bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rethinking Our Annual Congress—Meeting the Needs of Specialist Physicians by Partnering With Provincial Simulation Centers
Authors: Daniel Sam J. , Bouchard Marie-Josée , Tremblay Martin 
Published: October 2021

Abstract:
Canada's maintenance of certification programs for physicians has evolved to emphasize assessment activities. Our organization recognized the importance of offering more practice assessment opportunities to our members to enhance their practice and help them comply with a regulation from our provincial professional body related to ongoing continuing education. This led us to rethink our annual congress and enrich the program with a curriculum of interdisciplinary simulation sessions tailored to meet the needs of a broad audience of specialists. Our challenges are similar to those of many national specialty societies having limited access to simulation facilities, instructors, and simulation teams that can cover the breadth and scope of perceived and unperceived simulation needs for their specialty. Our innovative solution was to partner with local experts to develop 22 simulation sessions over the past three years. The response was very positive, drawing 867 participants. Over 95% of participants either agreed or strongly agreed that their simulation session (1) met their learning objectives, (2) was relevant for their practice, and (3) encouraged them to modify their practice. Narrative comments from a survey sent to the 2018 participants four months after their activity indicated several self-reported changes in their practice or patient outcomes. We were able to centralize offers from organizations that had previously worked in silo to develop simulation sessions meeting the needs of our members. Proposing simulation sessions allowed our organization to establish long-term partnerships and to expend our “educational toolbox” to address skill gaps not usually addressed during annual meetings.
Patient Partners in Continuing Professional Development: Experience Developing an End-of-Life Care Program for Family Physicians
Authors: Tajani Sarah , Towle Angela , Beamish Laura , Bluman Bob 
Published: October 2021

Abstract
Involvement of patients in continuing professional development (CPD) is less developed than in health professional education at undergraduate or postgraduate levels. Although patients are sometimes involved in delivering CPD, they are less likely to be involved in education planning. At our institution, patients have sometimes acted as consultants in the design of CPD. The problem we address is how to engage patients as partners throughout the design process. We applied principles of authentic patient engagement and lessons learned from patient involvement in undergraduate health professional education to the design of CPD for family physicians. We created a partnership between the CPD Office and Patient and Community Partnership for Education, a unit with a history of patient involvement in the education of health professional students. Practices for meaningful involvement were identified through literature review, environmental scan, and interviewing key informants, including patients involved in health professional education at the university. These principles and practices were applied to the development of a CPD module on end-of-life care. Patient partners contributed new perspectives and some CPD providers reassessed components of their own practice as a result. Lessons learned include the need for stakeholder buy-in; mechanisms to identify those patients best able to contribute expertise; ways to facilitate involvement that work for both patients and CPD providers; the importance of feedback mechanisms to patient partners; and recognition for patient contributions. CPD offices should view integration of patient partners in program planning as an opportunity to engage in ongoing quality improvement.
Aligning Family–Clinician Expectations During Pediatric Surgical Informed Consent: Development and Implementation of an Innovative Communication Skills Workshop
Authors: Cohen-Bearak Adena , Meyer Elaine C. , Mednick Lauren , Varrin Pamela , Burgess Lisa , Kuhlmann Pia H. , Bell Sigall , Lillehei Craig 
Published: October 2021

Introduction:
Aligning expectations during the informed consent process before a child's surgery is an important element of good communication that benefits both surgical staff and families. We developed and evaluated a 2-hour pilot interprofessional workshop to improve the communication and relational skills of pediatric surgeons and nurse practitioners.

Methods:
Focus groups with families identified key challenges in the process of informed consent. An interprofessional team, including parents whose children had experienced complex surgeries, developed the workshop collaboratively. A realistic simulation with professional actors portraying parents allowed surgical staff to practice communication skills and receive feedback about the parent perspective. Participants completed a postworkshop evaluation to determine whether the workshop met its objectives and whether they would change practice.

Results:
Five key themes identified for the workshop included customize communication; align expectations; share clinical uncertainty; recognize/attend to emotions; and identify team members. Thirty-five clinicians participated in a workshop, and 89% completed evaluations. Three-quarters reported the learning to be valuable, and 64% were likely to change practice. Eighty-seven percent would recommend the workshop to other colleagues, and 58 to 74% felt more prepared to achieve each of eight specific skills.

Discussion:
An innovative workshop for pediatric surgical practitioners to align family–clinician expectations can help improve clinician communication skills and comfort with informed consent. Keys to workshop development included involving parents to identify themes and participate as workshop co-faculty; enlisting leadership and recruiting surgical champions; and using pre-existing meetings to ease scheduling challenges of busy practitioners. Booster sessions may facilitate the desired cultural changes.
Characteristics of metachronous gastric neoplasms after curative endoscopic submucosal dissection for early gastric neoplasms
Authors: Xu Shan-Shan , Chai Ning-Li , Tang Xiao-Wei , Linghu En-Qiang , Wang Sha-Sha , Li Bao 
Published: October 2021

Abstract

Background:
With the wide application of endoscopic submucosal dissection (ESD) for early gastric neoplasms, metachronous gastric neoplasms (MGN) have gradually become a concern. This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.

Methods:
A total of 814 patients were retrospectively enrolled. All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People's Liberation Army General Hospital. The risk factors for MGN were analyzed using Cox hazard proportional model. Moreover, the cumulative incidence, the correlation of initial lesions and MGN lesions, and the treatment and follow-up outcomes of MGN patients were analyzed.

Results:
A total of 4.5% (37/814) of patients had MGN after curative ESD. The 3-, 5-, and 7-year cumulative incidences of MGN were 3.5%, 5.1%, and 6.9%, respectively, and ultimately reaching a plateau of 11.3% at 99 months after ESD. There was no significant correlation between initial lesions and MGN lesions in terms of gross type (P = 0.178), location (long axis: P = 0.470; short axis: P = 0.125), and histological type (P = 0.832). Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN (hazard ratio: 4.3, 95% confidence interval: 2.0–9.4, P < 0.001). Seventy-three percent of patients with MGN were treated by endoscopic resection. During follow-up, two patients with MGN died of gastric cancer with lymph node metastasis. The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN (94.6% vs. 99.6%, P = 0.006).

Conclusions:
The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD. Thus, regular and long-term surveillance endoscopy may be helpful, especially for patients with initial multiple neoplasms.
ACUTE MACULAR NEURORETINOPATHY AFTER SARS-COV-2 VACCINATION
Authors: Patel Samir N. , Yonekawa Yoshihiro 
Published: October 2021

Purpose:
To present the rare case of a patient who developed acute macular neuroretinopathy (AMN) after administration of a single-dose adenovector coronavirus vaccine.

Methods:
Retrospective chart review.

Results:
A 26-year-old woman presented with paracentral scotomas in both eyes that acutely developed 2 days after administration of a single-dose adenovector SARS-CoV-2 vaccine (Johnson & Johnson, New Brunswick, NJ). She had previously received the seasonal influenza immunization without any symptoms and denied having any recent history of viral illnesses. On examination, optical coherence tomography showed parafoveal hyperreflective bands in the outer retina of both eyes without retinal thickening and near-infrared reflectance showed wedge-shaped parafoveal lesions pointing to the fovea, both classic findings in acute macular neuroretinopathy.

Discussion:
This report highlights the development of acute macular neuroretinopathy after a SARS-CoV-2 vaccination in an otherwise healthy female patient. A single case cannot establish cause and effect, and millions of COVID-19 vaccines have been administered safely at the time of writing. However, this may be a rare association, and clinicians can consider inquiring about recent vaccination history in patients presenting with acute macular neuroretinopathy.
Surveillance Chest X-Ray and Pulmonary Function Testing in Patients Undergoing Intralesional Bleomycin in the Treatment of Vascular Malformations
Authors: DeHart Austin N. , Mack Joana M. , Garner Annsley , Nicholas Richard , Smith Amber , Lewis P. Spencer , Crary Shelley E. 
Published: October 2021

Purpose:
Bleomycin is an effective sclerosant in the treatment of vascular malformations; however, the risk of pulmonary toxicity remains a concern. This study analyzes the utility of routine chest x-ray (CXR) and pulmonary function testing (PFT) in a pediatric patient population receiving intralesional bleomycin sclerotherapy.

Methods:
Retrospective chart review of CXR and PFT results in patients who underwent bleomycin intralesional injection for the treatment of vascular malformations.

Results:
A total of 64 patients were identified with vascular malformations treated with intralesional bleomycin. The median cumulative bleomycin dose per patient was 10.9 U/m2 (range 1.8–106.8 U/m2 per patient). No difference was found in mean cumulative bleomycin dose between patients with a normal compared with abnormal CXR (32.4 versus 31.8 U/m2, P = 0.96). No patients had CXR findings which precluded the administration of bleomycin. Of 41 successfully completed PFTs, 39 (95.1%) were normal and 2 (4.9%) were abnormal with an obstructive pattern. There was no decrease in the mean DLCO (Hg) % predicted between baseline PFT and follow-up PFT groups (94.1 versus 101.8, P = 0.17). Linear regression was performed and no decrease in DLCO (Hg) % predicted with increasing cumulative bleomycin dose was identified (slope coefficient 0.37; 95% CI, –2.2 to 2.9; R2 = 0.01).

Conclusion:
Routine CXR for the surveillance of bleomycin-induced pulmonary toxicity seems to be of limited clinical utility. No diffusion abnormalities on PFT were seen in this patient cohort to date; however, as cumulative bleomycin doses increase, follow-up PFT monitoring will remain important.
Long-Term Hearing Outcomes From Gamma Knife Treatment for Vestibulocochlear Nerve Schwannomas in a Large, Tertiary Care, Academic Hospital
Authors: Maksimoski Matthew , Bajaj Amishi , Giri Sneha , Sharpe Laurin M. , Kalapurakal John , Micco Alan G. 
Published: October 2021

Objective:
Describe long-term hearing outcomes with audiologic data with modern stereotactic radiosurgery techniques for vestibular schwannoma tumors.

Background:
Since the mid-20th century, stereotactic radiosurgery has been an option for central nervous system tumors. Due to the non-invasive manner of treatment, this was extended to treatment for benign vestibular schwannomas without intracranial surgery. Modern advances have localized radiation and reduced dosage, but data are still lacking in the long-term hearing outcomes of this method of treatment. As one of the national leaders in this procedure, we present our full database of these outcomes over the full time period of our institutions utility of this modality.

Methods:
A retrospective review was performed of all patients undergoing stereotactic radiotherapy for vestibular schwannomas within the study period of 1998 to 2019 and their audiograms analyzed along with patient data. Laterality Gardner–Robertson hearing score changes were the primary outcome analyzed for each patient; and controls were placed to accommodate for patient demographic data.

Results:
Long-term, multi-year audiometric evaluation showed statistically significant loss of serviceable hearing and reduction in hearing ability with the use of stereotactic radiosurgery for treatment of vestibular schwannomas.

Conclusions:
Little long-term data exists on the audiometric outcomes related to stereotactic radiosurgery treatment for vestibular schwannomas. Our institution has performed more than 300 stereotactic radiosurgery treatments showing a continued reduction over time in serviceable hearing. Practitioners should advise patients undergoing treatment for vestibular schwannomas with this treatment of long-term results.
Auditory Outcomes Following Transmastoid and Middle Cranial Fossa Approaches for Superior Semicircular Canal Dehiscence Repair
Authors: Ellsperman Susan E. , Telian Steven A. , Kileny Paul R. , Welch Christopher M. 
Published: October 2021

Objective:
To describe postoperative hearing outcomes following transmastoid (TM) and middle cranial fossa (MCF) approaches for semicircular canal dehiscence (SSCD) repair.

Study Design:
Retrospective review.

Setting:
Academic, tertiary referral center.

Patients:
Adults with SSCD who underwent repair between 2005 and 2019.

Interventions:
Pure tone audiometry pre- and postoperatively after SSCD repair.

Main Outcome Measures:
Change in air-bone gap (ABG) at 250 and 500 Hz, pure tone average (PTA), bone conduction (BC), and air conduction (AC) thresholds at 500, 1000, 2000, and 4000 Hz for patients undergoing TM and MCF approaches for SSCD repair.

Results:
The average change in BC PTA for patients undergoing TM (n = 26) and MCF (n = 24) SSCD repair was not significantly different between the two groups. The first and final postoperative PTAs were recorded an average of 1.7 (range 0.30–3.0) and 29.1 (range 3.5–154) months postoperatively. For patients who underwent MCF repair, the average BC PTAs increased (+) by 2.2 dB HL (p 0.43) and 0.57 dB HL (p 0.88) at the first and final audiograms respectively compared to +1.27 dB HL (p 0.53) and a decrease (−) of 0.57 dB HL (p 0.63) for the TM group. The average changes in low frequency ABG for patients undergoing MCF repair were −4.7 dB (p 0.08) and −6.9 dB (p 0.15) at first and final audiograms respectively compared to −4.9 dB (p 0.06) and −4.1 dB (p 0.36) for patients who underwent TM repair. There was a high frequency hearing loss noted at 8000 Hz for the MCF (30.0 dB ± 18.7 preop; 41.7 dB ± 21.7 postop; p 0.01) and TM (32.1 dB ± 23.2 preop; 44.3 dB ± 29.6 postop; p 0.001) groups which persisted on long term follow up.

Conclusions:
Both TM and MCF approaches to SSCD repair can be performed with long-term preservation of hearing. ABGs were reduced in each treatment group but did not reach significance. A high frequency hearing loss (8000 Hz) may be expected with either approach.
Patient Self-Management of Benign Paroxysmal Positional Vertigo: Instructional Video Development and Preliminary Evaluation of Behavioral Outcomes
Authors: Kerber Kevin A. , Carender Wendy , Telian Steven A. , Fagerlin Angela , Tsodikov Alex , Meurer William J. 
Published: October 2021

Importance:
Benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) is a common disorder that is diagnosed using the Dix-Hallpike test (DHT) and treated with the canalith repositioning maneuver (CRM). Patients often seek out information about BPPV self-management, but studies to develop and evaluate patient-centered instructional resources are limited.

Objective:
To develop and preliminarily evaluate a patient-oriented PC-BPPV self-management instructional video.

Methods:
We assembled a multidisciplinary team and used an iterative process to develop a theory-based instructional video for self-performing the DHT and CRM. We recruited individuals searching online for information about dizziness to complete a survey and review the video. Patients rated the video by scoring seven questions that measure behavioral intent to perform the DHT or CRM (attitudes/acceptability, perceived self-efficacy, and social norms) using a 10-point scale (higher scores = more favorable ratings). A multilevel linear regression model was used to determine the association of age, sex, race, and education with video ratings.

Results:
Of the 771 participants who completed the survey, 124 (16%) also reviewed and evaluated the PC-BPPV instructional video. The video review participants were typically more than or equal to 55 years old (70%; 93/124), women (70%; 87/124), and White (70%; 88/124). These participants also generally reported acute-subacute and moderate-to-severe dizziness, and 60% (75/124) reported typical BPPV triggers. The median scores for the seven questions about attitudes/acceptability, self-efficacy, and social norms on the PC-BPPV instructional video were all more than or equal to 9 out of 10 with interquartile ratios that ranged from 7 to 9 at the 25th percentile to 10 at the 75th percentile. Female sex was the only demographic variable associated with higher video ratings (coefficient, 1.21, 95% CI 0.60–1.83).

Conclusion:
This study found that participants rated the PC-BPPV self-management video favorably on measures that contribute to behavioral intent to perform the DHT or CRM. The findings provide support that the video is appropriate to use in future studies that evaluate patient self-performance accuracy and outcomes.
The Value of Ultrashort Echo Time MR in Depiction of the Eustachian Tube at 3 Tesla
Authors: Wu Chao , Xu Qiang 
Published: October 2021

Objectives:
To investigate the feasibility of ultrashort echo time (UTE) imaging in the visualization of Eustachian tubes (ETs).

Methods:
The local institutional review board approved the study protocol. Twenty volunteers were involved in this study. The scanning scheme consisted of T2-sampling perfection with application-optimized contrasts by using different flip angle evolutions (T2-SPACE) MR imaging with water excitation, a UTE scan with a prototype sequence and a CT scan. The UTE images were compared with both the T2-SPACE and CT images. The quality of the images was rated by two radiologists blindly. Interobserver agreement was assessed using the kappa statistic. Statistical analysis was performed using SPSS software (version 17, SPSS Inc.). A value of p < 0.05 was considered statistically significant.

Results:
For all subjects, the T2-SPACE images successfully displayed the cartilaginous part of the ET (Fig. 1). The CT images fully showed the bony part of the ET for all the subjects (Fig. 2). The UTE images successfully displayed both the cartilaginous and bony parts of the ET (Fig. 3). However, the UTE images showed the cartilaginous and bony portions of the ET as a whole.

Conclusions:
By analyzing the depiction of the ET from UTE images and comparing it with that from MR and CT images, we found that UTE images could display not only the cartilaginous structure of the ET that cannot be seen by conventional MR sequences, but also the bony structure that previously could only be seen on CT images. This imaging modality could help provide a convenient and new method to display the overall shape of the ET.
Spontaneous Regression of a Middle Ear Melanoma
Authors: Krebbers Iris , Kunst Henricus P. M. , Baijens Laura W. J. , van den Hout Mari F. C. M. , Waterval Jerome J. 
Published: October 2021

Objective:
To describe a case of complete spontaneous regression of a middle ear melanoma.

Patient:
We present a case of a 68-year-old man with complaints of unilateral hearing loss and an ipsilateral facial nerve paresis. Radiological and histopathological examination revealed a cT4bN0M0 mucosal melanoma of the middle ear.

Interventions:
The patient underwent a subtotal petrosectomy and postoperative radiotherapy.

Main Outcome Measure:
Computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography/computed tomography with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG-PET-CT), and histopathological examination.

Results:
After subtotal petrosectomy, histopathological examination of the resection specimen showed only fibrosis and a histiocytic and clonal T-cell infiltration, but no residual melanoma at the primary tumor site, consistent with spontaneous tumor regression. Follow-up MRI scanning 6 and 12 months after radiotherapy showed no signs of tumor recurrence.

Conclusions:
This case describes the concept of spontaneous regression of a mucosal melanoma of the middle ear. Spontaneous tumor regression at this location has not been described before.
The Interplay of Biopsychosocial Factors and Quality of Life in Inflammatory Bowel Diseases
Authors: Thomann Anne K. , Knödler Laura-Louise , Karthikeyan Sandeep , Atanasova Konstantina , Bernstein Charles N. , Ebert Matthias P. , Lis Stefanie , Reindl Wolfgang 
Published: October 2021

Goal:
The aim of this study was to investigate the network of biopsychosocial factors and quality of life (QoL) in persons with inflammatory bowel diseases (IBDs) and explore the influence of psychological factors on the course of the disease.

Background:
QoL of persons with IBD depends on disease activity but also on numerous interacting psychosocial factors. The influence of psychosocial factors on the disease course in controversially discussed.

Materials and Methods:
In 2 independent IBD samples (sample 1: n=209, anonymous internet survey; sample 2: n=84, outpatients with active disease), we measured QoL, anxiety, depression, illness identity, self-esteem, loneliness, childhood trauma, and visceral sensitivity with questionnaires. In addition, fatigue, hemoglobin levels, and response to therapy were assessed in sample 2. We estimated multiple regularized partial correlation networks and conducted accuracy and stability tests of the networks.

Results:
In both samples, QoL had the strongest relationships with visceral sensitivity and the illness identity engulfment. Depression was the most central factor in the networks. Baseline depression scores, visceral sensitivity, and engulfment were associated with response to therapy in sample 2.

Conclusions:
This first network study to assess the interplay between biopsychosocial factors and QoL in IBD reveals a comparable network structure in 2 samples. Results partly replicate findings from previous studies with regard to the importance of depression and yield information on the central role of the newly introduced concepts of illness identity and visceral sensitivity. Preliminary findings point to an influence of these parameters on the disease course, which indicates their role as a possible target in individualized therapy.