bluuebunny/crossref_metadata_2025_split huggingface dataset:
External Ventricular Drain Placement Accuracy and Safety When Done by Midlevel Practitioners
Authors: Ellens Nathaniel R , Fischer D Luke , Meldau Jason E , Schroeder Brett A , Patra Sanjay E 
Published: February 2018

Abstract

BACKGROUND
External ventricular drains (EVDs) measure intracranial pressure, divert cerebrospinal fluid, and allow for orthotropic administration of pharmacologic agents. Currently, neurosurgeons and neurosurgery residents are the primary practitioners placing EVDs. Due to the urgency of neurosurgical pathologies and the lack of qualified residents at most hospitals, midlevel practitioner (MLP) placement of EVDs would be advantageous.

OBJECTIVE
To assess the accuracy and complication rates of MLP and neurosurgeon EVD placement.

METHODS
This was a retrospective cohort of all patients with an EVD placed between January 2012 and September 2016 at a level 1 trauma center. We compared safety and accuracy of EVD placement between neurosurgeons and MLPs.

RESULTS
MLP first attempted EVD placement in 238 patients and senior neurosurgeon first attempted EVD placement in 70 subjects. There was no significant difference between accuracy of placement within the ventricle (87.4% vs 90.0%, P = .5557), hemorrhage rate (5.9% vs 4.3%, P = .77), or infection rate (0.8% vs 1.4%, P = .5399) for placement attempted by an MLP compared with a neurosurgeon, respectively.

CONCLUSION
MLPs perform EVD placement safely with no significant difference in accuracy of placement or complication rates compared with placement by senior neurosurgeons. This may allow for earlier management of elevated intracranial pressure and access to care where previously unavailable; leading to improved patient outcomes.
Silent Witnesses: Faculty Reluctance to Report Medical Students’ Professionalism Lapses
Authors: Ziring Deborah , Frankel Richard M. , Danoff Deborah , Isaacson J. Harry , Lochnan Heather 
Published: February 2018

Purpose
Assessing students’ professionalism is a critical component of medical education. Nonetheless, faculty reluctance to report professionalism lapses remains a significant barrier to the effective identification, management, and remediation of such lapses. The authors gathered information from faculty who supervise medical students to better understand their perceived barriers to reporting.

Method
In 2015–2016, data were collected using a group concept mapping methodology, which is an innovative, asynchronous, structured mixed-methods approach using qualitative and quantitative measures to identify themes characterizing faculty reluctance to report professionalism lapses. Participants from four U.S. and Canadian medical schools brainstormed, sorted, and rated statements about perceived barriers to reporting. Multidimensional scaling and hierarchical cluster analyses were used to analyze these data.

Results
Of 431 physicians invited, 184 con-tributed to the brainstorming task (42.7%), 48 completed the sorting task (11.1%), and 83 completed the rating task (19.3%). Participants identified six barriers or themes to reporting lapses. The themes “uncertainty about the process,” “ambiguity about the ‘facts,’” “effects on the learner,” and “time constraints” were rated highest as perceived barriers. Demographic subgroup analysis by gender, years of experience supervising medical students, years since graduation, and practice discipline revealed no significant differences (P > .05).

Conclusions
The decision to report medical students’ professionalism lapses is more complex and nuanced than a binary choice to report or not. Faculty face challenges at the systems level and individual level. The themes identified in this study can be used for faculty development and to improve processes for reporting students’ professionalism lapses.
Advancing Health Professions Education Research by Creating a Network of Networks
Authors: Carney Patricia A. , Brandt Barbara , Dekhtyar Michael , Holmboe Eric S. 
Published: February 2018

Producing the best evidence to show educational outcomes, such as competency achievement and credentialing effectiveness, across the health professions education continuum will require large multisite research projects and longitudinal studies. Current limitations that must be overcome to reach this goal include the prevalence of single-institution study designs, assessments of a single curricular component, and cross-sectional study designs that provide only a snapshot in time of a program or initiative rather than a longitudinal perspective.
One solution to overcoming these limitations is to develop a network of networks that collaborates, using longitudinal approaches, across health professions and regions of the United States. Currently, individual networks are advancing educational innovation toward understanding the effectiveness of educational and credentialing programs. Examples of such networks include (1) the American Medical Association’s Accelerating Change in Medical Education initiative, (2) the National Center for Interprofessional Practice and Education, and (3) the Accreditation Council for Graduate Medical Education’s Accreditation System. In this Invited Commentary, the authors briefly profile these existing networks, identify their progress and the challenges they have encountered, and propose a vigorous way forward toward creating a national network of networks designed to determine the effectiveness of health professions education and credentialing.
Neuroimaging of Pain
Authors: Martucci Katherine T. , Mackey Sean C. 
Published: February 2018

Abstract
Neuroimaging research has demonstrated definitive involvement of the central nervous system in the development, maintenance, and experience of chronic pain. Structural and functional neuroimaging has helped elucidate central nervous system contributors to chronic pain in humans. Neuroimaging of pain has provided a tool for increasing our understanding of how pharmacologic and psychologic therapies improve chronic pain. To date, findings from neuroimaging pain research have benefitted clinical practice by providing clinicians with an educational framework to discuss the biopsychosocial nature of pain with patients. Future advances in neuroimaging-based therapeutics (e.g., transcranial magnetic stimulation, real-time functional magnetic resonance imaging neurofeedback) may provide additional benefits for clinical practice. In the future, with standardization and validation, brain imaging could provide objective biomarkers of chronic pain, and guide treatment for personalized pain management. Similarly, brain-based biomarkers may provide an additional predictor of perioperative prognoses.
Validation of a Novel Molecular Host Response Assay to Diagnose Infection in Hospitalized Patients Admitted to the ICU With Acute Respiratory Failure
Authors: Koster-Brouwer Maria E. , Verboom Diana M. , Scicluna Brendon P. , van de Groep Kirsten , Frencken Jos F. , Janssen Davy , Schuurman Rob , Schultz Marcus J. , van der Poll Tom , Bonten Marc J.M. , Cremer Olaf L. ,   on behalf of the MARS Consortium
Published: February 2018

Objectives:
Discrimination between infectious and noninfectious causes of acute respiratory failure is difficult in patients admitted to the ICU after a period of hospitalization. Using a novel biomarker test (SeptiCyte LAB), we aimed to distinguish between infection and inflammation in this population.

Design:
Nested cohort study.

Setting:
Two tertiary mixed ICUs in the Netherlands.

Patients:
Hospitalized patients with acute respiratory failure requiring mechanical ventilation upon ICU admission from 2011 to 2013. Patients having an established infection diagnosis or an evidently noninfectious reason for intubation were excluded.

Interventions:
None.

Measurement and Main Results:
Blood samples were collected upon ICU admission. Test results were categorized into four probability bands (higher bands indicating higher infection probability) and compared with the infection plausibility as rated by post hoc assessment using strict definitions. Of 467 included patients, 373 (80%) were treated for a suspected infection at admission. Infection plausibility was classified as ruled out, undetermined, or confirmed in 135 (29%), 135 (29%), and 197 (42%) patients, respectively. Test results correlated with infection plausibility (Spearman’s rho 0.332; p < 0.001). After exclusion of undetermined cases, positive predictive values were 29%, 54%, and 76% for probability bands 2, 3, and 4, respectively, whereas the negative predictive value for band 1 was 76%. Diagnostic discrimination of SeptiCyte LAB and C-reactive protein was similar (p = 0.919).

Conclusions:
Among hospitalized patients admitted to the ICU with clinical uncertainty regarding the etiology of acute respiratory failure, the diagnostic value of SeptiCyte LAB was limited.
Presepsin and Inflammatory Markers Correlate With Occurrence and Severity of Nonocclusive Mesenteric Ischemia After Cardiovascular Surgery
Authors: Stroeder Jonas , Bomberg Hagen , Wagenpfeil Stefan , Buecker Arno , Schaefers Hans-Joachim , Katoh Marcus , Groesdonk Heinrich Volker , Minko Peter 
Published: February 2018

Objectives:
To prospectively evaluate the relationship of established inflammatory markers and presepsin on nonocclusive mesenteric ischemia and to correlate presepsin levels to the occurrence and severity of nonocclusive mesenteric ischemia.

Design:
Patients were prospectively enrolled and blood samples taken, followed by a retrospective evaluation of laboratory values and angiographic findings. The study was ethics committee approved.

Settings:
Patients with clinical suspicion of nonocclusive mesenteric ischemia underwent catheter angiography of the superior mesenteric artery. Images were assessed by two experienced radiologists on consensus basis using a previously published standardized reporting system (Homburg-Nonocclusive Mesenteric Ischemia-Score). Two groups were formed according to the severity of nonocclusive mesenteric ischemia, mild and severe, patients without clinical signs of nonocclusive mesenteric ischemia formed the reference group. These data were correlated to inflammatory blood markers assessed pre- and postoperatively: C-reactive protein, leucocytes, procalcitonin, and presepsin as well as outcome data.

Patients:
Between January 2010 and March 2011, a total of 839 patients undergoing cardiovascular surgery participated in this study.

Measurements and Main Results:
Mild nonocclusive mesenteric ischemia was diagnosed in 4.5%, and severe nonocclusive mesenteric ischemia in 3.2%. Median postoperative presepsin concentrations were significantly greater in mild and severe nonocclusive mesenteric ischemia than in non-nonocclusive mesenteric ischemia. Statistics showed that postoperative presepsin better discriminated mild and severe nonocclusive mesenteric ischemia than any other tested biomarker.

Conclusions:
Elevated postoperative plasma presepsin concentrations are an independent predictor of mild and severe nonocclusive mesenteric ischemia. The established inflammatory blood markers significantly correlate with the development and severity of nonocclusive mesenteric ischemia.
Uncertainty and Quality of Life in Women With Breast Cancer
Authors: Ahadzadeh Ashraf Sadat , Sharif Saeed Pahlevan 
Published: February 2018

BackgroundThe negative relationship between uncertainty and quality of life is well reported in the literature. Also, there is abundant research linking coping strategies to cancer patients' quality of life. However, there exists a paucity of information on the moderating effect of coping styles on the relationship between uncertainty and quality of life in cancer patients.ObjectiveThe aim of this study was to examine whether uncertainty in illness is negatively correlated with quality of life and whether this relationship is moderated by coping strategies, namely, problem-focused, avoidant, and active emotional coping.MethodsA convenience sample of 135 Malaysian women with breast cancer participated in the study. Participants completed measures of uncertainty in illness, quality of life, and coping styles.ResultsUncertainty in breast cancer was negatively related to quality of life (β = −0.379,P< .001), and active emotional coping was found to moderate this negative relationship (β = 0.155,P< .05). The model explained 22.20% of the variance of quality of life.ConclusionLack of information about breast cancer, treatment, hospitalization, and disease recurrence is related to poorer quality of life. However, this negative relationship becomes weaker when active emotional coping strategies are used.Implications for PracticeNurses and health providers should help patients reduce their uncertainty in illness by providing them information on breast cancer or referring them to relevant sources. Moreover, they could reduce the deleterious effect of uncertainty on quality of life by encouraging patients to use more active emotional coping strategies.
Continuous Intravenous Valproate as Abortive Therapy for Pediatric Status Migrainosus
Authors: Zafar Muhammad S. , Stewart Alejandra M. , Toupin David N. , Cook Aaron M. , Baumann Robert J. 
Published: February 2018

Objective:
This study describes the use of continuous intravenous valproate as an abortive therapy for pediatric status migrainosus.

Background:
Intravenous valproate as a bolus dose has been shown to be an effective abortive therapy for status migrainosus in children; however, Valproate’s pharmacokinetic profile suggests that it would be safer and more therapeutic as a continuous infusion. This dosing strategy results in less serum concentration fluctuations, more consistent therapeutic effects, and less adverse effects.

Methods:
A retrospective chart review between August 2009 and August 2012 identified 83 patients who had presented with status migrainosus and had received continuous intravenous valproate after failing to respond to initial abortive treatment. These patients had received a 20 mg/kg loading dose, followed by continuous infusion at 1 mg/kg/h. Serum valproate levels had been drawn 4 hours and 24 hours after the loading dose. Infusion rate had been adjusted to maintain serum levels of 80 to 100 mcg/mL. Age-appropriate pain assessments had been recorded at regular intervals. Excellent response was defined as a 100% reduction in pain scores, moderate response as 50% to 99% reduction, and poor response as <50% reduction.

Results:
Of the 83 patients, 55 (66.2%) had reported an excellent response, 4 (4.8%) a moderate response, and 24 (28.9%) a poor response. Of those reporting an excellent response, 76% had responded within 24 hours. Nausea (8.4%) and vomiting (2.4%) had been the only reported side effects. Twenty-four hour serum levels had been within the goal range 91.9% of the time.

Conclusions:
Continuous intravenous valproate is safe, easy to monitor, and therapeutic in the abortive treatment of status migrainosus in pediatric patients.
Stiff Neck and Drooling in a Young Girl
Authors: Prince William B. , Cantor Richard M. 
Published: February 2018

Abstract
A 3-year-old girl was brought to the emergency department 4 days after she was playing with a button battery and subsequently had a choking episode. The patient was seen immediately at a different emergency department and was discharged home after a normal chest x-ray finding and able to tolerate an oral challenge with liquids. She was later evaluated by her primary care physician and started on amoxicillin for possible pharyngitis. On examination in our emergency department, the patient had pooling of secretions and was unwilling to range her neck due to pain. Soft tissue neck x-ray confirmed a 20-mm button battery in the esophagus with air lucencies in the prevertebral soft tissues.
Examining the Reproducibility of 6 Published Studies in Public Health Services and Systems Research
Authors: Harris Jenine K. , Wondmeneh Sarah B. , Zhao Yiqiang , Leider Jonathon P. 
Published: February 2018

Objective:
Research replication, or repeating a study de novo, is the scientific standard for building evidence and identifying spurious results. While replication is ideal, it is often expensive and time consuming. Reproducibility, or reanalysis of data to verify published findings, is one proposed minimum alternative standard. While a lack of research reproducibility has been identified as a serious and prevalent problem in biomedical research and a few other fields, little work has been done to examine the reproducibility of public health research. We examined reproducibility in 6 studies from the public health services and systems research subfield of public health research.

Design:
Following the methods described in each of the 6 papers, we computed the descriptive and inferential statistics for each study. We compared our results with the original study results and examined the percentage differences in descriptive statistics and differences in effect size, significance, and precision of inferential statistics. All project work was completed in 2017.

Results:
We found consistency between original and reproduced results for each paper in at least 1 of the 4 areas examined. However, we also found some inconsistency. We identified incorrect transcription of results and omitting detail about data management and analyses as the primary contributors to the inconsistencies.

Recommendations:
Increasing reproducibility, or reanalysis of data to verify published results, can improve the quality of science. Researchers, journals, employers, and funders can all play a role in improving the reproducibility of science through several strategies including publishing data and statistical code, using guidelines to write clear and complete methods sections, conducting reproducibility reviews, and incentivizing reproducible science.
Dual-Energy Computed Tomography–Based Display of Bone Marrow Edema in Incidental Vertebral Compression Fractures
Authors: Frellesen Claudia , Azadegan Mehrnoush , Martin Simon S. , Otani Katharina , D'Angelo Tommaso , Booz Christian , Eichler Katrin , Panahi Bita , Kaup Moritz , Bauer Ralf W. , Vogl Thomas J. , Wichmann Julian L. 
Published: February 2018

PurposeThe aim of this study was to evaluate the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) reconstructions enabling visualization of bone marrow edema for characterization of incidental thoracolumbar compression fractures in routine thoracoabdominal staging computed tomography (CT).Materials and MethodsWe retrospectively analyzed 51 oncological patients without suspected fracture or indicative complaints presenting at least 1 thoracolumbar compression fracture on routine thoracoabdominal staging DECT who had been examined between October 2015 and June 2017 using third-generation dual-source CT, had a previous CT within 3 months before, and also had undergone additional magnetic resonance imaging within 14 days, which served as the standard of reference. Three independent and blinded radiologists initially evaluated all vertebrae on conventional grayscale DECT series; after at least 8 weeks, observers reevaluated all cases using grayscale and color-coded VNCa DECT images. The age of each fracture was determined as either acute, chronic, or inconclusive. Specificity, sensitivity, and intraobserver and interobserver agreements were calculated taking into account clustering.ResultsA total of 98 vertebral compression fractures were detected in 51 patients (20 women, 31 men; median of 1 fracture per patient). The reference standard defined 45 as acute and 53 as chronic. For identification of only acute fractures (cutoff 1), the combination of grayscale and VNCa image series showed a higher sensitivity (91% vs 47%;P< 0.001) but equal specificity (both 100%) compared with analysis of grayscale images alone. When defining a positive finding as a fracture considered either acute or inconclusive (cutoff 2), combined analysis of grayscale and VNCa images showed similar sensitivity (96% vs 93%;P= 0.28) but significantly higher specificity (96% vs 75%;P< 0.001) compared with evaluation of grayscale images alone. Area under the curve analysis for detection of vertebral compression fractures showed superior results for reading of grayscale and VNCa image series (0.98) compared with analysis of grayscale images alone (0.89;P< 0.001).ConclusionDual-energy CT–derived color-coded VNCa reconstructions substantially improve the characterization of incidental thoracolumbar compression fractures seen on routine thoracoabdominal staging DECT by allowing for visualization of bone marrow edema.
Contour Restoration of Over-Resected Mandibular Angle and Lower Border by Reduction Mandibuloplasty Using Three-Dimensional Planning and Computer-Aided Design and Manufacturing Custom-Made Titanium Implants
Authors: Woo Jae Man , Baek Seung-Hak , Kim Jong-Cheol , Choi Jin-Young 
Published: February 2018

Objective:
The purpose of this clinical report was to introduce a new methodology for contour restoration of the over-resected mandible by reduction mandibuloplasty using 3-dimensional (3D) planning and computer-assisted design and manufacturing (CAD-CAM) custom-made titanium implants.

Patient and method:
A 20-year-old male patient had undergone reduction of the zygoma and mandibular angle and lower border for esthetic reason 1 year ago at a private clinic. However, he was not satisfied with surgical outcome and wanted to restore his original facial volume and contour. To assess the volume and dimension of resected bone, 3D-computed tomography (3D-CT) data at the original stage was superimposed with postsurgical CT. For restoration of the malar prominence, porous polyethylene malar implants with extensions into the lateral malar region (Medpor) were placed and fixed with microscrews. Custom-made titanium implants were fabricated for contour restoration of the mandibular angle and lower border using CAD-CAM technology (iDDA, Daegu, South Korea). Two-piece design per each titanium implant was adopted for easy placement and avoidance of tissue damage during placement. Thin buccal extension was incorporated for placement of screw holes. Location, direction, and length of bicortical screws were planned to avoid damage of the inferior alveolar nerve.

Result:
With the help of 3D planning and CAD-CAM technology, rigid fixation of the custom-made titanium implants into the mandibular angle and lower border successfully restored the contour of over-resected mandible to the original state.

Conclusion:
When over-resection by reduction mandibuloplasty becomes an issue, this method may be an effective treatment option for contour restoration of over-resected mandibular angle and lower border.
Simplified Access for Reduction and Fixation of a Frontal Bone Fracture
Authors: Pires Willian Ricardo , Oliveira Puttini Igor de , Oliva André Hergesel de , Jacob Ricardo Garcia Mureb , Figueira Júnior Heldo Cesar , Sonoda Celso Koogi , Fabris André Luis da Silva , Faverani Leonardo Perez , Souza Francisley Ávila , Júnior Idelmo Rangel Garcia 
Published: February 2018

Abstract
The frontal bone fractures occur very often in service units in oral and maxillofacial surgery. Bicoronal access is the most common for the surgical treatment of frontal bone fractures. However, patients are surprised when they receive notice that such invasive access will be made. This approach allows adequate visualization of the fracture site, but may be associated with complications, which can be avoided by the use of less invasive techniques. We describe an alternative approach that aims to minimize the complications of a coronal incision.