bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Interprofessional Team Experience—Value and Timing in a Doctor of Physical Therapy Curriculum
Authors: Schiller Martha , Gilkey Stephanie , Mendez Jennifer , Dunleavy Kim 
Published: January 2019

Introduction.
Intentional interprofessional experiences (IPE) in physical therapy education are needed to address Commission on Accreditation in Physical Therapy Education criteria and ensure student readiness for practice. The purpose of this study was to compare Doctor of Physical Therapy (DPT) student perceptions of participation in an older adult interprofessional team visit (IPTV) between 3 cohorts at different points in the professional entry level curriculum.

Methods.
A retrospective comparison of different cohorts was possible at different time points due to curricular changes. Ninety one DPT students in 3 cohorts from 2013 to 2015 participated in the same IPTV experience format in their first, second or third year of the professional program. Doctor of Physical Therapy students were matched with students from 2 disciplines. All participated in a team and discipline-specific orientation and debriefing and completed an assessment with an older adult living in the community and a prequestionnaire/postquestionnaire. Results from postvisit surveys were examined using nonparametric statistics, and open-ended questions were coded and analyzed for themes. Responses were compared for differences across the 3 years.

Results.
There were significant differences across cohorts. Student reflections were positive with themes emerging across all cohorts for communication, teamwork, and learning. First-year students reported the greatest overall agreement for all learning outcome statements in comparison to the second or third cohort of students.

Discussion and Conclusions.
The IPTV experience provided a unique opportunity for students to work in an interprofessional team while learning about issues experienced by community dwelling older adults. The activity was ideal to provide early active community participant exposure and meet curricular objectives for communication strategies but could be used for the team-based interprofessional objectives at any stage. While student perceptions of the activity were very positive for all cohorts, this activity was valued by the first-year group more than second or third years. Timing and design of community-based IPE activities should be intentionally sequenced to meet learning objectives suitable for the stage of professional development and take into account exposure to patient care as well as other logistical and curricular sequencing to maximize learning and motivation.
Data-Driven Decision-making in DPT Curricula Part II: Course-Level Analysis
Authors: Leard John , Wininger Michael , Roller Dawn , Crane Barbara 
Published: January 2019

Background and Purpose.
In a physical therapist entry-level education program, there is need for continuous monitoring of student progress toward degree completion and forecasts of potential roadblocks. We propose a method by which a course instructor can provide reasonable estimates of final course performance in real time, so that the student and instructor together can make data-driven decisions regarding next steps. Our primary goal was to apply this method to a course that had a high correlation of successful performance to first time pass rate on the National Physical Therapy Examination exam. Our secondary goal was to replicate this methodology in additional classes to further determine utility of this method.

Method/Model.
We have developed a methodology, using a simple algebraic framework, based on individual assessment grades (quizzes or tests) in any particular course, which can provide a student with a final grade prediction within two or four points to encourage conversation with the student and guide the student early in the semester.

Description and Evaluation.
To validate this approach, a retrospective analysis of course grades in one course across five Doctor of Physical Therapy (DPT) cohorts was performed and the technique was replicated using additional courses at the graduate and undergraduate levels.

Outcomes.
By Quiz 2, the final grade is predictable for 82 ± 13% of the students to within a 2-point margin and for 90 ± 9% of students to within a 4-point margin. Thus, with only 9.5% of the total grade determined and 83% of the time remaining in the semester, average prediction utility was greater than 80%. Prediction utility varied over time, and by margin, but is generally near 80% throughout the semester in the narrow margin (2 points; coefficient of variation = 0.13 ± 0.04) and greater than 90% in the wide margin (4 points; coefficient of variation = 0.05 ± 0.03).

Discussion and Conclusion.
We show that course performance can be predicted with high utility and with maximal time for intervention. We provide an evidence-based approach to guide the tandem investment in success, as shared between student and school. We believe that regular monitoring of course performance as described here may provide increased opportunity to intervene with remediation activities and foster better student success within a course, enhancing the probability of successful and timely program completion.
The transformation of health care for patients: Information and communication technology, digiceuticals, and digitally enabled care
Authors: Downes Elizabeth , Horigan Ann , Teixeira Patrick 
Published: January 2019

ABSTRACT
The way patients access care and interact with health care systems is rapidly changing through the use of information and communication technology (ICT). Health care is being transformed through digital innovations, such as wearable technology, remote monitoring, patient portals, mobile applications (apps), and new service models such as telemedicine and virtual visits. Through a review of the current literature, this article presents the use of digitally enabled tools and ICT, including electronic health records, telehealth, remote patient monitoring, and mobile health apps. These effective and innovative digitally enabled tools have expanded options for patients interested in actively engaging in their own health. Information and communication technology can improve health outcomes, enhance the patient experience, and curtail costs. Providers must stay fluent with ICT options to best collaborate with patients. Although providers recognize that patient-centered care can improve effectiveness and efficiency, many have been slow to incorporate digital therapeutics, or “digiceuticals,” into practice.
Implementation of an obstructive sleep apnea screening tool with hypertensive patients in the primary care clinic
Authors: Showalter Laura , O'Keefe Catherine 
Published: January 2019

ABSTRACT

Background and Purpose:
Patients with severe obstructive sleep apnea (OSA) have an almost 4-fold higher odds of resistant hypertension than those with less severe OSA. Obstructive sleep apnea screening practices in primary care are deficient. Additional study is needed regarding the value of OSA screening in hypertensive adults who present to the primary care clinic.

Methods:
This was a convenience sample of adults with hypertension from a rural primary care clinic in Iowa. Staff identified patients who met the inclusion criteria for the project. The STOP-Bang Questionnaire was used to screen the patients for OSA. Providers subsequently used discretion as to ordering polysomnography (PSG).

Conclusions:
Thirty-two patients were screened over a 3-month time period. All of the men included in the study scored either high or intermediate risk for OSA. Forty percent of the study participants scored high risk for OSA, with 33% of those participants referred for PSG. At project conclusion, three participants had undergone PSG testing, and all were diagnosed with sleep apnea.

Implications for Practice:
To ensure timely diagnosis and treatment of OSA, primary care providers should consider screening all hypertensive adults for OSA. With compulsory screening and subsequent identification and treatment of patients with OSA, nurse practitioner providers can pave the way in reducing mortality and morbidity associated with OSA, as well as resistant hypertension.
Implementation of pulmonary ultrasound training for critical care advanced practice providers
Authors: Leibenguth Emily , Magdic Kathy , Loeslie Vicki , Yadav Hemang , Guttendorf Jane 
Published: January 2019

ABSTRACT

Background and purpose:
The use of pulmonary ultrasound (US) in the critical care setting has been increasing over the past 2 decades. The use of advanced practice providers (APPs) in the critical care setting is also increasing. Limited data exist regarding the clinical and educational impact of a formal pulmonary US training course for APPs working in critical care settings.

Methods:
A preimplementation and postimplementation comparative design focused on the development and implementation of a formal pulmonary US course for novice critical care APPs.

Conclusions:
Eleven APPs underwent formal pulmonary US training. There was a significant increase in pulmonary US knowledge after the course, with pretest median of 13 and posttest median of 22 (p < .001; maximum score = 23). Presurvey and postsurvey comparison showed overall increase in skill and clinical use of pulmonary US. After the course, participating APPs reported a greater frequency of clinical decision-making based on US examination as measured by presurvey and postsurvey results.

Implications for practice:
Implementation of a formal pulmonary US course for critical care APPs improved pulmonary US knowledge, skill, and utilization, and impacted clinical decision-making and should be a highly recommended addition to the practice setting.
Predictors of gastrointestinal bleeding in older persons taking nonsteroidal anti-inflammatory drugs: Results from the FDA adverse events reporting system
Authors: McDonald Deborah Dillon 
Published: January 2019

ABSTRACT

Background and purpose:
Older adults continue to take nonsteroidal anti-inflammatory drugs (NSAIDs) to manage chronic pain. The study's purpose was to identify predictors of gastrointestinal (GI) bleeding in older adults taking NSAIDs.

Methods:
A secondary analysis of the 2016 Food and Drug Administration's Adverse Events Reporting System data was conducted with 1,347 cases aged 65 years and older with an NSAID as the primary suspect for an adverse drug event (ADE). Data included age, sex, NSAID, multiple NSAID use, rivaroxaban, warfarin, clopidogrel, cardiovascular drug (proxy for cardiovascular disease), diabetes drug (proxy for diabetes mellitus), and primary adverse drug response.

Conclusions:
Aspirin was the primary suspect NSAID in 72.5% of cases. Rivaroxaban was taken in 67.9% of cases. Logistic regression was conducted to predict GI bleed versus other NSAID-related ADEs with age, sex, cardiovascular medication, diabetes medication, warfarin, clopidogrel, concurrent NSAID use, aspirin, and rivaroxaban as predictors. Aspirin, rivaroxaban, and concurrent NSAID were significant predictors of GI bleed. Gastrointestinal bleed risk versus other ADE risk increased by 39.77 times when taking aspirin, rivaroxaban, and another NSAIDs concurrently.

Implications for practice:
Results support reduced NSAID use by older adults, especially aspirin, and avoidance of rivaroxaban in older persons taking NSAIDs.
Implementation of alcohol and drug screening, brief intervention, and referral to treatment: Nurse practitioner learner perspectives on a mobile app
Authors: Curtis Alexa C. , Satre Derek D. , Ly Khanh , Wamsley Maria , Satterfield Jason 
Published: January 2019

ABSTRACT

Background and purpose:
Screening, brief Intervention, and referral to treatment (SBIRT) is a widely trained evidence-based strategy to identify and address alcohol and drug use problems. The purpose of this qualitative study was to explore the experience of family nurse practitioner (FNP) learners in the implementation of SBIRT and the perceived clinical utility of an SBIRT mobile app.

Methods:
Twenty-two FNP learners completed didactic SBIRT training and orientation to an SBIRT mobile app. At the conclusion of the study, participant focus groups explored overall SBIRT delivery (N = 19) and SBIRT mobile app utilization (N = 14). Focus group data were analyzed within a Theory of Planned Behavior framework.

Results:
Participants indicated that the mobile app was useful in the ongoing development of SBIRT knowledge, skill confidence, and motivation. Learners identified the clinical context as a major factor in facilitating the delivery of SBIRT overall. Participants who did not deliver SBIRT indicated that the most significant barriers to SBIRT implementation were lack of support from clinical preceptors and health systems.

Conclusions:
Findings suggest that a mobile app is an acceptable and feasible tool to improve the delivery of SBIRT. However, collaboration with preceptors and clinical training organizations is essential to optimize clinical translation.
Clinical Validity of Quantified Visually Enhanced Vestibulo-ocular Reflex Test to Detect Horizontal Semicircular Canal Hypofunction
Authors: Rey-Martinez Jorge , Ninchritz Elisabeth , Palicio Idoia , Goiburu Miren , Casado Carmen Maria , Altuna Xabier 
Published: January 2019

Objective:
To investigate the clinical validity of the mathematical measured VVOR test results to detect horizontal semicircular canal hypofunction.

Study Design:
Prospective, nonrandomized, observational study.

Setting:
Tertiary referral center, hospital.

Patients:
Consecutive patients on first time visit to otoneurology unit.

Intervention(s):
Diagnostic.

Main Outcome Measure(s):
Values of statistical indicators of clinical validity for VVOR test to detect horizontal canal hypofunction were used considering vHIT horizontal aVOR gain values as gold standard.

Results:
Area under curve of ROC curve for quantified VVOR testing was 0.92. Head movement frequency on VVOR test and contralateral VVOR gain were identified as significant influence factors of (unilateral) VVOR gain (p < 0.0001) on statistical linear model.

Conclusions:
According to the obtained results, the quantified VVOR test has excellent clinical validity for detecting angular horizontal VOR hypofunction.
A Histopathologic Comparison of Eustachian Tube Anatomy in Pediatric and Adult Temporal Bones
Authors: Noonan Kathryn Y. , Linthicum Fred H. , Lopez Ivan A. , Ishiyama Akira , Miller Mia E. 
Published: January 2019

Hypothesis:
In children, the distance between the carotid canal (CC) and Eustachian tube (ET) is not significantly narrower than the adult population.

Background:
ET dysfunction treated with ET dilation is FDA approved for adults. Several studies describe the close relationship between the CC and the ET in adults, but the anatomy of the ET has not been well defined in children. This study seeks to investigate these relationships in the pediatric population.

Methods:
Histologic sections from 23 temporal bones of pediatric patients ages 0 to 18 were reviewed by two independent observers. The distance between the CC and the cartilaginous Eustachian tube (CET), bony-cartilaginous junction (BCJ), and bony Eustachian tube (BET) were measured. Fifteen adult temporal bones were used as a control group.

Results:
The distance to the CC was narrowest at the BET, and was actually higher in the pediatric population when compared to adults (0.5 mm and 0.2 mm, respectively, p = 0.06). The CC-CET distance was smaller in the pediatric group (2.3 mm vs 3.3 mm, p < 0.01). The bony-cartilaginous junction is often the region of most concern during dilation. There was no significant difference between the CC-BET distance in pediatric and adult groups (1.9 vs 2.3 mm, p = 0.20).

Conclusions:
CET-CC is smaller in the pediatric population, as expected due to smaller anatomic structures. However, the variable incline of the ET results in a CC-BCJ distance that is similar to the adult population. Although imaging studies are necessary.
A giant aggressive angiomyxoma of vulva in a young woman
Authors: Xie Yao , Qian Yanping , Zou Bingyu 
Published: January 2019

Abstract

Rationale:
Aggressive angiomyxoma (AAM) is a rare and benign invasive mesenchymal stromal tumor predominantly in women at reproductive age. AAM tends to relapse locally and should be differentially diagnosed from other mesenchymal tumors.

Patient concerns:
We report here a rare case of massive vulvar AAM in a 22-year-old Chinese woman with left labia majora mass with ulcer.

Diagnoses:
The diagnosis “aggressive angiomyxoma of vulva” was based on clinicopathologic and immunohistochemical features.

Interventions:
A surgery with local excision of the mass was performed.

Outcomes:
The patient was discharged 12 days after the surgery. There was no AAM recurrence or metastasis in a period of 12-month follow-up.

Lessons:
The vulvar AAM is a benign and aggressive mesenchymal tumor. In this case, we present the diagnosis, treatment, and prognosis for vulvar AAM. The tumor was removed completely by the surgery, but a long-term follow-up is requisite for surveilling on recurrence.
Neuroacanthocytosis with unusual clinical features
Authors: Zhu Hui , Feng Xue-min , Zhao Teng , Liu Jing-yao 
Published: January 2019

Abstract

Rationale:
Neuroacanthocytosis (NA) is a heterogeneous group of inherited neurodegenerative disorders characterized by misshapen spiculated erythorcytes and symptoms that resemble Huntington's disease.

Patient concerns:
A 59-year-old female who developed hyperkinetic involuntary movements that became progressively more obvious during the course of a year.

Diagnoses:
Acanthocytes were observed in a peripheral blood smear. The patient had elevated levels of serum creatine kinase (CK). Gene sequencing did not reveal a genetic mutation.

Interventions:
The patient was administered oral tiapride, alprazolam, B1 and B12 Vitamins.

Outcomes:
After 2 months of treatment the patient's symptoms were obviously alleviated. At the 6 month follow-up, the patient could feed herself and walk without assistance.

Lessons:
The NA syndrome is extremely rare. It may be identified in the clinic based on abnormal orofacial movement, chorea, cognitive decline, elevated CK levels, and acanthocytosis. If available, protein- or genetic-based testing may provide a confirmatory diagnosis.
A randomized controlled trial of neuromuscular electrical stimulation for chronic urinary retention following traumatic brain injury
Authors: Zhang Yong-bing , Cheng Yan-na 
Published: January 2019

AbstractBackground:This study aimed to evaluate the effectiveness of neuromuscular electrical stimulation (NMES) therapy for chronic urinary retention (CUR) following traumatic brain injury (TBI).Methods:This 2-arm randomized controlled trial (RCT) enrolled 86 eligible patients with CUR following TBI. All included patients were randomly allocated to a treatment group (n = 43) or a sham group (n = 43). The administration of NMES or sham NMES, as intervention, was performed for an 8-week period treatment, and 4-week period follow-up. In addition, all subjects were required to undergo indwelling urinary catheter throughout the study period. The primary outcome was assessed by the post-voiding residual urine volume (PV-VRU). The secondary outcomes were evaluated by the voided volume, maximum urinary flow rate (Qmax), and quality of life, as assessed by Barthel Index (BI) scale. In addition, adverse events were also recorded during the study period. All primary and secondary outcomes were measured at baseline, at the end of 8-week treatment, and 4-week follow-up.Results:At the end of 8-week treatment, the patients in the treatment group did not achieve better outcomes in PV-VRU (P = .66), voided volume (P = .59), Qmax(P = .53), and BI scores (P = .67), than patients in the control group. At the end of 4-week follow-up, there were also no significant differences regarding the PV-VRU (P = .42), voided volume (P = .71), Qmax(P = .24), and BI scores (P = .75) between 2 groups. No adverse events occurred in either group.Conclusions:In summary, the findings of this study showed that NMES therapy may not benefit patients with CUR following TBI.
D-hole breakage of 2 angular stable locking plates for medial opening-wedge high tibial osteotomy
Authors: Nha Kyung-Wook , Jung Woon-Hwa , Koh Young-Gon , Shin Young-Soo 
Published: January 2019

Abstract
An adequate stable fixation implant should be used for medial opening-wedge high tibial osteotomy (MOWHTO) to promote rapid bone healing without complications. To date, the highest fixation stability has been observed for angular stable locking plates. However, there is still little medical literature regarding breakage of these plates. The purpose of the present study was to report the results of plate breakage around D-hole with the use of both types of locking plate fixation for MOWHTO.
Medical records of 12 patients who experienced plate breakage after MOWHTO with either a TomoFix or OhtoFix plate between August 2013 and August 2016 were retrospectively reviewed.
A total of 12 patients (7 males and 5 females) who experienced plate breakage at the screw hole just above the osteotomy were evaluated (age, 63 ± 8 years; body mass index (BMI), 28 ± 2 kg/m2; opening gap height, 12 ± 2 mm). There were 9 patients (75%) with plate breakage and loss of correction necessitating revision surgery, and 11 patients (92%) had lateral cortical hinge fractures postoperatively. Of the 9 patients with loss of correction necessitating revision surgery, 4 had a TomoFix plate and 5 had an OhtoFix plate. The only statistically significant association with broken plates lost reduction was the presence of lateral cortical hinge fractures (P = .003), but there was no significant association with age, gender, BMI, diabetes, smoking, plate type, opening gap height, and material used to fill the wedge. In addition, mean knee society score in the 12 patients was significantly higher postoperatively than preoperatively (P < .001).
Since the amount of plate breakage was just over 1% and with only 12 in total, no true conclusion can be made with certainty. However, in the face of no lateral hinge or cortical disruption, there is a 99% success rate with the plate described. If the lateral hinge is disrupted, a restriction of activity or weight bearing may be needed.