bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender Differences in Medical Students' Experience of Burnout, Perceived Stress, and Empathic Concern
Authors: Worly Brett , Verbeck Nicole , Walker Curt , Clinchot Dan , Keder Lisa , Steinauer Jodi 
Published: September 2017

OBJECTIVE:
To evaluate the differences in burnout, empathy, and perceived stress between genders in 3rd-year medical students.

METHODS:
This is an IRB-approved, cross-sectional study of 657 3rd-year medical students who attended medical school from 2008 to 2014. Students responded to a Learning Environment Student Survey which included the Maslach Burnout Inventory- Student Scale (MBI-SS), Interpersonal Reactivity Index (IRI), and Perceived Stress Scale (PSS) items. These primary outcomes were compared between gender with independent sample t tests. Secondary outcomes, including the MBI-SS subscales of emotional exhaustion, professional efficacy, and cynicism; IRI subscales of fantasy, perspective taking, and empathic concern; and personal distress were evaluated with equal variances using Levene's Test for Equality of Variances. Multivariate analysis with two-way ANOVA was also performed.

RESULTS:
Females were more likely to have higher (IRI) empathic concern (21.0±3.9 versus 19.1±4.1, P<.001), but reported more (IRI) personal distress (8.9±4.3 versus 7.6±3.8, P<.001), (MBI-SS) emotional exhaustion (15.3±5.8 versus 14.4±5.9, P<.05), and (PSS) perceived stress (17.1±6.2 versus 15.2±6.6, P<.001). Males were more likely to have (MBI-SS) cynicism (8.6±4.9 versus 7.7±4.4, P=.03) and lower (MBI-SS) professional efficacy (11.5±4.9 versus 12.4±4.9, P=.03). No interactions between age, ethnicity, or gender were found on multivariate analysis.

CONCLUSION:
Although male and female 3rd-year medical students experience burnout, empathy, and perceived stress in a statistically different fashion, the measures between the groups were similar. Medical student support program design does not need to be redesigned based on gender.
Teaching the Unteachable: Educating Obstetrics and Gynecology Residents About the Patient Experience of Stillbirth
Authors: Fay Emily , Gravett Michael , Alexander Sarah , Stephenson-Famy Alyssa 
Published: September 2017

BACKGROUND:
Annually, approximately 24,000 fetuses in the United States are stillborn, and parents often feel alone in their grief. Obstetric providers may not be adequately trained to manage the medical and emotional aspects of stillbirth; therefore, we implemented a didactic for OB/GYN residents to address this need.

METHODS:
A 2-hour resident didactic including an overview of medical management and a panel of patients and families who had experienced stillbirth was offered in 2013 and 2015. Prior to each session, OB/GYN residents received an electronic 26-question survey about previous training and comfort with caring for patients with stillbirth. Following the didactic, residents were sent a follow-up survey to evaluate and reflect on the content.

RESULTS:
Of 47 residents, 41 responded to the pre-didactic survey (85%). Residents disagreed that the management of stillbirth was adequately covered in medical school (100%) or residency (90%). Forty-one percent agreed that they were unsure of how much personal emotion to express to patients. In qualitative comments following the session, residents felt more comfortable and confident caring for these patients throughout their experience. Residents felt that the session was “incredibly important,” “powerful and memorable,” “hard to attend…so much emotion, so many memories of so many patients.”

DISCUSSION:
Our experience suggests that residents feel unprepared to medically and emotionally care for families with stillbirth. Incorporating a didactic on stillbirth that includes a patient panel can improve resident knowledge and comfort.
Medical Student Attitudes on Abortion Reflect Professionalism: A Qualitative Exploration
Authors: Bartz Deborah , Janiak Elizabeth , Jackson Courtney , Berkowitz Lori , Steinauer Jody , Berkowitz Lori , Steinauer Jody 
Published: September 2017

OBJECTIVE:
In medical education we must train learners to be competent in aspects of professionalism. It is challenging to assess an individual’s professionalism. The goal of this study was to examine the extent that medical students' attitudes toward abortion, as captured through vignettes and interviews, reflect their overall general professionalism attitudes.

METHODS:
We conducted qualitative interviews with 4th-year medical students who had applied for ob/gyn residency programs between 2012 and 2014. Semi-structured interviews explored factors that influenced their attitudes toward abortion before medical school, any transition in attitudes that occurred during medical school, and how they perceive abortion to be relevant to their future training and medical practices. Narratives were analyzed for meaningful patterns regarding professionalism tenants as outlined in the Charter for Medical Professionalism based on an analytical approach.

RESULTS:
The final sample included 74 students enrolled in 39 medical schools in 25 states and the District of Columbia. Within-transcript content related to abortion attitudes, three themes emerged. First, students reflected on abortion care as a primacy of patient welfare. Second, students recognized patient autonomy was preserved when abortion was offered as a pregnancy option. Lastly, students advocated that availability of abortion services fell within the preview of social justice to be afforded to their future patients.

CONCLUSION:
The investigation of attitudes toward abortion through a qualitative approached provides an assessment of professionalism tenants in medical students. This finding may inform professionalism curricula that utilize pregnancy options and abortion case-based scenarios to facilitate medical student learning and assessment.
A Communication Curriculum for Obstetrics and Gynecology Residents: Applying the Principles of a “Goals of Care” Conversation
Authors: Bevis Kerri S. , Covarrubias Julie , Barnett Michael , Barnett Michael , Ricciotti Hope 
Published: September 2017

OBJECTIVE:
To develop an evidence-based communication training curriculum for obstetrics and gynecology residents using a “goals of care” framework and to develop the tools necessary to evaluate its effectiveness.

METHODS:
Following IRB approval, the baseline assessment examined: experience, comfort, concerns, and perceived barriers with conversations around serious illness; knowledge of communication skills; and a needs assessment. The existing and well-researched Vitaltalk curriculum for communicating in the setting of serious illness was adapted into a series of three 1-hour sessions including case scenarios relevant to Ob/Gyn practice. A postcourse evaluation assessed: self-reported comfort (retrospective) pre- and postintervention, knowledge of specific communication skills, and concerns and barriers regarding serious conversations. The curriculum and assessment tools were piloted in PGY-4 Ob/Gyn residents.

EVALUATION:
Eight PGY-4 residents participated in the pilot curriculum. All participants reported didactic training on delivering difficult news during medical school (1–10 hours). Thirty-eight percent of respondents reported ANY communication skills training in residency. Residents had poor baseline knowledge of communication skills (45% correct). Responding to patient emotion, addressing patient requests for unindicated treatment, and eliciting patient concerns about death and dying were the areas of greatest discomfort. Most (80%) participants found the training to be important to their development as an obstetrician/gynecologist.

DISSEMINATION:
Curricular materials and results of the pilot data will be submitted for publication on MedEdPORTAL.

REFLECTIVE CRITIQUE:
The value of a pilot study cannot be overstated. Moving forward, I will re-structure the didactic sessions, will not organize sessions by PGY class, and will streamline the assessment tools.
Multimodality Neuromonitoring in Adult Traumatic Brain Injury
Authors: Smith Martin 
Published: September 2017

Abstract
Neuromonitoring plays an important role in the management of traumatic brain injury. Simultaneous assessment of cerebral hemodynamics, oxygenation, and metabolism allows an individualized approach to patient management in which therapeutic interventions intended to prevent or minimize secondary brain injury are guided by monitored changes in physiologic variables rather than generic thresholds. This narrative review describes various neuromonitoring techniques that can be used to guide the management of patients with traumatic brain injury and examines the latest evidence and expert consensus guidelines for neuromonitoring.
Anesthesia with Dexmedetomidine and Low-dose Isoflurane Increases Solute Transport via the Glymphatic Pathway in Rat Brain When Compared with High-dose Isoflurane
Authors: Benveniste Helene , Lee Hedok , Ding Fengfei , Sun Qian , Al-Bizri Ehab , Makaryus Rany , Probst Stephen , Nedergaard Maiken , Stein Elliot A. , Lu Hanbing 
Published: September 2017

Abstract

Background
The glymphatic pathway transports cerebrospinal fluid through the brain, thereby facilitating waste removal. A unique aspect of this pathway is that its function depends on the state of consciousness of the brain and is associated with norepinephrine activity. A current view is that all anesthetics will increase glymphatic transport by inducing unconsciousness. This view implies that the effect of anesthetics on glymphatic transport should be independent of their mechanism of action, as long as they induce unconsciousness. We tested this hypothesis by comparing the supplementary effect of dexmedetomidine, which lowers norepinephrine, with isoflurane only, which does not.

Methods
Female rats were anesthetized with either isoflurane (N = 8) or dexmedetomidine plus low-dose isoflurane (N = 8). Physiologic parameters were recorded continuously. Glymphatic transport was quantified by contrast-enhanced magnetic resonance imaging. Cerebrospinal fluid and gray and white matter volumes were quantified from T1 maps, and blood vessel diameters were extracted from time-of-flight magnetic resonance angiograms. Electroencephalograms were recorded in separate groups of rats.

Results
Glymphatic transport was enhanced by 32% in rats anesthetized with dexmedetomidine plus low-dose isoflurane when compared with isoflurane. In the hippocampus, glymphatic clearance was sixfold more efficient during dexmedetomidine plus low-dose isoflurane anesthesia when compared with isoflurane. The respiratory and blood gas status was comparable in rats anesthetized with the two different anesthesia regimens. In the dexmedetomidine plus low-dose isoflurane rats, spindle oscillations (9 to 15 Hz) could be observed but not in isoflurane anesthetized rats.

Conclusions
We propose that anesthetics affect the glymphatic pathway transport not simply by inducing unconsciousness but also by additional mechanisms, one of which is the repression of norepinephrine release.
Mindfulness-Based Cognitive Therapy for Chronic Tinnitus: Evaluation of Benefits in a Large Sample of Patients Attending a Tinnitus Clinic
Authors: McKenna Laurence , Marks Elizabeth M. , Vogt Florian 
Published: September 2017

Objectives:
Mindfulness-based approaches may benefit patients with chronic tinnitus, but most evidence is from small studies of nonstandardized interventions, and there is little exploration of the processes of change. This study describes the impact of mindfulness-based cognitive therapy (MBCT) in a “real world” tinnitus clinic, using standardized MBCT on the largest sample of patients with chronic tinnitus to date while exploring predictors of change.

Design:
Participants were 182 adults with chronic and distressing tinnitus who completed an 8-week MBCT group. Measures of tinnitus-related distress, psychological distress, tinnitus acceptance, and mindfulness were taken preintervention, postintervention, and at 6-week follow-up.

Results:
MBCT was associated with significant improvements on all outcome measures. Postintervention, reliable improvements were detected in tinnitus-related distress in 50% and in psychological distress in 41.2% of patients. Changes in mindfulness and tinnitus acceptance explained unique variance in tinnitus-related and psychological distress postintervention.

Conclusions:
MBCT was associated with significant and reliable improvements in patients with chronic, distressing tinnitus. Changes were associated with increases in tinnitus acceptance and dispositional mindfulness. This study doubles the combined sample size of all previously published studies. Randomized controlled trials of standardized MBCT protocols are now required to test whether MBCT might offer a new and effective treatment for chronic tinnitus.
Binaural Pitch Fusion in Bilateral Cochlear Implant Users
Authors: Reiss Lina A. J. , Fowler Jennifer R. , Hartling Curtis L. , Oh Yonghee 
Published: September 2017

Objectives:
Binaural pitch fusion is the fusion of stimuli that evoke different pitches between the ears into a single auditory image. Individuals who use hearing aids or bimodal cochlear implants (CIs) experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3–4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The goal of this study was to determine if adult bilateral CI users also experience broad binaural pitch fusion.

Design:
Stimuli were pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus.

Results:
Bilateral CI listeners had binaural pitch fusion ranges varying from 0 to 12 mm (average 6.1 ± 3.9 mm), where 12 mm indicates fusion over all electrodes in the array. No significant correlations of fusion range were observed with any subject factors related to age, hearing loss history, or hearing device history, or with any electrode factors including interaural electrode pitch mismatch, pitch match bandwidth, or within-ear electrode discrimination abilities.

Conclusions:
Bilateral CI listeners have abnormally broad fusion, similar to hearing aid and bimodal CI listeners. This broad fusion may explain the variability of binaural benefits for speech perception in quiet and in noise in bilateral CI users.
Rheumatoid arthritis and citrullination
Authors: Darrah Erika , Andrade Felipe 
Published: September 2017

Purpose of review
Dysregulated citrullination is a key element that drives the production and maintenance of antibodies to citrullinated proteins, a hallmark in rheumatoid arthritis (RA). This article reviews recent literature on the origin of citrullinated antigens in RA.

Recent findings
The study of synovial fluid from patients with RA has provided important insights into the identity of citrullinated proteins that accumulate in the RA joint (the RA citrullinome) and mechanisms that control their generation.

Summary
Citrullinating enzymes (peptidylarginine deiminases, PADs) are tightly controlled to limit their hyperactivation. Calcium and redox conditions are important regulators of PAD activity. Studies suggest that citrullination is dysregulated both intra- and extracellularly in RA. In neutrophils, host (i.e., perforin and the membrane attack complex) and bacterial (i.e., toxins) pore-forming proteins induce prominent calcium influx, cytolysis, and hyperactivation of PADs. These factors likely drive hypercitrullination in the RA joint and at extraarticular sites of disease initiation, respectively. As oxidizing conditions present in the extracellular environment are known to inactivate PADs, extracellular citrullination in RA probably requires the constant release of active enzymes from dying cells and may be accelerated by autoantibodies that activate PADs.
Is “Early Total Care” a Safe and Effective Alternative to “Staged Protocol” for the Treatment of Schatzker IV–VI Tibial Plateau Fractures in Patients Older Than 50 Years?
Authors: Borade Amrut , Kempegowda Harish , Richard Raveesh , Graham Jove , Suk Michael , Horwitz Daniel S. 
Published: September 2017

Objectives:
To compare “Early Total Care” (ETC) with “Staged Protocol” (SP) for the treatment of Schatzker IV–VI tibial plateau fractures in patients older than 50 years regarding safety and effectiveness.

Design:
Retrospective cohort study.

Setting:
An academic level 1 US trauma center.

Patients/Participants:
Eighty-one patients older than 50 years with Schatzker grade IV–VI tibial plateau fractures were included.

Intervention:
Fifty-three patients were treated under SP with immediate external fixation followed by definitive internal fixation. Twenty-eight patients were treated under ETC with immediate internal fixation.

Main Outcome Measurements:
Comparison of perioperative findings, time to bony and clinical union, soft-tissue and bony complications, radiological outcome, and secondary procedures.

Results:
The 2 groups were comparable without significant difference regarding age, sex, side of involvement, body mass index, smoking status, American Society of Anesthesiologist classification, associated injuries, comorbidities, follow-up duration, and fracture classification. No statistically significant difference was found regarding the perioperative complications, quality of reduction, time to union, Rasmussen score at union or at the final follow-up, soft-tissue/bony complications, and the rate of the secondary procedures.

Conclusion:
ETC seems to be a safe, efficacious, and effective alternative to the SP for the treatment of some Schatzker IV–VI fractures in patients older than 50 years.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Surgical Management of Tibial Spine Fractures in Children: A Survey of the Pediatric Orthopaedic Society of North America (POSNA)
Authors: Jackson Taylor J. , Storey Eileen P. , Ganley Theodore J. 
Published: September 2017

Background:
Tibial spine fractures are rare, complex injuries. Management remains varied given a lack of consensus about the optimal approach. Thus, the purpose of this study is to determine prevailing strategies among pediatric orthopaedists and establish areas of agreement and ongoing controversy in the management of tibial spine fractures.

Methods:
An electronic survey was distributed to the Pediatric Orthopaedic Society of North America (POSNA) membership. Surgeon demographics, experience, and responses to clinical vignettes were collected. Surgeons were grouped according to how frequently they treat tibial spine fractures and responses were compared.

Results:
Of the 180 POSNA members who completed the survey, all were attending surgeons and nearly all (90.4%) had academic affiliations, treated mostly skeletally immature patients (88.5%), and 3 or fewer fractures per year (62.4%). In younger patients, respondents were more likely to treat type II fractures closed and less likely to cross the physis. Arthrofibrosis was the most commonly reported complication and postoperative duration of immobilization was identified as a risk factor by most. However, high-frequency surgeons identified this risk factor more often (P=0.015) and recommended immobilization for <2 weeks more frequently (P=0.018). There was, however, considerable discrepancy regarding the duration of immobilization. Although there were areas of agreement on general principles, there continues to be disagreement regarding specific treatment strategies.

Conclusions:
Surgeons within POSNA agree on general principles of treatment for tibial spine fractures. Members, regardless of high-volume or low-volume caseload, are all less likely to pursue surgical options when treating younger patients and treating arthrofibrosis during the first 2 postoperative months. The most commonly reported adverse outcome after treatment was arthrofibrosis, for which high-frequency surgeons identified length of immobilization as a significant risk factor more often and thus, recommended shorter periods of immobilization. Although surgeons may agree on general principles in some cases, there continues to be disagreement regarding specific strategies suggesting that a prospective multicenter study of this topic is warranted.

Level of Evidence:
Level V.
10 Years Later: Lessons Learned from an Academic Multidisciplinary Cosmetic Center
Authors: Chen Jenny T. , Nayar Harry S. , Rao Venkat K 
Published: September 2017

Background:
In 2006, a Centers for Medicare and Medicaid Services-accredited multidisciplinary academic ambulatory surgery center was established with the goal of delivering high-quality, efficient reconstructive, and cosmetic services in an academic setting. We review our decade-long experience since its establishment.

Methods:
Clinical and financial data from 2006 to 2016 are reviewed. All cosmetic procedures, including both minimally invasive and operative cases, are included. Data are compared to nationally published reports.

Results:
Nearly 3,500 cosmetic surgeries and 10,000 minimally invasive procedures were performed. Compared with national averages, surgical volume in abdominoplasty is high, whereas rhinoplasty and breast augmentation is low. Regarding trend data, breast augmentation volume has decreased by 25%, whereas minimally invasive procedural volume continues to grow and is comparable with national reports. Similarly, where surgical revenue remains steady, minimally invasive revenue has increased significantly. The majority of surgical cases (70%) are reconstructive in nature and insurance-based. Payer mix is 71% private insurance, 18% Medicare and Medicaid, and 11% self-pay. Despite year-over-year revenue increases, net profit in 2015 was $6,120. Rent and anesthesia costs exceed national averages, and employee salary and wages are the highest expenditure.

Conclusion:
Although the creation of our academic cosmetic ambulatory surgery center has greatly increased the overall volume of cosmetic surgery performed at the University of Wisconsin, the majority of surgical volume and revenue is reconstructive. As is seen nationwide, minimally invasive cosmetic procedures represent our most rapidly expanding revenue stream.