bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postapplication Advisement for U.S. Medical School Reapplicants: One School’s Program
Authors: Ballejos Marlene P. , Schmitt Cheryl L. , McKinney Kara L. , Sapien Robert 
Published: November 2018

Problem
Reapplicants make up over one-quarter of U.S. medical school applicants. Postapplication advisement (PAA) can provide potential reapplicants with concrete strategies for improvement, a contextualized basis for their scores, and a realistic idea of their chances for success. However, more data showing the effectiveness of PAA and an analysis of best practices are needed for PAA programs to be more widely adopted.

Approach
In 2010, the University of New Mexico School of Medicine (UNM SOM) created a PAA program that involves a postapplication seminar (PAS), mandatory self-assessment and action plan development, and an individual consult with an admissions dean to prepare participants for reapplication.

Outcomes
From 2010 to 2016, 892 applicants who interviewed and were rejected at UNM SOM were eligible to participate in PAA. Of these, 478 (53.6%) chose to participate in PAA over the seven-year period. Males had a higher participation rate (246/430; 57.2%) compared with females (232/461; 50.3%; P = .04). African Americans had a higher participation rate (12/17; 70.6%) and American Indian/Alaska Natives had a lower participation rate (17/64; 26.6%) than any other race/ethnicity. Of reapplicants who were subsequently accepted, 140/178 (78.7%) attended PAS and a consult, and 7/178 (3.9%) attended PAS only, compared with 31/178 (17.4%) of subsequently accepted reapplicants who did not participate in any PAA (P < .001).

Next Steps
Additional research should focus on the best approach for assisting reapplicants with prioritizing areas for improvement in their application. Demographic data may be used to target outreach to specific populations.
Comparison of Perioperative Systemic Lidocaine or Systemic Ketamine in Acute Pain Management of Patients With Opioid Use Disorder After Orthopedic Surgery
Authors: Sahmeddini Mohammad Ali , Khosravi Mohammad Bagher , Farbood Arash 
Published: November 2018

Introduction and Aims:
Patients with opioid use disorder experience great challenges during acute pain management due to opioid tolerance or withdrawal symptoms. Previous studies have recommended the use of adjuvant drugs in these patients. In this study, we compared the effect of intraoperative lidocaine with ketamine in postoperative pain management of these patients.

Design and Methods:
In this randomized clinical trial, 180 patients with opioid use disorder who underwent orthopedic surgery under general anesthesia were randomly allocated into 3 groups. Patients in groups A, B, and C received intravenous lidocaine, ketamine, or normal saline, respectively, during the operation. Then, postoperative pain scores, analgesic requirements, patient satisfaction, and patient sleepiness were recorded and compared among the 3 groups.

Results:
Numerical rating scales during the first hour postoperation were significantly lower in the lidocaine group than in the ketamine or control group (P < 0.001). The mean total amount of morphine consumption during the first 24-hour postoperation was 14.49 ± 26.89, 16.59 ± 30.65, and 21.72 ± 43.29 mg in the lidocaine, ketamine, and control group, respectively, being significantly lower in the lidocaine group in comparison with the other groups (P < 0.001). Patients in the lidocaine group were less restless, calmer, and less drowsy than patients in the ketamine and control group (P < 0.001).

Discussion and Conclusion:
According to these findings, systemic lidocaine is more effective than systemic ketamine to improve the quality of acute pain management without causing any significant complications in patients with opioid use disorder.
Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome
Authors: Pham Tài , Serpa Neto Ary , Pelosi Paolo , Laffey John Gerard , De Haro Candelaria , Lorente Jose Angel , Bellani Giacomo , Fan Eddy , Brochard Laurent Jean , Pesenti Antonio , Schultz Marcus Josephus , Artigas Antonio ,   on behalf of the LUNG SAFE Investigators* and the European Society of Intensive Care Medicine Trials Group
Published: November 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population.

Methods
This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: “worsening” if moderate or severe acute respiratory distress syndrome criteria were met, “persisting” if mild acute respiratory distress syndrome criteria were the most severe category, and “improving” if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2.

Results
Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening.

Conclusions
Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.
The Value of Prognostic Nutritional Index in Follicular Lymphoma
Authors: Lee Shing Fung , Ng Ting Ying , Wong Frank Chi Sing 
Published: November 2018

Objectives:
Previous studies reported that prognostic nutritional index (PNI), a marker of host inflammatory and nutritional status, is associated with prognoses in a number of cancer types. Thus, we investigated PNI at diagnosis as a prognostic factor in FL.

Methods:
We reviewed FL patients in Tuen Mun Hospital, Hong Kong from 2000 to 2014 (n=88). PNI was calculated by serum albumin (g/L)+5×absolute lymphocyte count (109/L). We determined the best PNI cut-off value using receiver-operating characteristic curves. The extent to which progression-free survival (PFS) and overall survival differed by PNI cut-off was assessed using Kaplan-Meier and log-rank tests. Cox proportional hazards model was utilized to adjust for covariates.

Results:
The best cut-off value for PNI was determined to be 45. Patients with high PNI (>45) had a higher complete response (CR) rate after primary treatment, 46 of 61 (75.4%) patients with high PNI had CR, compared with 10 of 23 (43.5%) for low PNI (2-sample test of proportions P-value=0.006). Further, higher PNI at relapse as a continuous variable was associated with superior postprogression survival with a hazard ratio (HR) 0.88 (95% confidence interval [CI], 0.81-0.96). In multivariate analysis, high PNI at diagnosis had superior PFS (adjusted HR of 0.37; 95% CI, 0.15-0.93).

Conclusions:
PNI was shown to be independent prognostic factor of PFS in FL. It is a cheap and widely available biomarker. Future study is needed to validate its prognostic value and clinical utility in a prospective cohort.
An Educational and Skill-Building Intervention to Improve Symptom Recognition and Interpretation in Women With Acute Coronary Syndrome
Authors: Davis Leslie L. , McCoy Thomas P. 
Published: November 2018

Background
The type of symptoms that a woman experiences during an acute coronary syndrome (ACS) event influences symptom recognition and interpretation. Women who experience intense, abrupt symptoms are more likely to correctly attribute symptoms to a cardiac etiology and seek care faster than women with less intense, intermittent symptoms.

Objective
A single-group pretest-posttest design was used to evaluate the feasibility and acceptability of a nurse-delivered education and skill-building intervention designed to improve symptom recognition and interpretation in women with recurrent ACS symptoms.

Methods
Women hospitalized for an ACS event received an individualized education and skill-building intervention that was conceptually framed by the investigator's previous research. Three in-person sessions were followed by 2 telephone sessions for reinforcement. Outcomes and acceptability were evaluated at close-out (approximately 2 months after the index event).

Results
All but 2 women approached agreed to participate. Of the 10 women enrolled, 9 completed all study sessions within an average of 55 days. Mean knowledge scores increased by 7.4% measured by the ACS Response Index. Attitudes toward symptom recognition and help seeking increased by 2.4, whereas beliefs toward expectations and actions increased by 3.2. The women were pleased with the intervention (satisfaction scores averaging 1.4 on a 4-point Likert scale, with 1 as “strongly agree” and 4 as “strongly disagree”). All women who completed the study would recommend it to others.

Conclusion
The nurse-delivered intervention was feasible and acceptable to women in the study. Results support further testing and refinement of the intervention in a longitudinal randomized control study to determine efficacy and sustainability.
System-Wide Improvement for Transitions After Ileostomy Surgery: Can Intensive Monitoring of Protocol Compliance Decrease Readmissions? A Randomized Trial
Authors: Grahn Sarah W. , Lowry Ann C. , Osborne Marc C. , Melton Genevieve B. , Gaertner Wolfgang B. , Vogler Sarah A. , Madoff Robert D. , Kwaan Mary R. 
Published: November 2018

BACKGROUND:
Hospital readmission is common after ileostomy formation and frequently associated with dehydration.

OBJECTIVE:
This study was conducted to evaluate a previously published intervention to prevent dehydration and readmission.

DESIGN:
This is a randomized controlled trial.

SETTING:
This study was conducted in 3 hospitals within a single health care system.

PATIENTS:
Patients undergoing elective or nonelective ileostomy as part of their operative procedure were selected.

INTERVENTION:
Surgeons, advanced practice providers, inpatient and outpatient nurses, and wound ostomy continence nurses participated in a robust ileostomy education and monitoring program (Education Program for Prevention of Ileostomy Complications) based on the published intervention. After informed consent, patients were randomly assigned to a postoperative compliance surveillance and prompting strategy that was directed toward the care team, versus usual care.

OUTCOME MEASURES:
Unplanned hospital readmission within 30 days of discharge, readmission for dehydration, acute renal failure, estimated direct costs, and patient satisfaction were the primary outcomes measured.

RESULTS:
One hundred patients with an ileostomy were randomly assigned. The most common indications were rectal cancer (n = 26) and ulcerative colitis (n = 21), and 12 were emergency procedures. Although intervention patients had better postdischarge phone follow-up (90% vs 72%; p = 0.025) and were more likely to receive outpatient intravenous fluids (25% vs 6%; p = 0.008), they had similar overall hospital readmissions (20.4% vs 19.6%; p = 1.0), readmissions for dehydration (8.2% vs 5.9%; p = 0.71), and acute renal failure events (10.2% vs 3.9%; p = 0.26). Multivariable analysis found that weekend discharges to home were significantly associated with readmission (OR, 4.5 (95% CI, 1.2–16.9); p = 0.03). Direct costs and patient satisfaction were similar.

LIMITATIONS:
This study was limited by the heterogeneous patient population and by the potential effect of the intervention on providers taking care of patients randomly assigned to usual care.

CONCLUSIONS:
A surveillance strategy to ensure compliance with an ileostomy education program tracked patients more closely and was cost neutral, but did not result in decreased hospital readmissions compared with usual care. See Video Abstract at http://links.lww.com/DCR/A812.
Role of Yoga in Cardiac Disease and Rehabilitation
Authors: Guddeti Raviteja R. , Dang Geetanjali , Williams Mark A. , Alla Venkata Mahesh 
Published: November 2018

Purpose:Cardiovascular disease continues to be the leading cause of morbidity and mortality around the world. Yoga, a combination of physical postures (asana), breathing exercises (pranayama), and meditation (dhyana), has gained increasing recognition as a form of mind-body exercise. In this narrative review, we intended to review the emerging evidence assessing the physiologic and clinical effects of yoga on the cardiovascular system and the potential role of yoga as a component of comprehensive cardiac rehabilitation.Methods:We searched PubMed, Google Scholar, Embase, and Cochrane databases for literature related to cardiovascular effects of yoga from inception up until 2017.Results:Yoga has been shown to have favorable effects on systemic inflammation, stress, the cardiac autonomic nervous system, and traditional and emerging cardiovascular risk factors.Conclusions:Yoga has shown promise as a useful lifestyle intervention that can be incorporated into cardiovascular disease management algorithms. Although many investigators have reported the clinical benefits of yoga in reducing cardiovascular events, morbidity, and mortality, evidence supporting these conclusions is somewhat limited, thereby emphasizing the need for large, well-designed randomized trials that minimize bias and methodological drawbacks.
New Treatment Options in Advanced Stage Follicular Lymphoma
Authors: Hübel Kai , Salles Gilles , Marcus Robert , Zinzani Pier Luigi , Dreyling Martin 
Published: November 2018

AbstractFollicular lymphoma is one of the most common non‐Hodgkin's lymphomas with an expected survival of more than 20 years for the majority of patients. This impressive outcome has been achieved with the introduction of immunochemotherapy, as first line treatment with remissions lasting over 8 years, followed by other treatment options at first or subsequent relapse. However, certain groups of patients still have a poor prognosis. In recent years the efficacy of chemotherapy regimens has been augmented by new compounds selectively targeting the cell surface, intracellular pathways, and/or the microenvironment. Some of these are beginning to change the therapeutic landscape. This review summarizes prognostic factors in follicular lymphoma in order to identify patients with greatest medical need for these new treatment options and reviews recent data from prospective clinical studies testing new agents in first‐line and relapsed follicular lymphoma. Finally, we assess the current role of immunochemotherapy and discuss the requirements for future clinical trials.
Performance Validity in Collegiate Football Athletes at Baseline Neurocognitive Testing
Authors: Abeare Christopher , Messa Isabelle , Whitfield Cameron , Zuccato Brandon , Casey Joseph , Rykulski Nicholas , Erdodi Laszlo 
Published: November 2018

Objective:
To assess the prevalence of invalid performance on baseline neurocognitive testing using embedded measures within computerized tests and individually administered neuropsychological measures, and to examine the influence of incentive status and performance validity on neuropsychological test scores.

Setting:
Sport-related concussion management program at a regionally accredited university.

Participants:
A total of 83 collegiate football athletes completing their preseason baseline assessment within the University's concussion management program and a control group of 140 nonathlete students.

Design:
Cross-sectional design based on differential incentive status: motivated to do poorly to return to play more quickly after sustaining a concussion (athletes) versus motivated to do well due to incentivizing performance (students).

Main Measures:
Immediate Post-Concussion and Cognitive Testing (ImPACT), performance validity tests, and measures of cognitive ability.

Results:
Half of the athletes failed at least 1 embedded validity indicator within ImPACT (51.8%), and the traditional neuropsychological tests (49.4%), with large effects for performance validity on cognitive test scores (d: 0.62-1.35), incentive status (athletes vs students; d: 0.36-1.15), and the combination of both factors (d: 1.07-2.20) on measures of attention and processing speed.

Conclusion:
Invalid performance on baseline assessment is common (50%), consistent across instruments (ImPACT or neuropsychological tests) and settings (one-on-one or group administration), increases as a function of incentive status (risk ratios: 1.3-4.0) and results in gross underestimates of the athletes' true ability level, complicating the clinical interpretation of the postinjury evaluation and potentially leading to premature return to play.
Management of Type 2 Bubble Formed During Big Bubble Deep Anterior Lamellar Keratoplasty
Authors: Goweida Mohamed Bahgat , Ragab Ahmed Mahmoud , Liu Christopher 
Published: November 2018

Purpose:
To review the outcome of 3 techniques for managing type 2 bubbles (between Descemet's membrane [DM] and stroma) formed during big bubble (BB) deep anterior lamellar keratoplasty (DALK) in different corneal pathologies.

Methods:
This is an interventional case series study of patients with type 2 bubbles formed during BB DALK. Three techniques to complete DALK are described: the first is a DM baring technique similar to Anwar's BB technique, the second is the microbubble incision technique to preserve the pre-Descemetic support to DM, and the third is done in eyes with combined type 1 and type 2 BB (mixed bubble), where the type 1 bubble is opened and surgery is completed avoiding the type 2 bubble.

Results:
Thirty-one eyes of 31 patients were included. The DM baring technique has a high rate of conversion to penetrating keratoplasty (12 of 16 eyes). In the other 2 techniques (which did not bare DM), DALK could be completed in all 15 cases with intact DM. Double anterior chamber is a relatively common complication after type 2 BB, even with an intact DM.

Conclusions:
DM baring techniques should be avoided in eyes with type 2 BB. Instead, deep stromal dissection searching for an incomplete type 1 bubble or using one of the manual dissection techniques as a guide to the clear pre-Descemetic stroma is safer and more reliable.
Conjunctival Colloid Milium
Authors: Bhargava Mona , Benurwar Saket , Krishnakumar S. 
Published: November 2018

Purpose:
To describe a rare case of conjunctival colloid milium.

Methods:
Case report.

Results:
We report a 45-year-old woman with a history of a slow-growing, painless mass extending from the medial canthal region to the inferior fornix and the inferior bulbar conjunctiva associated with redness. The patient underwent excisional biopsy of the lesion with amniotic membrane transplantation for the resulting conjunctival defect. Biopsy showed homogenous amorphous eosinophilic material with gaps. The stroma did not show any evidence of solar damage, and no refractive material was seen under the polarizer. Congo red stain for amyloid was negative. Based on histopathological findings, a diagnosis of nodular colloid milium was made.

Conclusions:
Adult periocular colloid milium is an unusual presentation of a rare cutaneous deposition disease. The occurrence of conjunctival colloid milium is rare, and we report this case to increase knowledge and management regarding this rare disease and to differentiate it from other diseases such as amyloidosis, lipoid proteinosis, plasmacytoma, and conjunctival lymphoma, which carry a graver prognosis, and have a similar clinical appearance and can be distinguished only on the basis of histopathological characteristics.
Orbital Metastasis From Urothelial Carcinoma: A Comprehensive Literature Review
Authors: Sklar Bonnie A. , Gervasio Kalla A. , Karmazin Konstantin , Wu Albert Y. 
Published: November 2018

Purpose:
To review the clinical features of orbital and choroidal metastases from urothelial carcinomas of the urinary tract among cases reported in the literature, and to describe a case of orbital metastasis from bladder cancer presenting as apparent internuclear ophthalmoplegia.

Methods:
Case reports of orbital and choroidal metastases from urothelial carcinomas published in the literature from 1965 to 2018 were reviewed. Data collected included patient demographics, cancer stage and primary site, time to onset of ocular symptoms, length of presenting ocular symptoms, types of primary ocular symptoms, diagnostic imaging, histology, systemic and ocular treatments, and survival time.

Results:
Twenty-eight cases of urothelial carcinoma with metastasis to the orbit or choroid were reviewed. Men were significantly more likely to suffer from this condition than women (p = 0.011). The average age of presentation with orbital symptoms was 63 years, with an average time of 19 months between primary cancer diagnosis and onset of orbital symptoms. Twenty-two patients had metastasis to the orbit and 6 to the choroid. In 4 cases, ocular deficits secondary to orbital and/or choroidal metastases were the initial presenting symptoms in patients with previously undiagnosed urothelial carcinoma. The most commonly noted primary ocular symptoms and signs consisted of decreased visual acuity, decreased ocular motility, proptosis, and diplopia. Average survival from onset of ocular symptoms was 4.67 months.

Conclusions:
Urothelial carcinoma may metastasize to the orbit or choroid; furthermore, its presentation may mimic internuclear ophthalmoplegia. It is recommended that any patient with visual symptoms and known urothelial cancer should undergo expedited workup for metastatic disease.