bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient Perspectives on Dialogue and Shared Decision Making
Authors: Dauer Lawrence T. 
Published: December 2018

Abstract
The fear of radiation on the part of patients and/or clinical staff can hamper adequate shared medical decision making. Typically, one-sided medical radiation risk communication methods with limited effectiveness are employed, such as paternalistic, risk numerology, and quality “assurance” approaches. More study is needed to determine patient preferences and potential fears associated with medical imaging radiation, and the results can provide insights for such discussions. Worry about the potential risks associated with medical imaging radiation has been shown to be substantial in the US population. The level of concern differs by sex, race/ethnicity, education, nationality, and overall health, suggesting that more care and individualized communication and discussion methods need to be employed by clinical staff. The opportunities for improved dialogue with patients (and parents of patients) and the public in general are plentiful.
Computed Tomography Technology—and Dose—in the 21st Century
Authors: McCollough Cynthia H. 
Published: December 2018

AbstractIn the last decade or so, a number of disruptive technological advances have taken place in x-ray computed tomography, making possible new clinical applications. Changes in scanner design have included the use of two x-ray sources and two detectors or the use of large detector arrays that provide 16 cm of longitudinal coverage in one gantry rotation. These advances have allowed images of the entire heart to be acquired in just one heartbeat, lowering the effective dose from cardiac computed tomography from ~15 mSv to <1 mSv. Dual-energy computed tomography is now in widespread clinical use, enabling the assessment of material composition and concentration, as well as a range of new clinical applications. An emerging technology known as photon-counting detector computed tomography directly measures the energies of detected photons and is capable of simultaneously acquiring more than two energy data sets. Photon-counting detector computed tomography also provides advantages such as the ability to reject electronic noise, better iodine contrast-to-noise for a given dose, and spatial resolution as fine as 150 μm. Optimized x-ray tube potential selection has allowed reduction in radiation and contrast doses. Finally, wide adoption of iterative reconstruction and noise-reduction techniques has occurred. In all, body computed tomography doses have fallen dramatically, for example, by over a factor of 3 from the early 1980s. All of these advances increase the medical benefit and decrease the potential radiation risk associated with computed tomography. However, care must be taken to ensure that doses are not lowered to the level at which the clinical task is compromised.
The IASP classification of chronic pain for ICD-11: applicability in primary care
Authors: Smith Blair H. , Fors Egil A. , Korwisi Beatrice , Barke Antonia , Cameron Paul , Colvin Lesley , Richardson Cara , Rief Winfried , Treede Rolf-Detlef ,   The IASP Taskforce for the Classification of Chronic Pain
Published: December 2018

Abstract
The International Classification of Diseases, 11th Revision (ICD-11), proposes, for the first time, a coding system for chronic pain. This system contains 1 code for “chronic primary pain,” where chronic pain is the disease, and 6 codes for chronic secondary pain syndromes, where pain developed in the context of another disease. This provides the opportunity for routine, standardised coding of chronic pain throughout all health care systems. In primary care, this will confer many important, novel advantages over current or absent coding systems. Chronic pain will be recognized as a centrally important condition in primary care. The capacity to measure incidence, prevalence, and impact will help in identification of human, financial, and educational needs required to address chronic pain in primary care. Finally, opportunities to match evidence-based treatment pathways to distinct chronic pain subtypes will be enhanced.
The IASP classification of chronic pain for ICD-11: chronic neuropathic pain
Authors: Scholz Joachim , Finnerup Nanna B. , Attal Nadine , Aziz Qasim , Baron Ralf , Bennett Michael I. , Benoliel Rafael , Cohen Milton , Cruccu Giorgio , Davis Karen D. , Evers Stefan , First Michael , Giamberardino Maria Adele , Hansson Per , Kaasa Stein , Korwisi Beatrice , Kosek Eva , Lavand'homme Patricia , Nicholas Michael , Nurmikko Turo , Perrot Serge , Raja Srinivasa N. , Rice Andrew S.C. , Rowbotham Michael C. , Schug Stephan , Simpson David M. , Smith Blair H. , Svensson Peter , Vlaeyen Johan W.S. , Wang Shuu-Jiun , Barke Antonia , Rief Winfried , Treede Rolf-Detlef ,   Classification Committee of the Neuropathic Pain Special Interest Group (NeuPSIG)
Published: December 2018

Abstract
The upcoming 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) of the World Health Organization (WHO) offers a unique opportunity to improve the representation of painful disorders. For this purpose, the International Association for the Study of Pain (IASP) has convened an interdisciplinary task force of pain specialists. Here, we present the case for a reclassification of nervous system lesions or diseases associated with persistent or recurrent pain for ≥3 months. The new classification lists the most common conditions of peripheral neuropathic pain: trigeminal neuralgia, peripheral nerve injury, painful polyneuropathy, postherpetic neuralgia, and painful radiculopathy. Conditions of central neuropathic pain include pain caused by spinal cord or brain injury, poststroke pain, and pain associated with multiple sclerosis. Diseases not explicitly mentioned in the classification are captured in residual categories of ICD-11. Conditions of chronic neuropathic pain are either insufficiently defined or missing in the current version of the ICD, despite their prevalence and clinical importance. We provide the short definitions of diagnostic entities for which we submitted more detailed content models to the WHO. Definitions and content models were established in collaboration with the Classification Committee of the IASP's Neuropathic Pain Special Interest Group (NeuPSIG). Up to 10% of the general population experience neuropathic pain. The majority of these patients do not receive satisfactory relief with existing treatments. A precise classification of chronic neuropathic pain in ICD-11 is necessary to document this public health need and the therapeutic challenges related to chronic neuropathic pain.
Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)
Authors: Treede Rolf-Detlef , Rief Winfried , Barke Antonia , Aziz Qasim , Bennett Michael I. , Benoliel Rafael , Cohen Milton , Evers Stefan , Finnerup Nanna B. , First Michael B. , Giamberardino Maria Adele , Kaasa Stein , Korwisi Beatrice , Kosek Eva , Lavand'homme Patricia , Nicholas Michael , Perrot Serge , Scholz Joachim , Schug Stephan , Smith Blair H. , Svensson Peter , Vlaeyen Johan W.S. , Wang Shuu-Jiun 
Published: December 2018

Abstract
Chronic pain is a major source of suffering. It interferes with daily functioning and often is accompanied by distress. Yet, in the International Classification of Diseases, chronic pain diagnoses are not represented systematically. The lack of appropriate codes renders accurate epidemiological investigations difficult and impedes health policy decisions regarding chronic pain such as adequate financing of access to multimodal pain management. In cooperation with the WHO, an IASP Working Group has developed a classification system that is applicable in a wide range of contexts, including pain medicine, primary care, and low-resource environments. Chronic pain is defined as pain that persists or recurs for more than 3 months. In chronic pain syndromes, pain can be the sole or a leading complaint and requires special treatment and care. In conditions such as fibromyalgia or nonspecific low-back pain, chronic pain may be conceived as a disease in its own right; in our proposal, we call this subgroup “chronic primary pain.” In 6 other subgroups, pain is secondary to an underlying disease: chronic cancer-related pain, chronic neuropathic pain, chronic secondary visceral pain, chronic posttraumatic and postsurgical pain, chronic secondary headache and orofacial pain, and chronic secondary musculoskeletal pain. These conditions are summarized as “chronic secondary pain” where pain may at least initially be conceived as a symptom. Implementation of these codes in the upcoming 11th edition of International Classification of Diseases will lead to improved classification and diagnostic coding, thereby advancing the recognition of chronic pain as a health condition in its own right.
The IASP classification of chronic pain for ICD-11: chronic primary pain
Authors: Nicholas Michael , Vlaeyen Johan W.S. , Rief Winfried , Barke Antonia , Aziz Qasim , Benoliel Rafael , Cohen Milton , Evers Stefan , Giamberardino Maria Adele , Goebel Andreas , Korwisi Beatrice , Perrot Serge , Svensson Peter , Wang Shuu-Jiun , Treede Rolf-Detlef ,   The IASP Taskforce for the Classification of Chronic Pain
Published: December 2018

Abstract
This article describes a proposal for the new diagnosis of chronic primary pain (CPP) in ICD-11. Chronic primary pain is chosen when pain has persisted for more than 3 months and is associated with significant emotional distress and/or functional disability, and the pain is not better accounted for by another condition. As with all pain, the article assumes a biopsychosocial framework for understanding CPP, which means all subtypes of the diagnosis are considered to be multifactorial in nature, with biological, psychological, and social factors contributing to each. Unlike the perspectives found in DSM-5 and ICD-10, the diagnosis of CPP is considered to be appropriate independently of identified biological or psychological contributors, unless another diagnosis would better account for the presenting symptoms. Such other diagnoses are called “chronic secondary pain” where pain may at least initially be conceived as a symptom secondary to an underlying disease. The goal here is to create a classification that is useful in both primary care and specialized pain management settings for the development of individualized management plans, and to assist both clinicians and researchers by providing a more accurate description of each diagnostic category.
The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain
Authors: Nugraha Boya , Gutenbrunner Christoph , Barke Antonia , Karst Matthias , Schiller Jörg , Schäfer Peter , Falter Silke , Korwisi Beatrice , Rief Winfried , Treede Rolf-Detlef ,   The IASP Taskforce for the Classification of Chronic Pain
Published: December 2018

Abstract
Physical, mental, and social well-being are part of the concept of health according to the World Health Organization, in addition to the absence of disease and infirmity. Therefore, for a full description of a person's health status, the International Classification of Functioning, Disability and Health (ICF) was launched in 2001 to complement the existing International Classification of Diseases (ICD). The 11th version of the ICD (ICD-11) is based on so-called content models, which have 13 main parameters. One of them is functioning properties (FPs) that, according to the WHO, consist of the activities and participation components of the ICF. Recently, chronic pain codes were added to the 11th edition of the ICD, and hence, a specific set of FPs for chronic pain is required as a link to the ICF. In addition, pain is one of the 7 dimensions of the generic set of the ICF, which applies to any person. Thus, assessment and management of pain are also important for the implementation of the ICF in general. This article describes the current consensus proposal by the International Association for the Study of Pain (IASP) and the International Society of Physical and Rehabilitation Medicine (ISPRM) for a specific set of FPs of chronic pain, which will have to be empirically validated in a next step. The combined use of ICD-11 and ICF is expected to improve research reports on chronic pain by a more precise and adequate coding, as well as patient management through better diagnostic classification.
Impact on Clinical Performance of Required Participation in a Student-Run Pro Bono Clinic
Authors: Gilles Jodi , Bishop Mark , McGehee William , Lulofs-MacPherson Kevin , Dunleavy Kim 
Published: December 2018

Background and Purpose.
Early opportunities for students to develop clinical skills and professional attributes are important to maximize clinical learning. Student-run pro bono clinics have the potential to provide early contextual exposure. This article describes the impact of required compared to voluntary participation in a student-run pro bono clinic on clinical performance during the first full-time internship.

Method/Model Description and Evaluation.
Students in the University of Florida Doctor of Physical Therapy program were assigned to one of four service learning groups including a pro bono clinic. While attendance at the clinic was encouraged for all students, only the assigned group was required to attend twice a semester. A retrospective analysis of student performance on the Clinical Performance Instrument (CPI) for the first internship was conducted. Clinician CPI ratings were categorized as beginner or intermediate and above. Median scores for safety, professional practice, and practice management items for those students who were required to attend the clinic were compared to students from the other service learning groups who did not attend or attended voluntarily using Chi-square analysis.

Outcomes.
At midterm, a higher proportion of the required pro bono group were rated as intermediate or above by clinical instructors for safety, all professional practice items except professional development, and all patient management items except diagnosis/prognosis, education, and consideration of financial resources. Differences were present at the final evaluation for safety, professional behavior, cultural competence, clinical reasoning, and examination.

Discussion and Conclusion.
Positive outcomes were present for students involved in the pro bono clinic, illustrating the potential benefits of required pro bono clinic experiences early in a professional curriculum for accelerating clinical performance.
Calcinosis Cutis of the Vulva: A Review
Authors: Wang Qing , Heller Debra S. 
Published: December 2018

Abstract
Idiopathic calcinosis cutis (CC) is an uncommon skin condition. Although it has been reported many times in the scrotum, it is exceedingly rare in the vulva. Most reports of vulvar CC are in children. Vulvar CC may be thought clinically to be inclusion cysts. Other causes of calcinosis such as autoimmune disease or alterations in serum calcium levels, potentially associated with malignancy, must be considered before considering a case as idiopathic.
Haptoglobin 2 Allele is Associated With Histologic Response to Vitamin E in Subjects With Nonalcoholic Steatohepatitis
Authors: Banini Bubu A. , Cazanave Sophie C. , Yates Katherine P. , Asgharpour Amon , Vincent Robert , Mirshahi Faridoddin , Le Peter , Contos Melissa J. , Tonascia James , Chalasani Naga P. , Kowdley Kris V. , McCullough Arthur J. , Behling Cynthia A. , Schwimmer Jeffrey B. , Lavine Joel E. , Sanyal Arun J. 
Published: December 2018

Background:
Haptoglobin (Hp) genotype has been linked to oxidative stress and cardiovascular outcomes in response to vitamin E (VitE) among patients with diabetes mellitus. Its effect on histologic response to VitE in nonalcoholic steatohepatitis (NASH) is unknown.

Goals:
Our objective was to determine if Hp genotype associates with response to VitE in patients with NASH.

Study:
A post hoc analysis of 228 patients receiving VitE or placebo in 2 clinical trials was performed. Regression analysis was used to assess the effect of VitE versus placebo, by Hp genotype (1-1, 2-1, or 2-2), on histologic features and laboratory markers of nonalcoholic fatty liver disease, comparing baseline to end of treatment values. An interaction term was included in the regression models to assess differential treatment effect across Hp genotype.

Results:
Hp 2-2 patients treated with VitE versus placebo showed significant histologic improvement (51% vs. 20%; OR=4.2; P=0.006), resolution of steatohepatitis (44% vs. 12%; OR=6.2; P=0.009), decrease in nonalcoholic fatty liver disease Activity Score (NAS) (−2.2 vs. −0.6; P=0.001), and decrease in liver enzymes alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and γ-glutamyl transpeptidase. Hp 2-1 patients on VitE versus placebo showed improved resolution of steatohepatitis, NAS and liver enzymes. Hp 1-1 patients showed no significant improvement in histology or liver enzymes. VitE had no effect on fibrosis stage in any group. Regression analysis showed incremental benefit of having Hp 2-2 or 2-1 versus 1-1 for all liver enzyme.

Conclusions:
Hp 2 allele is associated with greater histologic and biological improvement in NASH with VitE treatment compared with the Hp 1 allele.
Pathogenesis and treatment of electrolyte problems post transplant
Authors: Kim Erin 
Published: December 2018

Purpose of review
Electrolyte abnormalities posttransplant are common occurrences that can have significant short-term and long-term effects on graft outcome and patient quality of life. Understanding the pathophysiology of these electrolyte derangements can help guide management to optimize bone health and minimize cardiovascular disease. This review explores the pathogenesis of the most common postrenal transplant electrolytes abnormalities as well as current treatment options.

Recent findings
Clarifications of the role of FGF-23 has improved our understanding of posttransplant bone disease in addition to the known roles of hyperparathyroidism and vitamin D. The mechanisms of renal electrolyte wasting by immunosuppressive agents give insight into potential treatment options for hyperkalemia and hypomagnesemia.

Summary
Understanding the pathogenesis of the common electrolyte abnormalities found post renal transplant may lead to targeted treatment options that in turn may improve transplant complications. Further studies are required to evaluate the effects on long-term outcomes of renal allografts.
A Nursing Dashboard to Communicate the Evaluation of Program Outcomes
Authors: Opsahl Angela , Horton-Deutsch Sara 
Published: December 2018

Background
Schools of nursing pursue accreditation to convey the quality of their program. Communication of their process for continuous quality improvement and ability to produce competent nurse graduates are common program goals.

Purpose
This article describes the implementation of a nursing dashboard as an innovative approach to examine and communicate program outcomes.

Methods
A comprehensive evaluation document in the form of a dashboard was created in a user-friendly format to monitor and convey outcomes to stakeholders. This visual evaluation document was crafted in congruence with a utilization-oriented evaluation model incorporating accreditation standards.

Results
Stakeholders, including alumni, faculty, and students, conveyed satisfaction with the dashboard graphic of program evaluation data. Participant responses were greater than 4.3/5.0 on a Likert scale, indicating satisfaction with the dashboard communication of outcomes.

Conclusions
The nursing dashboard provides an innovative approach to the review of program outcomes with meaningful data for strategic planning and program decisions.
Birth Defects After Exposure to Efavirenz-Based Antiretroviral Therapy at Conception/First Trimester of Pregnancy: A Multicohort Analysis
Authors: Martinez de Tejada Begoña ,   European Pregnancy and Paediatric HIV Cohort Collaboration Study Group
Published: December 2018

Background:
To investigate the association between efavirenz (EFV) use during conception or first trimester (T1) of pregnancy and the occurrence of birth defects.

Setting:
Seven observational studies of pregnant HIV-positive women across 13 European countries and Thailand.

Methods:
Individual-level data were pooled on singleton pregnancies included in participating cohorts in 2002–2015. Birth defects were coded according to ICD-10 and the EUROCAT classification. We performed mixed-effects logistic regression models to assess the association between EFV exposure in utero and likelihood of birth defects.

Results:
We included 24,963 live births from 21,093 women. At conception, 30.2% (7537) women were on a non–EFV-based regimen, 4.8% (1200) on EFV, and 65% (16,226) were unexposed to antiretroviral therapy (ART). There were 412 infants with ≥1 birth defect, a prevalence of 1.65% (95% confidence interval: 1.50 to 1.82). Limb/musculoskeletal and congenital heart defects were the most common defects reported. Birth defects were present in 2.4%, 1.6%, and 1.3% of infants exposed to non-EFV, EFV, and unexposed to ART during conception/T1 (P = 0.135), respectively. The association between exposure to ART during conception/T1 and birth defects remained nonsignificant in adjusted analyses, as did exposure to EFV versus non-EFV (adjusted odds ratio 0.61; 95% confidence interval: 0.36 to 1.03, P = 0.067). Among the 21 birth defects in 19 infants on EFV, no neural tube defects were reported.

Conclusions:
Prevalence of birth defects after exposure to EFV-based compared with non–EFV-based ART in conception/T1 was not statistically different in this multicohort study, and even lower. EFV is at least as safe as other ART drugs currently recommended for antenatal use.
Retention in Care Trajectories of HIV-Positive Individuals Participating in a Universal Test-and-Treat Program in Rural South Africa (ANRS 12249 TasP Trial)
Authors: Gosset Andréa , Protopopescu Camelia , Larmarange Joseph , Orne-Gliemann Joanna , McGrath Nuala , Pillay Deenan , Dabis François , Iwuji Collins , Boyer Sylvie 
Published: December 2018

Objective:
To study retention in care (RIC) trajectories and associated factors in patients eligible for antiretroviral therapy (ART) in a universal test-and-treat setting (TasP trial, South Africa, 2012–2016).

Design:
A cluster-randomized trial whereby individuals identified HIV positive after home-based testing were invited to initiate ART immediately (intervention) or following national guidelines (control).

Methods:
Exiting care was defined as ≥3 months late for a clinic appointment, transferring elsewhere, or death. Group-based trajectory modeling was performed to estimate RIC trajectories over 18 months and associated factors in 777 ART-eligible patients.

Results:
Four RIC trajectory groups were identified: (1) group 1 “remained” in care (reference, n = 554, 71.3%), (2) group 2 exited care then “returned” after [median (interquartile range)] 4 (3–9) months (n = 40, 5.2%), (3) group 3 “exited care rapidly” [after 4 (4–6) months, n = 98, 12.6%], and (4) group 4 “exited care later” [after 11 (9–13) months, n = 85, 10.9%]. Group 2 patients were less likely to have initiated ART within 1 month and more likely to be male, young (<29 years), without a regular partner, and to have a CD4 count >350 cells/mm3. Group 3 patients were more likely to be women without social support, newly diagnosed, young, and less likely to have initiated ART within 1 month. Group 4 patients were more likely to be newly diagnosed and aged 39 years or younger.

Conclusions:
High CD4 counts at care initiation were not associated with a higher risk of exiting care. Prompt ART initiation and special support for young and newly diagnosed patients with HIV are needed to maximize RIC.