bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subjektiv erlebte Arbeitsbelastung in der Weiterbildung Allgemeinmedizin und Anforderungen an ein Kompetenzzentrum – eine Querschnittsstudie aus Sachsen-Anhalt
Authors: Köhler Sophie , Heise Marcus , Abendroth Jens , Sommer Susanne , Frese Thomas 
Published: August 2019

Zusammenfassung
Ziel der Studie Das Erwartungsbild von ÄrztInnen in Weiterbildung (ÄiW) an Kompetenzzentren ist in Teilen noch unklar. Vergangene Studien zeigten, dass sich hohe Arbeitsbelastung und Stressempfinden negativ auf die psychische Gesundheit auswirken und junge ÄrztInnen ab dem Berufseinstieg begleiten. Gibt es bei ÄiW im Fach Allgemeinmedizin Unterschiede im subjektiven Arbeitsbelastungsempfinden im stationären und ambulanten Bereich? Wie wirkt sich eine hohe subjektive Arbeitsbelastung auf Bedürfnisse/Wünsche der ÄiW an die Kompetenzzentren aus?
Methodik Design: Querschnittserhebung März - Juni 2017 in Sachsen-Anhalt, Stichprobe: alle bei der KOSTA registrierte ÄiWs (n=221) Messinstrument: Selbst entwickelter Fragebogen (Wünsche an ein Kompetenzzentrum, Soziodemographie, Weiterbildungsbiografie, Evaluation bisheriger Weiterbildung im ambulanten und stationären Bereich, Fragebogen zur Erfassung beruflicher Gratifikationskrisen (ERI).
Ergebnisse Insgesamt gingen 73 Antworten der ÄiWs ein (33,0%). Alle 73 Antworten wurden in der Analyse berücksichtigt. Auf einem Mittelwertindex von 1 (minimale Stressverausgabung) bis 4 (maximale Stressverausgabung) wurde eine höhere Arbeitsbelastung im stationären Weiterbildungssektor (MW stationär: 2,8 vs. ambulant: 2,1; p<0,01) angegeben. Die subjektive Arbeitsbelastung stieg signifikant mit dem Ausmaß der geleisteten Überstunden an (stationär: η²=18,3%, p=0,02; ambulant: η²=28,3%, p<0,01). Überdurchschnittlich Belastete äußerten tendenziell häufiger Bedarf nach lückenloser Weiterbildungsplanung (Prozentsatzdifferenz d%=0,31), nach Betreuung durch einen Mentor (d%=0,15) und informellem Austausch mit KollegInnen (d%=0,19). Das durch die ÄiWs empfundene Belastungsniveau erwies sich dagegen als unabhängig von personenbezogenen und demografischen Merkmalen.
Schlussfolgerung Der Betreuungsbedarf von ÄiW durch Weiterbildungsmanager und Mentoren wird durch ein erhöhtes Belastungsniveau gesteigert. Dies muss bedacht werden, um für jeden ÄiW einen individuellen Beratungsansatz bieten zu können.
Angsterkrankungen und Therapieresistenz
Authors: Zwanzger Peter , Diemer Julia 
Published: August 2019

ZUSAMMENFASSUNGEpidemiologischen Studien zufolge gehören Angsterkrankungen zu den häufigsten seelischen Störungen. Dabei stellen insbesondere diejenigen Verläufe die größte Herausforderung dar, die anamnestisch bereits zahlreiche erfolglose Behandlungsversuche aufweisen. Die in Anlehnung an die Depressionsbehandlung als therapieresistente Angsterkrankungen bezeichnete Gruppe von Störungen ist im Hinblick auf therapeutische Ansätze weit weniger untersucht als die therapieresistente Depression. Im Rahmen der Übersicht werden Studien zur Behandlung therapieresistenter Angsterkrankungen referiert. Der Fokus liegt dabei auf der Panikstörung, der generalisierten Angststörung sowie der sozialen Phobie. Die Behandlungsansätze umfassen pharmakologische Ansätze mit atypischen Antipsychotika und Antikonvulsiva, Kombinationstherapien, den psychotherapeutischen Ansatz der Acceptance and Commitment Therapy (ACT) sowie den experimentell pharmakologischen Einsatz von D-Cycloserin (DCS). Auf die Problematik von Pseudotherapieresistenz und die Notwendigkeit einer sorgfältigen Diagnostik und Differenzialdiagnostik wird ebenso eingegangen.
Malignant Extra-Gastrointestinal Stromal Tumor of the Mesentery
Authors: Sasmal Prakash K. , Sharma Rakesh , Patra Susama , Mishra Tushar S. , Mishra Pritinanda , Rout Bikram 
Published: August 2019

Gastrointestinal stromal tumors (GISTs), the commonest mesenchymal tumors of gastrointestinal tract are often described to take origin from the interstitial cells of Cajal (ICC) or its precursor cells. Rarely these tumors do arise in structures other than the alimentary tract like omentum, mesentery, retroperitoneum, etc., of varying malignant potential and are known as extra-gastrointestinal stromal tumors (eGISTs).This is a case report of a 70-year-old female with multicentric malignant eGISTs arising in the mesentery of ileum. On laparotomy, a large mass of 20 × 15 cm was found in the small bowel mesentery without involvement of the adjacent ileum, with multiple other small nodules resembling lymph nodes, present adjacent to it. Histopathological study of the excised lump, confirmed the mass to be malignant eGIST without involvement of the adjacent ileum, with cluster differentiation (CD)117 positive and of high-risk stratification. The mesenteric nodule was confirmed on histopathology to be malignant eGIST, similar to that of that of the primary, without any lymphoid tissue. Adjuvant imatinib mesylate treatment was started immediately postoperation with the patient doing well at 1 year of follow-up. We report this case, due to the rare occurrence of multifocal malignant eGISTS of small bowel mesentery, which is yet to be reported. The existing literature is unclear regarding the clinicopathology and management of multifocal malignant stromal tumors of the mesentery.
Massive Pulmonary Embolism after a Short Episode of Physical Restraint in an Adolescent Psychiatric Patient
Authors: Leibold Alexander , Melter Michael , Doerfler Christian , Alikadic Samra , Zimmermann Markus , Hanses Frank , Zant Robert 
Published: August 2019

AbstractMedical restraints, when used for short periods of time, can pose additional risk for deep vein thrombosis in adolescent psychiatric patients. The problem is often unrecognized, and there is a lack of awareness of this potential risk. However, as associated major adverse events may result in fatal outcomes, an individual patient's risk for deep vein thrombosis should be assessed and prophylactic anticoagulation may be indicated.
Reliability and Construct Validity of 3 Psychometric Trust Scales for Women Seeking Substance Abuse Treatment in a Community Setting
Authors: Cockroft Joshua D. , Adams Susie M. , Matlock Deondria , Dietrich Mary S. 
Published: August 2019

Background: Women with a history of substance use disorder (SUD) constitute a unique population with gender-specific needs in treatment. Most notable is high rates of prior trauma and the need for a trauma-informed care framework. Given theoretical links between trauma and interpersonal trust, understanding quantitatively how trust may impact outcomes for women in this population requires confirmation of validity of existing psychometric instruments. Objective: This study sought to confirm reliability and construct validity of the Rotter Interpersonal Trust Scale, Wake Forest Trust in Physician Scale, and the Revised Health Care System Distrust Scale (RHCSDS) for use in women with a history of SUD seeking treatment in a community-based setting. Methods: A total of 301 participants were enrolled between August 2017 and March 2018 at an urban, community-based residential substance abuse treatment program in the mid-South. Participants were given an electronic survey containing questions about demographics/clinical characteristics, the Rotter, Wake Forest, and RHCSDS scales, Socially Desirable Response Five-Item Survey (SDRS-5), and the Adverse Childhood Experiences (ACEs) questionnaire. All participants also completed a modified protocol of the “Trust Game.” Statistical analysis was completed for each trust scale in regard to scale means and distribution, internal consistency, interscale correlation, and scale correlation to the ACE score. Results: Results confirm statistically significant ( P < .001) differences in global trust and trust of health care providers compared with general population samples in prior studies. Internal consistency of scales is comparable to reliability testing in prior studies (α > .70 for all scales). Interscale correlation between individual scales is statistically significant, with the strongest relationship between the 2 health care–specific scales ( r = −.740, P < .001). There was a weak, negative correlation between the ACE score and interpersonal trust ( r = −.135, P = .019). Individual scales do not have statistically significant correlation with “Trust Game” scores. Discussion: Findings suggest reliability and construct validity of scales for use in this population.
The soil displacement measurement of mercury emission flux of the sewage irrigation farmlands in Northern China
Authors: Gao Yu , Wang Zhangwei , Wang Chunjie , Zhang Xiaoshan 
Published: August 2019

ABSTRACT
Mercury fate of sewage irrigation in farmlands deserves attention with increasing scarcity of freshwater resources for agriculture in the worldwide. Soil-air total gaseous mercury (TGM) fluxes from four-sewage and one-fresh water irrigated farmlands were determined simultaneously. During maize-wheat rotation, soil-air TGM fluxes showed patterns of both emission and deposition during different growth stages. It enhanced one-order of magnitude emission with increased Hg contamination from historical sewage irrigation. A linear response relationship of TGM fluxes with soil Hg concentration was found, which showed greater TGM emission potential comparing with those from forest and urban soils. However, the ratio of soil-air TGM flux in daytime to nighttime were 3.94 in maize-season and 3.41 in wheat-season, respectively, which were little related to the change in soil Hg concentration. Furthermore, soil temperature and moisture, ambient-air TGM concentration all effected TGM evasion from sewage-irrigated soils. The data presented here suggest that evasion of TGM from historical sewage irrigation farmlands with high Hg concentrations may be potential hotspots for Hg emission in atmosphere, and it was likely to underestimate Hg emissions from farmlands in existing emissions inventory. Additional regional-investigations and process-level researches are needed to better understand role of sewage irrigation farmlands in local-global Hg-biogeochemical-cycles.
Immunofluorescence and image analysis pipeline for Drosophila motor neurons
Authors: Brown Jeremy R , Phongthachit Chanpasith , Sulkowski Mikolaj J 
Published: August 2019

Abstract
The neuromuscular junction (NMJ) of larval Drosophila is widely used as a genetic model for basic neuroscience research. The presynaptic side of the NMJ is formed by axon terminals of motor neurons, the soma of which reside in the ventral ganglion of the central nervous system (CNS). Here we describe a streamlined protocol for dissection and immunostaining of the Drosophila CNS and NMJ that allows processing of multiple genotypes within a single staining tube. We also present a computer script called Automated Image Analysis with Background Subtraction which facilitates identification of motor nuclei, quantification of pixel intensity, and background subtraction. Together, these techniques provide a pipeline for neuroscientists to compare levels of different biomolecules in motor nuclei. We conclude that these methods should be adaptable to a variety of different cell and tissue types for the improvement of efficiency, reproducibility, and throughput during data quantification.
“Trust Us, We’re You”: Aspirational Realness in the Digital Communication of Contemporary Fashion and Beauty Brands
Authors: Findlay Rosie 
Published: August 2019

AbstractIn recent years, a number of fashion and beauty brands have developed promotional content that circulates an aspirational quality imbued with unstudied “cool” around their product. Despite the appeal of this conceit to tropes of the everyday, authenticity, and belonging, it presents a superficially relatable ideal whilst exploiting digital media’s capacities to foster intimacy and promote a postfeminist subjectivity based on consumption.This article examines three brands that circulate “aspirational realness” around their product: Glossier, Reformation, and Maryam Nassir Zadeh. All remediate the conventions of prior fashion media to communicate discourses of neoliberal femininity to a media-savvy consumer. Aspirational realness is thus read as a means by which consumption is both encouraged and situated as a means of self-realization in the likeness of other aspirational “cool girls.”
Impact of an Educational Program on the Knowledge and Attitude About Pain Assessment and Management Among Critical Care Nurses
Authors: Issa Marwan Rasmi , Awajeh Adel M. , Khraisat Firas S. , Rasheed Akram M. , Amirah Mohammad F. , Hussain Ashraf , Alharthy Abdulrhman 
Published: August 2019

BackgroundPain assessment and management are imperative parts of nursing care and considered as one of the most fundamental patient rights. The role of pain management education is well established in improving knowledge and attitude among nurses.ObjectivesThis study aims to evaluate the impact of pain management educational program on the knowledge and attitudes of intensive care unit (ICU) staff nurses toward pain assessment and management. The baseline score of pain assessment and management knowledge and attitude of ICU nurses has been identified in a previous research, and the result showed immense lack of knowledge and poor attitudes among ICU nurses toward pain assessment and management when dealing with ICU patients.MethodsThis is a pretest-posttest experimental study, utilizing a self-reporting questionnaire tool to obtain information about nurses' knowledge and attitudes toward pain assessment and management after implementation of new pain management educational program for critical care nurses. Data were collected using the Knowledge and Attitudes Survey Regarding Pain tool that measures knowledge with 22 question items and measures attitude with 17 question items. Paper-based questionnaire was distributed to nurses for data collection.Results and ConclusionThe results showed significant improvement in knowledge and attitudes about pain assessment and management among ICU nurses; it was evident after delivering pain management education program. At baseline, 204 ICU nurses gave consent and completed the questionnaire and thus included in baseline measurement before implementing the intervention. In the postintervention measurement, the questionnaire was distributed to the same participants included in the baseline phase from which 181 participants completed the questionnaire for the second time, with a response rate of 89%; the deficits and preconception in pain assessment and management can be improved through implementing pain management educational programs.
The Prevalence of Bacteria, Fungi, Viruses, and Acanthamoeba From 3,004 Cases of Keratitis, Endophthalmitis, and Conjunctivitis
Authors: Kowalski Regis P. , Nayyar Shannon V. , Romanowski Eric G. , Shanks Robert M.Q. , Mammen Alex , Dhaliwal Deepinder K. , Jhanji Vishal 
Published: August 2019

Purpose:
The definitive identification of ocular pathogens optimizes effective treatment. Although the types of ocular pathogens are known; there is less definitive information on the prevalence of causative infections including viruses, fungi, and protozoa, which is the focus of this retrospective laboratory review.

Methods:
Data used for laboratory certification were reviewed for the detection of bacteria, viruses, fungi, and protozoa, from patients with infectious keratitis, endophthalmitis, and conjunctivitis. The main outcome parameter was laboratory-positive ocular infection.

Results:
The distribution of infectious agents for keratitis (n=1,387) (2004–2018) was bacteria 72.1% (Staphylococcus aureus 20.3%, Pseudomonas aeruginosa 18%, Streptococcus spp. 8.5%, other gram-positives 12.4%, and other gram-negatives 12.9%), Herpes simplex virus 16%, fungi 6.7%, and Acanthamoeba 5.2%. For endophthalmitis, (n=770) (1993–2018), the bacterial distribution was coagulase-negative Staphylococcus 54%, Streptococcus spp. 21%, S. aureus 10%, other gram-positives 8%, and gram-negatives 7%. The distribution for conjunctivitis (n=847) (2004–2018) was Adenovirus 34%, S. aureus 25.5%, Streptococcus pneumoniae 9%, Haemophilus 9%, other gram-negatives 8.8%, other gram-positives 6%, coagulase-negative Staphylococcus 4.5% and Chlamydia 3.2%.

Conclusion:
An updated monitoring of ocular pathogens creates an awareness of the different infectious etiologies and the importance of laboratory studies. This information can determine treatment needs for infectious ocular diseases.
Lamellar Dissection Technique for Descemet Membrane Endothelial Keratoplasty Graft Preparation
Authors: Tan Tien-En , Devarajan Kavya , Seah Xin-Yi , Lin Shu-Jun , Peh Gary Swee Lim , Cajucom-Uy Howard Yu , Ang Marcus Han Nian , Tan Donald Tiang Hwee 
Published: August 2019

Purpose:
To describe a novel lamellar dissection technique for Descemet membrane endothelial keratoplasty (DMEK) graft preparation, and to evaluate the rate of endothelial cell loss (ECL) and graft preparation failure associated with this technique.

Methods:
We conducted an ex vivo laboratory-based study comparing ECL between the lamellar dissection and peeling techniques. Eight pairs of human donor corneas underwent calcein acetoxymethyl staining—all right eyes underwent the peeling technique and all left eyes underwent the lamellar dissection technique. ECL was quantified by image analysis with trainable segmentation software and compared between groups. We also conducted a retrospective analysis of 161 consecutive DMEK graft preparations by a single surgeon using the lamellar dissection technique from 2010 to 2018. Data on donor characteristics and graft preparation failures were obtained.

Results:
Baseline donor characteristics were comparable in both arms of the laboratory-based study. Mean (SD) ECL with the lamellar dissection and peeling techniques was 13.8% (4.2%) and 11.2% (6.1%), respectively. There was no significant difference between the two (P = 0.327). In the clinical series, there were 2 graft preparation failures in 161 cases (1.2%). Among cases performed on diabetic donor tissue, the rate of graft preparation failure was 4.7%.

Conclusions:
The lamellar dissection technique has a similar rate of ECL compared with the peeling technique for DMEK graft preparation. This technique also has a low rate of graft preparation failure and may be a useful technique for diabetic donor tissue.
Educational interventions for primary care providers to improve clinical skin examination for skin cancer
Authors: Stratton Delaney B. , Loescher Lois J. 
Published: August 2019

ABSTRACT

Background and Purpose:
Skin cancer, the most commonly diagnosed cancer in the United States, is a serious health care concern. Early skin cancer detection improves prognosis; most common early detection approach is a comprehensive clinical skin examination (CSE). A CSE consists of skin cancer risk assessment, head-to-toe skin examination, and skin lesion assessment. Nurse practitioners (NPs) currently lack adequate training and confidence to conduct CSE. The goal of this systematic review was to learn more about published interventions targeting CSE training for primary care NPs and/or other primary care providers. The findings were categorized based on the established procedures for intervention development.

Methods:
The databases PubMed, Google Scholar, CINAHL, and Web of Science were searched. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 10 articles were selected for data extraction.

Conclusions:
There is a paucity of articles that report rigorously developed interventions aimed at educating primary care NPs to conduct CSE. Existing CSE interventions were not tested for efficacy or effectiveness, and the implementation methods were weak or not reported. A synthesis of the review findings revealed inadequately reported sample characteristics, vague intervention goals, unspecified frequency or duration of interventions, and lack of standardized intervention protocols.

Implications for practice:
This review builds a foundation for more rigorously developed interventions to improve CSE and provides guidance for NPs to select education on CSE and other clinical foci. Future research will guide the development and evaluate the effectiveness of CSE education, which ultimately could improve skin cancer prognosis interventions and lack of standardized intervention protocols.
A potentially deadly influenza mimic
Authors: Koch Julie A. 
Published: August 2019

ABSTRACT
This case challenge presents a rare but potentially fatal condition initially mistaken for influenza. Prodromic manifestations are not uncommon at the time of diagnosis or in the preceding days in this idiopathic condition. Untreated, mortality rates are extremely high, but initiation of appropriate therapy has significantly improved survival. Pathophysiology, symptomatology, diagnostics, and treatment are detailed as the case study unfolds.
It takes a village: primary care of the pediatric liver transplant recipient
Authors: Hassan Sara , Ng Vicky Lee , Aqul Amal 
Published: August 2019

Purpose of review
Long-term survival is now the rule rather than the exception for infants and children who undergo liver transplantation for end-stage liver disease, metabolic liver conditions and a variety of other indications. Pediatricians and primary care providers play vital roles in the care and management of this patient population. The purpose of this review is to highlight key aspects important to the care of the pediatric liver transplant recipient.

Recent findings
Significant advances in immunosuppressive therapies and surgical techniques have contributed to improved graft and patient survival rates, shifting the focus beyond immediate survival to strategies to minimize comorbidities related to long-term immunosuppression during growing years, attend to patient and parent-reported outcomes and enhance quality of life. A multidisciplinary approach allows for monitoring and surveillance of both routine (growth, nutritional rehabilitation, cognitive development, mental and psychosocial health, contraception and daily activities) and transplant-related (adverse effects of immunosuppression, susceptible infections, extra-hepatic systems, transition from childhood to adolescence to adulthood) themes.

Summary
Effective communication between the primary care physician and the transplant team is imperative for optimizing best outcomes. The primary care provider should be aware of the multifacet nature of posttransplant management, which includes medication regimens, common complications and infections.
Essential Nursing Care Management and Coordination Roles and Responsibilities
Authors: Luther Brenda , Barra Joyce , Martial Marc-Aurel 
Published: August 2019

Background:
Care management roles and responsibilities are frequently called out in leading white papers and exemplars; yet, the actual roles and responsibilities are poorly defined.

Method:
A qualitative content analysis using 6 landmark white papers and exemplars from national organizations to collect emerging care management and coordination roles and responsibilities.

Results:
Three major themes emerged from the content analysis: (1) care management is about complex systems and complex medical and social needs, (2) nurses are central to the interdisciplinary team, and (3) informatics is vital to support and enhance care management.

Implications for Practice:
Care managers need to be experienced with complex systems of care as well as complex diagnoses and conditions that our clients and their caregiver's experience. A nurse being central to the clients and embedded within the interdisciplinary team aids in diminishing the burden of negotiating the trajectory of a condition/illness as well as improves the interdisciplinary communication and teamwork. This review of literature has defined the complexity of care management and the discreet roles and responsibilities, as well as how informatics is vital for care managers to target and monitor key populations needing care management.