bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Evaluation of an Implementation Strategy for Collecting Data in a National Registry and the Use of Patient-Reported Outcome Measures in Physical Therapist Practices: Quality Improvement Study
Authors: Meerhoff Guus A. , van Dulmen Simone A. , Maas Marjo J.M. , Heijblom Karin , Nijhuis-van der Sanden Maria W.G. , Van der Wees Philip J. 
Published: May 2017

Abstract
Background. In 2013, the Royal Dutch Society for Physical Therapy launched the program “Quality in Motion.” This program aims to collect data from electronic health record systems in a registry that is fed back to physical therapists, facilitating quality improvement.
Purpose. The purpose of this study was to describe the development of an implementation strategy for the program and to evaluate the feasibility of building a registry and implementing patient-reported outcome measures (PROMs) in physical therapist practices.
Methods. A stepwise approach using mixed methods was established in 3 consecutive pilots with 355 physical therapists from 66 practices. Interim results were evaluated using quantitative data from a self-assessment questionnaire and the registry and qualitative data from 21 semistructured interviews with physical therapists. Descriptive statistics and McNemar's symmetry chi-squared test were used to summarize the feasibility of implementing PROMs.
Results. PROMs were selected for the 5 most prevalent musculoskeletal conditions in Dutch physical therapist practices. A core component of the implementation strategy was the introduction of knowledge brokers to support physical therapists in establishing the routine use of PROMs in clinical practice and to assist in executing peer assessment workshops. In February 2013, 30.3% of the physical therapist practices delivered 4.4 completed treatment episodes per physical therapist to the registry; this increased to 92.4% in November 2014, delivering 54.1 completed patient episodes per physical therapist. Pre- and posttreatment PROM use increased from 12.2% to 39.5%.
Limitations. It is unclear if the participating physical therapists reflect a representative sample of Dutch therapists.
Conclusion. Building a registry and implementing PROMs in physical therapist practices are feasible. The routine use of PROMs needs to increase to ensure valid feedback of outcomes. Using knowledge brokers is promising for implementing the program via peer assessment workshops.
Evaluating the Impact of Educational Interventions on Patients and Communities: A Conceptual Framework
Authors: Bzowyckyj Andrew S. , Dow Alan , Knab Mary S. 
Published: May 2017

Health professions education programs can have direct effects on patients and communities as well as on learners. However, few studies have examined the patient and community outcomes of educational interventions. To better integrate education and health care delivery, educators and researchers would benefit from a unifying framework to guide the planning of educational interventions and evaluation of their impact on patients.
The authors of this Perspective mirrored approaches from Miller’s pyramid of educational assessment and Moore and colleagues’ framework for evaluating continuing professional development to propose a conceptual framework for evaluating the impact of educational interventions on patients and communities. This proposed framework, which complements these existing frameworks for evaluating the impact of educational interventions on learners, includes four levels: (1) interaction; (2) acceptability; (3) individual outcomes (i.e., knowledge, skills, activation, behaviors, and individual health indicators); and (4) population outcomes (i.e., community health indicators, capacity, and disparities). The authors describe measures and outcomes at each level and provide an example of the application of their new conceptual framework.
The authors encourage educators and researchers to use this conceptual framework to evaluate the impact of educational interventions on patients and to more clearly identify and define which educational interventions strengthen communities and enhance overall health outcomes.
Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting
Authors: Scheepers Renée A. , Lases Lenny S.S. , Arah Onyebuchi A. , Heineman Maas Jan , Lombarts Kiki M.J.M.H. 
Published: May 2017

Purpose
Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting.

Method
The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses.

Results
Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = −0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement.

Conclusions
Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians’ perspective, autonomy and learning opportunities could safeguard their work engagement.
Evaluation of and Feedback for Academic Medicine Leaders: Developing and Implementing the Memorial Method
Authors: Rourke James , Bornstein Stephen , Vardy Cathy , Speed David , White Tyrone , Corbett Paula 
Published: May 2017

Problem
Giving and receiving honest and helpful feedback for leadership development is a common challenge in all types of organizations but particularly in academic medicine.

Approach
At Memorial University of Newfoundland, in 2014, a consensus emerged to develop a new method for evaluating the leadership performance of the discipline chairs, dean, and vice dean, and to provide these leaders with the evaluation results to help them improve their performance. The leaders responsible for developing and implementing this method (called the Memorial Method) decided to use a survey to obtain faculty members’ perceptions about their leader’s performance. Beginning in October 2014, a portion of several regular meetings of the discipline chairs with the dean and vice dean was used to develop the survey, by first discussing the broad dimensions of leadership performance, then discussing these dimensions in more detail and drafting specific questions. The resulting survey included 44 quantitative questions addressing eight leadership dimensions. In March–April 2015, the survey was administered electronically to full-time faculty members on a confidential basis. The results were compiled and reported to each discipline chair and to the dean and vice dean.

Outcomes
In total, 144/249 faculty responded to the survey (response rate: 58%). For the various dimensions, individual chairs’ mean scores ranged from 2.82 to 4.70, and overall mean scores ranged from 3.57 to 4.24. Psychometric properties of the survey suggested it was both reliable and valid.

Next Steps
The survey will be repeated, this time with part-time as well as full-time faculty included.
Device Sales Representatives in the Operating Room: Do We Really Need or Want Them? A Survey of Orthopaedic Trauma Surgeons
Authors: Moed Berton R. , Israel Heidi A. 
Published: May 2017

Introduction:
The purposes of this study were to determine the current attitude of orthopaedic trauma surgeons toward device sales representatives (DSRs), especially regarding their presence in the operating room (OR), and to establish the existence of any surgeon generational differences.

Methods:
A survey was created using a 5-point Likert response scale, related to conflict of interest (COI) and attitudes toward DSRs. Participants were solicited from the Orthopaedic Trauma Association database of 384 active members and 127 (33%) completed the survey. Respondents were divided into 2 subcategories (Generation X vs. Baby Boomers).

Results:
Overall, respondents viewed their DSRs favorably without any perception of COI. However, they perceived their peers as being at risk for COI (P ≤ 0.004). Generation X responders feel that DSRs should be in the OR for all cases, whereas Baby Boomers do not (P < 0.01).

Conclusions:
With one striking generational difference, most orthopaedic trauma surgeons feel that they need DSRs in the OR. Similar to other physician groups, they also feel that they are not subject to COI from salesman contact that affects their peers. Reasons for this perceived need and any related COI risk, and the opportunities to address both, require further study.
Challenging Authority During an Emergency—the Effect of a Teaching Intervention
Authors: Friedman Zeev , Perelman Vsovolod , McLuckie Duncan , Andrews Meghan , Noble Laura M. K. , Malavade Archana , Bould M. Dylan 
Published: May 2017

Objectives:
Previous research has shown that residents were unable to effectively challenge a superior’s wrong decision during a crisis situation, a problem that can contribute to preventable mortality. We aimed to assess whether a teaching intervention enabled residents to effectively challenge clearly wrong clinical decisions made by their staff.

Subjects and Intervention:
Following ethics board approval, second year residents were randomized to a teaching intervention targeting cognitive skills needed to challenge a superior’s decision, or a control group receiving general crisis management instruction. Two weeks later, subjects participated in a simulated crisis that presented them with opportunities to challenge clearly wrong decisions in a can’t-intubate-can’t-ventilate scenario. It was only disclosed that the staff was a confederate during the debriefing. Performances were video recorded and assessed by two raters blinded to group allocation using the modified Advocacy-Inquiry Score.

Measurements and Main Results:
Fifty residents completed the study. The interrater reliability of the modified Advocacy-Inquiry Scores (intraclass correlation coefficient = 0.87) was excellent. The median (interquartile range) best modified Advocacy-Inquiry Score was significantly better in the intervention group 5.0 (4.50–5.62 [4–6]) than in the control group 3.5 (3.0–4.75 [3–6]) (p < 0.001).

Conclusions:
A short targeted teaching intervention was effective in significantly improving residents’ ability to challenge a wrong decision by a superior. This suggests that residents are not given the proper tools to challenge authority during a life-threatening crisis situation. This educational gap can have significant implications for patients’ safety.
Does Admission to the ICU Prevent African American Disparities in Withdrawal of Life-Sustaining Treatment?
Authors: Chertoff Jason , Olson Angela , Alnuaimat Hassan 
Published: May 2017

Objective:
We sought to determine whether black patients admitted to an ICU were less likely than white patients to withdraw life-sustaining treatments.

Design:
We performed a retrospective cohort study of hospital discharges from October 20, 2015, to October 19, 2016, for inpatients 18 years old or older and recorded those patients, along with their respective races, who had an “Adult Comfort Care” order set placed prior to discharge. A two-sample test for equality of two proportions with continuity correction was performed to compare the proportions between blacks and whites.

Setting:
University of Florida Health.

Patients:
The study cohort included 29,590 inpatient discharges, with 21,212 Caucasians (71.69%), 5,825 African Americans (19.69%), and 2,546 non-Caucasians/non–African Americans (8.62%).

Interventions:
Withdrawal of life-sustaining treatments.

Measurements and Main Results:
Of the total discharges (n = 29,590), 525 (1.77%) had the Adult Comfort Care order set placed. Seventy-eight of 5,825 African American patients (1.34%) had the Adult Comfort Care order set placed, whereas 413 of 21,212 Caucasian patients (1.95%) had this order set placed (p = 0.00251; 95% CI, 0.00248–0.00968). Of the 29,590 patients evaluated, 6,324 patients (21.37%) spent at least one night in an ICU. Of these 6,324 patients, 4,821 (76.24%) were white and 1,056 (16.70%) were black. Three hundred fifty of 6,324 (5.53%) were discharged with an Adult Comfort Care order set. Two hundred seventy-one White patients (5.62%) with one night in an ICU were discharged with an Adult Comfort Care order set, whereas 54 Black patients (5.11%) with one night in an ICU had the order set (p = 0.516).

Conclusions:
This study suggests that Black patients may be less likely to withdraw life-supportive measures than whites, but that this disparity may be absent in patients who spend time in the ICU during their hospitalization.
OPTICAL COHERENCE TOMOGRAPHY BASELINE PREDICTORS FOR INITIAL BEST-CORRECTED VISUAL ACUITY RESPONSE TO INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN EYES WITH DIABETIC MACULAR EDEMA
Authors: Santos Ana R. , Costa Miguel Â. , Schwartz Christian , Alves Dalila , Figueira João , Silva Rufino , Cunha-Vaz Jose G. 
Published: May 2017

Purpose:
To identify baseline optical coherence tomography morphologic characteristics predicting the visual response to anti-vascular endothelial growth factor therapy in diabetic macular edema.

Methods:
Sixty-seven patients with diabetic macular edema completed a prospective, observational study (NCT01947881-CHARTRES). All patients received monthly intravitreal injections of Lucentis for 3 months followed by PRN treatment and underwent best-corrected visual acuity measurements and spectral domain optical coherence tomography at Baseline, Months 1, 2, 3, and 6. Visual treatment response was characterized as good (≥10 letters), moderate (5–10 letters), and poor (<5 or letters loss). Spectral domain optical coherence tomography images were graded before and after treatment by a certified Reading Center.

Results:
One month after loading dose, 26 patients (38.80%) were identified as good responders, 19 (28.35%) as Moderate and 22 (32.83%) as poor responders. There were no significant best-corrected visual acuity and central retinal thickness differences at baseline (P = 0.176; P = 0.573, respectively). Ellipsoid zone disruption and disorganization of retinal inner layers were good predictors for treatment response, representing a significant risk for poor visual recovery to anti-vascular endothelial growth factor therapy (odds ratio = 10.96; P < 0.001 for ellipsoid zone disruption and odds ratio = 7.05; P = 0.034 for disorganization of retinal inner layers).

Conclusion:
Damage of ellipsoid zone, higher values of disorganization of retinal inner layers, and central retinal thickness decrease are good predictors of best-corrected visual acuity response to anti-vascular endothelial growth factor therapy.
Genetic predictors of recovery in low back and lumbar radicular pain
Authors: Bjorland Siri , Røe Cecilie , Moen Aurora , Schistad Elina , Mahmood Aqsa , Gjerstad Johannes 
Published: May 2017

Abstract
Previous data suggest that persistent back pain may be associated with genetic variability. In this study, we assessed the correlation between 8 genetic polymorphisms (VDR, COL11, MMP1, MMP9, IL-1α, IL-1RN, OPRM1, COMT) and pain recovery in patients with low back pain (LBP) and lumbar radicular pain (LRP). In total, 296 patients with LBP or LRP were followed for 5 years. The patients underwent standardized clinical examination and completed pain and function questionnaires. Univariate linear regression associations with P values <0.1 were included in the multivariable analysis, adjusting for pain intensity at baseline, age, sex, smoking, body mass index, and LBP or LRP. Pain intensity at 5-year follow-up was associated with VDR rs731236 (B = −0.5, 95% confidence interval [CI] −0.9 to −0.1, P = 0.017), MMP9 rs17576 (B = 0.5, 95% CI 0.1-0.9, P = 0.022), and OPRM1 rs1799971 (B = −0.8, 95% CI −1.4 to −0.2, P = 0.006) in the univariate analyses. MMP9 rs17576 and OPRM1 rs1799971 remained significant (B = 0.4, 95% CI 0.05-0.8, P = 0.026 and B = −0.8, 95% CI −1.3 to −0.2, P = 0.007) in the multivariable model. Thus, the data demonstrated that the rare allele of MMP9 rs17576 was associated with poor pain recovery, whereas the rare allele of OPRM1 rs1799971 was associated with better pain recovery at 5-year follow-up in the LBP and LRP patients. In particular, the present study suggested that the OPRM1 rs179971 A>G in men was associated with better long-term pain recovery. In men, the OPRM1 rs1799971 explained 4.7% of the variance of pain intensity. We conclude that the MMP9 rs17576 and OPRM1 rs1799971 genotypes may affect 5-year recovery in patients with LBP and LRP.
Coexistence of Colorectal Adenomas and Coronary Calcification in Asymptomatic Men and Women
Authors: Yun Kyung Eun , Chang Yoosoo , Rampal Sanjay , Zhang Yiyi , Cho Juhee , Jung Hyun-Suk , Kim Chan-Won , Jeong Chul , Cainzos-Achirica Miguel , Zhao Di , Pastor-Barriuso Roberto , Shin Hocheol , Guallar Eliseo , Ryu Seungho 
Published: May 2017

Goals:
Because of shared risk factors between clinically manifest cardiovascular disease and colorectal cancer, we hypothesized the coexistence of subclinical atherosclerosis measured by coronary artery calcium (CAC) and colorectal adenoma (CRA) and that these 2 processes would also share common risk factors.

Background:
No study has directly compared the risk factors associated with subclinical coronary atherosclerosis and CRA.

Study:
This was a cross-sectional study using multinomial logistic regression analysis of 4859 adults who participated in a health screening examination (2010 to 2011; analysis 2014 to 2015). CAC scores were categorized as 0, 1 to 100, or >100. Colonoscopy results were categorized as absent, low-risk, or high-risk CRA.

Results:
The prevalence of CAC>0, CAC 1 to 100 and >100 was 13.0%, 11.0%, and 2.0%, respectively. The prevalence of any CRA, low-risk CRA, and high-risk CRA was 15.1%, 13.0%, and 2.1%, respectively. The adjusted odds ratios (95% confidence interval) for CAC>0 comparing participants with low-risk and high-risk CRA with those without any CRA were 1.35 (1.06-1.71) and 2.09 (1.29-3.39), respectively. Similarly, the adjusted odds ratios (95% confidence interval) for any CRA comparing participants with CAC 1 to 100 and CAC>100 with those with no CAC were 1.26 (1.00-1.6) and 2.07 (1.31-3.26), respectively. Age, smoking, diabetes, and family history of CRC were significantly associated with both conditions.

Conclusions:
We observed a graded association between CAC and CRA in apparently healthy individuals. The coexistence of both conditions further emphasizes the need for more evidence of comprehensive approaches to screening and the need to consider the impact of the high risk of coexisting disease in individuals with CAC or CRA, instead of piecemeal approaches restricted to the detection of each disease independently.
Age and Sex Normalization of Intestinal Permeability Measures for the Improved Assessment of Enteropathy in Infancy and Early Childhood
Authors: Kosek Margaret N. , Lee Gwenyth O. , Guerrant Richard L. , Haque Rashidul , Kang Gagandeep , Ahmed Tahmeed , Bessong Pascal , Ali Asad , Mduma Estomih , Peñataro Yori Pablo , Faubion William A. , Lima Aldo A.M. , Paredes Olortegui Maribel , Mason Carl , Babji Sudhir , Singh Ravinder , Qureshi Shahida , Kosek Peter S. , Samie Amidou , Pascal John , Shrestha Sanjaya , McCormick Benjamin J.J. , Seidman Jessica C. , Lang Dennis R. , Zaidi Anita , Caulfield Laura E. , Gottlieb Michael ,   MAL‐ED Network
Published: May 2017

ABSTRACTObjectives:The aim of the study was to describe changes in intestinal permeability in early childhood in diverse epidemiologic settings.Methods:In a birth cohort study, the lactulose:mannitol (L:M) test was administered to 1980 children at 4 time points in the first 24 months of life in 8 countries. Data from the Brazil site with an incidence of diarrhea similar to that seen in the United States and no growth faltering was used as an internal study reference to derive age‐ and sex‐specific z scores for mannitol and lactulose recoveries and the L:M ratio.Results:A total of 6602 tests demonstrated mannitol recovery, lactulose recovery, and the L:M ratio were associated with country, sex, and age. There was heterogeneity in the recovery of both probes between sites with mean mannitol recovery ranging for 1.34% to 5.88%, lactulose recovery of 0.19% to 0.58%, and L:M ratios 0.10 to 0.17 in boys of 3 months of age across different sites. We observed strong sex‐specific differences in both mannitol and lactulose recovery, with boys having higher recovery of both probes. Alterations in intestinal barrier function increased in most sites from 3 to 9 months of age and plateaued or diminished from 9 to 15 months of age.Conclusions:Alterations in recovery of the probes differ markedly in different epidemiologic contexts in children living in the developing world. The rate of change in the L:M‐z ratio was most rapid and consistently disparate from the reference standard in the period between 6 and 9 months of age, suggesting that this is a critical period of physiologic impact of enteropathy in these populations.
Low-Energy Virtual Monochromatic Dual-Energy Computed Tomography Images for the Evaluation of Head and Neck Squamous Cell Carcinoma: A Study of Tumor Visibility Compared With Single-Energy Computed Tomography and User Acceptance
Authors: Forghani Reza , Kelly Hillary , Yu Eugene , Belair Manon , Létourneau-Guillon Laurent , Le Huy , Proulx Francesca , Ong Thomas , Tan Xianming , Curtin Hugh D. , Levental Mark 
Published: May 2017

ObjectiveDual-energy computed tomography (CT) 40-keV virtual monochromatic images (VMIs) have been reported to improve visualization of head and neck squamous cell carcinoma, but a direct comparison to single-energy CT (SECT) is lacking, and there is debate regarding subjective user preference. We compared 40-keV VMIs with SECT and performed a subjective evaluation of their utility and acceptability for clinical use.MethodsA total of 60 dual-energy CT and 60 SECT scans from 2 different institutions were evaluated. Tumor conspicuity was evaluated objectively using absolute and relative attenuation and subjectively by 3 head and neck specialists and 3 general radiologists.ResultsTumors had significantly higher absolute and relative attenuation on 40-keV VMIs (P< 0.0001). Subjectively, the 40-keV VMIs improved visualization, with substantial (κ, 0.61–0.80) to almost perfect (κ, 0.81–1) interrater agreements.ConclusionsThe 40-keV VMIs improve tumor visibility objectively and subjectively both by head and neck specialists and general radiologists.