bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple frequency bioimpedance is an adequate tool to assess total and regional fat mass in HIV‐positive patients but not to diagnose HIV‐associated lipoatrophy: a pilot study
Authors: Pérez‐Matute Patricia , Pérez‐Martínez Laura , Blanco José R , Ibarra Valvanera , Metola Luis , Sanz Mercedes , Hernando Luis , Martínez Sagrario , Ramírez Arsenio , Ramalle‐Gomara Enrique , Oteo José A 
Published: December 2013

IntroductionHIV‐associated lipodystrophy syndrome causes systemic metabolic alterations and psychological distress that worsen the quality of life of these patients. An early detection should be considered to efficiently treat it. Objective criteria or reference indices are needed for an early diagnosis. Bioelectrical Impedance Analysis (BIA) is an operator‐independent, repeatable and non‐invasive method of body composition evaluation that is less expensive than dual‐energy X‐ray absorptiometry (DXA) and/or CT scans. The aims of this pilot study were to validate the data obtained by BIA to measure fat mass in HIV‐positive patients with/without lipoatrophy and to determine if BIA correctly diagnoses lipoatrophy in HIV‐positive patients.MethodsThirty‐nine participants were included in this preliminary study. Fourteen were HIV‐negative (eight men) whereas 25 were HIV‐positive patients (17 men). Eleven of the HIV‐positive patients were classified as lipoatrophic according to subjective evaluation by the physicians. Total and regional body composition was measured in basal conditions by DXA and by BIA. To obtain abdominal CT scan fat values, transverse slices with 6‐mm thickness were acquired at the L4‐L5 intervertebral space.ResultsBIA measurements of total and regional body fat were significantly correlated with those obtained by DXA (p < 0.05 to <0.01) in HIV‐positive patients. However, agreement between methods was poor as not very high ICC (intraclass correlation coefficient) values were observed. BIA and DXA showed higher ICC values in lipoatrophic patients. The visceral index obtained by BIA was correlated with total and visceral fat in L4 measured by CT scan (r = 0.607 and r = 0.617, respectively, p < 0.01) in HIV‐positive patients. The Fat Mass Ratio (FMR) calculated by BIA did not correlate or agree with DXA values.ConclusionsMulti‐frequency BIA could be an effective method to evaluate the evolution of total and regional fat composition in HIV‐positive patients with/without lipoatrophy. The correlations between BIA and DXA improved in lipoatrophic patients and in men, suggesting that its efficacy depends on fat mass, gender and probably other factors. The visceral index obtained by BIA seems to be a reliable indicator of abdominal obesity. However, BIA did not fulfil the need for easy quantitative diagnostic tools for lipoatrophy, and it did not provide sufficient diagnostic cut‐off values for this syndrome.
Patterns of Misrepresentation of Clinical Findings on Patient Notes During the COMLEX-USA Level 2-PE
Authors: Sandella Jeanne M. , Smith Larissa A. , Gallagher Laurie A. , Langenau Erik E. 
Published: December 2013

Abstract

Context: A health care team depends on the accurate documentation of the patient-physician encounter, be it written or electronic. If documentation is inaccurate or incomplete, patient care may be adversely affected. Previous studies have identified factors that influence documentation errors, such as fatigue, carelessness, and being overworked. More research, however, is needed into the patterns of errors and, by extension, these patterns' potential effect on patient care. Insights about these areas would be valuable to practicing physicians, as well as to medical educators, who could incorporate such insights into the training of medical students.

Objective: To identify potential patterns of commissive documentation errors on SOAP notes during the Comprehensive Osteopathic Medical Licensing Examination-USA Level 2-Performance Evaluation (COMLEX-USA Level 2-PE); specifically, to calculate the frequency with which specific items are misrepresented in SOAP (subjective, objective, assessment, plan) notes and to explore patterns of misrepresentation in relation to the documentation of history taking and physical examination.

Methods: Among the 12,510 candidates tested between July 2007 and June 2010, there were 24 candidates who failed the COMLEX-USA Level 2-PE because they misrepresented clinical findings on SOAP notes. These errors of commission (over-documentation) were categorized as errors in either history-taking or physical examination, and then subcategorized and analyzed to determine if meaningful patterns in the documentation of these errors occurred.

Results: A total of 662 errors were recorded among the 24 candidates. History-taking items were more often misrepresented (n=378) than physical examination items (n=284). Patient history—a subcategory that included past medical, surgical, medication, allergy, and family histories—was more likely to be misrepresented than other subcategories under history taking (eg, “history of present illness” and ”associated symptoms”) and many physical examination subcategories. Results of the analysis indicated that the misrepresentations were not evenly distributed (

χ
10
2

=
323.1

; P<.01): candidates whose SOAP notes contained misrepresentations were statistically more likely to misrepresent in some categories rather than in others.

Conclusion: Physicians and medical students should pay particular attention to patient history, lifestyle history, and neurologic examination to minimize the risk of documentation errors.
A Degree of Difference: The Origins of Osteopathy and First Use of the “DO” Designation
Authors: Gevitz Norman 
Published: December 2013

AbstractThis article is the first installment in a series of 6 articles on the history of and controversies related to the DO degree. Four questions about the origins of osteopathy and the initial use of the DO designation will be addressed in this particular article. First, did Andrew Taylor Still earn an MD diploma?—he being invariably described as an MD in current osteopathic periodical literature. Second, what was the importance of “magnetic healing” in the evolution of Still's thought? Third, how did the principles and practice of “bonesetting” complete his new system? Finally, when did he originate the termosteopathyand first devise and employ the DO designation? Future articles will examine episodically the history of the DO degree from Still's establishment of the American School of Osteopathy in 1892 up through to the present debate over its significance and value.
A Research Primer, Part 2: Guidelines for Developing a Research Project
Authors: Yens David P. , Brannan Grace D. , Dumsha Jane Z. 
Published: December 2013

Abstract
In this article, the second in a series on the basic concepts of research, the authors review aspects of research design including participant considerations, randomization, reliability and validity of measurements, and data collection and management. The authors also discuss considerations for research using questionnaires and tests. The goal of this article is to assist the novice researcher in identifying potential problems that must be addressed during the design of a research project.
A Case of Seasonal Recurrent Myopericarditis
Authors: Divoky Laura , Wilford Rex D. 
Published: December 2013

Abstract
Myopericarditis occurs in 15% of patients with pericarditis. Recurrent myopericarditis occurs in 15% to 30% of patients after partial or complete recovery from acute myopericarditis. Relapse often occurs within 1 month of an initial episode. The standard of care for pericarditis or myopericarditis is initial treatment with nonsteroidal anti-inflammatory drugs for 10 to 14 days. Colchicine is often administered for 3 to 6 months for residual chest pain due to myopericarditis. The authors present a case of seasonal recurrent myopericarditis in a 32-year-old man who presented with severe chest pain in nearly the same month for 4 consecutive years. The authors conducted an extensive review of the literature but found no other case reports of seasonal recurrent myopericarditis. If a patient presents with severe chest pain requiring hospitalization, physicians should consider prescribing nonsteroidal anti-inflammatory drugs or colchicine before seasonal symptom recurrence.
A Case of Idiopathic Colonic Varices
Authors: Speicher Matthew V. , Keegan Michael T. , Kirk Kathryn E. 
Published: December 2013

Abstract
Colonic varices, usually detected by means of colonoscopy, are extremely rare and typically indicative of portal hypertension or chronic hepatopathology. Even more rare are those cases with no underlying disease, or idiopathic colonic varices. The authors report a case of these unexplained varices found during colonoscopy of a 30-year-old man with a 10-year history of diarrhea and occasional bloody stool. A thorough workup was performed, revealing no underlying abnormalities for his varices. Additionally, the authors review the literature of this rare diagnosis. Physicians must rule out hepatic, vascular, and cardiac causes before classifying a case of varices as idiopathic.
Use of Contrast‐Enhanced Sonography to Investigate Intraneural Vascularity in a Cohort of Macaca fascicularis With Suspected Median Mononeuropathy
Authors: Evans Kevin D. , Volz Kevin R. , Pargeon Rachel L. , Fout Larry T. , Buford John , Roll Shawn C. 
Published: December 2013

ObjectivesThe purpose of this study was to provide clinical evidence of the use of contrast‐enhanced sonography in detecting and quantifying changes in intraneural vascularity due to median mononeuropathy.MethodsFive Macaca fascicularis monkeys were exposed to 20 weeks of repetitive work to increase their risk of developing median mononeuropathy. Contrast‐enhanced sonograms were obtained in 30‐second increments for 7 minutes while a contrast agent was being delivered. Data were collected immediately at the conclusion of the 20‐week work exposure and then again during a recovery phase approximately 3 months after the completion of work. Quantitative analysis and trend graphs were used to analyze median nerve perfusion intensity. This study also compared the use of both manual counting of pixels and semiautomatic measurement using specialized software.ResultsBased on the average data, maximum intensity values were identified as the best indicators of nerve hyperemia. Paired t tests demonstrated significantly higher maximum intensities in the working stage for 4 of the 5 subjects (P < .01).ConclusionsThis study provides preliminary evidence that (1) in a controlled exposure model, a change in intraneural vascularity of the median nerve between working and recovery can be observed; (2) this vascular change can be measured using an objective technique that quantifies the intensity of vascularity; and (3) contrast‐enhanced sonography may improve the ability to reliably capture and measure low‐flow microvascularity.
Correlation Between Systolic Deformation and Dyssynchrony Indices and the Grade of Left Ventricular Hypertrophy in Hypertensive Patients With a Preserved Systolic Ejection Fraction Undergoing Coronary Angiography, Based on Tissue Doppler Imaging
Authors: Zoroufian Arezoo , Razmi Tannaz , Savandroomi Zahra , Tokaldany Masoumeh Lotfi , Sadeghian Hakimeh , Sahebjam Mohammad , Jalali Arash 
Published: December 2013

ObjectivesThe purpose of this study was to investigate whether systolic mechanical dyssynchrony occurs in hypertensive patients with a normal coronary artery and a normal ejection fraction and its relationship with different degrees of left ventricular (LV) hypertrophy.MethodsA total of 125 angiographically normal coronary patients (42.4% male; mean age ± SD, 57.16 ± 8.26 years) with an ejection fraction greater than 50% were included, of which 84 were hypertensive and 41 normotensive. The hypertensive patients were categorized into 3 groups: no, mild, and moderate LV hypertrophy. Tissue Doppler and deformation imaging parameters were measured in the 6 LV basal segments at peak systole.ResultsThe frequency of dyssynchrony was 40.5% in the hypertensive patients compared to 19.5% in the control patients (P = .020). Among the hypertensive patients, LV dyssynchrony was found in 5 patients (20%) with no hypertrophy, 20 (42.6%) with mild hypertrophy, and 9 (75%) with moderate hypertrophy. There was a moderate correlation between the grade of hypertrophy and septal‐lateral wall delay (r = 0.497), 6–basal segment delay (r = 0.454), overall strain (r = 0.453), overall peak systolic velocity (r = −0.430), and standard deviation of the time to peak systolic velocity in the basal segments (r = 0.429). After adjustment for the LV end‐systolic diameter and body surface area, overall strain was the best correlate of the hypertrophy grade (odds ratio, 7.043; 95% confidence interval, 1.839–26.980; P = .0044).ConclusionsAmong tissue Doppler and deformation indices, overall peak systolic strain was the strongest correlate of the LV hypertrophy grade. Therefore, in hypertensive patients with normal cardiac systolic function, a reduction in overall strain in the 6 basal LV segments may be a good indicator of progression of the LV hypertrophy grade and systolic dysfunction.
Strain Elastography for Prediction of Breast Cancer Tumor Grades
Authors: Grajo Joseph R. , Barr Richard G. 
Published: December 2013

ObjectivesThe purpose of this study was to determine whether the elasticity imaging/B‐mode ratio on strain elastography can predict breast cancer tumor grades.MethodsA retrospective review of patients with breast lesions who underwent strain elastography and had a diagnosis of breast cancer by image‐guided or surgical biopsy was performed. The axis of the maximum elastographic dimension was compared to the B‐mode dimension to form an elasticity imaging/B‐mode ratio. Lesions were categorized according to their pathologic type, including atypical ductal hyperplasia (ADH), mucinous or colloid cancer, ductal carcinoma in situ (DCIS), grade I invasive ductal carcinoma (IDC), grade II IDC, grade III IDC, invasive lobular carcinoma (ILC), and lymphoma. The mean elasticity imaging/B‐mode ratio of each tumor type was calculated. The elasticity imaging/B‐mode ratio of the tumor was compared to the tumor type by Kruskal‐Wallis and Tukey‐Kramer tests (lymphoma and ADH excluded because of small numbers).ResultsTumor grades included lymphoma (n = 3), ADH (n = 2), mucinous cancer (n = 11), DCIS (n = 19), IDC (grades I–III; n = 200), and ILC (n = 31). The mean elasticity imaging/B‐mode ratio varied with increasing tumor grade. Tumor grades could not have been selected at random from one population (P < .0001, χ2 test). Invasive lobular carcinoma and grade III IDC were statistically different from mucinous or colloid cancer, DCIS, and grade I and II IDC.ConclusionsThe elasticity imaging/B‐mode ratio on strain elastography is related to the tumor grade.
First‐Trimester Sonographic Prediction of Obstetric and Neonatal Outcomes in Monochorionic Diamniotic Twin Pregnancies
Authors: Allaf M. Baraa , Vintzileos Anthony M. , Chavez Martin R. , Wax Joseph A. , Ravangard Samadh F. , Figueroa Reinaldo , Borgida Adam , Shamshirsaz Amir , Markenson Glenn , Davis Sarah , Habenicht Rebecca , Haeri Sina , Ozhand Ali , Johnson Jeffery , Sangi-Haghpeykar Haleh , Spiel Melissa , Ruano Rodrigo , Meyer Marjorie , Belfort Michael A. , Ogburn Paul , Campbell Winston A. , Shamshirsaz Alireza A. 
Published: December 2013

ObjectivesThe purpose of this study was to investigate whether discordant nuchal translucency and crown‐rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes.MethodsWe conducted a multicenter retrospective cohort study including all monochorionic diamniotic twin pregnancies with two live fetuses at the 11‐week to 13‐week 6‐day sonographic examination who had serial follow‐up sonography until delivery. Isolated nuchal translucency, crown‐rump length, and combined discordances were correlated with adverse obstetric outcomes, individually and in composite, including the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction (IUGR), twin‐twin transfusion syndrome (TTTS), intrauterine fetal death (IUFD), growth discordance (≥20%), and preterm birth before 28 weeks' gestation. Correlations with adverse composite neonatal outcomes were also studied. A receiver operating characteristic curve analysis and a logistic regression analysis with a generalized estimating equation were conducted.ResultsFifty‐four of the 177 pregnancies included (31%) had an adverse composite obstetric outcome, with TTTS in 19 (11%), IUGR in 21 (12%), discordant growth in 14 (8%), IUFD in 14 (8%), and preterm birth before 28 weeks in 10 (6%). Of the 254 neonates included in the study, 69 (27%) were complicated by adverse composite neonatal outcomes, with respiratory distress syndrome being the most common (n = 59 [23%]). The areas under the curve for the combined discordances to predict composite obstetric and neonatal outcomes were 0.62 (95% confidence interval, 0.52–0.72), and 0.54 (95% confidence interval, 0.46–0.61), respectively.ConclusionsIn our population, nuchal translucency, crown‐rump length, and combined discordances in monochorionic diamniotic twin pregnancies were not predictive of adverse composite obstetric and neonatal outcomes.
Natural History of Vasa Previa Across Gestation Using a Screening Protocol
Authors: Rebarber Andrei , Dolin Cara , Fox Nathan S. , Klauser Chad K. , Saltzman Daniel H. , Roman Ashley S. 
Published: December 2013

ObjectivesThe purpose of this study was to estimate the prevalence and persistence rate of vasa previa in at‐risk pregnancies using a standardized screening protocol.MethodsWe conducted a descriptive study of patients with a diagnosis of vasa previa from a single ultrasound unit between June 2005 and June 2012. Vasa previa was defined as a fetal vessel within 2 cm of the internal cervical os on transvaginal sonography. Screening for vasa previa using transvaginal sonography with color flow mapping was performed routinely in the following situations: resolved placenta previa, prior pregnancy with vasa previa, velamentous insertion of the cord in the lower uterine segment, placenta succenturiata in the lower uterine segment, and twin gestations.ResultsA total of 27,573 patients were referred to our unit for fetal anatomic surveys over the study period. Thirty‐one cases of vasa previa were identified, for an incidence of 1.1 per 1000 pregnancies. Twenty‐nine cases had full records available for analysis. Five patients (17.2%) had migration and resolution of the vasa previa. When the diagnosis was made during the second trimester (<26 weeks), there was a 23.8% resolution rate (5 of 21); when the diagnosis was made in the third trimester, none resolved (0 of 8 cases). Of the 24 pregnancies (5 twin gestations and 19 singleton gestations) with persistent vasa previa, there was 100% perinatal survival and a median length of gestation of 35 weeks (range, 27 weeks 5 days–36 weeks 5 days). No known missed cases were identified over the study period.ConclusionsThe use of standardized screening for vasa previa based on focused criteria was found to be effective in diagnosing vasa previa, with a 100% survival rate. Vasa previa diagnosed during the second trimester resolves in approximately 25% of cases.
Likelihood Ratio of Sonohysterographic Findings for Discriminating Endometrial Polyps From Submucosal Fibroids
Authors: Bhaduri Mousumi , Tomlinson George , Glanc Phyllis 
Published: December 2013

ObjectivesThe purpose of this study was to determine which combination of sonohysterographic features has the highest likelihood ratios (LRs) in discriminating polyps from submucosal fibroids.MethodsThis retrospective study included 200 consecutive patients who underwent both sonohysterography and a procedure resulting in a positive pathologic diagnosis. A reader, masked to the imaging and pathologic findings, independently reviewed the 200 sonograms and recorded the findings using a standardized checklist for sonographic features on sonohysterography. The features assessed included angle, echogenicity, endometrial‐myometrial interface, and vascular pattern, among others. The reader chose one final diagnosis from the list of possibilities, which included normal, hyperplasia, polyp, submucosal fibroid, cancer, adhesions, and clots. Sonographic observations were then compared to pathologic findings.ResultsThe LR of 13.4 was achieved for polyps when there was a combination of an intact endometrial‐myometrial interface, a single vessel, an acute angle, and homogeneous echogenicity. The highest LR of 27.8 was achieved for submucosal fibroids when the combination of sonographic features included an absent endometrial‐myometrial interface, an arborized/multiple vascular pattern, an obtuse angle, and heterogeneous echogenicity.ConclusionsA combination of sonographic findings may provide high LRs for discriminating endometrial polyps from submucosal fibroids.
Trained Simulated Ultrasound Patients
Authors: Blickendorf J. Matthew , Adkins Eric J. , Boulger Creagh , Bahner David P. 
Published: December 2013

ObjectivesMedical educators must develop ultrasound education programs to ensure that future physicians are prepared to face the changing demands of clinical practice. It can be challenging to find human models for hands‐on scanning sessions. This article outlines an educational model from a large university medical center that uses medical students to fulfill the need for human models.MethodsDuring the 2011–2012 academic year, medical students from The Ohio State University College of Medicine served as trained simulated ultrasound patients (TSUP) for hands‐on scanning sessions held by the college and many residency programs. The extracurricular program is voluntary and coordinated by medical students with faculty supervision. Students receive a longitudinal didactic and hands‐on ultrasound education program as an incentive for serving as a TSUP.ResultsThe College of Medicine and 7 residency programs used the program, which included 47 second‐year and 7 first‐year student volunteers. Participation has increased annually because of the program's ease, reliability, and cost savings in providing normal anatomic models for ultrasound education programs. A key success of this program is its inherent reproducibility, as a new class of eager students constitutes the volunteer pool each year.ConclusionsThe TSUP program is a feasible and sustainable method of fulfilling the need for normal anatomic ultrasound models while serving as a valuable extracurricular ultrasound education program for medical students. The program facilitates the coordination of ultrasound education programs by educators at the undergraduate and graduate levels.