bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standardized Patient Encounters
Authors: Turner T. Robert , Scerbo Mark W. , Gliva-McConvey Gayle A. , Wallace Amelia M. 
Published: April 2016

Introduction
Standardized patients are a beneficial component of modern healthcare education and training, but few studies have explored cognitive factors potentially impacting clinical skills assessment during standardized patient encounters. This study examined the impact of a periodic (vs. traditional postencounter) evaluation approach and the appearance of critical verbal and nonverbal behaviors throughout a standardized patient encounter on scoring accuracy in a video-based scenario.

Methods
Forty-nine standardized patients scored either periodically or at only 1 point in time (postencounter) a healthcare provider’s verbal and nonverbal clinical performance during a videotaped standardized patient encounter. The healthcare provider portrayed in this study was actually a standardized patient delivering carefully scripted verbal and nonverbal behaviors in their portrayal of an actual physician. The encounter itself was subdivided into 3 distinct segments for the purpose of supporting periodic evaluation, with the expectation that both verbal and nonverbal cues occurring in the middle segment would be more challenging to accurately report for participants in the postscenario evaluation group as a result of working memory decay.

Results
Periodic evaluators correctly identified a significantly greater number of critical verbal cues midscenario than postencounter evaluators (P < 0.01) and correctly identified a significantly greater number of critical nonverbal cues than their postscenario counterparts across all 3 scenario segments (P < 0.001). Further, postscenario evaluations exhibited a performance decrement in terms of midscenario correct identifications that periodic evaluators did not (P < 0.01). Also, periodic evaluators exhibited fewer verbal cue false-positives during the first segment of the scenario than postscenario evaluators (P < 0.001), but this effect did not extend to other segments regardless of the cue type (ie, verbal or nonverbal).

Discussion
Pausing lengthier standardized patient encounters periodically to allow for more frequent scoring may result in better reporting accuracy for certain clinical behavioral cues. This could enable educators to provide more specific formative feedback to individual learners at the session’s conclusion. The most effective encounter design will ultimately depend on the specific goals and training objectives of the exercise itself.
Improvement in Trainees’ Attitude and Resuscitation Quality With Repeated Cardiopulmonary Resuscitation Training
Authors: Kim Jong Won , Lee Jeong Hun , Lee Kyeong Ryong , Hong Dae Young , Baek Kwang Je , Park Sang O 
Published: April 2016

Introduction
This study investigated the effect of increasing numbers of training sessions in cardiopulmonary resuscitation (CPR) on trainees’ attitude and CPR quality.

Methods
Cardiopulmonary resuscitation training for hospital employees was held every year from 2006 to 2010. Participants were recruited among the trainees in 2010. The trainees’ attitudes toward CPR were surveyed by questionnaire, and the quality of their CPR was measured using 5-cycle 30:2 CPR on a manikin. Participants were categorized according to the number of consecutive CPR training sessions as T1 (only 2010), T2 (2009 and 2010), T3 (from 2008 to 2010) and T4–5 (from 2006 or 2007 to 2010). The trainee attitude and CPR quality were compared among the 4 groups.

Results
Of 923 CPR trainees, 267 were enrolled in the study. There was significant increase in willingness to start CPR and confidence in chest compression and mouth-to-mouth ventilation (MTMV) with increasing number of CPR training sessions attended (especially for ≥ 3 sessions). There was a significant increase in mean compression depth and decrease in percentage of chest compressions with depth of less than 38 mm in the T3 and T4–5 compared with the T1 and T2. No-flow time decreased significantly, and the percentage of MTMV with visible chest rise increased, as the number of training sessions increased.

Conclusions
Repeated CPR training improved trainees’ attitude and CPR quality. Because the number of training sessions increased (≥3), the willingness to start CPR and the confidence in skills increased significantly, and chest compression depth, no-flow time, and MTMV improved.
Comparison of 4 Laryngoscopes in 2 Difficult Airway Scenarios
Authors: Altun Demet , Ozkan-Seyhan Tulay , Orhan-Sungur Mukadder , Sivrikoz Nukhet , Camci Emre 
Published: April 2016

Introduction
The performance of laryngoscopes that have been developed for difficult airways can vary widely. The aim of the study was to compare Macintosh, McCoy, McGrath MAC, and C-MAC laryngoscopes in cervical immobilization and tongue edema scenarios in a mannequin, primarily to evaluate the time to intubation.

Methods
In this randomized crossover study, 41 anesthesiology residents used 4 laryngoscopes in a mannequin (SimMan 3G) in 2 different scenarios. Intubation time (insertion of the blade between the teeth, to placement of the endotracheal tube into the trachea) longer than 120 seconds or inability to successfully place the endotracheal tube into the trachea after 5 or more attempts was defined as intubation failure. Besides intubation time, laryngoscopic view, number of intubation attempts, presence of esophageal intubation, need for stylet, difficulty of intubation, and success rate were recorded as secondary outcomes.

Results
Intubation time was observed from longest to shortest as McGrath > McCoy > C-MAC > Macintosh in both scenarios. Laryngeal view was better with C-MAC laryngoscope. McGrath laryngoscope performed poorly specifically in tongue edema scenarios, which resulted in higher number of intubation attempts, esophageal intubation, need for intubation stylets, and overall intubation failure.

Conclusions
The short intubation time observed with the Macintosh underlines the necessity of familiarity in success. Tongue edema is a more challenging scenario for simulated difficult airway and the McGrath may not be a good choice for such a scenario.
The Design of a Randomized Trial of Vaginal Surgery for Uterovaginal Prolapse: Vaginal Hysterectomy With Native Tissue Vault Suspension Versus Mesh Hysteropexy Suspension (The Study of Uterine Prolapse Procedures Randomized Trial)
Authors: Nager Charles W. , Zyczynski Halina , Rogers Rebecca G. , Barber Matthew D. , Richter Holly E. , Visco Anthony G. , Rardin Charles R. , Harvie Heidi , Wallace Dennis , Meikle Susan F. 
Published: April 2016

Objectives
We present the rationale for and design of a randomized controlled superiority trial comparing 2 vaginal surgical approaches for the treatment of uterovaginal prolapse. The Study of Uterine Prolapse Procedures Randomized Trial (SUPeR) trial compares the efficacy and safety of native tissue repair with vaginal hysterectomy and suture apical suspension versus uterine conservation with mesh hysteropexy through 36 to 60 months postoperatively for primary repair of uterovaginal prolapse.

Methods
The selection of the primary outcome measure, timing of randomization, patient and evaluator masking to surgical intervention, collection and adjudication of adverse events, cost effectiveness evaluations, partnering with industry, and surgeon certification of competency to perform the 2 procedures is described. A composite primary outcome of success defined as no prolapse symptoms, no objective prolapse beyond the hymen, and no retreatment of prolapse, with a minimum of 36 months postsurgery follow-up using survival analyses is planned. Secondary outcomes measured at baseline and every 6 months postsurgery include validated condition-specific and general quality of life assessments, global impression of improvement, body image, and sexual function measures. Unique challenges during the trial design include maintenance of patient masking to the intervention with routine gynecologic health maintenance and maintenance of evaluator masking.

Results
Recruitment and randomization of 180 participants is complete, and participants are currently in the follow-up phase.

Conclusions
This trial will provide information to help surgeons counsel patients and contribute evidence-based information regarding risks and benefits of 2 approaches for the treatment of uterovaginal prolapse.
Clinical Relevance and Treatment Selection of Ureteral Injury After Cesarean Section
Authors: Lo Tsia-Shu , Wijaya Tomy , Lo Liang-Ming , Kao Chuan-Chi , Wu Pei-Ying , Cortes Eileen Feliz M. , Huang Shih Yin , Lin Chih Hui 
Published: April 2016

Introduction
The aim of this case series was to report the clinical relevance and management outcomes of ureteral injuries acquired secondary to cesarean section.

Methods
This was a retrospective case series from January 2007 to September 2014. Description of the patients' characteristics, diagnostic tools for investigation, management, and postoperative follow-up was conducted on postcesarean section patients who developed symptoms of urine leakage after cesarean section and necessitated secondary surgery for ureteral injury. Descriptive statistics was used for demographics and operative data.

Results
A total of 5619 cases were managed by cesarean section during the study period. Six (0.107%; 95% confidence interval [CI], 0.1069%–0.1071%) patients had ureteral injury related to the cesarean section. Of 6 cases, 3 (0.053%; 95% CI, 0.0529%–0.0531%) had ureterouterine fistula. Three cases were managed by ureteroneocystostomy, 1 by ureteroneocystostomy with Boari flap, 1 by transureteroureterostomy, and the other one by ureteral stenting via ureterocystoscopy. Three patients had immediate operation because of an acute abdomen and 3 patients had delayed operation. The left ureter was the most common site of ureteral injury (5/6). The postoperative course was uneventful for all cases.

Conclusions
Continuous urinary leakage and acute abdominal distention associated with fluid accumulation after emergency cesarean section should be considered as “red flag” symptoms of ureteral injury and ureterouterine fistulae complications. Delayed management for ureteral repair may not be associated with bad outcomes for management of ureterouterine fistula. Delayed management was associated with less blood loss, less operating time, and acceptable outcome among patients with ureterouterine fistulae when the renal function is not compromised.
The Impact of Obesity on Intraoperative Complications and Prolapse Recurrence After Minimally Invasive Sacrocolpopexy
Authors: Turner Lindsay , Lavelle Erin , Lowder Jerry L. , Shepherd Jonathan P. 
Published: April 2016

Objective
Our objective was to compare the risk of intraoperative complications and prolapse recurrence among normal-weight, overweight, and obese women after minimally invasive sacrocolpopexy.

Methods
This is a retrospective study of all laparoscopic and robotic sacrocolpopexies performed at a large academic center from 2009 to 2014. Patient demographics and clinical and surgical data were compared between normal-weight, overweight, and obese women using χ2 test, analysis of variance (ANOVA), and logistic regression.

Results
Of the 556 subjects, 187 (33.6%) were normal weight, 248 (44.6%) were overweight, and 121 (21.8%) were obese. Compared with normal-weight and overweight women, obese women had more medical comorbidities (56.2% vs 29.4% and 39.5%, P < 0.001) and were more likely to undergo robotic surgery (odds ratio, 1.40; 95% confidence interval, 1.01–1.94). Obese women experienced greater blood loss compared with overweight women (82.4 [76.1] vs 63.8 [51.6] mL, P = 0.03) and longer operative times compared with both normal-weight and overweight women (250.7 [57.0] vs 233.8 [58.2] minutes, P = 0.04, and 250.7 [57.0] vs 233.8 [57.2] minutes, P = 0.03). Obesity was a significant predictor of intraoperative complications even after correcting for surgeon experience, estimated blood loss, and concomitant hysterectomy (adjusted odds ratio, 3.42; 95% confidence interval, 1.21-9.70). Few women (7.6%) experienced recurrence of prolapse. Obesity was not a significant predictor of prolapse recurrence.

Conclusions
In women undergoing minimally invasive sacrocolpopexy, obesity is associated with increased blood loss, longer operative times, and more intraoperative complications, specifically conversions to laparotomy. Even after correcting for blood loss, surgeon experience, and concomitant hysterectomy, obese women were 3 times as likely to have an intraoperative complication. Our data did not show that obesity was associated with increased risk of prolapse recurrence; however, postoperative follow-up was limited.
Transdermal Scopolamine and Acute Postoperative Urinary Retention in Pelvic Reconstructive Surgery
Authors: Propst Katie , O'Sullivan David M. , Tulikangas Paul K. 
Published: April 2016

Objective
To evaluate the relationship between perioperative use of transdermal scopolamine and the rate of urinary retention after stress urinary incontinence and pelvic organ prolapse procedures in women.

Methods
This is a retrospective, cohort study; the primary outcome is the rate of acute postoperative urinary retention. Study candidates were adult female patients who underwent pelvic reconstructive surgery at a tertiary care center. Subjects were excluded if preoperative postvoid residual urine volume was greater than 150 mL, preoperative urodynamic testing was not performed, or if a postoperative trial of void was not performed. Subjects were grouped based on preoperative use of transdermal scopolamine. Patients were selected consecutively until 138 subjects per group was reached. Differences in rates of acute postoperative urinary retention were evaluated using a chi-square test. Group demographics were evaluated using t tests and χ2 tests.

Results
Two hundred seventy-six subjects were included in the analysis, 138 received a transdermal scopolamine patch in the perioperative period and 138 did not. The overall rate of acute postoperative urinary retention was 25.3%. There was no significant difference in the rate of acute postoperative urinary retention between the study groups (scopolamine, 26.8%; no scopolamine, 23.9%; P = 0.580). Demographics of the 2 groups were compared; patients who received scopolamine patch were younger (P = 0.001), received a greater amount of intravenous fluids (P = 0.007), and underwent a greater percentage of incontinence procedures (P = 0.048). Otherwise, there were no differences between the groups.

Conclusions
Transdermal scopolamine is not a risk factor for acute postoperative urinary retention after pelvic reconstructive procedures.
Providing Better-Matched Donors for HLA Mismatched Compatible Pairs Through Kidney Paired Donation
Authors: Ferrari Paolo , Cantwell Linda , Ta Joseph , Woodroffe Claudia , D'Orsogna Lloyd , Holdsworth Rhonda 
Published: April 2016

Background
Participation of compatible pairs (CP) in kidney paired donation (KPD) could be attractive to CPs who have a high degree of HLA mismatch, if the CP recipient will gain a better HLA match. Because KPD programs were not designed to help CP, it is important to define allocation metrics that enable CP to receive a better-matched kidney, without disadvantage to incompatible pairs (ICP).

Methods
Simulations using 46 ICPs and 11 fully HLA-mismatched CPs were undertaken using the Australian KPD matching algorithm. Allocations were preformed adding 1 CP at a time or all 11 CPs at once, and with and without exclusion of unacceptable antigens selected to give a virtual calculated panel-reactive antibody ranging 70% to 80% to improve HLA matching in CP recipients.

Results
On average, most CP recipients could be matched and had a lower eplet mismatch (EpMM) with the matched donor (57 ± 15) than with their own donor (78 ± 19, P < 0.02). However, only recipients who had an EpMM to own donor greater than 65 achieved a significant reduction in the EpMM with the matched donor. The gain in EpMM was larger when CPs were listed with unacceptable antigens. Furthermore, inclusion of 1 CP at a time increased matching in ICP by up to 33%, and inclusion of all 11 CPs at once increased ICP matching by 50%.

Conclusions
Compatible pair participation in KPD can increase match rates in ICP and can provide a better immunological profile in CP recipients who have a high EpMM to their own donor when using allocation based on virtual crossmatch.
Robust Generation of Transgenic Mice by Hypotonic Shock Mediated Transgene Delivery in Testicular Germ Cells
Authors: Usmani Abul , Ganguli Nirmalya , Jain Subodh K , Ganguli Nilanjana , Sarkar Rajesh Kumar , Choubey Mayank , Shukla Mansi , Sarkar Hironmoy , Majumdar Subeer S 
Published: April 2016

AbstractOur ability to decipher gene sequences has increased enormously with the advent of modern sequencing tools but the ability to divulge functions of new genes have not increased correspondingly. This has caused a remarkable delay in functional interpretation of several newly found genes in tissue and age specific manner, limiting the pace of biological research. This is mainly due to lack of advancements in methodological tools for transgenesis. Predominantly practiced method of transgenesis by pronuclear DNA-microinjection is time consuming, tedious and requires highly skilled persons for embryo-manipulation. Testicular electroporation mediated transgenesis requires use of electric current to testis. To this end, we have now developed an innovative technique for making transgenic mice by giving hypotonic shock to male germ cells for the gene delivery. Desired transgene was suspended in hypotonic Tris-HCl solution (pH 7.0) and simply injected in testis. This resulted in internalization of the transgene in dividing germ-cells residing at basal compartment of tubules leading to its integration in native genome of mice. Such males generated transgenic progeny by natural mating. Several transgenic animals can be generated with minimum skill within short span of time by this easily adaptable novel technique.
The complexity of innovation: an assessment and review of the complexity perspective
Authors: Poutanen Petro , Soliman Wael , Ståhle Pirjo 
Published: April 2016

Purpose– The purpose of this paper is to provide a review of the innovation literature, with special focus on studies applying a complexity perspective. As a contribution in its own right to the innovation literature, the review clarifies the concept of complexity, explores possible points of relevance and the “added value” gained from complexity theory (CT) to the study of innovation, and identifies some of the applications of the theory.Design/methodology/approach– A literature search was conducted which yielded 20 relevant articles. These articles were analyzed by focusing on the key concepts of complexity and studying their applications in the context of innovation research.Findings– Based on the approach adopted, the literature was divided into three categories, namely research focusing on microdynamics, macrodynamics, and leadership and management. The key complexity concepts identified in the innovation literature were “edge of chaos”, “phase shift”, “emergence and self-organization”, “(co)evolution”, and “complexity regulation”. The articles reviewed differed in terms of their perspectives on complexity and, accordingly, their operationalization of the complexity concepts. Key areas of development suggested by the authors include forging a stronger link with existing innovation theory and giving greater weight to empirical evidence.Research limitations/implications– While a systematic review strategy was adopted to identify all relevant research on “open innovation” and complexity, a selective snowball strategy was deemed the only feasible approach to cover research conducted on “innovation” and complexity.Practical implications– Practitioners can learn to put CT-based research in context and also learn to recognize the value of CT for innovation management. The authors distilled three important lessons for practice from the research done: embracing complexity, embracing ambidexterity, and embracing failure.Originality/value– To the best of the authors’ knowledge no review has as yet been undertaken to encapsulate the current state of applications of CT to innovation research.
Effectuation, innovation and performance in SMEs: an empirical study
Authors: Roach David C. , Ryman Joel A. , Makani Joyline 
Published: April 2016

Purpose– Ever since Sarasvathy’s (2001) seminal article, scholars have sought to test effectuation’s affect on firm performance. Although recent work has begun the arduous process of testing effectuation’s effect on entrepreneurial performance, there is still much to learn about its impact on firm performance. One such area is the relationship between effectuation and innovation. The purpose of this paper is to first, propose a scale suitable to the explication of the effectuation construct relative to innovation. Second, it proposes a more parsimonious scale for the measurement of innovation. Third, these scales are tested relative to firm performance.Design/methodology/approach– This paper develops and tests a structural model, which investigates aspects of effectuation as mediators between innovation orientation and product/service innovation. This is accomplished using a sample of 169 electronic product manufacturing-based small and medium-sized enterprises (SMEs). Subjective measures of performance are used as the dependent variable.Findings– The three most widely used measures of innovativeness were found to break cleanly into two sub-constructs, namely innovation orientation and product/service innovation. Effectuation measures included means (who I know), leverage contingencies (experimentation), pre-commitments and affordable loss. Means and leverage contingencies were found to positively mediate innovation orientation and product/service innovation leading to increased firm performance. Affordable loss did not show a mediating role, but had a direct effect on firm performance.Research limitations/implications– This study establishes two distinct sub-constructs of firm-level innovation; namely innovation orientation and product/service innovation. Second, by testing an innovation-centric effectuation model, this research establishes an empirical relationship between effectuation, innovation and firm performance.Practical implications– Practical implications include establishing a relationship between means, leverage contingencies and innovation-performance, indicating that the ways through which small and medium-sized enterprises use their innovation networks may affect innovation outcomes and ultimately firm performance.Originality/value– This research establishes an empirical relationship between effectuation, innovation and firm performance, extending effectuation theory from the entrepreneurship to the innovation literature.