bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later
Authors: Quigley Denise D. , Elliott Marc N. , Slaughter Mary E. , Burkhart Q , Chen Alex Y. , Talamantes Efrain , Hays Ron D. 
Published: August 2021

Background:
Health care organizations strive to improve patient care experiences. Some use one-on-one provider counseling (shadow coaching) to identify and target modifiable provider behaviors.

Objective:
We examined whether shadow coaching improves patient experience across 44 primary care practices in a large urban Federally Qualified Health Center.

Research Design:
Seventy-four providers with “medium” (ie, slightly below average) overall provider ratings received coaching and were compared with 246 uncoached providers. We fit mixed-effects regression models with random effects for provider (level of treatment assignment) and fixed effects for time (linear spline with a knot and “jump” at coaching date), patient characteristics and site indicators. By design, coached providers performed worse at selection; models account for the very small (0.2 point) regression-to-the-mean effects. We assessed differential effects by coach.

Subjects:
A total of 46,452 patients (from 320 providers) who completed the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) Visit Survey 2.0.

Measures:
CAHPS overall provider rating and provider communication composite (scaled 0−100).

Results:
Providers not chosen for coaching had a nonsignificant change in performance during the period when selected providers were coached. We observed a statistically significant 2-point (small-to-medium) jump among coached providers after coaching on the CAHPS overall provider rating and provider communication score. However, these gains disappeared after 2.5 years; effects differed by coach.

Conclusions:
Shadow coaching improved providers’ overall performance and communication immediately after being coached. Regularly planned shadow coaching “booster” sessions might maintain or even increase the improvement gained in patient experience scores, but research examining additional coaching and optimal implementation is needed.
Third space endoscopy: the future of treating gastrointestinal dysmotility
Authors: Nabi Zaheer , Reddy D. Nageshwar 
Published: August 2021

Purpose of review
Third space endoscopy (TSE) or submucosal endoscopy provides with the opportunity for minimally invasive management of various gastrointestinal disorders. TSE is a relatively new field and the knowledge on its utility continues to advance. The purpose of this review is to provide with updated evidence on the efficacy and utility of TSE in gastrointestinal motility disorders including achalasia and refractory gastroparesis.

Recent findings
Peroral endoscopic myotomy (POEM) is a safe procedure with emerging evidence on its durability as well. Major technical variations do not appear to impact the outcomes of POEM. Recent randomized trials suggest superiority of POEM over pneumatic dilatation and noninferiority over Heller's myotomy in idiopathic achalasia. With regard to gastric POEM (G-POEM), recent evidence confirms its efficacy in refractory gastroparesis. Although effective, the long-term outcomes of G-POEM are not well known. In addition, the criteria for patient selection remain elusive.

Summary
TSE has emerged as a new frontier in the endoscopic management of gastrointestinal motility disorders. While short-term outcomes are encouraging, the durability of TSE remains to be seen in achalasia as well as refractory gastroparesis. Insights regarding patient selection and predictors of outcomes may help optimizing the results of gastric POEM in refractory gastroparesis.
Clinical Phenotype and Genetic Analysis of Twins With Congenital Coagulation Factor V Deficiency
Authors: Wei Yanhui , He Yuzhuo , Guo Xuejun 
Published: August 2021

Objective:
The aim was to investigate the clinical characteristics and molecular pathogenic mechanism of twins with congenital factor V (FV) deficiency.

Methods:
We comprehensively analyzed the clinical manifestations and laboratory test results of a set of twins and their parents and performed point mutation analysis with direct high-throughput exon sequencing.

Results:
The prothrombin time and activated partial thromboplastin time were prolonged for both probands, and the FV activity levels were 13.0% and 9.8%. Next-generation sequencing showed that the affected individuals harbored a paternal c.5113A>C (p.S1705R) and a maternal c.4949C>T (p.A1650V) heterozygous variants in the FV gene, which conformed to an autosomal recessive inheritance pattern. This is the first report of these point mutations. The older boy also had a congenital patent foramen ovale.

Conclusion:
In this set of twins, missense mutations of the FV gene were related to congenital FV deficiency but unrelated to the patent foramen ovale observed in the older boy.
Role of Cyclin D1 and BCOR Immunohistochemistry in Differentiating Clear Cell Sarcoma of Kidney From its Mimics
Authors: Singh Vikram , Gupta Kirti , Saraswati Aastha , Peters Nitin J. , Trehan Amita 
Published: August 2021

Background and Aim:
Clear cell sarcoma of kidney (CCSK) is the second most common pediatric renal malignancy, constituting ∼3% of renal tumors. Due to its morphologic diversity, the diagnosis of CCSK is often challenging. Recent studies have identified internal tandem duplication of BCL6 corepressor (BCOR) gene in CCSKs which coupled with cyclin D1 immunoreactivity, is helpful in differentiating it from its mimics, particularly blastema-rich Wilms tumor (WT), malignant rhabdoid tumor (MRT), and congenital mesoblastic nephroma (CMN). We aimed to evaluate the utility of cyclin D1 and BCOR immunohistochemistry in differentiating CCSK from its morphologic mimics.

Materials and Methods:
Our cohort comprised of 38 pediatric renal tumors which included CCSK (n=18), WT (n=10), MRT (n=5), and CMN (n=5) cases. A detailed clinicopathologic analysis was performed, and tissue microarray were constructed for CCSK and WT, while MRT and CMN tumors were individually stained.

Results:
The age ranged from 2 months to 16 years with male:female ratio of 3:1. Strong, diffuse nuclear immunoreactivity for cyclin D1 and BCOR was noted in 61% (n=11/18) and 83% (n=15/18) of CCSK, respectively, while it was significantly less in WT (n=3/10 for cyclin D1) (n=2/10 for BCOR). None of the MRT and CMN examples demonstrated any immunoreactivity. Interestingly, only the blastemal component of WTs showed distinct, rare nuclear immunoreactivity for cyclin D1 or BCOR and the combination of these was never positive in a given case.

Conclusion:
Our results provide evidence that concurrent immunopositivity with cyclin D1 and BCOR is helpful in distinguishing CCSK from its morphologic mimics.
Relationship of Circadian Rhythm and Psychological Health in Adolescents and Young Adults With Cancer
Authors: Li Lijun , Duan Yinglong , Sun Qian , Xiao Panpan , Wang Lu , He Shiwen , Liu Xiangyu , Zhou Jianda , Xie Jianfei , Cheng Andy S.K. 
Published: August 2021

Background
Evidence shows that adolescent and young adult (AYA) cancer patients have an increasing survival rate but experience psychological distress and circadian rhythm dysregulation. Little is known about the effect of circadian rhythm on psychological distress.

Objective
To investigate the type of circadian rhythm in Chinese AYA cancer survivors and examine the associations among chronotype, demographic characteristics, psychological distress, anxiety and depression, character strengths, and medical coping in this group.

Methods
This cross-sectional study enrolled 800 AYA cancer participants, 728 of whom completed the Chinese version of the Morningness-Eveningness Questionnaire, the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Three-Dimensional Inventory of Character Strengths, and the Medical Coping Modes Questionnaire.

Results
Evening- and morning-type participants accounted for 35.0% and 19.1%, respectively, among participants, which was significantly higher than those found in the general population. The prevalence of psychological distress was 84.9% among AYA cancer participants. Exercise, Distress Thermometer, and depression were important predictive factors for the circadian rhythm.

Conclusions
Circadian rhythm disorder and psychological distress were common among AYA cancer survivors. Evening-type participants performed worse on character strength, confrontation, and avoidance of medical coping.

Implications for practice
Healthcare professionals need to understand the circadian rhythm and psychological health of AYA cancer survivors. Psychological rehabilitation guidance, especially within the 6 months after diagnosis, may benefit AYA survivors according to their chronotype. Character strengths can also be used during rehabilitation to properly guide AYA survivors.
Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect?
Authors: Metersky Mark L. , Eldridge Noel , Wang Yun , Eckenrode Sheila , Galusha Deron , Jaser Lisa , Mathew Jasie , Angus Steven , Nardino Robert 
Published: August 2021

Objectives
This study aimed to determine whether patients in teaching hospitals are at higher risk of suffering from an adverse event during the summer trainee changeover period.

Methods
We performed a retrospective analysis of data from the Medicare Patient Safety Monitoring System, a medical-record abstraction-based database in the United States. Hospital admissions from 2010 to 2017 for acute myocardial infarction, heart failure, pneumonia, or a major surgical procedure were studied. Admissions were divided into nonsurgical (acute myocardial infarction, heart failure, or pneumonia) and surgical. Adverse event rates in July/August were compared with the rest of the year. Hospitals were stratified into major teaching, minor teaching, or nonteaching. Results were adjusted for patient demographics, comorbidities, and hospital characteristics. Outcomes were the adjusted odds of having at least 1 adverse event in July/August versus the rest of the year.

Results
We included 185,652 hospital admissions. The adjusted odds ratios (ORs) of suffering from at least one adverse event in a major teaching hospital in July/August was 0.83 (95% confidence interval [CI], 0.69–0.98) for nonsurgical patients and 1.09 (95% CI, 0.84–1.40) for surgical patients. In minor teaching hospitals, the adjusted ORs were 0.96 (95% CI, 0.88–1.04) for nonsurgical patients and 0.99 (95% CI, 0.87–1.12) for surgical patients. In nonteaching hospitals, the adjusted ORs were 0.98 (95% CI, 0.91–1.06) for nonsurgical patients and 1.10 (95% CI, 0.96–1.24) for surgical patients.

Conclusions
Patients admitted to teaching hospitals in July/August are not at increased risk of adverse events. These findings should reassure patients and medical educators that patients are not excessively endangered by admission to the hospital during these months.
Alveolar Bone Graft Timing in Patients With Cleft Lip & Palate
Authors: Mundra Leela S. , Lowe Kristen M. , Khechoyan David Y. 
Published: August 2021

Abstract
Cleft lip with or without cleft palate (CLP) is the most common craniofacial condition. Alveolar clefts are present in approximately 75% of patients with a cleft lip or CLP and often do not have sufficient support of surrounding teeth. Alveolar bone graft is commonly performed to reconstruct alveolar ridge in patient with osseous defects. Objective of this review is to critically analyze the literature to provide recommendations on appropriate timing for orthodontic preparation and surgical correction of alveolar clefts in the setting of unilateral or bilateral CLP. Search of PubMed database, MEDLINE, and EMBASE was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 15 studies were included. Majority of studies used chronological age to classify patients versus dental age. Most studies reported orthodontic treatment concomitant with surgery (12/15; 80.0%), and used orthodontics before alveolar bone grafting (8/12; 66.7%). No consensus on the best method to evaluate the success of alveolar bone grafting. Alveolar bone grafting with pre- and post-operative orthodontics is currently the standard of care for treatment of alveolar defects in patients with CLP. Authors recommend grafting during early mixed dentition phase, just before the eruption of the permanent central incisors, typically between 6 and 8 years old. Preoperative orthodontics for appropriate incisor alignment around cleft, and may be resumed 6 months postoperative.
Orbital Metastasis From Gastric Cancer Presenting as Orbital Cellulitis With Ptosis
Authors: Kim Jonghyun , Kim Joohyun , Baek Sehyun 
Published: August 2021

Abstract
We report a rare case of orbital metastasis that originated from gastric carcinoma, which presented as orbital cellulitis with ptosis. Orbital metastasis accounts for about only 1% to 13% of orbital tumors. Orbital metastasis in orbital soft tissue or bony structures is very uncommon.
A female patient with advanced gastric cancer with multiple metastases was referred to our clinic. She showed mild swelling and ptosis in her left eye. Contrast enhanced computed tomography imaging suggested orbital metastasis from gastric cancer in the superolateral aspect of the orbit. Based on her general condition and after consulting with an oncologist, we determined that fine needle biopsy and excisional biopsy for pathological diagnosis should not be performed as a therapeutic treatment.
It is important to distinguish orbital metastasis from orbital cellulitis with ptosis especially for patients with family or personal history of cancer. Clinicians should collect a through medical history from patients and suggest contrast enhanced computed tomography for appropriate diagnosis. Assessing quality of life and aggressive treatment options is crucial for determining the best treatment for orbital metastasis.
Clinical Anatomy Research Association in Oral and Maxillofacial Surgery
Authors: Iwanaga Joe , Matsushita Yuki , Watanabe Koichi , Kageyama Ikuo , Tubbs R. Shane , Ibaragi Soichiro 
Published: August 2021

Abstract
Sufficient knowledge of anatomy is critical for oral and maxillofacial surgeons to provide the best treatment to their patients. The authors have recently established the “Clinical Anatomy Research Association in Oral and Maxillofacial Surgery.” There is no doubt as to the benefits of collaboration between oral and maxillofacial surgeons/radiologists and anatomists. In this article, we share what was accomplished at the first annual online conference and discuss our mission for the future.
Combined Nasal Endoscopic and Subfrontal Craniotomy for Resection Tumors of Anterior Skull Base
Authors: Ngo Cong Van , Nguyen Hoang , Aklinski Joseph , Nguyen Khang Ngoc , Nguyen Dung Huu , Le John M. , Le Hoang Huy , Nguyen Chi , Tran Truong Minh 
Published: August 2021

Objective:
Sinonasal tumors invading anterior skull base is difficult to treat in Otorhinolaryngology and Neurosurgery. Treatment requires the collaboration of ear, nose and throat (ENT) and neurosurgeon to remove the tumor completely. This study was to evaluate the outcome of combined technique nasal endoscopic and subfrontal approach in case of sinonasal tumors involving anterior skull base

Methods:
Retrospective cross-sectional study

Results:
The study was a cross-sectional study that had taken place at Otorhinolaryngology and Neurosurgery Department of Cho Ray Hospital, Vietnam. All 45 patients were enrolled and underwent the surgery. 71.1% of these cases were malignant tumors. The ratio of sinonasal malignant tumor is squamous cell carcinoma and esthesioneuroblastoma were 24.4% and 11.1%, respectively. All the cases were diagnosed as sinonasal tumor invading anterior skull base and successfully removed by combining nasal endoscopic approach with subfrontal craniotomy.

Conclusions:
The combined nasal endoscopic with subfrontal craniotomy for resection nasoethmoid tumor invading the brain show a good result. This technique is an important adjunct that contribute to the treatment of anterior skull base tumor involving the brain.
Red Cell Distribution Width at Admission Predicts the Frequency of Acute Kidney Injury and 28-Day Mortality in Patients With Acute Respiratory Distress Syndrome
Authors: Cai Nan , Jiang Min , Wu Chao , He Fei 
Published: August 2021

ABSTRACT

Objectives:
To determine the association of red cell distribution width (RDW) at admission with frequency of acute kidney injury (AKI) and 28-day mortality in acute respiratory distress syndrome (ARDS) patients.

Methods:
Two hundred fifty-eight ARDS patients were investigated in retrospective and prospective studies. The primary outcome was frequency of AKI. The secondary outcome was 28-day mortality.

Results:
The retrospective study included 193 ARDS patients, of which 67 (34.7%) were confirmed AKI and 76 (39.4%) died within 28 days. The RDW level in the AKI group was significantly higher than in the non-AKI group ([15.15 ± 2.59]% vs. [13.95 ± 1.89]%). Increased RDW was a significant predictor of frequency of AKI (odds ratio: 1.247, 95% confidence interval [CI]: 1.044, 1.489). The area under the receiver operating characteristic curve of RDW for predicting AKI was 0.687 (95%CI: 0.610, 0.764) and the cut-off value was 14.45 (sensitivity, 56.7%; specificity, 72.8%). In addition, the proportion of patients with RDW ≥ 14.45% in the non-survival group was notably higher compared with the survival group (48.7% vs. 29.1%). Furthermore, cox regression analysis revealed that RDW ≥ 14.45% was associated with 28-day mortality (hazard ratio: 1.817, 95%CI: 1.046, 3.158), while Kaplan–Meier analysis showed patients with RDW ≥ 14.45% had a significantly lower survival rate than those with RDW < 14.45%. The prospective study, on the other hand, included 65 ARDS patients, with frequency of AKI and 28-day mortality in the RDW ≥ 14.45% group significantly higher than in RDW < 14.45%.

Conclusion:
RDW was a significant, independent predictor for frequency of AKI and 28-day mortality in ARDS patients.
MEF2D Participates in Microglia-Mediated Neuroprotection in Cerebral Ischemia-Reperfusion Rats
Authors: Shi Likai , Li Baowei , Chen Guoqing , Huang Yingsi , Tian Zhenpu , Zhang Lifeng , Tian Li , Fu Qiang 
Published: August 2021

ABSTRACT

Objective:
Microglial activation is a vital process in the neuroinflammatory response induced by I/R injury. It has been reported that myocyte enhancer factor (MEF)2D expression in activated microglia is associated with microglia-induced inflammatory responses and plays an important role in neuronal survival. This research aimed to investigate the role and mechanism of MEF2D in microglial activation and neuroinflammation in cerebral I/R in vitro and in vivo.

Methods:
A cerebral I/R model was established. In vitro, neuronal, or microglial cells were exposed to oxygen-glucose deprivation and reoxygenation to mimic I/R. MEF2D overexpression was induced, and siRNA was administered in vitro and in vivo. Microglial polarization; MEF2D, nuclear transcription factor (NF)-κb, TLR4, and cytokine levels; neuronal injury; mitochondrial function; brain injury and cognitive function were detected in the different groups in vitro and in vivo.

Results:
We found that oxygen-glucose deprivation increased MEF2D expression in a time-dependent manner in BV2 cells and primary microglia. MEF2D overexpression inhibited microglial activation, the expression of NF-κb and TLR, cytokine levels, and neuronal injury in microglia exposed to oxygen-glucose deprivation and reoxygenation. In the middle cerebral artery occlusion model, microglial activation, the neuroinflammatory response, mitochondrial dysfunction, brain injury, and cognitive function were improved by MEF2D overexpression and aggravated by MEF2D siRNA treatment.

Conclusion:
These results indicate that MEF2D is a necessary molecule for neuroinflammation regulation and neuronal injury in cerebral ischemia.
The Development of an Assessment Rubric for the Core and Contingency Team Interaction Among Rapid Response Teams
Authors: Singh Maninder , Moss Hillary , Thomas Gifty M. , Dadario Nicholas B. , Mirante Doreen , Ellsworth Kelly , Shulman Jodi , Bellido Simon , Amicucci Bernadette , Jafri Farrukh N. 
Published: August 2021

Introduction
Teamwork training is critical in the development of high-functioning rapid response teams (RRT). Rapid response teams involve interactions between a patient's core care team and a hospital contingency team, which can lead to disorganized and unsafe resuscitations, largely due to problems with communication and information dissemination. An extensive literature search found no assessment tools specific to the unique communicative challenges of an RRT, and thus, this study sought to develop an assessment rubric validated for training RRTs.

Methods
This study elucidates the development, implementation, and testing of an RRT rubric based on Kane's framework for validating testing instruments. Twenty-four inpatient code teams underwent team training using a Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) didactic, an online module on the TeamSTEPPS RRT program, and a subsequent presimulation and postsimulation experience. Two raters were randomized to give a bedside assessment for each team using the proposed RRT rubric. Simulation scores were assessed with Wilcoxon signed-rank tests. Interrater reliability was assessed using intraclass correlation coefficients. These analyses were then used to argue Kane's scoring, generalization, and extrapolation inferences.

Results
All teams significantly improved from the presimulation to postsimulation scenarios across all TeamSTEPPS domains. Content validity was obtained from 5 resuscitation experts with a scale-level content validity index of 0.9, with individual content validity index of 0.8 to 1.0. Intraclass correlation coefficient for “pre” scores were 0.856 (n = 24, P < 0.001), “post” scores of 0.738 (n = 24, P < 0.001), and a total of 0.890 (n = 48, P < 0.001).

Conclusions
The authors argue for the validity of a new RRT rubric based off Kane's framework, with a specific focus on teamwork training to improve coordination and function of core and contingency teams. A follow-up study with longitudinal data along with external validation of this rubric is needed.