bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tumor Size at Magnetic Resonance Imaging Association With Lymph Node Metastasis and Lymphovascular Space Invasion in Resectable Cervical Cancer: A Multicenter Evaluation of Surgical Specimens
Authors: Chen Xiao-li , Chen Guang-wen , Xu Guo-hui , Ren Jing , Li Zhen-lin , Pu Hong , Li Hang 
Published: July 2018

ObjectiveTo determine whether gross tumor volume (GTV) and the maximum diameter of resectable cervical cancer at magnetic resonance imaging (MRI) could predict lymph node metastasis (LNM) and lymphovascular space invasion (LVSI).Materials and MethodsA total of 315 consecutive patients with cervical cancer were retrospectively identified. Gross tumor volume and the maximum diameter of tumor were evaluated on MRI. Univariate and multivariate logistic regression analyses were performed to determine whether tumor size could predict LNM and LVSI. Cutoffs of GTV, maximum diameter, and the International Federation of Gynecology and Obstetrics (FIGO) classification of tumor were first investigated in 255 patients (group A) and then validated in an independent cohort of 60 patients (group B) using area under the receiver operating characteristic curve (AUC) analysis for predicting the presence of LNM and LVSI.ResultsUnivariate analysis showed that GTV and the maximum diameter of tumor could predict LNM and LVSI (all P < 0.0001). Multivariate analyses indicated GTV as an independent risk factor of LNM and LVSI (all P < 0.0001). In group A, GTV, the maximum diameter, and the FIGO stage could identify LNM (AUC, 0.813, 0.741, and 0.69, respectively) and LVSI (AUC, 0.806, 0.751, and 0.684, respectively). In group B, GTV, the maximum diameter, and the FIGO stage could help identify LNM (AUC, 0.902, 0.825, and 0.759, respectively) and LVSI (AUC, 0.771, 0.748, and 0.700, respectively).ConclusionsGross tumor volume and the maximum diameter of resectable cervical cancer at MRI demonstrated capability in predicting LNM and LVSI, which were more accurate than FIGO stage.
Development of an Innovative Taxonomy and Matrix Through Examination of the Director of Clinical Education's Roles and Responsibilities
Authors: Engelhard Chalee , McCallum Christine , Applebaum Donna , Teglia Valerie 
Published: July 2018

Background.
From the 2014 Clinical Education Summit, recommendations were made to strengthen physical therapist (PT) clinical education (CE). The Director of Clinical Education (DCE) is a key stakeholder in PT CE, and the roles and responsibilities of this position have come under review yet again. An investigation of this primary stakeholder is in alignment with the Summit's strategic plan and needed response to current inquiries.

Objectives.
To further the work of the study by McCallum et al
6
, the purpose of this study was to investigate and determine the evolution of DCE's roles and responsibilities, with the hypothesis that a new taxonomy would emerge, reflecting a distribution of responsibilities that would guide current and future roles of the DCE.

Design.
This study used a nonexperimental, descriptive, qualitative approach with a constructivist theoretical framework.

Methods:
The data set from the study by McCallum et al produced five primary themes. The fifth theme, studied in this report, produced three subthemes—improve efficiencies of systems, optimize clinical teaching, and collaboration with translational research. Watts' Taxonomy, as a foundational, theoretical construct, was the basis for the thematic analysis of these subthemes.

Results.
The development of an innovative DCE taxonomy with three responsibility levels—Processor, Coordinator, and Director emerged from the analysis of the fifth primary theme.

Conclusions.
Using the DCE taxonomy, DCE's roles and responsibilities matrix illustrates the importance of fitting tasks to the corresponding DCE's role and responsibility. The matrix shows how delegation of routine DCE tasks can promote the DCE's ability to engage in tasks higher in the taxonomy. This can lead to effective delivery of CE and DCE's engagement in strategic leadership in guiding the future direction of the CE aspect of the PT program.
Relationship Between Narrative Comments and Ratings for Entry-Level Performance on the Clinical Performance Instrument: A Call to Rethink the Clinical Performance Instrument
Authors: Wetherbee Ellen , Dupre Anne-Marie , Feinn Richard S. , Roush Susan 
Published: July 2018

Introduction.
Clinical instructors (CIs) use narratives to qualify anchor points for 18 performance criteria on the Clinical Performance Instrument: Version 2006 (CPI'06) when assessing students' performance during clinical experiences. Directors of Clinical Education (DCE) final narratives and anchor points on the CPI'06 to make sure that the narratives and anchor points are in alignment with each other. CIs and DCEs should have a mutual understanding of the terminology used on the CPI'06. The purpose of this study was to determine the level of agreement (concordance) between raters on whether examples of narratives supported the term, “entry-level performance” (ELP), before and after focus group discussions.

Methods.
Fifty-four CIs discussed the CPI'06 terminology. A pretest/posttest design was used with the intervention being focus group discussions. Participants compared the definition of ELP with sample narratives and agreed, disagreed, or remained undecided about whether the narratives supported ELP. Statistical tests were analyzed to determine participants' concordance about whether the narratives supported ELP. Their rationale to support their decisions was analyzed using qualitative methodology.

Results.
Participants' percent of pairwise agreement about whether the narratives supported ELP for testing conditions were highest for safety (65.2–95.3%) and lowest for professional behaviors (34.4–44.0%). Intraclass correlation for multiple raters using ICC(2,1) model indicated interrater reliability for absolute agreement on each test, across five performance criteria, was fair to poor. Qualitative assessment for participants' rationale about decisions indicated inconsistencies in the interpretation of CPI'06 terminology.

Discussion and Conclusion.
Agreement among professionals about the interpretation of the language used on the CPI'06 to ensure that students graduate with the requisite skills and behaviors is essential. This study indicates that there was a lack of participants' concordance with the interpretation of ELP on the CPI'06.
Outcomes of critical illness: what is meaningful?
Authors: Gajic Ognjen , Ahmad Sumera R. , Wilson Michael E. , Kaufman David A. 
Published: July 2018

Purpose of review
In this review, we will discuss efforts and challenges in understanding and developing meaningful outcomes of critical care research, quality improvement and policy, which are patient-centered and goal concordant, rather than mortality alone. We shall discuss different aspects of what could constitute outcomes of critical illness as meaningful to the patients and other stakeholders, including families and providers.

Recent findings
Different outcome pathways after critical illness impact the patients, families and providers in multiple ways. For patients who die, it is important to consider the experience of dying. For the increasing number of survivors of critical illness, challenges of survival have surfaced. The physical, mental and social debility that survivors experience has evolved into the entity called post-ICU syndrome. The importance of prehospital health state trajectory and the need for the outcome of critical care to be aligned with the patients’ goals and preferences have been increasingly recognized.

Summary
A theoretical framework is outlined to help understand the impact of critical care interventions on outcomes that are meaningful to patients, families and healthcare providers.
Early Readmission Predicts Increased Mortality in Cirrhosis Patients After Clostridium difficile Infection
Authors: Kruger Andrew J. , Durkin Claire , Mumtaz Khalid , Hinton Alice , Krishna Somashekar G. 
Published: July 2018

Goals:
We sought to determine the impact of Clostridium difficile infections (CDI) in cirrhosis by evaluating trends and outcomes of early readmission and mortality.

Background:
The incidence of CDI in cirrhotics is increasing.

Study:
We analyzed the Nationwide Readmissions Database (2011 to 2014) for hospitalized patients with CDI and differentiated them by presence of cirrhosis. Baseline characteristics, surgical rates, and outcomes were collected. The primary outcomes of interest included readmission and mortality rates.

Results:
Of 366,283 patients hospitalized with CDI, 12,274 (3.4%) had cirrhosis, of which 7741 (63.1%) were decompensated. Among patients with CDI, 30-day readmission rates (33% vs. 24%), index admission mortality (5% vs. 2.5%), and calendar-year mortality (9% vs. 4%) were higher in patients with cirrhosis compared with those without cirrhosis. Recurrent CDI (rCDI) (46%) and cirrhosis-related complications (34.6%) were the most common reasons for readmission. Patients with decompensated cirrhosis were more likely to be readmitted within 30-days than those with compensated cirrhosis [odds ratio (OR), 1.19; 95% confidence interval (CI), 1.03-1.36]. Multivariable analyses revealed that among patients with cirrhosis, index colectomy (OR, 6.50; 95% CI, 1.61-26.24) and decompensation (OR, 3.61; 95% CI, 2.49-5.23) predicted index admission mortality. In addition, 30-day readmission (OR, 3.71; 95% CI, 2.95-4.67) and decompensated cirrhosis (OR, 1.49; 95% CI, 1.17-1.89) independently predicted calendar-year mortality.

Conclusions:
One-third of CDI patients with cirrhosis were readmitted within 30-days, most commonly because of rCDI. The mortality associated with CDI in patients with cirrhosis is high, with decompensation and 30-day readmission heralding a poor prognosis. Reducing rCDI-related readmissions may potentially improve these outcomes.
Optimising emergency weight estimation in underweight and obese children: the accuracy of estimations of total body weight and ideal body weight
Authors: Wells Mike , Goldstein Lara N. 
Published: July 2018

Objective
During medical emergencies, underweight and obese children are at a higher risk of weight-estimation errors than ‘average’ children, which may lead to poorer outcomes. In obese children, optimum drug dosing requires a measure of both total body weight (TBW) and ideal body weight (IBW) for appropriate scaling. We evaluated the ability of the Broselow tape, the Mercy method and the PAWPER XL tape to estimate TBW and IBW in obese and underweight children.

Participants and methods
Data for children aged 0–18 years were extracted and pooled from three previous weight-estimation studies. The accuracy of estimation of TBW and IBW by each method was evaluated using percentage of estimations within 10% of target weight (PW10) as the primary outcome measure.

Results
The Broselow tape estimated TBW poorly in obese and underweight children (PW10: 3.9 and 41.4%), but estimated IBW extremely accurately (PW10: 90.6%). The Mercy method estimated TBW accurately in both obese and underweight children (PW10: 74.3 and 76.3%) but did not predict IBW accurately (PW10: 14.3%). The PAWPER XL tape predicted TBW well (PW10: 73.0% in obese children and 74.9% in underweight children) and predicted IBW extremely accurately (PW10: 100%).

Conclusion
The Broselow tape predicted IBW, but not TBW, accurately. The Mercy method estimated TBW very accurately, but not IBW. The PAWPER XL tape estimated both TBW and IBW accurately. The PAWPER XL tape should be considered when choosing a weight-estimation strategy for obese and underweight children.
Quick Sepsis-related Organ Failure Assessment predicts 72-h mortality in patients with suspected infection
Authors: Chen Fu-Cheng , Kung Chia-Te , Cheng Hsien-Hung , Cheng Chi-Yung , Tsai Tsung-Cheng , Hsiao Sheng-Yuan , Su Chih-Min 
Published: July 2018

Objective
The aim of this study was to compare quick Sepsis-related Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) scores for predicting mortality.

Patients and methods
A single-center, retrospective study of adult patients with suspected infection was conducted. Area under the curve (AUC) and multivariate analyses were used to explore associations between the qSOFA and SIRS scores and mortality.

Results
Of the 69 115 patients enrolled, 1798 died within 72 h and 5640 within 28 days. The qSOFA scores were better than SIRS scores at predicting 72-h mortality (AUC: 0.77 vs. 0.64). However, the discriminatory power of both scores was low in terms of 28-day mortality (AUC: 0.69 vs. 0.60). Patients with qSOFA score of at least 2 had a higher hazard ratio for 72-h mortality than for 28-day mortality (2.64 vs. 1.91).

Conclusion
The qSOFA scores are more accurate than SIRS scores for predicting 72-h mortality and are better at predicting 72-h mortality than 28-day mortality.
Combined petrosal approach
Authors: Polster Sean P. , Horowitz Peleg M. , Awad Issam A. , Gluth Michael B. 
Published: July 2018

Purpose of review
The combined petrosal approach to the lateral skull base merges a retrolabyrinthine-presigmoid posterior fossa craniotomy with an adjacent middle fossa craniotomy, which are rendered continuous by division of the tentorium. This is a hearing-preserving approach that affords wide access to the lateral aspect of the clivus, the prepontine space, and the cerebellopontine angle.

Recent findings
This article details the historical development of the combined petrosal approach alongside a description. In particular, the critically relevant anatomy is reviewed, including the course of the vein of Labbé, with a view toward avoiding the known complications associated with this approach. Outcomes for application of this approach as applied for various lesions are also reviewed as portrayed by the current literature.

Summary
The combined petrosal approach affords wide access to the lateral skull base in the middle and posterior fossa. The approach and the lesions addressed by this approach involve delicate and sensitive anatomy. We review the evolution of this approach and highlight advancements that have allowed the combined petrosal approach to be a safe addition to the surgeon's armamentarium.
Hepatic Hemosiderosis Contributes to Abnormal Vitamin D-PTH Axis in Thalassemia Major
Authors: Bajoria Rekha , Rekhi Elissa , Almusawy Muhsin , Chatterjee Ratna 
Published: July 2018

Objective:
The aim of this study was to evaluate the vitamin D-PTH axis in thalassemia major (TM) in relation to hepatic siderosis liver iron content.

Design and Participants:
In this case-controlled observational study, vitamin D-PTH axis was studied in 158 TM and 84 age and ethnicity-matched healthy nonthalassemic controls attending University College Hospital, London. Patients were classified as 25-hydroxy vitamin D (25-OHD) insufficient and sufficient if the value was less than or greater than 50 nmol/L, respectively. 25-OHD data were evaluated in relation to markers of iron load in TM.

Results:
In TM, 25-OHD insufficiency was 8-fold higher than the control group (odds ratio [OR], 8.1; 95% confidence interval [CI], 4.3-15.0; P<0.001). Similarly, serum PTH (P<0.001), calcium (P<0.001), and phosphate levels (P<0.05) were also significantly lower in TM compared with the controls. In TM, serum ferritin of >2500 μg/L (OR, 5.3; 95% CI, 2.3-12.3; P<0.01), liver iron of >7 mg/g dry weight (OR, 8.8; 95% CI, 3.5-10.3; P<0.001), and serum alanine aminotransferase of >50 IU/L (OR, 9.7; 95% CI, 4.0-23.5; P<0.001) were independent risk factors for low 25-OHD levels.

Conclusions:
Our results suggest that TM had a 8-fold higher risk of 25-OHD insufficiency compared with the controls. This was likely to be associated with hepatic hemosiderosis.
Exploring the Associations Between Patient Affect, Self-Care Actions, and Emergency Department Use for Community-Dwelling Adults
Authors: Tzeng Huey-Ming , Pierson James Marcus , Kang Yu , Barker Anne , Yin Chang-Yi 
Published: July 2018

Background:
Nurses and other health care providers need to ensure that patients receive care that addresses their specific needs and wants.

Purpose:
This exploratory study examined the associations between patients' self-reported positive and negative affect, the perceived importance of 57 self-care actions, the desire and ability to perform them, and emergency department use in the past 3 months.

Methods:
A secondary analysis from a cross-sectional survey project that surveyed 250 community-dwelling adults living in the southern United States, 2015-2016. Independent t tests and the χ2 test were used.

Results:
Positive affect was associated with positive perceptions of self-care actions and having no emergency department visit. Patients with a more negative affect perceived finding and using services that support their health behaviors as being important and expressed a desire to participate in local health screening or wellness events.

Conclusions:
Patients' perceptions of their self-care actions could lead to better outcomes.
Sexual Harassment in the Work Place: Its Impact on Gynecologic Oncology and Women's Health
Authors: von Gruenigen Vivian E. , Karlan Beth Y. 
Published: July 2018

(Abstracted from Gynecol Oncol 2018;149:227–229)
Sexual discrimination, harassment, abuse, and bullying occur in all industries and have for decades. In October of 2017, media and news outlets exposed prominent professionals in the entertainment industry and other settings who took advantage of their status of power and influence to engage in workplace sexual harassment and discrimination.
Minimizing the Risk of Perinatal Human Immunodeficiency Virus Transmission
Authors: Givens Matthew , Dotters-Katz Sarah K. , Stringer Elizabeth , Rahangdale Lisa , Kuller Jeffrey A. 
Published: July 2018

Importance
There are approximately 284,500 adolescent and adult women living with human immunodeficiency virus (HIV) in the United States. It is estimated that approximately 8500 of these women give birth annually. While the rate of perinatal transmission in the United States has decreased by more than 90% since the early 1990s, potentially preventable HIV transmission events still occur and cause significant morbidity and mortality.

Objective
The aim of this review was to summarize the current data regarding perinatal HIV transmission timing and risk factors, current management recommendations, and implications of timing of transmission on patient management.

Evidence Acquisition
Literature review.

Results
This review reiterates that the risk of perinatal HIV transmission can be reduced to very low levels by following current recommendations for screening for HIV in all pregnant women and properly treating HIV-infected mothers, as well as using evidence-based labor management practices.

Conclusions and Relevance
Familiarity with the pathogenesis of HIV transmission is important for obstetric care providers to appropriately manage HIV-infected women in pregnancy, intrapartum, and the postpartum period.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to (1) compare the various modes and risk factors for HIV transmission from mother to fetus, (2) assess current recommendations for HIV screening in pregnancy, and (3) to manage patients in the antepartum, intrapartum, and postpartum periods.
Fetal Major Cardiac Defects and Placental Dysfunction at 11–13 Weeks’ Gestation
Authors: Fantasia I. , Kasapoglu D. , Kasapoglu T. , Syngelaki A. , Akolekar R. , Nicolaides K. H. 
Published: July 2018

(Abstracted from Ultrasound Obstet Gynecol 2018;51:194–198)
Major congenital heart defects (CHDs) are those that require invasive interventions within the first year following birth and are often associated with fetal growth restriction (FGR). A recent study on isolated major CHDs found evidence of impaired placental angiogenesis in the absence of impaired placental perfusion and function in pregnancies with fetal CHD.
Trends in Deaths Due to Syphilis, United States, 1968—2015
Authors: Peterman Thomas A. , Kidd Sarah E. 
Published: July 2018

Background
Before penicillin, the syphilis case-fatality rate was 10% within 40 years. Late complications, such as cardiovascular syphilis, were still common in the 1950s but now seem quite rare even though some infections likely go undetected. We studied trends in syphilis mortality as an indicator of trends in severe complications of syphilis.

Methods
We assessed underlying cause of death from US death certificates for 1968 to 2015. We examined death trends by type of syphilis (cardiovascular, neuro, congenital, other). We compared trends in deaths with trends in primary and secondary syphilis from national STD surveillance data.

Results
During 1968 to 2015, there were 6498 deaths attributed to syphilis, 4149 males and 2349 females. Annual syphilis deaths decreased from 586 in 1968 to 94 in 1984, then leveled off to between 24 and 46 since 1998. Between 1968 and 2015, the decrease in annual cardiovascular syphilis deaths (from 338 to 3) exceeded the decrease in annual neurosyphilis deaths (from 191 to 33). Congenital syphilis deaths (which do not include stillbirths) generally decreased from 28 to 2 per year. An increase in primary and secondary syphilis among women in the late 1980s was accompanied by a 4-fold increase in congenital syphilis deaths (from 9 in 1986 to 35 in 1990), but there was no subsequent increase in syphilis deaths among women.

Conclusions
Adults now rarely die from syphilis. Increases in infections in the late 1980s did not lead to an increase in adult syphilis deaths. Congenital syphilis deaths still increase when syphilis increases among women.
Treatment of Acute Epididymitis: A Systematic Review and Discussion of the Implications for Treatment Based on Etiology
Authors: Louette Aaron , Krahn Jessica , Caine Vera , Ha Shalane , Lau Tim T. Y. , Singh Ameeta E. 
Published: July 2018

AbstractA systematic review of studies completed in the last 11 years for the treatment of acute epididymitis identified 1534 records, of which 29 were assessed for eligibility, and only 1 study met the criteria for inclusion. This highlights the need for more prospective studies evaluating treatment regimens for acute epididymitis.