bluuebunny/crossref_metadata_2025_split huggingface dataset:
Competency-Based Education in Physical Therapy: Developing a Framework for Education Research
Authors: Jensen Gail M. , Jette Diane U. , Timmerberg Jean Fitzpatrick , Chesbro Steven B. , Dole Robin L. , Kapasi Zoher , Lotshaw Ana 
Published: October 2022

Background and Purpose.
The physical therapy education community is actively engaged in planning and developing an approach to competency-based education in physical therapy (CBEPT). The creation of an underlying framework for education research in CBEPT can provide guidance in identifying key areas of needed study, give direction for future research, and provide opportunities for collaboration. The purpose of this article is to 1) describe the critical concepts of CBEPT as both an educational philosophy and design and 2) identify a working education research framework, examples of potential research questions, and associated methodological considerations.

Position and Rationale.
As the movement in CBEPT evolves, we have the opportunity to propose a working framework and potential research questions for our education community. An initial step in the development of a research framework was review of a model paper from medical education that proposed a research agenda for competency-based medical education. We developed a draft of categories and related research questions and then used an iterative group process that included members of the Education Leadership Partnership Education Research Network to review and provide feedback. Core areas for investigation include learners, the learning environment, learning progression, and faculty development needs along with examples of potential research questions in each area.

Discussion and Conclusion.
The development of a research framework for CBEPT that can guide much needed education research is critical and timely for the profession. Evidence is vital to widespread adoption, informed and refined processes, understanding, and infrastructure development all linked with the ultimate aim of CBEPT—learner development and meeting societal needs.
Lung transplantation in patients with lung disease secondary to coronavirus disease 2019 infection
Authors: Avella Diego , Bharat Ankit 
Published: October 2022

Purpose of review
In this article, we describe preoperative patient selection and outcomes of patients with lung disease secondary to infection from COVID-19 who receive lung transplantation.

Recent findings
Lung transplants for patients with lung disease secondary to infection from COVID-19 have been performed successfully in over 200 patients in the United States. The preoperative course of these patients is somewhat atypical in comparison with patients who have had lung transplants related to chronic lung diseases, where there are more traditional indications for lung transplants. COVID-19 patients have more severe pulmonary disease often requiring mechanical ventilation and extracorporeal mechanical ventilation (ECMO), frequent nosocomial infections, and renal and cardiac dysfunction. The intraoperative course of these COVID-19 patients is often longer and requires increased transfusions of blood products in comparison with non-COVID-19 patients. Additionally, in the postoperative period, COVID-19 patients more frequently require mechanical ventilation and ECMO support. However, the survival rate of such patients at 6 months is greater than 90%.

Summary
Patients with respiratory failure secondary to COVID-19 infection that require a lung transplant generally have a complicated preoperative course and the operations are more complex, but the long-term outcomes are excellent.
Neurotrauma
Authors: Niziolek Grace , Sandsmark Danielle K. , Pascual Jose L. 
Published: October 2022

Purpose of review
This review will highlight the latest research relevant to the clinical care of traumatic brain injury (TBI) patients over the last 2 years while underscoring the implications of these advances in the understanding of diagnosis, treatment, and prognosis of TBI.

Recent findings
Brain tissue oxygenation monitoring can identify hypoperfusion as an adjunct to intracerebral pressure monitoring. Multiple biomarker assays are now available to help clinicians screen for mild TBI and biomarker elevations correlate with the size of intracranial injury. Beta-blocker exposure following TBI has demonstrated a survival benefit in those with TBI though the mechanism for this remains unknown. The optimal timing for venous thromboembolism prophylaxis for TBI patients is still uncertain.

Summary
The current characterization of TBI as mild, moderate, or severe fails to capture the complexity of the disease process and helps little with prognostication. Molecular biomarkers and invasive monitoring devices including brain tissue oxygenation and measures of cerebral autoregulation are being utilized more commonly and can help guide therapy. Extracranial complications following TBI are common and include infection, respiratory failure, coagulopathy, hypercoagulability, and paroxysmal sympathetic hyperactivity.
Pharmacological Management of Pulmonary Tuberculosis: A Century of Expert Opinions in Cecil Textbook of Medicine
Authors: Manu Peter , Rogozea Liliana M. 
Published: October 2022

Background:
Advances in drug therapy for pulmonary tuberculosis have had an extraordinary impact on the incidence of tuberculosis in the United States in the past century, which has decreased from 113/100,000 persons in 1920 to 2.2/100,000 in 2020. Modern treatments have contributed to a remarkable decrease in hospitalizations and mortality and have had a significant impact on the duration and severity of illness, quality of life, and work potential of affected persons.

Study Question:
What are the milestones of the changes in the expert approach to the pharmacological management of pulmonary tuberculosis in the past century?

Study Design:
To determine the changes in the experts' approach to the management of pulmonary tuberculosis, as presented in a widely used textbook in the United States.

Data Sources:
The chapters describing the management of pulmonary tuberculosis in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020.

Results:
In the preantibiotic era (1927–1943), the Cecil authors emphasized rest, good food, and fresh air as the treatment pillars for pulmonary tuberculosis. The modern era (1947–1971) recorded the discovery of all the drugs that are still used for the initial treatment, in the following order: streptomycin, para-aminosalicylic acid, isoniazid, pyrazinamide, ethambutol, cycloserine, kanamycin, ethionamide, capreomycin, and rifampin. In the postmodern era (1975–2020), therapeutic advances continued with trials of many drug combinations aimed at ameliorating the duration of treatment, drug resistance adverse effects, and poor the recent addition of fluoroquinolones, bedaquiline, and clofazimine.

Conclusions:
The pharmacological management of tuberculosis has remained archaic until the middle of the 20th century. Fundamental progress occurred in a very short period (1947–1971) and was because of the recognition of the antituberculous effect of many antibiotics and chemotherapy agents. The challenges created by mycobacterial infections resistant to multiple drugs remain and have prompted the addition of new drugs in the past decade.
Postpartum Hemorrhage: A Comprehensive Review of Guidelines
Authors: Giouleka Sonia , Tsakiridis Ioannis , Kalogiannidis Ioannis , Mamopoulos Apostolos , Tentas Ioannis , Athanasiadis Apostolos , Dagklis Themistoklis 
Published: October 2022

ABSTRACT

Importance
Postpartum hemorrhage (PPH) is a common complication of childbirth and the leading cause of maternal deaths worldwide, also associated with important secondary sequelae.

Objective
The aim of this study was to review and compare the most recently published influential guidelines on evaluation, management, and prevention of this severe, life-threatening obstetric complication.

Evidence Acquisition
A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Network for the Advancement of Patient Blood Management, Hemostasis and Thrombosis in collaboration with the International Federation of Gynecology and Obstetrics, the European Board and College of Obstetrics and Gynecology and the European Society of Anaesthesiology, and the World Health Organization on PPH was carried out.

Results
There is a consensus among the reviewed guidelines that once PPH occurs, it is important to identify the underlying cause (4 T's), estimate the blood loss, and immediately initiate a resuscitation protocol with fluid replacement, blood transfusion, and close monitoring of the woman. In case of uterine atony, all the reviewed medical societies recommend uterine massage, bimanual uterine compression, and administration of uterotonics, although minor discrepancies are observed regarding the optimal regimens. If these measures fail, the use of intrauterine balloon tamponade or other surgical interventions is unanimously recommended. There is also agreement regarding the management of PPH due to retained placenta, placenta accreta, obstetric trauma, uterine rupture or inversion, and acute coagulopathy. Massive transfusion protocols are not consistent in the reviewed guidelines. Finally, all guidelines highlight the importance of the active management of the third stage of labor for the prevention of PPH, suggesting several interventions, with the administration of oxytocin being the criterion standard.

Conclusions
Postpartum hemorrhage is a significant contributor of maternal morbidity and mortality. Thus, the development of consistent international practice protocols for the effective management and prevention of this major complication seems of paramount importance and will hopefully improve obstetric outcomes and especially maternal mortality rate.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After participating in this activity, the learner should be better able to explain the definition of postpartum hemorrhage, as well as the initial maternal evaluation; describe the appropriate management of postpartum hemorrhage; and assess the risk factors and adopt strategies for the prevention of postpartum hemorrhage.
Fetal Omphalocele: Review of Predictive Factors Important for Antenatal Counseling?
Authors: Rieder Wawrzyniec , Maurer Sabine Vasseur , Giannoni Eric , Baud David 
Published: October 2022

ABSTRACT

Importance
Congenital omphalocele is among the most common antenatally diagnosed anomalies. As additional abnormalities are found in majority of cases, antenatal investigations target the search for additional structural anomalies and genetic disorders, including aneuploidy. Antenatal management focuses on the assessment of fetal well-being. Unfortunately, antenatal prediction of postnatal and long-term outcomes represents 2 less well-documented but crucial facets of this pathology. A large part of the prognosis relies on aspects that are difficult to predict such as quality of life, neurological development, and autonomy, which cause significant anxiety in expectant parents.

Objective
This article offers a comprehensive review of antenatal management of omphalocele with a specific focus on predictive factors and long-term outcomes.

Evidence Acquisition, Results
We conducted an extensive literature review targeting management of fetal omphalocele. We had a specific interest in factors predictive of fetal and neonatal outcome as well as long-term consequences of omphalocele. Fetuses with large defects and those containing the liver are at higher risk of having a complicated postnatal course. Neonates may experience pulmonary hypoplasia, pulmonary hypertension, and gastroesophageal reflux. In selected cases, motor and cognitive delay may be present, but the overall life-long prognosis and quality of life is good.

Conclusions and Relevance
A multidisciplinary approach should be encouraged after the diagnosis of fetal omphalocele. In addition to clinical team experience, antenatal counseling should be based on objective and gestational age-dependent criteria and should include long-term outcomes.

Target Audience
Obstetricians and gynecologists, family physicians.

Learning Objectives
After completing this activity, the learner should be better able to propose management of antenatal investigations and fetal surveillance; identify antenatal factors predictive of fetal and neonatal outcomes; and explain the different aspects and currents limitations in knowledge regarding long-term outcomes of omphalocele.
Quality of Life of Children Born With a Congenital Heart Defect
Authors: Derridj Neil , Bonnet Damien , Calderon Johanna , Amedro Pascal , Bertille Nathalie , Lelong Nathalie , Goffinet Francois , Khoshnood Babak , Guedj Romain 
Published: October 2022

(Abstracted from J Pediatr 2022;244:148–153)
Congenital heart defects are the most common cause of infant death linked to congenital malformations (CHDs). This group of congenital disorders therefore remains a cause for concern, despite improvements in medical and surgical management that have resulted in higher survival rates.
Early vs Expectant Artificial Rupture of Membranes Following Foley Catheter Ripening: A Randomized Controlled Trial
Authors: Gomez Slagle Helen B. , Fonge Yaneve N. , Caplan Richard , Pfeuti Courtney K. , Sciscione Anthony C. , Hoffman Matthew K. 
Published: October 2022

(Abstracted from Am J Obstet Gynecol 2022;226:724.e1–724.e9)
The rate of labor induction is nearly 30% of pregnancies in the United States and rising. Amniotomy is widely used as a safe, inexpensive, and effective labor intervention.
Longitudinal Trends in Case Histories and Rehabilitative Device Assessments at Low Vision Examinations
Authors: Nguyen Jacqueline D. , Tan Steven M. , Azenkot Shiri , Chu Marlena A. , Cooper Emily A. 
Published: October 2022

SIGNIFICANCE
Understanding longitudinal changes in why individuals frequent low-vision clinics is crucial for ensuring that patient care keeps current with changing technology and changing lifestyles. Among other findings, our results suggest that reading remains a prevailing patient complaint, with shifting priorities toward technology-related topics.

PURPOSE
This study aimed to understand changes in patient priorities and patient care in low vision over the past decade.

METHODS
We conducted a retrospective study of examination records (2009 to 2019, 3470 examinations) from two U.S. low-vision clinics. Automated word searches summarized two properties of the records: topics discussed during the case history and types of rehabilitative devices assessed. Logistic regression was used to model the effects of examination year, patient age, patient sex, and level of visual impairment.

RESULTS
Collapsing across all years, the most common topic discussed was reading (78%), followed by light-related topics (71%) and technology (59%). Whereas the odds of discussing reading trended downward over the decade (odds ratio, 0.57; P = .03), technology, social interaction, mobility, and driving trended upward (odds ratios, 4.53, 3.31, 2.71, and 1.95; all P's < 0.001). The most frequently assessed devices were tinted lenses (95%). Over time, video magnifier and spectacle assessments trended downward (odds ratios, 0.64 and 0.72; P = .004, 0.04), whereas assessments of other optical aids increased. The data indicate several consistent differences among patient demographics.

CONCLUSIONS
Reading is likely to remain a prevailing patient complaint, but an increase in technology-related topics suggests shifting priorities, particularly in younger demographics. “Low-tech” optical aids have remained prominent in low-vision care even as “high-tech” assistive devices in the marketplace continue to advance.
Male Partner Opinions of the Dapivirine Vaginal Ring Used During an Open-Label Extension HIV Prevention Trial in KwaZulu-Natal, South Africa
Authors: Morar Neetha S. , Mansoor Leila E. , Naidoo Kalendri , Katz Ariana W. K. , Garcia Morgan , Duma Cebo , Precious Myeni Nqobile Bonakele , Tshbalala Themba , Naidoo Sarita , Montgomery Elizabeth T. 
Published: October 2022

Background:
The dapivirine vaginal ring (“the ring”) reduced HIV acquisition by about 35% in phase III trials, with modeling from open-label extension trials estimating 50% HIV protection with consistent use. The ring may be used without male partner knowledge. The Assessment of ASPIRE and HOPE Adherence (AHA) substudy aimed to understand the impact of sociocontextual issues on ring adherence. This subanalysis provides insight into disclosure and male partner influence on ring acceptability.

Methods:
Data were collected using 4 focus group discussions with 18 male partners of phase III trial participants at 2 sites in KwaZulu-Natal, South Africa. Qualitative data were coded, summarized by urban vs. rural location, and analyzed thematically.

Results:
Male partners aged 23–49 years wanted to be informed about the ring use to maintain the trust in their relationships. Their initial response to the ring was characterized by fear due to perceived impact of the ring on their female partner's reproductive system, their penile safety, and that the ring would encourage women to engage in unprotected sex and infidelity. Over time and with information and experience with having a partner who had used the vaginal ring, this fear transformed to support for women to have their own HIV prevention option.

Conclusion:
Male partners supported the ring as an HIV prevention method for women but wanted to be informed about its use. Engaging male partners on female-initiated HIV prevention methods and increased education among rural men may contribute to improved partner support and facilitate women's consistent use.
Tissue plasminogen activator resistance is an early predictor of posttraumatic venous thromboembolism: A prospective study from the CLOTT research group
Authors: Knudson M. Margaret , Moore Hunter B. , Moore Ernest E. , Kornblith Lucy Z. , Kiraly Lazlo N. , McNutt Michelle K. , Wade Charles E. , Bruns Brandon R. , Sauaia Angela 
Published: October 2022

BACKGROUND
Venous thromboembolism (VTE) remains a frequent postinjury complication with well established but nonmodifiable risk factors. We hypothesized that fibrinolysis shutdown (SD) as measured by thromboelastography (TEG) would be an independent risk factor for VTE in trauma patients.

METHODS
A subgroup of patients enrolled in the CLOTT-2 (Consortium of Leaders in the Study of Traumatic Thromboembolism 2), multicenter prospective cohort study had kaolin TEG and tissue plasminogen activator (tPA)–TEG data at 12 and 24 hours postadmission. Patients underwent a screening duplex venous ultrasound examination during the first week unless clot was already detected on computed tomography. Injury factors associated with early fibrinolysis SD (defined as kaolin TEG Ly30 ≤0.3%) and/or tPA resistance (tPA-R) (defined as kaolin TEG with tPA 75 ng Ly30 <2.1%) were investigated as was the association of the TEG measurements with the development of VTE.

RESULTS
A total of 141 patients had both TEG measurements at 24 hours, and 135 had both TEG measurements at 12 hours. Shutdown was evident at 12 hours in 71 of 135 (52.6%) patients and in 62 of 141 (44%) at 24 hours. Tissue plasminogen activator resistance was found in 61 of 135 (45.2%) at 12 hours and in 49 of 141 (34.3%) at 24 hours. Factors significantly associated with SD included receiving >4 U of FFP in the first 24 hours, the presence of a major brain injury or pelvic fracture, and the need for major surgery. In contrast, factors significantly associated with early tPA-R included >4 U of red blood cells transfused in the first 24 hours and the presence of a major chest injury or long bone fracture. Deep vein thrombosis was detected in 15 patients and pulmonary clots in 5 (overall VTE rate, 14.2%). Tissue plasminogen activator resistance at 12 hours was found to be an independent risk factor for VTE (hazard ratio, 5.57; 95% confidence interval, 1.39–22.39).

CONCLUSION
Early development of a hypercoagulable state as defined by tPA-R at 12 hours after admission represents a potentially modifiable risk factor for postinjury VTE.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level II.
Adaptation, personalization and capacity in mental health treatments: a balancing act?
Authors: Bennett Sophie D. , Shafran Roz 
Published: October 2022

Purpose of review
There are increasing calls for mental health treatments to be adapted for different groups to maximize their acceptability and benefit to patients. However, adaptations can be costly to develop and evaluate, difficult to implement in routine clinical practice and may reduce service capacity at a time when there is unprecedented unmet need. An alternative method is personalization on an individual level. This review provides an overview of the issues related to personalization and adaptation of mental health interventions.

Recent findings
Several terms have been used to describe changes to existing therapies, these reflect different extents to which existing treatments have been changed. Evidence-based practice and modular therapies allow a level of flexibility within intervention delivery without formal changes and not all changes to therapy should be considered as a new/adapted treatment but instead regarded as ‘metacompetence’. Implementing existing interventions in new contexts is preferable to developing new interventions in many instances. New guidance outlines how researchers can adapt and transfer interventions to varied contexts.

Summary
The review provides proposed definitions of different changes to therapy. Modified and personalized treatments may improve acceptability to patients whilst maximizing implementation of evidence-based practice within clinical services.
An Evaluation of The Regional Distribution of Pediatric Surgery Workforce and Surgical Load in Brazil
Authors: Bustorff-Silva Joaquim , Miranda Márcio Lopes , Rosendo Amanda , de Oliveira Filho António Gonçalves 
Published: October 2022

ABSTRACTAimThe purpose of this study is to present data on the regional distribution of the pediatric surgical workforce and the expected local demand of pediatric operations in Brazil.MethodsWe collected data on the pediatric surgical workforce, surgical workload, GDP/capita and mortality for gastrointestinal tract malformations (MGITM) across the different regions of Brazil for 2019.FindingsData from CFM reported the existence of 1515 pediatric surgery registries in Brazil, corresponding to 1414 individual pediatric surgeons (some pediatric surgeons are registered in more than one State), or 2.4 pediatric surgeons per 100.000 children< 14 years. There were 828 male and 586 female with a M/F ratio of 1.14:1. Mean age was 51.5±12.8 years and mean time from graduation was 3,4±5,7years. Regional distribution showed a higher concentration of pediatric surgeons on the wealthier Central-West, South and Southeast regions. Individual workload ranged from 88 to 245 operations/year (average 146 operations/year) depending on the region. Only 9 (6.1%) of these were high complexity (including neonatal) operations. MGITM tended to be higher on the poorer North and Northeast regions of BrazilConclusionsWe found wide disparities in the surgical workforce and workload across Brazil, related to socioeconomic status. Areas of increased surgical workforce were associated with lower MGITM. The average number of complex operations performed yearly by the individual pediatric surgeon was considerably low. Strategic investment and definition of health policies may be needed to improve the quality of care in the different regions of Brazil.Level of EvidenceRetrospective review. Level III