bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acceptability and Effects of Commercially Available Activity Trackers for Chronic Pain Management Among Older African American Adults
Authors: Janevic Mary R , Shute Varick , Murphy Susan L , Piette John D 
Published: July 2019

Abstract

Background
Wearable activity trackers may facilitate walking for chronic pain management.

Objective
We assessed the acceptability of a commercially available tracker and three alternative modes of reporting daily steps among older adults in a low-income, urban community. We examined whether using the tracker (Fitbit ZipTM) was associated with improvements in functioning and activity.

Design
Randomized controlled pilot and feasibility trial.

Subjects
Fifty-one African American adults in Detroit, Michigan, aged 60 to 85 years, with chronic musculoskeletal pain (28 in the intervention group, 23 controls).

Methods
Participants completed telephone surveys at baseline and eight weeks. Intervention participants wore trackers for six weeks, alternately reporting daily step counts via text messages, automated telephone calls, and syncing (two weeks each). We used multimethods to assess satisfaction with trackers and reporting modalities. Adherence was indicated by the proportion of expected days on which valid step counts were reported. We assessed changes in pain interference, physical function, social participation, walking frequency, and walking duration.

Results
More than 90% of participants rated trackers as easy to use, but some had technical or dexterity-related difficulties. Text reporting yielded 79% reporting adherence vs 69% each for automated calls and syncing. Intervention participants did not show greater improvement in functioning or walking than controls.

Conclusions
With appropriate support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test whether the effects of trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques.
Effect of Combined Diclofenac and B Vitamins (Thiamine, Pyridoxine, and Cyanocobalamin) for Low Back Pain Management: Systematic Review and Meta-analysis
Authors: Calderon-Ospina Carlos-Alberto , Nava-Mesa Mauricio Orlando , Arbeláez Ariza Carlos Emilio 
Published: July 2019

AbstractBackgroundCumulative evidence suggests an analgesic effect of thiamine, pyridoxine, and cyanocobalamin (TPC) in monotherapy, and also when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), particularly diclofenac, in a synergistic manner. The aim of this review was to determine the effects of diclofenac combined with TPC compared with diclofenac monotherapy for low back pain (LBP) management.MethodsWe searched for randomized clinical trials on the MEDLINE, EMBASE, LILACS, and Cochrane databases of records of clinical trials, among other sources. We evaluated the risk of bias regarding randomization, allocation concealment, blinding, incomplete outcome data, selective reporting, and other biases. A random-effects meta-analysis to examine patients with acute LBP (N = 1,108 adults) was performed, along with a subsequent sensitivity analysis.ResultsFive studies in patients with LBP were included in the qualitative synthesis. Four of these studies in acute LBP were included in the first meta-analysis. A sensitivity test based on risk of bias (three moderate- to high-quality studies) found that the combination therapy of diclofenac plus TPC was associated with a significant reduction in the duration of treatment (around 50%) compared with diclofenac monotherapy (odds ratio = 2.23, 95% confidence interval = 1.59 to 3.13, P &lt; 0.00001). We found no differences in the safety profile and patient satisfaction.ConclusionsThis meta-analysis demonstrated that combination therapy of diclofenac with TPC might have an analgesic superiority compared with diclofenac monotherapy in acute LBP. However, there is not enough evidence to recommend this therapy in other types of pain due to the scarcity of high-quality studies.
Co-occurrence of Chronic Musculoskeletal Pain and Cardiovascular Diseases: A Systematic Review with Meta-analysis
Authors: Oliveira Crystian B , Maher Chris G , Franco Marcia R , Kamper Steven J , Williams Christopher M , Silva Fernanda G , Pinto Rafael Z 
Published: July 2019

AbstractObjectiveTo determine the magnitude of the association between cardiovascular disease and chronic musculoskeletal pain.DesignSystematic review with meta-analysis.MethodsA comprehensive search was performed in five electronic databases. Population-based studies reporting the prevalence of cardiovascular diseases in adults stratified by chronic musculoskeletal pain status were considered eligible. Two independent reviewers performed the screening of the records following the inclusion criteria, extracted data, and evaluated the risk of bias of the included studies using an assessment tool of risk of bias for observational studies. In addition, we assessed the overall quality of evidence using an adaptation of the GRADE approach for prognosis.ResultsTwenty studies were included in this review. There was high-quality evidence that people with chronic musculoskeletal pain are 1.91 times more likely to report having a cardiovascular disease compared with those without chronic musculoskeletal pain (risk ratio = 1.91, 95% confidence interval = 1.64–2.21).ConclusionsOur findings demonstrated associations between chronic musculoskeletal pain and any cardiovascular diseases. Future studies are still warranted to better understand the association between chronic musculoskeletal pain and the specific types of cardiovascular diseases.
Synaptic vesicle mimics affect the aggregation of wild-type and A53T α-synuclein variants differently albeit similar membrane affinity
Authors: Rocha Sandra , Kumar Ranjeet , Horvath Istvan , Wittung-Stafshede Pernilla 
Published: July 2019

Abstractα-Synuclein misfolding results in the accumulation of amyloid fibrils in Parkinson’s disease. Missense protein mutations (e.g. A53T) have been linked to early onset disease. Although α-synuclein interacts with synaptic vesicles in the brain, it is not clear what role they play in the protein aggregation process. Here, we compare the effect of small unilamellar vesicles (lipid composition similar to synaptic vesicles) on wild-type (WT) and A53T α-synuclein aggregation. Using biophysical techniques, we reveal that binding affinity to the vesicles is similar for the two proteins, and both interact with the helix long axis parallel to the membrane surface. Still, the vesicles affect the aggregation of the variants differently: effects on secondary processes such as fragmentation dominate for WT, whereas for A53T, fibril elongation is mostly affected. We speculate that vesicle interactions with aggregate intermediate species, in addition to monomer binding, vary between WT and A53T, resulting in different consequences for amyloid formation.
Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area
Authors: Palsson Thorvaldur S , Gibson William , Darlow Ben , Bunzli Samantha , Lehman Gregory , Rabey Martin , Moloney Niamh , Vaegter Henrik B , Bagg Matthew K , Travers Mervyn 
Published: July 2019

AbstractThe sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where SIJ is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, when the SIJ might be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the SIJ(s)—a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this Perspective article argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models with contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.
Updated management for patients with cardiovascular disease and diabetes
Authors: Dugan Joy , Butts Amy , Collins Billy St. John , Saini Parmjeet S. , Bradley Sarah 
Published: July 2019

ABSTRACT
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality for patients with diabetes. The latest guidelines from the American Diabetes Association include new information on hypertension, lipid management, heart failure, and coronary heart disease. This year, for the first time, the cardiovascular disease and risk management section was endorsed by the American College of Cardiology. Primary and secondary prevention of ASCVD is a critical element of the primary care visit for patients with diabetes. This article provides key highlights that are important for busy clinicians.
Substance Use Disorder Education in Medical Schools: A Scoping Review
Authors: Muzyk Andrew , Smothers Zachary P.W. , Akrobetu Dennis , Ruiz Veve Jennifer , MacEachern Mark , Tetrault Jeanette M. , Gruppen Larry 
Published: July 2019

Purpose
As medical schools adapt their curricula to prepare future physicians for the opioid crisis and for treating patients with substance use disorders (SUDs), educators should refer to courses described in the literature. This scoping review aimed to (1) provide a comprehensive evaluation and summation of peer-reviewed literature reporting on SUD education in medical schools globally and (2) appraise the research quality and educational outcomes reported in SUD education studies in medical schools.

Method
The authors searched 6 databases (3 Ovid MEDLINE databases, Embase, ERIC, and Web of Science) from inception through May 25, 2018. Original English-language research studies focusing on medical students and describing SUD education in medical schools were included. The Medical Education Research Study Quality Instrument (MERSQI) was used to assess included studies.

Results
Of 3,178 articles identified, 43 met inclusion criteria. Studies were conducted in 9 countries. Most reported on educational interventions for tobacco (n = 20; 47%); others reported on interventions for SUDs broadly (n = 15; 35%), alcohol (n = 8; 19%), and opioids (n = 1; 2%). The mean MERSQI score was 12.27 (standard deviation 2.30). Four studies (9%) reported on educational outcomes at the level of behaviors or patient or health care outcomes. The majority (n = 39; 91%) reported significant benefits.

Conclusions
Educational interventions relating to SUDs were effective in improving medical students’ knowledge, skills, and attitudes. Educators should develop courses that achieve higher-level educational outcomes, increase education on opioid use disorders, and focus on the greatest public health concerns.
Trends in Tenure Status in Academic Family Medicine, 1977–2017: Implications for Recruitment, Retention, and the Academic Mission
Authors: Xierali Imam M. , Nivet Marc A. , Syed Zubair A. , Shakil Amer , Schneider F. David 
Published: July 2019

Purpose
Tenure status has important implications for medical school faculty recruitment and retention and may affect educational quality, academic freedom, and collegiality. However, tenure trends in academic family medicine are unknown. This study aimed to describe trends in tenure status of family medicine faculty overall and by gender and status of minorities underrepresented in medicine (URM) in Liaison Committee on Medical Education–accredited medical schools.

Method
Association of American Medical Colleges Faculty Roster data were used to describe trends in tenure status of full-time family medicine faculty, 1977 to 2017. Bivariate and trend analyses were conducted to assess associations and describe patterns between tenure status and gender, race, and ethnicity. Interdepartmental variations in tenure trends over the years were also examined.

Results
Among family medicine faculty, the proportions of faculty tenured or on a tenure track dropped more than threefold from 1977 (46.6%; n = 507/1,089) to 2017 (12.7%; n = 729/5,752). Lower proportions of women and URM faculty were tenured or on a tenure track than male and non-URM faculty, respectively. But the gaps among them were converging. Compared with other clinical departments, family medicine had the highest proportion of faculty (74.6%; n = 4,291/5,752) not on a tenure track in 2017.

Conclusions
Proportion of tenure positions significantly decreased among family medicine faculty in U.S. medical schools. While gaps between male and female faculty and among certain racial/ethnic groups remained for family medicine tenure status, they have decreased over time, mainly because of a substantial increase in nontenured positions.
Developing and Implementing Curricular Objectives for Sexual Health in Undergraduate Medical Education: A Practical Approach
Authors: Stumbar Sarah E. , Brown David R. , Lupi Carla S. 
Published: July 2019

Problem
In 2014, medical students at the Florida International University Herbert Wertheim College of Medicine (FIU HWCOM) first drew attention to perceived gaps in the sexual health curriculum. The authors used Kern and colleagues’ model for curriculum development to review and update the existing curriculum.

Approach
To develop longitudinal sexual health curricular objectives for undergraduate medical education (UME), the authors reviewed existing specialty- and organization-specific objectives. Then, an iterative process guided by clear criteria was used to develop feasible objectives, which were refined through stakeholder feedback. As these objectives were being finalized in 2017, UME sexual health competencies were first published; the authors mapped their objectives to these, as possible. The medical school’s course activities and assessments were mapped to the authors’ sexual health objectives to identify curricular gaps and unplanned redundancies.

Outcomes
This process resulted in 12 sexual health curricular objectives that are adaptable by other institutions. In mapping the FIU HWCOM curriculum to these objectives, specific gaps and assessment weaknesses emerged. With stakeholder support obtained through a strong curricular management structure, the work of modifying content to address gaps has begun.

Next Steps
New assessments specific to these sexual health objectives are needed, especially within the clinical curriculum. Assessment of these objectives may be strengthened through the development of new sexual-health-related entrustable professional activities (EPAs) nested within the broader Core EPAs for Entering Residency being piloted. When data on learning outcomes are available, the process of targeting curricular improvement will begin.
Using Longitudinal Milestones Data and Learning Analytics to Facilitate the Professional Development of Residents: Early Lessons From Three Specialties
Authors: Holmboe Eric S. , Yamazaki Kenji , Nasca Thomas J. , Hamstra Stanley J. 
Published: July 2019

Purpose
To investigate the effectiveness of using national, longitudinal milestones data to provide formative assessments to identify residents at risk of not achieving recommended competency milestone goals by residency completion. The investigators hypothesized that specific, lower milestone ratings at earlier time points in residency would be predictive of not achieving recommended Level (L) 4 milestones by graduation.

Method
In 2018, the investigators conducted a longitudinal cohort study of emergency medicine (EM), family medicine (FM), and internal medicine (IM) residents who completed their residency programs from 2015 to 2018. They calculated predictive values and odds ratios, adjusting for nesting within programs, for specific milestone rating thresholds at 6-month intervals for all subcompetencies within each specialty. They used final milestones ratings (May–June 2018) as the outcome variables, setting L4 as the ideal educational outcome.

Results
The investigators included 1,386 (98.9%) EM residents, 3,276 (98.0%) FM residents, and 7,399 (98.0%) IM residents in their analysis. The percentage of residents not reaching L4 by graduation ranged from 11% to 31% in EM, 16% to 53% in FM, and 5% to 15% in IM. Using a milestone rating of L2.5 or lower at the end of post-graduate year 2, the predictive probability of not attaining the L4 milestone graduation goal ranged from 32% to 56% in EM, 32% to 67% in FM, and 15% to 36% in IM.

Conclusions
Longitudinal milestones ratings may provide educationally useful, predictive information to help individual residents address potential competency gaps, but the predictive power of the milestones ratings varies by specialty and subcompetency within these 3 adult care specialties.
Laparoscopic Hysterectomy Route, Resource Use, and Outcomes
Authors: Desai Vrunda B. , Wright Jason D. , Lin Haiqun , Gross Cary P. , Sallah Ya Haddy , Schwartz Peter E. , Xu Xiao 
Published: July 2019

OBJECTIVE:
To examine changes in utilization of different types of laparoscopic hysterectomy, as well as their associated resource use and surgical outcomes, after the U.S. Food and Drug Administration (FDA) safety statement in April 2014 regarding power morcellation.

METHODS:
We retrospectively analyzed data from the 2012–2016 American College of Surgeons National Surgical Quality Improvement Program and identified 145,746 women undergoing hysterectomy for benign indications. We measured use of laparoscopic supracervical hysterectomy compared to total laparoscopic hysterectomy (including laparoscopic-assisted vaginal hysterectomy) in these patients, as well as operative time, surgical setting (inpatient vs outpatient), length of stay, and 30-day surgical outcomes (wound complication, medical complication, reoperation, and readmission). We used an interrupted time series analysis to examine the association between FDA warning and changes in utilization and outcomes of laparoscopic hysterectomy.

RESULTS:
After adjusting for patient characteristics and background trends in practice, use of laparoscopic supracervical hysterectomy was significantly lower in the postwarning than prewarning period (odds ratio [OR]=0.49, 95% CI 0.45–0.53), whereas use of total laparoscopic hysterectomy was not affected (OR 1.01, 95% CI 0.96–1.06). Overall, after an initial reduction, use of laparoscopic hysterectomy (laparoscopic supracervical hysterectomy and total laparoscopic hysterectomy combined) increased over time in the postwarning period (adjusted OR of utilization for each calendar quarter elapsed=1.03, 95% CI 1.02–1.03). After the FDA warning, operative time for laparoscopic supracervical hysterectomy increased by 11.45 minutes (95% CI 6.22–16.69), whereas the decreasing trend in the likelihood of inpatient stay for total laparoscopic hysterectomy was attenuated (OR for each calendar quarter elapsed=0.92 in prewarning period, 95% CI 0.91–0.93; and 0.97 in postwarning period, 95% CI 0.97–0.98). There was no significant change in 30-day surgical outcomes after the FDA warning.

CONCLUSION:
Rates of laparoscopic supracervical hysterectomy fell in association with power morcellation safety warnings, whereas rates of other laparoscopic hysterectomies continued to rise. There was no change in patient outcomes among laparoscopic hysterectomies.
Bridge Plating of Proximal Tibial Metaphyseal Fracture by Limited Open Technique
Authors: Pulley Benjamin R. , Gardner Michael J. 
Published: July 2019

Summary:
In this video, we demonstrate application of a bridge plate by limited open technique for fixation of a proximal tibial metaphyseal fracture. Although intramedullary nailing remains our preferred surgical technique for treatment of most extra-articular fractures of the proximal tibia, we find bridge plating by limited open technique to be an important alternative option for select fracture patterns not amenable to intramedullary nailing.

Video available at:
http://links.lww.com/JOT/A801
Unstable Intertrochanteric Hip Repair With Short Cephalomedullary Nail
Authors: A. Egol Kenneth , Wasterlain Amy , Driesman Adam , Mandel Jessica , Konda Sanjit 
Published: July 2019

Introduction:
Approximately half of all hip fractures are intertrochanteric femur fractures. This video demonstrates the technique of repair of an unstable intertrochanteric hip fracture using a cephalomedullary device.

Methods:
The patient is an 88-year-old woman presenting with an intertrochanteric hip fracture secondary to a low-energy injury. The patient was indicated for surgery due to the unstable nature of the fracture.

Results:
This video demonstrates the cephalomedullary nailing technique for the repair of an unstable intertrochanteric hip fracture after a low-energy injury. Anatomical reduction and stable fixation were obtained with this technique.

Conclusions:
The case demonstrates a cephalomedullary technique of intertrochanteric fracture fixation using a cephalomedullary nail. The technique has significant advantages including minimal intraoperative blood loss, shorter operative times, potential for more biological healing with a load-sharing device, and low infection rate.

Video available at:
http://links.lww.com/JOT/A798
Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique
Authors: Egol Kenneth A. , Bianco Isabella , Milone Michael , Konda Sanjit 
Published: July 2019

Introduction:
Monteggia fractures are rare, although complex elbow injuries. Bado II Monteggia fractures are characterized by posterior dislocation of the radial head and concurrent fracture of the proximal or middle third of the ulna. This video demonstrates the open reduction and internal fixation of a complex Bado II Monteggia fracture dislocation.

Methods:
The patient is a 65-year-old woman with a Bado II Monteggia fracture after a low-energy fall from standing height. Given the extent of comminution and the instability of the elbow, the patient was indicated for surgical fixation.

Results:
This video demonstrates a locking plate technique for repair of a comminuted fracture of the proximal ulna. Anatomical reduction of ulnohumeral and radiocapitellar joints and stable fixation with bone grafting of the fracture are achieved with a medial 2.0/2.4-mm plate and a dorsal precontoured variable-angle locking plate. Demonstration of radial head arthroplasty is provided as an alternative for utilization in cases with a radial head fracture.

Conclusions:
Anatomical reduction and fixation of complex Monteggia fracture dislocations can be achieved with adherence to standard aspects of bony reconstruction. In this video we present the case of a Bado II Monteggia fracture surgically repaired with a locking plate construct.

Video available at:
http://links.lww.com/JOT/A791
Fibular Lengthening Osteotomy With Revision Syndesmotic Repair for Ankle Fracture Malunion
Authors: Ju Derek G. , Debbi Eytan M. , Neustein Adam Z. , Moon Charles N. 
Published: July 2019

Summary:
Ankle malunions with a shortened fibula and syndesmosis widening can pose challenges to the patient and treating physician. Indications for revision-operative intervention include persistent pain and disability. Shortened fibula malunions can be addressed using a lengthening fibular osteotomy and revision fixation. Chronic syndesmotic injuries can be addressed with syndesmotic debridement, open reduction, and suture button fixation. In this video, we present our surgical technique and rationale for the management of a shortened fibular malunion with persistent syndesmotic widening.

Video available at:
http://links.lww.com/JOT/A806