bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Experiential Communication Skills Education on Graduate Medical Education Trainees’ Communication Behaviors: A Systematic Review
Authors: Bylund Carma L. , Vasquez Taylor S. , Peterson Emily B. , Ansell Margaret , Bylund Kevin C. , Ditton-Phare Philippa , Hines April , Manna Ruth , Singh Ospina Naykky , Wells Robert , Rosenbaum Marcy E. 
Published: July 2022

Purpose
A better understanding of how communication skills education impacts trainees’ communication skills is important for continual improvement in graduate medical education (GME). Guided by the Kirkpatrick Model, this review focused on studies that measured communication skills in either simulated or clinical settings. The aim of this systematic review was to examine the effect of experiential communication skills education on GME trainees’ communication behaviors.

Method
Five databases were searched for studies published between 2001 and 2021 using terms representing the concepts of medical trainees, communication, training, and skills and/or behaviors. Included studies had an intervention design, focused only on GME trainees as learners, used experiential methods, and had an outcome measure of communication skills behavior that was assessed by a simulated or standardized patient (SP), patient, family member, or outside observer. Studies were examined for differences in outcomes based on study design; simulated versus clinical evaluation setting; outside observer versus SP, patient, or family member evaluator; and length of training.

Results
Seventy-seven studies were ultimately included. Overall, 54 (70%) studies reported some positive findings (i.e., change in behavior). There were 44 (57%) single-group pre–post studies, 13 (17%) nonrandomized control studies, and 20 (26%) randomized control studies. Positive findings were frequent in single-group designs (80%) and were likely in nonrandomized (62%) and randomized (55%) control trials. Positive findings were likely in studies evaluating communication behavior in simulated (67%) and clinical (78%) settings as well as in studies with outside observer (63%) and SP, patient, and family member (64%) evaluators.

Conclusions
This review demonstrates strong support that experiential communication skills education can impact GME trainees’ communication behaviors. Marked heterogeneity in communication trainings and evaluation measures, even among subgroups, did not allow for meta-analysis or comparative efficacy evaluation of different studies. Future studies would benefit from homogeneity in curricular and evaluation measures.
Anesthesia care in the interventional neuroradiology suite: an update
Authors: Bello Corina , Paisansathan Chanannait , Riva Thomas , Luedi Markus M. , Andereggen Lukas 
Published: July 2022

Purpose of review
The scope of procedures conducted by neurointerventionalists is expanding quickly, with lacking consensus over the best anesthesia modality. Although the procedures involve all age groups, the interventions may be complex and lengthy and may be provided in hospitals currently not yet familiar with the field. Here we review current literature addressing elective outpatient neurointerventional procedures and aim to provide an update on the management of intervention-specific crises, address special patient populations, and provide key learning points for everyday use in the neurointerventional radiology suite.

Recent findings
Various studies have compared the use of different anesthesia modalities and preinterventional and postinterventional care. Monitored anesthesia care is generally recommended for elderly patients, whereas children are preferably treated with general anesthesia. Additional local anesthesia is beneficial for procedures, such as percutaneous kyphoplasty and vascular access.

Summary
Combining different anesthetic modalities is a valuable approach in the neurointerventional radiology suite. More interventional and patient population-specific studies are needed to improve evidence-based perioperative management.
Frameworks for value-based care in the nonoperating room setting
Authors: Keswani Aakash , Licht Brian , Urman Richard D. 
Published: July 2022

Purpose of review
Nonoperating room anesthesia (NORA) presents a unique opportunity for the application of value-based care (VBC) principles to procedures performed in the office-based and nonoperating room inpatient settings. The purpose of this article is to review how value is defined in NORA and enabling principles by which anesthesiologists can maximize value in NORA.

Recent findings
In order to drive value, NORA providers can target improvements in clinical outcomes where NORA lags behind operating room-based anesthesia (death, over-sedation, nerve injury), implement protocols focusing on intermediate outcomes/quality (postoperative nausea and vomiting, pain control, hypothermia, delirium), incorporate patient-reported outcomes (PROs) to assess the trajectory of a patient's perioperative care, and reduce costs (direct and indirect) through operational and supply-based efficiencies. Establishing a culture of patient and provider safety first, appropriate patient selection with targeted, perioperative optimization of comorbidities, and efficient deployment of staff, space, and resources are critical enablers for success.

Summary
Value in NORA can be defined as clinical outcomes, quality, patient-reported outcomes, and efficiency divided by the direct and indirect costs for achieving those outcomes. We present a novel framework adapting current VBC practices in operating room anesthesia to the NORA environment.
The Association Between Perceived Injustice and Opioid Craving in Patients With Chronic Pain: The Mediating Role of Daily Pain Intensity, Negative Affect, and Catastrophizing
Authors: Verner Maria , Sirois Amanda , Coutu-Nadeau Emmanuelle , Fournier Catherine , Carriere Junie , Martel Marc O. 
Published: July 2022

Abstract: The rise in the use of opioids has been accompanied by increases in prescription opioid misuse among patients with chronic pain. Opioid craving has emerged as a robust determinant of opioid misuse, but the factors that contribute to opioid craving have yet to be fully elucidated. Perceived injustice has been linked to numerous negative pain outcomes, but little is known about its association with opioid craving.

Objectives
The first objective of this study was to examine the association between perceived injustice and opioid craving in patients with chronic pain who are prescribed opioids. We also examined whether pain intensity, negative affect, or catastrophizing mediated this association.

Methods
In this longitudinal diary study, patients (n = 103) completed a questionnaire assessing perceived injustice and then completed daily measures of pain intensity, negative affect, catastrophizing, and opioid craving for 14 consecutive days.

Results
A significant association was found between perceived injustice and opioid craving (P < 0.01), with higher levels of perceived injustice being associated with heightened levels of opioid craving. A 2-1-1 multilevel mediation analysis indicated that the association between perceived injustice and craving was significantly mediated by catastrophizing (P < 0.05).

Conclusions
The present study provides new insights into the factors that might contribute to opioid craving in patients with chronic pain. Our findings suggest that perceived injustice might lead to increased catastrophizing and, in turn, heightened daily levels of opioid craving. These findings could have implications for chronic pain management clinicians who prescribe opioids.
Preoperative Patient Education and Smaller Prescription Quantity Reduce Opioid Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Results of a Prospective Study
Authors: Yang Daniel , Jha Sahil , Swallow Jennylee , Caird Michelle S. , Lopyan Alexander , Stepanovich Matthew , Whyte Noelle , Li Ying 
Published: July 2022

Background:
Most opioids prescribed postoperatively are unused. Leftover opioids are a major source of nonmedical opioid use among adolescents. Postoperative opioid use has also been associated with prescription quantity. Our purpose was to evaluate the effect of preoperative patient education and implementation of evidence-based prescribing guidelines on opioid use and pain level after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods:
AIS patients aged 10 to 17 years undergoing PSF were prospectively enrolled [postintervention cohort (POST-INT)]. Previous data on 77 patients showed median consumption of 29 doses of oxycodone after PSF [preintervention cohort (PRE-INT)]. All eligible patients during the study period were discharged with 30 doses of oxycodone and standard nonopioid analgesics. Only study participants received education on postoperative pain control. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were collected. Requests for opioid refills were documented.

Results:
Forty-nine patients were enrolled. POST-INT was divided into low (L, ≤8 doses), average (AVE, 9-25), and high (H, >25) opioid use groups. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were similar between the groups. However, there was a difference in days of oxycodone use, doses consumed in the first week, and leftover doses (P<0.001). Comparison to the PRE-INT L (≤16 doses), AVE (17 to 42), and high (H, >42) use groups showed that POST-INT L and AVE consumed less oxycodone (L: P=0.002; AVE: P<0.001). Also, the overall POST-INT cohort had fewer mean days of oxycodone use (5.6 vs. 8.9, P<0.001) and doses used in the first week (14 vs. 23, P<0.001) compared with the PRE-INT cohort. Subanalysis showed fewer study participants requested and received an opioid refill [3/49 patients (6%)] compared with eligible patients who declined to participate, withdrew, or missed enrollment [8/35 patients (23%)] (P=0.045).

Conclusions:
Preoperative patient education and smaller prescription quantity successfully reduced opioid use while maintaining excellent pain control after PSF for AIS. Setting expectations regarding postoperative pain management is critical, as nonstudy participants were significantly more likely to request an opioid refill.

Level of Evidence:
Level II—therapeutic.
Patients With Coronal Malalignment Undergoing Adult Spinal Deformity Surgery
Authors: Zuckerman Scott L. , Chanbour Hani , Hassan Fthimnir M. , Lai Christopher , Kerolus Mena , Ha Alex , Buchannan Ian , Cerpa Meghan , Lehman Ronald A. , Lenke Lawrence G. 
Published: July 2022

Study Design:
Retrospective cohort study.

Objectives:
The objectives were to: (1) characterize the changes in coronal vertical axis (CVA) after adult spinal deformity (ASD) surgery from immediate postoperative to 2-years postoperative, and (2) assess for predictors of CVA change from immediate postoperative to 2-years postoperative.

Summary of Background Data:
It is unknown whether coronal correction obtained immediately postoperative accurately reflects long-term coronal alignment.

Materials and Methods:
A retrospective, single-institution registry was queried for patients undergoing ASD surgery from 2015-2019, including patients undergoing ≥6-level fusions with preoperative coronal malalignment (CM), defined as CVA≥3 cm. A clinically significant change in CVA was defined a priori as ≥1 cm. Radiographic variables were obtained preoperatively, immediately postoperative, and at 2-years postoperative.

Results:
Of 368 patients undergoing ASD surgery, 124 (33.7%) had preoperative CM, and 64 (17.0%) completed 2-years follow-up. Among 64 patients, mean age was 53.6±15.4 years. Preoperatively, absolute mean CVA was 5.4±3.1 cm, which improved to 2.3±2.0 cm (P<0.001) immediately postoperative and 2.2±1.6 cm (P<0.001) at 2-years. The mean change in CVA from preoperative to immediately postoperative was 2.2±1.9 cm (0.3–14.4). During the immediate postoperative to 2-years interval, 29/64 (45.3%) patients experienced a significant change of CVA by ≥1 cm, of which 22/29 (76%) improved by a mean of 1.7 cm and 7/29 (24%) worsened by a mean of 3.5 cm. No preoperative or surgical factors were associated with changed CVA from immediately postoperative to 2-years.

Conclusion:
Among 64 patients undergoing ASD surgery with preoperative CM, 45.3% experienced a significant (≥1 cm) change in their CVA from immediately postoperative to 2-years postoperative. Of these 29 patients, 22/29 (76%) improved, whereas 7/29 (24%) worsened. Although no factors were associated with undergoing a change in CVA, this information is useful in understanding the evolution and spontaneous coronal alignment changes that take place after major ASD coronal plane correction.
Future development of chimeric antigen receptor T cell therapies for patients suffering from malignant glioma
Authors: Watchmaker Payal B. , Colton Maggie , Pineo-Cavanaugh Psalm L. , Okada Hideho 
Published: July 2022

Purpose of review
Chimeric antigen receptor (CAR) T cell therapy has been successful in some haematologic malignancies, but the central nervous system (CNS) presents unique obstacles to its use against tumours arising therein. This review discusses recent improvements in the delivery and design of these cells to improve the efficacy and safety of this treatment against malignant gliomas.

Recent findings
The immunosuppressive environment of the CNS affects the functionality of CAR T cells, but recent developments using metabolic manipulation and cytokine delivery have shown that the performance of CAR T cells can be improved in this environment. Emerging techniques can improve the delivery of CAR T cells to the CNS parenchyma, which is normally well protected from peripheral immune cells. The implementation of novel antigens and CAR-expression regulation strategies will improve the specificity and efficacy of these cells. Finally, although autologous T cells have historically been the standard, recent developments have made the use of allogeneic T cells or natural killer (NK) cells more clinically feasible.

Summary
The discoveries highlighted in this review will aid the development of CAR cells that are safer, more resilient against immunosuppressive signals in the CNS, and able to specifically target intracranial tumour cells.
Molecular oncology: what is needed to speed access to innovative therapies in clinical research?
Authors: Gourari Karim , Awada Ahmad , Kotecki Nuria 
Published: July 2022

Purpose of review
A better understanding of the biology of cancer cells has led in the past 20 years to more and more molecular and immunological driven treatment strategies impacting both clinical trials and day-to-day practice. The aim of this review is to describe new approaches to conduct clinical trials in this area to speed up drug development and increase access to innovation for cancer patients.

Recent findings
The design of an early phase trial has an impact on its clinical benefit. Trials deriving from a specific biomarker or histologic characteristic (also known as enrichment design) are more likely to demonstrate benefit than trials based on a more conventional design. However, the increase of low incidence cancer molecular subtypes poses a major hurdle in the clinical management and drug development research for cancer patients.

Summary
With the identification of news targets and the subsequent introduction of precision medicine, new strategies and tools are needed to provide access to biomarker identification and target-oriented clinical trials to all cancer patients. We propose to set up a new patient-centered model to conduct clinical trials allowing simply to ‘bring the trial to the patient’.
Squamous Cell Carcinoma With Bone Invasion: A Systematic Review and Pooled Survival Analysis
Authors: Russell Emma , Udkoff Jeremy , Knackstedt Thomas 
Published: July 2022

BACKGROUND
Bone invasion has long been recognized as a poor prognostic indicator for cutaneous squamous cell carcinoma (SCC). Survival analyses of factors associated with SCC with bone invasion have not been published.

OBJECTIVE
To analyze all published demographic, clinical, and treatment data for SCC with bone invasion and assess the impact of prognostic variables on disease progression, disease-specific death, and overall mortality.

MATERIALS AND METHODS
A systematic review and pooled-survival analysis was performed using individual patient data from case reports. Progression-free survival (PFS), disease-specific survival (DSS), and overall survival (OS) were estimated by Kaplan–Meier analysis.

RESULTS
The study included 76 cases of SCC with bone invasion from 49 publications. Recurrent tumors and nonsurgical treatment modality were predictors of disease progression in univariable analysis and tumors of the trunk, head, and neck were predictors of disease progression in multivariable analysis. At 5 years from bone invasion diagnosis, patients had a PFS, DSS, and OS rate of 66.7%, 71.7%, and 66.2%, respectively.

CONCLUSION
Cases of SCC with bone invasion had poor DFS, DSS, and OS rates, with worse outcomes imparted to tumors of the trunk, head, and neck.
Exposure to natural vegetation in relation to mammographic density in a Massachusetts-based clinical cohort
Authors: Blair Lyndsey K. , Warner Erica T. , James Peter , Hart Jaime E. , VoPham Trang , Barnard Mollie E. , Newton Johnnie D. , Murthy Divya J. , Laden Francine , Tamimi Rulla M. , DuPre Natalie C. 
Published: July 2022

Background:
Inverse associations between natural vegetation exposure (i.e., greenness) and breast cancer risk have been reported; however, it remains unknown whether greenness affects breast tissue development or operates through other mechanisms (e.g., body mass index [BMI] or physical activity). We examined the association between greenness and mammographic density—a strong breast cancer risk factor—to determine whether greenness influences breast tissue composition independent of lifestyle factors.

Methods:
Women (n = 2,318) without a history of breast cancer underwent mammographic screening at Brigham and Women’s Hospital in Boston, Massachusetts, from 2006 to 2014. Normalized Difference Vegetation Index (NDVI) satellite data at 1-km2 resolution were used to estimate greenness at participants’ residential address 1, 3, and 5 years before mammogram. We used multivariable linear regression to estimate differences in log-transformed volumetric mammographic density measures and 95% confidence intervals (CIs) for each 0.1 unit increase in NDVI.

Results:
Five-year annual average NDVI was not associated with percent mammographic density in premenopausal (β = –0.01; 95% CI = –0.03, 0.02; P = 0.58) and postmenopausal women (β = –0.02; 95% CI = –0.04, 0.01; P = 0.18). Results were similar for 1-year and 3-year NDVI measures and in models including potential mediators of BMI and physical activity. There were also no associations between greenness and dense volume and nondense volume.

Conclusions:
Greenness exposures were not associated with mammographic density.

Impact:
Prior observations of a protective association between greenness and breast cancer may not be driven by differences in breast tissue composition, as measured by mammographic density, but rather other mechanisms.
Bone Flap Preservation in Subcutaneous Abdominal Pocket for Decompressive Craniectomy
Authors: Ishikawa Yohei , Kamochi Hideaki , Ishizaki Ryuji , Wataya Takafumi 
Published: July 2022

Summary:
We report our experiences of two pediatric cases in which a bone flap was preserved in the subcutaneous abdominal pocket for decompressive craniectomy. In one case, the bone flap was divided and preserved for cranioplasty without complications; in the other case, the bone flap was left intact as one piece. In pediatric patients, the storage space for a bone flap is sometimes difficult to achieve, and the technique described herein is useful in such situations. Notably, because the bone resorption rate with cryopreservation is higher in pediatric patients, in vivo preservation may be more useful in this population.
Impairments in Physiological Reactivity to Emotive Stimuli After Traumatic Brain Injury: A Systematic Review of Skin Conductance and Heart Rate Variability Evidence
Authors: Sarah Alysha , Ownsworth Tamara , Clough Bonnie , Neumann David L. 
Published: July 2022

Objective:
To examine evidence of impairments in physiological reactivity to emotive stimuli following traumatic brain injury (TBI).

Methods:
A search of PsychINFO, CINAHL (Cumulative Index to Allied Health Literature), Web of Science, EMBASE (Excerpta Medica dataBASE), and Scopus databases was conducted from 1991 to June 24, 2021, for studies comparing changes in skin conductance or heart rate variability to emotive stimuli between adults with TBI and controls. Two reviewers independently assessed eligibility and rated methodological quality.

Results:
Twelve eligible studies examined physiological reactivity to laboratory-based emotive stimuli, which included nonpersonal pictures/videos, posed emotion, stressful events, and personal event recall. Overall, 9 reported evidence that individuals with TBI experience lower physiological reactivity to emotive stimuli compared with healthy controls, although the findings varied according to the type and valence of emotional stimuli and physiological parameter. Most studies using nonpersonal pictures or videos found evidence of lower physiological reactivity in TBI participants compared with controls.

Conclusions:
Based on laboratory-based studies, individuals with TBI may experience lower physiological reactivity to emotive stimuli. Further research is needed to investigate physiological responses to personally relevant emotional stimuli in real-world settings and to understand the interplay between physiological reactivity, subjective experiences, and behavior.