bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simulation as a Method of Competency Assessment Among Health Care Providers: A Systematic Review
Authors: Keddington Amanda S. , Moore Jill 
Published: December 2018

Abstract

AIM
The aim of this study was to review and assess current research on simulation as a method of competency assessment among health care professionals and the efficacy of simulation-based competency assessment compared to standard methods.

BACKGROUND
Simulation has been proven to be an effective instructional methodology for many health care specialties. However, there is a limited amount of research on simulation as a method of competency assessment.

METHOD
Articles regarding competency assessment by simulation in health care professionals were reviewed from academic databases based on inclusion/exclusion criteria.

RESULTS
The effectiveness of simulation as a method of competency assessment needs further study in order to provide conclusive evidence of benefits. Assessment of high-risk, low-frequency skills promotes patient safety in situations that may occur infrequently enough to prevent continued practice of skills.

CONCLUSION
This systematic review indicates that simulation may be a safe and effective method of competency assessment in health care professionals.
Using the Two-Minute Assessment With Debriefing to Optimize Traditional Patient Care Clinical Experiences
Authors: Veesart Amanda , Johnson Kyle 
Published: December 2018

Abstract
Traditional patient care clinical experiences present numerous challenges to faculty in prelicensure nursing education. This article presents an adapted nontraditional clinical activity for use in patient care clinical experiences. The Two-Minute Assessment With Debriefing incorporates peer collaboration and attributes of debriefing, including assimilation, accommodation, and anticipation. Nursing students in acute care facilities are assigned to either traditional or nontraditional care, with the group ideally split in half. The use of nontraditional clinical activities with reflection has been supported as a strategy to engage higher order thinking about patient care while allowing focused faculty time with students in traditional patient care.
Technology Use Patterns Among Patients Enrolled in Inpatient Detoxification Treatment
Authors: Tofighi Babak , Leonard Noelle , Greco Peter , Hadavand Aboozar , Acosta Michelle C. , Lee Joshua D. 
Published: December 2018

Background:
Technology-based interventions offer a practical, low-cost, and scalable approach to optimize the treatment of substance use disorders (SUDs) and related comorbidities (HIV, hepatitis C infection). This study assessed technology use patterns (mobile phones, desktop computers, internet, social media) among adults enrolled in inpatient detoxification treatment.

Methods:
A 49-item, quantitative and qualitative semi-structured survey assessed for demographic characteristics, technology use patterns (ie, mobile phone, text messaging [TM], smart phone applications, desktop computer, internet, and social media use), privacy concerns, and barriers to technology use. We used multivariate logistic regression models to assess the association between respondent demographic and clinical characteristics and their routine use of technologies.

Results:
Two hundred and six participants completed the survey. Nearly all participants reported mobile phone ownership (86%). Popular mobile phone features included TM (96%), web-browsers (81%), and accessing social media (61%). There was high mobile phone (3.3 ± 2.98) and phone number (2.6 ± 2.36) turnover in the preceding 12 months. Nearly half described daily or weekly access to desktop computers (48%) and most reported internet access (67%). Increased smartphone ownership was associated with higher education status (P = 0.022) and homeless respondents were less likely to report mobile phone ownership (P = 0.010) compared to participants with any housing status (ie, own apartment, residing with friends, family, or in a halfway house). Internet search engines were used by some participants (39.4%, 71/180) to locate 12 step support group meetings (37%), inpatient detoxification programs (35%), short- or long-term rehabilitation programs (32%), and outpatient treatment programs (4%).

Conclusions:
Technology use patterns among this hard-to-reach sample of inpatient detoxification respondents suggest high rates of mobile phone ownership, TM use, and moderate use of technology to facilitate linkage to addiction treatment services.
Prevalence, Incidence, and Factors Associated With Substance Use Among Medical Students: A 2-Year Longitudinal Study
Authors: Moutinho Ivana Lúcia Damásio , Lucchetti Alessandra Lamas Granero , Ezequiel Oscarina da Silva , Lucchetti Giancarlo 
Published: December 2018

Objectives:
Although there are a number of studies about substance use by medical students, the majority are still cross-sectional. We aimed to investigate prevalence, 2-year incidence, and factors associated with substance use during medical training.

Methods:
This longitudinal study included medical students in 4 different waves (with each wave equaling 1 semester). Socio-demographic data, Duke Religion Index (DUREL), DASS-21, and the “Alcohol, Smoking and Substance Involvement Screening Test” (ASSIST) were used.

Results:
A total of 327 (56.2%) medical students were followed for 2 years. Prevalence of lifetime substance use was 89.9% for alcohol, 34.5% for cannabis, and 17.1% for sedatives. Tobacco had the greatest incidence of use over the 2 years (16.4%), followed by alcohol (13.8%) and cannabis (13.8%). At least 24% of the students would need an intervention for alcohol use, 11.4% for tobacco, and 6.5% for cannabis. Alcohol use during wave 4 was associated with organizational religiosity, and alcohol and tobacco use at the baseline; tobacco use during wave 4 was associated with age, non-organizational religiosity, and cannabis and tobacco use at the baseline; and cannabis use during wave 4 was associated with cannabis and tobacco use at the baseline.

Conclusions:
Our results indicate an increase in the incidence of lifetime substance use during medical training. Prior use of substance was associated with a higher chance of use after 2 years, while age and religiousness seem to reduce the chance of use.
Antihypertrophic Effects of Nebivolol on Neonatal Cardiomyocyte Hypertrophy Models
Authors: Ozakca Isil 
Published: December 2018

Abstract:
The antihypertrophic effect of nebivolol over cardioselective beta-blockers (β-blockers) is attributed to the activation of cardiac nitric oxide signaling. However, the precise role of nebivolol on hypertrophied cardiomyocytes remains unclear. In the current study, in vitro cardiomyocyte hypertrophy model was induced with isoprenaline (10 μM), angiotensin II (1 μM), and phenylephrine (20 μM) in neonatal cardiomyocytes isolated from 0- to 2-day-old Sprague–Dawley rats. In addition to hypertrophic agents, cardiomyocytes were treated with nebivolol (1 μM), metoprolol (10 μM), N(ω)-nitro-l-arginine methyl ester (l-NAME) (100 μM), KT5823 (1 μM), DETA-NONOate (1–10 μM), and BAY412272 (10 μM). After 24 hours of treatment, cardiomyocyte size and transcriptional changes in cardiac hypertrophy markers were evaluated. Cardiomyocyte size increased equally in response to all hypertrophic agents. Nebivolol reduced the enhancement in cell size in response to both isoprenaline and angiotensin II; metoprolol did not. The antihypertrophic effect of nebivolol was prevented with l-NAME blockage indicating the role of NOS signaling on cardiomyocyte hypertrophy. The increased mRNA levels of atrial natriuretic peptide induced by isoprenaline decreased with nebivolol, but both β-blockers reduced the angiotensin II–induced increase in atrial natriuretic peptide expression. Combined, these results reveal that by activating NOS signaling, nebivolol exerts antihypertrophic effects on neonatal cardiomyocytes independent from the action mechanism of hypertrophic stimulus.
MACULAR ATROPHY IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Rebhun Carl B. , Moreira-Neto Carlos , Gune Shamika , Hill Lauren , Duker Jay S. , Waheed Nadia K. 
Published: December 2018

Purpose:
To determine optical coherence tomography signs associated with macular atrophy (MA) in eyes with neovascular age-related macular degeneration and pigment epithelial detachments treated with vascular endothelial growth factor inhibitors.

Methods:
Optical coherence tomography scans from a subgroup of the pigment epithelial detachment cohort of the HARBOR study were analyzed for MA. Two groups were formed based on MA presence/absence at Month 24. Then, optical coherence tomography scans from each baseline visit were graded with standard reading center grading parameters including ellipsoid zone disruption, intraretinal cysts, subretinal fluid, and MA or nascent MA in the study and fellow eyes.

Results:
Twenty-eight eyes from 28 patients were included in the analysis. Fourteen eyes had optical coherence tomography–based MA at Month 24 and 14 did not. Macular atrophy at Month 24 was significantly associated with 1) MA/nascent MA at baseline (P = 0.0136), 2) intraretinal cysts at baseline (P = 0.0048), and 3) collapse of pigment epithelial detachments in the study eye (P = 0.0025). Macular atrophy was not associated with ellipsoid zone disruption or subretinal fluid in the study eye at baseline.

Conclusion:
This study suggests that some optical coherence tomography findings in eyes of patients with neovascular age-related macular degeneration were present before the start of anti–vascular endothelial growth factor therapy and may predict the development of MA.
RETINAL FINDINGS IN PRESUMED INFECTIOUS POSTERIOR UVEITIS AND CORRELATION WITH POLYMERASE CHAIN REACTION RESULTS
Authors: Elyashiv Sivan M. , Samson C. Michael , Jabs Douglas A. 
Published: December 2018

Purpose:
To correlate demographics, retinal lesion characteristics, and host immune status with the pathogen found on polymerase chain reaction analysis of aqueous fluid in patients with suspected infectious posterior uveitis.

Methods:
Medical records of patients who underwent anterior chamber paracentesis for suspected infectious posterior uveitis and had retinal photographs between 2014 and 2016 at a single institution were reviewed. Data collection included demographics, clinical appearance of the lesions, and polymerase chain reaction results. Fundus photographs were evaluated by two masked observers for the clinical features of the retinitis.

Results:
Twenty-eight patients were included in the study. There was substantial to almost perfect agreement on retinitis location (κ = 0.67) and number (κ = 0.76) between the masked photograph graders. Polymerase chain reaction results were positive for herpes simplex virus or varicella zoster virus in 43%, cytomegalovirus in 11%, and toxoplasmosis in 3%; 43% had negative polymerase chain reaction results. Detection of herpes simplex virus or varicella zoster virus on polymerase chain reaction of the aqueous was associated with paucifocal lesions (82%, P = 0.021) and lesions involving the peripheral retina (91%, P = 0.023), consistent with the diagnosis of acute retinal necrosis.

Conclusion:
These data suggest that the diagnosis of acute retinal necrosis can be reasonably inferred on clinical examination, providing a guide for initial empiric therapy.
INSIGHTS INTO PERIFOVEAL EXUDATIVE VASCULAR ANOMALOUS COMPLEX
Authors: Mrejen Sarah , Le Hoang Mai , Nghiem-Buffet Sylvia , Tabary Sandrine , Quentel Gabriel , Cohen Salomon Y. 
Published: December 2018

Purpose:
To report a series of eight patients with perifoveal exudative vascular anomalous complex imaged with optical coherence tomography angiography and the results of anti–vascular endothelial growth factor therapy or laser photocoagulation.

Methods:
Retrospective analysis of demographic data, imaging including color pictures, spectral domain optical coherence tomography, and optical coherence tomography angiography, and fluorescein angiography, course, and outcome.

Results:
Age at onset ranged from 45 to 84 years (mean ± SD: 68.6 ± 13.7). Five cases were initially misdiagnosed. The perifoveal exudative vascular anomalous complex lesion was unique in seven eyes and located predominantly in the superficial capillary plexus in two eyes, strictly in the deep capillary plexus in two eyes, but observed at the level of both plexi (3 eyes). One patient presented two lesions, one in the superficial capillary plexus and one in the deep capillary plexus. Capillary rarefaction was observed around the lesion in six eyes. Sustainable resolution of exudation could be achieved in 2 patients, one after 2 sessions of focal thermal laser photocoagulation and one after 13 intravitreal injections of anti–vascular endothelial growth factor.

Conclusion:
The present series confirms that perifoveal exudative vascular anomalous complex corresponds to a new entity that differs from other conditions associated with capillary aneurysmal lesions. Visual improvement could be obtained after treatment with focal laser or intravitreal anti–vascular endothelial growth factor agents.
NECROSIS OF THE RETINA AND UVEAL TRACT SECONDARY TO EXPANDING GAS TAMPONADE
Authors: Rooney David M. , Oltmanns Matthew H. , Sapp Mathew R. , Morris Robert E. 
Published: December 2018

Purpose:
To present a case of retinal and uveal necrosis caused by expanding gas tamponade after pars plana vitrectomy.

Methods:
Single case report.

Results:
An otherwise healthy 66-year-old woman underwent pars plana vitrectomy with intended 20% sulfur hexafluoride (SF6) tamponade for macular hole repair of her pseudophakic left eye. She developed intractable nausea, emesis and increasing left eye pain in association with gas expanded to totally fill the left eye, just hours after surgery. Extremely elevated intraocular pressure was lowered with a successful paracentesis but recurred within a few hours. She then underwent vitrectomy evacuation of all vitreous cavity gas, reformation of the anterior chamber, and silicone oil placement, normalizing intraocular pressure. Three weeks later, the left eye had no light perception, and devitalization of the retina, choroid, and iris was evident.

Conclusion:
We present a case of blindness and intraocular tissue dissolution/disorganization after vitrectomy with intended 20% SF6. To our knowledge, this is the most detailed report of the under-recognized complication of expanding gas tamponade. Institutions hosting vitrectomy surgery should consider enacting a formal “Time Out” that requires all team members to witness accurate fractionation of potentially expansile gas. In the event of acute postoperative glaucoma in such eyes, a single small volume paracentesis cannot be relied upon to protect against continued gas expansion.
Thymic Stromal Lymphopoietin-Related Allergic Pathway in Patients With Vernal Keratoconjunctivitis
Authors: Zhang Zong-Duan , Deng Yu-Xuan , Ma Hui-Xiang , Chen Xiao-Gang , Chen Lin-Hua , Qu Jia 
Published: December 2018

Purpose:
To investigate the expression of thymic stromal lymphopoietin (TSLP) and the relevant signaling pathways in the giant papillae obtained from patients with vernal keratoconjunctivitis (VKC) and to study the potential functional role and molecular mechanism of TSLP.

Methods:
Giant papillae from VKC patients and control samples were used to perform immunohistochemical staining and analyze the mRNA expression of TSLP and related pathway by real-time polymerase chain reaction.

Results:
TSLP was markedly expressed in the epithelial cells and some inflammatory cells of giant papillae, but not in the control conjunctival tissue. TSLP mRNA expression in the giant papillae of VKC was increased by 9.63 ± 0.99 (mean ± SD) fold compared with controls (P < 0.01). CD11c+ and OX40L+ immunoreactive cells largely infiltrated the giant papillae as observed by immunohistochemical staining. CD4+Th2 cell infiltration was observed through high immunoreactivity of CD4. Th2 cytokines (IL-4, IL-5 and IL-13) and OX40 in the VKC specimens showed increased expression. Augmented gene expression levels of CD4 (6.88 ± 1.84), OX40L (7.60 ± 1.79), OX40 (7.25 ± 1.38), IL-4 (6.89 ± 1.46), IL-5 (8.42 ± 1.55), and IL-13 (9.69 ± 1.94) were significantly different from controls (P < 0.05).

Conclusions:
Our observations provide strong evidence that TSLP may be a crucial factor that contributes to the development and progression of allergic conjunctivitis. The results also demonstrated that TSLP activates dendritic cells to prime CD4+T cells to differentiate into Th2 type and triggers Th2-dominant allergic inflammation through the TSLP/OX40L/OX40 signaling as part of immunopathogenesis of VKC.
Imaging Kayser-Fleischer Ring in Wilson Disease Using In Vivo Confocal Microscopy
Authors: Zhao Tantai , Fang Zhixue , Tian Jiao , Liu Jia , Xiao Yangyan , Li Huiling , Chen Baihua 
Published: December 2018

Purpose:
This study analyzes images of Kayser–Fleischer (K-F) rings in patients with Wilson disease (WD) using in vivo confocal microscopy (IVCM) and explores whether IVCM can be a useful clinical tool in facilitating the diagnosis and characterization of K-F rings.

Methods:
One hundred four eyes of 52 patients with WD and K-F rings (K-F group) and 52 normal eyes of 52 age- and gender-matched control subjects (control group) were enrolled in the study. Both K-F and control groups consisted of 29 male patients and 23 female patients. IVCM imaging was performed, and images of the peripheral Descemet membrane were analyzed.

Results:
All patients in K-F group showed abnormal patterns in the peripheral Descemet membrane from IVCM images. These abnormalities can be generally divided into 3 types: patchy, stripy, and spotty patterns. Each patient may have a combination of these patterns, with patchy pattern being most prevalent (100%), whereas stripy and spotty patterns are present in 30% to 40% of the K-F rings. Notably, these patterns are not correlated with other systematic symptoms of WD.

Conclusions:
IVCM images can be used as an objective clinical diagnostic tool to facilitate the identification of K-F rings and the diagnosis of WD.
Long-term Follow-up of Ahmed Glaucoma Valve Tube Position Changes
Authors: Mathew David J. , Anuradha Anindya , Low Stephanie A.W. , Belkin Avner , Buys Yvonne M. , Trope Graham E. 
Published: December 2018

Purpose:
To evaluate long-term (4.5 to 6 y) changes in the position of Ahmed glaucoma valve (AGV) tubes.

Materials and Methods:
Adult patients aged 18 years and above, 1 to 2 months post-AGV implantation were enrolled. Tube position was evaluated using anterior segment optical coherence tomography at baseline and final follow-up. The intracameral tube length (ICL), tube-cornea (TC) distance, and cornea-tube angle were measured. Wilcoxon-signed rank test was used to assess whether the changes in parameters from baseline were significant.

Results:
In total, 11 eyes of 9 patients were included in the analysis. Mean duration of follow-up was 5.2±0.8 years (4.4 to 6.1 y). The ICL increased from 1.58±0.40 to 1.74±0.62 mm (P=0.18). The TC decreased from 0.36±0.12 to 0.29±0.05 mm (P=0.04). The cornea-tube angle decreased from 27.76±5.57 to 24.82±5.69 degrees (P=0.08). Overall, 73% of the tubes moved toward the cornea (mean 0.11 mm, over 4.4 to 6.1 y). In total, 73% showed an increase in ICL; 45% showed an increase of >0.3 mm [mean 0.50 mm (33%) increase]. Two of 11 tubes (18%) showed no significant change in the parameters (ICL, 0.03 and 0.01 mm increase; TC, 0 and 0.01 mm increase); these tubes were noted to lie on the iris.

Conclusions:
Tubes tend to move toward the cornea over time. To avoid corneal damage and involvement of the visual axis in the future, tubes should be reasonably short and inserted tangentially, preferably in the posterior one third of the anterior chamber.
Anterior Corneal Folds Correlate With Low Intraocular Pressure and May Serve as a Marker for Ocular Hypotony
Authors: Abualhasan Hamza , Mimouni Michael , Safuri Shadi , Blumenthal Eytan Z. 
Published: December 2018

Purpose:
Subtle folds can be seen in the anterior cornea in eyes with hypotony using fluorescein and blue light. We aim to assess their extent and grade with respect to the level of intraocular pressure (IOP).

Patients and Methods:
Patients who presented to the department of ophthalmology at Rambam Health Care Campus with IOP<10 mm Hg during the period between July 2016 and June 2017. Corneal folds were evaluated after instilling an anesthetic drop and fluorescein staining. Outcome measures included: IOP, presence of anterior corneal folds, and the percentage of corneal surface containing folds.

Results:
Overall, 100 eyes of 100 patients were included. The mean age±SD was 63.6±16.7 years (range, 19 to 96 y); 56% (n=56) were of male sex. Mean IOP was 5.3±2.7 mm Hg (range, 0 to 9 mm Hg). Subjects with and without anterior corneal folds were of similar age (P=0.25) and sex (P=0.69). Those with anterior corneal folds had a significantly lower IOP than the control group (4.0±2.4 vs. 7.4±1.7; P<0.001). Eyes with IOP of 0 to 2, 3 to 4, 5 to 6, 7 to 9 mm Hg demonstrated anterior corneal folds in 95%, 91%, 67%, and 18.4%, respectively. At an IOP≤5 mm Hg cut-off, the sensitivity and specificity of corneal folds as a predictor of hypotony was 89.8% and 70.6%, respectively. A significant inverse correlation between the relative area of the cornea covered by folds and the IOP was found (r=−0.7; P<0.001).

Conclusions:
Folds observed in the anterior corneal surface appear to be a robust sign of severe hypotony.
Comparison of Fellow Eyes of Acute Primary Angle Closure and Phacomorphic Angle Closure
Authors: Moghimi Sasan , Fathollahzadeh Navid , Chen Rebecca , Lin Shan C. , Weinreb Robert N. 
Published: December 2018

Purpose:
To compare anterior segment parameters in fellow eyes of acute primary angle closure (APAC) and fellow eyes of phacomorphic angle closure (AC) and to identify parameters that could be used to differentiate fellow eyes of the 2 entities.

Methods:
This cross-sectional study included 55 unaffected fellow eyes of APAC, 48 unaffected fellow eyes of phacomorphic AC, and 52 eyes of control subjects. All patients underwent anterior segment optical coherence tomography imaging. Anterior chamber depth, anterior chamber area, anterior chamber width (ACW), iris thickness (IT), iris curvature, lens vault (LV), and angle parameters including angle-opening distance (AOD750) were measured in qualified images using customized software and compared among the groups using a linear mixed model.

Results:
Fellow eyes of APAC had the smallest axial length, AOD, anterior chamber depth, anterior chamber area, ACW, and the greatest LV, and IT (P≤0.002 for all), followed by fellow eyes of phacomorphic AC, after adjustment for age, sex, and pupil diameter. IT and curvature were comparable between fellow eyes of phacomorphic AC and controls. Angle parameters had the highest area of the receiver-operator characteristic curve for discrimination of fellow eyes of APAC eyes and phacomorphic AC (0.795, P=0.001 for AOD750). In a multivariable analysis, AOD750<0.161 µm [odds ratio (OR), 23.43; P=0.001], LV>768.6 µm (OR, 16.76; P=0.001), ACW<11.07 mm (OR, 8.93; P=0.023) and younger age (P=0.001) were the factors that discriminated fellow eyes of APAC from phacomorphic AC.

Conclusions:
Differences in ocular biometric parameters can be detected between fellow eyes of APAC and phacomorphic AC. Narrower angle, more anteriorly displaced lens, and thicker iris are the main parameters that distinguish fellow eyes of APAC and phacomorphic AC.