bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Use of Short, Animated, Patient-Centered Springboard Videos to Underscore the Clinical Relevance of Preclinical Medical Student Education
Authors: Adam Maya , Chen Sharon F. , Amieva Manuel , Deitz Jennifer , Jang Heeju , Porwal Aarti , Prober Charles 
Published: January 2017

Problem
Medical students often struggle to appreciate the clinical relevance of material taught in the preclinical years. The authors believe videos could be effectively used to interweave a patient’s illness script with foundational basic science concepts.

Approach
In collaboration with four other U.S. medical schools, educators at the Stanford University School of Medicine created 36 short, animated, patient-centered springboard videos (third-person, narrated accounts of authentic patient cases conveying foundational pathophysiology) in 2014. The videos were used to introduce students to 36 content modules, created as part of a microbiology, immunology, and infectious diseases curriculum. The videos were created with input from faculty content experts and in some cases medical students, and were piloted using a flipped classroom pedagogical approach in January 2015–June 2016.

Outcomes
Student feedback from course evaluations and focus groups was analyzed using a mixed-methods approach. On the course evaluations, the majority of students rated the patient-centered videos positively, and the majority of comments on the videos were positive, highlighting both enhanced engagement and enhanced learning and retention. Comments from focus groups mirrored the course evaluation comments and highlighted different usage patterns for the videos.

Next Steps
The authors will continue to gather and analyze data from schools using the videos as part of their core preclinical curriculum, and will produce similar videos for use in other areas of undergraduate medical education. These videos could support students’ review of content taught previously and be repurposed for use in continuing and graduate medical education, as well as patient education.
Lidocaine Induces Apoptosis and Suppresses Tumor Growth in Human Hepatocellular Carcinoma Cells In Vitro and in a Xenograft Model In Vivo
Authors: Xing Wei , Chen Dong-Tai , Pan Jia-Hao , Chen Yong-Hua , Yan Yan , Li Qiang , Xue Rui-Feng , Yuan Yun-Fei , Zeng Wei-An 
Published: January 2017

Abstract

Background
Recent epidemiologic studies have focused on the potential beneficial effects of regional anesthetics, and the differences in cancer prognosis may be the result of anesthetics on cancer biologic behavior. However, the function and underlying mechanisms of lidocaine in hepatocellular carcinoma both in vitro and in vivo have been poorly studied.

Methods
Human HepG2 cells were treated with lidocaine. Cell viability, colony formation, cell cycle, and apoptosis were assessed. The effects of lidocaine on apoptosis-related and mitogen-activated protein kinase protein expression were evaluated by Western blot analysis. The antitumor activity of lidocaine in hepatocellular carcinoma with or without cisplatin was investigated with in vitro experiments and also with animal experiments.

Results
Lidocaine inhibited the growth of HepG2 cells in a dose- and time-dependent manner. The authors also found that lidocaine arrested cells in the G0/G1 phase of the cell cycle (63.7 ± 1.7% vs. 72.4 ± 3.2%; P = 0.0143) and induced apoptosis (1.7 ± 0.3% vs. 5.0 ± 0.7%; P = 0.0009). Lidocaine may exert these functions by causing an increase in Bax protein and activated caspase-3 and a corresponding decrease in Bcl-2 protein through the extracellular signal-regulated kinase 1/2 and p38 pathways. More importantly, for the first time, xenograft experiments (n = 8 per group) indicated that lidocaine suppressed tumor development (P < 0.0001; lidocaine vs. control) and enhanced the sensitivity of cisplatin (P = 0.0008; lidocaine plus cisplatin vs. cisplatin).

Conclusions
The authors’ findings suggest that lidocaine may exert potent antitumor activity in hepatocellular carcinoma. Furthermore, combining lidocaine with cisplatin may be a novel treatment option for hepatocellular carcinoma.
Therapeutic Drug Monitoring of Everolimus: Comparability of Concentrations Determined by 2 Immunoassays and a Liquid Chromatography Tandem Mass Spectrometry Method
Authors: Shipkova Maria , Rapp Sonja , Rigo-Bonnin Raül , Wieland Eberhard , Peter Andreas 
Published: January 2017

Background:
Therapeutic drug monitoring is recommended to guide therapy with the immunosuppressant everolimus (EVL) in solid organ transplantation to prevent rejections and to limit toxicity. For therapeutic drug monitoring, predose EVL concentrations are measured in whole blood mainly by liquid chromatography tandem mass spectrometry (LC-MS/MS). In addition, 2 immunoassays [Quantitative Microsphere System (QMS) EVL and Elecsys EVL] are commercially available. The aim of this study was to evaluate the comparability of EVL results determined with the 2 immunoassays and a validated LC-MS/MS test using samples from kidney, liver, and heart transplant (KT, LT, and HT, respectively) recipients.

Methods:
Analysis of predose samples from KT (n = 56), LT (n = 60), and HT (n = 59) recipients, obtained at variable time points after transplantation, was performed by LC-MS/MS and with the 2 immunoassays. The QMS EVL assay was applied on Dimension Xpand Plus and the Elecsys EVL assay on cobas e 411 analyzer. Results were compared by the Spearman's rank correlation coefficient, unbiased Passing and Bablok linear regression test, and Bland–Altman plot.

Results:
Results generated with both immunoassays correlated well with those of LC-MS/MS. An overestimation of EVL concentrations by the Elecsys EVL compared with LC-MS/MS was observed (mean bias: 34.2%). Using the QMS EVL, a small but significant negative deviation (mean bias: −8.0%) was found. Looking at KT, HT, and LT samples separately, the bias to LC-MS/MS seen with the Elecsys EVL was similar. With the QMS EVL, the best agreement was observed with the KT samples followed by LT and HT.

Conclusions:
Results generated by the 3 methods are not consistent regarding their diagnostic value. Both laboratories and manufacturers should take care to inform their costumers about the between-method differences to avoid misinterpretation of the results in clinical practice.
The role of accountable care organization affiliation and ownership in promoting physician practice participation in quality improvement collaboratives
Authors: Hurley Vanessa B. , Rodriguez Hector P. , Shortell Stephen M. 
Published: January 2017

Background:
Quality improvement collaboratives (QICs) have emerged as an important strategy to improve processes and outcomes of clinical care through interorganizational learning. Little is known about the organizational factors that support or deter physician practice participation in QICs.

Purpose:
The aim of this study was to examine organizational influences on physician practices' propensity to participate in QICs. We hypothesized that practice affiliation with an accountable care organization (ACO) and practice ownership by a system or community health center (CHC) would increase the propensity of physician practices to participate in a QIC.

Methodology:
Data from the third wave of the National Study of Physician Organizations, a nationally representative sample of medical practices (n = 1,359), were analyzed. Weighted multivariate regression analyses were estimated to examine the association of ACO affiliation, ownership, and QIC participation, controlling for practice size, health information technology capacity, public reporting participation, and practice revenue from Medicaid and uninsured patients. The Sobel–Goodman Test was used to explore the extent to which practice use of quality improvement (QI) methods such as Lean, Six Sigma, and use of plan-do-study-act cycles mediates the relationship between ACO affiliation and QIC participation.

Findings:
Only 13.6% of practices surveyed in 2012–2013 participated in a QIC. In adjusted analyses, ACO affiliation (odds ratio [OR] = 1.51, p < .01), CHC ownership (OR = 6.57, p < .001), larger practice size (OR = 14.72, p < .001), and health information technology functionality (OR = 1.15, p < .001) were positively associated with QIC participation. Practice use of QI methods partially mediated (13.1%–46.7%) the association of ACO affiliation with QIC participation.

Practice Implications:
ACO-affiliated practices are more likely than non-ACO practices to participate in QICs. Practice size rather than system ownership appears to influence QIC participation. QI methods often promoted and used by health care systems such as CHCs and ACOs may promote QIC participation.
When open access might not work: Understanding patient attitudes in appointment scheduling
Authors: Finkelstein Stacey R. , Liu Nan , Rosenthal David , Poghosyan Lusine 
Published: January 2017

Background:
Open-access (OA) systems aim to reduce delays to care. However, recent evidence suggests that OA systems might reduce patient satisfaction and result in poorer patient experiences due to patients’ inability to obtain appointments with their usual care provider. We conducted a series of experiments to explore the role of risk attitudes, an individual difference variable that measures preferences for risky options, in patients’ perception of OA systems.

Purpose:
The aim of the study was to investigate the relationship between patient’s risk attitudes and attitudes toward OA systems and demonstrate whether patients’ attitudes toward OA systems will vary as a function of their risk attitudes.

Methodology:
Three separate experiments were conducted to assess the relationship between patient risk attitudes and their attitudes about OA systems. Study 1 (patient population) explored the aforementioned relationship. We explored two potential moderators for this effect: how salient the tradeoff is between delays to care and quality of care (Study 2; online population) and the severity of the patient’s health condition (Study 3; patient population).

Results:
Compared to risk-averse patients, risk-seeking patients have more favorable attitudes toward OA systems (a 1-point increase in risk attitudes on a 7-point scale resulted in a 0.44-point boost in attitudes toward OA systems on a 7-point scale). This relationship holds even when the tradeoff between access to care and quality of care is made salient (e.g., a practice informs patients they can have a same-day appointment but are unlikely to see their regular provider) and when people consider having a minor health condition. This relationship is attenuated when patients imagine having a serious medical condition because speedy access to care becomes a top priority.

Conclusion:
Risk-seeking patients have more favorable attitudes toward OA systems.

Practice Implications:
Risk-seeking patients are primarily driven by speed to access at the potential expense of continuity of care. Organizations that better understand patient motives in scheduling medical appointments can introduce more effective interventions and positively impact patient experiences of care.
Identifying and overcoming implementation challenges: Experience of 59 noninstitutional long-term services and support pilot programs in the Veterans Health Administration
Authors: Sullivan Jennifer L. , Adjognon Omonyêlé L. , Engle Ryann L. , Shin Marlena H. , Afable Melissa K. , Rudin Whitney , White Bert , Shay Kenneth , Lukas Carol VanDeusen 
Published: January 2017

Background:
From 2010 to 2013, the Department of Veterans Affairs (VA) funded a large pilot initiative to implement noninstitutional long-term services and supports (LTSS) programs to support aging Veterans. Our team evaluated implementation of 59 VA noninstitutional LTSS programs.

Purpose:
The specific objectives of this study are to (a) examine the challenges influencing program implementation comparing active sites that remained open and inactive sites that closed during the funding period and (b) identify ways that active sites overcame the challenges they experienced.

Methodology:
Key informant semistructured interviews occurred between 2011 and 2013. We conducted 217 telephone interviews over four time points. Content analysis was used to identify emergent themes. The study team met regularly to define each challenge, review all codes, and discuss discrepancies. For each follow-up interview with the sites, the list of established challenges was used as a priori themes. Emergent data were also coded.

Results:
The challenges affecting implementation included human resources and staffing issues, infrastructure, resources allocation and geography, referrals and marketing, leadership support, and team dynamics and processes. Programs were able to overcome challenges by communicating with team members and other areas in the organization, utilizing information technology solutions, creative use of staff and flexible schedules, and obtaining additional resources.

Discussion:
This study highlights several common challenges programs can address during the program implementation. The most often mentioned strategy was effective communication. Strategies also targeted several components of the organization including organizational functions and processes (e.g., importance of coordination within a team and across disciplines to provide good care), infrastructure (e.g., information technology and human resources), and program fit with priorities in the organization (e.g., leadership support).

Implications:
Anticipating potential pitfalls of program implementation for future noninstitutional LTSS programs can improve implementation efficiency and program sustainability. Staff at multiple levels in the organization must fully support noninstitutional LTSS programs to address these challenges.
Sensitivity, Specificity, and Receiver Operating Characteristics: A Primer for Neuroscience Nurses
Authors: McNett Molly , Amato Shelly , Olson DaiWai M. 
Published: January 2017

ABSTRACT
It is important for neuroscience nurses to have a solid understanding of the instruments they use in clinical practice. Specifically, when reviewing reports of research instruments, nurses should be knowledgeable of analytical terms when determining the applicability of instruments for use in clinical practice. The purpose of this article is to review 3 such analytical terms: sensitivity, specificity, and receiver operating characteristic curves. Examples of how these terms are used in the neuroscience literature highlight the relevance of these terms to neuroscience nursing practice. As the role of the nurse continues to expand, it is important not to simply accept all instruments as valid but to be able to critically evaluate their properties for applicability to nursing practice and evidence-based care of our patients.
Stereotactic Radiosurgical Treatment of Glomus Jugulare Tumors
Authors: Winford Tyler W. , Dorton Leighanne H. , Browne James D. , Chan Michael D. , Tatter Stephen B. , Oliver Eric R. 
Published: January 2017

Objective:
Determine treatment outcomes of stereotactic radiosurgery (SRS) for glomus jugulare tumors (GJT), focusing on three-dimensional volume change and symptoms before and after SRS, as well as complications related to SRS.

Study Design:
Retrospective case review.

Setting:
Tertiary referral center.

Patients:
Thirty-eight patients treated with SRS between 2000 and 2015.

Intervention:
SRS treatment of GJT.

Main Outcome Measures:
The tumor volumes on pre- and posttreatment imaging were compared utilizing the Leskell GammaPlan treatment plan software to assess tumor progression. Pre- and posttreatment symptoms, Fisch classification, and complications were recorded.

Results:
The mean radiographic follow-up was 39.1 months. The mean dose-to-tumor margin was 13.2 Gy. The mean tumor size at treatment was 5.8 and 5.2 cm3 at last follow-up. Thirty-three patients had follow-up imaging suitable for analysis. When defining both 10 and 15% tumor size increases as significant, 27 (82%) and 29 (88%) tumors decreased in size or remained stable, respectively. For the seven tumors with documented pre-SRS growth, treatment success was 86%. The mean marginal dose for treatment success and failure were 13.2 and 13.7 Gy, respectively. Patients receiving a higher margin dose had a greater risk of tumor progression (p = 0.0277). Fisch classification did not impact tumor progression rate. Initial tumor volume had no significance on tumor response to SRS.

Conclusions:
SRS is an effective treatment option for GJT. Both initial tumor volume and Fisch classification did not impact tumor progression. There were no significant patient or lesion characteristics that distinguished treatment success and/or failure.
Which indicators to include in a crowding scale in an emergency department? A national French Delphi study
Authors: Noel Guilhem , Drigues Camille , Viudes Gilles 
Published: January 2017

BackgroundEmergency department (ED) crowding is a serious international public health issue with a negative impact on quality of care. Despite two decades of research, there is no consensus on the indicators used to quantify crowding. The aim of our study was to select the most valid ED crowding indicators.Materials and methodsThe Delphi method was used. Selected indicators originated from a literature review and propositions from FEDORU (National Emergency Department Observatory Network) workgroup. Selected national experts were emergency physicians with a special interest in ED crowding. They had to assess each indicator in terms of validity out of a Likert scale from 1 to 9. Indicators withdrawal criteria after each round (consensus) were over 70% of answers of at least 7 with interquartile range less than 3 (positive consensus) or over 70% of answers of at least 4 and interquartile range less than 3 (negative consensus). The decision to stop the delphi procedure was based on the stability of answers between the rounds.Results41 (89.13%) experts answered the first round and 37 (80.43%) answered the second round. Among the 57 indicators included, 15 reached consensus: four input indicators, six throughput and five output ones. For those three categories of at least 7 answers rates were, respectively, 80.9, 76.9 and 75.0%. Five indicators were deducible from the mandatory Emergency Department Discharge Summary. They obtained 80.2% of at least 7 answers.ConclusionOur study results enable the construction and validation of a crowding measuring tool from indicators approved by experts. It is necessary to further reflect about ED crowding as a concept and what is expected from a complex score.
The Moderating Effect of Religion on the Relationship Between Depression and Suicidal Ideation in the Elderly
Authors: Jung JaeHoon , Roh Daeyoung , Moon Yoo Sun , Kim Do Hoon 
Published: January 2017

Abstract
This article aimed to compare the level of suicidal ideation in the religiously affiliated and nonaffiliated groups and identify the moderating effect of religion variables on the relationship between depression and suicidal ideation. The sample in this study was 1180 residents who were older than 60 years and who resided in Gangwon Province, South Korea. We studied the cross-sectional relationships among religions and studied variables including organizational religious activity (ORA), non-ORA (NORA), intrinsic religiosity (IR), depression, well-being, and suicidal ideation. After controlling for sociodemographic variables, the depression, well-being, and suicidal ideation level in the religiously affiliated group were not significantly different from that of the religiously nonaffiliated group and the variables also were not significantly different between Christians and Buddhists. The effect of depression on suicidal ideation was significantly moderated by ORA and IR, and the effect showed different patterns by religion; ORA was a moderator only among the Buddhist group, and IR only moderated the relationships among the Christians.
Finding Diagnostic Errors in Children Admitted to the PICU
Authors: Davalos Maria Caridad , Samuels Kenya , Meyer Ashley N. D. , Thammasitboon Satid , Sur Moushumi , Roy Kevin , Al-Mutairi Aymer , Singh Hardeep 
Published: January 2017

Objectives:
To determine whether the Safer Dx Instrument, a structured tool for finding diagnostic errors in primary care, can be used to reliably detect diagnostic errors in patients admitted to a PICU.

Design and Setting:
The Safer Dx Instrument consists of 11 questions to evaluate the diagnostic process and a final question to determine if diagnostic error occurred. We used the instrument to analyze four “high-risk” patient cohorts admitted to the PICU between June 2013 and December 2013.

Patients:
High-risk cohorts were defined as cohort 1: patients who were autopsied; cohort 2: patients seen as outpatients within 2 weeks prior to PICU admission; cohort 3: patients transferred to PICU unexpectedly from an acute care floor after a rapid response and requiring vasoactive medications and/or endotracheal intubation due to decompensation within 24 hours; and cohort 4: patients transferred to PICU unexpectedly from an acute care floor after a rapid response without subsequent decompensation in 24 hours.

Interventions:
Two clinicians used the instrument to independently review records in each cohort for diagnostic errors, defined as missed opportunities to make a correct or timely diagnosis. Errors were confirmed by senior expert clinicians.

Measurements and Main Results:
Diagnostic errors were present in 26 of 214 high-risk patient records (12.1%; 95% CI, 8.2–17.5%) with the following frequency distribution: cohort 1: two of 16 (12.5%); cohort 2: one of 41 (2.4%); cohort 3: 13 of 44 (29.5%); and cohort 4: 10 of 113 (8.8%). Overall initial reviewer agreement was 93.6% (κ, 0.72). Infections and neurologic conditions were the most commonly missed diagnoses across all high-risk cohorts (16/26).

Conclusions:
The Safer Dx Instrument has high reliability and validity for diagnostic error detection when used in high-risk pediatric care settings. With further validation in additional clinical settings, it could be useful to enhance learning and feedback about diagnostic safety in children.
Intranasal Analgesia and Sedation in Pediatric Emergency Care—A Prospective Observational Study on the Implementation of an Institutional Protocol in a Tertiary Children's Hospital
Authors: Nemeth Marcus , Jacobsen Nils , Bantel Carsten , Fieler Melanie , Sümpelmann Robert , Eich Christoph 
Published: January 2017

ObjectivesChildren presenting with acute traumatic pain or in need of therapeutic or diagnostic procedures require rapid and effective analgesia and/or sedation. Intranasal administration (INA) promises to be a reliable, minimally invasive delivery route. However, INA is still underused in Germany. We hence developed a protocol for acute pain therapy (APT) and urgent analgesia and/or sedation (UAS). Our aim was to evaluate the effectiveness and safety of our protocol.MethodsWe performed a prospective observational study in a tertiary children's hospital in Germany. Pediatric patients aged 0 to 17 years requiring APT or UAS were included. Fentanyl, s-ketamine, midazolam, or combinations were delivered according to protocol. Primary outcome variables included quality of analgesia and/or sedation as measured on age-appropriate scales and time to onset of drug action. Secondary outcomes were adverse events and serious adverse events.ResultsOne hundred pediatric patients aged 0.3 to 16 years were enrolled, 34 for APT and 66 for UAS. The median time onset of drug action was 5 minutes (ranging from 2 to 15 minutes). Fentanyl was most frequently used for APT (n = 19). Pain scores decreased by a median of 4 points (range, 0-10;P< 0.0001). For UAS, s-ketamine/midazolam was most frequently used (n = 25). Sedation score indicated minimal sedation in most cases. Overall success rate after the first attempt was 82%. Adverse events consisted of nasal burning (n = 2) and vomiting (n = 2). No serious adverse events were recorded.ConclusionsA fentanyl-, s-ketamine-, and midazolam-based INA protocol was effective and safe for APT and UAS. It should then be considered where intravenous access is impossible or inappropriate.