bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic Presence: Its Contribution to the Doctor-Patient Encounter
Authors: Krogh Edwin , Langer Álvaro , Schmidt Carlos 
Published: January 2019

Abstract:
In this article, we propose a model of doctor-patient encounter that integrates the concept of therapeutic presence (TP), derived from psychotherapy research, as an indispensable substrate for the benefit of the therapeutic alliance between patient and doctor. To this end, the concepts of the doctor-patient relationship and doctor-patient communication are revisited to explore their therapeutic dimensions. The concept of TP is defined, and existing literature about the relationship between that concept, the therapeutic alliance, and mindfulness is reviewed, alongside an examination of related concepts that have developed within nursing and medicine. We conclude that TP emerges as a transtheoretical concept that can be integrated into our understanding of the doctor-patient encounter to improve both doctor-patient communication and the doctor-patient relationship. The way in which the biomedical model may limit a present medicine is discussed, and the means of integrating such a model of doctor-patient encounter into medical training and practice is analyzed.
Creating Effective and Efficient Pediatric-Specific CME Content: More than Just Checking a Box
Authors: Nelson Benjamin A. 
Published: January 2019

Abstract:
States dictate the type of continuing medical education (CME) required for licensing; however, CME providers are not mandated to create content relevant to all specialties. This often forces pediatricians to engage in educational activities that are irrelevant to their practice. This is contrary to what constitutes effective CME. The goal was to develop pediatric content using adult learning theory that aligns with effective CME principles while simultaneously satisfying state licensure requirements. A targeted needs assessment of pediatric providers revealed that pediatric-specific CME activities satisfying the state's requirement for pain management and end-of-life issues were lacking. Webinars adhering to adult learning principles were created in consultation with content experts. Five hundred ninety-seven learners across 30 states successfully completed the webinars and received CME credit. To satisfy ongoing state licensing requirements, 44% of learners had completed similar activities in the past, but 72% of those learners participated in activities focused on adult medicine due to the lack of available pediatric modules. Until states and regulators allow for more flexibility in satisfying licensing requirements, it will be incumbent on those who create CME to develop educational activities that satisfy state requirements while aligning with the principles of effective CME. With strategic planning, this is possible and will hopefully empower physicians to engage in CME without resorting to “checking a box.”
Emergency Surgery in Acute Diverticulitis: A Systematic Review
Authors: Beyer-Berjot Laura , Maggiori Léon , Loiseau Didier , De Korwin Jean-Dominique , Bongiovanni Jean-Pierre , Lesprit Philippe , Salles Nathalie , Rousset Pascal , Lescot Thomas , Henriot Aymeric , Lefrançois Magalie , Cotte Eddy , Parc Yann 
Published: January 2019

BACKGROUND:
Acute diverticulitis is a common disease with public health significance. Many studies with a high level of evidence have been published recently on the surgical management of acute diverticulitis.

OBJECTIVE:
The aim of this systematic review was to define the accurate surgical management of acute diverticulitis.

DATA SOURCES:
Medline, Embase, and the Cochrane Library were sources used.

STUDY SELECTION:
One reviewer conducted a systematic study with combinations of key words for the disease and the surgical procedure. Additional studies were searched in the reference lists of all included articles. The results of the systematic review were submitted to a working group composed of 13 practitioners. All of the conclusions were obtained by full consensus and validated by an external committee.

INTERVENTIONS:
The interventions assessed were laparoscopic peritoneal lavage, primary resection with anastomosis with or without ileostomy, and the Hartmann procedure, with either a laparoscopic or an open approach.

MAIN OUTCOME MEASURES:
Morbidity, mortality, long-term stoma rates, and quality of life were measured.

RESULTS:
Seventy-one articles were included. Five guidelines were retrieved, along with 4 meta-analyses, 14 systematic reviews, and 5 randomized controlled trials that generated 8 publications, all with a low risk of bias, except for blinding. Laparoscopic peritoneal lavage showed concerning results of deep abscesses and unplanned reoperations. Studies on Hinchey III/IV diverticulitis showed similar morbidity and mortality. A reduced length of stay with Hartmann procedure compared with primary resection with anastomosis was reported in the short term, and in the long term, more definite stoma along with poorer quality of life was reported with Hartmann procedure. No high-quality data were found to support the laparoscopic approach.

LIMITATIONS:
Trials specifically assessing Hinchey IV diverticulitis have not yet been completed.

CONCLUSIONS:
High-quality studies showed that laparoscopic peritoneal lavage was associated with an increased morbidity and that Hartmann procedure was associated with poorer long-term outcomes than primary resection with anastomosis with ileostomy, but Hartmann procedure is still acceptable, especially in high-risk patients.
Recognizing maternal mental health disorders: beyond postpartum depression
Authors: Yeaton-Massey Amanda , Herrero Tiffany 
Published: January 2019

Purpose of review
Maternal mental health disorders, including anxiety and depression, are one of the most common obstetric complications, presenting in pregnancy and postpartum.

Recent findings
Maternal mental health disorders are associated with adverse maternal and neonatal outcomes. Screening women in pregnancy and postpartum for mental health disorders is key to early identification and treatment of anxiety and depression in the perinatal population. Although universal screening is now recommended by numerous professional organizations, rates of screening are low and often not performed with a validated screening instrument. Although clinical assessment is important, it is insufficient to identify maternal mental health disorders. As symptoms may change throughout pregnancy, screening for anxiety and depression should be done at multiple time points in pregnancy, including intake and postpartum. In addition, it is important to complete a mental health history on intake to identify women who are either at risk for, or experiencing, anxiety and depression. All screening programmes must be accompanied by a protocol to respond to a positive screen to ensure appropriate follow-up and treatment.

Summary
Identification and treatment of maternal mental health disorders has important implications for maternal and child health. Obstetric providers should screen all women using a validated screening instrument and have systems in place to ensure timely diagnosis and treatment.
Systemic lupus erythematosus in pregnancy: high risk, high reward
Authors: Do Samantha C. , Druzin Maurice L. 
Published: January 2019

Purpose of review
The aim of this study was to describe risks of systemic lupus erythematosus (SLE) in pregnancy and the importance of preconception counselling, medication optimization and close surveillance.

Recent findings
Advances in care for pregnant patients with SLE have led to improved obstetric outcomes, but maternal and foetal risks continue to be elevated. Conception during periods of disease quiescence and continuation of most medications decrease adverse pregnancy outcomes. Hydroxychloroquine (HCQ) appears protective against flares in pregnancy, neonatal congenital heart block and preterm birth.

Summary
SLE in pregnancy confers increased maternal and foetal risks, including disease flares, preeclampsia, preterm birth, foetal growth restriction, neonatal lupus erythematosus (NLE) and congenital heart block. Disease control on an effective medication regimen mitigates many of these risks, but pregnancy in women with SLE remains a high-risk condition requiring multidisciplinary care and an individualized approach to each patient.
Fibrinography: A Multiwavelength Light‐Scattering Assay of Fibrin Structure
Authors: Dassi Carhel , Seyve Landry , García Xabel , Bigo Emmanuelle , Marlu Raphaël , Caton François , Polack Benoît 
Published: January 2019

AbstractWe have previously developed a fibrin structural assay dedicated to purified fibrinogen‐thrombin system. Here, we extend the pertinence of this test, called Fibrinography, to tissue factor‐triggered plasma coagulation. We show that Fibrinography determines quantitatively the structure of fibrin fibers in plasma with an excellent reproducibility. We compare this assay with the commonly used single wavelength turbidity method, showing that the latter is not a proper structural assay, but determines essentially the fibrinogen content in plasma. In addition, we also show, in model plasmas, that Fibrinography is able to discriminate normal and hypocoagulant plasmas, and even between hypercoagulant plasmas. Therefore, Fibrinography, by measuring the final step of the coagulation cascade, may be used to evaluate patients’ plasma in hypo‐ or hypercoagulant diseases.
Do Donated Corneas Become Transplanted Corneas? The Causes of Discard in Southern Brazil
Authors: Almeida de Freitas Rosane , Dell'Agnolo Cátia Millene , Augusto de Melo Willian , de Andrade Luciano , Pimentel Rafael Rodrigo , Pelloso Sandra Marisa , Dalva de Barros Carvalho Maria 
Published: January 2019

Purpose:
To analyze the number of discarded donated corneas and the causes associated with discard in southern Brazil.

Methods:
This retrospective, cross-sectional, and analytic study of donor corneal discards and their associated factors and geospatial distribution was based on a macroregional strategy conducted from 2011 to 2015 in Paraná, southern Brazil. The dataset included all cornea donations from patients who died of cardiac arrest at ages between 3 and 70 years.

Results:
A total of 9290 donor corneas were identified from 4645 donor patients; of these corneas, 4235 (45.6%) were discarded and 5055 (54.4%) transplanted. Mean age of the donors was 51.13 ± 14.30 years. The main causes of discard were positive serology (49.6%), corneal viability (19.8%), corneal tissue quality (8.5%), and others (16.0%). The discard rate was higher in the 50 to 64 year age group.

Conclusions:
The corneal discard rate was high in all macroregions studied, with positive serology, viability, and quality of the donated corneas being the main causes of discard. Discards were more prevalent in older age groups (50–64 years and 65 or above age groups). Considering the presented results, the assessment process of potential cornea donors should be changed to reduce losses and costs.
Peripheral Pneumatic Dissection and Scar Peeling to Complete Deep Anterior Lamellar Keratoplasty in Eyes With Healed Hydrops
Authors: Goweida Mohamed Bahgat , Sobhy Mohamed , Seifelnasr Mohamed , Liu Christopher 
Published: January 2019

Purpose:
To describe a surgical technique to achieve the desired plane during deep anterior lamellar keratoplasty (DALK) in eyes with Descemet membrane (DM) tears due to previous hydrops.

Methods:
This was a prospective, consecutive, interventional case series of DALK in 12 keratoconic eyes with healed hydrops. Dissection of the peripheral cornea was performed by air injection and using the microbubble incision technique as a guide to the clear predescemetic stroma. The central posterior scar was then removed by peeling to bare DM.

Results:
DALK was successfully completed in all eyes, with DM tears ranging from a microperforation to approximately 4 mm. At 12 months, the mean logMAR best-corrected visual acuity was 0.38 ± 0.07, the mean keratometric astigmatism was 5.2 ± 1.9 diopters, and the mean endothelial cell density was 2364 ± 316.9 cells/mm2.

Conclusions:
Peripheral pneumatic dissection and central scar peeling technique is a useful technique to complete DALK in eyes with scars due to previous hydrops.
Sjögren's Syndrome: More Than Just Dry Eye
Authors: Akpek Esen K. , Bunya Vatinee Y. , Saldanha Ian J. 
Published: January 2019

Purpose:
Sjögren's syndrome (SS) is a common autoimmune disease affecting about four million Americans. Although approximately 1 in 10 patients with clinically-significant aqueous deficient dry eye has underlying SS, widespread underappreciation of SS leads to significant underdiagnosis, delays in diagnosis, and consequent morbidity and mortality. The purpose of this article is to illustrate that in addition to dry eye, SS can cause serious, vision-threatening extraglandular ocular manifestations.

Methods:
We conducted a narrative review of studies that have examined the dry eye and extraglandular ocular complications of SS.

Results:
SS-related dry eye is a progressive condition with major negative impact on the quality-of-life of afflicted patients, not only due to symptoms of ocular discomfort but also visual dysfunction. In addition, SS can lead to corneal melt/perforation, uveitis, scleritis, retinal vasculitis, and optic neuritis. A major problem with currently-available SS disease activity measurement instruments is the lack of domains evaluating dry eye-related visual dysfunction. For example, one of the most commonly-used instruments for assessing patient symptoms in SS (the EULAR Sjögren's Syndrome Patient Reported Index [ESSPRI]) only includes one item (out of three) that addresses the severity of overall dryness, without mention of dry eye symptoms or vision-related quality-of-life. Similarly, no extraglandular ocular complications are included in currently-available SS disease activity instruments (e.g., the EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI]).

Conclusions:
There needs to be a paradigm shift in which eye care providers and rheumatologists become more familiar with various SS-related extraglandular ocular manifestations. Existing disease activity measurement instruments must incorporate dry eye symptoms, particularly those related to visual dysfunction. An evidence-based screening algorithm for determining which patients with dry eye should be tested for underlying SS may be particularly helpful in preventing delays in diagnosis.
Intraoperative Optical Coherence Tomography to Guide Corneal Biopsy: A Case Report
Authors: Schmidt Eleanor M. , Stiefel Hillary C. , Houghton Donald C. , Chamberlain Winston D. 
Published: January 2019

Purpose:
To report on a new application of intraoperative optical coherence tomography (OCT) as a real-time imaging tool to help guide corneal biopsy.

Methods:
Single case report. After the negative result of a corneal biopsy, we used intraoperative OCT during repeat biopsy to assist in depth and acquisition of an anterior stromal opacity suspected to be immunoglobulin deposits.

Results:
The use of intraoperative OCT is a novel tool, which assisted in successful identification and conservative biopsy of corneal immunoglobulin deposits.

Conclusions:
Intraoperative OCT is a novel tool that assists in the identification and location of corneal pathology for biopsy.
Biobanking of Dehydrated Human Donor Corneal Stroma to Increase the Supply of Anterior Lamellar Grafts
Authors: Romano Vito , Levis Hannah J. , Gallon Paola , Lace Rebecca , Borroni Davide , Ponzin Diego , Ruzza Alessandro , Kaye Stephen B. , Ferrari Stefano , Parekh Mohit 
Published: January 2019

Purpose:To investigate the effect of dehydration on human donor corneal stroma for biobanking.Methods:Epithelium and endothelium of research-grade human donor corneas (n = 12) were scraped off, leaving a bare stroma with attached sclera. The tissues were placed in a large Petri dish prefilled with silica gel in the periphery and stored at room temperature for 14 days. At the end of preservation, the tissues were rehydrated by being submerged in phosphate-buffered saline for 15 minutes. Transparency (using a custom-built device) and thickness (using optical coherence tomography) measurements were recorded before dehydration, after dehydration, and after rehydration of the tissues. Periodic acid-Schiff and alpha-smooth muscle actin (α-SMA) staining before dehydration and after rehydration were performed to determine the presence of keratocytes and expression of α-SMA. Tensile stress-strain before dehydration and after rehydration was performed to evaluate the biomechanical properties.Results:No difference in corneal transparency before dehydration (69.57 ± 6.41%) and after rehydration (67.37 ± 2.82%),P= 0.36, was observed. The corneas were more compact after dehydration. A significant change in thickness between before dehydration (625.8 ± 75.58 μm) and after rehydration (563.6 ± 15.77 μm) stage,P= 0.03, was noticed. The thickness was reduced to 147.6 ± 3.71 μm when dehydrated. Periodic acid-Schiff staining showed presence of stromal keratocytes and α-SMA protein expressed in control, dehydrated, and rehydrated corneas. There was no significant difference in the stiffness between control (27.86 ± 11.65 MPa) and rehydrated corneas (31.46 ± 11.41 MPa).Conclusions:Human donor corneal stroma can be biobanked for up to 2 weeks in a dehydrated condition without losing their molecular or biomechanical properties after rehydration.
Anterior Chamber XEN Gel Stent Movements: The Impact on Corneal Endothelial Cell Density
Authors: Gillmann Kevin , Bravetti Giorgio E. , Mermoud André , Mansouri Kaweh 
Published: January 2019

Introduction:
Although there are several examples of glaucoma drainage devices’ dislocations in the literature, the movement of XEN gel stents is scarcely documented, and the impact of such displacements on the corneal endothelium remains unknown. In light of the recent global market withdrawal of the CyPass microstent over concerns with regard to endothelial cell loss, we present a case of XEN gel stent dislocation into the anterior chamber, with localized corneal damage.

Case Report:
We describe the case of a 64-year-old female patient who underwent bilateral XEN gel stent implantation for normal-tension glaucoma. While right eye surgery was uneventful, intraocular pressure increased in the left eye, and examination revealed a flat filtration bleb with no microstent visible through the conjunctiva. A 3 mm segment of the XEN stent was visible within the anterior chamber, with corneal contact during eye movement and blinking. Endothelial cell density was measured twice 1 month apart before the XEN gel stent was replaced.

Discussion:
First, our observations confirm that XEN gel stents can dislocate and advance within the anterior chamber. We speculate that this displacement was caused by regular eye rubbing after surgery. Second, this report illustrates that the position of a drainage device within the anterior chamber is dynamic and significantly influenced by eye movements and blinking. Finally, occasional corneal contact of a XEN gel stent can cause a reduction in endothelial cell density of 2.1% in a month, which represents 46.2% of the annual endothelial loss observed by Tan and colleagues in patients with a Baerveldt tube (4.54% annual decrease).
Alexithymia in individuals with chronic pain and its relation to pain intensity, physical interference, depression, and anxiety: a systematic review and meta-analysis
Authors: Aaron Rachel V. , Fisher Emma A. , de la Vega Rocio , Lumley Mark A. , Palermo Tonya M. 
Published: January 2019

Abstract
Numerous studies have examined how alexithymia (difficulty identifying and describing one's emotions and a preference for externally oriented thinking) relates to chronic pain and associated disability. We conducted a systematic review and meta-analysis to summarize individual studies that either assessed alexithymia in individuals with chronic pain vs controls or related alexithymia to pain intensity, physical interference, depression, and anxiety. We searched MEDLINE, Embase, and PsycINFO from inception through June 2017; 77 studies met the criteria (valid assessment of alexithymia in adults or children with any chronic pain condition) and were included in analyses (n = 8019 individuals with chronic pain). Primary analyses indicated that chronic pain samples had significantly higher mean alexithymia scores compared with nonclinical (d = 0.81) and clinical nonpain (d = 0.55) controls. In chronic pain samples, alexithymia was significantly positively associated with pain intensity (d = 0.20), physical interference (d = 0.17), depression (d = 0.46), and anxiety (d = 0.43). Secondary meta-analyses of 14 studies that conducted partial correlations that controlled for negative affect-related measures revealed that alexithymia was no longer significantly related to pain intensity or interference. Meta-analysis findings demonstrated that alexithymia is elevated in individuals with chronic pain and related to greater pain intensity and physical interference, although the latter relationships may be accounted for by negative affect. Critical future work is needed that examines alexithymia assessed using non–self-report measures, develops a person-centered perspective on this construct, and identifies how alexithymia is relevant to the assessment and treatment of individuals with chronic pain.
Normative data for common pain measures in chronic pain clinic populations: closing a gap for clinicians and researchers
Authors: Nicholas Michael K. , Costa Daniel S.J. , Blanchard Megan , Tardif Hilarie , Asghari Ali , Blyth Fiona M. 
Published: January 2019

Abstract
Normative data for chronic pain questionnaires are essential to the interpretation of aggregate scores on these questionnaires, for both clinical trials and clinical practice. In this study, we summarised data from 13,343 heterogeneous patients on several commonly used pain questionnaires that were routinely collected from 36 pain clinics in Australia and New Zealand as part of the electronic Persistent Pain Outcomes Collaboration (ePPOC) including the Brief Pain Inventory (BPI); the Depression Anxiety and Stress Scales (DASS); the Pain Self-Efficacy Questionnaire (PSEQ); and the Pain Catastrophizing Scale (PCS). The data are presented as summarised normative data, broken down by demographic (age, sex, work status, etc) and pain site/medical variables. The mean BPI severity score was 6.4 (moderate-severe), and mean interference score was 7.0. The mean DASS depression score was 20.2 (moderate-severe), mean DASS anxiety was 14.0 (moderate), and mean DASS stress was 21.0 (moderate). The mean PCS scores were 10.0, 5.9, 14.1, and 29.8 for rumination, magnification, helplessness, and total, respectively. The mean PSEQ score was 20.7. Men had slightly worse scores than women on some scales. Scores tended to worsen with age until 31 to 50 years, after which they improved. Scores were worse for those who had a greater number of pain sites, were unemployed, were injury compensation cases, or whose triggering event was a motor vehicle accident or injury at work or home. These results and comparisons with data on the same measures from other countries, as well as their uses in both clinical practice and clinical trials, are discussed.