bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of a Medical Student Research and Career Development Program to Increase Diversity in Academic Medicine
Authors: Fernandez Alicia , Chen Victoria , Quan Judy , Martinez Alma , Flowers Loma , Aronson Louise 
Published: April 2019

Purpose
To describe and evaluate an innovative research program supported by the National Institutes of Health, “Promoting Research Opportunities Fully—Prospective Academics Transforming Health” (PROF-PATH), designed to support medical students from groups underrepresented-in-medicine (URM) interested in pursuing academic careers.

Method
Based on social cognitive career theory (SCCT), PROF-PATH supplemented a traditional research program (TRP) by providing additional mentorship and a curriculum focused on “assumed knowledge” of academic culture, guidance with research challenges, and emotional competence. The four-year evaluation (2013–2016) consisted of pre- and postprogram surveys of PROF-PATH and TRP students, plus focus groups and individual structured interviews with PROF-PATH students. Survey questions queried students’ self-confidence in research- and career-related skills and abilities. The authors mapped themes elicited in focus groups and interviews onto SCCT domains.

Results
Of 454 medical students, 343 (75.6%) completed the surveys. According to preprogram surveys, PROF-PATH students (n = 85) were less confident in their ability to find or manage mentor relationships than TRP students (n = 258) and less likely to report having a mentor who provided strong support for their research interests. At program’s end, PROF-PATH students showed greater increases in confidence than TRP students in multiple ability domains. Qualitative analysis of themes indicated that PROF-PATH influenced students through seven SCCT domains and increased student academic career self-efficacy.

Conclusions
An innovative program for URM medical students participating in mentored research was successful in supporting academic career interest and academic self-efficacy. Schools motivated to increase diversity in academic medicine should consider adapting PROF-PATH.
Automated Ambulatory Blood Pressure Measurements and Intraoperative Hypotension in Patients Having Noncardiac Surgery with General Anesthesia
Authors: Saugel Bernd , Reese Philip C. , Sessler Daniel I. , Burfeindt Christian , Nicklas Julia Y. , Pinnschmidt Hans O. , Reuter Daniel A. , Südfeld Stefan 
Published: April 2019

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Normal blood pressure varies among individuals and over the circadian cycle. Preinduction blood pressure may not be representative of a patient’s normal blood pressure profile and cannot give an indication of a patient’s usual range of blood pressures. This study therefore aimed to determine the relationship between ambulatory mean arterial pressure and preinduction, postinduction, and intraoperative mean arterial pressures.

Methods
Ambulatory (automated oscillometric measurements at 30-min intervals) and preinduction, postinduction, and intraoperative mean arterial pressures (1-min intervals) were prospectively measured and compared in 370 American Society of Anesthesiology physical status classification I or II patients aged 40 to 65 yr having elective noncardiac surgery with general anesthesia.

Results
There was only a weak correlation between the first preinduction and mean daytime mean arterial pressure (r = 0.429, P < 0.001). The difference between the first preinduction and mean daytime mean arterial pressure varied considerably among individuals. In about two thirds of the patients, the lowest postinduction and intraoperative mean arterial pressures were lower than the lowest nighttime mean arterial pressure. The difference between the lowest nighttime mean arterial pressure and a mean arterial pressure of 65 mmHg varied considerably among individuals. The lowest nighttime mean arterial pressure was higher than 65 mmHg in 263 patients (71%).

Conclusions
Preinduction mean arterial pressure cannot be used as a surrogate for the normal daytime mean arterial pressure. The lowest postinduction and intraoperative mean arterial pressures are lower than the lowest nighttime mean arterial pressure in most patients.
Capsulotomy in Unstable Slipped Capital Femoral Epiphysis and the Odds of AVN: A Meta-analysis of Retrospective Studies
Authors: Kaushal Neil , Chen Cynthia , Agarwal Kunal N. , Schrader Tim , Kelly Derek , Dodwell Emily R. 
Published: April 2019

Background:
Unstable slipped capital femoral epiphysis (SCFE) may lead to avascular necrosis (AVN) in up to 60% of patients. The aim of this study was to assess the best clinical evidence to determine the effect of capsular decompression (CD) on odds of AVN in unstable SCFE.

Methods:
Medline, Embase, and Cochrane databases were systematically searched for comparative studies investigating AVN rates in unstable SCFE treated with or without CD (aspiration, percutaneous, or open). Quality was evaluated by the Newcastle Ottawa Scale. A comparative analysis with pooled effect estimates using random-effects modeling was calculated. Secondary analysis pooled AVN rates from both comparative studies and case series.

Results:
Comparative analysis included 17 retrospective studies with 453 hips (201 with CD, 252 without CD). Thirty-four of 201 (17%) hips with CD developed AVN, while 67 of 252 (27%) hips without CD developed AVN. The odds of AVN for patients treated with or without CD [odds ratio=0.80, 95% confidence interval (CI): 0.48-1.35] was not statistically different. Subanalysis on patients treated with in situ pinning or positional reduction and pinning showed no difference in AVN rates with or without CD (odds ratio=0.97, 95% CI: 0.44-2.10). In the secondary analysis of 17 comparative studies and 23 case series, the average rate of AVN was 17%, 0.17 (95% CI: 0.13-0.23) for patients treated with CD (60/447 hips) and 28%, 0.28 (95% CI: 0.22-0.35) for patients treated without CD (129/464 hips).

Conclusions:
There was no statistically significant decrease in odds of AVN with CD. However, studies were limited by their retrospective nature and inadequate documentation of CD techniques; the majority lacked femoral head blood flow monitoring to demonstrate adequate decompression. Future prospective studies with carefully documented complete decompression may help to elucidate the effect of CD on AVN risk. Although there was no statistically different odds of AVN with or without CD, even this large meta-analysis was underpowered, and one cannot conclude that there was truly no difference in odds of AVN without an appropriately powered study. Therefore, we recommend routine CD for all unstable SCFEs pending additional research, as CD adds little to the surgical procedure and may minimize the risk of a devastating insult to the femoral head.
Vitamin D Trends in the Pediatric Orthopaedic Population: A Survey
Authors: Williams Kevin , Hughes Daniel , Horan Michael 
Published: April 2019

Background:
Within the last decade, multiple studies have demonstrated the potential health benefits of vitamin D supplementation including improved bone health, reduced fracture risk, protection from autoimmune disease, and decreased cancer risk. Because of the prevalence of vitamin D deficiency in pediatric populations and despite recent evidence of increased vitamin D supplementation in the United States, our goal is to assess the knowledge of current vitamin D recommendations among pediatric orthopaedists and fellows within the Pediatric Society of North America (POSNA). It is our purpose to use the data to increase awareness and understanding of vitamin D among all pediatric providers.

Methods:
Our survey was distributed to 1316 POSNA members via a series of 2 email requests to participate in the survey on the SurveyMonkey website. They agreed to participate by responding positively on the first page of the survey. The data was depersonalized and analyzed via χ2 and the Fisher exact testing.

Results:
A total of 395 responses were recorded. Overall, 69% of participants rated their vitamin D knowledge as fair to good. In total, 68% of participants have been in practice over 10 years and represented most US geographic regions fairly equally. Most estimate that over 25% of their practice is vitamin D deficient with about a 50% compliance rate of supplementation. Over 30% of participants feel vitamin D management is mostly the role of the pediatrician; however, 64% of participants discuss or check vitamin D levels in their practice for patients with repeat fractures, medical comorbidities, or nonunions most commonly.

Conclusions:
Survey participants demonstrated a wide variety of responses indicating their understanding of vitamin D testing and supplementation. Although providers estimate a high deficiency rate, many do not routinely check vitamin D. When they do check, there is no standard indication for testing or supplementation and many believe this to be the role of the pediatrician or endocrinologist. More studies are needed to provide a standardized protocol for vitamin D testing and supplementation in the pediatric orthopaedic literature.

Clinical Relevance:
POSNA survey.
Circulating Endothelial Cells From Septic Shock Patients Convert to Fibroblasts Are Associated With the Resuscitation Fluid Dose and Are Biomarkers for Survival Prediction
Authors: Tapia Pablo , Gatica Sebastian , Cortés-Rivera Cristian , Otero Carolina , Becerra Alvaro , Riedel Claudia A. , Cabello-Verrugio Claudio , Kalergis Alexis M. , Simon Felipe 
Published: April 2019

Objectives:
To determine whether circulating endothelial cells from septic shock patients and from nonseptic shock patients are transformed in activated fibroblast by changing the expression level of endothelial and fibrotic proteins, whether the level of the protein expression change is associated with the amount of administered resuscitation fluid, and whether this circulating endothelial cell protein expression change is a biomarker to predict sepsis survival.

Design:
Prospective study.

Setting:
Medical-surgical ICUs in a tertiary care hospital.

Patients:
Forty-three patients admitted in ICU and 22 healthy volunteers.

Interventions:
None.

Measurements and Main Results:
Circulating mature endothelial cells and circulating endothelial progenitor cells from septic shock and nonseptic shock patients showed evidence of endothelial fibrosis by changing the endothelial protein expression pattern. The endothelial proteins were downregulated, whereas fibroblast-specific markers were increased. The magnitude of the expression change in endothelial and fibrotic proteins was higher in the septic shock nonsurvivors patients but not in nonseptic shock. Interestingly, the decrease in the endothelial protein expression was correlated with the administered resuscitation fluid better than the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores in the septic shock nonsurvivors patients but not in nonseptic shock. Notably, the significant difference between endothelial and fibrotic protein expression indicated a nonsurvival outcome in septic shock but not in nonseptic shock patients. Remarkably, area under the receiver operating characteristic curve analysis showed that endothelial protein expression levels predicted the survival outcome better than the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores in septic shock but not in nonseptic shock patients.

Conclusions:
Circulating endothelial cells from septic shock patients are acutely converted into fibroblasts. Endothelial and fibrotic protein expression level are associated with resuscitation fluid administration magnitude and can be used as biomarkers for an early survival diagnosis of sepsis.
High-Functioning Autism, Severe Anxiety, and Bullying in a 26 Year Old
Authors: Fogler Jason M. , Stein David , Barbaresi William J. , Bridgemohan Carolyn , Steinbauer-Schütz Andrea , Dirmhirn Anna , Holzinger Daniel , Radesky Jenny , Fellinger Johannes 
Published: April 2019

CASE:
Peter is a 26-year-old group home resident in Austria with a history of poor peer relationships, including being bullied, and previous diagnoses of attention-deficit hyperactivity disorder, Asperger syndrome, social anxiety, depression, and developmental coordination disorder. Consultation from our international neurodevelopmental team was requested for severe anxiety and avoidance of social interactions. He reported 4 or more spontaneous anxiety episodes per day. Anxiety triggers included returning to his group home from his vocational rehabilitation program each evening or returning to the group home after weekends at his parents' house. Each Sunday evening, in anticipation of returning to the group home, Peter engaged in tantrums, including screaming and throwing objects and suicidal threats without intent, but not direct aggression toward family members. He phoned his mother several times per day on weekdays.
Peter's early history was significant for hyperactivity, impulsivity, aggression, and socially intrusive behavior; he repeated kindergarten and by first grade was characterized as motorically clumsy and “too much in [peers'] personal space.” He played alone in kindergarten and had poor social boundaries; when older, he evidenced reduced social perception, and his family reported he did not notice when peers made fun of him. His language developed normally, but he had a “sophisticated style of speaking” and as an adult continued to have trouble understanding gestures, jokes, and social themes in movies.
Between ages 7 and 11 years, Peter had been bullied and ostracized by male peers but did well academically, always got along well with adults, and preferred to play with girls. Exclusion by peers persisted through high school, at which time his independent functioning declined and he required his mother's assistance with organizing his materials. At age 15 years, Peter repeated a grade so that he could change classmates, and by the equivalent of his junior year, his grades deteriorated. He had several psychiatric admissions for depression and destructive outbursts (to avoid going to school) and was diagnosed with Asperger disorder. At age 18 years, Peter refused to return to school. He lived at home with his parents, only leaving the house to accompany them on errands, until placed in a group home for people with mental health disorders at age 20 years. At age 26 years, he is sharing a supported-living apartment with 2 young adults with chronic psychiatric disorders. He works in 3 highly structured sheltered workshops for a few hours each and becomes easily overwhelmed in unstructured situations and/or in situations in which he anticipates being reprimanded or letting someone down. Despite a strong interest in marine biology, anxiety prevents him from considering college.
How would you proceed with diagnostic testing or intervention to help this young man?
Cancer-Related Symptoms and Cognitive Intervention Adherence Among Breast Cancer Survivors: A Mixed-Methods Study
Authors: Bail Jennifer R. , Ivankova Nataliya , Heaton Karen , Vance David E. , Triebel Kristen , Meneses Karen 
Published: April 2019

Background
Breast cancer survivors (BCSs) experience long-term symptoms of cancer and treatment, which may exacerbate cognitive function and ability to adhere to interventions aimed at improving cognition.

Objective
The intent of this study was to explore the relationship between selected cancer-related symptoms and adherence to the Speed of Processing in Middle Aged and Older BreAst Cancer SuRvivors (SOAR) cognitive training (CT) intervention among BCSs residing in Alabama.

Methods
A sequential quantitative to qualitative (Quan→Qual) mixed-methods design was used. First, the relationship between selected cancer-related symptoms and adherence to SOAR among BCSs (n = 30) was examined using self-reported questionnaire data. Follow-up semistructured interviews with 15 purposefully selected participants (adherent and nonadherent) were conducted to explore how symptoms contributed to/explained differences in adherence to SOAR. Data were analyzed using RStudio and NVivo software.

Results
Spearman’s ρ correlation suggested relationships between adherence and perceived cognitive impairment, depressive symptoms, and sleep quality. Inductive thematic analysis yielded 4 themes: (1) experiences of cancer-related symptoms, (2) influences of CT, (3) adherence to CT, and (4) environment for CT. Integration of quantitative and qualitative results revealed that experiences of and responses to CT and cancer-related symptoms differently shape adherence to CT among BCSs.

Conclusions
To aid in cognitive intervention adherence among BCSs, future studies may consider applying a comprehensive approach aimed at addressing concurrent cancer-related symptoms.

Implications for Practice
Clinicians can routinely assess cognition and provide education and resources for management of cancer-related symptoms.
Impact of Kamishibai Card Process on Compliance With the Central Venous Line Maintenance Bundle
Authors: Frith Julia , Hampton Debbie , Pendleton Michelle , Montgomery Vicki L. , Isaacs Pam 
Published: April 2019

Background:
The Kamishibai Card (K-Card) process is a storytelling methodology designed to help identify barriers and remove or redesign them.

Purpose:
The purpose of this study was to evaluate the effectiveness of the K-Card process for central venous line (CVL) maintenance bundle compliance in a pediatric intensive care unit.

Methods:
A retrospective evaluation of the implementation of the K-Card process was performed using a pretest and posttest design.

Results:
A total of 1003 central venous catheter maintenance observations were completed during the study period. A statistically significant change was noted in one element of the CVL maintenance bundle, tubing timed and dated. The most frequent cause for noncompliance with the CVL maintenance bundle was incomplete communication during handoff, followed by device associated factors (failure of device, use of device, and availability of device).

Conclusions:
The K-Card process had a positive impact on CVL maintenance bundle compliance in the study setting.
A Paper-Based Car Seat Safety Educational Intervention in the Pediatric Emergency Department
Authors: Cooper-Sood Jonathan Bryan , Chan Cristal , Cho Christine S. 
Published: April 2019

Objective
Motor vehicle crashes are a leading source of pediatric morbidity and mortality in children younger than 13 years. Proper car seat safety device (CSD) markedly reduces mortality, but the majority of families misuse them. Emergency department (ED)–based educational interventions can improve knowledge patient regarding proper CSD use but historically have been resource intensive. Our study evaluated the utility of a novel educational intervention in improving patient knowledge of proper CSD use and in evaluating for proper CSD installation.

Methods
Parents of children younger than 14 years presenting to the ED were given a paper-based quiz followed by a CSD-educational handout. Improvement in patient knowledge and evaluation for proper CSD installation were evaluated by repeat quiz and a phone-based survey 2 to 4 weeks later.

Results
Parents exhibited an 18% improvement in quiz answers evaluating knowledge of proper CSD use (P value < 0.0001). Eighty-two percent and 72% of families felt that the intervention improved their understanding of proper CSD use and increased their awareness of their importance, respectively, but only 18% had their CSD checked by a professional.

Conclusions
A paper-based educational intervention in the pediatric ED is well received by parents, may improve patient knowledge surrounding proper CSD use, and encourages some families to get their CSDs checked for proper installation.
Outcomes of Acute Inpatient Rehabilitation of Patients With Left Ventricular Assist Devices and Subsequent Stroke
Authors: Mathews Amy , Goodman Daniel A. , Rydberg Leslie 
Published: April 2019

Objective
The aim of the study was to examine the functional outcomes and medical complications of patients with left ventricular assist device implantation and subsequent stroke during comprehensive inpatient rehabilitation.

Design
Retrospective cohort study of 21 patients admitted to an inpatient rehabilitation facility between 2009 and 2015. Main outcome measurements include admission and discharge Functional Independence Measure, length of stay, and Functional Independence Measure efficiency.

Results
The study included 17 male and 4 female patients aged 32–75 yrs. Eleven patients (52%) required transfer to an acute care hospital for evaluation. Fifteen patients completed inpatient rehabilitation with median [interquartile range] length of stay 26 [13.5–34] days (range = 7–59 days), median [interquartile range] Functional Independence Measure gain of 18 [12.5–32], and median [interquartile range] Functional Independence Measure efficiency of 1.0 [0.6–1.44]. Patients who required transfer to acute care during their course but ultimately completed inpatient rehabilitation (n = 5) demonstrated larger median [interquartile range] Functional Independence Measure gain (40 [23–42]) and longer median [interquartile range] length of stay (35 [35–42]) compared with patients who completed inpatient rehabilitation without transfer (Functional Independence Measure gain = 15 [9.25–26.5]; length of stay = 14.5 [11.5–26.25]).

Conclusions
Patients with left ventricular assist device implantation and subsequent stroke demonstrate functional gains during acute inpatient rehabilitation programs. A large percent of patients required transfer to acute care.
Where Do We Look? Assessing Gaze Patterns in Cosmetic Face-Lift Surgery with Eye Tracking Technology
Authors: Cai Lawrence Z. , Kwong Jeffrey W. , Azad Amee D. , Kahn David , Lee Gordon K. , Nazerali Rahim S. 
Published: April 2019

Background:
Aesthetics plays a central role in determining success in plastic surgery. Understanding perceptions of favorable aesthetics is critical to ensure patient satisfaction. Eye-tracking technology offers an objective way of evaluating attention and understanding how viewers direct their focus on patients who undergo cosmetic face-lift procedures.

Methods:
Thirty-six subjects ranging from layperson to attending plastic surgeon viewed 15 sets of photographs before and after patients underwent an elective face-lift procedure. They were instructed to evaluate the aesthetic quality on a Likert scale while eye-tracking equipment tracked their gaze and analyzed their distribution of attention.

Results:
Postoperative images showed a Likert score improvement of 0.51 ± 0.26, with the greatest difference in attending cosmetic plastic surgeons (1.36 ± 0.22; p < 0.05). The nose was the most common first fixation location (31 percent of first fixations) and the most viewed area (16 ± 3 percent of fixation time) for all subjects. Experienced subjects spent less time in nonrelevant areas (30 ± 11 percent for attending cosmetic plastic surgeons and 37 ± 10 percent for attending noncosmetic plastic surgeons) compared with less experienced subjects (50 ± 15 percent for laypersons).

Conclusions:
This study demonstrates that viewers with greater experience in cosmetic surgery focus quickly on the cheeks, chin, and neck and have evenly distributed gaze across the entire face. These results suggest that a layperson’s gaze is drawn to the center of the face (because of both unfamiliarity with the face-lift procedure and the natural tendency to look at the central face), whereas attending plastic surgeons exhibit holistic gaze patterns and are more aware of the impact of the procedure.