bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flexibility in Postgraduate Medical Training in the Netherlands
Authors: Hoff Reinier G. , Frenkel Joost , Imhof Saskia M. , ten Cate Olle 
Published: February 2018

Postgraduate medical training in the Netherlands has become increasingly individualized. In this article, the authors describe current practices for three residency programs at the University Medical Center Utrecht: anesthesiology, pediatrics, and ophthalmology. These programs are diverse yet share characteristics allowing for individualized residency training. New residents enter each program throughout the year, avoiding a large simultaneous influx of inexperienced doctors. The usual duration of each is five years. However, the actual duration of rotations or of the program as a whole can be reduced because of residents’ previous medical experience or demonstration of early mastery of relevant competencies. If necessary, the duration of training can also increase.
Although working hours are already restricted by the European Working Time Directive, most residents choose to train on a part-time basis. The length of their program then is extended proportionally. The extension period added for those residents training part-time can be used to develop specific competencies, complete an elective rotation or research, or explore a focus area. If the resident meets all training objectives before the extension period is completed, the program director can choose to shorten the program length. Recently, entrustable professional activities have been introduced to strengthen workplace-based assessment. The effects on program duration have yet to be demonstrated.
Flexible postgraduate training is feasible. Although improving work–life balance for residents is a necessity, attention must be paid to ensuring that they gain the necessary experience and competencies and maintain continuity of care to ensure that high-quality patient care is provided.
A Comprehensive Review of Low-Speed Rear Impact Volunteer Studies and a Comparison to Real-World Outcomes
Authors: Cormier Joseph , Gwin Lisa , Reinhart Lars , Wood Rawson , Bain Charles 
Published: February 2018

Study Design.
This study combined all prior research involving human volunteers in low-speed rear-end impacts and performed a comparative analysis of real-world crashes using the National Automotive Sampling System – Crashworthiness Data System.

Objective.
The aim of this study was to assess the rates of neck pain between volunteer and real-world collisions as well as the likelihood of an injury beyond symptoms as a function of impact severity and occupant characteristics in real-world collisions.

Summary of Background Data.
A total of 51 human volunteer studies were identified that produced a dataset of 1984 volunteer impacts along with a separate dataset of 515,601 weighted occupants in real-world rear impacts.

Methods.
Operating-characteristic curves were created to assess the utility of the volunteer dataset in making predictions regarding the overall population. Change in speed or delta-V was used to model the likelihood of reporting symptoms in both real-world and volunteer exposures and more severe injuries using real-world data. Logistic regression models were created for the volunteer data and survey techniques were used to analyze the weighted sampling scheme with the National Automotive Sampling System database.

Results.
Symptom reporting rates were not different between males and females and were nearly identical between laboratory and real-world exposures. The minimal risk of injury predicted by real-world exposure is consistent with the statistical power of the large number of volunteer studies without any injury beyond the reporting of neck pain.

Conclusion.
This study shows that volunteer studies do not under-report symptoms and are sufficient in number to conclude that the risk of injury beyond neck strain under similar conditions is essentially zero. The real-world injury analyses demonstrate that rear impacts do not produce meaningful risks of cervical injury at impacts of similar and greater severity to those of the volunteer research. Future work concerning the mechanism of whiplash-related trauma should focus on impacts of severity greater than those in the current literature.

Level of Evidence: 3
Effects of Nurse-Led Intervention on Patients' Anxiety and Sleep Before Coronary Artery Bypass Grafting
Authors: Mousavi Malek Nesa , Zakerimoghadam Masoumeh , Esmaeili Maryam , Kazemnejad Anoushiravan 
Published: February 2018

The aim of this study to examine the effects of supportive-educational nurse-led intervention on the patients' anxiety and sleep before the coronary artery bypass grafting.
The current clinical trial recruited 160 patients (N = 160) waiting for the coronary artery bypass grafting by random block sampling and divided them into two 80-people experimental and control groups. Spielberger's State Anxiety Inventory was completed on the first day. The Groningen's Sleep Quality Index was also completed by the patients on the day of surgery. Data were analyzed in SPSS software version 16, using descriptive and inferential statistics tests.
The mean anxiety score in the experimental group decreased to 48.39, whereas in the control group, the mean anxiety score saw a rise after the intervention (61.09). The comparison of the mean quality of sleep the night before the surgery for both groups showed that sleep in the control group compared with sleep in the experimental group had a lower quality, and statistically, it was significant (P < .001).
Results showed that nonpharmacological and supportive interventions can reduce patients' anxiety and sleep disturbance before the coronary artery bypass grafting. According to the results, nonpharmacological therapies should be placed at the top of nurses' tasks.
Pathophysiological mechanisms of neuropathic pain: comparison of sensory phenotypes in patients and human surrogate pain models
Authors: Vollert Jan , Magerl Walter , Baron Ralf , Binder Andreas , Enax-Krumova Elena K. , Geisslinger Gerd , Gierthmühlen Janne , Henrich Florian , Hüllemann Philipp , Klein Thomas , Lötsch Jörn , Maier Christoph , Oertel Bruno , Schuh-Hofer Sigrid , Tölle Thomas R. , Treede Rolf-Detlef 
Published: February 2018

Abstract
As an indirect approach to relate previously identified sensory phenotypes of patients suffering from peripheral neuropathic pain to underlying mechanisms, we used a published sorting algorithm to estimate the prevalence of denervation, peripheral and central sensitization in 657 healthy subjects undergoing experimental models of nerve block (NB) (compression block and topical lidocaine), primary hyperalgesia (PH) (sunburn and topical capsaicin), or secondary hyperalgesia (intradermal capsaicin and electrical high-frequency stimulation), and in 902 patients suffering from neuropathic pain. Some of the data have been previously published. Randomized split-half analysis verified a good concordance with a priori mechanistic sensory profile assignment in the training (79%, Cohen κ = 0.54, n = 265) and the test set (81%, Cohen κ = 0.56, n = 279). Nerve blocks were characterized by pronounced thermal and mechanical sensory loss, but also mild pinprick hyperalgesia and paradoxical heat sensations. Primary hyperalgesia was characterized by pronounced gain for heat, pressure and pinprick pain, and mild thermal sensory loss. Secondary hyperalgesia was characterized by pronounced pinprick hyperalgesia and mild thermal sensory loss. Topical lidocaine plus topical capsaicin induced a combined phenotype of NB plus PH. Topical menthol was the only model with significant cold hyperalgesia. Sorting of the 902 patients into these mechanistic phenotypes led to a similar distribution as the original heuristic clustering (65% identity, Cohen κ = 0.44), but the denervation phenotype was more frequent than in heuristic clustering. These data suggest that sorting according to human surrogate models may be useful for mechanism-based stratification of neuropathic pain patients for future clinical trials, as encouraged by the European Medicines Agency.
Positioning a Novel Transcutaneous Bone Conduction Hearing Implant: a Systematic Anatomical and Radiological Study to Standardize the Retrosigmoid Approach, Correlating Navigation-guided, and Landmark-based Surgery
Authors: Arnold Heinz , Schulze Maximilian , Wolpert Stephan , Hirt Bernhard , Tropitzsch Anke , Zimmermann Rainer , Radeloff Andreas , Löwenheim Hubert , Reimann Katrin 
Published: February 2018

Hypothesis:
Anatomical and radiological evaluation improves safety and accuracy of the retrosigmoid approach for positioning a transcutaneous bone conduction implant and provides anatomical reference data for standardized, landmark-based implantation at this alternative site.

Background:
The primary implantation site for the floating mass transducer of a novel bone conduction hearing implant is the mastoid. However, anatomical limitations or previous mastoid surgery may prevent mastoid implantation. Therefore, the retrosigmoid approach has been introduced as an alternative.

Methods:
Mastoid and retrosigmoid implantation sites were radiologically identified and evaluated in preoperative computed tomography scans of anatomical head specimens. Navigation-guided implantation was then performed in the retrosigmoid site (n = 20). The optimal retrosigmoid position was determined in relation to both the asterion and the mastoid notch as surgical landmarks in an anatomical coordinate system.

Results:
Preoperative radiological analysis revealed spatial limitations in the mastoid in 45% of the specimens. Navigation-guided retrosigmoid implantation was possible without affecting the sigmoid sinus in all the specimens. The optimal implantation site was located 1.9 ± 0.1 cm posterior/1.7 ± 0.1 cm inferior to the asterion and 3.3 ± 0.2 cm posterior/2.1 ± 0.1 cm superior to the mastoid notch.
Retrosigmoid skull thickness was 6.6 ± 0.4 mm, measured anatomically, 7.0 ± 0.4 mm, measured radiologically and 6.7 ± 0.5 mm, measured with the navigation software.

Conclusion:
The navigation-guided retrosigmoid approach seemed to be a reliable procedure in all the specimens. Measurements of bone thickness revealed the need for spacers in 95% of the specimens. Reference coordinates of the optimal implantation site are provided and can confirm image-guided surgery or facilitate orientation if a navigation system is not available.
The Mediating Role of Exercise on Relationships Between Fatigue, Sleep Quality, and Quality of Life for Adolescents With Cancer
Authors: Wu Wei-Wen , Jou Shiann-Tarng , Liang Shu-Yuan , Tsai Shao-Yu 
Published: February 2018

BackgroundFatigue and poor sleep are two of the most common and most distressing symptoms for adolescents with cancer. These 2 symptoms concurrently heighten distress, further decreasing quality of life (QoL).ObjectivesThe aims of this study were to describe the degree of exercise involvement, fatigue, sleep quality, and QoL among adolescents with cancer and to determine whether exercise mediates the relationships between (a) fatigue and QoL and (b) sleep quality and QoL.MethodsA cross-sectional study of 100 participants was conducted. Multiple regression was performed to examine the mediation relationship.ResultsParticipants in the off-treatment group had a significantly higher degree of exercise involvement, as well as less fatigue, greater sleep quality, and less QoL distress. Exercise partially mediated the adverse effect of fatigue on QoL for adolescents undergoing cancer treatment, accounting for 49.80% of the total variation; exercise partially mediated the adverse effect of poor sleep on QoL for adolescents both in treatment and in survivorship, accounting for 42.06% and 28.71% of the total variations, respectively.ConclusionExercise partially mediated the relationship between fatigue and QoL for adolescents in cancer treatment and partially mediated the relationship between sleep quality and QoL both for those in cancer treatment and for those in survivorship.Implications for PracticeDeveloping tailored exercise programs based on both treatment status and the degree of fatigue and sleep quality is important. In-service education that enhances nurses’ awareness of the importance of exercise in improving adolescents’ QoL is recommended.
Use of Complementary Health Approaches for Acute Complaints Presenting to the Emergency Department
Authors: Kalaichandran Amitha , Barrowman Nick , Chan Jason , Toupin-April Karine , Vohra Sunita , Zemek Roger 
Published: February 2018

Objective
This study aimed to determine the prevalence of complementary health approaches (CHAs) specifically for acute complaints in patients assessed in a pediatric emergency department (ED) and factors associated with use.

Methods
A cross-sectional survey was offered to patients between the age of 28 days and 18 years assessed at a tertiary pediatric ED between December 2014 and July 2015. Univariate and multivariate logistic regressions were used to identify variables associated with CHA use.

Results
Of 475 potential participants, 412 (86.7%) participated, of which 369 (89.5%) completed the survey. Overall, 28.7% (95% confidence interval [CI], 24.3–33.5) reported using any CHA for their child to treat the presenting complaint in the prior 72 hours to the ED visit. Gastrointestinal complaints had the highest use of CHA (46.3% of presentations endorsed use). The most common complementary health products used were vitamins and minerals (40.9%; 95% CI, 31.2–51.4); the most common complementary health practice used was massage (37.2%; 95% CI, 24.4–52.1). Multivariate analysis showed lower odds of using CHA for rash/skin complaint (odds ratio, 0.23; 95% CI, 0.09–0.59; P < 0.01) or musculoskeletal/extremity complaints (odds ratio, 0.23; 95% CI, 0.07–0.75; P = 0.01) compared with use for fever. No statistically significant association was found between CHAs use and child's sex, child's age, private insurance, or caregiver education.

Conclusions
Caregivers commonly use CHA for acute pediatric complaints requiring an ED visit, with greatest use for gastrointestinal complaints. Clinicians should consider the use and safety of CHA when evaluating children presenting to the ED with acute conditions.
Oculocardiac Reflex in a Pediatric Trauma Patient
Authors: DesPain Angelica W. , Chapman Jennifer , Shaukat Haroon 
Published: February 2018

Abstract
We describe the case of a 6-year-old boy who presented to a tertiary care emergency department after a motor vehicle accident with facial trauma and bradycardia. The patient was found to have an orbital floor fracture and inferior rectus muscle entrapment with resulting bradycardia secondary to the oculocardiac reflex. The oculocardiac reflex is an uncommon cause of bradycardia in the setting of trauma but should be considered because it can necessitate surgical intervention.
Point-of-Care Ultrasound to Identify Congenital Heart Disease in the Pediatric Emergency Department
Authors: Rosenfield Daniel , Fischer Jason W. , Kwan Charisse W. 
Published: February 2018

Abstract
The first presentation of congenital heart disease can be a diagnostic challenge in the emergency department. We report on 2 cases where point-of-care ultrasound identified gross cardiac abnormalities in 2 children and expedited disposition and downstream care.
The Impact of a Displayed Checklist on Simulated Pediatric Trauma Resuscitations
Authors: Hulfish Erin , Diaz Maria Carmen G. , Feick Megan , Messina Catherine , Stryjewski Glenn 
Published: February 2018

Background
Advanced Trauma Life Support resuscitation follows a strict protocolized approach to the initial trauma evaluation. Despite this structure, elements of the primary and secondary assessments can still be omitted. The aim of this study is to determine if a cognitive aid checklist reduces omissions and speeds the time to assessment completion. We additionally investigated if a displayed checklist improved performance further.

Methods
A series of 131 simulated trauma resuscitations were performed. Teams were randomized to 1 of 3 arms (no checklist, handheld checklist, or displayed). The scenarios were recorded and analyzed to determine time to completion and absolute completion of tasks of the primary and secondary survey. The workload of individual team members was assessed via NASA-TLX.

Results
There was no difference in time to completion of surveys among the 3 arms. In the primary survey, there was a nonsignificant increase in the number of completed tasks with the use of the displayed checklist. In the secondary survey, there was a significant improvement in task completion with the displayed checklists with improved evaluation of the pelvis (P = 0.011), lower extremities (P = 0.048), and covering the patient (P = 0.046). There was a significant improvement in performance in those reported among nurse documenters with use of the displayed checklist.

Conclusions
Despite a structured approach to trauma resuscitations, omissions still occur. The use of a displayed checklist improves performance and reduces omissions without delaying assessment. Better compliance with Advanced Trauma Life Support protocols may improve patient outcomes.
Child Car Safety
Authors: Krepis Panagiotis , Papasotiriou Maria , Tsolia Maria N. , Soldatou Alexandra 
Published: February 2018

Objectives
This study aimed to assess parental behavior in terms of child restraint systems (CRS) use under emergency conditions while driving to the hospital's outpatient settings as well as their routine child car safety (CCS) practices.

Methods
A cross-sectional survey of parents/caregivers transporting children 13 years or younger was conducted at the Emergency Treatment Center of a pediatric tertiary care center in Athens, Greece. Participants completed a questionnaire inquiring about the possession of CRS, and type and use of appropriate CRS while driving to the Emergency Treatment Center and under routine conditions. In addition, presence and type of parental education with regard to CCS and the use of seat belts among drivers were assessed.

Results
Of 444 participants, 51.4% children were carried restrained, although 48.6% were fastened in an improper seat for their age, in contrast with 23.7% who travel unrestrained on a daily basis. Forward-facing restraint seats were most popular, with 53.9% total use even in children younger than 2 years or older than 4 years, whereas booster seats (9.4%) and rear-facing restraint seats (18.2%) were inappropriately disfavored. Children younger than 4 years, male drivers, and drivers who had received information on CCS had higher odds of using CRS. The proportion of those had never been provided any CCS education was 38.5%.

Conclusions
Child restraint systems use was inappropriately low under routine conditions and declined even further under emergency circumstances. Most children younger than 2 years and older than 4 years traveled inappropriately restrained in a forward-facing restraint seat. Parents should be more intensively educated on child car safety seat and the proper CRS use.
Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation in a 5-Year-Old Pediatric Patient
Authors: Klučka Jozef , Juřenčák Tomáš , Štourač Petr , Vít Pavel , Foralová Vladimíra , Synková Iva 
Published: February 2018

Abstract
Out-of-hospital cardiac arrest in pediatric population is rare and predominantly has respiratory aetiology. Authors present the relatively unique case of out-of hospital cardiac arrest in 5-years old pediatric patient due to ventricular fibrillation (VF) as the initial rhythm during the advanced life support. The patient was resuscitated by his parents and the initial rhythm was VF. After defibrillation the patient was admitted to the pediatric intensive care were another two episodes of VF was detected and treated. After standard postresuscitation care, patient was weaned from sedation and extubated with good neurologic outcome. Genetic screening of the 7 genes associated with cardiac channelopathies (KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, RYR2, CASQ2) found mutation in gene KCHN2 and gene SCN5A, that were according to actual data considered benign. This case highlights the need for automated external defibrillator implementation in basic life support also in pediatric population and possible role of genetic predisposition in emergence of fibrillation.
Spontaneous Spinal Epidural Hematoma in an Infant
Authors: Kim Michael , Hoffman Jessa , Amin Anubhav , Purohit Manish , Mohan Avinash 
Published: February 2018

Abstract
A spontaneous spinal epidural hematoma is a collection of blood in the spinal epidural space that occurs in the absence of trauma. They most commonly present in the fourth to fifth decade in life with acute onset neck or back pain with delayed neurologic deficit. However, this presentation is often complicated in children because of the limitations in the pediatric neurologic exam. Magnetic resonance imaging is the imaging modality of choice for diagnosis. Here is a rare case of an infant spontaneous spinal epidural hematoma whose diagnosis was delayed because of a recent history of fever and viral pharyngitis before his development of neurologic deficits. Spontaneous spinal epidural hematomas are a rare phenomenon, which often present with nonspecific symptoms in the pediatric population. This diagnosis should be considered to initiate treatment in a timely manner. The treatment typically is emergent surgical decompression to minimize the risk of permanent neurologic deficit.
Intra-Aortic Balloon Pump Simulating Thoracic Aortic Dissection
Authors: Siegel Yoel , Munera Felipe , Durso Anthony M. , Roth Patrick 
Published: February 2018

Abstract
We present a 70-year-old woman who had an intra-aortic balloon pump (IABP) in its deflated state in the aorta during a computed tomography angiogram scan. The scan was performed to assess for aortic dissection. The deflated IABP created a curvilinear filling defect in the aortic lumen that suggested an intimal flap. Herein, we described the finding and suggest key features that can help distinguish between this intra-aortic device and a true dissection. This distinction between the device and aortic dissection is not only important because of the potential pitfall of a false positive diagnosis but also because an IABP itself can lead to an aortic dissection and therefore its computed tomography features should be recognized in both its inflated and deflated state.