bluuebunny/crossref_metadata_2025_split huggingface dataset:
Der Einfluss multipler Anti-VEGF-Injektionen auf den intraokularen Druck
Authors: Lamprakis Ioannis , Todorova Margarita , Grüb Matthias , Schlote Torsten 
Published: October 2017

Zusammenfassung
Hintergrund Multiple Anti-VEGF-Injektionen sollen als möglicher Risikofaktor für postoperative Augendruckerhöhungen untersucht werden.
Methode Es wurden 50 Augen von 50 Patienten in die retrospektive Studie aufgenommen, die mindestens 10 intravitreale Injektionen mit VEGF-Inhibitoren (Indikationen: altersbedingte Makuladegeneration, diabetische Makulopathie, Makulaödem nach retinalem Venenverschluss) an einem Auge erhalten hatten und deren Augendruck am 1. postoperativen Tag gemessen wurde. Ein Intraokulardruck (IOD) > 21 mmHg wurde als erhöht eingestuft und auf einen Zusammenhang zur Zahl der Injektionen hin untersucht.
Ergebnisse Es wurden 669 IOD-Messungen analysiert (nach im Mittel 13,4 Injektionen pro Auge). Bei 43 Augen (86%) kam es nach keiner Injektion zu einer IOD-Erhöhung am 1. postoperativen Tag. Eine transiente IOD-Erhöhung (> 21 mmHg) war nach 19 Injektionen (2,8%) zu verzeichnen (1 Patient davon mit 8 IOD-Erhöhungen). Es konnte keine persistierende IOD-Erhöhung oder Tendenz zur Zunahme von transienten IOD-Erhöhungen mit zunehmender Zahl der Injektionen nachgewiesen werden. Augen mit bekanntem Glaukom waren signifikant häufiger von einer IOD-Erhöhung betroffen als Augen ohne Glaukom (5,5 vs. 2,2%).
Schlussfolgerungen Multiple intravitreale Injektionen von Anti-VEGF-Inhibitoren sind kein eigenständiger Risikofaktor für persistierende Augendruckerhöhungen. Individuelle Risikofaktoren (z. B. präexistentes Glaukom) prädisponieren jedoch zu transienten IOD-Erhöhungen.
Zur Desinfektion von Handschuhen: Wissen, Erfahrungen und Einstellungen von Mitgliedern des Hygieneteams und Betriebsärzten
Authors: Schulz-Stübner Sebastian , Hofmann Friedrich , Michaelis Martina 
Published: October 2017

Zusammenfassung
Hintergrund Chemikalienbeständige Handschuhe lassen zeitsparende Handschuhdesinfektionen anstelle eines Wechsels zu. Allerdings existieren teils heterogene Empfehlungen zur Durchführung.
Fragestellung und Ziele Mit der Frage, was Mitglieder von Hygieneteams und Betriebsärzte über das Thema Handschuhdesinfektion wissen und welche Erfahrungen bzw. Einstellungen sie haben, sollten bei 2 Gelegenheitsstichproben erste Erkenntnisse zum Umsetzungsgrad dieses Themas im Gesundheitsdienst generiert werden.
Material und Methoden Mitglieder von Hygieneteams und Betriebsärzte wurden 2016 auf 2 Fortbildungsveranstaltungen schriftlich befragt und die Daten berufsgruppenvergleichend ausgewertet.
Ergebnisse 558 von 1000 verteilten Fragebögen (55,8%) wurden ausgewertet (n=246 Hygienefachkräfte (HFK), 63 Hygienebeauftragte in der Pflege, 39 Medizin-/Krankenhaushygieniker (MKH), 97 hygienebeauftragte Ärzte, 46 Betriebsärzte (BÄ) und 67 „Sonstige“. Über 90% der HFK und MKH kannten die Inhalte der KRINKO-Empfehlungen. Rund 75% der HFK bzw. MKH, 35% der BÄ und 25% der hygienebeauftragten Ärzte und Pflegekräfte wurden in den 12 Monaten vor der Erhebung von Beschäftigten schon einmal auf das Thema Handschuhdesinfektion angesprochen. Vielfach sind Handschuhdesinfektionen in den Einrichtungen nicht erlaubt; auch sprachen sich 67% der Befragten dagegen aus. Generell werden große Defizite beim Personal beim Umgang mit Einmalhandschuhen wahrgenommen.
Schlussfolgerung Das Thema Handschuhdesinfektion beschäftigt in erster Linie das Hygienefachpersonal. Eine enge Abstimmung zwischen Krankenhaushygiene und Betriebsmedizin/Arbeitsschutz wäre bei diesem Thema wichtig, findet aber scheinbar nicht im gebotenen Umfang statt. Es bestehen Unsicherheiten bei den Anforderungen an desinfizierbare Handschuhe und die praktische Umsetzung der Handschuhdesinfektion.
Evaluation of Cortisol Production in Aldosterone-Producing Adenoma
Authors: Inoue Kosuke , Yamazaki Yuto , Tsurutani Yuya , Suematsu Sachiko , Sugisawa Chiho , Saito Jun , Omura Masao , Sasano Hironobu , Nishikawa Tetsuo 
Published: October 2017

AbstractAldosterone-producing adenoma (APA) is sometimes accompanied with subclinical hypercortisolism. We investigated the ability of cortisol production in APA, both clinically and pathologically. A retrospective cohort study was conducted at Yokohama Rosai Hospital from 2009 to 2016. Thirty patients with APA and serum cortisol levels during the 1 mg dexamethasone suppression test (F-DST)<3.0 μg/dl were included. We evaluated the 1) difference between pre-adrenalectomy F-DST (pre-F-DST) and post-adrenalectomy F-DST (ΔF-DST), 2) correlation between ∆F-DST and pre-F-DST, tumour size determined by CT, and type of adrenalectomy (total or partial), and 3) relationship between the ratio of F-DST divided by tumour size (ΔF-DST/pre-F-DST/mm) and immunoreactivity of CYP17A1, CYP11B1, and CYP11B2. The median [interquartile range] age was 48 [38–58] years. We found a significant decrease in F-DST after adrenalectomy [before: 1.4 (1.1–1.8); after: 0.9 (0.6–1.2); p<0.001]. Additionally, a significant correlation was found for ΔF-DST and both pre-F-DST (Spearman, ρ=–0.68, p<0.001) and tumour size (ρ=–0.51, p 0.005). No significant difference was found in ΔF-DST between total and partial adrenalectomy. CYP17A1 and CYP11B1 were positive in 21 (100%) and 17 (81%) adenomas, respectively. CYP17A1 immunoreactivity in the tumour was significantly related with ΔF-DST/pre-F-DST/mm (p 0.049). F-DST significantly decreased after adrenalectomy, and most of the adenomas were immunohistochemically positive for CYP17A1 and CYP11B1 as well as CYP11B2. We should consider the possibility of autonomous cortisol production as well as hyperaldosteronism in the evaluation and treatment of APA patients.
Association Between Chronic or Acute Use of Antihypertensive Class of Medications and Falls in Older Adults. A Systematic Review and Meta-Analysis
Authors: Kahlaee Hamid Reza , Latt Mark D , Schneider Carl R 
Published: October 2017

Abstract

BACKGROUND
Evaluating effect of acute or chronic use of antihypertensives on risk of falls in older adults.

METHODS
Data sources: Systematic search of primary research articles in CINAHL, Cochrane, EBM, EMBASE, and MEDLINE databases from January 1 2007 to June 1 2017. Study selection: Research studies of cohort, case-control, case-crossover, cross-sectional, or randomized controlled trial (RCT) design examining association between antihypertensives and falls in people older than 60 years were evaluated. Data synthesis: Twenty-nine studies (N = 1,234,667 participants) were included. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). PRISMA and MOOSE guidelines were used for abstracting data and random-effects inverse-variance meta-analysis was conducted on 26 articles examining chronic antihypertensive use, with odds ratios (ORs) and hazards ratios (HRs) analyzed separately. Time-risk analysis was performed on 5 articles examining acute use of antihypertensives. Outcomes: Pooled ORs and HRs were calculated to determine the association between chronic antihypertensive use and falls. For time-risk analysis, OR was plotted with respect to number of days since antihypertensive commencement, change, or dose increase.

RESULTS
There was no significant association between risk of falling and chronic antihypertensive medication use (OR = 0.97, 95% confidence interval [CI] 0.93–1.01, I2 = 64.1%, P = 0.000; and HR = 0.96, 95% CI 0.92–1.00, I2 = 0.0%, P = 0.706). The time-risk analysis demonstrated a significantly elevated risk of falling 0–24 hours after antihypertensive initiation, change, or dose increase. When diuretics were used, the risk remained significantly elevated till day 21.

CONCLUSIONS
There is no significant association between chronic use of antihypertensives and falls in older adults. Risk of falls is highest on day zero for all antihypertensive medications.
Heraclitus
Authors: Hülsz Enrique 
Published: October 2017

Active around 500 bce, Heraclitus of Ephesus is a universally recognized figure of the so-called Presocratic tradition. Biographical data are scarce and the anecdotes reported by later doxography seem untrustworthy (especially the stories about his death). There are extant over a hundred verbatim fragments from his book, the most extensive remains of written philosophical thought from the early 5th century (about two thousand words) before Empedocles. The collection, dependent on indirect sources that range in the standard edition from Plato to Albertus Magnus, suggests a unique and well-polished work, rich in poetical and rhetorical resources. Heraclitus became famous for the enigmatic qualities of his style and was dubbed “the obscure” (ὁ σκοτεινός). Although the style has been frequently categorized as aphoristic, some fragments show a clear narrative structure. Modern attempts at reconstruction have often been based on the locus classicus in Diogenes Laertius (IX.5) that divided the book into three sections, “On the Universe,” “Political,” and “Theological.” The dominant version of its overall philosophical character stems from the Aristotelian interpretation of Heraclitus as a materialistic and monistic natural philosopher (φυσικóς), upholder of fire as principle, and a cosmologist. Many fragments reveal an intense concern with human affairs, such as knowledge; moral and political praxis (including religious belief and ritual practice); and language. The fundamental notion of λóγος tended to be bypassed silently in antiquity, except for the Stoics, and only came to the interpretive foreground in modern times (its complex philosophical status and meaning, and wide range of application have remained, however, the object of scholarly dispute). Plato attributes to Heraclitus the ontological thesis of universal flux (πάντα ῥεῖ), which, together with the idea of the identity and Unity of Opposites, became a defining characteristic of “Heracliteanism.” The book criticized explicitly the figures of ancient and recent wisdom (such as Homer, Hesiod, Archilochus, Hecateus, Pythagoras, and Xenophanes), but also developed an original epistemological model centered in understanding the unity or oneness of things and their essential nature (φύσις), specially emphasizing the human ψυχή as the knowing subject and moral agent. Although traditionally marginalized, ethics, politics, and religion constitute an important area for current and future scholarship.
Why is buprenorphine coformulated with naloxone?
Authors: Urnoski Eric 
Published: October 2017

ABSTRACT
Combination buprenorphine-naloxone is a cornerstone of outpatient treatment for substance use disorder, and is more widely accessible in primary care. Because oral buprenorphine has been diverted and abused for its euphoric properties, a combination formulation was developed and will trigger withdrawal symptoms if injected IV.
How and Why Preclerkship Students Set Learning Goals and Assess Their Achievement: A Qualitative Exploration
Authors: Kindler Pawel M. , Bates Joanna , Hui Eric , Eva Kevin W. 
Published: October 2017

Purpose
Health professionals are expected to routinely assess their weaknesses, set learning goals, and monitor their achievement. Unfortunately, it is well known that these professionals often struggle with effectively integrating external data and self-perceptions. To know how best to intervene, it is critical that the health professionals community understand the cues students and practitioners use to assess their abilities. Here the authors aimed to gain insights into how and why medical students set learning goals, monitor their progress, and demonstrate their learning.

Method
In 2012, the authors conducted semistructured interviews with Year 2 students (n = 20), applying an inductive approach to data analysis by iteratively developing, refining, and testing coding structures.

Results
Themes were constructed through discussion and consensus: (1) Students were diverse in how they set learning goals, (2) they used a range of approaches to monitor their progress, and (3) they struggled to balance studying for exams with preparation for clinical training. Tensions observed highlight assumptions embedded in medical curricula that can be problematic.

Conclusions
Educators often treat medical students as a cohesive whole, thereby creating a mismatch between assessments that are intended to be formative and information students use to monitor their progress. Despite limited exposure to clinical contexts, goal generation and monitoring often stem from a desire to prepare for clinical practice. In grappling with these tensions, it is important to be mindful that students are individualistic in how they balance their commitment to prepare for clinical work and the need to concentrate on exams.
Formative Assessment in an Integrated Curriculum: Identifying At-Risk Students for Poor Performance on USMLE Step 1 Using NBME Custom Exam Questions
Authors: Brenner Judith M. , Bird Jeffrey B. , Willey Joanne M. 
Published: October 2017

Purpose
The Hofstra Northwell School of Medicine (HNSOM) uses an essay-based assessment system. Recognizing the emphasis graduate medical education places on the United States Medical Licensing Examination (USMLE) Step exams, the authors developed a method to predict students at risk for lower performance on USMLE Step 1.

Method
Beginning with the inaugural class (2015), HNSOM administered National Board of Medical Examiners (NBME) Customized Assessment Service (CAS) examinations as formative assessment at the end of each integrated course in the first two years of medical school. Using preadmission data, the first two courses in the educational program, and NBME score deviation from the national test takers’ mean, a statistical model was built to predict students who scored below the Step 1 national mean.

Results
A regression equation using the highest Medical College Admission Test (MCAT) score and NBME score deviation predicted student Step 1 scores. The MCAT alone accounted for 21% of the variance. Adding the NBME score deviation from the first and second courses increased the variance to 40% and 50%, respectively. Adding NBME exams from later courses increased the variance to 52% and 64% by the end of years one and two, respectively. Cross-validation demonstrated the model successfully predicted 63% of at-risk students by the end of the fifth month of medical school.

Conclusions
The model identified students at risk for lower performance on Step 1 using the NBME CAS. This model is applicable to schools reforming their curriculum delivery and assessment programs toward an integrated model.
An Innovative Shared Decision-Making Curriculum for Internal Medicine Residents: Findings From the University of Pittsburgh Medical Center
Authors: Rusiecki Jennifer , Schell Jane , Rothenberger Scott , Merriam Sarah , McNeil Melissa , Spagnoletti Carla 
Published: October 2017

Purpose
Shared decision making (SDM) is a core competency in health policy and guidelines. Most U.S. internal medicine residencies lack an SDM education curriculum. A standardized patient (SP)-based curriculum teaching key concepts and skills of SDM was developed.

Method
This curriculum consisted of an innovative seven-step SDM model and a skills-focused SP case, integrated into the ambulatory rotation for senior medicine residents at the University of Pittsburgh Medical Center in 2015. Evaluation consisted of pre/postcurriculum surveys assessing residents’ knowledge of and attitudes toward SDM. Skills development was assessed via pre/postcurricular audio recordings of clinical decision making.

Results
Thirty-six residents completed the curriculum (survey participation rate 88%). There was significant improvement in residents’ knowledge (median score pre 75%, post 100%, P < .01); confidence (median composite score pre 2.87, post 3.0, P < .01, where 1 = not confident/important, 4 = very confident/important); and importance of SDM (median composite score pre 3.14, post 3.5, P < .01). Forty-four clinical recordings (31 pre, 13 post) were assessed using the Observing Patient Involvement in Decision-Making scale. Improvement in use of SDM skills was seen among all residents (mean increase 1.84 points, P = .27). When data were stratified post hoc by U.S. versus international medical graduates, there was significant improvement in total score (mean increase of 5.15 points, P = .01) among U.S. graduates only.

Conclusions
SDM is teachable, and this skill-based curricular intervention resulted in improvement in senior medicine residents’ knowledge of, attitudes toward, and demonstration of SDM skills.
Reconstruction of Traumatic, Open Supracondylar Femoral Fractures by Autologous Fibular Strut Grafting and Cortico-Cancellous Bone Grafting—A Single-Centre, Observational Study
Authors: Iyengar Raju , Cherukuri Nagesh , Patnala Chandrasekar 
Published: October 2017

Objectives:
To study the safety and efficacy of staged reconstruction of distal femoral (supracondylar) bone loss using autologous fibular strut, cortico-cancellous bone grafting.

Design:
Single-centre, observational study, with review of literature.

Setting:
Urban Level I Trauma Center.

Patients/Participants:
Eighteen consecutive patients (mean age: 35 ± 8.5 years, all males) with open supracondylar fracture and intercondylar extension (OTA/AO type C3), operated between January 2010 and February 2014 with severe bone loss in 11 patients and moderate loss in 7.

Intervention:
Single free fibular strut was used in 12 femurs and dual fibula in 5 femurs with autologous cortico-cancellous bone grafting in all.

Main Outcome Measures:
Clinical union, radiological union, and knee function using the Sanders' score.

Results:
Mean follow-up was 45.5 ± 17 months. The mean radiological union time was 18 ± 2.6 weeks. Functional assessment after union revealed one patient with excellent knee function, 9 with good, 8 with fair, function according to Sanders' scoring. The mean knee range was 49 degrees (range 5–110 degrees) in which 9 patients achieved a knee range >80 degrees. Mean limb shortening was 2 cm (range 0–7 cm). No limb shortening was observed in 5 patients. Patients were pain free and had no significant graft or donor site morbidity.

Conclusions:
Staged fibular strut grafting, cortico-cancellous bone grafting for traumatic open supracondylar femoral fractures with significant bone loss is a promising technique with a good safety profile and long-term efficacy.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Partitioning an Artificial Anterior Chamber With a Latex Diaphragm to Simulate Anterior and Posterior Segment Pressure Dynamics: The “DMEK Practice Stage,” Where Surgeons Can Rehearse the “DMEK Dance”
Authors: Sáles Christopher S. , Straiko Michael D. , Fernandez Ana Alzaga , Odell Kelly , Dye Philip K. , Tran Khoa D. 
Published: October 2017

Purpose:
To present a novel apparatus for simulating the anterior and posterior segment pressure dynamics involved in executing Descemet membrane endothelial keratoplasty (DMEK) surgery when using a chamber-shallowing technique.

Methods:
An artificial anterior chamber (AAC), 18-mm trephine, latex glove, two 3-mL syringes, and one donor cornea comprising an intact corneoscleral cap from which a DMEK tissue was peeled and punched are required for the model. After making the corneal incisions with the corneoscleral cap mounted on the AAC in the usual fashion, the corneoscleral cap is remounted onto the dried AAC over an 18-mm latex diaphragm. The space between the latex diaphragm and the cornea is filled with saline to pressurize the anterior chamber, and the posterior segment is pressurized with air from a syringe. The resulting apparatus comprises a posterior segment and anterior chamber that exert pressure on each other by way of a distensible latex diaphragm.

Results:
A novice and experienced DMEK surgeon and 2 eye bank technicians were able to assemble the apparatus and perform the routine steps of a DMEK procedure, including maneuvers that require shallowing the anterior chamber and lowering its pressure. Only one cornea was required per apparatus.

Conclusions:
We present a novel in vitro model of the human eye that more closely mimics the anterior and posterior segment pressure dynamics of in vivo DMEK surgery than average human and animal cadaveric globes. The model is easy to assemble, inexpensive, and applicable to a range of teaching environments.
Topical Tacrolimus 0.03% for Maintenance Therapy in Steroid-Dependent, Recurrent Phlyctenular Keratoconjunctivitis
Authors: Yoon Chang Ho , Kim Mee Kum , Oh Joo Youn 
Published: October 2017

Purpose:
To evaluate the efficacy of topical tacrolimus 0.03% as steroid-free maintenance therapy in young patients with severe, recurrent phlyctenular keratoconjunctivitis (PKC).

Methods:
The medical records of 6 eyes of 5 patients (4 children and 1 young adult) with recurrent, steroid-dependent PKC were reviewed. The patients were treated with combined application of topical steroids and tacrolimus 0.03% in the active phase and maintained on topical tacrolimus alone after remission.

Results:
The clinical signs, symptoms, and visual acuities resolved in all patients after 25.2 ± 16.9 days of combined treatment with steroids and tacrolimus. After disease remission, the patients were maintained on topical tacrolimus 0.03% once daily alone for 8.4 ± 4.7 months, and no recurrence occurred during 10.6 ± 1.9 months of follow-up. Tacrolimus was successfully discontinued in 2 patients without further recurrence. There were no ocular side effects related to the use of topical tacrolimus.

Conclusions:
Topical tacrolimus 0.03% was effective in maintaining long-term remission in patients with recurrent, steroid-dependent PKC.
Predictors of Successful Yield of Transbronchial Lung Biopsy in Patients With Sarcoidosis
Authors: Sehgal Inderpaul S. , Bal Amanjit , Dhooria Sahajal , Gupta Nalini , Ram Babu , Aggarwal Ashutosh N. , Behera Digambar , Agarwal Ritesh 
Published: October 2017

Background:
Transbronchial lung biopsy (TBLB) is an important bronchoscopic procedure used in the diagnosis of sarcoidosis. Only a few studies have evaluated determinants associated with successful diagnostic yield of TBLB. Herein, we evaluate the factors predicting successful yield of TBLB in subjects with sarcoidosis.

Methods:
Consecutive subjects with a clinical suspicion of sarcoidosis who underwent TBLB were enrolled. We evaluated the association between symptoms, spirometric lung function, radiologic stage of sarcoidosis, number of specimens, presence of floating biopsies, number of alveoli, and successful diagnostic yield (presence of granuloma) on TBLB.

Results:
Of the 223 subjects, sarcoidosis was diagnosed in 209 [mean (SD) age, 43.9 (12.6) y; 50.7% men] individuals. A total of 1021 TBLB specimens were obtained. Granulomas were demonstrated in 123 (58.9%) subjects on TBLB. On a multivariate analysis, there was no association between successful diagnostic yield and the presence of dyspnea, spirometric lung function, radiologic stage of sarcoidosis, presence of floating biopsies, presence of at least 50 alveoli, or crush artifacts during histopathologic examination. Complications were encountered in 25 (11.9%) subjects. There were no deaths.

Conclusions:
TBLB is a reasonably safe procedure with a good diagnostic yield. The present study did not identify any predictors associated with successful diagnostic yield of TBLB in sarcoidosis.