bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electronic Medical Records, Medical Students, and Ambulatory Family Physicians: A Multi-Institution Study
Authors: White Jordan , Anthony David , WinklerPrins Vince , Roskos Steven 
Published: April 2017

Purpose
Medical students commonly encounter electronic medical records (EMRs) in their ambulatory family medicine clerkships, but how students interact with this technology varies tremendously and presents challenges to students and preceptors. Little research to date has evaluated the impact of EMRs on medical student education in the ambulatory setting; this three-institution study aimed to identify behaviors of ambulatory family medicine preceptors as they relate to EMRs and medical students.

Method
In 2015, the authors sent e-mails to ambulatory preceptors who in the preceding year had hosted medical students during family medicine clerkships, inviting them to participate in the survey, which asked questions about each preceptor’s methods of using the EMR with medical students.

Results
Of 801 ambulatory preceptors, 265 (33%) responded. The vast majority of respondents used an EMR and provided students with access to it in some way, but only 62.2% (147/236) allowed students to write electronic notes. Of those who allowed students electronic access, one-third did so by logging students in under their own (the preceptor’s) credentials, either by telling the students their log-in information (22/202; 10.9%) or by logging in the student without revealing their passwords (43/202; 21.3%).

Conclusions
Ambulatory medical student training in the use of EMRs not only varies but also requires many preceptors to break rules for students to learn important documentation skills. Without changes to the policies surrounding student access to and use of EMRs, future physicians will enter residency without the training they need to appropriately document patient care.
Minimal disease activity in axial spondyloarthritis: the need of the hour and a proposal for development
Authors: Deodhar Atul A. , Kumthekar Anand , Dubreuil Maureen 
Published: April 2017

Purpose of review
Axial spondyloarthritis (axSpA) is a chronic inflammatory condition with articular and extra-articular manifestations. Remission, a state of absence of clinical and imaging signs of disease activity over time, is the goal of management. This review addresses the concept of minimal disease activity (MDA) in axSpA, which is less stringent than remission, and is closer to patient and provider acceptable low disease state.

Recent findings
Existing axSpA treatments improve physical function and quality of life, and lead to remission in a minority of patients. A consistent MDA state decreases disease progression in rheumatoid arthritis and psoriatic arthritis. We argue a need to develop MDA in axSpA for clinical practice and clinical trials and propose methodology. Considering that MDA will be used in clinical practice, its elements must be easy to collect and cover both musculoskeletal and extra-articular domains. MDA will complement current disease activity measures in axSpA.

Summary
Defining an MDA target in axSpA would provide an outcome measure that is less stringent than remission, and will likely predict function and quality of life. We propose methods to develop MDA in axSpA and that further research be performed to determine if treating to an MDA target in axSpA improves patient outcomes.
New developments in uveitis associated with HLA B27
Authors: Rosenbaum James T. 
Published: April 2017

Purpose of review
Uveitis is the most common, clinically apparent, extra-articular manifestation of axial spondyloarthritis. This review summarizes recent publications related to this form of uveitis.

Recent findings
Studies published since the start of 2015 address the worldwide prevalence of human leukocyte antigen (HLA) B27-associated uveitis, the prevalence of axial spondyloarthritis among patients with B27-associated acute anterior uveitis (AAU), the genetics of AAU and some of the clinical implications of AAU. Progress has been made in the treatment of uveitis in general and in the treatment of uveitis in association with spondyloarthropathy in particular. The pathogenesis of AAU might derive clues from the above as well as from an understanding of the microbiome and possibly from knowledge derived from uveitis in association with Ebola.

Summary
Although HLA B27-associated uveitis has been recognized since 1973, a variety of recent observations shed new light on this common clinical association with spondyloarthritis.
Current Practice of Therapeutic Drug Monitoring of Biopharmaceuticals in Psoriasis Patients
Authors: Hermans Caroline , Herranz Pedro , Segaert Siegfried , Gils Ann 
Published: April 2017

Abstract:
The high prevalence of psoriasis and the high spending on pharmaceuticals motivate a more evidence-based and cost-effective usage of biopharmaceuticals. A growing body of evidence exists that the implementation of therapeutic drug monitoring for biopharmaceuticals in psoriasis patients optimizes patient management and clinical outcome and enhances their efficacy. Therefore, the aim of this review was to give an overview of the literature on therapeutic drug monitoring of biopharmaceuticals in the treatment of psoriasis and to provide the useful information to dermatologists to improve health care in psoriasis patients.
Sulfonylureas (not metformin) improve survival of patients with diabetes and resectable pancreatic adenocarcinoma
Authors: Toomey Paul , Teta Anthony , Patel Krishen , Downs Darrell , Luberice Kenneth , Ross Sharona , S. Rosemurgy Alexander 
Published: April 2017

Introduction:
Patients with pancreatic adenocarcinoma have an increased propensity for diabetes. Recent studies suggest patients with diabetes and pancreatic adenocarcinoma treated with metformin have increased survival. This study was undertaken to determine whether metformin use is associated with increased survival in patients with pancreatic adenocarcinoma.

Methods:
Patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma from 1991 to 2013 were included in this study. Survival was evaluated by Kaplan-Meier analysis. Median data are reported. Significance was accepted with 95% probability.

Results:
Of 414 patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, 132 (32%) were diabetic. Of patients with diabetes, 35 (27%) were diet-controlled, 34 (26%) were treated with insulin alone, 18 (14%) were treated with metformin alone, 14 (10%) were treated with sulfonylureas alone, 7 (5%) were taking sulfonylureas with insulin, and 24 (18%) patients were taking metformin with sulfonylureas and/or insulin. Patients with/without diabetes not taking sulfonylureas had survival of 16.4 months compared with patients taking sulfonylureas who achieved survival of 27.5 months after undergoing pancreaticoduodenectomy (P<0.05).

Conclusions:
Patients taking sulfonylureas with or without other therapy had improved survival compared with patients not taking sulfonylureas after pancreaticoduodenectomy. Metformin does not seem to be beneficial for patients with resectable disease, but may be beneficial for patients with unresectable and/or metastatic disease as shown in prior studies. The use of sulfonylureas is associated with a survival benefit for patients undergoing resection for pancreatic adenocarcinoma. Tumor staging and margin status continue to be the overriding predictors of survival in patients with resectable pancreatic adenocarcinoma, not metformin therapy.
Audiological Results in SSD With an Active Transcutaneous Bone Conduction Implant at a Retrosigmoidal Position
Authors: Salcher Rolf , Zimmermann Denise , Giere Thomas , Lenarz Thomas , Maier Hannes 
Published: April 2017

Objective:
One option for patients with single sided deafness (SSD) who experience problems with insufficient hearing in different surroundings is the treatment with percutaneous bone-anchored hearing aids. Common medical problems associated to a skin penetrating abutment can be avoided by active transcutaneous bone conduction hearing implants. The purpose of our study was to evaluate the benefit of an active transcutaneous bone conduction hearing implant in patients with SSD.

Patients and Methods:
Patients suffering from SSD who are implanted with an active transcutaneous bone conduction hearing implant in retrosigmoidal position were audiologically analyzed. The audiological test battery included air and bone conduction thresholds, word recognition score (WRS) in quiet and speech intelligibility (Oldenburg Sentence Test [OLSA]) in noise. Patient satisfaction was evaluated with the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Bern-Benefit in Single-Sided Deafness (BBSS) questionnaire.

Results:
The monosyllable WRS and the signal-to-noise ratio (SNR) assessed by the OLSA was significantly better in all aided conditions. Also, the APHAB categories ease of communication and reverberation and the average benefit in the BBSS improved significantly if using the device.

Conclusion:
The Bonebridge is a transcutaneous alternative to the well-established percutaneous bone conducting devices in patients with single sided deafness. An improvement in hearing in noise and quiet as well as a decrease of the head shadow effect can be expected.
Supportive technology in the resuscitation of out-of-hospital cardiac arrest patients
Authors: Youngquist Scott T. , Scheppke Kenneth A. , Pepe Paul E. 
Published: April 2017

Purpose of review
To discuss the increasing value of technological tools to assess and augment the quality of cardiopulmonary resuscitation (CPR) and, in turn, improve chances of surviving out-of-hospital cardiac arrest (OHCA).

Recent findings
After decades of disappointing survival rates, various emergency medical services systems worldwide are now seeing a steady rise in OHCA survival rates guided by newly identified ‘sweet spots’ for chest compression rate and chest compression depth, aided by monitoring for unnecessary pauses in chest compressions as well as methods to better ensure full-chest recoil after compressions. Quality-assurance programs facilitated by new technologies that monitor chest compression rate, chest compression depth, and/or frequent pauses have been shown to improve the quality of CPR. Further aided by other technologies that enhance flow or better identify the best location for hand placement, the future outlook for better survival is even more promising, particularly with the potential use of another technology – extracorporeal membrane oxygenation for OHCA.

Summary
After 5 decades of focus on manual chest compressions for CPR, new technologies for monitoring, guiding, and enhancing CPR performance may enhance outcomes from OHCA significantly in the coming years.
Risk Factors for Asparaginase-associated Pancreatitis
Authors: Oparaji Judy-April , Rose Fateema , Okafor Debra , Howard Amari , Turner Rose L. , Orabi Abrahim I. , Byersdorfer Craig , Mi Qi , Ritchey Kim , Lowe Mark E. , Husain Sohail Z. 
Published: April 2017

Goals:
To evaluate potential risk factors for the development of asparaginase-associated pancreatitis (AAP), we performed a systematic review of the current literature from January 1946 through May 2015.

Background:
Asparaginase, a primary treatment for the most common childhood cancer, acute lymphoblastic leukemia (ALL), is a well-described cause of pancreatitis. Further, pancreatitis is among the most burdensome and common complications of asparaginase treatment and represents a major reason for early-drug termination and inferior outcomes. The literature lacks clarity about the risk factors for AAP, and this knowledge gap has hampered the ability to reliably predict which patients are likely to develop AAP.

Study:
In an expansive screen, 1842 citations were funneled into a review of 59 full articles, of which 10 were deemed eligible based on predetermined inclusion criteria.

Results:
Of the 10 identified studies, only 2 studies showed that children above 10 years of age had a >2-fold risk of AAP compared with younger children. Patients placed in high-risk ALL categories had a greater incidence of pancreatitis in 2 studies. In addition, use of pegylated asparaginase resulted in a higher incidence of AAP in 1 study.

Conclusions:
In this systematic review, older age, asparaginase formulation, higher ALL risk stratification, and higher asparaginase dosing appear to play a limited role in the development of AAP. Further studies are needed to probe the underlying mechanisms contributing to the development of pancreatitis in patients receiving asparaginase.
Grandparents raising grandchildren: a primer for pediatricians
Authors: Ge William , Adesman Andrew 
Published: April 2017

Purpose of review
To provide clinicians with a review of key considerations relating to the physical and behavioral well-being of children raised by their grandparents.

Recent findings
As the number of children being raised by their grandparents in the United States steadily increases, the needs of these families require greater attention. These children and their custodial grandparents face unique health, social, legal, and financial challenges. Children being raised by their grandparents are at higher risk for developmental and behavioral problems because of prior or current adverse family environments. Moreover, there is evidence that custodial grandparents may experience negative health, social, and financial outcomes that may constrain their ability to provide the best care for their grandchildren.

Summary
Pediatricians should not only be aware of the medical and developmental status of children who are being reared by their grandparents, but also assess the needs, abilities, and potential limitations of these custodial grandparents. In addition to providing useful parenting advice and direct support to custodial grandparents, pediatricians should refer these families as needed to local grandparenting groups, social service agencies, experienced legal counsel, and relevant national organizations for support and guidance.
Unmet Supportive Care Needs of Men With Locally Advanced and Metastatic Prostate Cancer on Hormonal Treatment
Authors: Paterson Catherine , Kata Sławomir Grzegorz , Nandwani Ghulam , Das Chaudhury Debi , Nabi Ghulam 
Published: April 2017

Background:
Men affected by prostate cancer who are undergoing hormone therapy can endure a range of symptoms that can adversely affect quality of life. Little research has been conducted to date, to understand the specific unmet supportive care needs of this patient group within the context of current service delivery.

Objective:
The aim of this study was to understand the experiences of unmet supportive care needs of men affected by prostate cancer on hormone therapy in the United Kingdom.

Methods:
Mixed methods study recruited 31 men with ≥T3 prostate Cancer or worse and treated by hormone therapy. A small cross-sectional survey (European Organization for Research and Treatment of Cancer [EORTC] C30 and PR25, Self-Management Self-Efficacy Scale, and the Supportive Care Needs Survey) was used to inform the interview schedule. Semi-structured interviews were conducted, and framework approach was used to analyze the data.

Results:
Complex unmet supportive care needs that were related to physical, psychological/emotional, intimacy/sexual, practical, health system/informational, existential, and patient/clinician communication needs are experienced. Men articulated that current healthcare delivery is failing to provide a holistic person-centered model of care.

Conclusion:
This is one of the few studies that have identified the unmet supportive care needs of men receiving hormone therapy for ≥T3 prostate Cancer or worse. The needs are multiple and far-ranging.

Implications for Practice:
Despite national cancer reforms, unmet supportive care needs persist. The findings from this study may be central in the re-design of future services to optimize men’s quality of life and satisfaction with care. Clinicians are encouraged to use these finding to help them optimize care delivery and individual quality of life.
Improved Magnetic Resonance Imaging-Pathology Correlation With Imaging-Derived, 3D-Printed, Patient-Specific Whole-Mount Molds of the Prostate
Authors: Costa Daniel N. , Chatzinoff Yonatan , Passoni Niccolo M. , Kapur Payal , Roehrborn Claus G. , Xi Yin , Rofsky Neil M. , Torrealba Jose , Francis Franto , Futch Cecil , Hagens Phyllis , Notgrass Hollis , Otero-Muinelo Susana , Pedrosa Ivan , Chopra Rajiv 
Published: April 2017

Objectives
The aim of this study was to compare the anatomical registration of preoperative magnetic resonance imaging (MRI) and prostate whole-mount obtained with 3D-printed, patient-specific, MRI-derived molds (PSM) versus conventional whole-mount sectioning (WMS).

Materials and Methods
Based on an a priori power analysis, this institutional review board–approved study prospectively included 50 consecutive men who underwent 3 T multiparametric prostate MRI followed by radical prostatectomy. Two blinded and independent readers (R1 and R2) outlined the contours of the prostate, tumor, peripheral, and transition zones in the MRI scans using regions of interest. These were compared with the corresponding regions of interest from the whole-mounted histopathology, the reference standard, using PSM whole-mount results obtained in the study group (n = 25) or conventional WMS in the control group (n = 25). The spatial overlap across the MRI and histology data sets was calculated using the Dice similarity coefficient (DSC) for the prostate overall (DSCprostate), tumor (DSCtumor), peripheral (DSCPZ), and transition (DSCTZ) zone. Results in the study and control groups were compared using Wilcoxon rank sum test.

Results
The MRI histopathology anatomical registration for the prostate gland overall, tumor, peripheral, and transition zones were significantly superior with the use of PSMs (DSCs for R1: 0.95, 0.86, 0.84, and 0.89; for R2: 0.93, 0.75, 0.78, and 0.85, respectively) than with the use of standard WMS (R1: 0.85, 0.46, 0.66, and 0.69; R2: 0.85, 0.46, 0.66, and 0.69) (P < 0.0001).

Conclusions
The use of PSMs for prostate specimen whole-mount sectioning provides significantly superior anatomical registration of in vivo multiparametric MRI and ex vivo prostate whole-mounts than conventional WMS.
APC and PIK3CA Mutational Cooperativity Predicts Pathologic Response and Survival in Patients Undergoing Resection for Colorectal Liver Metastases
Authors: Yamashita Suguru , Chun Yun-Shin , Kopetz Scott E. , Maru Dipen , Conrad Claudius , Aloia Thomas A. , Vauthey Jean-Nicolas 
Published: April 2017

Objective:
The aim of the study was to determine the prognostic impact of co-existence of APC and PIK3CA mutations in patients undergoing preoperative chemotherapy and resection for colorectal liver metastases (CLM).

Background:
Co-occurring genetic events have been shown to drive carcinogenesis in multiple malignancies.

Methods:
We identified 396 patients with primary colorectal cancer and known somatic mutation status by next-generation sequencing who underwent hepatectomy for CLM (2005–2015). Survival after hepatectomy in patients with double mutation of APC and PIK3CA and others was analyzed. Predictors of pathologic response and survival were determined. The prognostic value of double mutation was evaluated with a separate cohort of 157 patients with CLM undergoing chemotherapy alone.

Results:
Forty-five patients had double mutation of APC and PIK3CA; 351 did not. Recurrence-free survival (RFS) and overall survival (OS) after hepatectomy were worse in patients with double mutation (3-year RFS, 3.1% vs 20% [P < 0.001]; 3-year OS, 44% vs 84% [P < 0.001]). Independent predictors of major pathologic response were bevacizumab use (odds ratio [OR] 2.22; P = 0.001), tumor size <3 cm (OR 1.97; P = 0.004), wild-type RAS (OR 2.00; P = 0.003), and absence of double mutation (OR 2.91; P = 0.002). Independent predictors of worse OS were primary advanced T category (hazard ratio [HR] 2.12; P = 0.021), RAS mutation (HR 1.74; P = 0.015), and double mutation (HR 3.09; P < 0.001). In the different medical cohort, patients with double mutation had worse 3-year OS of 18%, compared with 35% without double mutation (P = 0.023).

Conclusions:
Double mutation of APC and PIK3CA predicts inferior response to preoperative chemotherapy and poor survival in patients with CLM.
Interim Report of a Prospective Trial on the Clinical Efficiency of a New Full-thickness Endoscopic Plication Device for Patients With GERD: Impact of Changed Suture Material
Authors: Weitzendorfer Michael , Spaun Georg O. , Antoniou Stavros A. , Tschoner Andreas , Schredl Philipp , Emmanuel Klaus , Koch Oliver O. 
Published: April 2017

Background:
The aim of the present trial is to investigate the clinical efficiency of the GERDx device for patients with gastroesophageal reflux disease (GERD).

Materials and Methods:
Prospective study evaluating Gastrointestinal Quality of Life Index, symptoms scores, as well as esophageal manometry and impedance-pH-monitoring data at baseline and 3 months after endoscopic full-thickness plication with the GERDx device.

Results:
In total, 28 patients underwent the procedure so far. Mean Gastrointestinal Quality of Life Index scores, DeMeester scores, and general and reflux-specific scores improved (P<0.01). Three of 6 patients, who were treated with converted sutures, experienced postoperative complications.

Conclusions:
Endoscopic plication using the GERDx device may be effective in improving quality of life and GERD symptoms. Suture length between pledgets and suture material may have an impact on procedure outcomes.
APOBEC-mediated mutagenesis in urothelial carcinoma is associated with improved survival, mutations in DNA damage response genes, and immune response
Authors: Glaser Alexander P. , Fantini Damiano , Rimar Kalen J. , Meeks Joshua J. 
Published: April 2017

AbstractBackgroundThe APOBEC family of enzymes is responsible for a mutation signature characterized by a TCW>T/G mutation. APOBEC-mediated mutagenesis is implicated in a wide variety of tumors, including bladder cancer. In this study, we explore the APOBEC mutational signature in bladder cancer and the relationship with specific mutations, molecular subtype, gene expression, and survival. We hypothesized that tumors with high levels of APOBEC-mediated mutagenesis would be enriched for mutations in DNA damage response genes and associated with higher expression of genes related to activation of the immune system.MethodsGene expression (n=408) and mutational (n=395) data from the Cancer Genome Atlas (TCGA) bladder urothelial carcinoma provisional dataset was utilized for analysis. Tumors were split into “APOBEC-high” and “APOBEC-low” tumors based on APOBEC enrichment score. Analysis was performed with R.FindingsPatients with APOBEC-high tumors have better overall survival compared to those with APOBEC-low tumors (38.2 vs 18.5 months, p=0.005). Tumors enriched for APOBEC mutagenesis are more likely to have mutations in DNA damage response genes (TP53, ATR, BRCA2), and chromatin regulatory genes (MLL, MLL3), while APOBEC-low tumors are more likely to have mutations inFGFR3andKRAS. APOBEC3AandAPOBEC3Bexpression correlates with total mutational burden, regardless of bladder tumor molecular subtype. APOBEC mutagenesis and enrichment is associated with increased expression of immune-related genes, including interferon signaling.InterpretationTumors enriched for APOBEC mutagenesis are more likely to have mutations in DNA damage response genes and chromatin regulatory genes, potentially providing more single-strand DNA substrate forAPOBEC3AandAPOBEC3B, leading to a hypermutational phenotype and the subsequent immune response.HighlightsABPOEC enzymes, particularlyAPOBEC3AandAPOBEC3B, are responsible for the predominant pattern of mutagenesis in bladder cancerTumors enriched for APOBEC-mediated mutagenesis are more likely to have mutations in DNA damage response genes and chromatin regulatory genes, while tumors not enriched for APOBEC-mediated mutagenesis are more likely to have mutations inKRASandFGFR3APOBEC enrichment is associated with upregulation of genes involved in the immune response