bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Evolving Purposes of Medical Revalidation in the United Kingdom: A Qualitative Study of Professional and Regulatory Narratives
Authors: Tazzyman Abigail , Ferguson Jane , Walshe Kieran , Boyd Alan , Tredinnick-Rowe John , Hillier Charlotte , Regan De Bere Samantha , Archer Julian 
Published: November 2017

Purpose
Previous research found professionalism and regulation to be competing discourses when plans for medical revalidation in the United Kingdom were being developed in 2011. The purpose of this study was to explore how these competing discourses developed and how the perceived purposes of revalidation evolved as the policy was implemented.

Method
Seventy-one interviews with 60 UK policy makers and senior health care leaders were conducted during the development and implementation of revalidation: 31 in 2011, 26 in 2013, and 14 in 2015. Interviewees were selected using purposeful sampling. Across all interviews, questions focused around three areas: individual roles in relation to revalidation; interviewees’ understanding of revalidation, its purpose, and aims; and predictions or experiences of revalidation’s impact. The first two interview sets also included questions about measurement and evaluation of revalidation. Data were analyzed using the constant comparative method to understand changes and continuities.

Results
Two main discourses regarding the purpose of revalidation were present across the implementation period: professionalism and regulation. The nature of the relationship between these two purposes and how they were described changed over time, with the separate discourses converging, and early concerns about actual or potential conflict being replaced by perceptions of coexistence or codependency.

Conclusions
The changing nature of the discourse about revalidation suggests that early concerns about adverse consequences were not borne out as organizations and professionals engaged with implementation and experienced the realities of revalidation in practice. Reconciling professional and regulatory narratives was arguably necessary to the effective implementation of revalidation.
The Hidden Curricula of Medical Education: A Scoping Review
Authors: Lawrence Carlton , Mhlaba Tsholofelo , Stewart Kearsley A. , Moletsane Relebohile , Gaede Bernhard , Moshabela Mosa 
Published: November 2017

Purpose
To analyze the plural definitions and applications of the term “hidden curriculum” within the medical education literature and to propose a conceptual framework for conducting future research on the topic.

Method
The authors conducted a literature search of nine online databases, seeking articles published on the hidden, informal, or implicit curriculum in medical education prior to March 2017. Two reviewers independently screened articles with set inclusion criteria and performed kappa coefficient tests to evaluate interreviewer reliability. They extracted, coded, and analyzed key data, using grounded theory methodology.

Results
The authors uncovered 3,747 articles relating to the hidden curriculum in medical education. Of these, they selected 197 articles for full review. Use of the term “hidden curriculum” has expanded substantially since 2012. U.S. and Canadian medical schools are the focus of two-thirds of the empirical hidden curriculum studies; data from African and South American schools are nearly absent. Few quantitative techniques to measure the hidden curriculum exist. The “hidden curriculum” is understood as a mostly negative concept. Its definition varies widely, but can be understood via four conceptual boundaries: (1) institutional–organizational, (2) interpersonal–social, (3) contextual–cultural, and/or (4) motivational–psychological.

Conclusions
Future medical education researchers should make clear the conceptual boundary or boundaries they are applying to the term “hidden curriculum,” move away from general musings on its effects, and focus on specific methods for improving the powerful hidden curriculum.
“Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine
Authors: LaDonna Kori A. , Ginsburg Shiphra , Watling Christopher 
Published: November 2017

Purpose
Mistakes are ubiquitous in medicine; when confronted by error, physicians may experience anxiety, guilt, and self-doubt. Feedback may be useful for navigating these feelings, but only if it matches a physician’s self-assessment; self-doubt and the imposter syndrome are examples of inaccurate self-assessments that may affect receptivity to feedback. The impact of real or imagined underperformance on seemingly competent physicians is poorly understood. This study aimed to develop a deeper understanding to identify strategies to support all physicians who struggle.

Method
In 2015, 28 physicians were interviewed about their experiences with underperformance. Early in the data collection process, participants spontaneously identified the imposter syndrome as a feature of their experiences; questions about the imposter syndrome were probed in subsequent interviews.

Results
Many participants—even those at advanced career stages—questioned the validity of their achievements; progressive independence and career advancement were variably experienced as “rising to the level of your incompetence.” Not all participants identified as imposters; the imposter syndrome occurred at the extreme end of a spectrum of self-doubt. Even positive feedback could not buffer participants’ insecurities, which participants rarely shared with their colleagues.

Conclusions
Self-doubt variably affects clinicians at all career stages. Frequent transitions may cause a resurgence of self-doubt that may affect feedback credibility. Medical educators must recognize that it is not just the underperforming or failing learners who struggle and require support, and medical culture must create space for physicians to share their struggles.
Knee joint reconstruction using liquid nitrogen recycled autograft prosthesis composite after wide resection for high-grade chondrosarcoma
Authors: Abdel Rahman Mohamed , Mashhour Mohamed Ahmed , El Masry Ayman Mohammad , Azmy Sherif Ishak 
Published: November 2017

Background:
Chondrosarcoma is the second most common malignant primary tumor of bone. The prognosis for chondrosarcoma depends mainly on its histologic grading and location. High-grade chondrosarcoma has higher a tendency to recur and metastasize. The standard treatment for chondrosarcoma is wide resection without adjuvant therapy. Numerous reconstructive options are available, varying from endoprostheses, biological reconstruction using allografts or osteoarticular allografts, and recycling of tumor-bearing segment.

Methods:
We retrospectively reviewed seven patients with high-grade chondrosarcoma who underwent wide resection of the tumor mass and reconstruction using liquid nitrogen treated recycled autograft prosthesis composite. Evaluation was done for local recurrence, metastasis, graft-bone union, osteosynthesis, implant, or graft-related complications. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system.

Results:
The mean follow-up period was 46 mo (range 24-65 mo). The average duration for graft union was 8.2 mo (range 7-10 mo). No local recurrence was detected in any patient. None of them had any metastatic deposits. One had a superficial wound infection. One had fulminant infection that required hip disarticulation. The mean Musculoskeletal Tumour Society functional score was 67.7% (range 60-78).

Conclusions:
Recycled autograft prosthesis composite using liquid nitrogen is an oncologically safe and effective reconstructive option for the management of chondrosarcoma around the knee. It maintains knee function and restores the bone stock. It overcomes endoprosthesis-related problems, overcoming the obstacles of allograft in countries where it is not available or not socially or religiously acceptable.
Challenges in using the internet to evaluate value in orthopaedic surgery
Authors: Bernstein David N. , Mesfin Addisu , Bozic Kevin J. 
Published: November 2017

Background:
The Internet is one tool commonly used by patients to seek out healthcare information, including for orthopaedics. Our goal was to determine and compare the availability (“findability”) of cost, quality, and patient experience information related to orthopaedic services with and without a geographic identifier.

Methods:
A list of 21 common search terms was compiled a priori. Using Google, each term was searched with and without a geographic identifier; the top 15 results were recorded. Findability, source of information, website ownership, information available (cost, quality, and/or patient experience), and frequency of website updates were noted. Bivariate analysis was used to compare results.

Results:
The prevalence of provider websites was significantly higher using the geographic identifier (47% vs. 0%, P=0.023). There was a significantly higher prevalence of patient experience information when using the location-specific search terms (59% vs. 11%, 0.036). However, there was no difference in the prevalence of sites offering cost (0% vs. 0%, P=0.99) or quality (59% vs. 33%, P=0.41) information between the two groups. No website in either search provided cost information. Ownership did not differ between the two search groups: government (0% vs. 11%, P=0.35); non-profit (41% vs. 11%, P=0.19); and for-profit (59% vs. 78%, P=0.42).

Conclusions:
The Internet can be a rich source of quality and patient experience information for orthopaedic patients. However, the use of search engine optimization and other marketing techniques may limit the ability of patients to receive unbiased and complete information.
Prior staphylococcal bacteremia and risk of surgical site infection after total joint arthroplasty: a nested case-control study
Authors: Everhart Joshua S. , Mayerson Joel L. , Glassman Andrew H. , Barlow Jonathan D. , Bishop Julie Y. , Scharschmidt Thomas J. 
Published: November 2017

Background:
Staphylococcus species can become dormant, causing recurrent infection after long latent periods. We sought to determine surgical site infection (SSI) risk after knee, hip, or shoulder arthroplasty with a history of staphylococcal bacteremia.

Methods:
Data on 7604 patients who underwent primary or revision knee, hip, or shoulder arthroplasty were reviewed. Twenty-four cases of prior documented staphylococcal bacteremia were identified. These cases were matched 1:4 to controls with similar procedures, surgical indications, and medical comorbidities. Conditional logistic regression was used to determine the risk of SSI due to prior bacteremia relative to medically similar controls.

Results:
Staphylococcal isolates at the time of most recent bacteremia were methicillin-sensitive S. aureus (MSSA)( 9/24), methicillin-resistant S. aureus (MRSA)(8/24), and methicillin-resistant S. epidermidis (MRSE)(7/24). Prior patients with bacteremia who developed subsequent SSI (46%, 11/24 patients) all presented within 6 mo (mean 32.0 days IQR 10-142) with deep infection and positive perarticular tissue or synovial aspirate cultures. The conditional odds ratio (cOR) for SSI among prior bacteremia patients was greater than 7-fold that of controls (cOR 7.28 CI 2.21, 24.1; P<0.001). Among prior native or periprosthetic joint infection patients, prior bacteremia did not significantly increase recurrent SSI risk after two-stage arthroplasty (cOR 1.52 CI 0.29, 7.94 P=0.62). Among patients without prior joint infections, bacteremia significantly elevated future SSI risk (cOR 28.0 CI 3.44, 227, P=0.002).

Conclusions:
A history of staphylococcal bacteremia poses a significantly elevated risk of deep infection after hip, knee, or shoulder arthroplasty in patients without a prior native or periprosthetic joint infection.
Prolonged Infusion Piperacillin-Tazobactam Decreases Mortality and Improves Outcomes in Severely Ill Patients: Results of a Systematic Review and Meta-Analysis*
Authors: Rhodes Nathaniel J. , Liu Jiajun , O’Donnell J. Nicholas , Dulhunty Joel M. , Abdul-Aziz Mohd H. , Berko Patsy Y. , Nadler Barbara , Lipman Jeffery , Roberts Jason A. 
Published: November 2017

Objective:
Piperacillin-tazobactam is a commonly used antibiotic in critically ill patients; however, controversy exists as to whether mortality in serious infections can be decreased through administration by prolonged infusion compared with intermittent infusion. The purpose of this systematic review and meta-analysis was to describe the impact of prolonged infusion piperacillin-tazobactam schemes on clinical endpoints in severely ill patients.

Design:
We conducted a systematic literature review and meta-analysis searching MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library from inception to April 1, 2017, for studies.

Interventions:
Mortality rates were compared between severely ill patients receiving piperacillin-tazobactam via prolonged infusion or intermittent infusion. Included studies must have reported severity of illness scores, which were transformed into average study-level mortality probabilities.

Measurements and Main Results:
Two investigators independently screened titles, abstracts, and full texts of studies meeting inclusion criteria for this systematic review and meta-analysis. Variables included author name, publication year, study design, demographics, total daily dose(s), average estimated creatinine clearance, type of prolonged infusion, prevalence of combination therapy, severity of illness scores, infectious sources, all-cause mortality, clinical cure, microbiological cure, and hospital and ICU length of stay. The review identified 18 studies including 3,401 patients who received piperacillin-tazobactam, 56.7% via prolonged infusion. Across all studies, the majority of patients had an identified primary infectious source. Receipt of prolonged infusion was associated with a 1.46-fold lower odds of mortality (95% CI, 1.20–1.77) in the pooled analysis. Patients receiving prolonged infusion had a 1.77-fold higher odds of clinical cure (95% CI, 1.24–2.54) and a 1.22-fold higher odds of microbiological cure (95% CI, 0.84–1.77). Subanalyses were conducted according to high (≥ 20%) and low (< 20%) average study-level mortality probabilities. In studies reporting higher mortality probabilities, effect sizes were variable but similar to the pooled results.

Conclusions:
Receipt of prolonged infusion of piperacillin-tazobactam was associated with reduced mortality and improved clinical cure rates across diverse cohorts of severely ill patients.
Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes
Authors: Xu Zhaomin , Becerra Adan Z. , Justiniano Carla F. , Boodry Courtney I. , Aquina Christopher T. , Swanger Alex A. , Temple Larissa K. , Fleming Fergal J. 
Published: November 2017

BACKGROUND:
It is unclear whether traveling long distances to high-volume centers would compensate for travel burden among patients undergoing rectal cancer resection.

OBJECTIVE:
The purpose of this study was to determine whether operative volume outweighs the advantages of being treated locally by comparing the outcomes of patients with rectal cancer treated at local, low-volume centers versus far, high-volume centers.

DESIGN:
This was a population-based study.

SETTINGS:
The National Cancer Database was queried for patients with rectal cancer.

PATIENTS:
Patients with stage II or III rectal cancer who underwent surgical resection between 2006 and 2012 were included.

MAIN OUTCOME MEASURES:
The outcomes of interest were margins, lymph node yield, receipt of neoadjuvant chemoradiation, adjuvant chemotherapy, readmission within 30 days, 30-day and 90-day mortality, and 5-year overall survival.

RESULTS:
A total of 18,605 patients met inclusion criteria; 2067 patients were in the long-distance/high-volume group and 1362 in the short-distance/low-volume group. The median travel distance was 62.6 miles for the long-distance/high-volume group and 2.3 miles for the short-distance/low-volume group. Patients who were younger, white, privately insured, and stage III were more likely to have traveled to a high-volume center. When controlled for patient factors, stage, and hospital factors, patients in the short-distance/low-volume group had lower odds of a lymph node yield ≥12 (OR = 0.51) and neoadjuvant chemoradiation (OR = 0.67) and higher 30-day (OR = 3.38) and 90-day mortality (OR = 2.07) compared with those in the long-distance/high-volume group. The short-distance/low-volume group had a 34% high risk of overall mortality at 5 years compared with the long-distance/high-volume group.

LIMITATIONS:
We lacked data regarding patient and physician decision making and surgeon-specific factors.

CONCLUSIONS:
Our results indicate that when controlled for patient, tumor, and hospital factors, patients who traveled a long distance to a high-volume center had improved lymph node yield, neoadjuvant chemoradiation receipt, and 30- and 90-day mortality compared with those who traveled a short distance to a low-volume center. They also had improved 5-year survival. See Video Abstract at http://links.lww.com/DCR/A446.
Couples' Experiences With Healthy Lifestyle Behaviors After Cardiac Rehabilitation
Authors: Rowland Sheri A. , Schumacher Karen L. , Leinen Dee Dee , Phillips Brenda G. , Schulz Paula S. , Yates Bernice C. 
Published: November 2017

Purpose:
Many cardiac patients discontinue heart-healthy eating and physical activity (PA) behaviors in the months following cardiac rehabilitation (CR). Involving the spouse in CR with the patient may be 1 strategy to increase the maintenance of these behaviors after CR. Assisting patients and spouses with the maintenance of healthy eating and PA behavior following CR begins with a better understanding of the couple-focused factors, impacting their experiences with these behaviors. The purpose of this study was to qualitatively examine couple-focused facilitators and barriers to maintaining changes in healthy eating and PA behavior from the perspectives of both cardiac patients and their spouses following phase 2 CR.

Methods:
A purposive sample of 11 couples (patients undergoing postcoronary artery bypass graft surgery and their spouses) were selected from a larger randomized control trial. Semistructured, in-person interviews were conducted with patients and their spouses separately following CR. Data were analyzed using line-by-line coding to identify facilitator and barrier themes.

Results:
Two couple-focused barrier themes emerged: unnegotiated situations and unshared behaviors. Two couple-focused facilitator themes emerged: supportive exchanges and partnerships.

Conclusion:
These findings will help guide interventions targeting changes in diet and PA behavior in both patients and their spouses through minimizing unnegotiated situations, fostering supportive exchanges, and creating a partnership for the couple to work together on shared diet and PA goals. Targeting both patients and their spouses may be an innovative and effective way to intervene to increase adherence to healthy eating and PA behaviors post-CR.
PREDICTIVE FACTORS OF SURGICAL OUTCOMES IN VITRECTOMY FOR MYOPIC TRACTION MACULOPATHY
Authors: Hattori Kyoko , Kataoka Keiko , Takeuchi Jun , Ito Yasuki , Terasaki Hiroko 
Published: November 2017

Purpose:
To assess predictive factors and surgical outcomes for myopic traction maculopathy.

Methods:
This retrospective observational case study enrolled 73 patients who underwent vitrectomy for myopic traction maculopathy. The 79 eyes obtained from our study sample were divided into 4 types: retinoschisis, lamellar macular hole (lamellar MH), foveal retinal detachment (FRD), and FRD + lamellar MH, or into 2 types according to the presence of FRD preoperatively. Dependent variables of interest were age, sex, pre- and postoperative best-corrected visual acuity (BCVA) at 6 months, and axial length.

Results:
All the four types showed moderately strong-to-strong positive correlations with pre- and postoperative BCVA (retinochisisi: r = 0.61; lamellar MH: r = 0.62; FRD: r = 0.51; FRD + lamellar MH; r = 0.83). Preoperative BCVA was associated with postoperative BCVA (P < 0.0001), but age, axial length, and the types of preoperative foveal status were not. Eyes with FRD had significantly worse pre- and postoperative BCVA than eyes without FRD (P = 0.036 and P = 0.046, respectively). Postoperative full-thickness macular holes developed in 5.1% of cases and in all types but retinoschisis.

Conclusion:
Preoperative visual acuity and the presence of FRD should be considered for surgical indication of myopic traction maculopathy.
AN ELDERLY PATIENT WITH ACUTE TRANSIENT OUTER RETINAL DISRUPTION RESEMBLING BILATERAL MULTIPLE EVANESCENT WHITE DOT SYNDROME
Authors: Golshani Cyrus , Gal-Or Orly , Giovinazzo Vincent , Freund K. Bailey 
Published: November 2017

Purpose:
To report an unusual case of an elderly patient with transient outer retinal disruption resembling bilateral multiple evanescent white dot syndrome.

Methods:
Observational case report. Fundus photographs, fluorescein angiography, standard and ultra–widefield fundus autofluorescence, and cross-sectional and en face optical coherence tomography were used to characterize and describe the clinical findings.

Results:
A 67-year-old woman presented with decreased vision and floaters in her left eye. Best-corrected visual acuity was 20/20-3 in the right eye and 20/80-2 in the left eye. Funduscopic examination showed small deep white dots and foveal granularity of the left eye corresponding to hyperautofluorescent spots on fundus autofluorescence and ellipsoid zone disruption on spectral domain optical coherence tomography. The asymptomatic right eye had evidence of subretinal deposits on spectral domain optical coherence tomography but was otherwise unremarkable. At 4-week follow-up, the patient noted resolution of her symptoms in the left eye but had developed floaters and blurry vision in her right eye. The left eye showed resolving white spots and ellipsoid zone disruption. However, the right eye had new evidence of white spots corresponding to hyperautofluorescent spots on fundus autofluorescence. Spectral domain optical coherence tomography demonstrated subretinal deposits overlying areas of ellipsoid zone disruption. At 8-week follow-up, the patient was asymptomatic in both eyes with best-corrected visual acuity of 20/20 in both eyes. The hyperautofluorescent spots on ultra–widefield fundus autofluorescence had faded with restoration of ellipsoid zone disruption in both eyes and disappearance of subretinal deposits.

Conclusion:
Our case demonstrates multimodal retinal imaging findings resembling multiple evanescent white dot syndrome in an elderly patient. The bilateral presentation, presence of subretinal deposits before symptom onset, and older age of the patient were atypical features for this entity.