bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of emphysema on dosimetric parameters for stereotactic body radiotherapy of the lung
Authors: Ochiai Satoru , Nomoto Yoshihito , Yamashita Yasufumi , Inoue Tomoki , Murashima Shuuichi , Hasegawa Daisuke , Kurita Yoshie , Watanabe Yui , Toyomasu Yutaka , Kawamura Tomoko , Takada Akinori , Ii Noriko , Kobayashi Shigeki , Sakuma Hajime 
Published: July 2016

Abstract
The purpose of this study was to evaluate the impact of emphysematous changes in lung on dosimetric parameters in stereotactic body radiation therapy (SBRT) for lung tumor. A total of 72 treatment plans were reviewed, and dosimetric factors [including homogeneity index (HI) and conformity index (CI)] were evaluated. Emphysematous changes in lung were observed in 43 patients (60%). Patients were divided into three groups according to the severity of emphysema: no emphysema ( n = 29), mild emphysema ( n = 22) and moderate to severe emphysema groups ( n = 21). The HI ( P &lt; 0.001) and the CI ( P = 0.029) were significantly different in accordance with the severity of emphysema in one-way analysis of variance (ANOVA). The HI value was significantly higher in the moderate to severe emphysema group compared with in the no emphysema (Tukey, P &lt; 0.001) and mild emphysema groups ( P = 0.002). The CI value was significantly higher in the moderate to severe emphysema group compared with in the no emphysema group ( P = 0.044). In multiple linear regression analysis, the severity of emphysema ( P &lt; 0.001) and the mean material density of the lung within the PTV ( P &lt; 0.001) were significant factors for HI, and the mean density of the lung within the PTV ( P = 0.005) was the only significant factor for CI. The mean density of the lung within the PTV was significantly different in accordance with the severity of emphysema (one-way ANOVA, P = 0.008) and the severity of emphysema ( P &lt; 0.001) was one of the significant factors for the density of the lung within the PTV in multiple linear regression analysis. Our results suggest that emphysematous changes in the lung significantly impact on several dosimetric parameters in SBRT, and they should be carefully evaluated before treatment planning.
Vascular Anatomy in Laparoscopic Colectomy for Right Colon Cancer
Authors: Lee Sang Jae , Park Sung Chan , Kim Min Jung , Sohn Dae Kyung , Oh Jae Hwan 
Published: July 2016

BACKGROUND:
The vascular anatomy in the right colon varies; however, related studies are rare, especially on the laparoscopic vascular anatomy of living patients.

OBJECTIVE:
The purpose of this study was to describe vascular variations around the gastrocolic trunk, middle colic vein, and ileocolic vessels in laparoscopic surgery for right-sided colon cancer.

DESIGN:
This is a retrospective descriptive study of patients undergoing laparoscopic colectomy for right colon cancer.

SETTINGS:
The study was conducted at a single tertiary institution in Korea.

PATIENTS:
Consecutive patients with right colon cancer who underwent laparoscopic right colectomy using the cranial-to-caudal approach (N = 116) between January 2014 and April 2015 were included.

MAIN OUTCOME MEASURES:
Three colorectal surgeons took photographs and videos of the vascular anatomy during each laparoscopic right colectomy, and these were analyzed for vascular variations.

RESULTS:
We classified venous variations around the gastrocolic trunk into 2 types (3 subtypes), type 1 (n = 92 (79.3%)), defined as 1 or 2 colic veins draining into the gastrocolic trunk, and type II (n = 24 (20.7%)), defined as having no gastrocolic trunk. We also investigated the tributaries of the superior mesenteric vein. One, 2, and 3 middle colic veins were found in 86 (74.1%), 26 (22.4%), and 4 patients (3.5%). The right colic vein drained directly into the superior mesenteric vein in 22 patients (19.0%). All of the patients had a single ileocolic vein draining into the superior mesenteric vein and a single ileocolic artery from the superior mesenteric artery. The right colic artery from the superior mesenteric artery was present in 38 patients (32.7%). The ileocolic artery passed the superior mesenteric vein anteriorly or posteriorly in 58 patients (50%) each.

LIMITATIONS:
Unlike cadaver or radiological studies, we could not clarify the complete vessel paths.

CONCLUSIONS:
We classified vascular anatomic variations in laparoscopic colectomy for right colon cancer, which could be helpful for colorectal surgeons.
Normal Values and Clinical Use of Bedside Sonographic Assessment of Postoperative Gastric Emptying
Authors: Mirbagheri Naseem , Dunn Graham , Naganathan Vasikaran , Suen Michael , Gladman Marc A. 
Published: July 2016

BACKGROUND:
GI dysfunction is common after abdominal surgery. However, assessment and diagnosis currently lack objective measurement.

OBJECTIVE:
The purpose of this study was to evaluate the feasibility and clinical use of bedside sonographic assessment of gastric emptying by measuring the time to complete emptying of a standard volume of ingested water in patients after colorectal surgery.

DESIGN:
This was a prospective cohort study.

SETTINGS:
The study was conducted at a single tertiary institution in Sydney.

PATIENTS:
Healthy volunteers (n = 30) were studied to establish a reference range. Gastric emptying was then measured in patients (n = 39) before and after colorectal surgery.

INTERVENTION:
Assessment of gastric emptying was performed on days 1 to 4 by measuring antral cross-sectional area every 10 minutes after ingestion of 250 mL of water.

MAIN OUTCOME MEASURES:
The time to complete emptying of water was used as a surrogate measure of gastric emptying. Information concerning postoperative outcomes, GI symptoms, and recovery was also recorded.

RESULTS:
The median time to complete emptying of water for healthy volunteers was 20 minutes (range, 10–40 minutes). The study protocol was completed in 30 of 39 patients. The time to complete emptying of water on day 2 had the best discriminatory power to identify patients with ileus (sensitivity, 85.71%; specificity, 82.61%). Gastric emptying was normal in 20 of 30 (67%) patients, with only 1 case of ileus (false negative). These patients had less nausea (p = 0.0003), earlier intake of solid diet (p = 0.001), and shorter hospital stay (p = 0.040) compared with patients with abnormal gastric emptying.

LIMITATIONS:
Ultrasound is operator dependent with a learning curve.

CONCLUSIONS:
Bedside sonographic assessment of gastric emptying is feasible and reliable. Assessment of antral contents with a single ultrasound 40 minutes after ingestion of water enables classification of patients into those with normal and abnormal gastric emptying. When performed on postoperative day 2, it has good sensitivity/specificity for discriminating patients with ileus.
Improving testing for hepatitis B before treatment with rituximab
Authors: Dyson Jessica K. , Jopson Laura , Ng Sarah , Lowery Matthew , Harwood Jayne , Waugh Sheila , Valappil Manoj , McPherson Stuart 
Published: July 2016

Aims/Objectives/Background
Individuals with current or previous infection with the hepatitis B virus (HBV) can experience viral reactivation when treated with immunosuppression. Rituximab, an anti-CD20 antibody used to treat many diseases, has potent immunosuppressant effects with a high risk of causing HBV reactivation. Reactivation can range from elevated liver enzymes to acute severe hepatitis with liver failure and a significant mortality risk. HBV screening and appropriate use of prophylactic antiviral therapy can prevent reactivation. This work describes the introduction of a local policy for HBV testing in patients before rituximab treatment and assesses its impact.

Methods and Results
A baseline review (before policy introduction) of 90 patients showed that only 21 (23%) had hepatitis B surface antigen (HBsAg) and 17 (19%) had hepatitis B core antibody (anti-HBcAb) tested before receiving rituximab. Following introduction of the policy (on the basis of international guidelines), improved laboratory reporting protocols and targeted education sessions, two further reviews of HBV testing rates among patients being initiated onto rituximab were performed. There was a marked increase in pre-rituximab testing for HBsAg from 23 to 79% and for anti-HBcAb from 19 to 78%. Throughout the study period, a total of one (0.8%) HBsAg-positive and six (4.7%) anti-HBcAb-positive patients were identified.

Conclusions
This work clearly indicates that simple strategies can markedly improve appropriate HBV screening. In our cohort, 6% (of whom only 43% had recognized HBV risk factors) required antiviral prophylaxis, which emphasizes the importance of universal screening before rituximab. Reinforcement of the guidelines and ongoing education is needed to further increase testing rates.
Adherence to a Low-Support Cognitive Remediation Training Program for Psychosis
Authors: Dillon Rachael , Hargreaves April , Anderson-Schmidt Heike , Castorina Marco , Corvin Aiden , Fitzmaurice Brian , Robertson Ian , Donohoe Gary 
Published: July 2016

Abstract
Cognitive remediation (CR) has emerged as the treatment of choice for impaired cognition in psychosis. However, little is known about adherence rates and factors predicting adherence to CR, particularly in clinical settings where high-level therapist support is unavailable. This study aimed to establish adherence rates and examine variables predicting adherence to a computerized CR program for psychosis (with minimal support). Patients with psychosis (n = 61) participated in an 8-week CR program. Results showed 46% completed a meaningful amount of CR training. The fully adherent (>80% of the prescribed amount) and nonadherent groups differed where adherent participants had poorer working-memory and higher negative symptom scores. These findings suggest that approximately half of the sample were adherent to treatment despite minimal therapist support. Furthermore, higher cognitive deficits and negative symptoms did not impede adherence, and may have contributed to patients’ motivation to complete the program.
Risk and Protective Factors, Perceptions of Family Environment, Ethnicity, and Schizophrenia Symptoms
Authors: Gurak Kayla , Weisman de Mamani Amy 
Published: July 2016

Abstract
The family environment can play either a detrimental or a protective role in symptom severity for people with schizophrenia. The current study examined both patient and caregiver perspectives of the family environment in an ethnically diverse sample of 221 patients with schizophrenia. We hypothesized that environments characterized by high levels of perceived caregiver criticism, low perceived caregiver warmth, and low family cohesion (from both the patient and caregiver perspective) would predict greater symptom severity. As expected, results demonstrated that lower patient ratings of family cohesion and caregiver warmth were associated with greater symptom severity. However, once put into a hierarchical regression analysis, only patient ratings of family cohesion remained significant. Ethnic patterns were also examined and revealed that family cohesion may be particularly protective for ethnic minorities. Study implications are discussed.
Randomized Trial of Intranasal Fentanyl Versus Intravenous Morphine for Abscess Incision and Drainage
Authors: Fenster Daniel B. , Dayan Peter S. , Babineau John , Aponte-Patel Linda , Tsze Daniel S. 
Published: July 2016

ObjectivesAbscess incision and drainage (I&D) are painful and distressing procedures in children. Intranasal (IN) fentanyl is an effective analgesic for reducing symptomatic pain associated with fractures and burns but has not been studied for reducing procedural pain during abscess I&D. Our objective was to compare the analgesic efficacy of IN fentanyl with intravenous (IV) morphine for abscess I&D in children.MethodsWe performed a randomized noninferiority trial in children aged 4 to 18 years undergoing abscess I&D in a pediatric emergency department. Patients received IN fentanyl (2 μg/kg; maximum, 100 μg) or IV morphine (0.1 mg/kg; maximum, 8 mg). The primary outcome, determined independently by blinded assessors, was the Observational Scale of Behavioral Distress-Revised (OSBD-R). The prestated margin of noninferiority (Δ) was 1.80. Secondary outcomes included self-reported pain, treatment failure, and patient and parental satisfaction.ResultsWe enrolled 20 children (median age, 15.4 years), 10 in each group. The difference between total OSBD-R scores was −13.45 (95% confidence interval, −24.24 to −2.67), favoring IN fentanyl.There was less self-reported pain in patients who received IN fentanyl immediately after the procedure. Four patients (40%) receiving IV morphine had treatment failures and required moderate sedation or had the procedure terminated. More patients who received IN fentanyl were satisfied with the analgesic administered compared with those who received IV morphine.ConclusionsIn a small sample of children aged 4 to 18 years undergoing abscess I&D, IN fentanyl was noninferior, and potentially superior, to IV morphine for reducing procedural pain and distress.
Mastery Learning of Video Laryngoscopy Using the Glidescope in the Emergency Department
Authors: Ahn James , Yashar Michael D. , Novack Jared , Davidson Joey , Lapin Brittany , Ocampo Jose , Wang Ernest 
Published: July 2016

Introduction
According to the Accreditation Council for Graduate Medical Education emergency medicine requirements established before the popularity of video laryngoscopy (VL) use, 35 intubations are necessary for graduation. Our study aimed to establish a mastery-learning model for a skill set very different (VL) from direct laryngoscopy (DL) and to determine the number of attempts needed to achieve mastery with VL.

Methods
With the use of a randomized, controlled crossover study design, two learner groups underwent baseline testing intubating a mannequin using VL. Afterward, the intervention group received a mastery training intervention. After training, learners were required to repeat the procedure until achievement of 100% on the checklist for two consecutive attempts was achieved. After 3 months, both groups returned for retesting, and the control group received the same mastery training as the intervention group. Both groups returned for final testing after another 3 months.

Results
The intervention arm had an improvement in performance versus the control arm at 3 months of total time (P < 0.05). Both groups had an improvement within their groups’ checklist scores at 3 months after training (P < 0.05), and within the intervention arm, this effect was sustained at 6 months (P < 0.05). There was no significant difference in the mean required attempts to demonstrate mastery (overall, 2.5; intervention, 2.75; control 2.25; P = 0.28).

Conclusions
Simulation-based mastery-learning produces skill enhancement with VL that is resistant to decay across 6 months. Furthermore, although a small number of attempts are needed to achieve mastery, clinical experience did not substitute as a proxy for skill acquisition. This mastery-learning model provides skill sets that are not otherwise obtained in the clinical curriculum in a 3-month period.
How Do Simulated Error Experiences Impact Attitudes Related to Error Prevention?
Authors: Breitkreuz Karen R. , Dougal Renae L. , Wright Melanie C. 
Published: July 2016

Introduction
The objective of this project was to determine whether simulated exposure to error situations changes attitudes in a way that may have a positive impact on error prevention behaviors.

Methods
Using a stratified quasi-randomized experiment design, we compared risk perception attitudes of a control group of nursing students who received standard error education (reviewed medication error content and watched movies about error experiences) to an experimental group of students who reviewed medication error content and participated in simulated error experiences. Dependent measures included perceived memorability of the educational experience, perceived frequency of errors, and perceived caution with respect to preventing errors.

Results
Experienced nursing students perceived the simulated error experiences to be more memorable than movies. Less experienced students perceived both simulated error experiences and movies to be highly memorable. After the intervention, compared with movie participants, simulation participants believed errors occurred more frequently. Both types of education increased the participants’ intentions to be more cautious and reported caution remained higher than baseline for medication errors 6 months after the intervention.

Conclusions
This study provides limited evidence of an advantage of simulation over watching movies describing actual errors with respect to manipulating attitudes related to error prevention. Both interventions resulted in long-term impacts on perceived caution in medication administration. Simulated error experiences made participants more aware of how easily errors can occur, and the movie education made participants more aware of the devastating consequences of errors.
The Role of Ultrasound Simulation in Obstetrics and Gynecology Training: A UK Trainees’ Perspective
Authors: Patel Hersha , Chandrasekaran Dhivya , Myriokefalitaki Eva , Gebeh Alpha , Jones Kate , Jeve Yadava B 
Published: July 2016

Introduction
Ultrasonography is a core skill required by all obstetrics and gynecology trainees; however, training opportunities in clinical ultrasound are declining. Simulation ultrasound training has been proposed as a strategy to overcome this.
The study aims were to determine the current availability of clinical and simulation ultrasound training in obstetrics and gynecology in the United Kingdom and to explore the trainees’ perspective on the role of ultrasound simulation.

Methods
All obstetrics and gynecology trainees within the East Midlands Local Education Training Board in the United Kingdom were asked to complete an anonymous web-based survey in July 2014.

Results
Of 140 trainees, 70 (50%) responded to the survey, and 69% reported rarely having dedicated clinical ultrasound sessions. Fifty percent had failed to achieve ultrasound competencies required for their stage of training, and 83% felt that the pressures of service provision limited their exposure to clinical ultrasound.
Seventy-three percent of the trainees considered ultrasound simulation to be an essential component of training, and 69% agreed that it would help improve their clinical skills. Only 50% had access to an ultrasound simulator. Seventy-seven percent of the trainees thought that it would be useful to have ultrasound simulation integrated into training.

Conclusions
Trainees are struggling to achieve minimal ultrasound competences with clinical ultrasound training alone. They believe that ultrasound simulation will shorten the learning curve and improve their clinical skills and knowledge. Despite the cost implications of simulation training, we propose that consideration is given to formal integration of ultrasound simulation into the curriculum as a possible way forward.
Can Corneal Biomechanical Properties Give Clues About Elasticity of Optic Nerve Scleral Component in Nonarteritic Anterior Ischemic Optic Neuropathy?
Authors: Uysal Betul S. , Yulek Fatma , Nalcacioglu Pinar , Sarac Ozge , Yorgun Mucella A. , Cagil Nurullah 
Published: July 2016

Objective:
To investigate corneal biomechanical properties among individuals with unilateral nonarteritic anterior ischemic optic neuropathy (NAION) compared to healthy gender- and age-matched subjects.

Methods:
The study subjects were separated into 2 groups: 66 eyes of 33 patients with unilateral NAION (study group) and 33 eyes of 33 healthy individuals (control group). Reichert ocular response analyzer (Reichert Ophthalmic Instruments) was used to assess corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated intraocular pressure values. Also, central corneal thickness was measured using Scheimpflug camera combined with a Placido disc corneal topographer (Sirius; Costruzioni Strumenti Oftalmici).

Results:
Mean CH and median CRF values were significantly lower in the affected eyes (8.8 ± 1.8 mm Hg, 9.4 mm Hg, respectively) and contralateral unaffected eyes (9.1 ± 1.6 mm Hg, 9.8 mm Hg, respectively) of NAION patients than those in the control group (9.9 ± 1.3 mm Hg, 10.4 mm Hg, respectively; all P < 0.017). Mean IOPcc was significantly higher in the affected eyes of NAION patients (19.2 ± 3.5 mm Hg) than in the eyes of control group (17.1 ± 3.6 mm Hg; P = 0.002).

Conclusions:
CH and CRF are significantly reduced in patients with NAION, possibly indirectly reflecting structural weakness in the lamina cribrosa.
Personal experiences of autism and secure units
Authors: Ghosh Sanjib Kumar , Chaplin Eddie 
Published: July 2016

Purpose
– A consultant forensic psychiatrist and an individual with autism under his care discuss their experiences of working with autism in secure care. Dr Ghosh is a Consultant Forensic Psychiatrist who analyses some of the practice issues and concerns for clinicians working with people with autism in secure care. He includes comments on the issues raised by one individual with autism (who has consented to sharing his thoughts) in secure care based on his experiences. This is particularly relevant given the recent publication of Building the Right Support, which offers national guidance to develop community services and close inpatient facilities for people with a learning disability and/or autism who display challenging behaviour, including those with a mental health condition. The paper aims to discuss these issues.

Design/methodology/approach
– X is an autistic patient on a medium secure unit. His viewpoint, together with his then inpatient consultant psychiatrist
'
s view, is given.

Findings
– There are multiple issues for patients and staff to consider when on a secure unit. The approach to take is focusing on holistic management.

Originality/value
– This paper starts with the patient perspective of his experiences with autism in the community and in hospital. This provides a framework for the paper to demonstrate how theoretical knowledge and holistic, patient-centred management can be applied to address the issues raised for an autistic patient who has spent a number of years as an inpatient on a medium secure unit. It shows how such plans can directly involve the patient and be adapted to suit the patient
'
s self-identified needs and wishes. It also looks at the challenges longer-term inpatients with autism face in their rehabilitative journey from the patient and clinician perspectives.