bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decision Making in Neonatal End-of-Life Scenarios in Low-Income Settings1
Authors: McTavish James 
Published: May 2017

The challenge of decision making in end-of-life scenarios is exacerbated when the patient is a newborn and in a low-income setting. The principle of proportionate care is a helpful guide but needs to be applied. The complex interplay of benefit, burden, and cost of various treatments all need to be considered. In patients with severe neonatal encephalopathy, prognosis can be hard to determine, and a team approach to decision making can help. In low-income settings, or where there are limited resources, the ideal care needs to be incarnated in the real context. Issues of social justice also arise as finite resources need to be used prudently. Summary Decisions regarding medical care become difficult when the patient is a seriously ill newborn baby. In the developing world, scarce medical facilities and minimal economic resources also limit possible treatment options. The Catholic Church offers practical ethical principles which can help the medical team and family to strive to do what is morally best in these difficult situations.
The 2015 general elections in Nigeria: new media, party politics and the political economy of voting
Authors: Mustapha Mala 
Published: May 2017

SUMMARY
This Briefing argues that social media evidently did not provide the platforms for democratic struggles and the transformation of the political economy of voting during the 2015 general elections in Nigeria. Arguably, only the trade union movements such as the Nigerian Labour Congress formed a vibrant vanguard for democratic struggles challenging neoliberal policy and state hegemony.
Mixed Messages or Miscommunication? Investigating the Relationship Between Assessors’ Workplace-Based Assessment Scores and Written Comments
Authors: Sebok-Syer Stefanie S. , Klinger Don A. , Sherbino Jonathan , Chan Teresa M. 
Published: May 2017

Purpose
The shift toward broader, programmatic assessment has revolutionized the approaches that many take in assessing medical competence. To understand the association between quantitative and qualitative evaluations, the authors explored the relationships that exist among assessors’ checklist scores, task ratings, global ratings, and written comments.

Method
The authors collected and analyzed, using regression analyses, data from the McMaster Modular Assessment Program. The data were from emergency medicine residents in their first or second year of postgraduate training from 2012 through 2014. Additionally, using content analysis, the authors analyzed narrative comments corresponding to the “done” and “done, but needs attention” checklist score options.

Results
The regression analyses revealed that the task ratings, provided by faculty assessors, are associated with the use of the “done, but needs attention” checklist score option. Analyses also identified that the “done, but needs attention” option is associated with a narrative comment that is balanced, providing both strengths and areas for improvement. Analysis of qualitative comments revealed differences in the type of comments provided to higher- and lower-performing residents.

Conclusions
This study highlights some of the relationships that exist among checklist scores, rating scales, and written comments. The findings highlight that task ratings are associated with checklist options while global ratings are not. Furthermore, analysis of written comments supports the notion of a “hidden code” used to communicate assessors’ evaluation of medical competence, especially when communicating areas for improvement or concern. This study has implications for how individuals should interpret information obtained from qualitative assessments.
Continuing Professional Development for Faculty: An Elephant in the House of Academic Medicine or the Key to Future Success?
Authors: Davis David A. , Rayburn William F. , Smith Gary A. 
Published: May 2017

The scope of change required by academic medical centers (AMCs) to maintain their viability and achieve their tripartite mission in the future is large; such reform is affected by numerous global, national, and local forces. Most AMCs focus their transformational efforts on organizational infrastructure (e.g., undertaking payment reform, developing new organizational structures, investing in information technology) and educational programs (with subsequent changes in undergraduate and graduate medical education curricula). Although useful, these efforts have failed to produce the kind of change required for AMCs to succeed in the future.
The authors of this Invited Commentary describe a key element missing from most of these reform efforts—the preparation of faculty for new models of health care and educational practice. To address this issue, they call for the effective, system-aligned presence of continuing professional development (CPD) programs. CPD combines continuing medical education, with its focus on content knowledge, and faculty development, with its focus on evidence-based learning methodologies, across the institution to produce a more robust, system- and outcomes-oriented program to facilitate both individual and organizational learning. If sufficiently supported, CPD programs can provide a platform for the human changes necessary to ensure the smooth transition of AMCs to new models of education, clinical research, and ultimately patient care.
Mother's Lived Experience During Repair of Long-Gap Esophageal Atresia
Authors: Fleck Patricia , Kenner Carole , Board Rhonda , Mott Sandra 
Published: May 2017

Background:
Infants born with long-gap esophageal atresia (LGEA) pose unique physiologic risks in the newborn period. Anatomic and physiologic anomalies require an extended hospitalization with procedural analgesia and sedation that impact the mother's experience of birth, maternal response, and nurturing of her infant.

Purpose:
The aim of this study was to understand the meaning of experiences that mothers of infants born with LGEA encounter in the neonatal intensive care unit while their infant undergoes esophageal repair.

Methods:
A hermeneutical phenomenological design was used to guide this inquiry. Three mothers were interviewed on 3 separate occasions. The conversations were audio-recorded and transcribed verbatim. The findings were analyzed using fundamental existential lifeworld themes.

Results:
The essence that conceptualized the study was “making connections: day-by-day.” Themes that emerged are (a) the many phases; (b) the long and winding road; (c) a new me, my purpose; and (d) our new community.

Implications for Practice:
Nurses' knowledge and understanding of maternal experiences of having an infant with LGEA will enable for increased physical closeness, optimizing time spent together to learn their infant's unique personality. Creating partnerships with mothers can enhance our understanding of their perspectives, concerns, needs, and guide interventions.

Implications for Research:
Further exploration of family dynamics including fathers, siblings, and contextual factors may illuminate interventions to enhance relationships and communication that may influence developmental outcomes for families of infants with LGEA.
Can Source Triangulation Be Used to Overcome Limitations of Self-Assessments? Assessing Educational Needs and Professional Competence of Pharmacists Practicing in Qatar
Authors: Kheir Nadir , Al-Ismail Muna Said , Al-Nakeeb Reem 
Published: May 2017

Introduction:
Continuing professional development activities should be designed to meet the identified personal goals of the learner. This article aims to explore the self-perceived competency levels and the professional educational needs of pharmacists in Qatar and to compare these with observations of pharmacy students undergoing experiential training in pharmacies (students) and pharmacy academics, directors, and managers (managers).

Methods:
Three questionnaires were developed and administered to practicing pharmacists, undergraduate pharmacy students who have performed structured experiential training rotations in multiple pharmacy outlets in Qatar and pharmacy managers. The questionnaires used items extracted from the National Association of Pharmacy Regulatory Authorities (NAPRA) Professional competencies for Canadian pharmacists at entry to practice and measured self- and observed pharmacists' competency and satisfaction with competency level.

Results:
Training and educational needs were similar between the pharmacists and observers, although there was trend for pharmacists to choose more fact-intensive topics compared with observers whose preferences were toward practice areas. There was no association between the competency level of pharmacists as perceived by observers and as self-assessed by pharmacists (P ≤ .05). Pharmacists' self-assessed competency level was consistently higher than that reported by students (P ≤ .05).

Discussion:
The results suggest that the use of traditional triangulation might not be sufficient to articulate the professional needs and competencies of practicing pharmacists as part of a strategy to build continuing professional development programs. Pharmacists might have a limited ability to accurately self-assess, and observer assessments might be significantly different from self-assessments which present a dilemma on which assessment to consider closer to reality. The processes currently used to evaluate competence may need to be enhanced through the use of well-designed rubrics or other strategies to empower and to better inform respondents and subsequently improve their ability to self-assess their competencies.
Rebooting Kirkpatrick: Integrating Information System Theory Into the Evaluation of Web-based Continuing Professional Development Interventions for Interprofessional Education
Authors: Shen Nelson , Yufe Shira , Saadatfard Omid , Sockalingam Sanjeev , Wiljer David 
Published: May 2017

Introduction:Information system research has stressed the importance of theory in understanding how user perceptions can motivate the use and adoption of technology such as web-based continuing professional development programs for interprofessional education (WCPD-IPE). A systematic review was conducted to provide an information system perspective on the current state of WCPD-IPE program evaluation and how current evaluations capture essential theoretical constructs in promoting technology adoption.Methods:Six databases were searched to identify studies evaluating WCPD-IPE. Three investigators determined eligibility of the articles. Evaluation items extracted from the studies were assessed using the Kirkpatrick–Barr framework and mapped to the Benefits Evaluation Framework.Results:Thirty-seven eligible studies yielded 362 evaluation items for analysis. Most items (n = 252) were assessed as Kirkpatrick–Barr level 1 (reaction) and were mainly focused on the quality (information, service, and quality) and satisfaction dimensions of the Benefits Evaluation. System quality was the least evaluated quality dimension, accounting for 26 items across 13 studies. WCPD-IPE use was reported in 17 studies and its antecedent factors were evaluated in varying degrees of comprehensiveness.Discussion:Although user reactions were commonly evaluated, greater focus on user perceptions of system quality (ie, functionality and performance), usefulness, and usability of the web-based platform is required. Surprisingly, WCPD-IPE use was reported in less than half of the studies. This is problematic as use is a prerequisite to realizing any individual, organizational, or societal benefit of WCPD-IPE. This review proposes an integrated framework which accounts for these factors and provides a theoretically grounded guide for future evaluations.
Primary Cutaneous Small Cell Variant of Anaplastic Large Cell Lymphoma: A Case Series and Review of the Literature
Authors: Magro Cynthia M. , Momtahen Shabnam , Kiuru Maija 
Published: May 2017

Abstract:Primary cutaneous anaplastic large cell lymphoma (ALCL), similar to systemic ALCL, has as its histomorphologic hallmarks cohesive sheets of large lymphoid cells expressing CD30. Several morphologic variants of systemic ALCL have been reported, including the common (classic) type, lymphohistiocytic, and small cell variants. The small cell variant of ALCL is characterized by a predominant cytomorphology which is unexpected for ALCL, being in the context of a small- to medium-sized hyperchromatic atypical lymphocyte. Although well recognized in its systemic form including cases with secondary cutaneous involvement, it is less well characterized as a form of primary cutaneous ALCL. In this study, we collected 8 cases of primary cutaneous small cell variant of ALCL and examined their clinical, histologic, and phenotypic features. All patients were middle aged to older adult men; the youngest patient was a 46-year-old man with underlying hepatitis C. In one case, there was a history of lymphomatoid papulosis. In all patients, the disease was in the context of a local regional presentation. Patients were treated with complete excision and/or radiation except in one in whom chemotherapy was administered. In all but one patient, the cutaneous presentation was a regionally confined process; however, in 2 cases, recurrent disease occurred, and in 25% of cases, extracutaneous dissemination specifically to regional lymph nodes was observed. Although there was nodal involvement, there was no dissemination to bone marrow or peripheral blood; no patient has died because of disseminated lymphoma. In all cases, there was a predominance of small atypical hyperchromatic cells with a variable background of larger hallmark cells typical of ALCL. Epidermotropism was seen in half of the cases, and in one case, there was striking pseudoepitheliomatous hyperplasia. The smaller cells demonstrated CD30 positivity, and the neoplastic cells showed a CD4-positive phenotype with a variable expression of cytotoxic proteins in about half of the cases, whereas in the remaining cases, a double negative phenotype was observed. Epithelial membrane antigen expression was observed in the cases tested. In our literature review, similar demographics were observed with a comparable percent of cases with extracutaneous dissemination; one case manifested an aggressive clinical course eventuating in death. In summation, the small cell variant of primary cutaneous ALCL exhibits distinctive features clinically and histologically. While exhibiting an overall higher incidence of extracutaneous dissemination, the prognosis fairs better compared with other forms of cutaneous T-cell lymphoma associated with extracutaneous dissemination, an event that defines a harbinger of aggressive disease.
Current Practices for Therapeutic Drug Monitoring of Biopharmaceuticals in Pediatrics
Authors: Murias Sara , Magallares Lorena , Albizuri Fatima , Pascual-Salcedo Dora , Dreesen Erwin , Mulleman Denis 
Published: May 2017

Abstract:
Biopharmaceuticals have recently emerged as effective treatments for refractory pediatric autoimmune conditions. Several reports have shown a relationship between drug concentration, antidrug antibodies, and clinical response in these patients, strongly suggesting the potential interest, usefulness, and reliability of therapeutic drug monitoring (TDM) in children. This article reviews the current state of research in juvenile idiopathic arthritis, pediatric inflammatory bowel disease, and pediatric psoriasis from a TDM point of view. There is a remarkable lack of evidence-based data in pediatric patients, which is reflected throughout the article. Most investigations of TDM are focused on research of tumor necrosis factor alpha antagonists in inflammatory bowel disease, albeit preliminary publications are emerging from pediatric rheumatologists and dermatologists. To date, immunogenicity has been a primary concern, particularly regarding infliximab and adalimumab therapy in children, as it may lead to a loss of therapeutic response. Preliminary investigations show that adjusting the dose according to blood drug concentrations improves disease outcomes by overcoming antidrug antibodies, suggesting a crucial role for TDM. Patients who receive other drugs, such as etanercept, abatacept, or tocilizumab, could benefit from TDM because dosage can be optimized by adjusting it to the minimum effective dose.
HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING THROUGH THE UNDILATED PUPIL IN INFANTS BORN PRETERM OR WITH HYPOXIC INJURY OR HYDROCEPHALUS
Authors: Tran-Viet Du , Wong Brittany M. , Mangalesh Shwetha , Maldonado Ramiro , Cotten C. Michael , Toth Cynthia A. 
Published: May 2017

Purpose:
The authors investigated feasibility of undilated handheld spectral domain optical coherence tomography (SDOCT) retinal imaging in preterm infants and children with neurologic abnormalities.

Methods:
Under an institutional review board–approved protocol, the authors attempted handheld SDOCT imaging of the retina, choroid, and optic nerve in infants and young children without pupil dilation. Scans were analyzed for quality and successful capture of foveal, optic nerve, and retinal structural parameters and abnormalities.

Results:
The authors obtained images through an undilated pupil of 11 infants/children over 28 eye imaging sessions, 27 at the bedside without sedation, and one under anesthesia. Infants had retinopathy of prematurity (n = 8), hypoxic ischemic encephalopathy (n = 2), or obstructive hydrocephalus (n = 1 child). Pupil sizes ranged from 1.0 mm to 3.5 mm. The authors captured fovea and optic nerve scans in 25/28 eye imaging sessions, with scans of adequate quality to discern prespecified foveal and optic nerve morphology, and of the 25 sessions, the choroidal–scleral junction was visible in all but 6 sessions.

Conclusion:
Undilated, handheld SDOCT imaging is a potential alternative method to evaluate the retina and optic nerve in patients with relative contraindication to pharmacological pupil dilation. This approach will enable the study of the eye–brain connection and ocular manifestations of neurologic diseases.
Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation
Authors: Dugan Sheila A. , Lewis Tené T. , Everson-Rose Susan A. , Jacobs Elizabeth A. , Harlow Siobán D. , Janssen Imke 
Published: May 2017

Abstract
A growing literature links discrimination to key markers of biobehavioral health. While racial or ethnic differences in pain are seen in experimental and clinical studies, the authors were interested in how chronic discrimination contributes to pain within multiple racial or ethnic groups over time. Participants were 3056 African American, Caucasian, Chinese, Hispanic, and Japanese women from the Study of Women's Health Across the Nation. The Everyday Discrimination Scale was assessed from baseline through 13 follow-up examinations. The bodily pain subscale of the MOS 36-Item Short-Form Health Survey (SF-36) was assessed annually. There were large racial or ethnic differences in reports of discrimination and pain. Discrimination attributions also varied by race or ethnicity. In linear mixed model analyses, initially adjusted for age, education, and pain medications, chronic everyday discrimination was associated with more bodily pain in all ethnic groups (beta = −5.84; P < 0.002 for Japanese; beta = −6.17; P < 0.001 for African American; beta = −8.74; P < 0.001 for Chinese; beta = −10.54; P < 0.001 for Caucasians; beta = −12.82; P < 0.001 for Hispanic). Associations remained significant in all ethnic groups after adjusting for additional covariates in subsequent models until adding depressive symptoms as covariate; in the final fully-adjusted models, discrimination remained a significant predictor of pain for African American (beta = −4.50; P < 0.001), Chinese (beta = −6.62; P < 0.001), and Caucasian (beta = −7.86; P < 0.001) women. In this longitudinal study, experiences of everyday discrimination were strongly linked to reports of bodily pain for the majority of women. Further research is needed to determine if addressing psychosocial stressors, such as discrimination, with patients can enhance clinical management of pain symptoms.
Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations
Authors: Tremblay Sophie , Ranger Manon , Chau Cecil M.Y. , Ellegood Jacob , Lerch Jason P. , Holsti Liisa , Goldowitz Daniel , Grunau Ruth E. 
Published: May 2017

Abstract
Oral sucrose is administered routinely to reduce pain of minor procedures in premature infants and is recommended as standard care in international guidelines. No human or animal studies on effects of early repeated sucrose exposure on long-term brain development have been done in the context of pain. We evaluated the effects of repeated neonatal sucrose treatment before an intervention on long-term brain structure in mouse pups. Neonatal C57Bl/6J mice (n = 109) were randomly assigned to one of 2 treatments (vehicle vs sucrose) and one of 3 interventions (handling, touch, or needle-prick). Mice received 10 interventions daily from postnatal day 1 to 6 (P1-6). A dose of vehicle or 24% sucrose was given orally 2 minutes before each intervention. At P85-95, brains were scanned using a multichannel 7.0 T MRI. Volumes of 159 independent brain regions were obtained. Early repetitive sucrose exposure in mice (after correcting for whole brain volume and multiple comparisons) lead to smaller white matter volumes in the corpus callosum, stria terminalis, and fimbria (P < 0.0001). Cortical and subcortical gray matter was also affected by sucrose with smaller volumes of hippocampus and cerebellum (P < 0.0001). These significant changes in adult brain were found irrespective of the type of intervention in the neonatal period. This study provides the first evidence of long-term adverse effects of repetitive sucrose exposure and raises concerns for the use of this standard pain management practice during a period of rapid brain development in very preterm infants.