bluuebunny/crossref_metadata_2025_split huggingface dataset:
CLINICAL PRESENTATIONS, DIAGNOSIS, AND MANAGEMENT OUTCOMES OF CURVULARIA ENDOPHTHALMITIS AND A REVIEW OF LITERATURE
Authors: Dave Vivek Pravin , Joseph Joveeta , Pathengay Avinash , Pappuru Rajeev R. , Das Taraprasad 
Published: October 2018

Purpose:
To describe the clinical presentation and management of Curvularia endophthalmitis and compare with previous published literature.

Methods:
Retrospective interventional comparative case series and literature review. Eight cases with culture-proven Curvularia endophthalmitis from January 2000 to March 2018 underwent vitrectomy/vitreous biopsy, intravitreal antibiotic with or without additional procedures as appropriate. The undiluted vitreous biopsy was subjected to microbiologic evaluation. Pre-existing literature was reviewed, and the current outcomes were compared with them. The mean age at presentation, etiology, number of interventions, interval between inciting event and presentation, type of intravitreal antifungal used, anatomical, and the functional outcomes were reported and compared with pre-existing literature. A favorable anatomical outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit.

Results:
In the current series, there were 4 men and 4 women. Mean age at presentation was 34.5 ± 13.51 years (median 30 years). Inciting event was open-globe injury in five cases and cataract surgery, trabeculectomy, and endogenous cause in one case each. Presenting visual acuity was ≥20/400 in 3 cases at presentation and 5 cases at the last visit. One case with staphyloma and endophthalmitis underwent evisceration for a painful blind eye. The patients in the current series were much younger than those described previously.

Conclusion:
Presentation and diagnosis of Curvularia can be delayed especially in postoperative cases. Early and appropriate management with multiple interventions can result in an acceptable visual and anatomical outcome.
EPSTEIN–BARR VIRUS ACUTE RETINAL NECROSIS IN AN IMMUNOCOMPETENT HOST
Authors: Chan Errol W. , Sun Vincent , Eldeeb Mohab , Kapusta Michael A. 
Published: October 2018

Purpose:
To describe a case of Epstein–Barr virus (EBV)-associated acute retinal necrosis (ARN) in an immunocompetent patient and to summarize the clinical features of published molecularly confirmed EBV–ARN cases.

Methods:
Case report and literature review.

Results:
An 83-year-old immunocompetent woman with unilateral ARN presented with visual acuity of light perception. Oral valacyclovir was started. One week later, vitrectomy was conducted for worsening inflammation. Intraoperatively, a severe confluent necrotizing retinitis and occlusive vasculitis involving all four quadrants of posterior and peripheral retina were noted. Vitreous polymerase chain reaction was exclusively positive for EBV. Other autoimmune, infective, and hematological work-up was negative. The retinitis resolved 3 months later, but with significant macular and generalized retinal atrophy, visual acuity remained light perception. From the literature, there are four EBV–ARN cases (six eyes) diagnosed based on polymerase chain reaction or fluorescence in-situ hybridization of vitreous or retinal samples. All patients were immunocompromised or on immunosuppressive treatment. Presenting visual acuity was light perception or worse in 3/6 eyes. Three patients received systemic acyclovir-based therapy. Vitrectomy was performed in 4/6 eyes between 4 and 8 weeks from disease onset. All cases had involvement of the posterior and peripheral retina. Retinal detachment occurred in 2/6 eyes, and final visual acuity was no light perception in 3/6 eyes.

Conclusion:
This case expands the clinical spectrum of EBV–ARN to include infection in immunocompetent hosts. Epstein–Barr virus–ARN seems to be characterized by a global peripheral and posterior fulminant retinitis, with adverse visual acuity outcomes despite systemic acyclovir-based therapy. The benefits of adjunctive intravitreal foscarnet, systemic steroids, and early vitrectomy may warrant further investigation.
Randomized Study of Collagen Cross-Linking With Conventional Versus Accelerated UVA Irradiation Using Riboflavin With Hydroxypropyl Methylcellulose: Two-Year Results
Authors: Hagem Anne Marie , Thorsrud Andreas , Sandvik Gunhild Falleth , Drolsum Liv 
Published: October 2018

Purpose:
To compare the clinical outcome 2 years after corneal collagen cross-linking (CXL) with conventional and accelerated ultraviolet A (UVA) irradiation using riboflavin with hydroxypropyl methylcellulose.

Methods:
Prospective randomized controlled study. Forty patients with keratoconus (40 eyes) were randomized to either CXL using conventional 3 mW/cm2 UVA irradiation for 30 minutes (CXL30 group) or accelerated 9 mW/cm2 UVA irradiation for 10 minutes (CXL10 group). In both groups, a solution of 0.1% riboflavin with 1.1% hydroxypropyl methylcellulose (methylcellulose–riboflavin) was used. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), and Scheimpflug tomography were performed at baseline and after 24 months.

Results:
Both groups had statistically significant improvement in CDVA and maximum keratometric reading compared with baseline; however, with no statistically significant difference in the change between the 2 groups. No significant changes in flattest, steepest and mean keratometry (K1, K2 and K mean) were found in either of the groups. There were no statistically significant changes in ECD in either group after 2 years or in the difference in the change between the 2 groups. A literature review showed comparative clinical outcome after accelerated CXL compared with conventional CXL; however, in several studies, there was a tendency for less pronounced corneal flattening after accelerated CXL.

Conclusions:
Improvement in visual acuity and maximum keratometric reading 2 years after CXL was found after both conventional and accelerated UVA irradiation using methylcellulose–riboflavin. This suggests that when using riboflavin with methylcellulose, the less time-consuming accelerated protocol is a valuable and effective option in CXL treatment.
Classification of Limbal Stem Cell Deficiency Using Clinical and Confocal Grading
Authors: Aravena Carolina , Bozkurt Kansu , Chuephanich Pichaya , Supiyaphun Chantaka , Yu Fei , Deng Sophie X. 
Published: October 2018

Purpose:
To grade the severity of limbal stem cell deficiency (LSCD) based on the extent of clinical presentation and central corneal basal epithelial cell density (BCD).

Methods:
This is a retrospective observational comparative study of 48 eyes of 35 patients with LSCD and 9 eyes of 7 normal subjects (controls). Confocal images of the central cornea were acquired. A clinical scoring system was created based on the extent of limbal and corneal surface involvement. LSCD was graded as mild, moderate, and severe stages based on the clinical scores. The degree of BCD reduction was given a score of 0 to 3.

Results:
Compared with BCD in controls, BCD decreased by 23.0%, 40.4%, and 69.5% in the mild, moderate, and severe stages of LSCD classified by the clinical scoring system, respectively. The degree of BCD reduction was positively correlated with larger limbal and corneal surface involvement and when the central visual axis was affected (all P ≤ 0.0005). Mean corrected distance visual acuity logarithm of the minimum angle of resolution was 0.0 ± 0.0 in control eyes, 0.2 ± 0.5 in mild LSCD, 0.6 ± 0.4 in moderate LSCD, and 1.6 ± 1.1 in severe LSCD (P < 0.0001). There was a significant correlation between a higher clinical score and corrected distance visual acuity logarithm of the minimum angle of resolution (rho = 0.82; P < 0.0001) and a greater decrease in BCD (rho = −0.78; P < 0.0001).

Conclusions:
A clinical scoring system was developed to assess the extent of clinical presentation of LSCD. A classification system to grade the severity of LSCD can be established by combining the BCD score with the clinical score.
Mechanistic pain profiling as a tool to predict the efficacy of 3-week nonsteroidal anti-inflammatory drugs plus paracetamol in patients with painful knee osteoarthritis
Authors: Petersen Kristian Kjær , Olesen Anne Estrup , Simonsen Ole , Arendt-Nielsen Lars 
Published: October 2018

Abstract
Joint inflammation is present in a subpopulation of knee osteoarthritis (OA) patients. Proinflammatory cytokines are known to sensitize the peripheral and central pain pathways. This can be mechanistically assessed by pressure pain thresholds and temporal summation of pain (TSP). Nonsteroidal anti-inflammatory drugs (NSAIDs) combined with paracetamol are recommended as OA treatment. The current study hypothesized that evidence of central sensitization would predict poor responses to peripherally directed therapies in knee OA and therefore aimed to investigate the value of mechanistic pain profiling for predicting pain outcome of treatment with NSAIDs plus paracetamol. One hundred thirty-two patients received ibuprofen 1200 mg/daily, paracetamol 3 g/daily, and pantoprazole 20 mg/daily for 3 weeks. Before administration, cuff pain detection, tolerance threshold, and TSP were assessed. Worst pain within the last 24 hours and pain during activity (visual analogue scales) were assessed before and after treatment. Facilitated TSP was found at baseline in the nonresponders to the 3-weeks treatment as compared to responders for both the 30% and 50% pain alleviation criteria (P < 0.02). Linear regression models identified facilitated TSP (P < 0.01) and low clinical pain scores (P < 0.001) as independent factors for prediction of poor pain alleviation by the treatment. In conclusion, this study found that mechanistic pain profiling can predict pain alleviation of NSAIDs and paracetamol. Facilitated TSP and low clinical pain scores before treatment are independent predictors of poor pain alleviation after NSAIDs and paracetamol. This study adds to the growing evidence that a subgroup of knee OA patients with manifested central sensitization may require special management attention.
A Tailored Dietary Sodium Intervention Using Technology and Psychosocial Support
Authors: Heo Seongkum , McSweeney Jean , Prewitt T. Elaine , Lee Jeannette Y. , Moser Debra K. , Shaw-Devine Allison , Morell Audrey , Kim JinShil , Yeary Karen H. K. 
Published: October 2018

Background
In patients with heart failure (HF), high dietary sodium intake is common and associated with HF symptoms, poor health-related quality of life (HRQOL), and high hospitalization rates.

Purpose
The aims of this study were to examine the feasibility of a tailored dietary intervention with a practical tool (MyFitnessPal) and to obtain preliminary data about the effects on sodium intake, factors affecting sodium intake (knowledge, skills, experiences, confidence, perceived benefits and barriers, and depressive symptoms), HF symptoms, and HRQOL.

Methods
A 6-session intervention was delivered to 11 participants. Paired t tests were used to compare the baseline outcomes with those at 3 months.

Results
Participants completed 98% of intervention sessions, and 91% used MyFitnessPal. Sodium intake was reduced, and factors affecting sodium intake, symptoms, and HRQOL were improved (all P < .05).

Conclusion
The intervention was feasible and warrants further research to test the effects of the intervention on the outcomes using larger, heterogeneous samples.
A Method to Study the Effect of a Physician Assistant Student on Preceptor Productivity
Authors: Evans Timothy C. , Wick Keren H. , Andrilla C. Holly A. , Skaggs Steven A. , Burgin Tiffani 
Published: October 2018

Purpose
Guided clinical experience is a critical component of a physician assistant (PA) student's education. However, clinical precepting is strongly perceived to have deleterious effects on productivity. In this study, we sought to test a method for evaluating the effect that PA students have on clinical productivity.

Methods
We recruited 14 family medicine preceptors and second-year PA students from 2 programs, the University of Washington (UW) and the University of Texas Health Science Center San Antonio (UT). We collected productivity data during 3 weeks of preceptor clinical practice—one week without a PA student present and 2 weeks with a PA student present (one week early in the student's family medicine clinical rotation and a second week late in the rotation). We collected preceptor demographic data, patient characteristics, and the primary outcome—relative value units (RVUs) per preceptor per half-day during the 3 data collection weeks. At the end of the study, we asked preceptors about the ease of data collection and any negative effects of the study itself on their clinical productivity.

Results
No significant differences were found in preceptor demographics or in patient characteristics, numbers of patients, or RVUs per patient seen in any of the weeks or between UW and UT. In this pilot study, no significant differences were seen in RVUs per preceptor per half-day between the 3 weeks of observation or between UW and UT.

Conclusion
In this pilot study, the protocol was straightforward, unintrusive, and preliminarily showed no significant effects of a PA student on preceptor productivity.
Nonoperative Applications of Placental Tissue Matrix in Orthopaedic Sports Injuries: A Review of Literature
Authors: Sultan Assem A. , Piuzzi Nicolas S. , Mont Michael A. 
Published: October 2018

Objective:
Recently, various amniotic tissue and placental-based tissue matrix (PTM) products have become increasingly available as a nonoperative treatment for tendinopathies and orthopaedic sports injuries. The aim of this review was to evaluate: (1) safety and efficacy of nonoperative use of PTM products, in acute and chronic tendon injuries and (2) the commercially available tissue options to better understand their differences.

Data Sources:
A comprehensive literature search was performed. Inclusion criteria were studies reporting on: (1) nonoperative uses of PTM therapy in sports injuries; and (2) clinical outcomes; in (3) human subjects. We excluded: (1) animal studies; (2) basic science studies; (3) non-English language literature; (4) review articles; and (5) duplicate studies. In addition, to determine the various product formulations, their tissue contents, and indications for use, we searched publicly available website content, marketing literature, and Food and Drug Administration (FDA) registration documents.

Main Results:
Current evidence investigated various PTM products for the treatment of various tendon injuries with demonstrated efficacy mainly in the short term with follow-up ranging between 6 weeks and 3 months. In addition, across all studies, no specific adverse events were reported. Substantial differences exist among the currently available products due to variations in their tissue source, formulations, processing methods, method of sterilization, preservation, and storage, indications for use, and FDA regulation.

Conclusions:
Placental- and amniotic membrane–derived tissues seem to be safe for the nonoperative treatment of tendinopathies. However, several factors may affect the efficacy and safety profile of these products, and the orthopaedic surgeons should be aware of the differences.
Identifiable Factors Associated With Acceptance Into Sports Medicine Fellowship Programs: A Brief Report
Authors: Zaremski Jason L. , Rao Ashwin , Myers Rebecca , Mautner Ken , Berkoff David , Ross David , Logan Kelsey , Horodyski MaryBeth , Asif Irfan M. 
Published: October 2018

Objective:
To identify factors associated with entry into primary care sports medicine (PCSM) fellowship programs.

Design:
Primary care sports medicine fellowship directors (FDs) and fellowship faculty were surveyed regarding preferences for accepting applicants into their programs.

Setting:
Survey study.

Participants:
Primary care sports medicine FDs and fellowship faculty.

Assessment of Risk Factors:
Questions were designed to delineate factors [clinical experience, letters of recommendation (LOR), scholarship, service commitment, interview performance, etc] perceived to be associated with entry into PCSM fellowship (1-10 scale; 10 = highest value). Weighted mean ± SD were calculated for each question.

Main Outcome Measures:
Determination of most valued factors for entry into PCSM fellowship.

Results:
Responses were provided by 242/2332 (10.4%) of the American Medical Society for Sports Medicine members, including 77 of 175 (44%) FDs. The top 3 factors for entry into PCSM fellowships for all respondents were as follows: interview performance (9.17 ± 1.13), LOR from SM fellowship faculty (8.20 ± 1.67), and high school game/event coverage (7.83 ± 1.70). Musculoskeletal ultrasound experience (4.50 ± 2.23) and residency training in pediatrics (4.58 ± 2.54), internal medicine (4.48 ± 2.44), emergency medicine (4.44 ± 2.59), and physical medicine and rehabilitation (4.40 ± 2.83) received the lowest scores.

Conclusions:
Applicants seeking entry into SM fellowships should prioritize performance during interviews, LOR from SM fellowship faculty, and team game/event coverage experiences.
Personnel Management and Biosecurity of U.S. High-Level Isolation Units
Authors: Herstein Jocelyn J. , Biddinger Paul D. , Gibbs Shawn G. , Le Aurora B. , Jelden Katelyn C. , Hewlett Angela L. , Lowe John J. 
Published: October 2018

OBJECTIVE
To describe strategies used by US high-level isolation units (HLIUs) to recruit, train, and sustain a full team of multidisciplinary staff and identify how units are secured.

BACKGROUND
Fifty-six US hospitals have been designated HLIUs, capable of providing safe care to patients with highly infectious disease.

METHODS
An electronic survey was administered to the 56 HLIUs in spring of 2016. Responses were collected via a fillable PDF and analyzed using descriptive statistics.

RESULTS
Thirty-six HLIUs (64%) responded; 33 completed surveys, and 3 reported no longer being a designated HLIU. HLIUs reported large numbers of multidisciplinary staff, primarily consisting of RNs and critical care clinicians. Nearly all HLIUs (94%) required orientation training, although hours varied.

CONCLUSIONS
Over a short period, HLIUs recruited and trained significant numbers of staff with little guidance. Costs of ongoing trainings are considerable, and it remains unclear how HLIUs will continue funding these activities.
Staff Perceptions of Decision-Making in a Shared Governance Culture
Authors: Di Fiore Tina , Zito Antoinette , Berardinelli Amy , Bena James F. , Morrison Shannon L. , Keck Diane E. , Kennedy Kathleen , Stibich Ann , Albert Nancy M. 
Published: October 2018

OBJECTIVE
To evaluate differences in the shared decision-making perceptions of clinical nurses between initial implementation of a shared governance model and perceptions 3 years later after the model has matured.

BACKGROUND
Shared decision-making empowers nurses to have a voice in their practice and supports engagement and retention.

METHODS
A prospective, 2-group comparative design was conducted using the Index of Professional Nursing Governance, a validated, reliable tool. After comparing data univariately, a multivariable linear regression model was used to evaluate the impact of nurse characteristics on shared decision-making responses.

RESULTS
Mean overall shared decision-making score (P = .23) and domain scores (P values between .055 and .63) did not increase in 2015 compared with 2012. After adjusting for differences in nurse characteristics between groups, overall score (P = .017) and 3 of 6 domain scores improved: professional control of work, structures for decisions and access to information (all P values between .005 and .031).

CONCLUSION
As shared governance became established, shared decision-making scores increased.
Incivility Toward Nursing Students in Clinical Rotations
Authors: Tecza Bonnie M. , Boots Brenda K. , Mains Brandi C. , Dryer Lisa D. , Oertle Dena L. , Pontius Camie J. , Cantu Chelcia L. , Olney Adrienne , McElroy Susan , Teasley Susan 
Published: October 2018

OBJECTIVE
The purpose of this study was to measure nursing student perceptions of incivility in the clinical learning environment and test interventions that improve these perceptions. The secondary aim was to further test the reliability of the Nursing Student Perception of Civil and Uncivil Behaviors (NSPCUB) tool.

BACKGROUND
Incidence of incivility in nursing is well documented in the literature; however, there are few evidence-based interventions to combat this phenomenon.

METHODS
NSPCUB was administered to 314 nursing students. Data were used to develop hospital-wide and unit-specific interventions. After implementation of the interventions, the survey was administered to 410 students.

RESULTS
There was a statistically significant mean increase for 7 of the 12 survey items, hospital-wide, and the findings reenforced NSPCUB as a highly reliable tool.

CONCLUSIONS
This instrument can be used by nurse executives to measure perceptions of incivility, identify areas for improvement, and implement interventions.
Dynamic of the somatosensory system in postherpetic neuralgia
Authors: Gierthmühlen Janne , Braig Olga , Rehm Stefanie , Hellriegel Jana , Binder Andreas , Baron Ralf 
Published: October 2018

Abstract

Introduction:
In postherpetic neuralgia (PHN) different types of patients can be distinguished regarding their predominant peripheral nociceptor function.

Objective:
The aim was to examine somatosensory profiles in the course of disease with special regard to the different subtypes existing in PHN.

Methods:
Twenty patients with PHN (7 men and 13 women, age 67 ± 9.6 years) were examined at baseline (disease duration 18.1 ± 26 months) and follow-up (31.6 ± 23.8 months later) with quantitative sensory testing (protocol of the German Research Network on Neuropathic Pain).

Results:
Fourteen (70%) PHN patients presented with impaired (iPHN) and 6 (30%) with preserved (pPHN) C-fiber function. Groups did not differ regarding age, disease duration, or pain intensity at baseline. Both groups did not differ regarding change in pain intensity (−0.5 ± 2.3 vs −1.7 ± 2.6 numerical rating scale, P = n.s.) at follow-up. Impaired PHN improved in thermal and mechanical detection thresholds as well as allodynia independent from change in pain intensity. By contrast, pPHN showed an increase in mechanical pain sensitivity (1.4 ± 2.5 vs −0.4 ± 2.2, P < 0.05) and a trend towards a stronger loss of detection (66% vs 33%, P = n.s.) on follow-up.

Conclusion:
Results demonstrate that patients with preserved C-fiber function are more predisposed to develop signs of central sensitization as demonstrated by an increased mechanical pain sensitivity. Impaired C-fiber function is able to improve even in chronic cases, but a functional loss is unlikely to play a role here. The knowledge of development of somatosensory profiles in the course of the disease offers possibilities to optimize a mechanism-based treatment.