bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians
Authors: Tavares Walter , Piquette Dominique , Luong Dorothy , Chiu Michelle , Dyte Christopher , Fraser Kristin , Clark Marcia 
Published: February 2023

Introduction:
Practicing physicians have the responsibility to engage in lifelong learning. Although simulation is an effective experiential educational strategy, physicians seldom select it for continuing professional development (CPD) for reasons that are poorly understood. The objective of this study was to explore existing evidence on simulation-based CPD and the factors influencing physicians' engagement in simulation-based CPD.

Methods:
A scoping review of the literature on simulation-based CPD included MEDLINE, Embase, and CINAHL databases. Studies involving the use of simulation for practicing physicians' CPD were included. Information related to motivations for participating in simulation-based CPD, study objectives, research question(s), rationale(s), reasons for using simulation, and simulation features was abstracted.

Results:
The search yielded 8609 articles, with 6906 articles undergoing title and abstract screening after duplicate removal. Six hundred sixty-one articles underwent full-text screening. Two hundred twenty-five studies (1993–2021) were reviewed for data abstraction. Only four studies explored physicians' motivations directly, while 31 studies described incentives or strategies used to enroll physicians in studies on simulation-based CPD. Most studies focused on leveraging or demonstrating the utility of simulation for CPD. Limited evidence suggests that psychological safety, direct relevance to clinical practice, and familiarity with simulation may promote future engagement.

Discussion:
Although simulation is an effective experiential educational method, factors explaining its uptake by physicians as a CPD strategy are unclear. Additional evidence of simulation effectiveness may fail to convince physicians to participate in simulation-based CPD unless personal, social, educational, or contextual factors that shape physicians' motivations and choices to engage in simulation-based CPD are explored.
Evaluation of Two Educational Modalities for the Clinical Practice Guideline for Opioid Therapy for Chronic Pain for US Military Physicians
Authors: Hurtado Suzanne L. , Simon-Arndt Cynthia M. , Belding Jennifer N. , Sanchez Sandra S. , Spevak Christopher , Osik Amy 
Published: February 2023

Introduction:
The Department of Veterans Affairs and Department of Defense Clinical Practice Guideline (CPG) for the Management of Opioid Therapy for Chronic Pain was updated in 2017 with targeted guidance to provide safe opioid use while mitigating the increasing levels of prescription opioid misuse among military personnel. The objective of this study was to determine the effectiveness of two educational training modalities for the CPG (an online training [OLT] module and a mobile app) on provider's knowledge, practices, and comfort with the CPG. The OLT was a self-paced interactive slide-based module that emphasized practical application, and the app provided information on the revised CPG and provider and patient resources.

Methods:
Active duty providers (N = 56) were randomly assigned to one of four groups (OLT only, app only, OLT and app combined, or neither OLT nor the app), and they completed a pre-test and an 8-week post-test.

Results:
Compared with those who received neither intervention, providers who received OLT only or the app only showed significant increases in knowledge over time. The combination of both OLT and app did not seem to significantly increase knowledge above either the OLT or the app alone. Neither the OLT, the app, nor their combination significantly increased either practices or comfort over time.

Discussion:
These results show that use of these educational tools, individually, was associated with an increase in provider knowledge, suggesting that these tools constitute a valuable addition to the available resources to optimize CPG implementation.
Survey of Home Cleaning Practices With Noninvasive Ventilation Equipment
Authors: Qu Yiwei , Milross Maree , McGuiness Olivia , Menadue Collette , Piper Amanda 
Published: February 2023

Purpose:
Home noninvasive ventilation (NIV) equipment is often observed to be dirty, potentially increasing patients' risk of respiratory infection. This study aimed to describe the cleaning practices of home NIV patients.

Methods:
This single-site, cross-sectional, observational study surveyed 100 patients from the respiratory failure clinic regarding cleaning instructions, cleaning habits, barriers, and motivators to cleaning. Open-ended responses were analyzed with basic content analysis and closed categorical responses with frequencies and percentages.

Results:
Of 100 participants, 77% responded. Cleaning instructions most commonly recalled included cleaning with soapy water for masks (26/47, 55%), head straps (19/47, 40%), and tubing (21/47, 45%); vinegar solution for humidifiers (9/39, 23%); and replacing filters (14/39, 36%). Fourteen respondents reported barriers to cleaning, including forgetfulness (7/14, 50%) and physical difficulties (6/14, 43%). Commonly reported cleaning practices included soapy water to soak masks (28/77, 36%) and tubing (35/77, 46%), weekly masks (34/77, 44%) and tubing cleaning (29/77, 38%), vinegar solution to clean humidifiers for the 36 humidifier users (15/36, 44%), monthly humidifier cleaning (13/36, 36%), and monthly filter cleaning/replacement (36/77, 47%).

Conclusion:
Few respondents could recall specific instructions about when and how to clean their equipment. Many reported routine cleaning, with varied methods and frequencies. Our results will inform future NIV equipment cleaning educational package design.
Access to Care After Autism Diagnosis During the COVID-19 Pandemic: A Quality Improvement Project
Authors: Landau-Taylor Jessica , McGivney Christine , Christiansen Audrey 
Published: February 2023

Abstract:

Objective:
The aim of this study was to identify barriers and improve access to services for children diagnosed with autism spectrum disorder (ASD) during the COVID-19 pandemic.

Methods:
Sixty-two patients diagnosed with ASD between March 23 and June 30, 2020, at a large urban safety net hospital were identified by chart review. Patients were called from January to March 2021 and queried regarding access to services. Brief interventions were provided as part of a modified Plan-Do-Study-Act approach. A second chart review was conducted between April and May 2021 to determine whether families accessed any additional services.

Results:
At the time of initial evaluation, 12 patients (19%) had been able to access all recommended services, 32 (52%) had been able to access some recommended services, and 9 (15%) were not able to access any services. Service levels for 9 families (15%) were undetermined. Sixteen patients (26%) lacked any follow-up with their developmental behavioral pediatrician since their initial evaluation. Thirty patients (48%) reported changes to their individualized educational program or early intervention services, and 17 patients (27%) were receiving in-home applied behavior analysis. After the brief intervention, 13 patients had accessed new services, and 9 patients previously lost to follow-up had completed an appointment.

Conclusion:
Patients diagnosed with ASD in the spring of 2020 had significant difficulty accessing community services. The transition to telemedicine exacerbated this hospital's difficulty contacting patients for follow-up. Additional research is needed to fully characterize the disruptions to services experienced by patients diagnosed with ASD during the pandemic and to increase accessibility and equity of care.
Decisional Regret Among Caregivers of Infants with Differences of Sex Development Reared as Male
Authors: Fisher Rachel S. , Datillo Taylor M. , Baskin Laurence S. , Cheng Earl Y. , Kolon Thomas , Nokoff Natalie J. , Poppas Dix P. , Reyes Kristy J. , Mullins Larry L. , Wisniewski Amy B. 
Published: February 2023

Abstract:

Objective:
Differences of sex development (DSD) are congenital conditions in which individuals are discordant in their chromosomal, phenotypic, and/or gonadal sex. Treatment of DSD can involve surgical intervention to external genitalia to make anatomy seem male-typical (i.e., male genitoplasty). Caregiver-perceived decisional regret regarding young boys with DSD was explored quantitatively and qualitatively.

Method:
Participants (N = 39) were caregivers of infants (N = 23) diagnosed with DSD (mean age = 8.9 months, standard deviation = 5.9 months) reared male participating in a longitudinal investigation of psychosocial outcomes. Qualitative data were collected at 6 to 12 months after baseline enrollment to evaluate caregiver decision-making corresponding to levels of regret concerning their child's treatment. All but one infant received genital surgery before caregiver reporting on their decisional regret. Quantitative exploratory analyses evaluated longitudinal predictors of decisional regret at 6 to 12 months.

Results:
When completing a write-in item inquiring about decision-making and potential regret, most caregivers (n = 16, 76%) reported that their child's genital surgery was their first medical decision. Two caregivers referenced gender assignment as a decision point. One-third of caregivers reported some level of decisional regret (33%), with 67% reporting no regret. No hypothesized predictors of decisional regret were statistically significant.

Conclusion:
Many caregivers of infants with DSD reared male view genital surgery as a first health care decision. Approximately one-third of caregivers reported some level of decisional regret. Further research is warranted to explore long-term decisional regret; it will be particularly important to investigate the decisional regret of patients with DSD.
Postoperative Complications After Interpolated Flap Repair for Mohs Defects of the Nose: A Multicenter Prospective Cohort Study
Authors: Perz Allison M. , Lukowiak Tess M. , Lee Michael P. , Neal Donald , Aizman Leora , Miller Christopher J. , Golda Nicholas , Albertini John G. , Holmes Todd , Bar Anna , Leitenberger Justin , Maher Ian , Sobanko Joseph F. , Chen David , Hollmig Tyler , Aasi Sumaira , Sutton Adam , Higgins H. William , Shin Thuzar M. , Weinberger Christine , Mattox Adam , Wysong Ashley , Etzkorn Jeremy R. 
Published: February 2023

BACKGROUND
Dermatologists perform most interpolated flaps after skin cancer resection. Prospective, multicenter data on complications after interpolated flap repair in this setting are limited.

OBJECTIVE
To determine the rate of physician-reported complications after interpolated flap repair of the nose.

METHODS
Multicenter, prospective cohort study of 169 patients undergoing 2-stage interpolated flap repair of post-Mohs nasal defects. Frequency of bleeding, infection, dehiscence, necrosis, hospitalization, and death in the 30 days after flap placement and flap takedown are reported.

RESULTS
Patients experienced 23 complications after flap placement (13.61%) and 6 complications after flap takedown (3.55%) that were related to the surgical procedure. The most frequent complication after flap placement was bleeding (9, 5.33%, 95% confidence interval [CI]: 2.83%–9.82%). The most frequent complication after flap takedown was infection (5, 2.96%, 95% CI: 1.27%–6.74%). There was one hospitalization related to an adverse reaction to antibiotics. There were no deaths.

CONCLUSION
Most complications after interpolated flap repair for post-Mohs defects of the nose are minor and are associated with flap placement. Interpolated flap repair for post-Mohs defects can be performed safely in the outpatient setting under local anesthesia.
Therapeutic Drug Monitoring of Ganciclovir in Cytomegalovirus-Infected Patients With Solid Organ Transplants and Its Correlation to Efficacy and Toxicity
Authors: van der Wekken-Pas Lena C. , Totté Joan , Lunel Frans V. , van Zuilen Arjan , van Luin Matthijs 
Published: February 2023

Background:
Cytomegalovirus causes morbidity and mortality, especially in immunocompromised patients, and is treated with (val)ganciclovir. Therapeutic drug monitoring of ganciclovir is often performed; however, clinically established target trough levels corresponding to efficacy are lacking. In 2021, our clinic increased the target trough level for ganciclovir from 1 to 2 mg/L to 2–4 mg/L. This study aims to compare both target trough levels in efficacy, toxicity, and occurrence of resistance.

Methods:
A retrospective cohort study was performed in adult solid organ recipients treated for cytomegalovirus infection with (val)ganciclovir. Clinical efficacy was defined as the absence of treatment failure, defined as > 1 log10 increase in viral load within 2 weeks of treatment initiation, therapy switch to foscarnet, and/or request for resistance analysis.

Results:
A total of 46 patients were involved in the study, with 200 ganciclovir trough levels obtained. The composite endpoint was recorded in 23 (69.7%) and 10 (76.9%) patients in the 1–2 mg/L and the 2–4 mg/L group, respectively (P = 0.18). No association was found between ganciclovir trough levels and the composite endpoint (P = 1.0). However, a correlation was found between ganciclovir trough levels and the occurrence of lymphopenia (P = 0.02).

Conclusions:
Our study could not establish a difference in clinical efficacy or toxicity between target trough levels of 1–2 mg/L or 2–4 mg/L because of the lack of clinical differences between the compared groups. However, a correlation was found between ganciclovir trough levels and lymphopenia, which warrants further investigation.
Doravirine Exposure Decreased by Dialysis in a HIV Patient: A Grand Round
Authors: Fromage Yeleen , Codde Cyrielle , Monchaud Caroline , Labriffe Marc , Lê Minh P. , Faucher Jean-François , Woillard Jean-Baptiste 
Published: February 2023

Background:
The authors report the case of a 66-year-old male patient who was hemodialyzed 3 times per week for chronic renal failure and treated with 100 mg of doravirine once daily in combination with dolutegravir for HIV-1. No dose adjustment is required for doravirine in cases of severe renal injury, but the effect of dialysis on its exposure is poorly understood.

Methods & Results:
Two series of 2 samples were drawn before and after 4-hour hemodialysis and showed an average doravirine concentration decrease of 48.1 ± 6.7%. The effects of hemodialysis were important, contrary to what was expected and has been previously reported. In addition, intraindividual variability was low. Nevertheless, because the concentrations reported were largely above the inhibitory concentration 50 (IC50), no dose adjustment was required.

Conclusions:
The decrease in doravirine concentration due to hemodialysis observed in this case report was quite significant. Therefore, therapeutic drug monitoring might be recommended in certain patients undergoing doravirine treatment also on hemodialysis.
Successful and Safe Real-Time TDM-Guided Treatment of Invasive Pulmonary and Cerebral Aspergillosis Using Low-Dose Isavuconazole in a Patient with Primary Biliary Cirrhosis: Grand Round/A Case Study
Authors: Cojutti Pier Giorgio , Rinaldi Matteo , Giannella Maddalena , Viale Pierluigi , Pea Federico 
Published: February 2023

Background:
The authors present a case of a 67-year-old woman with primary biliary cirrhosis (Child-Pugh class B) who was treated with isavuconazole for invasive pulmonary and cerebral aspergillosis. Isavuconazole treatment was initiated with the standard maintenance dose of 200 mg daily. Therapeutic drug monitoring (TDM) was performed to target trough concentrations within the desired range of 1.0–5.13 mg/L.

Methods:
Real-time TDM and pharmacokinetic analyses were used to determine the dose adjustments. Liver transaminases (alanine aminotransferase and gamma-glutamyl transferase) were assessed to monitor hepatotoxicity.

Results:
The trough plasma levels gradually increased over time up to 17.8 mg/L. TDM-guided clinical pharmacological advice was helpful to initially reduce the dose, then to temporarily suspend drug administration, and finally to calculate the correct dose that allowed for long-term treatment up to day 258. No major signs and/or symptoms of drug-related toxicity occurred, apart from a transient increase in gamma-glutamyl transferases that normalized after the drop in isavuconazole trough levels within the desired range.

Conclusions:
TDM-guided clinical pharmacological advice was essential for the successful and safe management of isavuconazole treatment in this patient with moderate liver dysfunction.
Bioanalytical Methods for Poly(ADP-Ribose) Polymerase Inhibitor Quantification: A Review for Therapeutic Drug Monitoring
Authors: Orleni Marco , Canil Giovanni , Posocco Bianca , Gagno Sara , Toffoli Giuseppe 
Published: February 2023

Background:
Therapeutic drug monitoring (TDM) of poly(ADP-ribose) polymerase inhibitors (PARPis) is an exploratory practice aimed at improving the quality of treatment through personalized therapy. Currently, there are 4 European Medicines Agency-approved and US Food and Drug Administration–approved PARPis available clinically whose quantification requires validated analytical methods: olaparib, niraparib, rucaparib, and talazoparib. The purpose of this literature review was to highlight the pharmacological features of PARPis that could support their TDM practice and provide a detailed discussion of the available liquid chromatography coupled with tandem mass spectrometry methods for their quantification.

Methods:
Using several Medical Subject Heading terms, the literature was searched using several research engines, including SciFinder, Web of Science, Google Scholar, and PubMed, to find articles published before August 2022.

Results:
Exposure-efficacy and exposure-safety profiles, drug–drug interactions, and hepatic/renal impairment of PARPis provide the potential rationale to monitor their concentrations through TDM. Several bioanalytical methods for their quantification have been reported and compared, and a great deal of heterogeneity has been found among methods, regarding both their analytical and regulatory aspects.

Conclusions:
In addition to reducing toxicity and increasing the efficacy of PARPis therapy, TDM could be beneficial to thoroughly investigate the exposure–response relationships of PARPis and to establish pharmacokinetic thresholds for clinical decisions. Based on the comparison of published bioanalytical methods, their transferability and validation both play a key role in method selection. For future use in clinical TDM, we anticipate that bioanalytical methods should address every analytical need more thoroughly and should be validated with standardized guidelines.
Developmental Outcomes Following Abusive Head Trauma in Infancy: A Systematic Review
Authors: Sarmiento Cristina A. , Wyrwa Jordan M. , Chambliss Amy V. , Stearns-Yoder Kelly A. , Hoffberg Adam S. , Appel Amanda , Brenner Benjamin O. , Brenner Lisa A. 
Published: February 2023

Objective:
A systematic review of the literature was conducted to identify measures used to evaluate developmental outcomes after abusive head trauma (AHT), as well as describe outcomes among those with AHT, and explore factors and interventions influencing such outcomes.

Design:
This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The protocol is in PROSPERO, registration number CRD42020179592. On April 17, 2020, OVID Medline, Embase, OVID PsycINFO, Web of Science, CINAHL, Cochrane Library, and Google Scholar were searched (since inception). Inclusion criteria included original, peer-reviewed study data; AHT exposure; infants younger than 24 months at time of AHT; and evaluation of developmental outcomes. Reviewers independently evaluated studies for inclusion and assessed risk of bias using the Effective Public Health Practice Project quality assessment tool for quantitative studies. A descriptive synthesis approach was utilized as variability of study designs, follow-up periods, and outcome assessment tools precluded a meta-analytic approach.

Results:
Fifty-nine studies were included; 115 assessment tools were used to evaluate developmental outcomes; and 42 studies examined factors influencing outcomes. Two studies evaluated interventions. Five percent of studies (n = 3) were rated low risk of bias.

Conclusions:
Notable variation was observed in terms of case ascertainment criteria. Developmental outcomes after AHT have been assessed in a manner that limits understanding of how AHT impacts development, as well as the efficacy of interventions intended to improve outcomes. Researchers and clinicians are encouraged to adopt consistent diagnostic and assessment approaches.
Relationship Between Neighborhood Disadvantage and Mild Traumatic Brain Injury Symptoms
Authors: Miller Tessa , Kallenbach Madeline D. , Huber Daniel L. , Brett Benjamin L. , Nelson Lindsay D. 
Published: February 2023

Objective:
To test the hypotheses that (1) higher neighborhood disadvantage is associated with greater injury-related symptom severity in civilians with mild traumatic brain injury (mTBI) and (2) neighborhood disadvantage remains predictive after controlling for other established predictors.

Setting:
Level 1 trauma center and affiliated academic medical center.

Participants:

N = 171 individuals with mTBI.

Design:
Prospective cohort study.

Main Measures:
Rivermead Post Concussion Symptoms Questionnaire (RPQ) total score assessed less than 24 hours and at 2 weeks, 3 months, and 6 months postinjury. Linear mixed-effects models were used to assess the relationship between predictor variables and mTBI-related symptom burden (RPQ score). Neighborhood disadvantage was quantified by the Area Deprivation Index (ADI), a composite of 17 markers of socioeconomic position (SEP) scored at the census block group level.

Results:
Individuals in the upper ADI quartile of the national distribution displayed higher RPQ symptoms than those in the lower 3 quartiles (P < .001), with a nonsignificant ADI × visit interaction (P = .903). In a multivariable model, the effect of ADI remained significant (P = .034) after adjusting for demographics, individual SEP, and injury factors. Other unique predictors in the multivariable model were gender (gender × visit P = .035), health insurance type (P = .017), and injury-related litigation (P = .012).

Conclusion:
Neighborhood disadvantage as quantified by the ADI is robustly associated with greater mTBI-related symptom burden throughout the first 6 months postinjury. That the effect of ADI remained after controlling for demographics, individual SEP, and injury characteristics implies that neighborhood disadvantage is an important, understudied factor contributing to clinical recovery from mTBI.