bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Oral Medication on Wound Healing
Authors: Levine Jeffrey M. 
Published: February 2017

GENERAL PURPOSE:
The purpose of this learning activity is to provide information about the effects of oral medications on wound healing.

TARGET AUDIENCE:
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:
After participating in this educational activity, the participant should be better able to:
1. Identify oral medications that aid in wound healing.
2. Recognize oral medications that interfere with wound healing.

ABSTRACT
Given the accelerated medical discoveries of recent decades, there is a surprising lack of oral medications that directly improve wound healing. Of the oral medications available, most target ancillary aspects of wound care such as pain management, infection mitigation, and nutrition. This article describes oral pharmacologic agents intended to build new tissue and aid in wound healing, as well as an introduction to oral medications that interfere with wound healing. This review will not discuss the pharmacology of pain management or treatment of infection, nor will it address nutritional supplements.
Structural Failure Sites in Anterior Vaginal Wall Prolapse: Identification of a Collinear Triad
Authors: Chen Luyun , Lisse Sean , Larson Kindra , Berger Mitchell B. , Ashton-Miller James A. , DeLancey John O. L. 
Published: February 2017

(Abstracted from Obstet Gynecol 2016;128:853–862)
The most common form of pelvic organ prolapse and the most frequent site of operative failure is cystocele formation (anterior vaginal wall prolapse). Potential fascial and muscular failure factors (anatomic sites of injury) identified as causal factors contributing to cystocele formation include 2 vaginal failure sites (apical support and paravaginal defects), 2 vaginal wall factors (vaginal width and length), and 2 levator ani factors (hiatus size and levator ani defects).
Fetal and Neonatal Outcomes After Term and Preterm Delivery After Betamethasone Administration in Twin Pregnancies
Authors: Braun Thorsten , Weichert Alexander , Gil Hannah C. , Sloboda Deborah M. , Tutschek Boris , Harder Thomas , Dudenhausen Joachim W. , Plagemann Andreas , Henrich Wolfgang 
Published: February 2017

(Abstracted from Int J Gynaecol Obstet 2016;134:329–335)
Prenatal betamethasone administration in singleton pregnancies is associated with a dose-dependent decrease in birth weight. This study aimed to determine the effects of betamethasone overall, and at different doses on fetal growth and neonatal outcomes in twin pregnancies based on fetal sex, chorionicity, and severity of prematurity.
Understanding the Role of Religious Views in the Discussion About Resuscitation at the Threshold of Viability
Authors: McGuirl J. , Campbell D. 
Published: February 2017

(Abstracted from J Perinatol 2016;36:694–698)
One of the challenges faced by neonatologists and obstetric care providers is their interaction with parents expecting the delivery of a fetus at the “threshold of viability,” between 22 weeks and 25 weeks of gestation. Conversations regarding the chances of survival, the probability of survival without disability, or the risk of moderate to severe disability are common in such situations.
Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-Term Weight Loss: The IDEA Randomized Clinical Trial
Authors: Jakicic John M. , Davis Kelliann K. , Rogers Renee J. , King Wendy C. , Marcus Marsha D. , Helsel Diane , Rickman Amy D. , Wahed Abdus S. , Belle Steven H. 
Published: February 2017

(Abstracted from JAMA 2016;316(11):1161–1171)
Obesity is an increasing public health concern and is associated with several health conditions. Commercial technologies, including wearable devices, are available to monitor physical activity and diet and have been demonstrated to be moderately effective in promoting weight loss in prior studies.
Risk of Psychiatric Illness From Advanced Paternal Age Is Not Predominantly From De Novo Mutations
Authors: Gratten Jacob , Wray Naomi R. , Peyrot Wouter J. , McGrath John J. , Visscher Peter M. , Goddard Michael E. 
Published: February 2017

(Abstracted from Nat Genet 2016;48:718–724)
Epidemiologic studies have reported an increased risk of schizophrenia, autism, and other psychiatric disorders among offspring of older fathers. It is widely assumed that paternal age–related de novo mutations are the primary underlying causal mechanism.
Feedback for Learners in Medical Education: What Is Known? A Scoping Review
Authors: Bing-You Robert , Hayes Victoria , Varaklis Kalli , Trowbridge Robert , Kemp Heather , McKelvy Dina 
Published: February 2017

Purpose
To conduct a scoping review of the literature on feedback for learners in medical education.

Method
In 2015–2016, the authors searched the Ovid MEDLINE, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Web of Science, and Scopus databases and seven medical education journals (via OvidSP) for articles published January 1980–December 2015. Two reviewers screened articles for eligibility with inclusion criteria. All authors extracted key data and analyzed data descriptively.

Results
The authors included 650 articles in the review. More than half (n = 341) were published during 2010–2015. Many centered on medical students (n = 274) or residents (n = 192); some included learners from other disciplines (n = 57). Most (n = 633) described methods used for giving feedback; some (n = 95) described opinions and recommendations regarding feedback. Few studies assessed approaches to feedback with randomized, educational trials (n = 49) or described changes in learner behavior after feedback (n = 49). Even fewer assessed the impact of feedback on patient outcomes (n = 28).

Conclusions
Feedback is considered an important means of improving learner performance, as evidenced by the number of articles outlining recommendations for feedback approaches. The literature on feedback for learners in medical education is broad, fairly recent, and generally describes new or altered curricular approaches that involve feedback for learners. High-quality, evidence-based recommendations for feedback are lacking. In addition to highlighting calls to reassess the concepts and complex nature of feedback interactions, the authors identify several areas that require further investigation.
Emergency Medical Technician Training During Medical School: Benefits for the Hidden Curriculum
Authors: Russ-Sellers Rebecca , Blackwell Thomas H. 
Published: February 2017

Problem
Medical schools are encouraged to introduce students to clinical experiences early, to integrate biomedical and clinical sciences, and to expose students to interprofessional health providers and teams. One important goal is for students to gain a better understanding of the patients they will care for in the future and how their social and behavioral characteristics may affect care delivery.

Approach
To promote early clinical exposure and biomedical integration, in 2012 the University of South Carolina School of Medicine Greenville incorporated emergency medical technician (EMT) training into the curriculum. This report describes the program; outlines changes (made after year 1) to improve biomedical integration; and provides a brief analysis and categorization of comments from student reflections to determine whether particular themes, especially related to the hidden curriculum, appeared.

Outcomes
Medical students wrote frequently about EMT-related experiences: 29% of reflections in the charter year (1.2 per student) and 38% of reflections in the second year (1.5 per student) focused on EMT-related experiences. Reflections related to patient care, professionalism, systems-based practice, and communication/interpersonal skills. The frequency of themes in student reflections may provide insight into a medical program’s hidden curriculum. This information may serve to inform curricula that focus on biosocial elements such as professionalism and communication with the goal of enhancing future physicians’ tolerance, empathy, and patient-centeredness.

Next Steps
The authors plan to conduct further qualitative analysis of student reflections to iteratively revise curricula to address gaps both in learning and in the differences between the explicit curriculum and actual experiences.
Training Internal Medicine Residents in Social Medicine and Research-Based Health Advocacy: A Novel, In-Depth Curriculum
Authors: Basu Gaurab , Pels Richard J. , Stark Rachel L. , Jain Priyank , Bor David H. , McCormick Danny 
Published: February 2017

Problem
Health disparities are pervasive worldwide. Physicians have a unique vantage point from which they can observe the ways social, economic, and political factors impact health outcomes and can be effective advocates for enhanced health outcomes and health equity. However, social medicine and health advocacy curricula are uncommon in postgraduate medical education.

Approach
In academic year (AY) 2012, the Cambridge Health Alliance internal medicine residency program transformed an elective into a required social medicine and research-based health advocacy curriculum. The course has three major innovations: it has a yearlong longitudinal curriculum, it is required for all residents, and all residents complete a group research-based health advocacy project within the curricular year. The authors describe the structure, content, and goals of this curriculum.

Outcomes
Over the last four years (AYs 2012–2015), residents (17/32; 53%) have rated the overall quality of the course highly (mean = 5.2, where 6 = outstanding; standard deviation = 0.64). In each year since the new course has been implemented, all scholarly work from the course has been presented at conferences by 31 resident presenters and/or coauthors. The course seems to enhance the residency program’s capacity to recruit high-caliber residents and faculty members.

Next Steps
The authors are collecting qualitative and quantitative data on the impact of the course. They will use their findings to advocate for a national health advocacy competency framework. Recommendations about how to initiate or further develop social medicine and health advocacy curricula are offered.
Interprofessional Medical–Legal Education of Medical Students: Assessing the Benefits for Addressing Social Determinants of Health
Authors: Pettignano Robert , Bliss Lisa , McLaren Susan , Caley Sylvia 
Published: February 2017

Problem
Screening tools exist to help identify patient issues related to social determinants of health (SDH), but solutions to many of these problems remain elusive to health care providers as they require legal solutions. Interprofessional medical–legal education is essential to optimizing health care delivery.

Approach
In 2011, the authors implemented a four-session didactic interprofessional curriculum on medical–legal practice for third-year medical students at Morehouse School of Medicine. This program, also attended by law students, focused on interprofessional collaboration to address client/patient SDH issues and health-harming legal needs. In 2011–2014, the medical students participated in pre- and postintervention surveys designed to determine their awareness of SDH’s impact on health as well as their attitudes toward screening for SDH issues and incorporating resources, including a legal resource, to address them. Mean ratings were compared between pre- and postintervention respondent cohorts using independent-sample t tests.

Outcomes
Of the 222 medical students who participated in the program, 102 (46%) completed the preintervention survey and 100 (45%) completed the postintervention survey. Postintervention survey results indicated that students self-reported an increased likelihood to screen patients for SDH issues and an increased likelihood to refer patients to a legal resource (P < .001).

Next Steps
Incorporating interprofessional medical–legal education into undergraduate medical education may result in an increased likelihood to screen patients for SDH and to refer patients with legal needs to a legal resource. In the future, an additional evaluation to assess the curriculum’s long-term impact will be administered prior to graduation.
Proposing a Model of Co-Regulated Learning for Graduate Medical Education
Authors: Rich Jessica V. 
Published: February 2017

Primarily grounded in Zimmerman’s social cognitive model of self-regulation, graduate medical education is guided by principles that self-regulated learning takes place within social context and influence, and that the social context and physical environment reciprocally influence persons and their cognition, behavior, and development. However, contemporary perspectives on self-regulation are moving beyond Zimmerman’s triadic reciprocal orientation to models that consider social transactions as the central core of regulated learning. Such co-regulated learning models emphasize shared control of learning and the role more advanced others play in scaffolding novices’ metacognitive engagement.
Models of co-regulated learning describe social transactions as periods of distributed regulation among individuals, which instrumentally promote or inhibit the capacity for individuals to independently self-regulate. Social transactions with other regulators, including attending physicians, more experienced residents, and allied health care professionals, are known to mediate residents’ learning and to support or hamper the development of their self-regulated learning competence. Given that social transactions are at the heart of learning-oriented assessment and entrustment decisions, an appreciation for co-regulated learning is likely important for advancing medical education research and practice—especially given the momentum of new innovations such as entrustable professional activities.
In this article, the author explains why graduate medical educators should consider adopting a model of co-regulated learning to complement and extend Zimmerman’s models of self-regulated learning. In doing so, the author suggests a model of co-regulated learning and provides practical examples of how the model is relevant to graduate medical education research and practice.
Lipids and lipid changes with synthetic and biologic disease-modifying antirheumatic drug therapy in rheumatoid arthritis: implications for cardiovascular risk
Authors: Myasoedova Elena 
Published: February 2017

Purpose of review
To highlight recently published studies addressing lipid changes with disease-modifying antirheumatic drug use and outline implications on cardiovascular outcomes in rheumatoid arthritis (RA).

Recent findings
Growing evidence suggests lower lipid levels are present in patients with active RA vs. general population, and significant modifications of lipid profile with inflammation suppression. Increase in lipid levels in patients with RA on synthetic and biological disease-modifying antirheumatic drugs may be accompanied by antiatherogenic changes in lipid composition and function. The impact of lipid changes on cardiovascular outcomes in RA is a subject of active research. The role of lipids in cardiovascular risk in RA may be overpowered by the benefits of inflammation suppression with antirheumatic medication use. Recommendations on lipid management in RA are evolving but uncertainty exists regarding frequency of lipid testing and goals of treatment.

Summary
Knowledge about quantitative and qualitative lipid changes in RA is expanding. The relative role of lipids in cardiovascular risk in the context of systemic inflammation and antirheumatic therapy remains uncertain, delaying development of effective strategies for cardiovascular risk management in RA. Studies are underway to address these knowledge gaps and may be expected to inform cardiovascular risk management in RA and the general population.
Recent advances in the pathogenesis, prediction, and management of rheumatoid arthritis-associated interstitial lung disease
Authors: Johnson Cheilonda 
Published: February 2017

Purpose of review
To provide an overview of recently published articles covering interstitial lung disease associated with rheumatoid arthritis (RA-ILD).

Recent findings
Over the past year, many studies replicated previous findings in more diverse and occasionally larger populations internationally. Specifically, the association among cigarette smoking, high rheumatoid factor titer, elevated anticitrullinated protein antibody (ACPA) levels, and RA-ILD was strengthened. Clinical characteristics, autoantibodies, and biomarkers to aid in RA-ILD development, progression, and mortality prediction were explored. Finally, direct and indirect treatment effects were highlighted.

Summary
The ability to identify risk factors for preclinical RA-ILD has been enhanced, but the proper management strategy for these patients is yet to be defined. ACPAs and cigarette smoking are highly associated with RA-ILD, but the mechanistic relationship between lung injury and autoantibody generation remains unknown. There is conflicting evidence regarding the significance of a usual interstitial pneumonia (UIP) versus non-UIP pattern on high-resolution computed tomography. The use of biologic agents in patients with rheumatoid arthritis does not appear to increase the risk of incident ILD or RA-ILD exacerbation. Randomized prospective studies of specific therapy for RA-ILD are still lacking.
When Is a Fracture Not “Fresh”? Aligning Reimbursement With Patient Outcome After Treatment With Low-Intensity Pulsed Ultrasound
Authors: Zura Robert , Xu Zekun (Jack) , Della Rocca Gregory J. , Mehta Samir , Steen R. Grant 
Published: February 2017

Objective:
The clinical value of low-intensity pulsed ultrasound (LIPUS) for fresh fracture is known. Yet, in the absence of a definition of what “fresh” is, payers have adopted study inclusion criteria drawn from randomized clinical trials as de facto definitions of which patients should be treated, with “fresh” defined as <1 week old. Patients with fracture may thus be ineligible for LIPUS treatment after week 1, which potentially denies access to patients who could benefit from LIPUS. We seek to characterize the inflection point at which heal rate declines.

Design:
Prospective cohort.

Setting:
Food and Drug Administration–mandated nationwide postmarketing surveillance registry.

Patients:
Observational cohort of 5983 registry enrollees.

Intervention:
LIPUS, 20 min/d.

Main Outcome Measure:
Fracture heal rate. Logistic regression was used to model the odds ratio of nonunion from week 1 to week 12. Covariates in the model included age, gender, body mass index, open fracture, and smoking.

Results:
We estimated the time point at which a fracture responds to LIPUS as well as during the first week after fracture. There was significant bone-to-bone variation; metatarsal was “fresh” until week 7, ankle until week 9, humerus until week 10, and femur and radius until week 12. Healing was significantly impacted by patient age, body mass index, and open fracture (all, P ≤ 0.02).

Conclusions:
Our results suggest that fractures of the metatarsal, femur, humerus, ankle, and radius respond to LIPUS treatment, as if they were still fresh at least 6 weeks longer than the eligibility allowed under current coverage policies.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
When Should We Change Drill Bits? A Mechanical Comparison of New, Reprocessed, and Damaged Bits
Authors: Myers Richard , Kim Hyunchul , Hsieh Adam H. , O'Toole Robert V. , Sciadini Marcus F. 
Published: February 2017

Objectives:
We assessed how reprocessed and damaged drill bits perform relative-to-new drill bits in terms of drilling force required, heat generated at near and far cortices, and number of usable passes.

Methods:
Nine pairs of nonosteoporotic human cadaveric femora were tested using 3 types of 3.2-mm drill bits (new, reprocessed, and damaged) in 3 investigations (force, temperature, and multiple usable passes). Operating room conditions were simulated. Force and temperature data were collected for each type. The multiple pass investigation measured only force.

Results:
New and reprocessed drill bits performed similarly regarding force required and heat generated; both outperformed damaged bits. New and reprocessed bits had a similar number of usable passes in ideal conditions. Damaged bits required nearly 2.6 times as much force to maintain drilling rate.

Conclusions:
Reprocessed drill bits seem to be a viable alternative to new drill bits for fracture treatment surgery in terms of force required, heat generated, and number of usable passes. Drill bits that are damaged intraoperatively should be replaced. In ideal conditions, new and reprocessed drill bits can be used for multiple consecutive cases.

Clinical Relevance:
Reprocessed drill bits may be as effective as new drill bits, representing potential cost savings for institutions. Both types can be considered for reuse.
Gravity Stress Radiographs and the Effect of Ankle Position on Deltoid Ligament Integrity and Medial Clear Space Measurements
Authors: Ashraf Ali , Murphree Jacob , Wait Eric , Winston Travis , Wooldridge Adam , Meriwether Matthew , Wilson Joshua , Grimes Jerry S. 
Published: February 2017

Introduction:
External rotation and gravity stress radiographs have been described to distinguish stable supination-external rotation-II (SER-II) ankle fractures from unstable SER-IV fractures. It has been previously shown that both external rotation and gravity stress views are equivalent in their ability to diagnose deltoid ligament injury. It has also been shown that the position of the ankle influences the external rotation stress radiograph. However, no data of ankle position exist for gravity stress radiographs.

Methods:
Eight fresh-frozen cadaveric ankles were dissected and destabilized sequentially according to the SER mechanism of ankle fractures, starting with the anterior inferior tibiofibular ligament, distal fibula osteotomy at the level of the syndesmosis, posterior inferior tibiofibular ligament, superficial deltoid ligament, and finally the deep deltoid ligament. Fluoroscopic radiographs were taken with gravity stress views in both neutral and plantarflexion. Measurements of both dorsal and the medial clear space were taken for each stage. The difference between the dorsal and medial clear space was measured.

Results:
Positive predictive value (PPV) with a medial clear space cutoff of 5 mm was 80% in plantarflexion and 72.72% in neutral with a negative predictive value (NPV) of 100% in both positions. Using a 6-mm cutoff, the PPV improved to 100% and NPV remained 100% for both neutral and plantarflexion. When the difference measurement is used, a 1.0-mm difference yielded a PPV of 72% and an NPV of 100% in both neutral and plantarflexion. With a 1.5-mm cutoff, the PPV and NPV were 100% for both positions.

Conclusions:
The position of the ankle during gravity stress radiographs does not influence the clinical effectiveness of the images. Using larger references for stability, the PPV can be improved.