bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Psychological Adverse Reactions in First-Time Ritual Ayahuasca Users
Authors: Gómez-Sousa María , Jiménez-Garrido Daniel F. , Ona Genís , dos Santos Rafael Guimaraes , Hallak Jaime E. C. , Alcázar-Córcoles Miguel Ángel , Bouso José Carlos 
Published: February 2021

Abstract

Background
In recent decades, ritualistic use of ayahuasca has spread throughout the world. Retrospective studies have suggested a good psychological safety profile, but prospective studies involving ceremony ayahuasca-naive participants are lacking.

Methods
We conducted the study using a subsample from a previous study, for which first-time ceremony ayahuasca participants were recruited. The subsample consisted of 7 subjects who experienced acute and challenging psychological reactions. The semistructured Mini-International Neuropsychiatric Interview and psychometric questionnaires were administered before participants attended the ayahuasca ceremony and at 1 and 6 months after exposure. Subjective experiences were also recorded.

Results
Seven subjects from a sample of 40 reported having experienced intense challenging psychological effects during the ayahuasca ceremony. Four of those 7 subjects met the diagnostic criteria for 1 or more psychiatric disorder before the ayahuasca ceremony. One month after the ceremony, 2 of those subjects no longer showed psychiatric symptoms, whereas the symptoms of the other 2 were reduced considerably. Those results persisted at the 6-month follow-up. Inappropriate setting/context (poor guiding skills and screening) contributed to some of the challenging reactions. Most of the participants (6 of 7) did not take ayahuasca again during the study period.

Conclusions
Based on the cases reported here, we suggest that although it is possible that participating in ayahuasca ceremonies may entail acute psychological negative reactions, those challenging experiences can also have positive long-term effects. Prospective research on the safety profile of ayahuasca and how it is affected by the context of different practices and safety strategies is therefore necessary.
Does the Starting of Clozapine Influence Coprescription of Other Medications?
Authors: Grover Sandeep , Naskar Chandrima , Chakrabarti Subho 
Published: February 2021

Abstract

Purpose/Background
Little is understood about the prescription load before and after the starting of clozapine. Accordingly, this study aimed to evaluate the medication load of patients receiving clozapine, just before starting clozapine and after being on clozapine for at least 1 year. Additionally, the impact of clozapine on severity of illness was evaluated.

Methods/Procedures
Two hundred seventy-seven outpatients receiving clozapine were prospectively evaluated for their prescription after at least 1 year of starting clozapine. Additionally, these patients were assessed on the Clinical Global Impression-Improvement scale to evaluate the overall clinical benefit with clozapine.

Findings/Results
They had been receiving clozapine for 6.55 (SD, 4.8; range, 1–24; median, 5) years at the time of assessment. At the start of clozapine, more than one third of the patients were receiving 2 antipsychotics. A small proportion was receiving other psychotropics, such as antidepressants, mood stabilizers, and benzodiazepines. After being on clozapine for 1 year, there was a significant reduction in the number of patients receiving two antipsychotic medications (P < 0.001), number of patients receiving antidepressants (if amitriptyline was left out), benzodiazepine (P < 0.001), and anticholinergic medications (P < 0.001). Further, there was a reduction in the mean chlorpromazine equivalent of antipsychotics (P < 0.001) and the total number of medications received by the patients (P < 0.001). However, there was an increase in the prescription rates of antihypertensive drugs (P = 0.03), anti-diabetic medications (P < 0.01), and anti-dyslipidemic medications. At follow-up, there was a significant improvement in symptoms as assessed by Clinical Global Impression-Improvement scale.

Implications/Conclusions
This study suggests that long-term use of clozapine is associated with substantial improvement in symptoms with a reduction in the medication load.
Reflections on a Physician Assistant Entrance Exam: Does the Profession Need One?
Authors: VanderMeulen Stephane , Hills Karen , Snyder Jennifer A. , Kohlhepp William , Alexander Lisa Mustone , Bowser Jonathan , Lane Steven 
Published: February 2021

Abstract
Standardized entrance exams are used in many health professions as one way to objectively measure knowledge and facilitate comparisons across student groups. The physician assistant (PA) profession has historically not employed a profession-specific entrance exam, and the idea was never seriously explored until the Physician Assistant College Admissions Test was developed recently by a commercial assessment publisher, with field testing in some volunteer programs in 2018 and the exam's first administration in May of 2020.
The 2020 Physician Assistant Education Association Presidents Commission chose to investigate the issues raised by a consensus-derived, PA-specific entrance exam to stimulate more informed discussion on the efficacy of such an exam. While it may have the potential to enhance efficiency in PA admissions and reduce variability in admissions requirements, a PA entrance exam would also likely introduce new challenges, including increased costs, impact on the diversity of the applicant pool, and incongruence with an increasingly holistic admissions process. The biggest barrier would likely be the lack of current consensus on the knowledge, skills, and attributes that matriculants need to be successful in the program and in clinical practice. Development of a consensus-derived PA entrance exam would be a complex, expensive, and time-consuming endeavor, requiring considerable attention to technical issues of psychometric quality, process transparency, and legal defensibility. Changes being made to health professions admissions practices due to the COVID-19 pandemic, including the dropping of test scores as a requirement by some institutions, may make some of the issues raised in this paper more timely than ever.
Physician Assistant Education in Bulgaria
Authors: Vracheva Penka , Hooker Roderick S. 
Published: February 2021

Abstract
The development of physician assistants (PAs) in the Republic of Bulgaria began in 2014 with the inauguration of the first class at Trakia University, Stara Zagora, and at Faculty of Public Health, Sofia. Modeled after North American and European education systems, the preparation of PAs complies with state requirements for higher medical education from the Bulgarian Ministry of Health. As of 2020, the PA training program is in the state's register of regulated professions. Three programs, in Ruse, Burgas, and Plovdiv, will start in the early 2020s, building on the success of the initial programs in Sofia and Stara Zagora. In the Bulgarian PA education system, a bachelor's degree includes 8 semesters and nearly 5000 combined classroom and clinical hours (254 credits). Accreditation is through the state system, and graduation is achieved by passing 3 national examinations, after which the PA is awarded a diploma. The quality of PA education is guaranteed by the Ordinance of Unified State Requirements for the acquisition of higher education with a bachelor's degree in the PA specialty. As of 2020, 2 PA cohorts have graduated and serve in ambulatory medical roles throughout the state. Newer roles in curative (hospital) centers are being explored. This new medical workforce is designed to contribute to the national health system as a cost-effective medical resource that replaces an older feldsher system.
How Do We Measure Success? A Review of Performance Evaluations for Lower-Limb Neuroprosthetics
Authors: Valgeirsdóttir Vigdís Vala , Sigurðardóttir Jóna Sigrún , Lechler Knut , Tronicke Lisa , Jóhannesson Ómar I. , Alexandersson Ásgeir , Kristjánsson Árni 
Published: February 2021

ABSTRACT

Introduction
Neuroprostheses that can relay signals to and from the nervous system and work with lower-limb prostheses are currently being developed to provide users with sensory feedback and/or intent control over their prostheses. Such systems incorporate functions not available to persons with lower-limb amputation before, and many of their potential benefits have not yet been addressed in performance-based outcome measures. As such, the evaluation of neuroprosthetic systems is considerably more difficult than that of current devices, which are already difficult due to limitations of testing strategies. This review includes an overview of performance-based measures for lower-limb prostheses as well as an appraisal of their utility for neuroprosthetic assessment.

Methods
Electronic searches were conducted (2013–2019) in the PubMed (PM) database, the Web of Science (WOS), and Cochrane (CC), resulting in 72 included articles.

Conclusions
There is an urgent need for further development of performance tests and metrics, as well as new strategies specifically intended for the evaluation of lower-limb neuroprosthetic systems.
The Art of Connection: A Model for Teaching Therapeutic Alliance to Doctoral Physical Therapy Students Within an Acute Care Course
Authors: Gang Gina R. , Wilson Christine A. , Garcia Henry A. , Daher Noha S. , Johnson Eric G. 
Published: February 2021

Background and Purpose.
The connection and collaborative relationship, or therapeutic alliance, between clinician and patient reflects physical therapy's core values and serves as a vehicle for the essential goal of patient-centered care. The purpose of this study was to assess the effectiveness of integrating therapeutic alliance education into an entry-level doctoral physical therapy acute care course.

Method/Model Description and Evaluation.
Sixty-seven students completed an 11-week acute care course that integrated therapeutic alliance through lecture, simulation, self-assessment, peer and faculty feedback, debriefing, standardized patient written feedback, and written reflection. Surveys were completed before and on completion of the course.

Outcomes.
Quantitative results indicated that there was a significant increase in median (minimum, maximum) students' knowledge (8[2,10] vs 0 [0,9], effect size r = 0.86, P < .001), and perception of importance (10 [6,10] vs 10 [1,10], z = −3.6, r = 0.44, P < .001), of therapeutic alliance. Qualitative analysis of student reflections revealed the following perceptions of therapeutic alliance: high-quality health care, a strong relationship, awareness of self, awareness of others, communication (nonverbal and verbal), and emotional responsiveness. Qualitative analysis also revealed spontaneous, strong verbal language to describe the importance of therapeutic alliance indicating high impact and value to students.

Conclusion.
It is imperative that skills facilitating connection and patient-centered care become embedded within the physical therapy curriculum. By educating students in the affective domain of learning, tools are provided to facilitate the crucial therapist–patient connection. Including therapeutic alliance in entry-level doctoral physical therapy curriculum supports an academic culture promoting patient-centered care.
Effects of completing a postgraduate residency or fellowship program on primary care nurse practitioners' transition to practice
Authors: Park Jeongyoung , Faraz Covelli Asefeh , Pittman Patricia 
Published: February 2021

ABSTRACT

Background:
To prepare new graduate nurse practitioners (NPs) for transition to practice, postgraduate residency or fellowship programs have been spreading across the nation in the past decade.

Purpose:
We examined the effects of completing a postgraduate residency or fellowship program on role perception, practice autonomy, team collaboration, job satisfaction, and intent to leave among primary care NPs (PCNPs).

Methods:
We analyzed 8,400 PCNP respondents, representing a total of 75,963 PCNPs nationwide, to the 2018 National Sample Survey of Registered Nurses. We conducted multivariate logistic regression analyses to examine whether completing a postgraduate training program was associated with increased role perception, greater practice autonomy, improved team collaboration, increased job satisfaction, and decreased intent to leave in their work, controlling for NP personal and practice characteristics.

Results:
About 10% of PCNPs completed some form of postgraduate training. Primary care NPs who had completed a residency or fellowship program were more likely to have a minority background (e.g., non-White and male) and also see more underserved populations (e.g., minority background, with limited English proficiency) than those without residency training. We found that PCNPs with residency training were more likely to report enhanced confidence in independent roles, greater practice autonomy, improved team collaboration, increased job satisfaction, and decreased intent to leave than those without residency training.

Implications for Practice:
This study supports further expansion of such programs, which would have positive effects for NPs, health care organizations, and patients, necessitating a long-overdue conversation about real public funding for primary care graduate nursing education.
The efficacy of docusate sodium and senna glycoside for the treatment of constipation after rotator cuff repair: A randomized controlled study
Authors: Weekes Danielle G. , Campbell Richard E. , Giunta Nicholas J. , Pepe Matthew D. , Tucker Bradford S. , Londahl-Ramsey Virginia E. , Tjoumakaris Fotios P. 
Published: February 2021

ABSTRACT

Background:
Although stool softeners and laxatives are commonly prescribed for postoperative constipation, it is unclear if they are effective during the postoperative period. The data gained from this study will be beneficial for advanced practitioners when examining for postoperative constipation concerns.

Purpose:
This study aimed to investigate the efficacy of docusate sodium and senna glycoside in the prevention and treatment of constipation following rotator cuff repair (RCR).

Methods:
Patients (n = 107) were randomized to receive docusate sodium, senna glycoside, or nothing (control) in addition to a standardized postoperative protocol. Patients maintained a daily bowel-movement log for postoperative days 0–10. Constipation symptoms and quality of life were assessed preoperatively and at 2 and 6 weeks postoperatively using the Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires.

Results:
Sixty-seven percent of patients experienced constipation. There was no difference in the prevalence of constipation in the docusate, senna, and control groups (71.4%, 66.7%, and 64.3%, respectively; p = .88). Neither PAC-SYM nor PAC-QOL scores significantly differed between the 3 groups at any time point during 6-week follow-up (p > .05).

Implications for practice:
The majority (67%) of patients experience postoperative constipation following RCR. Although docustate sodium and senna glycoside are common first-line agents for the treatment of constipation, they are ineffective during the postoperative period. Providers need to explore other treatment modalities for postoperative constipation pain.
Addressing Unmet Basic Needs to Improve Colposcopy Adherence Among Women With Abnormal Cervical Cancer Screening
Authors: Kuroki Lindsay , Massad L. Stewart , Martin Anne , Liu Jingxia , Brown Dominique , Leon Andrea , Groesch Kathleen , Wilson Teresa , Zeino Yahia , Diaz-Sylvester Paula , Delfino Kristin , Hyon Katherine , Kreuter Matthew 
Published: February 2021

Objectives
The aims of the study were to identify unmet basic needs (BNs) among women referred to colposcopy, to assess patient acceptability/satisfaction with assistance from a navigator to address unmet BNs, and to estimate adherence to colposcopy.

Methods
Women were recruited between September 2017 and January 2019 from 2 academic colposcopy centers, one serving a rural and one an urban area. Basic needs were assessed by phone before colposcopy appointments and considered unmet if unlikely to resolve in 1 month. Colposcopy adherence prestudy and poststudy implementation was abstracted over 4–6 months from administrative records. After a lead-in phase of 25 patients at each site, a BN navigator was offered to new participants with 1 or more unmet BNs. Primary outcome was adherence to initial appointment.

Results
Among 100 women, 59% had 1 or more unmet BNs, with similar prevalence between urban and rural sites. Adherence to initial colposcopy was 83% overall, 72% at the rural clinic, and 94% at the urban clinic (p = .006). These adherence rates were improved from 4 months before study launch (30/59 [51%] rural clinic and 68/137 [50%] urban clinic). Although acceptability of BN navigation was greater than 96% and women felt that it helped them get to their colposcopy visit, having a navigator was not associated with adherence. Women reporting no unmet BNs had the lowest adherence compared with women with 1 or more unmet BNs, regardless of navigator assistance (p = .03).

Conclusions
Disadvantaged women who need colposcopy have unmet BNs and value navigator assistance for initial appointments. However, when appointment scheduling includes telephone reminders and inquiring about BNs, a navigator may not add value.
Assessment of Tumor Volume Dynamics and Outcome After Radiosurgery for the Treatment of Vestibular Schwannoma: A Single-Center Experience
Authors: Ermiş Ekin , Egger Riccarda , Leiser Dominic , Anschuetz Lukas , Raabe Andreas , Abu-Isa Janine , Manser Peter , Aebersold Daniel M. , Wagner Franca , Herrmann Evelyn 
Published: February 2021

Objective:
To assess the factors affecting early local and audiometric outcomes in vestibular schwannoma (VS) patients treated with stereotactic radiosurgery (SRS).

Study Design:
A retrospective review of medical records.

Setting:
Tertiary referral center.

Patients:
Records of all adult patients who underwent SRS between 2010 and 2016 for the treatment of VS were retrospectively reviewed. Patients treated with microsurgery or multi-fractionation schemes, and those who had neurofibromatosis type 2, were excluded.

Intervention:
SRS, tumor volume/size measurements.

Main Outcome Measures:
The impact of tumor volume dynamics on the early local and hearing-related outcomes, together with the factors that influence them following SRS, and comparison of different tumor size measurement methods.

Results:
From 2010 to 2016, 53 patients underwent single fraction SRS of 12 Gy. Median follow-up time was 32 months (range, 6–79). At the last follow-up, only one patient had clinical progression. Age less than or equal to 65 years (p = 0.04; odds ratio [OR]: 0.17; 95% confidence interval [CI]: 0.03–0.93) and baseline pure-tone average (PTA) level less than or equal to 30 dB (p = 0.03; OR: 0.90; 95% CI: 0.84–0.96) were associated with maintenance of serviceable hearing. On multivariate analysis, PTA remained significant (p = 0.01; OR: 0.04; 95% CI: 0.003–0.45). In patients with a loss of serviceable hearing, the mean volume increase tended to be higher than in the patients whose hearing was maintained. The linear measurement method underestimated, and the A × B × C/2 equation overestimated, the radiological progression compared with 3D-volumetric delineations.

Conclusion:
During the median observation period of almost 3 years, we reported our early outcome results. Tumor volume increase may have an impact on serviceable hearing loss after SRS. Currently there is no widely accepted method for the evaluation of post-SRS response. Linear measurement and the A × B × C/2 equation produce less reliable estimates of radiological progression compared with 3D-volumetric delineations. Accurate volume measurements with 3D delineations should be considered as part of clinical routine for assessing progression and deciding on salvage therapies.
Study on the Bone Metabolism Indices and Otoconin-90 in Benign Paroxysmal Positional Vertigo
Authors: Bi Jingtao , Liu Bo , Zhang Yi , Zhou Qian 
Published: February 2021

Objective:
To investigate the correlation between benign paroxysmal positional vertigo (BPPV) and abnormal bone metabolism and to evaluate the value of otoconial protein otoconin-90 in the pathogenesis research and clinical treatment of BPPV.

Study Design:
Prospective pilot clinical trial (Level of Evidence: 2b).

Setting:
Outpatient otolaryngologic department.

Patients:
Twenty seven patients with a diagnosis of BPPV referred to the otolaryngologic department and 25 controls with no history of dizziness from 2018.4 to 2018.9 were reviewed.

Interventions:
No.

Main Outcome Measures:
Dual-energy x-ray absorptiometry scanning (DEXA), bone mineral density (BMD) measurement, and assessment of serum levels of otoconin-90 and bone metabolism indices (osteocalcin, OC; 25-OH Vitamin D; total procollagen type 1 N-peptide, TP1NP; β-C-terminal telopeptide of type 1 collagen, β-CTX).

Results:
1) The average serum level of otoconin-90 in the BPPV group was significantly higher than that in the control group (p < 0.05), whereas both the BMD T scores and serum 25-OH Vitamin D levels of the BPPV group were significantly lower than those of the control group (p < 0.05). 2) There was a strong positive correlation between serum otoconin-90 and age (r = 0.44, p < 0.05) and a moderate negative correlation between otoconin-90 and the bone metabolism indices OC (r = –0.33, p > 0.05), 25-OH Vitamin D (r = –0.35, p > 0.05), and TP1NP (r = –0.30, p > 0.05). 3) Logistic regression analysis showed that serum otoconin-90 level was an independent risk factor for BPPV (odd ratio = 0.998, 95% confidence interval 0.997–0.999, p < 0.01).

Conclusion:
A correlation between BPPV and abnormal bone metabolism was found. Moreover, otoconin-90 could serve as a research tool for BPPV.
Predictors of Postoperative Electrode Deactivation Among Adult Cochlear Implantees
Authors: Wen Christopher , Hwa Tiffany Peng , Kaufman Adam C. , Brant Jason A. , Eliades Steven J. , Bigelow Douglas C. , Ruckenstein Michael J. 
Published: February 2021

Objective:
To characterize postoperative electrode functionality after adult cochlear implantation; to identify rationale and risk factors for electrode deactivation.

Study Design:
Retrospective Chart Review.

Setting:
Academic Cochlear Implant Center.

Subject Population:
Five hundred nineteen cochlear implants in 433 adult patients over 5 years.

Interventions:
Unilateral or bilateral cochlear implantation.

Main Outcome Measures:
Rate of electrode deactivation after adult cochlear implantation.

Results:
One hundred twenty (27.7%) patients experienced electrode deactivation postoperatively, involving a total of 447 electrodes. The most common reasons for deactivation were bothersome nonauditory symptoms (n = 170, 38.0%), perceived benefit by patients (n = 64, 14.3%), and bothersome auditory symptoms (n = 60, 13.4%). Four hundred nineteen (93.7%) of involved electrodes remained deactivated at most recent follow-up, whereas 28 (6.3%) were able to be reactivated. Deactivation was most likely to occur within the first 4 weeks after activation (n = 90 patients,75.0%; p < 0.01). Among affected patients, the average number of electrodes deactivated was 3.44 (range 1–13; SD 2.50). Age was not associated with electrode deactivation.

Conclusions:
While 98% of cochlear implants had full insertions, more than a quarter of implantees may experience electrode deactivation postoperatively for a multitude of reasons, with bothersome nonauditory symptoms most prevalent. Deactivation of five or more electrodes and simultaneous deactivation of two or three electrodes seems to increase the odds of subsequent device failure. However, deactivation encompasses a wide range of issues that likely include patient factors, surgical technique, and device-specific issues. Prognosis varies greatly at the individual level and further evaluation is required to better identify the issues underlying deactivation and identify true predictors of failure.