bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Patient-Centered Approach to Developing Entrustable Professional Activities
Authors: El-Haddad Carlos , Damodaran Arvin , McNeil H. Patrick , Hu Wendy 
Published: February 2017

Purpose
The medical education community is rapidly accepting the use of entrustable professional activities (EPAs) as a means of assessing residents. Stakeholder engagement is advised in developing EPAs, but no studies have investigated the role of patient input. In this qualitative study, the authors investigated what patient input may add to designing a patient-centered EPA.

Method
The authors chose “management of acute low back pain (LBP)” as a common, important clinical task on which to base the patient-centered EPA. In 2015, 14 patients who presented to a teaching hospital with acute LBP participated in semistructured interviews exploring their illness experience and expectations of doctors. Clinicians representing multiple disciplines participated in a focus group. The authors used the Framework Method to analyze data, identifying and developing themes, similarities, and differences between patient and clinician input. They used the findings to develop the EPA. Through an iterative procedure of data review and tracking data sources, they determined how patient and clinician input informed each EPA descriptor.

Results
Drawing from their firsthand experience of LBP, patients described unique expectations of trainees which directly informed EPA descriptors. For example, the authors primarily used patients’ detailed descriptions of desirable and observable trainee behaviors to inform the required attitudes descriptor.

Conclusions
Patients can provide unique contributions, complementary to those of clinicians, to EPAs. Consultations with patients led to the development of a patient-centered EPA, which aligned best clinical practice with patient expectations. Educators seeking to apply patient-centered care to EPA development could adopt a similar approach.
The Use of Social Media in Graduate Medical Education: A Systematic Review
Authors: Sterling Madeline , Leung Peggy , Wright Drew , Bishop Tara F. 
Published: February 2017

Purpose
Despite the growing presence of social media in graduate medical education (GME), few studies have attempted to characterize their effect on residents and their training. The authors conducted a systematic review of the peer-reviewed literature to understand the effect of social media on resident (1) education, (2) recruitment, and (3) professionalism.

Method
The authors identified English-language peer-reviewed articles published through November 2015 using Medline, Embase, Cochrane, PubMed, Scopus, and ERIC. They extracted and synthesized data from articles that met inclusion criteria. They assessed study quality for quantitative and qualitative studies through, respectively, the Medical Education Research Study Quality Instrument and the Consolidated Criteria for Reporting Qualitative Studies.

Results
Twenty-nine studies met inclusion criteria. Thirteen (44.8%) pertained to residency education. Twitter, podcasts, and blogs were frequently used to engage learners and enhance education. YouTube and wikis were more commonly used to teach technical skills and promote self-efficacy. Six studies (20.7%) pertained to the recruitment process; these suggest that GME programs are transitioning information to social media to attract applicants. Ten studies (34.5%) pertained to resident professionalism. Most were exploratory, highlighting patient and resident privacy, particularly with respect to Facebook. Four of these studies surveyed residents about their social network behavior with respect to their patients, while the rest explored how program directors use it to monitor residents’ unprofessional online behavior.

Conclusions
The effect of social media platforms on residency education, recruitment, and professionalism is mixed, and the quality of existing studies is modest at best.
Doctors Without Borders
Authors: Wass Val , Southgate Lesley 
Published: February 2017

The unprecedented demands of patient and population priorities created by globalization and escalating health and social inequities will not be met unless medical education changes. Educators have failed to move fast enough to create an education framework that meets current population needs. A new common set of professional values around global social accountability is necessary. Education borders must be broken down at three levels—societal-institutional, interpersonal, and individual.
At a societal-institutional level, global health must be embraced as part of a philosophy of population needs, human rights, equity, and justice. A move from informative acquisition of knowledge and skills to formative learning where students socialize around values, develop leadership attributes, and become agents for change is needed. At an interpersonal level, radical changes in curriculum delivery, which move away from the well-defined borders of specialty rotations, are required. Students must develop an integrated understanding of the future of health care and the patient’s journey through health care delivery, within the context of population needs. At an individual level, doctors need to understand the boundaries of the professional values they hold within themselves and develop a deeper understanding of their own internal prejudices and conflicts. Opening the borders between the sciences and humanities is essential. Fostering and mentoring that emphasize that resilience, leadership, flexibility, and the ability to cope with uncertainty are needed to tackle the complexities of current, as well as future, health care. Doctors need to understand the restraints within themselves to work effectively without borders.
Validity Evidence From Ratings of Pediatric Interns and Subinterns on a Subset of Pediatric Milestones
Authors: Turner Teri L. , Bhavaraju Vasudha L. , Luciw-Dubas Ulana A. , Hicks Patricia J. , Multerer Sara , Osta Amanda , McDonnell Jennifer , Poynter Sue , Schumacher Daniel J. , Tenney-Soeiro Rebecca , Waggoner-Fountain Linda , Schwartz Alan 
Published: February 2017

Purpose
To investigate evidence for validity of faculty members’ pediatric milestone (PM) ratings of interns (first-year residents) and subinterns (fourth-year medical students) on nine subcompetencies related to readiness to serve as a pediatric intern in the inpatient setting.

Method
The Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN) and the National Board of Medical Examiners collaborated to investigate the utility of assessments of the PMs for trainees’ performance. Data from 32 subinterns and 179 interns at 17 programs were collected from July 2012 through April 2013. Observers used several tools to assess learners. At each site, a faculty member used these data to make judgments about the learner’s current developmental milestone in each subcompetency. Linear mixed models were fitted to milestone judgments to examine their relationship with learner’s rank and subcompetency.

Results
On a 5-point developmental scale, mean milestone levels for interns ranged from 3.20 (for the subcompetency Work effectively as a member of a team) to 3.72 (Humanism) and for subinterns from 2.89 (Organize and prioritize care) to 3.61 (Professionalization). Mean milestone ratings were significantly higher for the Professionalism competency (3.59–3.72) for all trainees compared with Patient Care (2.89–3.24) and Personal and Professional Development (3.33–3.51). Mean intern ratings were significantly higher than mean subintern ratings for all nine subcompetencies except Professionalization, Humanism, and Trustworthiness.

Conclusions
The PMs had a coherent internal structure and could distinguish between differing levels of trainees, which supports their validation for documenting developmental progression of pediatric trainees.
A Rare Case of CK20/CK7 Double Negative Merkel Cell Carcinoma
Authors: Le Mary D. , O'Steen Luke H. , Cassarino David S. 
Published: February 2017

Abstract:
The authors present a case of Merkel cell carcinoma (MCC) with unique immunohistochemical staining characteristics. A 57-year-old woman presented with a firm 0.3 cm tan papule on her left nasal-labial fold that was reportedly increasing in size and bleeding. She had a history of multiple head and neck actinic keratoses, papillary thyroid carcinoma, and a family history of an uncle with melanoma. The clinical differential diagnosis was “non-melanoma skin cancer.” Histological examination showed a markedly atypical-appearing basaloid neoplasm, present mostly in the dermis, with focal pagetoid spread into the epidermis. The cells showed hyperchromatic-staining nuclei, crowding, nuclear molding, and scant cytoplasm with atypical mitoses. The findings were consistent with a malignant tumor, highly suspicious for MCC. A pancytokeratin stain was strongly positive and showed perinuclear dot-like positivity. CK20 and CK7 stains were both negative. Synaptophysin was strongly positive, chromogranin was focally positive, CD56 was weakly positive, and neurofilament was positive in a perinuclear dot-like pattern. TTF-1, PAX5, S100, and Melan-A were negative, arguing against metastatic small cell carcinoma of lung or thyroid, B-cell lymphoma, or melanoma, respectively. Although the CK20/CK7 double negativity is very unusual, the staining characteristics of this case are most consistent with a primary cutaneous MCC. Up to 10%–15% of MCCs can be CK20 negative, and those cases are typically CK7 positive. This case is unique, as a CK20/CK7 double negative case has not been previously reported; however, the diagnosis can still be rendered based on the clinical, histological, and other immunohistochemical findings.
Menopause and big data: Word Adjacency Graph modeling of menopause-related ChaCha data
Authors: Carpenter Janet S. , Groves Doyle , Chen Chen X. , Otte Julie L. , Miller Wendy R. 
Published: February 2017

Abstract

Objective:
To detect and visualize salient queries about menopause using Big Data from ChaCha.

Methods:
We used Word Adjacency Graph (WAG) modeling to detect clusters and visualize the range of menopause-related topics and their mutual proximity. The subset of relevant queries was fully modeled. We split each query into token words (ie, meaningful words and phrases) and removed stopwords (ie, not meaningful functional words). The remaining words were considered in sequence to build summary tables of words and two and three-word phrases. Phrases occurring at least 10 times were used to build a network graph model that was iteratively refined by observing and removing clusters of unrelated content.

Results:
We identified two menopause-related subsets of queries by searching for questions containing menopause and menopause-related terms (eg, climacteric, hot flashes, night sweats, hormone replacement). The first contained 263,363 queries from individuals aged 13 and older and the second contained 5,892 queries from women aged 40 to 62 years. In the first set, we identified 12 topic clusters: 6 relevant to menopause and 6 less relevant. In the second set, we identified 15 topic clusters: 11 relevant to menopause and 4 less relevant. Queries about hormones were pervasive within both WAG models. Many of the queries reflected low literacy levels and/or feelings of embarrassment.

Conclusions:
We modeled menopause-related queries posed by ChaCha users between 2009 and 2012. ChaCha data may be used on its own or in combination with other Big Data sources to identify patient-driven educational needs and create patient-centered interventions.
Intradermal Infiltration of Local Anesthetic—Rapid and Bloodless Deepithelialization of the Breast Pedicle
Authors: Bennett Katelyn G. , Gilman Robert H. 
Published: February 2017

Summary:
Breast reduction is one of the most commonly performed plastic surgery procedures, and pedicle deepithelialization remains a time-consuming step of the operation. This is especially true when using an inferior pedicle. We present a novel technique of intradermal infiltration of the breast pedicle with local anesthetic to facilitate efficient, bloodless deepithelialization. The senior author uses a 20-ml syringe to inject 0.25% lidocaine and 1:400,000 epinephrine just beneath the epidermis of the breast pedicle to create a series of wheals. Approximately 20 ml of local anesthetic is used per pedicle. After injection of local anesthetic, the breast pedicle is deepithelialized in less than 3 minutes. The plane is bloodless, allowing improved visualization secondary to the epinephrine-induced hemostasis. The senior author has had only one case of nipple necrosis in 20 years of experience. Intradermal infiltration of local anesthetic with epinephrine hydrodissects between the epidermis and dermis and provides hemostasis to facilitate rapid deepithelialization.
Board characteristics, governance objectives, and hospital performance: An empirical analysis of German hospitals
Authors: Thiel Andrea , Winter Vera , Büchner Vera Antonia 
Published: February 2017

Background:
There is a growing need for hospital supervisory boards to support hospital management in different areas, including (financial) monitoring, resource provision, stakeholder relationships, and strategic decision-making. Little is currently known about how boards’ emphases on these various governance objectives contribute to performance.

Purpose:
Using a dominant logics perspective, this article aims to detect the governance logics that hospital boards emphasize, to determine whether there are distinct clusters of hospitals with the same sets of emphases, and to show how cluster membership relates to board characteristics and financial performance.

Methodology:
Using factor analysis, we identify latent classes of governance objectives and use hierarchical cluster analysis to detect distinct clusters with varying emphasis on the classes. We then use multinomial regression to explore the associations between cluster membership and board characteristics (size, gender diversity, and occupational diversity) and examine the associations between clusters and financial performance using OLS regression.

Results:
Classes of objectives reflecting three governance theories—agency theory, stewardship theory, and stakeholder theory—can be distinguished, and hospitals can be divided into four clusters based on their board’s relative emphasis on the classes. Cluster membership is significantly associated with board characteristics. There is also a significant association between cluster membership and hospital financial performance, with two of three groups performing significantly better than the reference group.

Conclusion:
High performance in hospitals can be the result of governance logics, which, compared to simple board characteristics, are associated with better financial outcomes.

Practice implications:
Hospitals can influence the emphasis placed on different governance objectives and enhance organizational success by creating boards that are small enough to be effective yet diverse enough to profit from a wide variety of expertise and experience.
Predicting HCAHPS scores from hospitals’ social media pages: A sentiment analysis
Authors: Huppertz John W. , Otto Peter 
Published: February 2017

Background:
Social media is an important communication channel that can help hospitals and consumers obtain feedback about quality of care. However, despite the potential value of insight from consumers who post comments about hospital care on social media, there has been little empirical research on the relationship between patients’ anecdotal feedback and formal measures of patient experience.

Purpose:
The aim of the study was to test the association between informal feedback posted in the Reviews section of hospitals’ Facebook pages and scores on two global items from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, Overall Hospital Rating and Willingness to Recommend the Hospital.

Methodology/Approach:
We retrieved star ratings and anecdotal comments posted in Reviews sections of 131 hospitals’ Facebook pages. Using a machine learning algorithm, we analyzed 57,985 comments to measure consumers’ sentiment about the hospitals. We used regression analysis to determine whether consumers’ quantitative and qualitative postings would predict global measures from the HCAHPS survey.

Results:
Both number of stars and the number of positive comments posted on hospitals’ Facebook Reviews sections were associated with higher overall ratings and willingness to recommend the hospital. The findings suggest that patients’ informal comments help predict a hospital’s formal measures of patient experience.

Conclusion:
Consistent with crowd wisdom, ordinary consumers may have valid insights that can help others to assess patient experience at a hospital. Given that some people will judge hospital quality based on opinions voiced in social media, further research should continue to explore associations between anecdotal commentary and a variety of quality indicators.

Practice Implications:
Administrators can tap into the wealth of commentary on social media as the forum continues to expand its influence in health care. Comments on social media may also serve as an early snapshot of patient-reported experiences, alerting administrators to problems that may appear in subsequent HCAHPS survey results.
LONG-TERM OUTCOMES OF RITUXIMAB THERAPY IN PATIENTS WITH NONINFECTIOUS POSTERIOR UVEITIS REFRACTORY TO CONVENTIONAL IMMUNOSUPPRESSIVE THERAPY
Authors: Lasave Andres F. , You Caiyun , Ma Lina , Abusamra Khawla , Lamba Neerav , Valdes Navarro Manuel , Meese Halea , Foster C. Stephen 
Published: February 2017

Purpose:
To assess long-term effectiveness of rituximab therapy for refractory noninfectious uveitis affecting the posterior segment.

Methods:
Retrospective case series. Patients diagnosed with recalcitrant noninfectious posterior uveitis who were treated with rituximab intravenous infusions between 2010 and 2015 were included. Patients underwent best-corrected visual acuity testing and fluorescein angiography evidence of disk or vascular staining at 6, 12, 18, and 24 months. Patients had at least 24 months of follow-up.

Results:
Eleven patients (21 eyes) with refractory posterior uveitis treated with intravenous rituximab were included. Nine (81.8%) patients were female. Mean follow-up was 29.3 ± 7.8 months. rituximab was administered as complementary therapy because of previous inefficacy of other therapies in 7 (63.7%) patients, and it was the only treatment in four (36.3%) patients who did not tolerate other drugs. Inflammation signs by fluorescein angiography were controlled in nine (81.8%) patients at the end of follow-up. Baseline best-corrected visual acuity was 20/80 (logarithm of the minimal angle of resolution 0.6 ± 0.4), and final best-corrected visual acuity was 20/40 (0.3 ± 0.5) (P = 0.005). No significant side effects were reported.

Conclusion:
Rituximab therapy was associated with stability and remission of recalcitrant noninfectious posterior uveitis in patients who did not tolerate or did not respond to other therapies.
Roles of Medication Responsibility, Executive and Adaptive Functioning in Adherence for Children and Adolescents With Perinatally Acquired HIV
Authors: Garvie Patricia A. , Brummel Sean S. , Allison Susannah M. , Malee Kathleen M. , Mellins Claude A. , Wilkins Megan L. , Harris Lynnette L. , Patton E. Doyle , Chernoff Miriam C. , Rutstein Richard M. , Paul Mary E. , Nichols Sharon L. 
Published: February 2017

Background:
Medication adherence is a critical but challenging developmental task for children and adolescents with perinatally acquired HIV (PHIV). Understanding how medication responsibility, executive functions (EFs) and adaptive functioning (AF) influence adherence may help prepare adolescents for transition to adulthood.

Methods:
Participants included PHIV children and adolescents 7–16 years of age enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol, who were prescribed antiretroviral medications. Measures included caregiver report and child self-report measures of adherence, medication responsibility and EF, caregiver report of child AF, examiner-administered tests of EF and processing speed and demographic and health characteristics.

Results:
Two hundred fifty-six participants with PHIV (mean age: 12 years old) were 51% female, 80% black and 79% non-Hispanic. Per 7-day recall, 72% were adherent (no missed doses). Children/adolescents self-reported that 22% had sole and 55% had shared medication responsibility. Adjusted logistic models revealed significantly higher odds of adherence with sole caregiver responsibility for medication [odds ratio (OR): 4.10, confidence interval (CI): 1.43–11.8, P = 0.009], child nadir CD4% <15% (OR: 2.26, CI: 1.15–4.43, P = 0.018), better self-reported behavioral regulation (OR: 0.65, CI: 0.44–0.96, P = 0.029) and slower processing speed (OR: 0.54, CI: 0.38–0.77, P < 0.001), adjusting for demographic variables (age, race and caregiver education).

Conclusions:
Among children and adolescents with PHIV, continued caregiver medication management, especially during adolescence, is essential. Although global EF and AF were not significantly associated with adherence, behavioral regulation was. Given that EF and AF develop throughout adolescence, their relationships to adherence should be evaluated longitudinally, especially as youth transition to adulthood and caregiver responsibility diminishes.
Case Series of Wounded Warriors Receiving Initial Fit PowerKnee™ Prosthesis
Authors: Pasquina Paul F. , Carvalho Antonio J. , Murphy Ian , Johnson Jessica L. , Swanson Thomas M. , Hendershot Brad D. , Corcoran Michael , Ritland Bradley , Miller Matthew E. , Isaacson Brad M. 
Published: February 2017

ABSTRACT

Introduction
Combat-related lower-limb amputations challenge prosthetic device prescription and rehabilitation practices. Moreover, wounded warriors are relatively young and lived highly active lifestyles before injury, underscoring their eagerness to quickly regain independent mobility and higher levels of physical function.

Methods
Four US military service members with combat-related unilateral amputation were fit with the PowerKnee™ as their initial prosthesis.

Results
All patients achieved significant mobility milestones more rapidly than historical norms of similarly injured patients using other prosthetic knees. Level-ground gait analysis of each patient was comparable with historical normative data of patients using advanced microprocessor variable dampening knee (MPK) prostheses, although the PowerKnee users generated less power in their intact limb hip and knee, suggesting less strain on intact joints. Each patient was also subsequently fit with an MPK and offered a hydraulic knee prosthesis for higher-level activities. Two of the four patients ultimately chose an alternative prosthesis as their primary knee, citing weight, ability to run, and battery life as key determinants. All patients, however, perceived the PowerKnee prosthesis to be valuable during their rehabilitation. Conclusion: The PowerKnee may be a viable option for the initial prosthetic fitting of individuals with transfemoral amputation. Further research is necessary to better understand the advantages or disadvantages of powered prosthetic technology, including their biomechanical effects on intact limbs, especially for high-level activities, and their ability to enhance early rehabilitation and optimal patient selection and timing of fitting.