bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Medical Error Shapes Physicians’ Perceptions of Learning: An Exploratory Study
Authors: Shepherd Lisa , LaDonna Kori A. , Cristancho Sayra M. , Chahine Saad 
Published: April 2019

Purpose
Error is inevitable in medicine, given its inherent uncertainty and complexity. Errors can teach powerful lessons; however, because of physicians’ self-imposed silence and the intricacies of responsibility and blame, learning from medical error has been underexplored. The purpose of this study was to understand how physicians perceived learning from medical errors by exploring the tension between responsibility and blame and factors that affected physicians’ learning.

Method
Nineteen physicians participated in semistructured interviews, conducted in 2016–2017 at Western University in Canada, that probed their experiences in learning from medical errors. Data collection and analysis were conducted iteratively, with themes identified through constant comparative analysis.

Results
Participants felt personal responsibility and blame for their errors. Residency produced particularly salient memories of errors. Participants identified interconnecting cultural factors (normalizing error, peer support and mentorship, formal rounds) and individual factors (emotional response, confidence and experience), which either helped or hindered their perceived learning.

Conclusions
Learning from medical error requires navigation through blame and responsibility. The keen responsibility felt by physicians must be acknowledged when enacting a system-based approach to medical error. Adopting a learning culture perspective suggests opportunities to enable and disable features of the learning environment to optimize learning from error as residents learn to become the most responsible physician for all outcomes. A better understanding of the factors that shape learning from error can help make the transition from error to learning more explicit, thereby increasing the opportunity to learn and teach from errors that permeate the practice of medicine.
The Long-term Reoperation Rate Following Surgery for Lumbar Herniated Intervertebral Disc Disease
Authors: Kim Chi Heon , Chung Chun Kee , Choi Yunhee , Kim Min-Jung , Yim Dahae , Yang Seung Heon , Lee Chang Hyun , Jung Jong-Myung , Hwang Sung Hwan , Kim Dong Hwan , Yoon Joon Ho , Park Sung Bae 
Published: April 2019

Study Design.
A retrospective cohort study of a nationwide sample database.

Objective.
The objective of the present study was to compare the long-term incidence of reoperation for lumbar herniated intervertebral disc disease (HIVD) after major surgical techniques (open discectomy, OD; laminectomy; percutaneous endoscopic lumbar discectomy, PELD; fusion).

Summary of Background Data.
HIVD is a major spinal affliction; if the disease is intractable, surgery is recommended. Considering both the aging of patients and the chronicity of lumbar degenerative disease, the effect of surgical treatment for the lumbar spine should be durable for as long as possible.

Methods.
The National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Republic of Korea was utilized to establish a cohort of adult patients (N = 1856) who underwent first surgery for lumbar HIVD during 2005 to 2007. Patients were followed for 8 to 10 years. Considering death before reoperation as a competing event, reoperation hazards were compared among surgical techniques using the Fine and Gray regression model after adjustment for age, gender, Charlson comorbidity score, osteoporosis, diabetes, the severity of disability, insurance type, and hospital type.

Results.
The overall cumulative incidences of reoperation were 4% at 1 year, 6% at 2 years, 8% at 3 years, 11% at 5 years, and 16% at 10 years. The cumulative incidences of reoperation were 16%, 14%, 16%, and 10% after OD, laminectomy, PELD, and fusion, respectively, at 10 years postoperation, with no difference among the surgical techniques. However, the distribution of reoperation types was significantly different according to the first surgical technique (P < 0.01). OD was selected as the reoperation surgical technique in 80% of patients after OD and in 81% of patients after PELD.

Conclusion.
The probability of reoperation did not differ among OD, laminectomy, PELD, and fusion during the 10-year follow-up period. However, OD was the most commonly used technique in reoperation.

Level of Evidence: 4
TAMOXIFEN-INDUCED CHORIORETINAL CHANGES
Authors: Crisóstomo Sara , Vieira Luísa , Cardigos Joana , Fernandes Diogo H. , Luís Maria E. , Nunes Susana , Morujão Inês , Anjos Rita , Flores Rita 
Published: April 2019

Purpose:
To study structural chorioretinal changes in tamoxifen-treated patients.

Methods:
Cross-sectional case–control study comparing structural chorioretinal aspects in tamoxifen-treated patients and healthy controls. Enhanced depth spectral domain optic coherence tomography with choroidal binarization and optic coherence tomography angiography were performed. Individual retinal layer thickness and chorioretinal vascular components were compared. Subgroup analysis regarding history of chemotherapy was performed.

Results:
Two hundred eyes of 100 TAM-treated patients (Group 1) and 80 eyes of 40 healthy controls (Group 2) were included. Of the 200 spectral domain optic coherence tomography scans from patients, 2 showed structural changes attributable to tamoxifen. Group 1 showed significantly lower values in choroidal parameters and in total retinal, ganglion cell layer, inner plexiform layer, outer nuclear layer, and retinal pigment epithelial thicknesses as well as an increased thickness in the outer plexiform layer. The subgroup not submitted to chemotherapy maintained significant reductions in total retinal thickness, ganglion cell layer, retinal pigment epithelium, outer nuclear layer, outer retinal layer, choroidal parameters, as well as an increased thickness in the outer plexiform layer, in comparison with Group 2.

Conclusion:
Subclinical structural retinal changes could indicate early retinal pigment epithelial and photoreceptor damage. The new finding of choroidal thinning could point toward another important pathophysiologic process in tamoxifen-induced toxicity.
Kahook Dual Blade Excisional Goniotomy and Goniosynechialysis Combined With Phacoemulsification for Angle-closure Glaucoma: 6-Month Results
Authors: Dorairaj Syril , Tam Mai Dang 
Published: April 2019

Purpose:
The purpose of this study was to characterize reductions in intraocular pressure (IOP) and the need for IOP-lowering medications following phacoemulsification combined with Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy in eyes with angle-closure glaucoma and cataract.

Methods:
In this retrospective, interventional case series, preoperative, operative, and postoperative data were collected through 6 months of follow-up from 42 eyes of 24 subjects. Outcomes included mean IOP reduction, reduction in IOP-lowering medications, and the proportion of patients achieving IOP reduction ≥20%, IOP≤18 mm Hg, and reduction of ≥1 medication.

Results:
Preoperatively, mean (SE) IOP was 25.5 (0.7) mm Hg and the mean number of IOP-lowering medications used was 2.3 (0.1) per eye. Through 6 months of follow-up, mean IOP reductions of 10.1 to 12.8 mm Hg (38.4% to 49.5%; P<0.0001) and mean IOP medication reductions of −2.2 to −2.3 (91.7% to 98.4%; P<0.0001) were seen. At month 6, 92.9% of eyes (39/42) achieved IOP≤18 mm Hg, 100% (42/42) achieved IOP reduction of ≥20%, 100% (42/42) required ≥1 fewer medications for IOP control, and 85.7% (36/42) were medication free.

Conclusions:
Phacoemulsification combined with Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy safely provides statistically and clinically meaningful reductions in both IOP and the need for IOP-lowering medications in eyes with angle-closure glaucoma.
Differences in Optic Nerve Head Blood Flow Regulation in Normal Tension Glaucoma Patients and Healthy Controls as Assessed With Laser Speckle Flowgraphy During the Water Drinking Test
Authors: Mursch-Edlmayr Anna S. , Luft Nikolaus , Podkowinski Dominika , Ring Michael , Schmetterer Leopold , Bolz Matthias 
Published: April 2019

Précis:
Optic nerve head (ONH) perfusion was not significantly altered in subjects with normal tension glaucoma (NTG) nor in healthy individuals after performing the water drinking test (WDT), because of its limited effect on ocular perfusion pressure (OPP).

Purpose:
ONH blood flow can be maintained stable in healthy individuals because of a physiological phenomenon called autoregulation. Impairment of autoregulation has been shown especially under condition of NTG. The purpose of this study was to investigate the ONH blood flow autoregulation in patients with NTG by influencing the OPP with the WDT.

Methods:
The study included 9 eyes from 9 white patients with a diagnosis of NTG and 9 eyes from age-matched and sex-matched healthy individuals. In the glaucoma group, the antiglaucomatous therapy was paused 3 weeks before the investigations. Measurements of ONH blood flow were performed with laser speckle flowgraphy. After baseline measurements, individuals ingested 800 mL of water in <5 minutes. Measurements were repeated after 15, 30, and 45 minutes.

Results:
The water ingestion led to a significant rise in intraocular pressure (P<0.001) but also mean arterial pressure (P<0.001) in both groups. This resulted in stable OPP (P=0.051) with no significant difference between the groups (P=0.43). ONH blood flow remained stable over time in both groups (P=0.719). No significant interaction of time and group was shown for all parameters.

Conclusions:
Our findings show that the WDT does not significantly influence the OPP and therefore has to be considered inferior to other methods used to assess blood flow autoregulation.
Prevalence and Clinical Characteristics of Childhood Glaucoma at a Tertiary Care Children’s Hospital
Authors: Bouhenni Rachida A. , Ricker Isabel , Hertle Richard W. 
Published: April 2019

Precis:
Glaucoma suspect was the most prevalent category in this study followed by glaucoma associated with acquired ocular anomaly and juvenile open-angle glaucoma. Primary congenital glaucoma was diagnosed in only 3% of the population studied.

Purpose:
To describe the prevalence and clinical characteristics of childhood glaucoma diagnosed over a 10-year period among patients aged 18 years or below who were seen at a tertiary care children’s hospital using the new Childhood Glaucoma Research Network classification system.

Methods:
Medical records of all patients aged 18 years or below (n=108) who were diagnosed with glaucoma between January 1, 2008 through September 30, 2018 were reviewed. Data collected included demographics (age at diagnosis, sex, and family history of glaucoma), intraocular pressure, disc-to-cup ratio, retinal nerve fiber layer thickness, and refractive errors. Clinical characteristics of each patient were evaluated according to the criteria established by Childhood Glaucoma Research Network. Categorical distributional equivalence comparisons were performed using the Pearson χ2 test. A P-value <0.05 was defined as statistically significant.

Results:
A total of 108 patients with a diagnosis of childhood glaucoma or glaucoma suspect were included in this study. Sixty-four percent of these patients were males (P<0.0001). The mean age at the time of diagnosis was 7.07±5.4 years. “Glaucoma suspect” was the most prevalent category (46%, P=0.0002), followed by glaucoma associated with the acquired ocular anomaly (20%) and juvenile open-angle glaucoma (16%). Primary congenital glaucoma represented 3% and all these patients were males. Sixty-nine percent of the patients had bilateral involvement (P=0.0073). The highest intraocular pressure recorded in the study was 57 mm Hg, the largest cup-to-disc ratio was 0.96, and the lowest retinal nerve fiber layer measurement was 39 μm. Ninety-two percent of the patients had refractive errors and 85% of them had astigmatism.

Conclusions:
Establishing a pattern and the associated clinical characteristics of childhood glaucoma at tertiary care children’s hospitals will help in developing collaborative research efforts and effective treatment/management strategies for children with these rare groups of disorders.
Incidence of Bleeding Complications With Flexible Bronchoscopy in Cancer Patients With Thrombocytopenia
Authors: Faiz Saadia A. , Jimenez Carlos A. , Fellman Bryan M. , Huk Tauqir , Jazbeh Sammer , Haque Sajid A. , Morice Rodolfo C. , Grosu Horiana B. , Balachandran Diwakar D. , Shannon Vickie R. , Eapen Georgie A. , Bashoura Lara 
Published: April 2019

Background:
Bronchoscopy is a safe procedure, but current guidelines recommend transfusion for platelets <20 K/μL. Studies of bronchoscopy in thrombocytopenia are limited.

Objectives:
Our objective was to evaluate the incidence of bleeding with flexible bronchoscopy in those with thrombocytopenia especially those <20 K/μL.

Method:
We performed a retrospective review of all flexible bronchoscopies between June 1, 2008 and December 31, 2010. Biopsies and therapeutic procedures were excluded. The χ2, Fisher exact, and Rank-sum test were conducted to evaluate associations of clinically significant bleeding.

Results:
There were 1711 patients who underwent 2053 flexible bronchoscopies. Cancer diagnosis included hematologic (61.3%) and solid organ malignancy (34.9%). Half of the bronchoscopies had moderate to severe thrombocytopenia (<100 K/μL) with the following ranges: 14.7% with 50 to <100 K/μL, 20.6% with 20 to <50 K/μL, 10.6% with 10 to <20 K/μL, 4.1% with <10 K/μL. Platelet transfusion was given in 90.6% of those with platelets <10 K/μL and 55.5% of those with platelets 10 to <20 K/μL. The nasal route for bronchoscopy was used in 92.4%. Bleeding complication rate however was 1.1% (0.2% major) and not affected by platelets.

Conclusion:
Bronchoscopy with lavage can be safely performed without platelet transfusion in those with platelets of ≥10 K/μL. In the absence of nasal bleeding, trauma, or deformity, the nasal route can be used for bronchoscopy.
Tablet-Based Patient Education Regarding Human Papillomavirus Vaccination in Colposcopy Clinic
Authors: Gockley Allison A. , Pena Nancy , Vitonis Allison , Welch Kelly , Duffey-Lind Eileen C. , Feldman Sarah 
Published: April 2019

Objective
The aim of this study was to use an electronic tablet–based education module to increase patient knowledge about human papillomavirus (HPV).

Methods
Patients presenting to an academic colposcopy clinic were first queried as to whether they had been infected with HPV. A quality improvement project was then conducted using a 4-question pretest assessing baseline knowledge about HPV and cancer, followed by a tablet-based education module and a 5-question posttest.

Results
Between June 2017 and January 2018, 119 patients participated in the tablet education. At their initial visit, only 50 (42.0%) of patients were aware that they had an HPV infection; however, medical records revealed that 74 women (62.2%) were presenting with a documented HPV infection. After the tablet education, 95% of women identified cervical cancer as a problem that can be caused by HPV, as compared with 88.2% in the pretest (p = .046). Knowledge of head and neck cancer as a disease that can be caused by HPV increased from 10.9% to 80.7% (p < .001). More patients answered that they “definitely” or “probably” would consider the vaccine for a child in their family: 108 (95.6%) pretest vs. 112 (99.1%) posttest (p = .046). The activities were ranked as “extremely” or “very” helpful by 93.3% of patients.

Conclusions
Patients presenting to colposcopy clinic are not well educated regarding the connection between an abnormal Pap test, HPV infection, and certain cancers. Tablet-based education improves patient knowledge of HPV-associated cancers in an outpatient clinic setting.
Clinical features and outcomes of revascularization in very old patients with left main coronary artery disease
Authors: Sliman Hussein , Jaffe Ronen , Rubinshtein Ronen , Karkabi Basheer , Zissman Keren , Flugelman Moshe Y. , Zafrir Barak 
Published: April 2019

Background
Coronary artery disease (CAD) is often more extensive in older adults and may involve multivessel and left main coronary artery (LMCA) disease. Elderly patients are commonly excluded from clinical trials, and limited real-world data exist on the management of LMCA disease in the very old. We aimed to investigate clinical features and outcomes of very old patients undergoing revascularization due to LMCA disease.

Patients and methods
A retrospective single-center analysis of patients at least 80 years (n = 139) who underwent revascularization owing to CAD involving unprotected LMCA stenosis more than 50% was conducted. Subsequent major adverse cardiovascular events (MACE: myocardial infarction, stroke, and all-cause death) and repeat revascularizations were recorded, and their relation to revascularization procedure was studied.

Results
Percutaneous coronary intervention (PCI) was performed in 74 patients and coronary artery bypass surgery (CABG) in 65. Most patients (80%) had multivessel disease involving at least 2 additional coronary arteries. PCI was associated with older age, higher rates of baseline disability, previous revascularization, reduced ventricular function, significant aortic stenosis, and presentation with acute coronary syndrome, compared with CABG. Cumulative 3-year MACE rates were higher in patients undergoing PCI versus CABG (P = 0.009). After multivariable adjustment, predictors of MACE included presentation with ST-segment elevation myocardial infarction (STEMI) [hazard ratio (HR) = 2.39; 95% confidence interval: 1.24–4.63; P = 0.010], revascularization by PCI compared with CABG [HR = 2.21 (1.18–4.15); P = 0.013], baseline disability [HR = 2.17 (1.20–3.91); P = 0.010], and distal LMCA disease [HR = 1.87 (1.04–3.38); P = 0.038]. The difference in 3-year MACE between PCI and CABG was not observed in a propensity-score analysis of 90 patients matched 1: 1 for baseline disability, STEMI, and aortic stenosis (P = 0.797).

Conclusion
In very old patients undergoing coronary revascularization owing to LMCA disease, PCI was associated with worse cardiovascular outcomes compared with CABG, influenced by a more severe and comorbid population selected for PCI. Baseline disability, presentation with STEMI, and distal LMCA bifurcation disease were additional independent outcome predictors.
Incivility and Clinical Performance, Teamwork, and Emotions
Authors: Johnson Susan L. , Haerling Katie A. , Yuwen Weichao , Huynh Van , Le Chi 
Published: April 2019

Background:
Incivility has been identified as a common occurrence in health care settings. While anecdotal evidence exists that these behaviors negatively impact patient care, more robust evidence is lacking.

Purpose:
This randomized controlled trial investigated the effects of exposure to incivility on clinical performance, teamwork, and emotions.

Methods:
Teams of nurses were randomly assigned to a control or experimental group. The experimental group was exposed to incivility. Both groups were then prompted to perform basic life support on a high-fidelity manikin. Teams were scored on cardiopulmonary resuscitation (CPR) performance and teamwork. Individuals completed measures of affect and a cognitive test.

Results:
There were no differences in CPR, cognitive or teamwork scores, or emotional state. However, 66% of the experimental group had a major error in their CPR performance. None of the control groups made the same error.

Conclusions:
These findings support anecdotal evidence that exposure to incivility may contribute to errors in clinical performance.
Quality of Sleep in a Pediatric Hospital
Authors: Crawford Sara , Utt Aaron , Beebe Caylin , Armbruster Renee , Fisher Amanda , Olney Adrienne , Sherman Ashley K. , Roberts Cristine 
Published: April 2019

OBJECTIVE
To investigate the amount and type of hospitalized children's nighttime sleep interruptions, perceptions, and efficiency.

BACKGROUND
Sleep in hospitals is notoriously poor and impedes healing. Pediatric studies have been limited including breadth of diagnoses, age, or measures.

METHODS
Actigraphy, sleep surveys, and nursing diaries were used to describe sleep on 2 nursing units along with environmental assessments.

RESULTS
Ninety-five children from 1 month to 17 years with multiple diagnoses participated. The median number of awakenings was 2.7 per night. The median for the longest uninterrupted episode of sleep was 5.5 hours. Children need 8 to 17 hours of daily sleep, while this sample had a median of 7.5 hours of night sleep. Sensors showed talk as the predominant noise, whereas surveys showed alarms and vital signs awakened patients.

CONCLUSIONS
Children are not getting essential, minimally interrupted sleep in hospitals. Disseminating results will increase awareness and accelerate environmental changes.
Pharmaceutical consultations in oncology: French Society for Oncology Pharmacy (Société Francaise de Pharmacie Oncologique – SFPO) guidelines
Authors: Petit-Jean Emilie , Correard Florian , Maillan Gaelle , de Crozals Françoise , Bertrand Benjamin , Regnier Véronique , Chevrier Régine , Streicher Caroline , Madelaine Isabelle , Pourroy Bertrand 
Published: April 2019

Abstract

Introduction:
Pharmaceutical consultations is a key point for oral therapy-treated cancer patients’ management.

Methods:
French Society for Oncology Pharmacy built recommendations according to French High Authority of Health regarding the guidelines for Good Practice.

Results:
Fourteen guidelines were issued and tools proposed to hospital pharmacist's community.

Discussion:
These guidelines allow to secure management of cancer patients treated by oral therapies.
Coarctation of the Aorta in Adolescence
Authors: Asad Imran , Lee Michelle Sin , Banihani Rudaina , Wong Peter D. , Etoom Yousef 
Published: April 2019

Abstract
Although coarctation of the aorta (CoAo) is a congenital anomaly, it can pose a diagnostic challenge in those presenting beyond neonatal period, as some patients can remain asymptomatic until complications of hypertension develop later in life. Careful physical examination can play an important role in timely diagnosis and prevention of complications.
We present 2 cases of adolescents with undiagnosed CoAo who both presented with nonspecific headaches and hypertension. Both were initially misdiagnosed as essential hypertension until careful detailed physical examination later detected weak/absent femoral pulses and discrepancy in upper and lower limb blood pressures. These findings raised the clinical suspicion of CoAo, which was confirmed on further investigations.
Our cases highlight the importance of considering CoAo in the differential diagnosis of hypertension in adolescents. These cases also stress the significance of detailed cardiac examination including 4-limb blood pressure and femoral pulses in a patient presenting to the emergency department with high blood pressure irrespective of the primary complaint.