bluuebunny/crossref_metadata_2025_split huggingface dataset:
A National Evaluation of the Scholarly Activity Requirement in Residency Programs: A Survey of Emergency Medicine Program Directors
Authors: Geyer Brian C. , Kaji Amy H. , Katz Eric D. , Jones Alan E. , Bebarta Vikhyat S. 
Published: October 2015

AbstractObjectivesThe Review Committee for Emergency Medicine (RC‐EM) requirement for scholarly activity, which programs may define as an original research project or some other form of scholarly activity, applies to all EM residents. The objectives of this study were to: 1) describe the percentage of residency programs that require an original research project to meet the RC‐EM requirement for scholarly activity, 2) describe specific challenges and resources for residents completing the RC‐EM scholarly activity requirement, and 3) identify associations between the interpretation of the requirement and early career outcomes.MethodsThis was a cross‐sectional online survey of program or research directors from all U.S. allopathic EM residency programs. Respondents were queried about key demographics and domains relating to research curriculum, resources, expectations, outcomes, challenges, and future opportunities. Data were analyzed using descriptive statistics.ResultsThe overall response rate was 113 of 156 (72%) EM residency programs. Respondents were more likely to represent university‐based programs, but otherwise did not differ from nonrespondents across key demographic criteria. An original research project was required by 39% of responding programs, with a minimum deliverable in 93% of these programs. Program directors listed data collection and study design as the principle challenges residents face while completing their scholarly activities. Faculty mentorship, biostatistical support, and travel support were common resources reportedly available to residents. Comparison of programs with an original research requirement to those without revealed many differences in outcomes. Programs with a research requirement were more likely to have residents with oral or poster presentations (46% vs. 25%, mean difference = 21%, 95% confidence interval [CI] = 16% to 28%), published manuscripts (25% vs. 18%, mean difference = 7%, 95% CI = 2% to 10%), entering fellowship training after residency (27% vs. 20%, mean difference = 7%, 95% CI = 4% to 10%), and using a biostatistician (64% vs. 28%, median difference = 26%, 95% CI = 24% to 28%). There were no statistically significant differences in other evaluations of resources or outcome measures, including resident choice of academic career after leaving residency.ConclusionsThere is no consistent interpretation and implementation of the RC‐EM requirement for scholarly activity among EM residency programs. Residency programs requiring an original research project were more likely to have residents with accepted oral or poster presentations, published manuscripts, and entering fellowships after residency training.
Sex Differences in Substance Use Among Adult Emergency Department Patients: Prevalence, Severity, and Need for Intervention
Authors: Beaudoin Francesca L. , Baird Janette , Liu Tao , Merchant Roland C. 
Published: October 2015

AbstractBackgroundSubstance use is prevalent among emergency department (ED) patients, and sex has been implicated as an important factor in the etiology, pathophysiology, sequelae, and treatment of substance use disorders. However, additional information is needed about the epidemiology of substance use as it relates to sex among ED patients.ObjectivesThis study examined sex differences in the prevalence and severity of self‐reported tobacco, alcohol, and drug use among adult ED patients.MethodsA random sample of English‐ or Spanish‐speaking, non–critically ill or injured, 18‐ to 64‐year‐old patients was approached at two urban EDs and asked to self‐report their lifetime and past 3‐month tobacco, alcohol, and drug use. Participants completed the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) using an audio computer‐assisted self‐interview. Participants were categorized by their substance severity (ASSIST score) and need for a brief or more intensive intervention per World Health Organization recommendations. Substance misuse prevalence, frequency, severity, and need for interventions were compared between sexes by substance category. Multivariable logistic regression models were used to examine the association between sexes and the need for intervention after adjusting for sociodemographic characteristics.ResultsOf the 6,432 participants in the study, the median age was 37 years (interquartile range = 26 to 48 years), and 56.6% were female. Overall, lifetime, and past 3‐month use was higher for men across all substances (tobacco, alcohol, and drugs). Among those reporting past 3‐month use, the frequency of use was similar between sexes for tobacco and all drugs, but men reported more frequent alcohol use. Men had higher mean ASSIST scores compared to women, 30.3 (standard error [SE] ± 0.8) vs. 21.1 (SE ± 0.5); mean difference 9.2 (95% confidence interval [CI] = 7.4 to 10.9). The need for any intervention (brief or intensive) was similar between sexes for tobacco and drugs. After sociodemographic factors were adjusted for, women were less likely than men to need any intervention for alcohol (odds ratio [OR] = 0.6; 95% CI = 0.4 to 0.8), but not other substances: tobacco (OR = 0.9; 95% CI = 0.6 to 1.3), marijuana (OR = 0.8; 95% CI = 0.6 to 1.1), or other drugs (OR = 1.1; 95% CI = 0.7 to 1.7).ConclusionsAlthough men have a higher overall prevalence of substance use, the frequency and severity of use were similar for men and women for most substances. After other characteristics were adjusted for, sex appears associated with the need for interventions for alcohol, but not tobacco, marijuana, or other drugs.
Comparison of Two Sepsis Recognition Methods in a Pediatric Emergency Department
Authors: Balamuth Fran , Alpern Elizabeth R. , Grundmeier Robert W. , Chilutti Marianne , Weiss Scott L. , Fitzgerald Julie C. , Hayes Katie , Bilker Warren , Lautenbach Ebbing 
Published: October 2015

AbstractObjectivesThe objective was to compare the effectiveness of physician judgment and an electronic algorithmic alert to identify pediatric patients with severe sepsis/septic shock in a pediatric emergency department (ED).MethodsThis was an observational cohort study of patients older than 56 days with fever or hypothermia. All patients were evaluated for potential sepsis in real time by the ED clinical team. An electronic algorithmic alert was retrospectively applied to identify patients with potential sepsis independent of physician judgment. The primary outcome was the proportion of patients correctly identified with severe sepsis/septic shock defined by consensus criteria. Test characteristics were determined and receiver operating characteristic (ROC) curves were compared.ResultsOf 19,524 eligible patient visits, 88 patients developed consensus‐confirmed severe sepsis or septic shock. Physician judgment identified 159 and the algorithmic alert identified 3,301 patients with potential sepsis. Physician judgment had sensitivity of 72.7% (95% confidence interval [CI] = 72.1% to 73.4%) and specificity of 99.5% (95% CI = 99.4% to 99.6%); the algorithmic alert had sensitivity of 92.1% (95% CI = 91.7% to 92.4%) and specificity of 83.4% (95% CI = 82.9% to 83.9%) for severe sepsis/septic shock. There was no significant difference in the area under the ROC curve for physician judgment (0.86, 95% CI = 0.81 to 0.91) or the algorithm (0.88, 95% CI = 0.85 to 0.91; p = 0.54). A combination method using either positive physician judgment or an algorithmic alert improved sensitivity to 96.6% and specificity to 83.3%. A sequential approach, in which positive identification by the algorithmic alert was then confirmed by physician judgment, achieved 68.2% sensitivity and 99.6% specificity. Positive and negative predictive values for physician judgment versus algorithmic alert were 40.3% versus 2.5% and 99.88% versus 99.96%, respectively.ConclusionsThe electronic algorithmic alert was more sensitive but less specific than physician judgment for recognition of pediatric severe sepsis and septic shock. These findings can help to guide institutions in selecting pediatric sepsis recognition methods based on institutional needs and priorities.
Psychiatric patients' perception of physical restraint
Authors: Fugger G. , Gleiss A. , Baldinger P. , Strnad A. , Kasper S. , Frey R. 
Published: October 2015

ObjectiveTo investigate psychiatric patients' subjective perception during and after belt fixation.MethodAll patients who were involuntarily admitted and physically restrained at a psychiatric intensive care unit within an 18‐month study period were analysed. Ratings were obtained at four visits when questioning was possible.ResultsWithin a heterogeneous diagnostic sample of 47 patients, only 12 patients were eligible to participate during belt fixation. After cessation of fixation, eight patients lacked any memory of restraint, while 36 could be questioned. Visual analogue scale median scores indicated powerlessness and depressiveness rather than anxiety and aggression. Patients' acceptance of the coercive measure was significantly higher (P = 0.003), while patients' memory was significantly lower than expected (P < 0.001). About 50% of the patients documented high perceived coercion, and post‐traumatic stress disorder (PTSD) could be supposed in a quarter of the restrained individuals. Subjective perceptions concerning fixation showed no significant changes over time. Results showed high interindividual variability.ConclusionVisual analogue scale revealed that belt fixation seemed to be forgotten or accepted in the majority of patients, probably due to psychiatric intensive care, psychopharmacological treatment and clinical improvements. The responses of a quarter of the patients assessed before discharge may be in accordance with symptoms of PTSD.
Project QUIT (Quit Using Drugs Intervention Trial): a randomized controlled trial of a primary care‐based multi‐component brief intervention to reduce risky drug use
Authors: Gelberg Lillian , Andersen Ronald M. , Afifi Abdelmonem A. , Leake Barbara D. , Arangua Lisa , Vahidi Mani , Singleton Kyle , Yacenda‐Murphy Julia , Shoptaw Steve , Fleming Michael F. , Baumeister Sebastian E. 
Published: October 2015

AbstractAimsTo assess the effect of a multi‐component primary care delivered brief intervention for reducing risky psychoactive drug use (RDU) among patients identified by screening.DesignMulticenter single‐blind two‐arm randomized controlled trial of patients enrolled from February 2011 to November 2012 with 3‐month follow‐up. Randomization and allocation to trial group were computer‐generated.SettingPrimary care waiting rooms of five federally qualified health centers in Los Angeles County (LAC), USA.ParticipantsA total of 334 adult primary care patients (171 intervention; 163 control) with RDU scores (4–26) on the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) self‐administered on tablet computers. 261 (78%) completed follow‐up. Mean age was 41.7 years; 62.9% were male; 37.7% were Caucasian.Intervention(s) and MeasurementIntervention patients received brief (typically 3–4 minutes) clinician advice to quit/reduce their drug use reinforced by a video doctor message, health education booklet and up to two 20–30–minute follow‐up telephone drug use coaching sessions. Controls received usual care and cancer screening information. Primary outcome was patient self‐reported use of highest scoring drug (HSD) at follow‐up.FindingsIntervention and control patients reported equivalent baseline HSD use at 3‐month follow‐up. After adjustment for covariates, in the complete sample linear regression model, intervention patients used their HSD on 3.5 fewer days in the previous month relative to controls (P<0.001), and in the completed sample model, intervention patients used their HSD 2.2 fewer days than controls (P < 0.005). No compensatory increases in use of other measured substances were found.ConclusionsA primary‐care based, clinician‐delivered brief intervention with follow‐up coaching calls may decrease risky psychoactive drug use.
Outcomes of high‐volume bariatric surgery in the public system
Authors: Burton Paul , Brown Wendy , Chen Richard , Shaw Kalai , Packiyanathan Andrew , Bringmann Ingra , Smith Andrew , Nottle Peter 
Published: October 2015

AbstractBackgroundBariatric surgery has not been widely used in the Australian public health system. As obesity is strongly associated with socio‐economic status, excluding its use from the public system will deny many of the most in‐need access to a potentially very effective treatment. Alternatively, with rigorous follow‐up and behavioural change requirements, highly successful outcomes in the private system may not translate to the public system.MethodsThe Alfred Hospital rapidly expanded bariatric surgery from 2007. A 6‐year prospective follow‐up study was conducted with annual review of weight, co‐morbidities, retention in follow‐up, serum HbA1c, quality of life and patient satisfaction.ResultsThere were 1453 patients. Procedures were predominantly laparoscopic‐adjustable gastric bands (n = 861). Patient details were age 49 ± 11 years, body mass index 50.7 ± 11.2 kg/m2 and weight 139.0 ± 30.2 kg. There was no mortality, and mean length of stay was 1.1 ± 1.2 days. Follow‐up was 98% (1 year) and 85% (6 years). Weight loss was 22 ± 13.1 kg (32.8 ± 18% excess weight loss) at 1 and 30.1 ± 16.8 kg (60 ± 28%) at 6 years. The mean number of co‐morbidities was 4.2 ± 1.1 with significant improvements observed. Patient satisfaction was 7.7 ± 2.3 out of 10. Mental and physical summary scores (SF‐36) improved from 41.02 ± 13.17 to 45.50 ± 13.27 (P < 0.001) and 33.97 ± 10.53 to 44.79 ± 11.19 (P < 0.001).ConclusionsPatients were older, heavier and suffered more co‐morbid disease than previously reported cohorts. For the first time, excellent outcomes across a range of key quality domains in a large patient cohort have been reported in the public system. High‐volume bariatric surgery in the public system is viable.
Papillary thyroid cancer in childhood: is parental screening helpful?
Authors: Stephenson Carlos , Norlen Olov , Shun Albert , Karpelowsky Jonathon , Robinson Bruce , Delbridge Leigh 
Published: October 2015

AbstractBackgroundFamilial non‐medullary thyroid cancer (FNMTC) mandates family screening with ultrasound; however, the need for screening paediatric thyroid cancer with no family history has not been addressed.MethodsThis study conducted a retrospective cohort study in a tertiary hospital. The study group is composed of patients ≤18 years undergoing surgery for papillary thyroid cancer (PTC) from 2008 to 2014.ResultsDuring the study period, 15 paediatric patients had PTC. Only one patient had a prior family history of PTC involving two second‐degree relatives. Of the 30 parents, four were lost to follow‐up, with the remaining 26 undergoing screening thyroid ultrasound. Nodular thyroid disease was documented in eight ultrasounds performed. Subsequently, one has not undergone fine‐needle biopsy, five were benign and two underwent surgical resection: one having a benign follicular adenoma and the other a papillary microcarcinoma with nodal micrometastasis.ConclusionsRoutine ultrasound screening of parents of children presenting with PTC and no family history do not demonstrate an increased incidence of FNMTC. Screening of affected families is likely to demonstrate the expected background incidence of nodular thyroid disease and incidental papillary microcarcinoma. As such, it is unlikely to be useful.
Hepatic venous outflow obstruction in piggyback liver transplantation: single centre experience
Authors: Arudchelvam Joel , Bartlett Adam , McCall John , Johnston Peter , Gane Edward , Munn Stephen 
Published: October 2015

AbstractBackgroundHepatic venous outflow obstruction (HVOO) is a rare but serious complication in liver transplantation (LT).MethodsWe conducted a retrospective analysis of HVOO with venography and gradient measurement in consecutive LT from a single centre.ResultsFive hundred and six LTs were performed in 486 patients with a median age of 49 years (range 3 months to 71 years). Nineteen (3.8%) cases of HVOO were identified. Diagnosis was confirmed at a median of 26 days post‐LT (1–2312). The incidence fell from 5.5% in the first 253 LT, to 2.0% in the second 253 (P = 0.03). Seventeen were due to narrowing at the anastomosis and two cases were due to thrombosis. In adult patients, reconstruction of the supra‐hepatic donor inferior vena cava (IVC) onto two veins versus modified 2–3 hepatic veins did not alter the likelihood of HVOO. 17/19 cases were managed successfully by stenting or venoplasty. Two paediatric patients with early onset HVOO had attempted surgical thrombectomy, one was successful and the other required retransplantation.ConclusionThe incidence of HVOO appears to fall with increasing experience and does not appear to be related to the number of veins the donor IVC is anastomosed to in adult recipients.
Vaginally obtained amniotic fluid samples in the diagnosis of subclinical chorioamnionitis
Authors: Myntti Tarja , Rahkonen Leena , Tikkanen Minna , Paavonen Jorma , Stefanovic Vedran 
Published: October 2015

AbstractIntroductionPreterm birth is often caused by infection or inflammation. High concentration of lactate dehydrogenase and low concentration of glucose in amniotic fluid obtained by amniocentesis are associated with subclinical chorioamnionitis. We evaluated amniotic fluid lactate dehydrogenase and glucose concentrations in relation to histologic chorioamnionitis in vaginally obtained samples.Material and methodsIn a prospective study, vaginally obtained amniotic fluid samples were collected from 53 women with preterm prelabor rupture of membranes at 23+4 to 34+5 weeks of gestation at University Hospital, Helsinki, Finland. Amniotic fluid lactate dehydrogenase and amniotic fluid glucose were measured by immunochemiluminometric assays. Histopathologic examination of placenta was performed. The main outcome measure was histologic chorioamnionitis.ResultsMedian concentration of vaginally obtained amniotic fluid lactate dehydrogenase was higher in women with histologic chorioamnionitis than in women without (1400 IU/L vs. 784.5 IU/L, p = 0.005). By receiver operating characteristics curve the optimal cut‐off for amniotic fluid lactate dehydrogenase in relation to histologic chorioamnionitis was 1029 IU/L (sensitivity 65%, specificity 69%, positive predictive value 83% and negative predictive value 46%). Amniotic fluid lactate dehydrogenase concentrations showed striking fluctuation in repeat samples. Amniotic fluid glucose concentrations did not differ among women with or without histologic chorioamnionitis (0 mmol/L vs. 0.65 mmol/L, p = 0.20).ConclusionElevated amniotic fluid lactate dehydrogenase was associated with histologic chorioamnionitis, but decreased amniotic fluid glucose was not. However, the clinical value of vaginally obtained amniotic fluid lactate dehydrogenase is limited because of high sample‐to‐sample variability. Better biomarkers for optimal timing of delivery in women with preterm prelabor rupture of membranes are needed.
Mid‐pregnancy fetal biometry, uterine artery Doppler indices and maternal demographic characteristics: role in prediction of small‐for‐gestational‐age birth
Authors: Familiari Alessandra , Bhide Amar , Morlando Maddalena , Scala Carolina , Khalil Asma , Thilaganathan Basky 
Published: October 2015

AbstractIntroductionThe aim of this study was to evaluate the role of mid‐trimester fetal biometry, uterine artery Doppler indices and maternal demographics in prediction of small‐for‐gestational‐age (SGA) birth.Materials and methodsWe conducted a retrospective cohort study in a single referral center. The study included 23 894 singleton pregnancies scanned between 19 and 24 weeks of gestation. Maternal demographics included age, body mass index and ethnicity. Fetal biometry, birthweight and uterine artery pulsatility index values were converted into centiles. Multivariable logistic regression analysis was performed and the predictive accuracy was assessed using receiver operating characteristic curve analysis. The main outcome measure was prediction of delivery of preterm and term SGA neonates defined as a birthweight in the lowest centile groups (<10th, <5th and <3rd centiles).ResultsMaternal ethnicity, fetal biometry and uterine artery Doppler indices were significantly associated with the risk of SGA <5th centile (p < 0.01). Maternal factors or fetal biometry alone showed poor to moderate performance in prediction of term and preterm SGA <5th centile at a 10% false‐positive rate. Uterine artery pulsatility index alone was able to predict 25, 60 and 77% of SGA <5th centile delivering at >37, <37 and <32 weeks of gestation respectively at a 10% false‐positive rate; maternal factors, fetal biometry and uterine artery Doppler combined detected 40, 66 and 89% of term, preterm and very preterm SGA <5th centile at a 10% false‐positive rate.ConclusionsSecond‐trimester screening can identify the majority of pregnancies at high risk of SGA birth and showed a higher performance for earlier gestational ages at birth and lower birthweight centiles.
Neurocontrol of Movement in Humans With Spinal Cord Injury
Authors: Dimitrijevic Milan R. , Danner Simon M. , Mayr Winfried 
Published: October 2015

AbstractIn this review of neurocontrol of movement after spinal cord injury, we discuss neurophysiological evidences of conducting and processing mechanisms of the spinal cord. We illustrate that external afferent inputs to the spinal cord below the level of the lesion can modify, initiate, and maintain execution of movement in absence or partial presence of brain motor control after chronic spinal cord injury. We review significant differences between spinal reflex activity elicited by single and repetitive stimulation. The spinal cord can respond with sensitization, habituation, and dis‐habituation to regular repetitive stimulation. Therefore, repetitive spinal cord reflex activity can contribute to the functional configuration of the spinal network. Moreover, testing spinal reflex activity in individuals with motor complete spinal cord injury provided evidences for subclinical residual brain influence, suggesting the existence of axons traversing the injury site and influencing the activities below the level of lesion. Thus, there are two motor control models of chronic spinal cord injury in humans: “discomplete” and “reduced and altered volitional motor control.” We outline accomplishments in modification and initiation of altered neurocontrol in chronic spinal cord injury people with epidural and functional electrical stimulation. By nonpatterned electrical stimulation of lumbar posterior roots, it is possible to evoke bilateral extension as well as rhythmic motor outputs. Epidural stimulation during treadmill stepping shows increased and/or modified motor activity. Finally, volitional efforts can alter epidurally induced rhythmic activities in incomplete spinal cord injury. Overall, we highlight that upper motor neuron paralysis does not entail complete absence of connectivity between cortex, brain stem, and spinal motor cells, but there can be altered anatomy and corresponding neurophysiological characteristics. With specific input to the spinal cord below the level of the lesion, the clinical status of upper motor neuron paralysis without structural modification can be modified, and movements can be initiated. Thus, external afferent input can partially replace brain control.