bluuebunny/crossref_metadata_2025_split huggingface dataset:
Furthering the Validity of a Tool to Assess Simulated Pregnancy Options Counseling Skills
Authors: Lupi Carla , Ward-Peterson Melissa , Coxe Stefany , Minor Suzanne , Eliacin Irmanie , Obeso Vivian 
Published: September 2016

OBJECTIVE:
To further the validity of a tool to assess nondirective pregnancy options counseling skills.

METHODS:
Using a cross-sectional design, we explored four sources of construct validity evidence for an objective structured clinical examination for training and assessment of nondirective pregnancy options counseling: content, response process, internal structure, and relations to other variables. Content of the previously developed tool was enhanced through input from five family medicine educators. The objective structured clinical examination was implemented in a family medicine clerkship with third-year medical students from 2014 to 2015 using trained raters. Response process was addressed after a pilot round. Three new raters evaluated videotapes of 46 performances. Cronbach's alpha, intraclass correlation coefficients, and Spearman's rho were estimated with 95% confidence intervals.

RESULTS:
The content validity was affirmed. Cronbach's alpha was 0.71. According to Landis and Koch's criteria, all but two items unique to the clinical situation of pregnancy options counseling generated substantial to perfect agreement (0.62–1.00). Relations to other variables within the checklist were strong, ranging from 0.66 to 0.87.

DISCUSSION:
This tool for assessing pregnancy options counseling skills has excellent content and strong internal structure. Further work to improve the Global Rating Scale may be necessary for summative use.
Initial Experience With Percutaneous IM Rodding of the Humeri in Children With Osteogenesis Imperfecta
Authors: Grossman Leonid S. , Price Amber L. , Rush Eric T. , Goodwin Jennifer L. , Wallace Maegen J. , Esposito Paul W. 
Published: September 2016

Background:
To report a single-center surgical experience treating humeral deformity and fractures in children with osteogenesis imperfecta (OI) using the Fassier-Duval (FD) intramedullary elongating rods.

Methods:
A retrospective review was conducted between December 2005 and July 2013 of all OI patients who underwent FD rodding with a minimum of 1-year follow-up. All patients were also being concurrently treated with bisphosphonates.

Results:
Eighteen patients underwent internal fixation on a total of 35 humeri: 7 males and 11 females with an average age of 49 months. Thirty-five procedures were performed using FD rodding, with 5 utilizing only the male portion. Thirty procedures were primary FD implantation and 5 were revisions. Twelve patients had type III OI and 6 patients type IV OI. Indications for surgery included recurrent fracture, severe bowing deformity, and pain. Osteotomy methods included closed osteoclasis, percutaneous, or open osteotomies. Two patients required transfusions during their hospital stay. At our determined endpoint, 23 humeri (65.7%) had acceptable results with a mean follow-up time of 43 months (SD=27) with no revision. The remaining 12 humeri (34.3%) necessitated revision with a mean time to revision of 35 months (SD=29). Reasons for revision included: migration resulting in pain and functional difficulty (8.6%), migration with bowing (8.6%), and hardware failure secondary to trauma (8.6%). In addition, 2 revisions were required for nonunion (5.7%) and 1 for malunion (2.9%). To our knowledge, all other osteotomies performed during surgery resulted in bony union.

Conclusions:
The use of the FD system for correction of humeral deformity demonstrates a reasonable option to improve comfort and function in children with recurrent fractures and deformity secondary to OI. The FD system allows for decreased revision rates and less morbid instrumentation.

Level of Evidence:
Level IV—retrospective case series.
Prognosticating Factors of Relapse in Clubfoot Management by Ponseti Method
Authors: Zhao Dahang , Li Hai , Zhao Li , Kuo Ken N. , Yang Xuan , Wu Zhenkai , Liu Jianlin , Zhu Jie 
Published: September 2016

Background:
It is challenging that some Ponseti method corrected clubfeet have a tendency to relapse. Controversies remain as to the implication of initial severity, representing the deformity degree, as well as number of casts needed, representing the treatment process, in predicting relapse. However, no study has been reported to take these 2 parameters into comprehensive consideration for outcome measurement. The purpose of this study is to investigate the correlation between the initial Pirani score and the number of casts required to correct the deformity in our series; to evaluate noncompliance as a risk factor of the deformity recurrence in Ponseti treatment; to test the validity and predictive value of a new proposed parameter, ratio of correction improvement (RCI) which is indicated by the initial Pirani scores divided by the number of casts.

Methods:
A total of 116 consecutive patients with 172 idiopathic clubfeet managed by Ponseti method were followed prospectively for a minimum of 2 years from the start of brace wearing. RCI value and the other clinical parameters were studied in relation to the risk of relapse by using multivariate logistic regression analysis modeling.

Results:
A positive correlation between the initial Pirani score and the number of casts required to correct the deformity was found in our series (r=0.67, P<0.01). There were 45 patients (39%) with brace noncompliance. The relapse rate was 49% (22/45). The odds ratio of relapse in noncompliant patients was 10 times more that in compliant patients (odds ratio=10.30 and 95% confidence interval, 2.69-39.42; P<0.01). The multivariate logistic regression analysis showed that there was significant association between relapse and RCI value. There were 42 patients (36%) with RCI value <1, among them, the relapse rate was 57% in 24 patients. The odds ratio of relapse in patients with RCI value <1 was 27 times more likely to relapse than those >1 (odds ratio=26.77 and 95% confidence interval, 5.70-125.72; P<0.01).

Conclusions:
On the basis of the findings from our study, we propose the RCI to be a new parameter in predicting the risk of relapse in Ponseti method of clubfoot management. Early intervention is recommended to optimize the brace compliance particularly in case with lower RCI value.

Level of Evidence:
Level II—prognostic.
Knee Arthritis in Children: When Can It Be Safely Treated With Needle Joint Aspiration? A Large Children’s Tertiary Hospital Study
Authors: Tornero Eduard , De Bergua-Domingo Josep Maria , Domenech Pedro , Soldado Francisco , Torner Ferran , Castellanos Juan , Soriano Alex , Knörr Jorge 
Published: September 2016

Background:
Early joint decompression associated to antibiotic therapy is the most important procedure to reduce joint damage in septic knee arthritis in children. Several joint decompression methods have been described such as arthrotomy with open debriding, arthroscopic drainage or needle joint aspiration. The aim of the present study was to determinate which patients with acute septic knee arthritis could be safely treated with needle joint aspiration.

Methods:
Patients with an acute knee arthritis diagnosed between September 2003 and December 2013 in our children’s tertiary hospital were retrospective review. All cases were initially treated with needle joint aspiration. Primary end-point was failure of joint aspiration.

Results:
A total of 74 patients were included in the study. Forty-two (56.8%) were male and median age was 1.49 years. Mean delay between onset of symptoms and diagnosis was 3.6 days and in 25 (33.8%) cases patients needed more than 1 visit to the emergency room. Median C-reactive protein (CRP) value was 36.3 mg/L and was >20 mg/L in 59 (79.7%) cases. A total of 11 (14.9%) patients showed failure of the joint aspiration treatment between 3 and 21 days after initial joint aspiration. The stepwise forward logistic regression model only identified as independent predictor of joint aspiration failure an age older than 3 years old (odds ratio, 5.64; 95% confidence interval, 1.38-29.61; P=0.018). Joint aspiration did not fail in any patient younger than 12 months and neither in any patient younger than 3 years old with CRP value <20 mg/L. Otherwise, treatment failed in 38% of patients older than 3 years and in 16% of patients between 1 and 3 years with a CRP>20 mg/L.

Conclusions:
Septic knee arthritis treated with needle joint aspiration succeed in all patients younger than 1 year and in all patients between 1 and 3 years with a CRP<20 mg/L. Alternative treatment such as arthroscopy debridement should be early considered in patients older than 3 years and patients between 1 and 3 years with CRP>20 mg/L.

Level of Evidence:
Level III.
Hospital-Level Changes in Adult ICU Bed Supply in the United States
Authors: Wallace David J. , Seymour Christopher W. , Kahn Jeremy M. 
Published: September 2016

Objectives:
Although the number of intensive care beds in the United States is increasing, little is known about the hospitals responsible for this growth. We sought to better characterize national growth in intensive care beds by identifying hospital-level factors associated with increasing numbers of intensive care beds over time.

Design:
We performed a repeated-measures time series analysis of hospital-level intensive care bed supply using data from Centers for Medicare and Medicaid Services.

Setting:
All United States acute care hospitals with adult intensive care beds over the years 1996–2011.

Patients:
None.

Interventions:
None.

Measurements and Main Results:
We described the number of beds, teaching status, ownership, intensive care occupancy, and urbanicity for each hospital in each year of the study. We then examined the relationship between increasing intensive care beds and these characteristics, controlling for other factors. The study included 4,457 hospitals and 55,865 hospital-years. Overall, the majority of intensive care bed growth occurred in teaching hospitals (net, +13,471 beds; 72.1% of total growth), hospitals with 250 or more beds (net, +18,327 beds; 91.8% of total growth), and hospitals in the highest quartile of occupancy (net, +10,157 beds; 54.0% of total growth). In a longitudinal multivariable model, larger hospital size, teaching status, and high intensive care occupancy were associated with subsequent-year growth. Furthermore, the effects of hospital size and teaching status were modified by occupancy: the greatest odds of increasing ICU beds were in hospitals with 500 or more beds in the highest quartile of occupancy (adjusted odds ratio, 18.9; 95% CI, 14.0–25.5; p < 0.01) and large teaching hospitals in the highest quartile of occupancy (adjusted odds ratio, 7.3; 95% CI, 5.3–9.9; p < 0.01).

Conclusions:
Increasingly, intensive care bed expansion in the United States is occurring in larger hospitals and teaching centers, particularly following a year with high ICU occupancy.
A Direct Observation Checklist to Measure Respect and Dignity in the ICU
Authors: Carrese Joseph A. , Geller Gail , Branyon Emily D. , Forbes Lindsay K. , Topazian Rachel J. , Weir Brian W. , Khatib Omar , Sugarman Jeremy 
Published: September 2016

Objective:
Treating patients and family members with respect and dignity is a core objective of health care, yet it is unclear how best to measure this in the ICU setting. Accordingly, we sought to create a direct observation checklist to assess the “respect and dignity status” of an ICU.

Design:
A draft checklist based on previous work was iteratively revised to enhance accuracy and feasibility.

Setting:
Seven ICUs within the Johns Hopkins Health System.

Subjects:
A total of 351 patient-clinician encounters with 184 different patients.

Interventions:
Four study team members pilot tested the checklist between January and August 2015.

Measurements and Main Results:
Standard psychometric analyses were performed. The direct observation checklist exhibits strong content and face validity as well as high reliability and internal consistency. All items load on one factor that supports the unidimensionality of the total index. Furthermore, concurrent validity of the direct observation checklist is demonstrated by statistically significant differences in mean scores between ICUs, between types of clinicians, and between patients’ clinical status and mood.

Conclusions:
We rigorously developed, pilot tested, and analyzed a direct observation checklist designed to assess the extent to which patients and families in the ICU setting are treated with respect and dignity. Future research should validate this checklist in other settings and compare its results with other measures. Data gathered about individual items on the direct observation checklist could be used to target areas for training and education; doing so should help facilitate more respectful treatment of patients and their families.
Ombitasvir-Paritaprevir-Ritonavir-Dasabuvir (Viekira Pak)–Induced Lactic Acidosis
Authors: Oberg Catherine L. , Hiensch Robert J. , Poor Hooman D. 
Published: September 2016

Objective:
To report a case series of three patients with hepatitis C virus infection who all presented with severe type B lactic acidosis shortly after starting treatment with ombitasvir-paritaprevir-ritonavir-dasabuvir.

Design:
Case series.

Setting:
ICU.

Patients:
Three patients, all who had HCV cirrhosis with mild hepatic impairment (Child-Pugh A) and had started taking ombitasvir-paritaprevir-ritonavir-dasabuvir within the preceding 2 weeks, presented with similar nonspecific symptoms of lethargy, fatigue, and nausea. All had elevated lactate levels at admission without evidence of hypovolemia, cardiogenic failure, or vasodilatory shock.

Interventions:
All patients were given appropriate supportive intensive care for what was initially suspected to be sepsis, including a minimum of 30 mL/kg of IV fluids, infectious workup including blood cultures, broad-spectrum antibiotics, and mechanical ventilatory support. The first patient received continuous veno-venous hemofiltration. The second patient received hemodialysis. The third patient was initially started on hemodialysis despite high norepinephrine requirements and ultimately transitioned to continuous veno-venous hemofiltration.

Measurements and Main Results:
The first patient died despite maximal intensive care. The second patient improved immediately upon starting hemodialysis and was extubated within 48 hours and discharged home. The third patient eventually became hypotensive and was treated with repeated sessions of renal replacement therapy. He ultimately was extubated and discharged home. The infectious workup was negative for all three patients, and antibiotics were discontinued after 2 days in the second and third patients.

Conclusions:
Ombitasvir-paritaprevir-ritonavir-dasabuvir may cause type B lactic acidosis. Further study is warranted to identify risk factors and elucidate the mechanisms of excessive lactate production.
Association Between Executive Function and Problematic Adolescent Driving
Authors: Pope Caitlin N. , Ross Lesley A. , Stavrinos Despina 
Published: September 2016

ABSTRACT:

Objective:
Motor vehicle collisions (MVCs) are one of the leading causes of injury and death for adolescents. Driving is a complex activity that is highly reliant on executive function (EF) to safely navigate through the environment. Little research has examined the efficacy of using self-reported EF measures for assessing adolescent driving risk. This study examined the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire and performance-based EF tasks as potential predictors of problematic driving outcomes in adolescents.

Methods:
Forty-six adolescent drivers completed the (1) BRIEF, (2) Trail Making Test, (3) Backwards Digit Span, and (4) self-report on 3 problematic driving outcomes: the number of times of having been pulled over by a police officer, the number of tickets issued, and the number of MVCs.

Results:
Greater self-reported difficulty with planning and organization was associated with greater odds of having a MVC, whereas inhibition difficulties were associated with greater odds of receiving a ticket. Greater self-reported difficulty across multiple BRIEF subscales was associated with greater odds of being pulled over.

Conclusion:
Overall findings indicated that the BRIEF, an ecological measure of EF, showed significant association with self-reported problematic driving outcomes in adolescents. No relationship was found between performance-based EF measures and self-reported driving outcomes. The BRIEF could offer unique and quick insight into problematic driving behavior and potentially be an indicator of driving risk in adolescent drivers during clinical evaluations.
Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Temple
Authors: Carruthers Jean , Jones Derek , Hardas Bhushan , Murphy Diane K. , Donofrio Lisa , Sykes Jonathan M. , Carruthers Alastair , Creutz Lela , Marx Ann , Dill Sara 
Published: September 2016

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

OBJECTIVE
To describe the development and validation of the 5-point photonumeric Allergan Temple Hollowing 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 = 298) completed during 2 sessions occurring 3 weeks apart.

RESULTS
A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.1 [0.94–1.26] for clinically different image pairs and 0.67 [0.51–0.83] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (mean weighted kappa = 0.86). Interrater agreement was almost perfect during the second session (0.81, primary endpoint).

CONCLUSION
The Allergan Temple Hollowing Scale is a validated and reliable scale for physician rating of temple volume deficit.
Development and Validation of a Photonumeric Scale for Evaluation of Volume Deficit of the Hand
Authors: Jones Derek , Donofrio Lisa , Hardas Bhushan , Murphy Diane K. , Carruthers Jean , Carruthers Alastair , Sykes Jonathan M. , Creutz Lela , Marx Ann , Dill Sara 
Published: September 2016

BACKGROUND
A validated scale is needed for objective and reproducible comparisons of hand appearance before and after treatment in practice and clinical studies.

OBJECTIVE
To describe the development and validation of the 5-point photonumeric Allergan Hand Volume Deficit 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 = 296) completed during 2 sessions occurring 3 weeks apart.

RESULTS
A score difference of ≥1 point was shown to reflect a clinically significant difference (mean [95% confidence interval] absolute score difference, 1.12 [0.99–1.26] for clinically different image pairs and 0.45 [0.33–0.57] for not clinically different pairs). Intrarater agreement between the 2 validation sessions was almost perfect (mean weighted kappa = 0.83). Interrater agreement was almost perfect during the second session (0.82, primary end point).

CONCLUSION
The Allergan Hand Volume Deficit Scale is a validated and reliable scale for physician rating of hand volume deficit.
Therapeutic Efficacy of Intralesional Steroid With Carbon Dioxide Laser Versus With Cryotherapy in Treatment of Keloids: A Randomized Controlled Trial
Authors: Behera Biswanath , Kumari Rashmi , Thappa Devinder Mohan , Malathi Munisamy 
Published: September 2016

BACKGROUND
Keloids are difficult to treat due to their poor response and high recurrence rate.

OBJECTIVE
We conducted a randomized controlled trial to compare the therapeutic efficacy of intralesional triamcinolone acetonide (ILTA) in combination with carbon dioxide laser (Group 1) versus in combination with cryotherapy (Group 2) in the treatment of keloids.

MATERIALS AND METHODS
Sixty patients with 101 keloids were randomized into 2 groups. On Day 1, keloids were ablated using either CO2 laser or cryotherapy followed by injection of ILTA at baseline and at 4 weeks interval for 3 months. Patients were followed up for 12 months to assess for therapeutic response and side effects.

RESULTS
Successful therapeutic response (>50% improvement) between the 2 groups (CO2 vs cryotherapy) were assessed in terms of reduction in thickness, reduction in volume, patient's self-assessment, observer's assessment, and Vancouver Scar Scale score at the end of 6 months and 12 months (55.55% vs 70.37%; 61.1% vs 77.8%; 75% vs 77.78%; 61.12% vs 85.18%; 52.78% vs 62.96% respectively). The difference in therapeutic response between the 2 groups was not statistically significant at the end of 12 months.

CONCLUSION
Both CO2 laser and cryotherapy in combination with ILTA were found to be equally effective in the treatment of keloids.
Facial Treatment Preferences Among Aesthetically Oriented Men
Authors: Jagdeo Jared , Keaney Terrence , Narurkar Vic , Kolodziejczyk Julia , Gallagher Conor J. 
Published: September 2016

BACKGROUND
There is a paucity of data describing male attitudes toward age-related changes to their facial features and associated preferences for prioritizing treatment.

METHODS
Injectable-naive but aesthetically oriented men aged 30 to 65 participated in an online study (N = 600). Respondents indicated how concerned they were by the appearance of 15 age-related facial features, and the Maximum Difference scaling system was used to explore which features were most likely to be prioritized for treatment. The correlation between the features of most concern and the areas of treatment priority was assessed. Other aspects regarding the male perspective on aesthetic procedures, such as awareness, motivating factors, and barriers, also were explored.

RESULTS
Crow's feet and tear troughs were rated as the most likely to be treated first (80% of first preferences) followed by forehead lines (74%), double chin (70%), and glabellar lines (60%). The areas of most concern in order were tear troughs, double chin, crow's feet, and forehead lines. There was a strong correlation between the features of most concern and the areas of treatment priority (r
2 = 0.81).

CONCLUSION
The periorbital areas, in particular crow's feet and tear troughs, are of most concern and likely to be prioritized for treatment among aesthetically oriented men.