bluuebunny/crossref_metadata_2025_split huggingface dataset:
La simulación clínica como estrategia para el desarrollo del pensamiento crítico en estudiantes de medicina
Authors: Valencia Castro Johanna Lizbeth , Tapia Vallejo Sara , Olivares Olivares Silvia Lizett 
Published: October 2016

Introducción: Las instituciones que ofrecen carreras de medicina han centrado su atención en formar estudiantes para el desarrollo de competencias genéricas, entre ellas el pensamiento crítico. Una estrategia que se ha utilizado para su desarrollo es la simulación clínica mediante sus etapas. Sin embargo, es relevante identificar cómo la simulación clínica da al estudiante la oportunidad de pensar en diversos momentos de su aprendizaje (por adelantado, durante la acción y en retrospectiva) con la finalidad de razonar, deliberar y emitir juicios con objetivos y fines establecidos para autorregular su aprendizaje.
Objetivo: Valorar el desarrollo del pensamiento crítico a partir de la simulación clínica en cada una de sus etapas (diagnóstico, intervención y reflexión) en estudiantes de la carrera de medicina en una institución privada.
Método: Cualitativo descriptivo. Se diseñó y aplicó una rúbrica a 4 equipos de 5 estudiantes con el objetivo de valorar el desarrollo del pensamiento crítico en las etapas de la simulación clínica, utilizando simulación de alta fidelidad. A partir de la observación se identificaron los niveles bajo, medio y alto de la competencia para cada equipo.
Resultados: En cuanto al nivel de pensamiento crítico, 2 de 4 equipos fueron capaces de diagnosticar y analizar el balance entre los beneficios y los riesgos de las pruebas y de los tratamientos; 1 de 4 equipos fue capaz de reconocer opciones de tratamiento a partir de datos relevantes; y 3 de 4 equipos fueron capaces de describir objetiva y subjetivamente la experiencia de simulación. La etapa de reflexión fue en la que los estudiantes se posicionaron en un nivel alto de pensamiento crítico medido durante la simulación clínica.
Conclusiones: Las actividades simuladas brindan a los estudiantes la oportunidad de analizar, reflexionar, evaluar contenidos y enfrentar situaciones asociadas con su quehacer profesional mediante la aproximación a la realidad clínica que enfrentarán en el futuro, logrando aprendizaje interactivo y retroalimentación inmediata.
Combining natural language processing and network analysis to examine how advocacy organizations stimulate conversation on social media
Authors: Bail Christopher Andrew 
Published: October 2016

Significance
Social media provide potent opportunities for advocacy organizations to shape public debates because of the rapidly increasing number of people who frequent such forums each day. However, social scientists have not yet explained why some advocacy organizations create large-scale public debate whereas most others do not. Using automated text analysis and a Facebook application, I found that advocacy organizations are more likely to stimulate conversation if they produce messages that link discursive themes that are usually discussed in isolation from each other. Such messages not only resonate with multiple audiences, but also put such audiences in conversation with each other. This manuscript thereby contributes a theory of public deliberation on social media for the emerging field of computational social science.
Activation of Notch1 synergizes with multiple pathways in promoting castration-resistant prostate cancer
Authors: Stoyanova Tanya , Riedinger Mireille , Lin Shu , Faltermeier Claire M. , Smith Bryan A. , Zhang Kelvin X. , Going Catherine C. , Goldstein Andrew S. , Lee John K. , Drake Justin M. , Rice Meghan A. , Hsu En-Chi , Nowroozizadeh Behdokht , Castor Brandon , Orellana Sandra Y. , Blum Steven M. , Cheng Donghui , Pienta Kenneth J. , Reiter Robert E. , Pitteri Sharon J. , Huang Jiaoti , Witte Owen N. 
Published: October 2016

SignificanceA high nuclear Notch homolog 1, translocation-associated (Notch1) intracellular domain level distinguishes high-risk prostate cancer and castration-resistant prostate cancer from benign and low/intermediate-risk prostate cancer. Chronic activation of Notch1 cooperates with multiple oncogenic pathways altered in early prostate cancer, including AKT, Myc, and Ras/Raf/MAPK, to promote progression to androgen ablation-resistant prostate adenocarcinoma.
Force– and power–time curve comparison during jumping between strength‐matched male and female basketball players
Authors: Rice Paige E. , Goodman Courtney L. , Capps Christopher R. , Triplett N. Travis , Erickson Travis M. , McBride Jeffrey M. 
Published: October 2016

AbstractThe purpose of this study was to compare force– and power–time curve variables during jumping between Division I strength‐matched male and female basketball athletes. Males (n = 8) and females (n = 8) were strength matched by testing a one‐repetition maximum (1RM) back squat. 1RM back squat values were normalised to body mass in order to demonstrate that strength differences were a function of body mass alone. Subjects performed three countermovement jumps (CMJ) at maximal effort. Absolute and relative force– and power–time curve variables from the CMJs were analysed between males and females. Average force– and power–time curves were generated for all subjects. Jump height was significantly greater (p ≤ .05) in males than females. Absolute force was higher in males during the concentric phase, but not significantly different (p ≥ .05) when normalised to body mass. Significance was found in absolute concentric impulse between sexes, but not when analysed relative to body mass. Rate of force development, rate of power development, relative peak force, and work were not significantly different between sexes. Males had significantly greater impulse during the eccentric phase as well as peak power (PP) during the concentric phase of the CMJ than did females in both absolute and relative terms. It is concluded that sex differences are not a determining factor in measured force during a CMJ when normalised to body mass between strength‐matched subjects. However, eccentric phase impulse and concentric phase PP appear to be influenced by sex differences independent of matching strength levels.
Overlap syndrome
Authors: Borukhov Ilana , Rizzolo Denise 
Published: October 2016

ABSTRACT
Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) both cause an inflammatory response and hypoxia. Patients who have both conditions (overlap syndrome) have increased morbidity and mortality. This article aims to increase awareness of the potential effects that untreated OSA can have on COPD and the importance of treating patients with overlap syndrome.
Benign anal disease
Authors: Clark Susannah J. 
Published: October 2016

ABSTRACT
Benign anal disease encompasses common problems including hemorrhoids, anal fissures, pruritus ani, perianal abscesses, and fistulae. Although many people will suffer from at least one of these conditions in their lives, healthcare practitioners diagnose and treat them accurately about 50% to 83% of the time. This article reviews common anal problems and the importance of a thorough history and physical examination to proper patient management.
Extubation Failure in Brain-injured Patients
Authors: Godet Thomas , Chabanne Russell , Marin Julien , Kauffmann Sophie , Futier Emmanuel , Pereira Bruno , Constantin Jean-Michel 
Published: October 2016

Abstract

Background
The decision to extubate brain-injured patients with residual impaired consciousness holds a high degree of uncertainty of success. The authors developed a pragmatic clinical score predictive of extubation failure in brain-injured patients.

Methods
One hundred and forty brain-injured patients were prospectively included after the first spontaneous breathing trial success. Assessment of multiparametric hemodynamic, respiratory, and neurologic functions was performed just before extubation. Extubation failure was defined as the need for ventilatory support during intensive care unit stay. Extubation failure within 48 h was also analyzed. Neurologic outcomes were recorded at 6 months.

Results
Extubation failure occurred in 43 (31%) patients with 31 (24%) within 48 h. Predictors of extubation failure consisted of upper-airway functions (cough, gag reflex, and deglutition) and neurologic status (Coma Recovery Scale-Revised visual subscale). From the odds ratios, a four-item predictive score was developed (area under the curve, 0.85; 95% CI, 0.77 to 0.92) and internally validated by bootstrap. Cutoff was determined with sensitivity of 92%, specificity of 50%, positive predictive value of 82%, and negative predictive value of 70% for extubation failure. Failure before and beyond 48 h shared similar risk factors. Low consciousness level patients were extubated with 85% probability of success providing the presence of at least two operating airway functions.

Conclusions
A simplified clinical pragmatic score assessing cough, deglutition, gag reflex, and neurologic status was developed in a preliminary prospective cohort of brain-injured patients and was internally validated (bootstrapping). Extubation appears possible, providing functioning upper airways and irrespective of neurologic status. Clinical practice generalizability urgently needs external validation.
Cephalomedullary nail versus sliding hip screw for fixation of AO 31 A1/2 intertrochanteric femoral fracture: a 12-year comparison of failure, complications, and mortality
Authors: Whale Casey S. , Hulet D. Andrew , Beebe Michael J. , Rothberg David L. , Zhang Chong , Presson Angela P. , Stuart Ami R. , Kubiak Erik N. 
Published: October 2016

Background:
In the United States intertrochanteric and pertrochanteric fractures occur at a rate of more than 150,000 cases annually. Current standard of care for these fractures includes fixation with either a cephalomedullary nail (CMN) or a sliding hip screw (SHS). The purpose of this study was to compare failure and medical complications of intertrochanteric femoral fractures repaired by CMN or SHS.

Methods:
This study is a retrospective cohort study that included 249 patients with AO/OTA 31 A1.1-3, 31 A2.1-3 nonpathological fractures of the femur, of which 137 received CMN and 112 received SHS. Analysis was stratified by fracture type as stable (AO 31A1.1-2.1) or unstable (AO 31A2.2-3).

Results:
The tip-apex distance in stable fractures fixed with CMN was 17.3±5.9 compared to 26.2±7.9 in the stable SHS group (P<0.001) while it was 19.0±5.3 in the unstable CMN group compared to 24.0±6.7 in the unstable SHS patients (P=0.004). Among patients with stable fracture patterns there was no difference in collapse, complications, failure, or mortality (all P>0.05). Among patients with unstable fractures CMN had significantly less collapse (P<0.001) and failure (P=0.046) but no difference in complications (P=0.126) or mortality (P=0.586).

Conclusions:
There were no significant differences in failure or complication rates when comparing the CMN to the SHS in stable intertrochanteric fractures. CMN demonstrated significantly reduced failure and collapse rates in unstable intertrochanteric fractures when compared to SHS; however, this study had a relatively small sample size of unstable fractures and all results must be interpreted within this context.
Early clinical and functional results of short modular femoral metaphyseal stem hip arthroplasty: a pilot study
Authors: Karampinas Panagiotis , Vlamis John , Papadelis Eustratios , Pneumatikos Spiros 
Published: October 2016

Background:
The purpose of this study was to evaluate the short-term results, complications, and functional outcomes associated with short femoral metaphyseal hip arthroplasty.

Methods:
Twenty-nine hips with coxarthrosis were included in the study. Each patient had outpatient clinical examination and follow-up (mean 20 mo) with evaluation using the Harris Hip Score (HHS), Western Ontario and McMaster University (WOMAC) score, Short-Form 36 (SF-36), and anteroposterior and lateral radiographs of the hip.

Results:
Statistical analysis revealed a significant difference between the preoperative and the postoperative outcome scores. The radiographic evaluation revealed no differences. No one had cup or femoral implant loosening and no heterotopic ossification.

Conclusions:
This study showed that a short femoral metaphyseal stem can obtain early satisfactory clinical and functional outcomes without compromising implant stability. Future investigations should evaluate whether such results may be maintained after a longer time.
Haglund’s syndrome: classification system and surgical protocol
Authors: Diab Hossam S. 
Published: October 2016

Background:
Haglund’s deformity is not an uncommon cause of retrocalcaneal pain. Currently, there is neither a classification system nor a standard surgical protocol for this condition. The purpose of this study was to evaluate the outcome after Achilles tendon debridement, partial detachment, and anchor reattachment of the tendon, osteotomy of the Haglund deformity, and excision of the retrocalcaneal bursa. An MRI-based classification system is proposed that relies on the extent of Achilles tendon pathology in the presence of the Haglund deformity.

Methods:
Fifty heels in 46 patients were surgically treated with the proposed surgical protocol. Patients were evaluated using the Tegner Activity Level and the Foot and Ankle Outcome (FAOS) scores.

Results:
The mean Tegner Activity Level score improved from a preoperative mean of 3.44 to a mean of 6.56 at 6 mo, then to a mean of 6.84 at 12 mo follow-up. The mean FAOS score improved from 47.60 preoperatively to a mean of 66.50 at 6 mo and to a mean of 79.49 at 12 mo follow-up.

Conclusions:
Surgical treatment of Haglund’s deformity with tendon debridement, partial detachment, calcaneal osteotomy, and bursal debridement provides good results and functional outcomes that continues to improve over 12 mo follow-up.
Patient satisfaction after total hip arthroplasty in an Egyptian population as an example of a developing country
Authors: Issa Khaled H. , Shehata Ehab M. , El-Tantawy Ahmad , Samy Ahmed M. 
Published: October 2016

Background:
Cementless total hip arthroplasty is a solution for advanced hip arthritis. Although in many patients the operation appears successful clinically and radiographically, often many are not completely satisfied. This study was done to evaluate the intermediate results of cementless total hip replacement and its relation to satisfaction in Egyptian patients.

Methods:
This was a prospective study of 129 patients (153 hips) who had cementless total hip replacement. Clinical evaluation was done using the Harris Hip Score, a modified questionnaire, and radiographic evaluation. Statistical analysis was conducted.

Results:
The mean Harris Hip Score improved from 44.10 preoperatively to 90.40 at the end of follow-up and this was statistically significant (P<0.001). Range of motion and lower limb discrepancy improved postoperatively and this also was statistically significant (P<0.001). In regard to the modified questionnaire, 51 of 129 (39.5%) respondents noted that their expectations regarding the outcome of total hip arthroplasty had not been fulfilled 2 yr postoperatively, and this dissatisfaction continued until final follow-up despite 43 patients scoring over 90 on the Harris Hip Score. The correlation between the Harris Hips Score and the modified questionnaire was not significant.

Conclusions:
Although cementless total hip arthroplasty is a successful salvage operation for many hip problems, it still did not completely fulfill the daily requirements and habits of patients in our developing country.
Does the Level of Cervical Disc Herniation Surgery Affect Performance-based Outcomes in National Football League Athletes?
Authors: Mai Harry T. , Burgmeier Robert J. , Mitchell Sean M. , Hecht Andrew C. , Maroon Joseph C. , Nuber Gordon W. , Hsu Wellington K. 
Published: October 2016

Study Design.
Retrospective cohort study.

Objective.
The aim of this study was to determine whether the level of a cervical disc herniation (CDH) procedure will uniquely impact performance-based outcomes in elite athletes of the National Football League (NFL).

Summary of Background Data.
Comparative assessments of postsurgical outcomes in NFL athletes with CDH at different levels are unknown. Further, the surgical decision-making for these types of injuries in professional football athletes remains controversial.

Methods.
NFL players with a CDH injury at a definitive cervical level were identified through a review of publicly available archives. Injuries were divided into upper- (C2-C4) and lower-level (C4-T1) CDH. The impact on player outcomes was determined by comparing return to play statistics and calculating a “Performance Score” for each player on the basis of pertinent statistical data, both before and after surgery.

Results.
A total of 40 NFL athletes met inclusion criteria. In the upper-level group, 10 of 15 (66.6%) players successfully returned to play an average of 44.6 games over 2.6 years. The lower-level cohort had 18 of 25 (72%) players return to play with an average of 44.1 games over 3.1 years. There was no significant difference in the rate of return to play (P = 0.71). Postsurgical performance scores of the upper and lower-level groups were 1.47 vs. 0.69 respectively, with no significant difference between these groups (P = 0.06). Adjacent segment disease requiring reoperation occurred in 10% of anterior cervical discectomy and fusion patients. In 50% of foraminotomy patients, a subsequent fusion was required.

Conclusion.
A uniquely high percentage of upper-level disc herniations develop in NFL athletes, and although CDH injuries present career threatening implications, an upper-level CDH does not preclude a player from successfully returning to play at a competitive level. In fact, these athletes showed comparable postsurgical performance to those athletes who underwent CDH procedures at lower cervical levels.

Level of Evidence: 4
Implementation of a Sustainable Ventilator-Associated Pneumonia Prevention Protocol in a Pediatric Intensive Care Unit in Managua, Nicaragua
Authors: Chinnadurai Kelsey , Fenlason Lindy , Bridges Brian , Espahbodi Mana , Chinnadurai Sivakumar , Blood-Siegfried Jane 
Published: October 2016

Background:
Ventilator-associated pneumonia (VAP) is a common nosocomial infection in pediatric intensive care units (ICUs). Ventilator-associated pneumonia protocols decrease the incidence of VAP; however, many components of these protocols are not feasible in all settings. This study was done in a large pediatric hospital in Nicaragua.

Objective:
The aim of this study is to implement a sustainable evidence-based VAP protocol, in a different culture, for the purpose of decreasing VAP rates.

Methods:
This quality improvement study used a bidirectional cohort design with the retrospective group as the control and the prospective group as the experimental population. A daily checklist monitored compliance to the implemented protocol in the prospective group. A 2-sided Fisher exact test compared the differences in VAP rates between the 2 populations.

Results:
During the 90-day implementation period, 123 ventilated patients in 3 separate ICU wings were evaluated, with 99 included in the final analysis. These data for 2014 were compared with the VAP rates recorded for the same time period in 2013. The highest adherence to the protocol was demonstrated by ICU wing 1, with a 90% decrease in VAP rates. No statistical difference in VAP rates was demonstrated by ICU 2, and ICU 3 demonstrated an increase in both patient acuity and VAP rates.

Discussion:
Implementation of a sustainable VAP protocol in a pediatric ICU in Nicaragua can reduce the incidence of VAP. Multiple barriers and challenges associated with implementation in a resource-constrained environment are discussed.
Congruence of the Medical Record and Subject Interview on Time of Symptom Onset in Patients Diagnosed With Acute Coronary Syndrome
Authors: Davis Leslie L. , McCoy Thomas P. , Riegel Barbara , McKinley Sharon , Doering Lynn V. , Dracup Kathleen , Moser Debra K. 
Published: October 2016

Background:
Past research has shown discrepancies between the time of symptom onset for patients with acute coronary syndrome (ACS) as documented in the medical record (MR) and patients’ recall of the time assessed through subject interviews done later by researchers.

Purpose:
The aim of this study is to determine if there were differences between the time of symptom onset documented in the MR and subject interview taking into consideration sex, age group, and recall period for patients admitted to the emergency department for symptoms suggestive of ACS.

Methods:
A secondary analysis was conducted on data from the PROMOTION (Patient Response to Myocardial Infarction Following a Teaching Intervention Offered by Nurses) trial, a multicenter randomized clinical trial to reduce patient prehospital delay to treatment in ACS.

Results:
Of the 3522 subjects with CAD enrolled into the trial, 3087 subjects completed 2-year follow-up. Of these, 331 subjects sought treatment in the emergency department for ACS symptoms and 276 patients (83%) had complete information on the time of symptom onset from both sources. Of the 276 patients, 25 (9%) had differing times more than 48 hours and were thus excluded. The median difference between the 2 sources was 45.0 minutes. When both times were examined, there were no significant differences in time by sex (P = .720) or by age group (P = .188). The median number of days between the interview and the date of symptom onset was 29.5 days. There was a significant correlation between differences in the time of symptom onset and the length of recall period (rs = 0.148, P = .023). In multivariable modeling, a longer recall period was associated with greater median differences in the symptom onset time (b = 13.2, P = .023).

Conclusion:
These results suggest that the time of symptom onset obtained at the time of the index event and documented in the MR is not interchangeable with data obtained later by research staff, especially if the interview is not conducted near the time of the index event.
Interprofessional Perspectives on ABCDE Bundle Implementation
Authors: Boehm Leanne M. , Vasilevskis Eduard E. , Mion Lorraine C. 
Published: October 2016

Background:
The ABCDE bundle is a multifaceted, interprofessional intervention that is associated with reduced ventilator and delirium days as well as increased likelihood of mobility in intensive care.

Objectives:
The aim of this study is to describe organizational domains that contribute to variation in ABCDE bundle implementation as reported by intensive care unit providers and to examine the capability of a conceptual framework for identifying variation in ABCDE bundle implementation.

Methods:
We conducted 2 separate focus groups that included nurses, respiratory therapists, occupational and physical therapists (N = 16) from the surgical and medical intensive care units at 1 academic medical center. All participants had experience performing ABCDE bundle activities.

Results:
Variation in how the ABCDE bundle was interpreted and executed within and across disciplines was noted. Organizational facets, the physical environment, labor quantity and quality, task burden, provider attitudes, and patient characteristics were noted to influence ABCDE bundle execution. The difficulty coordinating and implementing early mobility was emphasized.

Discussion:
The number of disciplines required to perform an activity and individual component complexity was reported to influence ABCDE bundle implementation. Nurses repeatedly described challenges with coordinating care across disciplines. Small tests of change, adequate staffing, interprofessional training and protocol development efforts, and role modeling may be effective methods for successful ABCDE bundle implementation.