bluuebunny/crossref_metadata_2025_split huggingface dataset:
Career Impact of the Chief Resident in Quality and Safety Training Program: An Alumni Evaluation
Authors: Aboumrad Maya , Carluzzo Kathleen , Lypson Monica , Watts Bradley V. 
Published: August 2019

Purpose
Most evaluations of quality improvement and patient safety (QI/PS) training programs provide inadequate data on their impact on alumni careers and QI/PS involvement. To address this gap, the authors investigated continued participation in and barriers to QI/PS work, employment, and satisfaction with training among alumni of the Department of Veterans Affairs (VA) Chief Resident in Quality and Safety (CRQS) program.

Method
A cross-sectional, web-based survey was administered in January 2018 to all 238 CRQS program alumni (program years 2009–2017, 54 program sites).

Results
A total of 145 alumni (61%) completed the survey, of whom 40% were employed at the VA. Participants reported various professional roles including academic appointments, QI/PS-specific positions, and hospital leadership positions. Most respondents reported involvement in QI/PS activities within the past year, including conducting QI or PS projects and teaching QI or PS. Alumni dedicated a median 15% of their work time to QI/PS. Almost all alumni reported experiencing barriers to QI/PS involvement, most frequently lack of time given clinical responsibilities. Most were satisfied with the training, and almost all reported CRQS participation helped their professional career advancement.

Conclusions
The continued involvement in QI/PS reported by alumni suggests training programs such as the CRQS program may be successful in building a workforce of leaders equipped to conduct and teach QI/PS. Dedicated time for QI/PS efforts is an important barrier. Future research should address possible career options and assess the larger, overall effect training physicians in QI/PS has on health systems and patient care.
Realizing One’s Own Subjectivity: Assessors’ Perceptions of the Influence of Training on Their Conduct of Workplace-Based Assessments
Authors: Hodwitz Kathryn , Kuper Ayelet , Brydges Ryan 
Published: August 2019

Purpose
Assessor training is essential for defensible assessments of physician performance, yet research on the effectiveness of training programs for promoting assessor consistency has produced mixed results. This study explored assessors’ perceptions of the influence of training and assessment tools on their conduct of workplace-based assessments of physicians.

Method
In 2017, the authors used a constructivist grounded theory approach to interview 13 physician assessors about their perceptions of the effects of training and tool development on their conduct of assessments.

Results
Participants reported that training led them to realize that there is a potential for variability in assessors’ judgments, prompting them to change their scoring and feedback behaviors to enhance consistency. However, many participants noted they had not substantially changed their numerical scoring. Nonetheless, most thought training would lead to increased standardization and consistency among assessors, highlighting a “standardization paradox” in which participants perceived a programmatic shift toward standardization but minimal changes in their own ratings. An “engagement effect” was also found in which participants involved in both tool development and training cited more substantial learnings than participants involved only in training.

Conclusions
Findings suggest that training may help assessors recognize their own subjectivity when judging performance, which may prompt behaviors that support rigorous and consistent scoring but may not lead to perceptible changes in assessors’ numeric ratings. Results also suggest that participating in tool development may help assessors align their judgments with the scoring criteria. Overall, results support the continued study of assessor training programs as a means of enhancing assessor consistency.
Role of Distal Femoral Replacement for Periprosthetic Fractures Above a Total Knee Arthroplasty: When and How?
Authors: Haidukewych George J. 
Published: August 2019

Summary:
With increasing incidence of total knee arthroplasty (TKA), a concurrent rise in periprosthetic fractures is also expected. Although many periprosthetic fractures about a TKA can be fixed through locked plating, retrograde intramedullary nailing, or both, some fracture patterns combined with poor bone stock and/or osteolysis can offer a loose femoral component requiring TKA revision. TKA revision in the setting of periprosthetic fracture can be challenging and, often, nearly impossible as fractures that extend proximally may not be amenable to standard revision components. Distal femoral replacement may offer a more efficient, facile approach to treating periprosthetic fractures about a loose TKA component. Here, the role of distal femoral replacement is reviewed, offering indications, salient technical points, and tips to avoid pitfalls while allowing for immediate, reliable weight bearing in this challenging patient population.
Use of Antibiotic Plates and Spacers for Fracture in the Setting of Periprosthetic Infection
Authors: Maceroli Michael A. , Yoon Richard S. , Liporace Frank A. 
Published: August 2019

Summary:
Prosthetic joint infection is a common cause of hip revision surgery, typically managed with a staged protocol and an antibiotic cement spacer. Patients being treated for prosthetic joint infection are at risk of fracture below the level of the spacer. Fracture in the setting of periprosthetic infection is a complex problem that requires the treating surgeon to use multiple techniques to achieve a successful outcome. The purpose of this case report is to highlight surgical strategies to successfully manage periprosthetic fractures complicated by infection.
Vancouver B3 Fractures: Treatment Options and Tips
Authors: Khan Saad , Kyle Richard 
Published: August 2019

Summary:
The incidence of periprosthetic fracture around hip arthroplasty has increased with the rise of total hip arthroplasty. These fractures are challenging to treat and often require revision of the femoral prosthesis. Vancouver B3 fractures are particularly difficult to treat because of extensive bone loss and limited options. A revised stable femoral component requires distal femoral fixation. Most cases can be performed with a tapered component or a long-stem fully coated prosthesis. Femoral allograft composite and proximal femoral replacement has been recommended for Vancouver B3 fractures with extremely poor bone stock but is rarely performed today. We present our surgical technique, as well as pearls and pitfalls in treating Vancouver B3 fractures with a loose prosthesis and proximal bone loss.
Syme Amputation: Function, Satisfaction, and Prostheses
Authors: Morrison Stewart G. , Thomson Phoebe , Lenze Ulrich , Donnan Leo T. 
Published: August 2019

Background:
Syme amputation (SA) is a term used to describe an amputation at the level of the ankle joint in which the heel pad is preserved. It is performed for a number of indications in a pediatric population. SA is purported to hold the advantage of allowing weight bearing without a prosthesis. A limb length discrepancy (LLD) is useful for ambulation without a prosthesis but can be restrictive with regards to the fitting of modern prostheses.

Methods:
A voluntary survey was distributed to persons living with SA. Recruitment occurred through hospital electronic database and electronic advertising. Data collected included baseline demographic information, data pertaining to weight bearing in different environments, as well as 2 validated outcome measures: the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R activity restriction scale) and the Locomotor Capabilities Index-5 (LCI-5). An illustration was designed to allow participants to classify their LLD by zone in relation to their nonamputated limb.

Results:
At total of 47 persons living with SA participated. The average age at amputation was 3.7 years (range, 0.5 to 14.1 y), and at survey completion 15.8 years (1.7 to 60.3). Five of the described “zones” of LLD were represented. Average LCI-5 score was 52.6. Mean TAPES-R activity restriction scale was 0.59, the lowest mean being achieved by zone E participants, indicating the least restriction. Ability to walk without a prosthesis was lower in those participants over 11 years, when compared with those under, as well as being dependent on the walking environment.

Conclusions:
Our study found no trend indicating that a very low LLD was functionally optimal, and indeed found participants with a moderate LLD (zone E) to have the least mean restriction with regard to their prosthesis. Our study demonstrates that ambulation without a prosthesis depends on the environment (ie, flooring), and rates decrease significantly into adulthood. Optimal care should not focus simply “preserving length,” but rather functional optimization and length modulation in parallel with a nuanced understanding of actual daily activities and prosthetic options.

Level of Evidence:
Level III—retrospective comparative study.
Thermal Imaging Facilitates Design of a Keystone Perforator Island Flap for a Myxofibrosarcoma Resection Reconstruction: Case Report
Authors: Patel Shimul S. , Homsy Christopher , Atamian Elisa K. , Chaffin Abigail E. 
Published: August 2019

Summary:
Lower extremity defects are challenging to reconstruct. The keystone perforator island flap proves useful in difficult cases. Traditionally, a handheld Doppler is used to confirm perforator vessel(s) within the flap but has disadvantages including low sensitivity/specificity. Surgeons can use thermal imaging to localize “hot spots” on the skin, corresponding to perforators. FLIR ONE (FLIR Systems Inc., Wilsonville, OR) is a portable thermal camera with high concordance with computed tomographic angiography. In this case, when faced with handheld Doppler failure, we used intraoperative thermal imaging to continue planning and raising of a complex lower extremity keystone perforator island flap.
Latissimus Dorsi Musculocutaneous Flap for Complex Breast Reconstruction: Indications, Outcomes and a Proposed Algorithm
Authors: Kokosis George , Khavanin Nima , Nahabedian Maurice Y. 
Published: August 2019

Purpose:
The latissimus dorsi (LD) flap is an ideal flap for salvage following failed primary breast reconstruction in the setting of radiation therapy. This study will review outcomes following secondary reconstruction with the LD flap with or without a tissue expander (TE) or implant (I).

Methods:
The following 4 cohorts were included: 1-stage LD only in 28 patients (48.3%), 1-stage LD + I in 7 patients (12.1%), 2-stage LD + TE/I in 8 patients (13.8%), and 3-stage LD + TE + I in 15 patients (25.9%).

Results:
The average age across all patients was 53.2 years. Complications did not differ significantly across the 4 cohorts. Complications included partial flap necrosis, wound dehiscence, seroma, and infection occurring in 4 of 28 patients of 1-stage LD alone, 2 of 7 (28.6%) patients of 1-stage LD + I, 5 of 8 (52.5%) patients of 2-stage LD + TE/I, and 4 of 15 (26.7%) patients of 3-stage LD + TE + I (P = 0.055). Reoperation rates were 10.7%, 14.3%, 25%, and 0% across the 4 cohorts, respectively (P = 0.295). The LD only cohort had a 14.3% surgical revision rate, compared with 42.9% in the 1-stage + I, 50% in the 2-stage + TE/I, and 33.3% in the 3-stage LD + TE + I (P = 0.135). The rate of contralateral symmetry procedures was 10.7%, 0%, 25%, and 6.7%, across the 4 cohorts, respectively (P = 0.410).

Conclusion:
Secondary breast reconstruction with the LD flap in 1, 2, or 3 stages has demonstrated success. A decision-making algorithm is provided.
Exercise Interventions in Patients With Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy
Authors: Steinhaus Daniel A. , Lubitz Steven A. , Noseworthy Peter A. , Kramer Daniel B. 
Published: August 2019

Purpose:
Physical activity improves outcomes across a broad spectrum of cardiovascular disease. The safety and effectiveness of exercise-based interventions in patients with implantable cardioverter-defibrillators (ICDs) including cardiac resynchronization therapy defibrillators (CRT-Ds) remain poorly understood.

Methods:
We identified clinical studies using the following search terms: “implantable cardioverter-defibrillators”; “ICD”; “cardiac resynchronization therapy”; “CRT”; and any one of the following: “activity”; “exercise”; “training”; or “rehabilitation”; from January 1, 2000 to October 1, 2015. Eligible studies were evaluated for design and clinical endpoints.

Results:
A total of 16 studies were included: 8 randomized controlled trials, 5 single-arm trials, 2 observational cohort trials, and 1 randomized crossover trial. A total of 2547 patients were included (intervention groups = 1215 patients, control groups = 1332 patients). Exercise interventions varied widely in character, duration (median 84 d, range: 23-168 d), and follow-up time (median 109 d, range: 23 d to 48 mo). Exercise performance measures were the most common primary endpoints (87.5%), with most studies (81%) demonstrating significant improvement. Implantable cardioverter-defibrillator shocks were uncommon during active exercise intervention, with 6 shocks in 635 patients (0.9%). Implantable cardioverter-defibrillator shocks in follow-up were less common in patients receiving any exercise intervention (15.6% vs 23%, OR = 0.68; 95% CI, 0.48-0.80, P < .001).

JOURNAL/jcprh/04.03/01273116-201909000-00005/5FSM1/v/2023-09-11T074719Z/r/image-gif

o
2 peak improved significantly in patients receiving exercise intervention (1.98 vs 0.36 mL/kg/min, P < .001).

Conclusion:
In conclusion, exercise interventions in patients with ICDs and CRT-Ds appear safe and effective. Lack of consensus on design and endpoints remains a barrier to broader application to this important patient population.
ETIOLOGY AND CLINICAL CHARACTERISTICS OF MACULAR EDEMA IN PATIENTS WITH FAMILIAL EXUDATIVE VITREORETINOPATHY
Authors: Rao Prethy , Lertjirachai Itsara , Yonekawa Yoshihiro , Hasbrook Madeline , Thomas Benjamin J. , Wood Edward H. , Mehta Neesurg , Mane Greta , Drenser Kimberly A. , Trese Michael T. , Capone Antonio 
Published: August 2019

Purpose:
To describe the etiology and clinical characteristics of macular edema (ME) in patients with familial exudative vitreoretinopathy.

Methods:
Observational, retrospective case series of 30 patients (34 eyes) with ME and familial exudative vitreoretinopathy who underwent spectral-domain optical coherence tomography imaging between 2009 and 2016. Baseline and follow-up optical coherence tomographies were correlated with color fundus photography and fluorescein angiography.

Results:
The average age was 20.6 years (6.6–68.7). Eighteen eyes exhibited cystoid ME (52.9%), 14 noncystoid ME (41.2%), and 2 eyes (5.9%) with both. Macular edema was foveal in 52.9% (n = 18). Eighteen of 24 eyes (64.3%) with an available fluorescein angiography showed leakage from ME. The most common structural feature was posterior hyaloidal organization/contraction (n = 15). Sixteen eyes were treated with topical or intravitreal steroids (n = 6), intravitreal anti–vascular endothelial growth factor (n = 3), or pars plana vitrectomy with membrane stripping (n = 7). There was no difference between mean preoperative and postoperative LogMAR visual acuity (0.63 [20/85] vs. 0.87 [20/148], P = 0.35) after vitrectomy despite a statistical improvement in the mean central foveal thickness (596 mm3 vs. 303 mm3, P = 0.04).

Conclusion:
Macular edema in familial exudative vitreoretinopathy occurs most commonly because of traction. Vitrectomy is effective for relieving tractional forces with anatomical improvement.
The Neural Differentiation Potential of Limbal Stem Cells: A Model for Studying the Multipotency of Limbal Stem Cells
Authors: Tsai Chia-Ying , Chu Hsiao-Sang , Cheng Chao-Min , Chen Wei-Li 
Published: August 2019

Purpose:
To investigate the multipotency, especially the neural differentiation potential, of limbal stem cells (LSCs) using a coculture system and to provide a relevant literature review.

Methods:
Limbal tissue was harvested from adult New Zealand white rabbits and treated with collagenase A. Small pieces of the resulting limbal epithelial sheets were cocultured with a neuroblastoma cell line (Neuro-2A) in transwells. Morphological observation of the growing epithelial sheets was accomplished by microscopy, and marker expression was detected by immunocytochemistry for ßIII-tubulin and microtubule-associated protein 2. A literature review of associated studies was performed.

Results:
In the coculture group, directly adherent colonies of neuron-like (DACN) cells were observed among the growing limbal epithelial sheets from day 3. The DACN cells exhibited neuron-like morphology. The control group comprising limbal cell sheets cultured alone showed a very small number of DACN cells at the end of the culture period (day 14). Immunocytochemical staining revealed that the DACN cells were positive for ßIII-tubulin and microtubule-associated protein 2, confirming the neuronal phenotype of the neuron-like cells. By contrast, the DACN cells in the control group produced negative results. In previous reports, LSCs and niches exhibited neural potential, but most differentiated neural cells were observed as floating spheres, in contrast to the DACN cells observed in the present study.

Conclusions:
We developed a coculture system of LSCs and Neuro-2A neuroblastoma cells and obtained DACN cells with neural differentiation potential. Our findings confirm the neural potential of LSCs, consistent with previous reports, but in a form other than floating spheres.
NS Endo-Inserter: A New Graft Inserter for Descemet Stripping Automated Endothelial Keratoplasty
Authors: Soma Takeshi , Koh Shizuka , Maeda Naoyuki , Nishida Kohji 
Published: August 2019

Abstract:
Although Descemet stripping automated endothelial keratoplasty (DSAEK) has become widespread as a first choice for the treatment of bullous keratopathy, corneal endothelial cell loss during the early postoperative period caused by intraoperative mechanical stress to the donor endothelium remains a clinical challenge. At present, a pull-through technique is the standard procedure for graft delivery in DSAEK. However, the anterior chamber is likely to collapse during graft delivery in patients with a small eye or shallow anterior chamber, as often seen in Asian patients, leading to endothelial cell damage. To solve this problem, we developed a new device for DSAEK, known as NS Endo-Inserter, in which the graft flows into the anterior chamber in a balanced salt solution in one step. This article reviews the features of NS Endo-Inserter and the outcomes of DSAEK using this device.
A Correlational Study of Skin Toxicity and Quality of Life in Patients With Advanced Lung Cancer Receiving Targeted Therapy
Authors: CHAN Jui-Chun , LEE Yun-Hsiang , LIU Chien-Ying , SHIH Hui-Hsuan , TSAY Pei-Kwei , TANG Woung-Ru 
Published: August 2019

ABSTRACT

Background
Oral targeted therapy is increasingly used worldwide to treat patients with advanced lung cancer. The adverse skin toxicity that is associated with treatment with epidermal growth factor receptor inhibitors often results in acneiform rash, dry skin (xerosis), pruritus, and paronychia, which may cause discomfort in patients and affect their quality of life.

Purpose
This study was designed to explore changes in skin toxicity and quality of life (measured overall by three subscales) as well as the correlation between skin toxicity and overall quality of life over a 3-month period for patients with advanced lung cancer receiving oral targeted therapy.

Methods
This study used a longitudinal research design. Baseline data were collected before initiating targeted therapy. Data for the effects of targeted therapy on skin toxicity and quality of life were collected at 2, 4, 8, and 12 weeks after therapy initiation. Data on skin toxicity were collected using the Common Terminology Criteria for Adverse Events Version 4.03, and quality of life was measured using the Chinese version of the Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitor-18 questionnaire. Demographic and clinical data were analyzed using descriptive statistics, and Spearman's rank correlation coefficient was used to measure the correlation between skin toxicity and quality of life.

Results
Thirty-two patients participated in this study. The symptoms of skin toxicity that increased over the 3-month study period included xerosis and paronychia, whereas acneiform rash and pruritus fluctuated during this period. Over the study period, more than 70% of the participants exhibited symptoms of skin toxicity. Skin toxicity was the greatest and quality of life was the lowest, respectively, at the end of the study. All of the symptoms of skin toxicity were significantly correlated with quality of life, although each varied over time (r = .36–.61, p < .05).

Conclusions/Implications for Practice
The results of this study indicate that healthcare providers should consider the impact of skin toxicity on quality of life in patients with advanced lung cancer who are receiving oral targeted therapy. These findings may be used to design interventional measures for skin and medical care to improve quality of life in patients with advanced lung cancer.
Application of peripherally inserted central catheters in critically ill newborns experience from a neonatal intensive care unit
Authors: Li Renfeng , Cao Xia , Shi Tian , Xiong Lei 
Published: August 2019

Abstract
Peripherally inserted central catheters (PICCs) can provide nutritional and medical support for very low birth weight or critically ill newborns. The aim of this study was to retrospectively analyze the use of PICCs in our clinic for critically ill newborns to evaluate the relationship between catheter related factors and the occurrence of complications.
Retrospective analysis was conducted for all newborns consecutively admitted at the Neonatal Intensive Care Unit (NICU), Chongqing Health Center for Women and Children, who underwent PICC insertion between May 2011 and March 2018. Data collected included total puncture success rate, one puncture success rate, infection rate, complication rate, unplanned catheter withdrawal rate, device days, and catheter indwelling time.
Five-hundred eighty-eight infants (304 males and 284 females) aged 3.4 ± 3.9 days, mean gestational age of 30.9 ± 2.7 weeks and a mean body mass of 1.38 ± 0.47 kg at insertion were included. Total puncture success rate was 99.65%, one puncture success rate was 77.77%. The mean catheter retention was 13.6 ± 6.7 days: more than 30 days in 15 (2.61%) cases, 20 to 30 days in 60 (10.43%) cases, 10 to 19 days in 372 (64.70%) cases, and 62 days in 1 case. Complications occurred in 63 (10.71%) cases: with PICC insertion within 24 hours after birth in 29 (15.43%), within 48 hours in 13 (6.63%), and after 48 hours in 21 (10.99%) cases. Catheter tip culture was positive in 3 cases and there was 1 case of catheter-related bloodstream infection.
Nursing measures of the maintenance of body temperature and the evaluation of blood vessels were important conditions for improving the success rate of one puncture in critically ill neonates. PICC catheterization as early as 48 hours will not increase the difficulty of PICC puncture. Nor did it increase the incidence of PICC complications.