bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time to Reevaluate the Away Rotation: Improving Return on Investment for Students and Schools
Authors: Griffith Max , DeMasi Stephanie C. , McGrath Abigail J. , Love Jeffrey N. , Moll Joel , Santen Sally A. 
Published: November 2018

Away rotations are common among senior medical students preparing to apply for residency. For competitive specialties, multiple away rotations may be viewed as a de facto requirement for a strong application. Although away rotations are often valuable learning experiences, a variety of noneducational factors motivate students to enroll, including the need for letters of recommendation, students’ uncertainty regarding their strength as applicants, perceived competitiveness of residency applications, and conflicting guidance from advisors.
Students who enroll in away rotations often benefit from a novel educational environment, opportunities for career exploration, and the chance to assess “fit” with a program. Yet away rotations also come at a significant cost. Students must deal with the time and expenses of rotating at multiple institutions. The application process for away rotations is expensive, disjointed, and inefficient. Students must work hard to make an impression on host institution faculty, and risk hurting their residency applications with a negative letter of recommendation.
To reduce the burden of away rotations, future research should assess the impact of multiple away rotations on success in the Match. Allowing students limited access to letters of recommendation content would allow students and advisors to make informed decisions regarding additional rotations. Students would benefit from greater standardization of the application process for away rotations, with uniform dates, timely acceptances and rejections, and a cap for the number of applications per student. Students can maximize their returns by targeting away rotations that provide the most diverse educational experiences and valuable letters of recommendation.
Validity Evidence for a Brief Online Key Features Examination in the Internal Medicine Clerkship
Authors: Lang Valerie J. , Berman Norman B. , Bronander Kirk , Harrell Heather , Hingle Susan , Holthouser Amy , Leizman Debra , Packer Clifford D. , Park Yoon Soo , Vu T. Robert , Yudkowsky Rachel , Monteiro Sandra , Bordage Georges 
Published: November 2018

Purpose
Medical educators use key features examinations (KFEs) to assess clinical decision making in many countries, but not in U.S. medical schools. The authors developed an online KFE to assess third-year medical students’ decision-making abilities during internal medicine (IM) clerkships in the United States. They used Messick’s unified validity framework to gather validity evidence regarding response process, internal structure, and relationship to other variables.

Method
From February 2012 through January 2013, 759 students (at eight U.S. medical schools) had 75 minutes to complete one of four KFE forms during their IM clerkship. They also completed a survey regarding their experiences. The authors performed item analyses and generalizability studies, comparing KFE scores with prior clinical experience and National Board of Medical Examiners Subject Examination (NBME-SE) scores.

Results
Five hundred fifteen (67.9%) students consented to participate. Across KFE forms, mean scores ranged from 54.6% to 60.3% (standard deviation 8.4–9.6%), and Phi-coefficients ranged from 0.36 to 0.52. Adding five cases to the most reliable form would increase the Phi-coefficient to 0.59. Removing the least discriminating case from the two most reliable forms would increase the alpha coefficient to, respectively, 0.58 and 0.57. The main source of variance came from the interaction of students (nested in schools) and cases. Correlation between KFE and NBME-SE scores ranged from 0.24 to 0.47 (P < .01).

Conclusions
These results provide strong evidence for response-process and relationship-to-other-variables validity and moderate internal structure validity for using a KFE to complement other assessments in U.S. IM clerkships.
A Philosophical Approach to Addressing Uncertainty in Medical Education
Authors: Tonelli Mark R. , Upshur Ross E.G. 
Published: November 2018

Conveying the uncertainty inherent in clinical practice has rightly become a focus of medical training. To date, much of the emphasis aims to encourage trainees to acknowledge and accept uncertainty. Intolerance of uncertainty is associated with medical student distress and a tendency in clinicians toward overtreatment. The authors argue that a deeper, philosophical understanding of the nature of uncertainty would allow students and clinicians to move beyond simple acceptance to explicating and mitigating uncertainty in practice.
Uncertainty in clinical medicine can be categorized philosophically as moral, metaphysical, and epistemic uncertainty. Philosophers of medicine—in a way analogous to ethicists a half century ago—can be brought into medical education and medical practice to help students and physicians explore the epistemic and metaphysical roots of clinical uncertainty. Such an approach does not require medical students to master philosophy and should not involve adding new course work to an already-crowded medical curriculum. Rather, the goal is to provide students with the language and reasoning skills to recognize, evaluate, and mitigate uncertainty as it arises. The authors suggest ways in which philosophical concepts can be introduced in a practical fashion into a variety of currently existing educational formats. Bringing the philosophy of medicine into medical education promises not only to improve the training of physicians but, ultimately, to lead to more mindful clinical practice, to the benefit of physicians and patients alike.
Surgical and Health-related Quality-of-Life Outcomes of Growing Rod “Graduates” With Severe versus Moderate Early-onset Scoliosis
Authors: Helenius Ilkka J. , Sponseller Paul D. , McClung Anna , Pawelek Jeff B. , Yazici Muharrem , Emans John B. , Thompson George H. , Johnston Charles E. , Shah Suken A. , Akbarnia Behrooz A. 
Published: November 2018

Study Design.
A retrospective review of a prospective, multicenter database.

Objective.
The aim of this study was to compare surgical and quality-of-life outcomes at the end of growing rod treatment in patients with severe versus moderate early-onset scoliosis (EOS).

Summary of Background Data.
Knowledge of the outcomes of severe EOS after growth-friendly treatment is limited because this condition is uncommon.

Methods.
We identified 40 children with severe EOS (major curve ≥90°) treated with growing rods before age 10 with minimum 2-year follow-up after last lengthening or final fusion. From the same registry, we matched 40 patients with moderate EOS (major curve < 90°). Twenty-seven patients in the severe group and 12 in the moderate group underwent final fusion (P < 0.001).

Results.
Mean preoperative curves were 102° (range, 90°–139°) in the severe group and 63° (range, 33°–88°) in the moderate group (P < 0.001). At final follow-up, mean curves were 56° (range, 10°–91°) and 36° (range, 12°–89°), respectively (P < 0.001). Fourteen (35%) children in the severe group and 32 (80%) in the moderate group had scoliosis of < 45° at final follow-up [risk ratio (RR), 0.44; 95% confidence interval (95% CI), 0.20–0.57]. At final follow-up, 30 (75%) children in the severe group and 35 (88%) in the moderate group had achieved T1-T12 length of ≥18 cm (RR, 0.86; 95% CI, 0.70–1.09). Thirty-five children in the severe group and 26 in the moderate group had at least one complication (RR, 1.35; 95% CI, 1.05–1.73). Mean 24-Item Early-Onset Scoliosis Questionnaire scores were similar between groups at final follow-up.

Conclusion.
Delaying surgery until the major curve has progressed beyond 90° is associated with larger residual deformity and more complications than treating at a lesser curve magnitude. Quality-of-life outcomes were similar between those with severe and moderate EOS.

Level of Evidence: 3
An Evaluation of the Influence of Body Mass Index on Severity Scoring*
Authors: Deliberato Rodrigo Octavio , Serpa Neto Ary , Komorowski Matthieu , Stone David J. , Ko Stephanie Q , Bulgarelli Lucas , Rodrigues Ponzoni Carolina , de Freitas Chaves Renato Carneiro , Celi Leo Anthony , Johnson Alistair E. W. 
Published: November 2018

Objectives:
Although one third or more of critically ill patients in the United States are obese, obesity is not incorporated as a contributing factor in any of the commonly used severity of illness scores. We hypothesize that selected severity of illness scores would perform differently if body mass index categorization was incorporated and that the performance of these score models would improve after consideration of body mass index as an additional model feature.

Design:
Retrospective cohort analysis from a multicenter ICU database which contains deidentified data for more than 200,000 ICU admissions from 208 distinct ICUs across the United States between 2014 and 2015.

Setting:
First ICU admission of patients with documented height and weight.

Patients:
One-hundred eight-thousand four-hundred two patients from 189 different ICUs across United States were included in the analyses, of whom 4,661 (4%) were classified as underweight, 32,134 (30%) as normal weight, 32,278 (30%) as overweight, 30,259 (28%) as obese, and 9,070 (8%) as morbidly obese.

Interventions:
None.

Measurements and Main Results:
To assess the effect of adding body mass index as a risk adjustment element to the Acute Physiology and Chronic Health Evaluation IV and Oxford Acute Severity of Illness scoring systems, we examined the impact of this addition on both discrimination and calibration. We performed three assessments based upon 1) the original scoring systems, 2) a recalibrated version of the systems, and 3) a recalibrated version incorporating body mass index as a covariate. We also performed a subgroup analysis in groups defined using World Health Organization guidelines for obesity. Incorporating body mass index into the models provided a minor improvement in both discrimination and calibration. In a subgroup analysis, model discrimination was higher in groups with higher body mass index, but calibration worsened.

Conclusions:
The performance of ICU prognostic models utilizing body mass index category as a scoring element was inconsistent across body mass index categories. Overall, adding body mass index as a risk adjustment variable led only to a minor improvement in scoring system performance.
Trends in Pediatric Emergency Department Utilization for Mild Traumatic Brain Injury Before and After Legislation
Authors: Singichetti Bhavna , Leonard Julie C. , Janezic Alyssa R. , Li Hongmei , Yi Honggang , Yang Jingzhen 
Published: November 2018

Objective:
To examine the effect of state youth traumatic brain injury (TBI) legislation on pediatric emergency department (ED) utilization for sports and recreation-related mild TBIs (mTBIs).

Participants:
ED visits by children ages 5 to 18 years between 2006 and 2014 in the Pediatric Health Information System database (N = 452 900).

Design:
Retrospective analysis.

Main Measures:
Rates of ED visits, and injury comparison groups (mTBI, moderate to severe TBI, minor head injury, and long bone fracture).

Results:
Of the 452 900 ED visits, 123 192 (27.2%) were for mTBI, along with visits for moderate to severe TBIs (n = 5190), minor head injuries (n = 54 566), and long bone fractures (n = 269 952). ED visits for mTBIs were more common among males (67.5%), children ages 10-14 years (42.1%), and the privately insured (50.6%). The proportion of mTBI ED visits increased significantly, particularly from 5 years prelegislation to immediately postlegislation (57.8 to 94.8 mTBI visits per 10 000 ED visits). A similar trend was observed for minor head injuries; however, no significant changes were observed for moderate to severe TBIs and long bone fractures.

Conclusion:
Pediatric ED utilization trends for the injury comparison groups differed from each other, and from pre- and post-TBI legislation. Further research assessing effects of TBI legislation on healthcare utilization is warranted.
MANAGEMENT OF NEOVASCULAR OCULAR HISTOPLASMOSIS
Authors: Blinder Kevin J. 
Published: November 2018

Purpose:
To review the wide variety of treatment modalities available for choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome.

Methods:
A literature search was performed to review the multitude of studies conducted to investigate the efficacy and safety of treatment modalities available for choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome.

Results:
Each treatment modality is reviewed, with the studies summarized and presented to support or refute the method of treatment. Two case reports are presented to demonstrate the treatment regimens.

Conclusion:
This is a comprehensive review of the treatment modalities available to address choroidal neovascularization secondary to the presumed ocular histoplasmosis syndrome. Investigators will continue to strive toward higher efficacy and safety with future innovations in the field.
CHOROIDAL NEOVASCULARIZATION IN NORTH CAROLINA MACULAR DYSTROPHY RESPONSIVE TO ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY
Authors: Bakall Benjamin , Bryan J. Shepard , Stone Edwin M. , Small Kent W. 
Published: November 2018

Purpose:
To report a new family with North Carolina macular dystrophy including a patient with choroidal neovascularization (CNV).

Methods:
Diagnostic modalities included fundus imaging, fluorescein angiography, optical coherence tomography, and genetic testing. The CNV was treated with intravitreal anti–vascular endothelial growth factor according to a treat-and-extend protocol in both eyes.

Results:
A 60-year-old man presented with North Carolina macular dystrophy with decreasing vision in the left eye and persistently deceased central vision in the right eye. Optical coherence tomography examination showed intraretinal and subretinal fluid consistent with CNV. Genetic testing was performed. Examination of family members showed no signs of CNV. The visual acuity improved from 20/400 to 20/150 in the right eye and from 20/100 to 20/40 in the left eye after intravitreal bevacizumab treatment for CNV. Molecular analysis of the PRDM13 gene revealed a pathogenic heterozygous point mutation.

Conclusion:
Recognition and treatment of CNV in North Carolina macular dystrophy can result in improved vision. Genetic testing of the PRDM13 gene can confirm a molecular diagnosis for North Carolina macular dystrophy.
Development and Long-Term Evaluation of Ocular Surface Conditions Using Ovariectomized Cynomolgus Monkey
Authors: Li Chang , Zhang Xiaofeng , Wang Yun , Li Mengmeng 
Published: November 2018

Objectives:
We aim to use the ovariectomized cynomolgus monkey to observe the effect of long-term changes of sex hormone levels on ocular surface.

Methods:
Six healthy adolescent cynomolgus monkeys were randomly assigned to control and experimental groups (n=3/group). Bilateral ovariectomy was performed in experimental group, and sham operation was performed on control animals with their ovaries reserved. The concentrations of serum estradiol and testosterone in cynomolgus monkeys' lower-limb venous were detected by radioimmunoassay before surgery, and at 6, 12, 18, and 24 months after the surgery. Phenol red cotton thread test, tear osmolarity, corneal fluorescein staining, and conjunctival impression cytology were performed to evaluate the ocular surface conditions before surgery, and at 6, 12, 18, and 24 months after the surgery. The histological examinations of the bulbar conjunctiva and labial glands tissues were performed at 12 and 24 months after the surgery.

Results:
There were no significant differences in the serum level of estradiol and testosterone between the experimental and control groups before surgery, at 6, and 12 months after surgery (P>0.05). Serum level of estradiol and testosterone were significantly less in experimental versus control group at 18 and 24 months after surgery (P<0.05). There was no significant differences in phenol red cotton between the experimental and control groups before surgery, at 6, 12, 18, and 24 months after surgery (P>0.05). Tear osmolarity had no significant differences between experimental and control group before surgery (P>0.05), and it was significantly higher in experimental versus control group at all four time-points after surgery (P<0.05). The number of conjunctival goblet cells had no significant differences between experimental and control group before surgery, at 6 months after surgery (P>0.05), and it was significantly lower in experimental versus control group at 12, 18, and 24 months after surgery (P<0.05). There were no significant differences in the corneal fluorescein staining score between the experimental and control groups before surgery, at 6, 12, and 18 months after surgery (P>0.05), and it was higher in experimental than control group at 24 months after surgery (P<0.05). In addition, inflammatory cell infiltration in bulbar conjunctiva and labial glands tissues was observed in experimental group and was unobserved in control group at 24 months after surgery.

Conclusions:
Ovariectomy led to decreased sex hormone levels in cynomolgus monkey. In turn, tear osmolarity was increased, the number of conjunctival goblet cells were decreased, the corneal fluorescence staining was increased, and the pathological examination of the bulbar conjunctiva and labial glands tissues were abnormal, phenol red cotton thread test did not change significantly.
Predictors of Perinatal HIV Transmission Among Women Without Prior Antiretroviral Therapy in a Resource-Limited Setting
Authors: Ewing Alexander C. , Ellington Sascha R. , Wiener Jeffrey B. , Chasela Charles S. , Tegha Gerald , Nelson Julie A. E. , Jamieson Denise J. , van der Horst Charles , Kourtis Athena P. 
Published: November 2018

Background:
To investigate potential risk factors for perinatal (intrauterine and intrapartum) mother-to-child transmission (MTCT) of HIV in women unexposed to antiretroviral therapy (ART) during pregnancy.

Methods:
We compared factors according to perinatal MTCT outcome among 2275 ART-naive (until the onset of labor) HIV-infected women in the Breastfeeding, Antiretrovirals and Nutrition study (2004–2010) in Lilongwe, Malawi. Factors included HIV viral load during pregnancy, food security, demographic characteristics, hematologic and blood chemistry measures, medical history and physical factors. Associations with perinatal MTCT and interactions with maternal viral load were assessed using simple and multivariable logistic regression.

Results:
There were 119 (115 intrauterine and 4 intrapartum) cases of perinatal MTCT, only one to a mother with <1000 HIV copies/mL. Maternal viral loads >10,000 copies/mL were common (63.1%). Lower maternal viral load (<1000 copies/mL and 1000.1–10,000 copies/mL) was associated with reduced odds of perinatal MTCT [adjusted odds ratio (aOR), 0.1; 95% confidence interval (CI): 0.01–0.4 and aOR, 0.2; 95% CI: 0.1–0.4, respectively), compared with maternal viral load >10,000 copies/mL. Low CD4+ T cell count (≤350 cells/μL) was only associated with perinatal MTCT in unadjusted models. Food shortage (aOR, 1.8; 95% CI: 1.2–2.6), sexually transmitted infection (STI) (past year; aOR, 1.9; 95% CI: 1.0–3.7), histories of herpes zoster (aOR, 3.0; 95% CI: 1.6–5.6) and tuberculosis (aOR, 2.5; 95% CI: 1.1–5.7) were associated with increased odds of perinatal MTCT.

Conclusions:
These findings confirm that lowering maternal HIV viral load is most important in preventing perinatal MTCT and support efforts to address food shortage, STI and tuberculosis prevention, while informing programs to improve ART coverage in pregnancy.
Using a Text Mining Approach to Explore the Recording Quality of a Nursing Record System
Authors: CHANG Hsiu-Mei , HUANG Ean-Weng , HOU I-Ching , LIU Hsiu-Yun , LI Fang-Shan , CHIOU Shwu-Fen 
Published: November 2018

ABSTRACT

Background:
Most nursing records in Taiwan have been computerized, resulting in a large amount of unstructured text data. The quality of these records has rarely been discussed.

Purpose:
This study used a text mining method to analyze the quality of a nursing record system to establish an auditing model and associated tools for nursing records, with the ultimate objective of improving the quality of electronic nursing records.

Methods:
This study utilized a retrospective method to collect the electronic nursing records of 6,277 patients who had been discharged from the internal medicine departments of a medical center in northern Taiwan from January to June 2014. SAS Enterprise Guide Version 6.1 and SAS Text Miner Version 13.2 software were used to perform text mining. Nursing experts were invited to examine the electronic nursing records. The text mining results were compared against a benchmark that was developed by the experts, and the efficiency of SAS Text Miner was examined using the criteria of specificity, sensitivity, and accuracy.

Results:
In this study, 27,356 nurse-formulated events were used in the analysis. The results of the nurse-formulated events showed an 8.08% similar error with system-formulated events, 29.72% were identified as necessary and appropriate names, 17.53% were retained, 10.15% involved error event names, and 34.52% were not classified. In this study, the sensitivity of SAS text mining in the training (testing) data set was 96% (95%), and the specificity and accuracy were both 99% (99%).

Conclusions:
The results of this study show that text mining is an effective approach to auditing the quality of electronic nursing records. SAS Text Miner software was shown to identify inappropriate nursing record content quickly and efficiently. Furthermore, the results of this study may be included in in-service education teaching materials to promote the writing of better nursing records to improve the quality of electronic nursing records.
Diagnosis and treatment of migraine in the patient with depression
Authors: Cook Calli L. , Shedd Glenn C. 
Published: November 2018

ABSTRACT

Background and purpose:
Migraine headache is an enormous health care burden resulting in billions of dollars in workforce revenue lost and millions of lost workdays per year. Migraine headaches and depression are common comorbidities and require expertise in treatment and prevention.

Methods:
The aim of this article is to update the nurse practitioner (NP) on best clinical practices for managing the patient with migraine and previously diagnosed depression. This will include an overview of the pathophysiology of migraine, as well as criteria for diagnosis, treatment, prevention, and patient teaching.

Conclusions:
Migraine and depression are commonly linked and require expertise in treatment to achieve the best patient outcomes.

Implications for Practice:
Patients with migraine are more likely to have depression than the general population. Both conditions require optimal treatment and patient education to reduce overall disease burden. A better understanding of the relationship between depression and migraine will enable the NP to better manage patients with migraine and comorbid depression.