bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differentiated Antiretroviral Therapy Delivery: Implementation Barriers and Enablers in South Africa
Authors: Sharer Melissa , Davis Nicole , Makina Ndinda , Duffy Malia , Eagan Sabrina 
Published: February 2019

Abstract
Scale-up of antiretroviral therapy (ART) for people living with HIV requires differentiated models of ART delivery to improve access and contribute to achieving viral suppression for 95% of people on ART. We examined barriers and enablers in South Africa via semistructured interviews with 33 respondents (program implementers, nurses, and other health care providers) from 11 organizations. The interviews were recorded, transcribed, and analyzed for emerging themes using NVivo 11 software. Major enablers of ART delivery included model flexibility, provision of standardized guidance, and an increased focus on person-centered care. Major barriers were related to financial, human, and space resources and the need for time to allow buy-in. Stigma emerged as both a barrier and an enabler. Findings suggest that creating and strengthening models that cater to client needs can achieve better health outcomes. South Africa's efforts can inform emerging models in other settings to achieve epidemic control.
Employer Perceptions of Physical Therapists' Residency and Fellowship Training: Insights for Career Development Planning
Authors: Briggs Matthew S. , Whitman Julie , Olson-Kellogg Becky , Farrell Joseph , Glaws Kathryn R. , Walker Joann M. , Clutter Jill , Tichenor Carol Jo 
Published: February 2019

Introduction.
Residencies and fellowships have been developed to train physical therapists (PTs) toward advanced expertise while emphasizing patient outcomes, evidence-based care, and advancing practice. Research evaluating the impact of PT residency or fellowship training, its value, and/or benefits is scarce. The purpose of this study was to evaluate if employers perceive the performance of residency- and/or fellowship-trained employees differently than non–residency-trained and/or non–fellowship-trained employees.

Methods.
Participants were employers who employ PTs who have graduated from accredited physical therapy residency and fellowship programs in the United States. A survey was distributed asking perceptions of how employees, who were residency and/or fellowship trained, performed compared to employees with equivalent years of experience who were not residency or fellowship trained. Mann–Whitney U tests were used for comparison.

Results.
A total response rate of 40% (n = 226) was achieved, and a total of 184 responses were included. Respondents rated residency- and/or fellowship-trained employees higher in domains of Leadership, Communication, Clinical Aptitude, Scholarship/Evidence Based Practice, and Teaching when compared to experienced-matched colleagues. Employers rated fellowship-trained employees higher than residency-trained employees in areas of Leadership, Communication, and Clinical Aptitude.

Discussion and Conclusion.
These results may be important for assisting students and early- and mid-career professionals in making decisions about whether to attend residency and/or fellowship education and for understanding what employers value in making hiring decisions. Further, these considerations may influence future promotion opportunities, patient satisfaction, and payment policies.
Weekend PTA to DPT Bridge Program: An Innovative Educational Alternative
Authors: George Deborah A. , Dutton Lisa L. 
Published: February 2019

Background and Purpose.
Motivated to advance their careers, nontraditional students often choose to return to graduate education. Because of their multiple responsibilities, these students frequently seek alternative educational delivery formats, such as accelerated, hybrid distance, weekend, and bridge programs. In physical therapist (PT) education, bridge programs with online coursework and weekend formats are a relatively new alternative curricular model available for physical therapist assistants (PTAs) who wish to build on their past experiences in a realistic and efficient manner. Thus, this article describes a weekend PTA to Doctor of Physical Therapy bridge program and its outcomes.

Method/Model Description and Evaluation.
The described bridge program has a weekend format, some online coursework, and formal clinical experiences, clustered at the end of the curriculum. All students entering the program possess a baccalaureate degree from a 4-year institution and an associate degree from an accredited PTA program, as well as a minimum of 1 year of practice experience as a PTA. Multiple outcomes were used to evaluate this model, including focus groups, clinical performance instrument ratings, graduation rates, National Physical Therapy Examination pass rates, and alumni surveys.

Outcomes.
The average age of the bridge students was 31.5 years, and the average years of experience as a PTA was 7.08 years. The bridge students demonstrated nontraditional student characteristics such as being married, having one or more children, and living out of state. All but 3 students worked more than 20 hours per week as a PTA while in the program. Motivations for students entering the bridge program, as identified through focus group interviews, included finances, curricular fit, time and delivery structure, backup plan, and health care forces. The bridge students also reported expectations of expanded PT career opportunities, financial stability, autonomy as a health professional, and lifetime friendships with their classmates. Most alumni were satisfied with their overall learning experience and reported being adequately prepared to well prepared with their clinical performance skills. The average rating across all clinical performance instrument skills at the end of the final clinical experience was beyond entry level, the average graduation rate was 93.35%, and the ultimate 2-year National Physical Therapy Examination pass rate was 96.15%.

Discussion and Conclusion.
Major components of the studied model, including experience as PTAs, weekend format, use of online coursework, and clustered clinical experiences, may have interacted to promote positive outcomes for the nontraditional students enrolled in this bridge program. The presented model provides a sound alternative for PTAs seeking to advance their professional development and career.
Transcutaneous Neuromodulation at ST36 (Zusanli) is More Effective than Transcutaneous Tibial Nerve Stimulation in Treating Constipation
Authors: Wu Gao-jue , Xu Feng , Sun Xiao-meng , Chen Jiande D.Z. 
Published: February 2019

Background and Goals:
Combined transcutaneous neuromodulation (TN) at acupoint ST36 (Zusanli) and TN at the posterior tibial nerve (PTN) has been reported effective in treating functional constipation. This study was designed to compare the effectiveness of TN between these 2 points.

Materials and Methods:
Eighteen functional constipation patients (M/F: 9/9) were recruited to participate in a cross-over study with a 2-week TN at ST36 and a 2-week TN at PTN. A bowel movement diary, and the questionnaires of Patient Assessment of Constipation Symptom (PAC-SYM) and Constipation Quality of Life (PAC-QoL) were completed; anorectal manometry and spectral analysis of heart rate variability for assessing the autonomic function were performed.

Results:
(1) Both TN at ST36 and TN at PTN improved constipation-related symptoms (PAC-SYM scores on pre-TN vs. post-TN: 1.4±0.1 vs. 0.6±0.1 for ST36, 1.4±0.1 vs. 0.9±0.1 for PTN, both P≤0.001). (2) TN at ST36, but not TN at PTN, increased the number of weekly spontaneous bowel movements (0.9±0.2 pre-TN vs. 3.5±0.7 post-TN, P<0.001) and decreased the total PAC-QoL score. TN at ST36 was more potent than TN at PTN in improving the PAC-SYM score (decrement 0.8±0.1 vs. 0.5±0.1, P<0.05). (3) TN at ST36 rather than TN at PTN resulted in a reduction in sensation thresholds, including rectal distention for urge (134.1±14.3 mL pre-TN vs. 85.6±6.5 mL post-TN, P<0.01) and maximum tolerance (P<0.05). (4) Both TN at ST36 and TN at PTN significantly increased vagal activity and decreased sympathetic activity (P<0.05).

Conclusions:
TN at ST36 is more potent than TN at PTN in treating constipation and improving constipation-related symptoms and rectal sensation.
Vinpocetine in the treatment of poststroke cognitive dysfunction
Authors: Liu Yang , Yin Yanying , Lu Qiao-li , Dan Ying , Xu Mei-song , Song Ge , Li Chen 
Published: February 2019

Abstract

Background:
Previous clinical trials have reported that vinpocetine can be used for the treatment of cognitive dysfunction. However, its efficacy is still inconclusive. In this systematic review study, we aim to assess its efficacy and safety for the treatment of poststroke cognitive dysfunction (PSCD).

Methods:
We will search the following electronic databases from the inception to the present to evaluate the efficacy and safety of vinpocetine for patients with PSCD. These databases include CENTRAL, EMBASE, MEDILINE, CINAHL, AMED, and four Chinese databases. All randomized controlled trials (RCTs) of vinpocetine for PSCD will be considered for inclusion without the language restrictions. The methodological quality of all included RCTs will be evaluated by the Cochrane risk of bias tool. The 95% confidence intervals will be utilized to calculate the continuous data, the mean difference or standard mean difference, and dichotomous data with risk ratio.

Dissemination and ethics:
The results of this review will be disseminated through peer-reviewed journals. Its results may provide important evidence for the clinical practice, as well as the future studies. It does not require ethical approval, because this systematic review will not involve the individual data.

Systematic review registration:
PROSPERO CRD42018115224.
Staged reconstruction of large skull defects with soft tissue infection after craniectomy using free flap and cranioplasty with a custom-made titanium mesh constructed by 3D-CT-guided 3D printing technology
Authors: Kim Seong Hwan , Lee Seong Joo , Lee Jun Won , Jeong Hii Sun , Suh In Suck 
Published: February 2019

Abstract

Rationale:
A craniectomy, which results in a large skull defect, is performed to decrease the intracranial pressure under conditions such as intracranial hemorrhage and ischemic stroke. When the patient's condition is stabilized, autologous cranioplasty using the bone flap previously removed in the craniectomy is performed. Bone flap infection after the autologous cranioplasty is not uncommon and is difficult to treat. After the infection is controlled, cranioplasty is needed to improve the head deformity and neurologic function. Cranioplasty with a titanium mesh can result in aesthetic improvement and a low infection rate. Using 3-dimensional computed tomography (3D-CT) and 3D printing, titanium mesh is manufactured to fit perfectly on the patient's skull defect.

Patient concerns:
Two patients with large skull defects in the right temple area due to previous craniectomy were referred to our department for reconstruction. They had histories of recurrent infections at the operation site even after removal of the autologous bone flap that had been used for the cranioplasty.

Diagnosis:
Preoperative computed tomography (CT) showed 12×16 cm and 8×8.3 cm skull defect on right temporal area, respectively.

Interventions and outcome:
The infection was controlled by well-vascularized free flap coverage. After the surgery, cranioplasty with custom-made titanium mesh was performed to improve the aesthetic and functional problems of the patients. The contour of the temporal area was symmetric. The patients were satisfied with the results.

Lessons:
Staged reconstruction of large skull defects with soft tissue infection after craniectomy using free flap followed by cranioplasty with titanium mesh on can lead to safe, aesthetic, and satisfactory result.
Approach to diagnosis of factitious disorder with unexplained hemoptysis
Authors: Yue Peng , Zhou Kaiyu , Hua Yimin , Fang Jie , Li Yifei 
Published: February 2019

Abstract

Rationale:
Hemoptysis or hematemesis is a common clinical symptom in adults, but is unusually to be observed in children. Hemoptysis can occur with circulatory diseases, injuries, several types of systemic diseases, or systemic factors including factitious disorder (FD), which is difficult to be diagnosed. Here, we report a case of hemoptysis caused by FD to provide a diagnostic flow chart for such kind of disease.

Patient concerns:
An 11-year-old female patient had a history of hemoptysis or hematemesis for 6 months and suffered with paroxysmal syncope for a month.

Diagnosis and intervention:
A series of examinations had been launched to evaluate any possible malformation or abnormalities of the patient including fiberoptic bronchoscopy, cardiac catheterization, gastroscopy, nasolaryngoscopy, electrocardiogram, electroencephalogram, and enhanced magnetic resonance image of the paranasal sinus. Several methods had been performed and tried to stop hemoptysis such as taking hemostatic medications, lavage of fiberoptic bronchoscopy, and embolism for abnormal bronchial arterial using cardiac catheter. All the interventions, however, failed to achieve our treatment goal. Given that more careful observation during hospitalization had been done, and we suspected the symptom of hemoptysis from this patient might be originated from an FD.

Outcomes:
Based on the diagnosis of FD, targeted psychological intervention was provided by experts. After the treatment completed, the patient did not present hemoptysis anymore.

Lessons:
FD is an uncommon type of disease. This rare case described here is to help us to reconsider the long diagnosis process of hemoptysis with a series of examinations including some invasive procedures, whether all the examinations and interventions are necessary for a nonsevere hemoptysis patient.
Risk factors associated with outcomes of peritoneal dialysis in Taiwan
Authors: Chen Hsiao-Ling , Tarng Der-Cherng , Huang Lian-Hua 
Published: February 2019

Abstract
Peritoneal dialysis (PD) is one option for renal replacement therapy in patients with end-stage renal disease (ESRD). Maintenance of the PD catheter is an important issue for patient outcomes and quality of life. The aim of this retrospective cohort study is to clarify the risk factors of technique failure and outcomes at a single institute in Taiwan.
The study enrolled ESRD patients who had received PD catheters in a tertiary hospital in northern Taiwan. Using a competing risks regression model, we reviewed clinical data and analyzed them in terms of the time to technical failure and clinical outcomes, including PD-related peritonitis and mortality.
A total of 514 patients receiving PD between 2001 and 2013 were enrolled in the study. According to the multivariate analysis model, we found that diabetes mellitus was a risk factor for PD-related peritonitis (subdistribution hazard ratio [SHR] 1.47, 95% confidence interval [CI] 1.06–2.04, P = .021). Female gender and higher serum albumin levels were associated with lower risks of technique failure (SHR 0.67, 95% CI 0.48–0.94, P = .02; SHR 0.75, 95% CI 0.58–0.96, P = .023, respectively), but Gram-negative and polymicrobial infection increased the technique failure rate (SHR 1.68, 95% CI 1.08–2.61, P = .021; SHR 1.93, 95% CI 1.11–3.36, P = .02, respectively). Female gender was a risk factor associated with overall mortality (SHR 6.4, 95% CI 1.42–28.81, P = .016). Higher weekly urea clearance (Kt/V) and weekly creatinine clearance (WCCr) were associated with a lower risk of mortality (SHR 0.1, 95% CI 0.01–0.89, P = .04; SHR 0.97, 95% CI 0.96–0.99, P = .004, respectively).
Diabetes mellitus is a risk factor contributing to PD-related peritonitis. Male patients and lower serum albumin levels were associated with higher rates of technique failure. Female gender, lower Kt/V, and WCCr are risk factors for overall mortality in PD patients.
Postoperative outcomes of patients with chronic obstructive pulmonary disease undergoing coronary artery bypass grafting surgery
Authors: Zhao Hui , Li Lifang , Yang Guang , Gong Jiannan , Ye Lu , Zhi Shuyin , Zhang Xulong , Li Jianqiang 
Published: February 2019

Abstract

Introduction:
Chronic obstructive pulmonary disease (COPD) is a frequent comorbid disease in patients undergoing coronary artery bypass grafting (CABG) surgery, with an incidence ranging from 4% to 20.5%. Conventionally, COPD was recognized as a surgical contraindication to CABG. Because of the recent improvements in surgical techniques, anesthesia, and postoperative management, CABG has been performed more commonly in patients with COPD. However, studies have shown the various effects of COPD on postoperative morbidity and mortality after CABG, and this remains to be well defined.

Objectives:
To compare the postoperative outcomes after CABG between patients with and those without COPD.

Methods:
A systematic search was conducted in the Cochrane Library, PubMed, EmBase, and Ovid databases (until May 10, 2018). Studies comparing perioperative results and mortality outcomes after CABG between patients with and those without COPD were evaluated independently by 2 reviewers to identify the potentially eligible studies. Review Manager and STATA software were used for statistical analyses.

Results:
No significant difference in the mortality rates were found between patients with and those without COPD. COPD was associated with a higher respiratory failure rate (odds ratio [OR] = 4.01; 95% CI: 1.19–13.51, P = .03; P <.001 for heterogeneity), higher pneumonia rate (OR = 2.92; 95% CI: 2.37–3.60, P <.00001; P = .73 for heterogeneity), higher stroke rate (OR = 2.91; 95% CI: 1.37–6.18, P = .005; P = .60 for heterogeneity), higher renal failure rate (OR = 1.60; 95% CI: 1.30–1.97, P <.00001; P = .19 for heterogeneity), and higher wound infection rate (OR = 2.16; 95% CI: 1.21–3.88, P = .01; P = .53 for heterogeneity) after CABG.

Conclusions:
Patients with COPD were at higher risks for developing postoperative morbidities, particularly pneumonia, respiratory failure, stroke, renal failure, and wound infection. Although COPD was not associated with a higher risk of mortality, caution should be taken when a patient with COPD is indicated for CABG, considering the higher odds of postoperative complications involving the respiratory system and others.
The biochemical and genetic diagnosis of lipid disorders
Authors: Schaefer Ernst J. , Geller Andrew S. , Endress Gregory 
Published: February 2019

Purpose of review
To examine recent advances in our knowledge on the diagnosis of lipid disorders.

Recent findings
Fasting values above the 99th percentile for direct LDL-cholesterol (LDL-C), lipoprotein(a), and triglycerides are greater than 225 mg/dl, greater than 160 mg/dl, and greater than 500 mg/dl (>5.82, >394, and >5.65 mmol/l), respectively, whereas such values for plasma lathosterol, β-sitosterol, and cholestanol are greater than 8.0, 8.0, and 5.0 mg/l (>0.021, 0.019, and 0.013 mmol/l), respectively. Values below the first percentile for LDL-C are less than 40 mg/dl (<1.03 mmol/l) and for HDL-cholesterol (HDL-C) less than 25 mg/dl (<0.65 mmol/l) in men and less than 30 mg/dl (<0.78 mmol/l) in women, respectively. The above values can predispose to premature CVD, pancreatitis, neurologic disease, and kidney failure, and may be associated with monogenic lipid disorders. In the absence of secondary causes including diabetes or kidney, liver, or thyroid disease, consideration should be given to sequencing the following genes: ABCA1, ABCG5, ABCG8, APOA1, APOA5, APOB, APOC2, APOE, CETP, CYP27A1, GPIHBP1, LCAT, LDLR, LDLRAP1, LIPA, LIPC, LMF1, LPL, MTTP, PCSK9, SCARB1, and STAP1.

Summary
Recent data indicate that secondary causes and a wider range of conditions need to be considered in identifying the underlying causes of hypercholesterolemia, hypertriglyceridemia, hyperalphalipoproteinemia, hypobetalipoproteinemia, and HDL deficiency. Identifying such disorders allows for a more precise assessment of prognosis and the formulation of optimal therapy.
Neurotoxicity of general anesthetics in children: evidence and uncertainties
Authors: Bellinger David C. , Calderon Johanna 
Published: February 2019

Purpose of review
Compelling evidence in animal models that, under some conditions, general anesthetics and sedatives produce changes in the brain and persistent impairments in learning, memory, and behavior. The present review summarizes recent clinical studies investigating whether the use of these agents in children causes similar neurotoxicities.

Recent findings
Although the results of retrospective studies are somewhat mixed, multiple exposures to general anesthesia were generally found to confer greater risk than single exposures with regard to learning disability, attention deficit hyperactivity disorder, school readiness, and academic achievement. Recent clinical studies, including a large randomized controlled trial, are consistent in confirming that a single exposure in infancy to general anesthesia lasting less than 1 h is not associated with neurodevelopmental impairments in later childhood. These studies do not, however, clarify the potential impacts of longer exposures or multiple exposures.

Summary
Given that approximately half of the anesthetic exposures in young US children are 1 h or less in duration, the results of the recent clinical studies are reassuring. Because of the clinical necessity of administering general anesthetics and sedatives for longer periods for many surgical, procedural, or diagnostic purposes, the identification of adjuvants that prevent or reduce the potential neurotoxicity of these agents is an area of active research.
Microscopic/“Backwash” Ileitis and Its Association With Colonic Disease in New Onset Pediatric Ulcerative Colitis
Authors: Najarian Robert M. , Ashworth Lori A. , Wang Helen H. , Bousvaros Athos , Goldsmith Jeffrey D. 
Published: February 2019

ABSTRACTBackground:Microscopic ileitis and its association with pancolitis in adults with ulcerative colitis (UC) have been described. The incidence of ileitis and associations with colonic disease in pediatric UC have, however, not been thoroughly investigated. This study was undertaken to examine the prevalence of microscopic ileal inflammation at the time of initial diagnosis in a cohort of children with UC.Methods:We reviewed colonoscopy and biopsy data at time of diagnosis from 105 children and young adults with treatment naïve UC; ileal and colonic mucosal biopsies were available on all patients. Ileal mucosal biopsies were examined for the presence and severity of ileal inflammation, and other histologic features. Concurrently obtained colonic mucosal biopsies were assessed to define the severity, distribution, and extent of disease; endoscopic and clinical follow‐up data were reviewed.Results:A total of 107 ileal mucosal biopsies and 693 corresponding colonic mucosal biopsies were examined. Seventeen of 105 patients (16%) were found to have ileal inflammation (mean age = 10.4 years, 59% girls), 14 (82%) of whom had histologic pancolitis. The presence of ileal inflammation was significantly associated with endoscopic pancolitis (P = 0.02). The association between histologic pancolitis, severity of active inflammation in the cecum, and ascending colon suggested a possible association with ileal inflammation (P = 0.06, 0.07, and 0.08 respectively), but did not reach statistical significance.Conclusion:Patients with new onset UC may have microscopic ileal inflammation at time of diagnosis, even if the terminal ileum appears macroscopically normal. The presence of endoscopic pancolitis is associated with the presence of histologic ileitis. In contrast to existing studies in adults, an association between the presence of ileitis and the histologic severity or the histologic extent of colitis was not observed. Children with microscopic ileitis in the context of UC do not need to be reclassified as “indeterminate colitis” or Crohn disease.