Main Measures:
BTACT; California Verbal Learning Test—second edition (CVLT-2); Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span; Trail Making Test; semantic fluency; phonemic fluency; Symbol Digit Modalities Test; Wisconsin Card Sorting Test.

Results:
The BTACT was significantly associated with established neuropsychological tests across composite scores of overall cognition (r = 0.64, P < .001), episodic verbal memory (r = 0.66, P < .001), and executive function (r = 0.56, P < .001). For BTACT subtests, Word List Immediate Recall and Word List Delayed Recall were correlated with CVLT-2 learning trials total score (r = 0.57, P < .01) and long delay free recall (r = 0.60, P < .001), respectively. BTACT Digits Backward correlated with WAIS-IV Digit Span (r = 0.51, P < .01). BTACT Animal Fluency was associated with semantic fluency (r = 0.65, P < .01), phonemic fluency (r = 0.60, P < .01), and Trail Making Test Part B (r = 0.39, P < .01).

Conclusion:
BTACT composite scores of overall cognition, verbal memory, and executive function demonstrate initial convergent validity in a TBI inpatient population. Future research should examine validity in a larger sample of individuals with TBI.
Stargardt disease masquerades
Authors: Ricca Aaron M. , Han Ian C. , Sohn Elliott H. 
Published: March 2021

Purpose of review
Stargardt disease is the most common inherited macular dystrophy but has a wide clinical spectrum, and several inherited macular dystrophies have phenotypic similarities that can make clinical diagnosis challenging. This review seeks to highlight key clinical and multimodal imaging features to aid clinicians in accurate diagnosis.

Recent findings
Multimodal imaging has provided additional information to aid in the diagnosis of Stargardt disease and its masquerades. These data from multimodal imaging are important to correlate with findings from clinical examination to help support the clinical diagnosis or guide molecular investigations.

Summary
This review highlights the key similarities and differences, in history, clinical examination and multimodal imaging, to help distinguish between Stargardt disease and other macular dystrophies. These findings can help direct a focused molecular analysis for accurate diagnosis, which is critical in the era of gene and stem cell therapies.
Device Adjustment and Recovery in Patients With Heart Failure Undergoing a Cardiac Resynchronization Therapy Implantation
Authors: Thylén Ingela , Jaarsma Tiny , Ingadottir Brynja 
Published: March 2021

Background
Little is known about risk factors for poor adjustment to the device after cardiac resynchronization therapy (CRT) implantation in patients with heart failure.

Purpose
The aim of this study was to explore device adjustment and the postoperative recovery of patients with heart failure undergoing elective CRT device implantation.

Methods
In this prospective multicenter longitudinal study, data were collected before implantation and after 2 weeks, 6 months, and 1 year, using validated self-reported instruments and investigator-designed, CRT-specific questions.

Results
A total of 133 patients, 79% male, with a mean age of 70 ± 10 years, were included. Patients adjusted to the device over time (P < .001), but 20% of patients had difficulties after 2 weeks, and 11% had difficulties at the 1-year follow-up. Fatigue was the most common health problem before surgery (87%), which was reduced to 65% after 1 year, P < .001. Patients' recovery improved over time (P < .001). Device-specific problems with hiccups (7% vs 14%), pulsation around the device (29% vs 24%), tachycardia (28% vs 29%), appearance of the scar (21% vs 17%), and the device bulging out (65% vs 61%) remained unchanged over time, whereas stiffness in the shoulder (64% vs 28%, P < .001) and wound healing (9% vs 2%, P < .05) improved.

Conclusions
Most patients with heart failure recover and adjust early after their CRT implantation and improve even more during follow-up. However, recovery and adjustment are problematic for some patients, and many experience bodily discomforts because of the device. Early screening for poor adjustment and psychological distress can lead to appropriate interventions and timely referrals. This is important in the era of remote monitoring with less face-to-face contact.
The Association of Spirituality with Anxiety and Depression in Stroke Survivor–Caregiver Dyads
Authors: Bolgeo Tatiana , De Maria Maddalena , Vellone Ercole , Ambrosca Rossella , Simeone Silvio , Alvaro Rosaria , Pucciarelli Gianluca 
Published: March 2021

Background
Although several authors have analyzed the effects of spirituality on stroke survivors' physical functioning and on their own caregiver's outcomes, such as quality of life, only few authors have explored the interaction between spirituality and anxiety and depression using a dyadic approach.

Objectives
The aim of this study was to analyze the influence of spirituality in the stroke survivor–caregiver dyad and specifically on anxiety and depression in both parties.

Methods
A total of 217 stroke survivor–caregiver dyads were enrolled at discharge from several rehabilitation hospitals in central and southern Italy. The actor-partner interdependence model was used to analyze the dyadic data. To verify the differences in the effects between survivors and caregivers, comparisons were made between the χ2 values of the model in which actor and partner effects were constrained to be equal.

Results
The average age of stroke survivors and their caregivers at baseline was 71.2 and 52.7 years, respectively. Among the stroke survivors, there were slightly more men than women, whereas 65% of the caregivers were women. Most stroke survivors had had an ischemic stroke. Four statistically significant actor effects were identified. Higher survivors' and caregivers' spirituality was associated with higher survivor and caregiver anxiety. The only significant partner effect that was identified was the association between stroke survivor spirituality and caregiver depression.

Conclusions
This study highlights the importance of studying spirituality in the population with stroke. Spirituality seems to play an important protective role in both stroke survivors' and caregivers' depression but not in anxiety.
Continuation of Treatment With Clozapine After an Episode of Neutropenia
Authors: Tirupati Srinivasan , Gordon Tracy 
Published: March 2021

Abstract

Background
Clozapine is the most effective in treatment-resistant schizophrenia. Neutropenia is an adverse effect of the drug requiring treatment discontinuation. This study related treatment continuation with little or no interruption after a neutropenia episode. The study contrasted from rechallenge studies after an extended treatment interruption.

Methods
This retrospective chart audit examined 37 patients with an episode of neutropenia. It described characteristics of patients continuing treatment with minimal interruption.

Findings
Thirty-one patients continued treatment after an initial treatment interruption for less than 3 days. A probable cause for neutropenia other than clozapine was identified in 14 patients. Twelve patients continued treatment with a change in the absolute neutrophil counts threshold to 1000/μL to determine treatment cessation. Most patients recovered from the index episode of neutropenia within 2 days. They also frequently presented with recurring benign episodes of low neutrophil cell counts during treatment than a comparative group.

Implications
The study recommends modifying clozapine treatment protocol absolute neutrophil count thresholds to less than 1000/μL to determine treatment cessation. Consideration of other probable causes for neutropenia, diurnal variations in cell counts, and laboratory errors reduced preemptive discontinuation of treatment. A risk-benefit approach supports continuing clozapine treatment after an episode of neutropenia.
Shades of Frustration
Authors: Hoff Mary 
Published: March 2021

ABSTRACT
Postinflammatory hyperpigmentation (PIH) is a distressing condition associated with a number of inflammatory etiologies, with acne vulgaris being one of the most common. Even when resolution of inflammatory papules is achieved through treatment, patients are often dissatisfied with their overall appearance if their PIH is not addressed and treated appropriately. Because PIH can be associated with pigment deposition that extends beyond the epidermis, a number of topical therapies available to treat epidermal PIH often fail to provide meaningful improvement when deeper tissue is involved. A review of PIH as a disease process will be explored, and the mechanisms and limitations of first-line topical therapies will be discussed.
Evaluation and Modification of the Physical Therapist Clinical Performance Instrument
Authors: Wolden Mitch , Drevyn Elsa , Flom-Meland Cindy , Gusman Lori N. 
Published: March 2021

Introduction.
Doctor of Physical Therapy (DPT) programs and clinical instructors (CIs) must have a reliable and valid instrument to assess the clinical competence of each DPT student. The Physical Therapist Clinical Performance Instrument (PT CPI) is the most commonly used instrument to assess DPT students' clinical competence. Validation studies of the PT CPI: Version 1997 and Version 2006 have identified 3 factors that account for students' clinical performance. Given the widespread use of the PT CPI and CIs and DPT programs concerns, evaluation of the current PT CPI (PT CPI: Web) as a three-factor model is warranted. The purpose of our investigation was to evaluate the three-factor model, suggest model modifications, and then analyze the modified PT CPI model.

Methods.
PT CPI data were analyzed from 703 DPT students' clinical experiences from 3 institutions. Data analyses were conducted in 2 phases. Phase 1: Confirmatory factor analysis (CFA) was conducted for the three-factor PT CPI (model I). Phase 2: CFA was performed on the modified PT CPI (model II). The 2 models were then compared to determine the preferred model.

Results.
The proposed 2-factor PT CPI (model II) with 15 performance criteria was found to be the preferred model over the current three-factor PT CPI (model I) for measuring DPT students learning and performance during clinical experiences.

Discussion and Conclusion.
Modifying the current three-factor PT CPI (model I) to the proposed 2-factor model (model II) may better support DPT students, CIs, and DPT programs in the assessment of DPT students' clinical learning and performance. Our findings also provide preliminary evidence to decrease the length of the PT CPI while maintaining instrument integrity.
Professionalism development of undergraduate medical students
Authors: Sattar Kamran , Akram Ashfaq , Ahmad Tauseef , Bashir Ulfat 
Published: March 2021

Abstract
Changeover phases are essential and inevitable times in professional life, which let the learners adapt and grasp emerging opportunities for learning based on the past experiences with the catering of novel creativity as required in the present as well as emerging time. This study was carried out to examine the effectiveness of a professionalism course, during the transition from a non-clinical to clinical setting, within the context of undergraduate medical education.
This observational study was conducted during 2019 to 2020, with pre- and post-professionalism course evaluation. We used the Dundee Poly-professionalism inventory-1: Academic Integrity, among the undergraduate medical students.
Our results are based on the medical student's professional progress with the transition from 2nd year to 3rd year. During the 1st phase of the study, the participants at their Pre-Professionalism Course (PrPC) level in their 2nd medical year (only attended the introductory lectures for professionalism), showed a good understanding of professionalism. For the 2nd phase, when the same students, at their Post-Professionalism Course (PoPC) level, in their 3rd year (completed professionalism course) filled the same survey and it was found that there was no decline in their understanding of the topic, even after more than a year. They were even more aware of the significance of professionalism in their clinical settings.
Despite a year gap, the understanding of professionalism among students was stable. Results helped us infer that time laps did not affect the professionalism concept learned earlier; rather during clinical settings, students become more aware of professionalism.
Improving the discomfort and satisfaction of colonoscopy by distraction with smartphones
Authors: Han Chaoqun , Xu Tao , Sheng Liping , Nie Chi , Liu Jun , Ding Zhen , Hou Xiaohua 
Published: March 2021

Abstract

Background:
Colonoscopy is an uncomfortable procedure. Distraction is thought to reduce pain by decreasing the amount of attention a person spends on a painful stimulus. We aimed to assess the usefulness of smartphones on discomfort associated with the colonoscopy.

Methods:
We designated 360 enrolled patients according to prospective randomized controlled study into two groups, including smartphone (SP) group (Relaxation by smartphones) and Control group (No relaxation). Measured outcomes included the discomfort, satisfaction, polyp detection rate and the willingness to repeat colonoscopy were analyzed between groups.

Results:
The pain and distension scores of SP group patients were significantly lower than those of the Control group (2.18 ± 2.80 vs 3.55 ± 3.07, P < .001; 4.15 ± 2.35 vs 4.79 ± 2.36, P = .011, respectively). Importantly, patient-reported satisfaction scores of the SP group were significantly higher than those of the Control group (96.45 ± 7.17 vs 91.12 ± 10.49, respectively; P < .001). Moreover, although there were no statistical differences, patients using smartphones were more likely to have shorter reach cecum times (09m:11 s vs 07m:37 s, P = .116) and more polyp detection rate (13.3% vs 9.4%, P = .246). In addition, more patients using smartphones were willing to repeat colonoscopy but no statistical difference (85.0% vs 81.7%, P = .396).

Conclusion:
Patient using smartphone is a special manner to increase satisfaction during colonoscopy with a less discomfort and is more likely to be polyp detection rate.
National level data analysis of facial lacerations in Korea using the National Health Insurance Service (NHIS) database
Authors: Mo Young Woong , Cho Gyo-Young , Mo Young Taek , Lee Dong Lark 
Published: March 2021

Abstract
No national epidemiological investigations have been conducted recently regarding facial lacerations. The study was performed using the data of 3,634,229 people during the 5-year period from 2014 to 2018 archived by the National Health Information Database (NHID) of the Health Insurance Review and Assessment Service. Preschool and children under 10 years old accounted for about one-third of patients. Facial lacerations were concentrated in the “T-shaped” area, which comprised forehead, nose, lips, and the perioral area. The male to female ratio for all study subjects was 2.16:1. Age and gender are significantly related with each other (P < .001). Mean hospital stays decreased, and numbers of outpatient department visits per patient were highest for hospitals and lowest for health agencies. Over the study period, hospital costs per patient in tertiary and general hospitals increased gradually. Preschool and school-aged children are vulnerable to trauma. Male patients outnumbered female patients by a factor of more than 2. The “T-shaped’” area around forehead is vulnerable to injury. Total cost of medical care benefits per patient in tertiary hospitals was about 7 times on average than in health agencies. Regarding functional, behavioral, and aesthetic outcomes, more attention should be paid to epidemiologic data and hospital costs for facial lacerations.
Genetic analysis of rapidly progressing esophageal squamous cell carcinoma
Authors: Zhao Shuang , Sun Ni , Yuan Xi , Shen Zetian , Zhu Xixu , Li Jing 
Published: March 2021

Abstract

Introduction:
Numerous investigations have been performed to explore candidate biomarker proteins in esophageal squamous cell carcinoma (ESCC) patients, which could predict the response to chemoradiotherapy (CRT). Here we report a patient with unresectable ESCC who had unsatisfactory effects with radiotherapy, chemotherapy and immunotherapy. We performed genetic analysis in this patient to gain insights about the cause of the rapid progression.

Patient concerns:
A 65-year-old man presented with food obstruction, hoarse voice and choking on drinking water for 2 months, and pain behind the breastbone for 1 month.

Diagnosis:
The patient was clinically diagnosed with ESCC and staged as T4N1M1 Stage IV

Interventions:
The patient was treated with CRT and immunotherapy. Mutational analyses through high throughput DNA sequencing methodology (next generation sequencing; NGS) was performed on the patient's blood sample.

Outcomes:
The tumor progressed rapidly during the treatment period, and the patient passed away only 3 months from the onset of symptoms.

Conclusion:
Although the role of TP53 gene and PIK3CA gene in the progression, treatment and sensitivity of esophageal cancer has been studied, the mechanism of their simultaneous appearance has not been demonstrated in relevant studies. We speculate that the reason for the rapid progression in this patient during active treatment might be related to this. Further studies are needed to validate our observations.
The effectiveness of problem-based learning in gynecology and obstetrics education in China
Authors: Bi Siwei , Liu Ruiqi , Li Jingyi , Gu Jun 
Published: March 2021

Abstract

Background:
A meta-analysis was conducted to assess the effectiveness of problem-based learning (PBL) in gynecology and obstetrics education in China.

Methods:
English and Chinese databases were systematically searched for eligible studies that compared the effects of PBL and traditional teaching methods measuring theoretical knowledge, student satisfaction, clinical operations, and clinical practice scores in gynecology and obstetrics education in China. The authors restricted included studies to randomized controlled trials and performed a meta-analysis. Standardized mean difference (SMD) and risk ratio with 95% confidence interval (CI) were estimated

Results:
A total of 38 randomized controlled trials with 3005 participants were included. Compared with traditional teaching group, the PBL group significantly increased theoretical knowledge scores (SMD: 3.17, 95% CI: 2.28, 4.07), student satisfaction (risk ratio: 1.29, 95% CI: 1.16, 1.43), clinical operations (SMD: 1.15, 95% CI: 0.93, 1.37) and clinical practice (SMD: 2.17, 95% CI: 3.63, 2.71).

Conclusion:
The current research shows that PBL in gynecology and obstetrics education in China is more effective than the traditional teaching in enhancing theoretical knowledge, student satisfaction, clinical operations, and clinical practice scores. However, more delicate-designed studies on this topic are needed in the future to validate these results.
Unintentional exposure and incidental findings during conventional chest radiography in the pediatric intensive care unit
Authors: Temsah Mohamad-Hani , Al-Eyadhy Ayman , Alsohime Fahad , Nassar Saeed Majed , AlHoshan Talal Nabil , Alebdi Hatim Abdullah , Almojel Faisal , AlBattah Muath Abdullah , Narayan Omendra , Alhaboob Ali , Hasan Gamal Mohamad , Abujamea Abdullah 
Published: March 2021

Abstract
Radiation overexposure is common in chest X-ray (CXRs) of pediatric patients. However, overexposure may reveal incidental findings that can help to guide patient management or warrant quality improvement.
To assess the prevalence of overexposure in CXRs in pediatric intensive care unit (PICU); and identify the incidental findings within overexposed areas, we conducted a retrospective cohort study of children who were admitted to PICU. Two independent evaluators reviewed patient's charts and digital CXRs according to the American College of Radiology standards; to evaluate overexposure of the anatomical parameters and incidental findings.
A total of 400 CXRs of 85 patients were reviewed. The mean number of CXRs per patient was 4.7. Almost all (99.75%) CXRs met the criteria for overexposure, with the most common being upper abdomen (99.2%), upper limbs (97%) and neck (95.7%). In addition, 43% of these X-rays were cropped by the radiology technician to appear within the requested perimeter. There was a significant association between field cropping and overexposure (t-test: t = 9.8, P < .001). Incidental findings were seen in 41.5% of the radiographs; with the most common being gaseous abdominal distension (73.1%), low-positioned nasogastric tube (24.6%), and constipation (10.3%).
Anatomical overexposure in routine CXRs remains high and raises a concern in PICU practice. Appropriate collimation of the X-ray beam, rather than electronically cropping the image, is highly recommended to minimize hiding incidental findings in the cropped-out areas. Redefining the anatomic boundaries of CXR in critically ill infants and children may need further studies and consideration. Quality improvement initiatives to minimize radiation overexposure in PICU are recommended, especially in younger children and those with more severe illness upon PICU admission.
The effects of robot-assisted left-hand training on hemispatial neglect in older patients with chronic stroke
Authors: Park Jin-Hyuck 
Published: March 2021

Abstract

Background:
Even though a variety of rehabilitative technique have been implemented to ameliorate neglect symptoms of patients with stoke, the effects of limb activation using a robotic device are still unknown. The purpose of this study was to investigate the effects of the robot-assisted hand training on hemispatial neglect of older patients with chronic stroke.

Methods:
The participants were randomly allocated to the experimental group (EG) receiving robot-assisted left-hand training (n = 12) or the control group (CG) receiving conventional treatments for neglect symptoms (n = 12). All participants received 20 sessions for 4-week. To examine the effects on hemispatial neglect, the line bisection test (LBT), the Albert test, and the Catherine Bergego Scale (CBS) were utilized. The outcome measures were analyzed before and after the 20 training sessions.

Results:
After the intervention, improvements in the LBT, the Albert test, and the CBS were found in the EG whereas there were significant improvements in the LBT and the CBS but not the Albert test in the CG. In addition, the EG showed a significantly greater gain in all outcome measures compared to the CG (p < .05).

Conclusions:
These results indicate that robot-assisted hand training was beneficial to improving the hemispatial neglect of elderly person with chronic stroke compared to the conventional treatments. Robot-assisted limb activation might be useful to ameliorate hemispatial neglect of the elderly with chronic stroke.