bluuebunny/crossref_metadata_2025_split huggingface dataset:
Satisfaction With an Electronic Feedback Tool for the OBGYN Clerkship
Authors: Pearson Mary Jane , Meyer Bruce , Green Victoria , Lai Ki 
Published: September 2016

Local Mentor: Bruce Meyer, MD, MBA

APGO Advisor: Alice R. Goepfert, MD

PURPOSE:
To develop an electronic feedback tool and evaluate clerkship student and faculty satisfaction.

BACKGROUND:
Provision of formative feedback during clerkships is mandated by the Liaison Council on Medical Education as important in the development of clinical competence. A common concern in medical student education is the dichotomy wherein faculty believe that feedback has been provided but students do not recognize feedback was given. There is need for a simple tool that documents and collects feedback. No recent literature has cited use of an electronic feedback tool.

METHODS:
An electronic feedback tool, using elements of the AAMC Entrustable Professional Activities, was developed following a needs assessment survey administered to students and ObGyn faculty. This tool, housed on a secure institutional website, was available to both clerkship students and faculty using smartphone, tablet or computer. The project was IRB exempt.

EVALUATION PLAN:
The electronic tool was offered at family planning and ambulatory gynecology clinics to 31 clerkship students and the 11 attending faculty. Thirty student satisfaction surveys and 7 faculty satisfaction surveys were collected. Satisfaction with the electronic tool was assessed using an online survey. Sixty percent of students and 100% faculty were neutral or dissatisfied with the electronic tool. Commonly cited issues were electronic access problems and adequacy of training.

DISSEMINATION:
Information in this survey will be helpful in the further development of electronic tools in the clinical setting.

REFLECTIVE CRITIQUE:
Future development will need to incorporate strategies to enrich faculty training and improve access.
Use of a Perceptual Adaptive Learning Module Results in Improved Accuracy and Fluency of Fetal Heart Rate Categorization by Medical Students
Authors: Wong Melissa 
Published: September 2016

Local Mentor: Sally Krasne, PhD

APGO Advisor: Nancy Hueppchen, MD, MSc

PURPOSE:
Our aim is to evaluate whether use of a Perceptual Adaptive Learning Module (PALM) by medical students would result in improved accuracy and “fluency” (accuracy and speed) of Fetal Heart Rate (FHR) categorization versus traditional lecture methods.

BACKGROUND:
No published studies have evaluated the best method of teaching FHR interpretation. The PALM has been shown to improve learning in skills requiring pattern recognition.

METHODS:
This is a non-randomized controlled trial of third-year medical students. All subjects underwent a pretest and received a basic FHR physiology lecture. Subjects were then exposed to the PALM or to additional lecture reviewing details of FHR categorization. All subjects took an immediate posttest and a delayed test 5 weeks later.

RESULTS:
From April to September 2015, 66 subjects participated: 33 were assigned to the experimental (PALM) arm and 33 to the control (traditional lecture) arm. Only the PALM showed a significant improvement in accuracy and fluency from the pretest to posttest (accuracy from 35% to 71%, P<.05; fluency 27–65%, P<.05). Both interventions showed significant improvement in accuracy and fluency on the delayed test reflecting learning throughout the rotation. However, the PALM showed a significantly greater improvement as compared to the lecture group in both the posttest (accuracy 70% PALM versus 47% lecture, P<.05; fluency 61% versus 29%, P<.05) and the delayed test (accuracy 69% PALM versus 57% lecture, P<.05; fluency 58% versus 41%, P<.05).

DISCUSSION:
The PALM resulted in more accurate and fluent categorization of FHR tracings compared to traditional lecture, and the effect persisted on delayed testing.
Faculty Attitudes Towards TVH and Impact of Vaginal Hysterectomy Simulator
Authors: Dayaratna Sandra 
Published: September 2016

BACKGROUND:
Resident education is dependent on the expertise of faculty. Many residents are graduating with the minimum acceptable number of TVHs. Increasing the number TVH scheduled by faculty, will have a tremendous impact on resident education.

METHODS:
Attending physicians practicing gynecology at a large University hospital were surveyed regarding experience and current practice with performing TVH. Physicians were asked to identify perceived difficulties or barriers with the procedure. OR logs were reviewed for the number of TVHs performed by provider. Faculty members used a vaginal hysterectomy simulator with guidance by a gynecologic expert. A post intervention survey was distributed. OR logs will be pulled for the year after the intervention.

RESULTS:
Less than 50% of faculty reported being very comfortable with TVH. All participants had performed twenty or fewer TVHs during training. Anterior entry was identified as the most difficult step. Over half reported they would more likely do a TVH if they could double scrub. Results from use of the simulator are to be reported at a later date.

DISCUSSION:
There is ample data that TVH is the safest and most cost effective mode of hysterectomy when feasible. There is also data that volume of cases has an impact on surgical outcomes. At present, all faculty were considered low volume surgeons. This underscores the importance of increasing faculty comfort level with TVH so that residents can be trained adequately. In addition, additional support should be provided for anterior entry as most respondents identified that as the most difficult part of the procedure.
Faculty Development and Surgical Training: Are Audio Podcasts an Effective Tool?
Authors: Smith Katie , Crouse Elisa , Anderson Ted 
Published: September 2016

BACKGROUND:
Increased workload and reduction in resident work hours have made didactic teaching and faculty development more difficult to achieve. Needs assessment at the University of Oklahoma revealed a gap in effective faculty development. Audio podcasts are ideal developmental tools as they can be accessed in many settings while engaged in activities such as driving or exercise. Our objective was to create an audio podcast for departmental faculty development. The podcast will address identification of and early interventions for residents who are having difficulty with mastering surgical skills.

METHODS:
A single high fidelity audio podcast was created and distributed to our faculty. A survey was given to faculty before and after the podcast distribution.

RESULTS:
Most of the 24 faculty responding to the initial survey had no structured format for evaluating resident surgical skills. Although 67% had previously listened to a podcast, about half reported that it had been more than 2 months. Eight faculty listened to the podcast and responded to the post listening survey. The majority reported learning new information from listening which some have used and all felt it was an effective way of learning.

DISCUSSION:
Faculty in our department had some baseline knowledge and experience with audio podcasts. All who listened to our podcast felt it was an effective tool for faculty development and education.
Impact of an Abdominal Hysterectomy Simulator on Obstetrics and Gynecology Residents Surgical Confidence
Authors: Stickrath Elaine , Alston Meredith , Mazzoni Sara 
Published: September 2016

BACKGROUND:
The number of abdominal hysterectomies (AH) performed by Obstetrics and Gynecology (OB/GYN) residents has decreased dramatically. Thus, there is a need for simulation training to compliment operating room experience. The objective of this study is to evaluate the impact of an AH simulator on resident surgeon confidence.

METHODS:
A low-fidelity AH simulator was constructed from craft store supplies costing less than $40. OB/GYN residents in a single academic program completed the simulation between July and September 2015. The 1-hour simulation experience included a pre-test, a 5 minute presentation, the simulation, and a post-test. On the pre and post-tests, participants rated their confidence with the steps of AH as Not at All, Somewhat or Very confident.

RESULTS:
Eighty-six percent (32/37) of possible residents completed the session with even representation from all levels of training (9 PGY-1, 7 PGY-2, 8 PGY-3 and 8 PGY-4). Knowledge of the steps of the procedure and instrumentation improved for all levels of trainees (P=.001). One hundred percent (16/16) of the PGY-1 and PGY-2 residents rated their confidence as increased afterwards, while only 25% (4/16) of the PGY-3 and PGY-4 residents did so. Ninety-four percent (30/32) rated the session as Very helpful on a scale of Not at All, Somewhat or Very Helpful.

DISCUSSION:
A low-fidelity, low-cost simulator showed an increase in trainee confidence with AH, particularly in the first and second year trainees. Nearly all participants found the exercise helpful, suggesting that it may be beneficial to incorporate into OB/GYN training programs nationwide.
Monitoring Resident Surgical Performance Through Dictated Feedback
Authors: Rhoades-Lazenby Courtney 
Published: September 2016

BACKGROUND:
We rely on 3 faculty for most feedback about resident surgical performance. However, more than half the resident surgical experience involves private surgeons from whom we were not receiving case-specific feedback. We needed a system to capture this feedback.

METHODS:
We implemented a phone dictation system distributed to all surgeons participating in resident education in May 2015. We consented 17 gynecologists who were asked to use telephone dictation cards to provide feedback after each case involving a resident. We compared number of dictations with number of resident cases that could have been dictated each month using resident logs of cases scrubbed. We also tracked how many different surgeons provided dictations.

RESULTS:
Not all gynecologists used the dictation system. Despite initial promising results, there was a time dependent trail-off in both number of surgeons using the system and number of dictations received. In total, out of 205 cases performed, we received 50 dictations—24% feedback rate.

DISCUSSION:
It is difficult to get resident surgical performance feedback from private surgeons, even when you provide structure and accessibility. However, a 24% feedback rate is still improved from no surgical case feedback.
Spine Injuries in Child Abuse
Authors: Jauregui Julio J. , Perfetti Dean C. , Cautela Frank S. , Frumberg David B. , Naziri Qais , Paulino Carl B. 
Published: September 2016

Background:
Although rare, spinal injuries associated with abuse can have potentially devastating implications in the pediatric population. We analyzed the association of pediatric spine injury in abused children and determined the anatomic level of the spine affected, while also focusing on patient demographics, length of stay, and total hospital charges compared with spine patients without a diagnosis of abuse.

Methods:
A retrospective review of the Kids’ Inpatient Database was conducted from 2000 to 2012 to identify pediatric patients (below 18 y) who sustained vertebral column fractures or spinal cord injuries. Patients with a documented diagnosis of abuse were identified using ICD-9-CM diagnosis codes. Our statistical models consisted of multivariate linear regressions that were adjusted for age, race, and sex.

Results:
There were 22,192 pediatric patients with a diagnosis of spinal cord or vertebral column injury during the study period, 116 (0.5%) of whom also had a documented diagnosis of abuse. The most common type of abuse was physical (75.9%). Compared with nonabused patients, abused patients were more likely to be below 2 years of age (OR=133.4; 95% CI, 89.5-198.8), female (OR=1.67; 95% CI, 1.16-2.41), and nonwhite (black: OR=3.86; 95% CI, 2.31-6.45; Hispanic: OR=2.86; 95% CI, 1.68-4.86; other: OR=2.33; 95% CI, 1.11-4.86). Abused patients also presented with an increased risk of thoracic (OR=2.57; 95% CI, 1.67-3.97) and lumbar (OR=1.67; 95% CI, 1.03-2.72) vertebral column fractures and had a multivariate-adjusted mean length of stay that was 62.2% longer (P<0.001) and mean total charges that were 52.9% higher (P<0.001) compared with nonabused patients. Furthermore, 19.7% of all pediatric spine patients under 2 years of age admitted during the study period belonged to the abused cohort.

Conclusions:
Spine injuries are rare but can be found in the pediatric population. With an additional documented diagnosis of abuse, these injuries affect younger patients in the thoracolumbar region of the spine, and lead to longer lengths of stay and higher hospital costs when compared with nonabused patients. Because of these findings, physicians should maintain a higher level of suspicion of abuse in patients with spine injuries, especially patients under 2 years of age.

Level of Evidence:
Level III evidence—a case-control study.
Effects of Antibiotic Timing on Culture Results and Clinical Outcomes in Pediatric Musculoskeletal Infection
Authors: Benvenuti Michael A. , An Thomas J. , Mignemi Megan E. , Martus Jeffrey E. , Thomsen Isaac P. , Schoenecker Jonathan G. 
Published: September 2016

Introduction:
Musculoskeletal infection (MSI) is a common cause of morbidity and hospital resource utilization in the pediatric population. Many physicians prefer to withhold antibiotics until tissue cultures can be taken in an effort to improve culture yields. However, there is little evidence that this practice improves culture results or outcomes in pediatric MSI. Therefore, investigating the effects of antibiotic timing may lead to improved clinical practice guidelines for treating children with MSI.

Methods:
An IRB-approved retrospective review was conducted that identified 113 patients aged 0 to 18 who presented to the pediatric emergency room at a tertiary care children’s hospital with MSI from 2008 to 2013. Demographic data, culture results, severity markers, and intervention timing were obtained from the medical record. Logistic regression and Cox survival analysis were performed to determine the relationship of antibiotic timing with culture sensitivity and time to discharge.

Results:
No difference was seen in culture sensitivity antibiotic administration in either the local (55% culture before antibiotics vs. 89% after antibiotics) or disseminated group (76% before vs. 79% after), which persisted when further accounting for disease severity with C-reactive protein. However, later administration of antibiotics in the local infection group correlated with a decreased likelihood of discharge (3.91 d when cultured before antibiotics vs. 2.93 d when cultured after antibiotics; hazard ratio, 0.53; P<0.05). In patients with disseminated infection, antibiotic administration was not shown to correlate with any difference in time to discharge (hazard ratio, 1.08).

Conclusions:
The authors were surprised to find that tissue culture sensitivities were not decreased by antibiotic administration in either local or disseminated MSI, suggesting that antibiotic administration should not be delayed to obtain tissue cultures. The correlation of earlier antibiotic administration with shorter length of stay in children with local MSI led the authors to conclude that antibiotics should be initiated as quickly as possible. Further study is necessary to confirm these findings and establish clinical practice guidelines.

Level of Evidence:
Level III—retrospective cohort.
Development and Validation of a Photonumeric Scale for Evaluation of Facial Skin Texture
Authors: Donofrio Lisa , Carruthers Alastair , Hardas Bhushan , Murphy Diane K. , Carruthers Jean , Jones Derek , Sykes Jonathan M. , Creutz Lela , Marx Ann , Dill Sara 
Published: September 2016

BACKGROUND
A validated scale is needed for objective and reproducible comparisons of facial skin roughness before and after aesthetic treatment in practice and in clinical studies.

OBJECTIVE
To describe the development and validation of the 5-point photonumeric Allergan Skin Roughness Scale.

METHODS
The scale was developed to include an assessment guide, verbal descriptors, morphed images, and real subject images for each grade. The clinical significance of a 1-point score difference was evaluated in a review of image pairs representing varying differences in severity. Interrater and intrarater reliability was evaluated in a live-subject validation study (N = 290) completed during 2 sessions occurring 3 weeks apart.

RESULTS
A score difference of ≥1 point was shown to reflect a clinically meaningful difference (mean [95% confidence interval] absolute score difference 1.09 [0.96–1.23] for clinically different image pairs and 0.53 [0.38–0.67] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (weighted kappa = 0.83). Interrater agreement was almost perfect during the second rating session (0.81, primary end point).

CONCLUSION
The Allergan Skin Roughness Scale is a validated and reliable scale for physician rating of midface skin roughness.
Borderline Personality Disorder and Narcissistic Personality Disorder Diagnoses From the Perspective of the DSM-5 Personality Traits
Authors: Fossati Andrea , Somma Antonella , Borroni Serena , Maffei Cesare , Markon Kristian E. , Krueger Robert F. 
Published: September 2016

Abstract
To evaluate the associations between Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Alternative Model of Personality Disorder traits and domains and categorically diagnosed narcissistic personality disorder (NPD) and borderline personality disorder (BPD), respectively, 238 inpatient and outpatient participants who were consecutively admitted to the Clinical Psychology and Psychotherapy Unit of San Raffaele Hospital in Milan, Italy, were administered the Personality Inventory for DSM-5 (PID-5) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Based on SCID-II, the participants were assigned to the following groups: a) NPD (n = 49), b) BPD (n = 32), c) any other PD (n = 91), and d) no PD (n = 63). Emotional lability, separation insecurity, depressivity, impulsivity, risk taking, and hostility were significantly associated with BPD diagnosis. Attention seeking significantly discriminated participants who received an SCID-II categorical NPD diagnosis. Separation insecurity, impulsivity, distractibility, and perceptual dysregulation were the DSM-5 traits that significantly discriminated BPD participants. Domain-level analyses confirmed and extended trait-level findings.
Does Exercise Decrease Pain via Conditioned Pain Modulation in Adolescents?
Authors: Stolzman Stacy , Bement Marie Hoeger 
Published: September 2016

Purpose:
Pain relief after exercise, exercise-induced hypoalgesia (EIH), is established across the lifespan. Conditioned pain modulation (CPM: pain inhibits pain) may be a mechanism for EIH.

Methods:
In 55 adolescents, pressure pain thresholds were measured before and after exercise (deltoid, quadriceps, and nail bed) and during CPM at the nail bed and deltoid test stimulus sites. The relationship between EIH and CPM was explored.

Results:
EIH occurred at deltoid and quadriceps; CPM occurred at nail bed and deltoid. CPM and EIH correlated at deltoid; adolescents with greater CPM experienced greater pain relief after exercise. At this site, CPM predicted 5.4% of EIH. Arm lean mass did not add a significant effect. Peak exercise pain did not influence EIH. Adolescents with none, minimal, moderate, or severe peak exercise pain experienced similar EIH.

Conclusions:
A potential relationship exists between CPM and EIH in adolescents. Pediatric physical therapists should consider the CPM response when prescribing exercise as a pain management tool.
Cholecystostomy Treatment in an ICU Population: Complications and Risks
Authors: Friedrich Ann-Kristin U. , Baratta Kevin P. , Lewis Joanne , Karam Adib R. , Hudlin Margaret , Litwin Demetrius E.M. , Cahan Mitchell A. 
Published: September 2016

Background:
Percutaneous cholecystostomy tube placement has widely been used as an alternative treatment to cholecystectomy, especially in advanced disease or critically ill patients. Reported postprocedural complication rates have varied significantly over the last decade. The goal of this study is to evaluate the safety of percutaneous cholecystostomy tube treatment in critically ill patients.

Study Design:
We performed a retrospective chart analysis of 96 critically ill patients who underwent cholecystostomy tube placement during an intensive care unit (ICU) stay between 2005 and 2010 in a tertiary care center in central Massachusetts. Complications within 72 hours of cholecystostomy tube placement and any morbidity or mortality relating to presence of cholecystostomy tube were considered.

Results:
A total of 65 male and 31 female patients with a mean age of 67.4 years underwent percutaneous cholecystostomy tube placement during an ICU stay. Sixty-six patients experienced a total of 121 complications, resulting in an overall complication rate of 69%. Fifty-four of these complications resulted from the actual procedure or the presence of the cholecystostomy tube; the other 67 complications occurred within 72 hours of the cholecystostomy procedure. Ten patients died. Tube dislodgment was the most common complication with a total of 34 episodes.

Conclusions:
Cholecystostomy tube placement is associated with frequent complications, the most common of which is tube dislodgment. Severe complications may contribute to serious morbidity and death in an ICU population. Complication rates may be underreported in the medical literature. The potential impact of cholecystostomy tube placement in critically ill patients should not be underestimated.
A Whole-Brain Computational Modeling Approach to Explain the Alterations in Resting-State Functional Connectivity during Progression of Alzheimer’s Disease
Authors: Demirtaş Murat , Falcon Carles , Tucholka Alan , Gispert Juan Domingo , Molinuevo José Luis , Deco Gustavo 
Published: September 2016

AbstractUnderstanding the mechanisms behind Alzheimer’s disease (AD) is one of the most challenging problems in neuroscience. Recent efforts provided valuable insights on the genetic, biochemical and neuronal correlates of AD. The advances in structural and functional neuroimaging provided massive evidence for the AD related alterations in brain connectivity. In this study, we investigated the whole-brain resting state functional connectivity (FC) and variability in dynamic functional connectivity (v-FC) of the subjects with preclinical condition (PC), mild cognitive impairment (MCI) and Alzheimer’s disease (AD). The synchronization in the whole-brain was monotonously decreasing during the course of the progression. However, only in the AD group the reduced synchronization produced significant widespread effects in FC. Furthermore, we found elevated variability of FC in PC group, which was reversed in AD group. We proposed a whole-brain computational modeling approach to study the mechanisms behind these alterations. We estimated the effective connectivity (EC) between brain regions in the model to reproduce observed FC of each subject. First, we compared ECs between groups to identify the changes in underlying connectivity structure. We found that the significant EC changes were restricted to temporal lobe. Then, based on healthy control subjects we systematically manipulated the dynamics in the model to investigate its effect on FC. The model showed FC alterations similar to those observed in clinical groups providing a mechanistic explanation to AD progression.