bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining Demographics, Prior Academic Performance, and United States Medical Licensing Examination Scores
Authors: Rubright Jonathan D. , Jodoin Michael , Barone Michael A. 
Published: July 2018

Purpose
To examine whether demographic differences exist in United States Medical Licensing Examination (USMLE) scores and the extent to which any differences are explained by students’ prior academic achievement.

Method
The authors completed hierarchical linear modeling of data for U.S. and Canadian allopathic and osteopathic medical graduates testing on USMLE Step 1 during or after 2010, and completing USMLE Step 3 by 2015. Main outcome measures were computer-based USMLE examinations: Step 1, Step 2 Clinical Knowledge, and Step 3. Test-taker characteristics included sex, self-identified race, U.S. citizenship status, English as a second language, and age at first Step 1 attempt. Covariates included composite Medical College Admission Test (MCAT) scores, undergraduate grade point average (GPA), and previous USMLE scores.

Results
A total of 45,154 examinees from 172 medical schools met the inclusion criteria. The sample was 67% white and 48% female; 3.7% non-U.S. citizens; and 7.4% with English as a second language. Hierarchical linear models examined demographic variables with and without covariates including MCAT scores and GPA. All Step examinations showed significant differences by gender after adding covariates, varying by Step. Racial differences were observed for each Step, attenuated by the addition of covariates.

Conclusions
Demographic differences in USMLE performance were tempered by previous examination performance and undergraduate performance. Additional research is required to identify factors that contribute to demographic differences, can aid educators’ identification of students who would benefit from assistance preparing for USMLE, and can assist residency program directors in assessing performance measures while meeting diversity goals.
It’s Time for Medical Schools to Introduce Climate Change Into Their Curricula
Authors: Wellbery Caroline , Sheffield Perry , Timmireddy Kavya , Sarfaty Mona , Teherani Arianne , Fallar Robert 
Published: July 2018

Climate change presents unprecedented health risks and demands universal attention to address them. Multiple intergovernmental organizations, health associations, and health professions schools have recognized the specific importance of preparing physicians to address the health impacts of climate change. However, medical school curricula have not kept pace with this urgent need for targeted training.
The authors describe the rationale for inclusion of climate change in medical education and some potential pathways for incorporating this broad topic into physician training and continuing medical education. Reasons include the magnitude and reach of this transboundary issue, the shared responsibility of the U.S. health care sector as a major contributor to greenhouse gas emissions, and the disproportionate effects of climate change on vulnerable populations. The integration of climate-change-related topics with training of essential physician skills in a rapidly changing environment is feasible because many health topic areas already exist in medical school curricula in which climate change education can be incorporated. To fully integrate the health topics, underlying concepts, and the needed clinical and system-wide translations, content could be included across the scope of training and into continuing medical education and faculty development. The authors provide examples of such an approach to curricular inclusion.
Effects of the OPRM1 A118G Polymorphism (rs1799971) on Opioid Analgesia in Cancer Pain
Authors: Yu Zhicao , Wen Lei , Shen Xingyong , Zhang Hongmei 
Published: July 2018

Objectives:
Although previous studies have demonstrated that the OPRM1 A118G polymorphism may influence the analgesia response to cancer pain, the results are inconsistent. In this article we aimed to fully examine the association between OPRM1 A118G (rs1799971) polymorphism and opioid analgesia by analyzing published information. This will provide information for better cancer pain management.

Materials and Methods:
A systematic search of the literature dating to August 31, 2017 was conducted using PubMed, EMBase, Sinomed, and the Cochrane Library databases. The standardized mean difference (SMD) of required amounts of opioids between AA homozygotes and the G-allele was calculated. Subgroup analyses for race and opioid use was performed. In addition, drug sensitivity analysis, heterogeneity description, and publication bias assessment were performed.

Results:
Of the 467 screened studies, 12 including 2118 participants were eligible to be included in our analysis. The meta-analysis results indicated that G-allele carriers (AG+GG) of the OPRM1 A118G polymorphism required higher opioid doses for pain management than those with the AA homozygotes (SMD=−0.3; 95% confidence interval [CI], −0.45 to −0.15; P<0.001). In subgroup analysis, we did not find statistically significant correlation between OPRM1 A118G polymorphism and opioid pain relief among Caucasian patients (SMD=−0.15; 95% CI, −0.29 to −0.00; P=0.04), as well as among morphine users (SMD =−0.20; 95% CI, −0.40 to 0.00, P=0.05), except for Asian patients (SMD=−0.42; 95% CI, −0.62 to −0.23; P<0.001).

Discussion:
Our meta-analysis indicates that G allele (AG+GG) carriers of OPRM1 A118G polymorphism required more opioid analgesia in cancer pain management. The OPRM1 A118G polymorphism may help predict individuals’ response to analgesia and achieve satisfactory cancer pain control.
Nurses Providing End-of-Life Care for Infants and Their Families in the NICU
Authors: Gibson Kim , Hofmeyer Anne , Warland Jane 
Published: July 2018

Background:
Nurses working in the neonatal intensive care unit (NICU) who care for dying infants and their families say they do not necessarily have the expertise or the specific training to provide quality end-of-life-care (EOLC).

Purpose:
The purpose of this review was to critically appraise the existing qualitative literature regarding nurses' experiences when caring for infants during end of life in the NICU and to identify barriers and enablers to provide quality EOLC.

Search Strategy:
A literature search was conducted using CINAHL and OVID databases. Studies that explored nurses' experiences when caring for infants who were dying or when lifesaving care was withdrawn were retrieved and 15 studies were thematically analyzed.

Results:
Five major themes emerged: advocating for the dying infant, building close relationships with the family, providing an appropriate care environment, nurses' emotional responses to dying or death, and professional inadequacy in EOLC.

Implications for Practice:
Nurses face multiple challenges when providing EOLC including moral dilemmas and feelings of professional inadequacy. Avoidance was a common strategy used by nurses to cope with the stress associated with EOLC. Managers can foster quality EOLC by implementing education sessions about infant mortality, EOLC, advocacy, team communication, and self-care practices.

Implications for Research:
Research could evaluate the effectiveness of EOLC education sessions to build nurses' competence and confidence in advocacy and EOLC clinical skills.
Congenital Syphilis
Authors: Rowe Christine R. , Newberry Desi M. , Jnah Amy J. 
Published: July 2018

Background:
Syphilis is caused by the spirochete bacterium Treponema pallidum. Syphilis left untreated, or inadequately treated during pregnancy, can result in congenital syphilis (CS). Congenital syphilis can lead to severe sequelae or fetal, neonatal, or infant death.

Purpose:
To discuss the epidemiological trends, pathophysiology, diagnosis, and management of CS; the implications of CS upon the infant; as well as the importance of the nurse's role in the prompt identification of CS and the timely interventions needed to minimize sequelae.

Methods:
A literature search was completed using ProQuest, CINAHL, Google Scholar, and PubMed. Articles published within the past 10 years were included.

Findings:
Epidemiological trends of CS in the United States indicate that maternal syphilis infection and CS are on the rise. Risk factors include ethnicity, socioeconomic status, access to prenatal care, and sexual behaviors, as well as compliance with prenatal syphilis screening by prenatal providers. Risks of CS to the developing fetus begin at approximately 14 weeks. Timely treatment is necessary to minimize or eliminate mortality and morbidity.

Implications for Practice:
Evidence-based, interprofessional strategies, which promote a collaborative perinatal/neonatal preventative approach to care of the pregnant female, are indicated to reverse the increasing incidence of CS within the United States. Strategies prioritizing early identification and treatment of at-risk neonates are necessary to reduce/eliminate the devastating long-term consequences of CS upon this vulnerable population.

Implications for Research:
The paucity of research, which focuses on CS, is most likely due to ethical concerns related to infants as research participants and provides an opportunity for future research. Future research could focus on factors that focus on maternal–fetal/maternal–child transmission of CS.
Systemic High-Mobility Group Box-1: A Novel Predictive Biomarker for Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage*
Authors: Chaudhry Shafqat R. , Güresir Agi , Stoffel-Wagner Birgit , Fimmers Rolf , Kinfe Thomas M. , Dietrich Dirk , Lamprecht Alf , Vatter Hartmut , Güresir Erdem , Muhammad Sajjad 
Published: July 2018

Objectives:
To investigate the release of proinflammatory damage-associated molecular pattern molecule “high-mobility group box-1” in the serum of patients after aneurysmal subarachnoid hemorrhage and its association with cerebral vasospasm.

Design:
Retrospective observational study.

Setting:
University hospital.

Patients:
Aneurysmal subarachnoid hemorrhage patients admitted within 24 hours of ictus.

Interventions:
Standard subarachnoid hemorrhage treatment after clipping or coiling of aneurysm.

Measurements and Main Results:
We enrolled 53 aneurysmal subarachnoid hemorrhage patients from which peripheral venous blood was withdrawn on days 1, 3, 5, 7, 9, 11, and 13 and once from the controls to obtain the serum. Serum high-mobility group box-1 concentration was quantified by enzyme-linked immunosorbent assay. Serum interleukin-6 and peripheral blood leukocytes were also determined over the first 2 weeks after subarachnoid hemorrhage. Patients’ data were recorded prospectively. Serum high-mobility group box-1 was significantly elevated in subarachnoid hemorrhage patients from day 1 to day 13 when compared with nonsubarachnoid hemorrhage patients (p < 0.05). Patients with cerebral vasospasm showed significantly higher high-mobility group box-1 starting from day 1 to day 13 when compared with patients without cerebral vasospasm. Cumulative levels of high-mobility group box-1 showed significant correlation with peripheral blood leukocytes and interleukin-6 levels (p < 0.05). Receiver operating characteristic curve analysis showed that serum high-mobility group box-1 level at admission may be a predictive biomarker for cerebral vasospasm with a sensitivity of 59% and a specificity of 82% at a cutoff value of 5.6 ng/mL.

Conclusions:
Serum high-mobility group box-1 is differentially elevated after subarachnoid hemorrhage. Serum high-mobility group box-1 levels were elevated early after subarachnoid hemorrhage (day 1) and remained significantly high until day 13 in patients who developed cerebral vasospasm. Our data suggest that serum high-mobility group box-1 may be a predictive biomarker for the detection of CVS.
Handovers Among Staff Intensivists: A Study of Information Loss and Clinical Accuracy to Anticipate Events*
Authors: Dutra Mariana , Monteiro Mariana V. , Ribeiro Karina B. , Schettino Guilherme P. , Kajdacsy-Balla Amaral Andre Carlos 
Published: July 2018

Objectives:
Handovers are associated with medical errors, and our primary objective is to identify missed diagnosis and goals immediately after a shift handover. Our secondary objective is to assess clinicians’ diagnostic accuracy in anticipating clinical events during the night shift.

Design:
Single-center prospective observational cohort study.

Setting:
Thirty-bed tertiary ICU in Sao Paulo, Brazil.

Patients:
Three-hundred fifty-two patient encounters over 44 day-to-night handovers.

Interventions:
None.

Measurements and Main Results:
We used a multimethods approach to measure transmission of information among staff physicians on diagnoses and goals for the night shift. We surveyed clinicians immediately after a handover and identified clinical events through chart abstractions and interviews with clinicians the next morning. Nighttime clinicians correctly identified 454 of 857 diagnoses (53%; 95% CI 50–56) and 123 of 304 goals (40%; 95% CI, 35–46). Daytime clinicians were more sensitive (65% vs 46%; p < 0.01) but less specific (82% vs 91%; p < 0.01) than nighttime clinicians in anticipating clinical events at night, resulting in similar accuracy (area under the receiver operating characteristic curve, 0.74 [95% CI, 0.68–0.79] vs 0.68 [95% CI 0.63–0.74]; p = 0.09). The positive predictive value of both daytime and nighttime clinicians was low (13% vs 17%; p = 0.2). Gaps in diagnosis and anticipation of events were more pronounced in neurologic diagnoses.

Conclusions:
Among staff intensivists, diagnoses and goals of treatment are either not conveyed or retained 50–60% of the cases immediately after a handover. Clinicians have limited ability to anticipate events, and the expectation that anticipatory guidance can inform handovers needs to be balanced against information overload. Handovers among staff intensivists showed more gaps in the identification of diagnostic uncertainty and for neurologic diagnoses, which could benefit from communication strategies such as cognitive checklists, prioritizing discussion of neurologic patients, and brief combined clinical examination at handover.
Do Patterns of Reconstruction Choices After Mohs Surgery Vary by Specialty? A Pilot Study of Mohs Surgeons and Facial Plastic Surgeons
Authors: Kurta Anastasia O. , Sarhaddi Deniz , Sheikh Umar A. , Bernstein Michael , Walen Scott , Armbrecht Eric S. , Maher Ian A. 
Published: July 2018

BACKGROUND
Differences in approach to repair a specified defect after Mohs micrographic surgery (MMS) between specialties have not been previously examined.

OBJECTIVE
To assess the difference in frequency of which reconstruction repairs are selected after MMS, among Mohs surgeons and facial plastic surgeons (FPS), and evaluate whether the level of satisfaction with the final repair outcome differed between specialties.

MATERIALS AND METHODS
The study was approved by the Saint Louis University Institutional Review Board. A link to the survey was distributed to members of American College of Mohs Surgery (ACMS) and American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), between January and May 2016.

RESULTS
The reconstructive procedure selected most often (“top choice”) was not significantly different between Mohs surgeons and FPS for the majority of the images. There was no material difference in how dermatologists and FPS rate the aesthetic outcome of the 3 presented closure types, with the exception of one closure type—nose with graft.

CONCLUSION
Mohs surgeons were found to more likely cluster around a single preference for their reconstruction technique compared with FPS, in which a higher percentage of surgeons also selected other options.
Reconstruction of Preauricular Wounds Using a Flipped Island Pedicle Flap
Authors: DeWitt Corey , Holmes Todd 
Published: July 2018

BACKGROUND
Island pedicle flaps (IPFs) are a frequently used reconstructive option in dermatologic surgery. With variations in its execution, the flap can be used for an assortment of facial defects.

OBJECTIVE
To describe the execution of a flipped IPF for the reconstruction of medium to large preauricular wounds after Mohs micrographic surgery.

MATERIALS AND METHODS
An analysis of the flipped IPF reconstruction of 12 preauricular defects is presented. Patient demographics, surgical defects, aesthetic outcomes, and complications are described.

RESULTS
Twelve patients with 12 preauricular tumors (9 basal cell carcinomas, 2 squamous cell carcinomas, and 1 malignant melanoma) were treated using Mohs micrographic surgery. A flipped IPF reconstruction was successfully used with good cosmetic outcomes and no complications in all 12 patients.

CONCLUSION
In this series, the authors demonstrate the effective use of flipped IPFs for the reconstruction of medium to large preauricular defects with good aesthetic outcomes and no complications.
Surgical Site Infections After Dermatologic Surgery in Immunocompromised Patients: A Single-Center Experience
Authors: Balakirski Galina , Kotliar Konstantin , Pauly Karolin J. , Krings Laura K. , Rübben Albert , Baron Jens M. , Schmitt Laurenz 
Published: July 2018

BACKGROUNDImmunosuppression is often considered as an indication for antibiotic prophylaxis to prevent surgical site infections (SSI) while performing skin surgery. However, the data on the risk of developing SSI after dermatologic surgery in immunosuppressed patients are limited.PATIENTS AND METHODSAll patients of the Department of Dermatology and Allergology at the University Hospital of RWTH Aachen in Aachen, Germany, who underwent hospitalization for a dermatologic surgery between June 2016 and January 2017 (6 months), were followed up after surgery until completion of the wound healing process. The follow-up addressed the occurrence of SSI and the need for systemic antibiotics after the operative procedure. Immunocompromised patients were compared with immunocompetent patients. The investigation was conducted as a retrospective analysis of patient records.RESULTSThe authors performed 284 dermatologic surgeries in 177 patients. Nineteen percent (54/284) of the skin surgery was performed on immunocompromised patients. The most common indications for surgical treatment were nonmelanoma skin cancer and malignant melanomas. Surgical site infections occurred in 6.7% (19/284) of the cases. In 95% (18/19), systemic antibiotic treatment was needed. Twenty-one percent of all SSI (4/19) were seen in immunosuppressed patients.CONCLUSIONAccording to the authors' data, immunosuppression does not represent a significant risk factor for SSI after dermatologic surgery. However, larger prospective studies are needed to make specific recommendations on the use of antibiotic prophylaxis while performing skin surgery in these patients.
NOVEL OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BIOMARKER IN BRANCH RETINAL VEIN OCCLUSION MACULAR EDEMA
Authors: Yeung Ling , Wu Wei-Chi , Chuang Lan-Hsin , Wang Nan-Kai , Lai Chi-Chun 
Published: July 2018

Purpose:
To evaluate the association between deep–superficial flow ratio (DSFR) and the treatment response of macular edema in branch retinal vein occlusion.

Methods:
Thirty eyes from 30 patients with branch retinal vein occlusion who had received optical coherence tomography angiography examination were included. Seventeen normal fellow eyes acted as the control group. Patients were classified into the “good response group” and the “refractory group” by absence or presence of macular edema after 6 months of treatment. The DSFRs were calculated by dividing deep capillary plexus vessel density by superficial capillary plexus vessel density on optical coherence tomography angiography.

Results:
The DSFR was 1.00 (SD ± 0.05) over parafoveal area in the control group. Among branch retinal vein occlusion eyes, parafoveal DSFR remained stable in the good response group (P = 0.822) and significantly decreased in the refractory group (P = 0.002). The DSFRs in the most severe nonperfusion area were significantly lower in the refractory group than in the good response group (0.85 ± 0.13 vs. 1.01 ± 0.15, P = 0.004). The DSFR in the most severe nonperfusion area was associates with treatment response in multivariate logistic regression (P = 0.015).

Conclusion:
Deep–superficial flow ratio can represent the relative damage of deep capillary plexus to superficial capillary plexus. Decreased DSFR was found in branch retinal vein occlusion eyes with refractory macular edema.
PATTERNS OF CHORIOCAPILLARIS FLOW SIGNAL VOIDS IN CENTRAL SEROUS CHORIORETINOPATHY
Authors: Matet Alexandre , Daruich Alejandra , Hardy Samuel , Behar-Cohen Francine 
Published: July 2018

Purpose:
To investigate choriocapillaris flow signal void distribution on optical coherence tomography (OCT) angiography in central serous chorioretinopathy (CSCR) and its correlation to choroidal vessel morphology.

Methods:
Fifty-three CSCR eyes (48 patients) and 34 healthy control eyes were included, retrospectively. Exclusion criteria were refractive error >2D, previous laser or photodynamic therapy, low-quality OCT angiography, or excessive shadowing artifacts. Choriocapillaris OCT angiography scans were processed by local-threshold binarization to identify signal voids, and extract their cumulative area. The locations of the two largest voids in each eye were reported on the corresponding enhanced depth imaging OCT raster scan. Choriocapillaris thickness and diameter of underlying outer choroidal vessels were measured at the level of flow voids and of adjacent outer choroidal vessels, not colocalizing with voids.

Results:
There were 22 acute, 16 recurrent, and 15 chronic CSCR eyes. Total flow void area was larger in CSCR than control eyes. In univariate analysis, the total flow void area on OCT angiography increased with age (P = 0.0002), duration since CSCR diagnosis (P = 0.004), extension of autofluorescence alterations (P = 0.016), and CSCR severity (P < 0.0001). In multivariate analysis, age (P = 0.014) and CSCR type (P = 0.046) influenced independently the total flow void area. On enhanced depth imaging OCT, outer choroidal vessel diameter was higher (P < 0.0001), and choriocapillaris was thinner (P < 0.0001) at flow voids compared with adjacent sites, independently from eccentricity from the fovea.

Conclusion:
Choriocapillaris flow voids colocalize with choriocapillaris thinning and deep choroidal vessel dilation in CSCR eyes. Age and CSCR severity influence choriocapillaris flow, a key contributor to CSCR pathophysiology and clinical expression.