bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neglect in Undergraduate Medical Education: A Systematic Review
Authors: Bazella Corinne , El-Nashar Sherif A. , Gupta Aekta , Gecsi Kimberly , Learman Lee A. 
Published: September 2017

OBJECTIVE:
To describe and compare the definitions of neglect used in the medical education literature and the estimated prevalence of neglect reported on clinical rotations.

DATA SOURCES:
EMBASE and Ovid MEDLINE were searched using these terms: lack of appreciation, lack of guidance, ignored, passed over, unintentional mistreat, unintentional mistreatment, missed learning opportunity, environment-based mistreatment, insidious mistreatment, marginalized learner, neglect, social dominance, medical education, undergraduate medical education, medical student.

METHODS OF STUDY SELECTION:
Non-English language articles, editorials, commentaries, and letters were excluded using search filters or by hand. Publications were selected for full-text review if they commented on medical students’ perceptions of being ignored, neglected, mistreated, or experiencing an unwelcoming learning environment. Further screening of 1,698 identified only three that focused specifically on neglect. Three additional studies were identified from reference lists or findings of prior literature searches.

TABULATION, INTEGRATION AND RESULTS:
The six publications included in the review reported the results of three qualitative and three cross-sectional studies. Medical Education Research Study Quality Instrument scores for the cross-sectional studies were low due to limitations in study design: single institution, no comparison group, and unknown validity of evaluation instruments. A discrete definition of neglect was not found, but several authors described a spectrum including “covert, status related abuse” and “environment-based mistreatment” to describe this phenomenon.

CONCLUSION:
Poor study quality and missing or inconsistent definitions and measures limit the validity of efforts to estimate the prevalence of neglect on different clinical rotations for medical students.
Whole exome sequencing in inborn errors of immunity: use the power but mind the limits
Authors: Bucciol Giorgia , Van Nieuwenhove Erika , Moens Leen , Itan Yuval , Meyts Isabelle 
Published: September 2017

Purpose of review
Next-generation sequencing, especially whole exome sequencing (WES), has revolutionized the molecular diagnosis of inborn errors of immunity. This review summarizes the generation and analysis of next-generation sequencing data.

Recent findings
The focus is on prioritizing strategies for unveiling the potential disease-causing variant. We also highlighted oversights and imperfections of WES and targeted panel sequencing, as well as the need for functional validation.

Summary
The information is crucial for a judicious use of WES by researchers, but even more so by the clinical immunologist.
Obstetricians and Gynecologists of the Future
Authors: Alston Meredith J. , Autry Amy (Meg) , Wagner Sarah A. , Winkel Abigail , Allshouse Amanda A. , Stephenson-Famy Alyssa 
Published: September 2017

OBJECTIVE:
To understand the characteristics and career goals of medical students selecting a career in obstetrics and gynecology.

METHODS:
In 2015–2016, medical students invited for interviews for obstetrics and gynecology residency at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, and New York University received a voluntary 20-item electronic survey regarding factors influencing their choice of medical specialty.

RESULTS:
Two hundred twenty-six of 356 students responded (63%). Mean age was 27 years, and 88% (n=199) were women. General surgery was the most common alternate specialty (36%, n=81). The most commonly cited drawback to obstetrics and gynecology was “long hours” (66%, n=148). After residency, 157 (70%) applicants planned to complete fellowship training, 127 (56%) pursue international work, 156 (69%) seek an academic position, and 207 (92%) practice in an urban setting. One hundred twenty-four applicants (55%) planned to work 51–60 hours per week and 111 (49%) planned to take 2–3 nights of call per month. Two thirds (n=150) predicted they will have greater than $100,000 educational debt on graduation.

CONCLUSION:
Contemporary residency applicants have high educational debt and disproportionately plan to pursue fellowship, international work, careers in academic medicine, and work in urban centers. Based on the projected career plans among obstetrics and gynecology applicants, the workforce needs of the population may not be met.
Entrustment Evidence Used by Expert Gynecologic Surgical Teachers to Determine Residents' Autonomy
Authors: Chen Xiaodong (Phoenix) , Sullivan Amy M. , Bengtson Joan M. , Dalrymple John L. 
Published: September 2017

OBJECTIVE:
To identify entrustment evidence used by expert gynecologic surgical teachers to determine obstetrics and gynecology residents' level of autonomy in the operating room.

METHODS:
A qualitative interview study was undertaken from March to November 2016. Four selection criteria were used to define and purposefully sample expert gynecologic surgical teachers across the United States to represent all four geographic regions. All interviews were audio-recorded and transcribed. We applied the Framework Method of content analysis. Transcripts were iteratively analyzed and emergent themes identified.

RESULTS:
Twenty-seven expert gynecologic surgical teachers from 15 institutions across the United States participated in 30-minute interviews. We identified four domains of entrustment evidence (resident characteristics, medical knowledge, technical performance, and “beyond current surgical case”) commonly reported by expert gynecologic surgical teachers to determine residents' autonomy as well as the particular evidence associated with expert gynecologic surgical teachers' determination of resident autonomy at two decision-making points (surgical time-out and taking over certain intraoperative steps) in the operating room. Onsite direct observation and conversation were two common methods used by expert gynecologic surgical teachers to obtain this evidence.

CONCLUSION:
Entrustment evidence from resident characteristics, medical knowledge, and technical performance domains and from “beyond current surgical case” was commonly used by expert gynecologic surgical teachers to determine residents' autonomy. Our findings provide a potential framework for designing educational interventions that aim to increase residents' readiness for autonomy and entrustment in the operating room.
Is Night Float a Poison Apple to Shelf Exam Performance? Evaluating the Impact of Night Float During the Last Week of the Clerkship on Shelf Examination Score
Authors: Baecher-Lind Laura , Maxwell Sue , Ramesh Saradha 
Published: September 2017

BACKGROUND:
Obstetrics and Gynecology clerkships often incorporate a week of night float in which students work overnight and sleep during the day. Night float systems allow a team atmosphere for students and also portray practice trends within Ob/Gyn. However, sleep deprivation has been shown to negatively impact examination performance in many settings. We sought to determine whether students completing their clerkship on night float—culminating in their shelf examination at the end of that week—performed differently on the examination compared with students completing night float earlier in the clerkship.

METHODS:
We evaluated students completing the Ob/Gyn clerkship at our institution over the past 3 academic years. Student's t test was used to compare mean shelf exam scores between students who completed night float week on the last week of the Ob/Gyn clerkship and students not on night float during the last week.

RESULTS:
Thirty-four of 190 students completed night float during the last week of the clerkship (17.9%). Mean shelf exam score during the 3 academic years reviewed (2013–2016) was 77.6 (range 59–99, SD 7.9). Students on night float during the last week of the clerkship did not score differently from students not on nights during that final week (mean 76.6 versus 77.8, P=.42).

DISCUSSION:
Students completing a week of night float during the last week of the Ob/Gyn clerkship scored similarly to students completing night float earlier in the clerkship. Clerkship directors can comfortably schedule students for night float even during the last week of the clerkship, and can reassure students that having night float during the final week of the clerkship does not negatively impact shelf exam performance.
Validation of Ultrasound Guidance Targeting Tasks
Authors: Nitsche Joshua F. , Shumard Kristina M. , Brost Brian C. 
Published: September 2017

OBJECTIVE:
To assess whether health care provider performance on a novel task trainer and a set of newly created ultrasound guidance targeting tasks relates with their level of clinical experience.

METHODS:
In a prospective cohort study, two assessment sessions were carried out in which inexperienced (n=21 and n=15) and experienced (n=14 and n=10) health care providers completed five previously described ultrasound guidance targeting tasks. Raw completion time, number of targeting errors, and error-adjusted completion time for each task were compared between groups with a t test for independent measures. Receiver operating characteristic analyses were performed to estimate whether error-adjusted completion time or number of errors could accurately differentiate between groups.

RESULTS:
Raw completion time was similar between groups. The number of errors and error-adjusted completion time were significantly lower in the experienced health care providers in all but the out-of-plane dowel task. The receiver operating characteristic analyses of number of errors demonstrated very high areas under the curve (0.93–0.98), sensitivities (100%), specificities (76–86%), positive likelihood ratios (4.2–7.0), and negative likelihood ratios (<0.001) indicating excellent differentiation between experienced and inexperienced health care providers. These values were notably lower in the receiver operating characteristic analyses of error-adjusted completion times.

CONCLUSION:
Task performance related well with a health care provider's level of clinical experience providing evidence of construct validity. For each task, we were able to determine a cutoff for number of errors that categorized experienced and inexperienced health care providers with very favorable sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. Our findings suggest it may be possible to use these cutoffs to objectively classify trainees as competent or not competent.
An Anatomic Study on Whether Femoral Version Originates in the Neck or the Shaft
Authors: Archibald Hunter D. , Petro Kathleen F. , Liu Raymond W. 
Published: September 2017

Background:
Femoral anteversion is generally asymptomatic but can result in lower extremity issues like patellofemoral instability and pain. Surgical correction of anteversion can be performed proximal, mid shaft or distal. A better understanding of the specific location of the rotational deformity can help guide the optimal location of the osteotomy. In this study we examine the contribution of the femoral neck and shaft to total femoral version.

Methods:
We studied 590 pairs of well-preserved cadaveric femurs. Total femoral version was defined as the axial plane angle between the femoral neck and posterior femoral condyles. Femoral shaft torsion was defined as the axial plane angle between the lesser trochanter and posterior femoral condyles. Neck version was the mathematical difference between total femoral version and shaft version.

Results:
Neck version (right femur R=0.582; left femur R=0.632) contributed slightly more than shaft version (right femur R=0.505; left femur R=0.480) to overall femoral version, but both were substantial and neither completely predicted overall femoral version. Age was not found to contribute to femoral version, and sex and race had statistically significant but small contributions.

Conclusions:
Our data show that both the femoral neck and femoral shaft substantially contribute to femoral version, and to our knowledge is the first to statistically demonstrate that neither level can be used to predict total femoral version. This suggests that one cannot generalize a single optimal site for correction or prediction of femoral version from an osteological perspective, and that individualized assessment may be beneficial.

Clinical Relevance:
This study suggests that methodologies for determining the level of femoral version might be important as the level in any given patient can vary.
Two-Stage Prosthetic Breast Reconstruction after Mastectomy with or without Prior Postmastectomy Radiotherapy
Authors: Lam Thomas C. , Hsieh Frank , Salinas James , Boyages John 
Published: September 2017

Background:
Two-stage prosthetic breast reconstruction with initial insertion of a tissue expander followed by an implant after a period of inflation is a well-established breast reconstruction option. Most of the current literature concentrates on the immediate setting, and there are only a few reports into delayed cases, especially after postmastectomy radiotherapy (RT). We performed a retrospective review of our experience over a 12.5-year period.

Methods:
Between June 1998 and December 2010, a total of 671 patients received prosthetic-only breast reconstruction. Of these, 170 (25.3%) underwent delayed 2-stage prosthetic breast reconstruction after mastectomy for cancer. Patients were divided into group A, no postmastectomy RT (n = 150), and group B, postmastectomy RT (n = 20). The primary factor examined was the failure of the reconstruction from loss of prosthesis with or without smoking. Other complications, as well as rates of revisional surgery were also recorded.

Results:
Expander or implant loss occurred in 3 of 150 patients in group A (2.0%) and 3 of 20 patients in group B (15%; P = 0.02). For nonsmokers, implant loss was 1.6% and 5.6%, respectively (P = NS). Smoking was associated with 1 of the 3 losses in group A and 2 of the 3 in group B (smokers, n = 2; P < 0.01). There was no significant difference in other complications such as seromas or minor wound infections.

Conclusions:
Delayed 2-stage prosthetic breast reconstruction has a low failure rate. It can also be successfully completed in selected patients after postmastectomy RT, but care must be taken with patients who smoke.
Enabling Remote Monitoring Using Free Apps and Smart Devices for a Free-Flap Adjunct Monitor
Authors: Yuen James C. 
Published: September 2017

Summary:
Remote monitoring capability does not currently exist for Periflux (Perimed AB, Järfälla, Sweden) laser Doppler and other perfusion monitors. Two simple adaptations using free apps (applications) and smart devices can enable transmission of the perfusion readout to the surgeon's smartphone. A literature review was conducted to identify reports relating to remote free flap monitoring. In addition, 2 wireless methodologies are devised: One method uses a free app that converts a smart device into a camera, stationed next to the perfusion monitor, to stream live video of the laser Doppler readout to the surgeon's smartphone; a second method uses a free app installed on a bedside laptop computer, which is connected to the laser Doppler flowmeter via a data cord. A live feed of the computer's desktop as a teleconference host is transmitted to the surgeon's smart device over the Internet. These 2 methodologies were employed on 9 and 8 free flaps, respectively, as a pilot study. All free flaps were monitored remotely for 4–6 days with near 100% reliability. The Internet connectivity became disrupted only on several occasions, requiring simple Wi-Fi and software reset. Minor mechanical issues were encountered with the video streaming method. Literature review identified very few articles describing remote monitoring of free flaps. The 2 methodologies reported here provided reliable continuous transmission of quantitative data of flap perfusion to smart devices via Internet connection, which can revolutionize the microsurgeon's practice if his/her adjunctive perfusion monitor with display does not yet have Wi-Fi capability.
Dark Endothelial Spots After Descemet Membrane Endothelial Keratoplasty May Appear as Recurrent Fuchs Dystrophy or Herald Graft Failure or Rejection
Authors: Zygoura Vasiliki , Baydoun Lamis , Monnereau Claire , Satué Maria , Oellerich Silke , Melles Gerrit R. J. 
Published: September 2017

Purpose:
To evaluate the clinical significance of dark spots in the donor endothelial cell layer as observed with specular microscopy, in patients who underwent Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy (FED).

Methods:
Specular microscopy images of 83 consecutive eyes up to 7 years after DMEK were retrospectively reviewed in a masked fashion for the presence of dark spots and morphologic changes in the endothelial cell layer and processed for endothelial cell density (ECD) measurements.

Results:
A normal endothelial cell layer was found in 52/83 eyes (62.7%) (group 0). In the remaining 31/83 eyes, various dark discolorations with or without altered endothelial cell morphology were categorized into 4 groups. Dark spots were classified as artifacts in 10/83 (12.0%) eyes (group I) and as “superimposed” dots in 10/83 (12.0%) eyes (group II), that is, optical irregularities slightly anterior to a healthy endothelial cell layer. In 11/83 (13.3%) eyes, endothelial stress was characterized by dark grayish discolorations and/or nuclear activation (group III). Most of the latter eyes also had a significant ECD decrease; 3 of these eyes later developed secondary graft failure, of which one was preceded by allograft rejection. None of the eyes showed recurrent guttae typical for FED (group IV).

Conclusions:
Dark endothelial spots after DMEK for FED may not represent a recurrent disease, but tissue irregularities just anterior to the graft. However, if associated with changes in endothelial cell morphology, nuclear activation and/or ECD decrease, dark discolorations may reflect “cellular stress” heralding secondary graft failure or (subclinical) allograft rejection.
NASPGHAN Clinical Report on Postoperative Recurrence in Pediatric Crohn Disease
Authors: Splawski Judy B. , Pffefferkorn Marian D. , Schaefer Marc E. , Day Andrew S. , Soldes Oliver S. , Ponsky Todd A. , Stein Philip , Kaplan Jess L. , Saeed Shehzad A. 
Published: September 2017

ABSTRACTPediatric Crohn disease is characterized by clinical and endoscopic relapses. The inflammatory process is considered to be progressive and may lead to strictures, fistulas, and penetrating disease that may require surgery. In addition, medically refractory disease may be treated by surgical resection of inflamed bowel in an effort to reverse growth failure. The need for surgery in childhood suggests severe disease and these patients have an increased risk for recurrent disease and potentially more surgery. Data show that up to 55% of patients had clinical recurrence in the first 2 years after initial surgery. The current clinical report on postoperative recurrence in pediatric Crohn disease reviews the risk factors for early surgery and postoperative recurrence, operative risk factors for recurrence, and prevention and monitoring strategies for postoperative recurrence. We also propose an algorithm for postoperative management in pediatric Crohn disease.
Second Neoplasms in Children Following a Treatment for Acute Leukemia and/or Lymphoma: 29 Years of Experience in a Single Institution in Argentina
Authors: Felice María S. , Rossi Jorge G. , Alonso Cristina N. , Rubio Patricia , Gallego Marta S. , Galluzzo María L. , Lubieniecki Fabiana , Gutiérrez Gladys , Guitter Myriam R. , Alderete Daniel H. , Rose Adriana B. , Cacciavillano Walter D. , Herzovich Viviana , Alfaro Elizabeth M. , Sánchez La Rosa Cristian G. , Millán Natalia , Chantada Guillermo L. , Figueroa Turienzo Carlos M. , Zubizarreta Pedro A. 
Published: September 2017

Introduction:
Childhood acute leukemias (AL) and lymphomas achieve good survival rates. However, second neoplasms (SN) are a devastating event.

Methods:
From August 1987 to December 2016, 34 of 3321 (1%) patients with diagnosis of AL or lymphoma developed SN. SN were AL (n=16), CNS tumors (n=5), endocrinal tumors (n=3), lymphomas (n=2), schwannoma (n=2) assorted sarcomas (n=4), retinal melanoma (n=1), and Vanek tumor (n=1). Median latency was 51 (range, 10 to 110) months for hematological malignancies and 119 (range, 25 to 236) months for solid tumors (P=0.001).

Results:
A total of 33 patients with SN were treated taking into account cumulative doses of anthracyclines and radiotherapy. Twenty-three (67.6%) patients achieved complete remission (CR), 5 died early during therapy and 5 were refractory or partial responders. Six patients presented relapses of the SN and 1 died in CR. Seventeen patients remain alive in CR, with a median follow-up of 110 (range, 4 to 276) months.

Conclusions:
(1) The latency period was significantly longer for patients developing solid tumors than for those developing AL. (2) AL was the most frequent SN. (3) Our results strongly encourage giving standard therapy to SN, considering cumulative doses of previous treatment, since similar probabilities of surviving as “de novo” counterparts can be achieved.
The Role of Tranexamic Acid in Plastic Surgery: Review and Technical Considerations
Authors: Rohrich Rod J. , Cho Min-Jeong 
Published: September 2017

Summary:
Minimizing blood loss during surgery is critical, and many modalities have been used to decrease unwanted surgical bleeding. Among many methods, use of pharmacologic agents such as antifibrinolytic drugs has been shown to significantly reduce blood loss and the rates of postoperative blood transfusion in many articles. Tranexamic acid is an antifibrinolytic agent that has been widely used in other surgical specialties, especially in cardiac, orthopedic, and trauma surgery. Despite its known benefits, the use of tranexamic acid in plastic surgery is extremely limited, primarily because most plastic surgery procedures do not involve the extent of blood loss that can lead to anemia and the need for blood transfusion, as is common in major orthopedic and cardiac surgery procedures. Nevertheless, there are significant benefits to be gained from the use of antifibrinolytic drugs in the full range of plastic surgery. In this article, the authors introduce the benefits, dosages, and technical considerations of using tranexamic acid in plastic surgery procedures.