bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study
Authors: Taft Teresa , Lenert Leslie , Sakaguchi Farrant , Stoddard Gregory , Milne Caroline 
Published: October 2014

Abstract
Background The effects of electronic health records (EHRs) on doctor–patient communication are unclear.
Objective To evaluate the effects of EHR use compared with paper chart use, on novice physicians’ communication skills.
Design Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication.
Setting A large academic internal medicine training program.
Population First-year internal medicine residents.
Intervention Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale.
Results Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p&lt;0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (&gt;3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR.
Limitations This study was conducted in first-year residents in a training environment using simulated patients at a single institution.
Conclusions Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart.
Functional evaluation of out-of-the-box text-mining tools for data-mining tasks
Authors: Jung Kenneth , LePendu Paea , Iyer Srinivasan , Bauer-Mehren Anna , Percha Bethany , Shah Nigam H 
Published: October 2014

AbstractObjective The trade-off between the speed and simplicity of dictionary-based term recognition and the richer linguistic information provided by more advanced natural language processing (NLP) is an area of active discussion in clinical informatics. In this paper, we quantify this trade-off among text processing systems that make different trade-offs between speed and linguistic understanding. We tested both types of systems in three clinical research tasks: phase IV safety profiling of a drug, learning adverse drug–drug interactions, and learning used-to-treat relationships between drugs and indications.Materials We first benchmarked the accuracy of the NCBO Annotator and REVEAL in a manually annotated, publically available dataset from the 2008 i2b2 Obesity Challenge. We then applied the NCBO Annotator and REVEAL to 9 million clinical notes from the Stanford Translational Research Integrated Database Environment (STRIDE) and used the resulting data for three research tasks.Results There is no significant difference between using the NCBO Annotator and REVEAL in the results of the three research tasks when using large datasets. In one subtask, REVEAL achieved higher sensitivity with smaller datasets.Conclusions For a variety of tasks, employing simple term recognition methods instead of advanced NLP methods results in little or no impact on accuracy when using large datasets. Simpler dictionary-based methods have the advantage of scaling well to very large datasets. Promoting the use of simple, dictionary-based methods for population level analyses can advance adoption of NLP in practice.
Innovative information visualization of electronic health record data: a systematic review
Authors: West Vivian L , Borland David , Hammond W Ed 
Published: October 2014

Abstract
Objective This study investigates the use of visualization techniques reported between 1996 and 2013 and evaluates innovative approaches to information visualization of electronic health record (EHR) data for knowledge discovery.
Methods An electronic literature search was conducted May–July 2013 using MEDLINE and Web of Knowledge, supplemented by citation searching, gray literature searching, and reference list reviews. General search terms were used to assure a comprehensive document search.
Results Beginning with 891 articles, the number of articles was reduced by eliminating 191 duplicates. A matrix was developed for categorizing all abstracts and to assist with determining those to be excluded for review. Eighteen articles were included in the final analysis.
Discussion Several visualization techniques have been extensively researched. The most mature system is LifeLines and its applications as LifeLines2, EventFlow, and LifeFlow. Initially, research focused on records from a single patient and visualization of the complex data related to one patient. Since 2010, the techniques under investigation are for use with large numbers of patient records and events. Most are linear and allow interaction through scaling and zooming to resize. Color, density, and filter techniques are commonly used for visualization.
Conclusions With the burgeoning increase in the amount of electronic healthcare data, the potential for knowledge discovery is significant if data are managed in innovative and effective ways. We identify challenges discovered by previous EHR visualization research, which will help researchers who seek to design and improve visualization techniques.
Multi-source development of an integrated model for family health history
Authors: Chen Elizabeth S , Carter Elizabeth W , Winden Tamara J , Sarkar Indra Neil , Wang Yan , Melton Genevieve B 
Published: October 2014

AbstractObjective To integrate data elements from multiple sources for informing comprehensive and standardized collection of family health history (FHH).Materials and methods Three types of sources were analyzed to identify data elements associated with the collection of FHH. First, clinical notes from multiple resources were annotated for FHH information. Second, questions and responses for family members in patient-facing FHH tools were examined. Lastly, elements defined in FHH-related specifications were extracted for several standards development and related organizations. Data elements identified from the notes, tools, and specifications were subsequently combined and compared.Results In total, 891 notes from three resources, eight tools, and seven specifications associated with four organizations were analyzed. The resulting Integrated FHH Model consisted of 44 data elements for describing source of information, family members, observations, and general statements about family history. Of these elements, 16 were common to all three source types, 17 were common to two, and 11 were unique. Intra-source comparisons also revealed common and unique elements across the different notes, tools, and specifications.Discussion Through examination of multiple sources, a representative and complementary set of FHH data elements was identified. Further work is needed to create formal representations of the Integrated FHH Model, standardize values associated with each element, and inform context-specific implementations.Conclusions There has been increased emphasis on the importance of FHH for supporting personalized medicine, biomedical research, and population health. Multi-source development of an integrated model could contribute to improving the standardized collection and use of FHH information in disparate systems.
Efficacy and safety of ginger-salt-indirect moxibustion for urge urinary incontinence after stroke: protocol for a pilot multicentre randomised controlled trial
Authors: Wang Linpeng , Wang Lichen , Shi Guangxia , Zeng Lin , Yang Yi , Zhang Tao , Liu Huilin 
Published: October 2014

IntroductionGinger-salt-indirect moxibustion is widely applied to treat urge urinary incontinence after stroke, which is a common complication in stroke survivors. Moxa cone moxibustion and moxa box moxibustion are the main techniques of ginger-salt-indirect moxibustion. Our previous study had shown that ginger-salt-indirect moxibustion using moxa cones was feasible and effective for urination disorders post-stroke. This pilot study aims to assess the feasibility of conducting research to evaluate the efficacy and safety of ginger-salt-indirect moxibustion for patients with post-stroke urge urinary incontinence.Methods and analysisThis is a multicentre, prospective, single-blinded, pilot randomised controlled trial. 120 eligible patients will be randomly allocated to three groups. Treatment group A (n=40) will receive moxa cone moxibustion and routine care; treatment group B (n=40) will receive moxa box moxibustion and routine care; control group (n=40) will only receive routine care for stroke recovery. The entire moxibustion treatment will consist of a total of 28 sessions during the course of 4 weeks. The primary outcome measure will be the increase in mean volume per void assessed at week 4 from the first moxibustion session (baseline). Secondary outcome measures will include mean frequency of urination per day and quality of life assessments measured by completion of the Incontinence Quality of Life Questionnaire and Barthel Index. All outcome measures will be assessed at baseline and at 4 and 16 weeks from baseline. Adverse events in the three groups will be recorded to assess the safety of moxibustion.Ethics and disseminationResearch ethics was approved by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to the Capital Medical University (ref: 2013BL-094). Written informed consent will be obtained from all participants. Study results will be published in peer reviewed journals.Trial registration numberISRCTN 44706974.
Analysing organisational context: case studies on the contribution of absorptive capacity theory to understanding inter-organisational variation in performance improvement
Authors: Harvey Gill , Jas Pauline , Walshe Kieran 
Published: October 2014

BackgroundOrganisational context is frequently cited as an important consideration when implementing and evaluating quality improvement interventions in healthcare, but limited guidance is available on which aspects of context are most influential or modifiable. This paper examines how internal and external contextual factors mediate organisational-level performance improvement through applying the knowledge-based theory of absorptive capacity (AC).MethodsThree healthcare case studies are presented. Each case is a UK National Health Service organisation that had been identified as having performance problems. Qualitative data were collected through semi-structured interviews with general and clinical managers within the organisation and members of external teams supporting or overseeing performance improvement (n=22). Interview data were analysed using an existing AC framework from the literature.ResultsThe organisation with the highest AC showed the quickest and most comprehensive performance improvement. Internal characteristics including strategic priorities, processes for managing information, communication and orientation to learning and development impacted on the organisation's ability to engage successfully with external stakeholders and make use of available knowledge. This enabled the organisation to thrive despite the challenging external environment. Lower levels of AC appeared to delay or limit the improvement trajectory.ConclusionsDeveloping a more detailed and nuanced understanding of how context influences improvement is an important step towards achieving more effective and sustainable quality improvement programmes in healthcare. AC, with its focus on knowledge and organisational learning, provides a useful way to explore the relationship between context and quality improvement and represents a potentially valuable area for future research and development.
Chest pain symptom scoring can improve the quality of referrals to Rapid Access Chest Pain Clinic
Authors: Rathod Krishnaraj Sinhji , Ward Helen , Farooqi Fahad 
Published: October 2014

AbstractTypical stable angina is a clinical diagnosis based on history. The challenge for GPs in primary care is to identify those patients who are presenting with either possible or typical angina symptoms and refer onwards for specialist assessment in the local Rapid Access Chest Pain Clinic (RACPC).Our initial information gathering study suggested that referring GPs may be cautiously overdiagnosing angina in primary care, potentially resulting in avoidable or unnecessary referrals to RACPC. We sought a practical and cost effective solution to reducing avoidable referrals by assisting GPs with chest pain discrimination.We tested a change of referral form incorporating chest pain symptom scoring to see whether GP referral quality could be improved and then assessed its impact post implementation. GPs that used the chest pain symptom scoring questionnaire were more than twice as likely to correctly discriminate non-cardiac chest pain. Our post implementation study of the new referral form showed that the proportion of referrals to RACPC with diagnosis of non-cardiac chest pain reduced by almost 19%, and there was a statistically significant 30% fall in the total number of referrals to RACPC. This was likely to be driven by the deterrent effect of the novel referral form on avoidable referrals. Fewer avoidable referrals results in shorter wait times for specialist review, reduces the risk of waiting time breach, and improves RACPC efficiency.In summary, chest pain symptom scoring resulted in improved GP discrimination of chest pain, improved referral quality, fewer overall referrals to RACPC and shorter patient wait times. These benefits were achieved without using additional financial resources and without the time or capital expense of training GPs. These findings could assist GPs and Clinical Commisioning Groups to achieve cost savings by reducing avoidable secondary care referrals.
Advance care planning in people with early cognitive impairment
Authors: Cheong Kenny , Fisher Paul , Goh Jenny , Ng Lynette , Koh Hui Mien , Yap Philip 
Published: October 2014

Background/aimPeople with early cognitive impairment (ECI), comprising mild cognitive impairment and early dementia face the risk of diminished mental capacity with progressive disease. Advance care planning (ACP) is advocated as a means to uphold the autonomy of individuals and enable them to express their wishes for the future while they still possess mental capacity. This study aims to explore the perspectives of patients with ECI regarding ACP, and in particular, understand their reasons for resistance.MethodConsecutive patients undergoing a counselling service for persons with ECI who fulfilled inclusion criteria (Mini Mental State Examination score ≥18, Global Clinical Dementia Rating (GCDR)=0.5 or 1 were recruited. Demographic and clinical data was collected and the detailed documentation in the case records of the counselling sessions was subjected to a thematic analysis. Differences between patients who were willing to engage in ACP and those who declined were also analysed.Results93 patients (mean age 76, 60.2% female) were recruited of which 38.7% chose to engage further in ACP discussions. GCDR was the only factor that emerged significant on bivariate analysis for willingness to engage in ACP (t (79)=2.191, p<0.05, two-tailed) whereby milder CI was associated with a greater likelihood of ACP engagement. Among those who declined ACP, three main themes emerged from the thematic analysis. The majority deferred decision-making to their families. Some perceived ACP as irrelevant or unnecessary, and displayed avoidance and denial during ACP discussions.ConclusionsA large proportion of patients with ECI decline ACP discussions and the reasons are influenced by personal values, coping behaviours and sociocultural norms. These findings have important implications for practice.
Myeloid IKKβ Promotes Antitumor Immunity by Modulating CCL11 and the Innate Immune Response
Authors: Yang Jinming , Hawkins Oriana E. , Barham Whitney , Gilchuk Pavlo , Boothby Mark , Ayers Gregory D. , Joyce Sebastian , Karin Michael , Yull Fiona E. , Richmond Ann 
Published: October 2014

AbstractMyeloid cells are capable of promoting or eradicating tumor cells and the nodal functions that contribute to their different roles are still obscure. Here, we show that mice with myeloid-specific genetic loss of the NF-κB pathway regulatory kinase IKKβ exhibit more rapid growth of cutaneous and lung melanoma tumors. In a BRAFV600E/PTEN−/− allograft model, IKKβ loss in macrophages reduced recruitment of myeloid cells into the tumor, lowered expression of MHC class II molecules, and enhanced production of the chemokine CCL11, thereby negatively regulating dendritic-cell maturation. Elevated serum and tissue levels of CCL11 mediated suppression of dendritic-cell differentiation/maturation within the tumor microenvironment, skewing it toward a Th2 immune response and impairing CD8+ T cell–mediated tumor cell lysis. Depleting macrophages or CD8+ T cells in mice with wild-type IKKβ myeloid cells enhanced tumor growth, where the myeloid cell response was used to mediate antitumor immunity against melanoma tumors (with less dependency on a CD8+ T-cell response). In contrast, myeloid cells deficient in IKKβ were compromised in tumor cell lysis, based on their reduced ability to phagocytize and digest tumor cells. Thus, mice with continuous IKKβ signaling in myeloid-lineage cells (IKKβCA) exhibited enhanced antitumor immunity and reduced melanoma outgrowth. Collectively, our results illuminate new mechanisms through which NF-κB signaling in myeloid cells promotes innate tumor surveillance. Cancer Res; 74(24); 7274–84. ©2014 AACR.
The Ability of Bilirubin in Identifying Smokers with Higher Risk of Lung Cancer: A Large Cohort Study in Conjunction with Global Metabolomic Profiling
Authors: Wen Chi-Pang , Zhang Fanmao , Liang Dong , Wen Christopher , Gu Jian , Skinner Heath , Chow Wong-Ho , Ye Yuanqing , Pu Xia , Hildebrandt Michelle A.T. , Huang Maosheng , Chen Chien-Hua , Hsiung Chao Agnes , Tsai Min Kuang , Tsao Chwen Keng , Lippman Scott M. , Wu Xifeng 
Published: October 2014

Abstract
Purpose: We aimed to identify serum metabolites as potential valuable biomarkers for lung cancer and to improve risk stratification in smokers.
Experimental Design: We performed global metabolomic profiling followed by targeted validation of individual metabolites in a case–control design of 386 lung cancer cases and 193 matched controls. We then validated bilirubin, which consistently showed significant differential levels in cases and controls, as a risk marker for lung cancer incidence and mortality in a large prospective cohort composed of 425,660 participants.
Results: Through global metabolomic profiling and following targeted validation, bilirubin levels consistently showed a statistically significant difference among healthy controls and lung cancer cases. In the prospective cohort, the inverse association was only seen in male smokers, regardless of smoking pack-years and intensity. Compared with male smokers in the highest bilirubin group (&gt;1 mg/dL), those in the lowest bilirubin group (&lt;0.75 mg/dL) had 55% and 66% increase in risks of lung cancer incidence and mortality, respectively. For every 0.1 mg/dL decrease of bilirubin, the risks for lung cancer incidence and mortality increased by 5% and 6% in male smokers, respectively (both P &lt; 0.001). There was a significant interaction between low serum bilirubin level and smoking on lung cancer risk (Pinteraction = 0.001).
Conclusion: Low levels of serum bilirubin are associated with higher risks of lung cancer incidence and mortality in male smokers and can be used to identify higher risk smokers for lung cancer. Clin Cancer Res; 21(1); 193–200. ©2014 AACR.
New, Tolerable γ-Secretase Inhibitor Takes Desmoid Down a Notch
Authors: Hughes Dennis P.M. , Kummar Shivaani , Lazar Alexander J. 
Published: October 2014

Abstract
A phase I trial of PF-03084014, an oral reversible γ-secretase inhibitor, in solid tumor malignancies shows drug tolerability in patients. Evidence of Notch pathway inhibition was demonstrated in peripheral blood. A surprisingly high rate of response was seen in desmoid tumors, a rare but sometimes locally aggressive sarcoma. Clin Cancer Res; 21(1); 7–9. ©2014 AACR.
See related article by Messersmith et al., p. 60
“Teaching” the therapeutic alliance: on peeling a banana with a knife and fork
Authors: Chazan Lynette 
Published: October 2014

Objective: This paper discusses the implications for training of the centrality of the therapeutic alliance to the practice of psychiatry. Conclusion: Recent research highlights the centrality of the therapeutic alliance, not only to positive outcomes across the psychotherapies but in all psychiatric practice. This understanding, along with a cultural shift toward psychological-mindedness, suggests that we teach relational as well as intellectual skills and implement a broader role for psychotherapy training. A subsequent article will address the question of whether and how such skills can be developed.
Mallet fingers with bone avulsion and DIP joint subluxation
Authors: Wada T. , Oda T. 
Published: October 2014

One-third of all mallet fingers are associated with a fracture. Mallet fractures associated with large fracture fragments may result in volar subluxation of the distal phalanx. The management of mallet fractures varies based on injury pattern and surgeon preference. These treatment options include splinting regimens, closed reduction and percutaneous pinning and open reduction and internal fixation. Although numerous surgical techniques have been described, there is little clear consensus on operative treatment. Moreover, there is insufficient evidence to support operative over nonoperative treatment for mallet fractures. Level of evidence: Level V