bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perspectives on Training and Working in the VHA: Implications for Primary Care Physician Recruitment and Retention
Authors: Moldestad Megan , Sayre George , Rinne Seppo , Kaboli Peter J. , Reddy Ashok , Sanders Karen M. , Mao Johnny , Henrikson Nora B. , Sterling Ryan , Nelson Karin M. , Wong Edwin S. 
Published: February 2022

Purpose
The primary care physician shortage in the United States presents significant challenges for health systems seeking to maintain a sufficient primary care workforce. Perspectives on training or working in primary care in the Veterans Health Administration (VHA) may yield insights into strategic recruitment to make the VHA and other health systems more attractive to primary care physicians. The authors sought to understand the experiences of resident and staff physicians with limited tenure within VHA primary care to identify factors to guide health systems in improving recruitment and retention.

Method
This qualitative exploratory study was conducted from June 2018 to October 2019 with 24 internal medicine residents and 30 staff physicians in VHA primary care. Heterogeneity was ensured by sampling for geographical region, rurality, and gender within each cohort. The authors conducted semistructured interviews to ascertain perspectives on training and employment preferences at VHA and non-VHA sites. Combined content analysis was used to generate findings.

Results
The authors identified 4 key themes, centered around shared values and the VHA’s mission-driven culture: the VHA “community” was perceived as unique and a major contributor to job satisfaction; facility-level leadership support was important to perceptions of workplace culture around harassment; the VHA primary care delivery model allowed residents and staff physicians to get patients needed care but did not always live up to its potential; and VHA employment was better than expected, but the process of getting hired was a challenge.

Conclusions
Mission and workplace culture may serve important roles in the desirability of health systems for prospective physicians and the job satisfaction of physicians who work in these systems. Physician recruitment efforts based on these attributes may yield the most success in maintaining a sufficient physician workforce.
Implementation of a Case Investigation and Contact Tracing Program at an Academic Medical Center in New York City
Authors: Bruno Denise M. , Afable Aimee , Pervil-Ulysse Mona , Putman Jeffrey S. , Demissie Kitaw 
Published: February 2022

Problem
In the spring of 2020, New York City was an epicenter of COVID-19 infections, hospitalizations, and mortality. One of the hardest hit areas in New York City was central Brooklyn, where State University of New York (SUNY) Downstate is located. As the severity of the initial wave of the COVID-19 pandemic waned in New York City, SUNY Downstate Health Sciences University planned to institute COVID-19 surveillance on campus to limit its spread among employees and students.

Approach
In collaboration with university leadership and students across schools, the SUNY Downstate Contact Tracing Corps was established in July 2020. Using guidance from the Centers for Disease Control and Prevention and the New York State Department of Health, protocols for case and contact investigations, including scripts, were developed. Students were recruited and trained in remote and confidential case and contact investigations.

Outcomes
From August 1, 2020, to March 23, 2021, there were 185 COVID-19 cases referred to the contact tracing program; of these, 180 were successfully investigated and isolated (97%). Case investigations identified 111 Downstate close contacts; 105 were investigated and quarantined (94.5%). There were 122 exposure-only investigations referred to the program, and 121 were successfully investigated and quarantined (99%).

Next Steps
The SUNY Downstate Contact Tracing Corps transitioned to a core group of tracers in January 2021 and has been maintained at 4 to 6 tracers since that time. With the emergence of COVID-19 variants, the threat of new variants, and variable COVID-19 vaccination rates across Brooklyn, Downstate employees and students remain vulnerable to COVID-19 transmission. Given this, the SUNY Downstate Contact Tracing Corps will continue to conduct case and contact investigations.
Cannabidiol Effect on Anxiety Symptoms and Stress Response in Individuals With Cocaine Use Disorder: Exploratory Results From a Randomized Controlled Trial
Authors: Mongeau-Pérusse Violaine , Rizkallah Elie , Morissette Florence , Brissette Suzanne , Bruneau Julie , Dubreucq Simon , Gazil Guillaume , Trépanier Annie , Jutras-Aswad Didier 
Published: February 2022

Objectives
Individuals with a cocaine use disorder (CUD) are more likely to present anxiety, which in turn negatively impacts substance use outcomes. Some evidence suggests that cannabidiol (CBD) presents anxiolytic properties and could be a treatment for substance use disorders. This study explores CBD’s effect on stress biomarker (cortisol) and anxiety symptoms in people with CUD.

Methods
Exploratory analyses were conducted using data from a randomized, double-blind, placebo-controlled trial evaluating CBD’s efficacy to treat CUD. We randomized 78 individuals with CUD into receiving a daily oral dose up to 800 mg CBD (n = 40) or placebo (n = 38). The trial was divided into 2 phases: an inpatient detoxification lasting 10 days and an outpatient follow-up lasting 12 weeks. Anxiety symptoms and stress response were assessed using a visual analog scale, the Beck Anxiety Inventory, and cortisol levels at multiple time points throughout the study. We also measured anxiety after a stressful and a cocaine-cue scenarios. We used generalized estimating equations models and multiple linear regression to assess CBD’s effects on anxiety and cortisol levels.

Results
Both treatment groups had similar mean anxiety scores according to the Beck Anxiety Inventory (P = 0.27) and the visual analog scale (P = 0.18). CBD did not decrease anxiety after a stressful (P = 0.14) and a cocaine (P = 0.885) scenarios compared with placebo. No statistically significant group difference was found in cortisol levels (P = 0.76).

Conclusions
We found no evidence for 800 mg of CBD to be more efficacious than placebo for modulating anxiety symptoms and cortisol levels in individuals with CUD.
Transosseous Suture With an All-FiberWire Technique in Patellar Fracture Fixation
Authors: Wongthongsalee Ponrachai , Chobpenthai Thanapon 
Published: February 2022

Background:
Patellar fractures account for 0.5% to 1.5% of all bone fractures. Tension band wiring with heavy gauge steel wire and K-wires is traditionally procedure for treating patellar fractures. However, this method is associated with implant-related complications. Present study aimed to evaluate functional clinical outcomes of patellar fracture fixation with transosseous suture using an all-FiberWire technique.

Methods:
This was a retrospective study involving 16 patellar fractures patients were repaired by open reduction and internal fixation with FiberWire using a 3-transosseous tunnel technique. The functional outcomes were evaluated with Tegner-Lysholm and Bostman scoring. We also evaluated clinical and radiologic outcomes.

Results:
The mean time to bony union was 8.87±1.54 weeks (range, 7 to 12 wk). The mean Bostman score at final follow-up was 27.13±2.5 (range, 21 to 30), and mean Lysholm score at final follow-up was 90.69±5.75 (range, 83 to 100). Fractures healed in all patients, with no fixation failures. Minor loss of reduction (<2 mm) were observed in 3 patients (18.75%). No patient has reoperation. One patient developed knee stiffness, with an infected hematoma 10 weeks postoperatively. None of patients developed anterior knee pain postoperatively. Two patients (12.5%) developed mild localized pain from prominent suture knots. There were no significant implant-related complications and no repeat surgery was necessary.

Conclusions:
The use of nonmetallic sutures with an all-FiberWire technique in patellar fracture fixation avoids implant-associated complications and possibility of a second surgery to remove metal implants. Nonmetallic high-resistance FiberWire matches traditional metallic fixation, with a reduced risk of postoperative complications.

Level of Evidence:
Level IV (therapeutic).
CytoSorb Rescue for COVID-19 Patients With Vasoplegic Shock and Multiple Organ Failure: A Prospective, Open-Label, Randomized Controlled Pilot Study*
Authors: Stockmann Helena , Thelen Philipp , Stroben Fabian , Pigorsch Mareen , Keller Theresa , Krannich Alexander , Spies Claudia , Treskatsch Sascha , Ocken Michele , Kunz Julius Valentin , Krüger Anne , Khadzhynov Dmytro , Kron Susanne , Budde Klemens , Eckardt Kai-Uwe , Enghard Philipp , Lehner Lukas Johannes 
Published: February 2022

OBJECTIVES:
To investigate the effect of extracorporeal cytokine reduction by CytoSorb (CytoSorbents, Monmouth Junction, NJ) on COVID-19–associated vasoplegic shock.

DESIGN:
Prospective, randomized controlled pilot study.

SETTING:
Eight ICUs at three sites of the tertiary-care university hospital Charité—Universitätsmedizin Berlin.

PATIENTS:
COVID-19 patients with vasoplegic shock requiring norepinephrine greater than 0.2 µg/kg/min, C-reactive protein greater than 100 mg/L, and indication for hemodialysis.

INTERVENTIONS:
Randomization of 1:1 to receive CytoSorb for 3–7 days or standard therapy. To account for inadvertent removal of antibiotics, patients in the treatment group received an additional dose at each adsorber change.

MEASUREMENTS AND MAIN RESULTS:
The primary endpoint was time until resolution of vasoplegic shock, estimated by Cox-regression. Secondary endpoints included mortality, interleukin-6 concentrations, and catecholamine requirements. The study was registered in the German Registry of Clinical Trials (DRKS00021447). From November 2020 to March 2021, 50 patients were enrolled. Twenty-three patients were randomized to receive CytoSorb and 26 patients to receive standard of care. One patient randomized to cytokine adsorption was excluded due to withdrawal of informed consent. Resolution of vasoplegic shock was observed in 13 of 23 patients (56.5%) in the CytoSorb and 12 of 26 patients (46.2%) in the control group after a median of 5 days (interquartile range [IQR], 4–5 d) and 4 days (IQR, 3–5 d). The hazard ratio (HR) for the primary endpoint, adjusted for the predefined variables age, gender, extracorporeal membrane oxygenation-therapy, or time from shock onset to study inclusion was HR, 1.23 (95% CI, 0.54–2.79); p = 0.63. The mortality rate was 78% in the CytoSorb and 73% in the control group (unadjusted HR, 1.17 [95% CI, 0.61–2.23]; p = 0.64). The effects on inflammatory markers, catecholamine requirements, and the type and rates of adverse events were similar between the groups.

CONCLUSIONS:
In severely ill COVID-19 patients, CytoSorb did not improve resolution of vasoplegic shock or predefined secondary endpoints.
Knee Reconstruction following Sarcoma Resection Utilizing Pedicled Anterolateral Thigh Propeller Flap: A Case Series
Authors: Benedict Katherine C. , Wegener Brown Kathryn , Barr Jennifer S. , McIntyre Benjamin C. 
Published: February 2022

Summary:
Coverage of knee wounds with exposure or violation of the joint capsule has long been a challenge to plastic surgeons. Wide resection and radiation treatment for soft-tissue sarcomas further this difficulty due to resultant diminished vascularity and soft tissue fibrosis. Traditional muscle flaps such as the gastrocnemius may be within the radiated field, limiting their arc of rotation to the knee. We present a series of exposed knee joint reconstructions using pedicled propeller flaps after sarcoma resection. Three patients diagnosed with soft tissue sarcomas underwent neoadjuvant radiation followed by wide local resection by orthopedic oncology. All patients had underlying knee joint exposure and underwent successful soft tissue reconstruction utilizing pedicled anterolateral thigh (ALT) propeller flaps. The ALT flap is widely used in plastic surgery for reconstruction of soft tissue defects due to its reliable vascularity, long pedicle, versatility, low donor-site morbidity, and large size. As a propeller flap, we demonstrate this is a viable alternative for reconstruction when the vascular plexus around the knee is unreliable after neoadjuvant radiation. Extending the ALT propeller flap with a large proximal skin paddle provides a nonmicrosurgical alternative to traditional muscle flaps at this location. The ALT propeller flap is an excellent option for reconstruction of large defects of the knee, especially in the setting of a radiated wound bed with unpredictable vascularity. In our case series, all three patients underwent successful reconstruction of exposed knee joints after resection of soft tissue sarcoma utilizing ALT propeller flaps.
A Structured Review of Commercially Available Cardiac Rehabilitation mHealth Applications Using the Mobile Application Rating Scale
Authors: Meddar John M. , Ponnapalli Aditya , Azhar Rimsha , Turchioe Meghan Reading , Duran Andrea Tiana , Creber Ruth Masterson 
Published: February 2022

Purpose:
This study systematically evaluated the quality and functionalities of patient-facing, commercially available mobile health (mHealth) apps for cardiac rehabilitation (CR).

Methods:
We performed our search in two of the most widely used commercial mobile app stores: Apple iTunes Appstore and Google Play Store (Android apps). Six search terms were used to query relevant CR apps: “cardiac rehabilitation,” “heart disease and remote therapy,” “heart failure exercise,” “heart therapy and cardiac recovery,” “cardiac recovery,” and “heart therapy.” App quality was evaluated using the Mobile Application Rating Scale (MARS). App functionality was evaluated using the IQVIA functionality scale, and app content was evaluated against the American Heart Association guidelines for CR. Apps meeting our inclusion criteria were downloaded and evaluated by two to three reviewers, and interclass correlations between reviewers were calculated.

Results:
We reviewed 3121 apps and nine apps met our inclusion criteria. On average, the apps scored a 3.0 on the MARS (5-point Likert scale) for overall quality. The two top-ranking mHealth apps for CR for all three quality, functionality, and consistency with evidence-based guidelines were My Cardiac Coach and Love My Heart for Women, both of which scored ≥4.0 for behavior change.

Conclusion:
Overall, the quality and functionality of free apps for mobile CR was high, with two apps performing the best across all three quality categories. High-quality CR apps are available that can expand access to CR for patients with cardiovascular disease.
Percentage of Age-Predicted Cardiorespiratory Fitness and Risk of Incident Hypertension
Authors: Laukkanen Jari A. , Kunutsor Setor K. 
Published: February 2022

Purpose:
There are inverse and independent associations between cardiorespiratory fitness (CRF) and several adverse cardiometabolic outcomes including hypertension (HTN). The prospective relationship between percentage of age-predicted CRF and risk of HTN has not been previously investigated. We aimed to assess the association of percentage of age-predicted CRF with incident HTN in a long-term prospective cohort study.

Methods:
Cardiorespiratory fitness, as measured by peak oxygen uptake, was assessed using the gold standard respiratory gas exchange analyzer in 1602 men who underwent cardiopulmonary exercise testing. The age-predicted CRF estimated from a regression equation for age was converted to percentage of age-predicted CRF ([achieved CRF/age-predicted CRF] × 100). The HR with 95% CI were estimated for HTN.

Results:
During a median follow-up of 26.8 yr, 308 HTN cases were recorded. There was a linear relationship between age-predicted CRF and incident HTN (P value for nonlinearity = .68). A 1-SD increase in percentage of age-predicted CRF was associated with a decreased risk of HTN in analysis adjusted for established risk factors (HR = 0.79: 95% CI, 0.69-0.90), which remained consistent on further adjustment for several other potential confounders including alcohol consumption, physical activity, socioeconomic status, and inflammation (HR = 0.83: 95% CI, 0.72-0.95). The corresponding adjusted HRs were 0.55 (95% CI, 0.38-0.80) and 0.63 (95% CI, 0.43-0.91), respectively, when comparing extreme quartiles of percentage of age-predicted CRF levels.

Conclusions:
Percentage of age-predicted CRF is linearly, inversely, and independently associated with risk of incident HTN, and it is comparable to absolute CRF as a risk indicator for HTN in a general population of middle-aged men.
Validation of the PROMIS-29v2 Health-Related Quality-of-Life Questionnaire in Patients With Coronary Heart Disease Participating in Remote Cardiac Rehabilitation
Authors: Candelaria Dion , Ladak Laila Akbar , Randall Sue , Kirkness Ann , Roach Kellie , Fethney Judith , Gallagher Robyn 
Published: February 2022

Purpose:
The aim of this study was to validate the 29-item Patient-Reported Outcomes Measurement Information System version 2.0 (PROMIS-29v2) health-related quality-of-life (HRQL) questionnaire for use in patients with coronary heart disease (CHD) participating in remotely delivered cardiac rehabilitation (CR).

Methods:
Patients commencing remote CR across four sites in New South Wales, Australia, answered the PROMIS-29v2 and 12-item Short Form Health Survey version 2.0 (SF-12v2) questionnaires at CR entry and completion (6 wk). The data were analyzed for validity, reliability, and responsiveness to change.

Results:
Patients (N = 89) had a mean age of 66.9 ± 9.3 yr; 83% were male and were referred to CR for elective percutaneous coronary intervention (PCI) (42%), myocardial infarction (36%), and coronary artery bypass grafting (22%). Internal consistency reliability was adequate, with the Cronbach α ranging from 0.78-0.98. Convergent validity between the PROMIS-29v2 and SF-12v2 summary scores showed significantly strong correlations for physical (r = 0.62) and moderate for mental (r = 0.36) health. Discriminant validity was confirmed for sex (women reported lower physical and mental health) and referral diagnosis (patients who had elective PCI reported better physical health). Effect size (ES) comparisons confirmed responsiveness to change from CR entry to completion in physical health (ES = 0.51) and demonstrated evidence of more responsiveness than SF-12v2 for mental health (ES = 0.70).

Conclusion:
The PROMIS-29v2 is reliable, valid, and responsive to changes in patients with CHD attending remotely delivered CR and allows for baseline HRQL assessment, between-diagnosis comparisons, and evaluation of changes over time.
How psychological safety and feeling heard relate to burnout and adaptation amid uncertainty
Authors: Kerrissey Michaela J. , Hayirli Tuna C. , Bhanja Aditi , Stark Nicholas , Hardy James , Peabody Christopher R. 
Published: February 2022

Background
Psychological safety—the belief that it is safe to speak up—is vital amid uncertainty, but its relationship to feeling heard is not well understood.

Purpose
The aims of this study were (a) to measure feeling heard and (b) to assess how psychological safety and feeling heard relate to one another as well as to burnout, worsening burnout, and adaptation during uncertainty.

Methodology
We conducted a cross-sectional survey of emergency department staff and clinicians (response rate = 52%; analytic N = 241) in July 2020. The survey measured psychological safety, feeling heard, overall burnout, worsening burnout, and perceived process adaptation during the COVID-19 crisis. We assessed descriptive statistics and construct measurement properties, and we assessed relationships among the variables using generalized structural equation modeling.

Results
Psychological safety and feeling heard demonstrated acceptable measurement properties and were correlated at r = .54. Levels of feeling heard were lower on average than psychological safety. Psychological safety and feeling heard were both statistically significantly associated with lower burnout and greater process adaptation. Only psychological safety exhibited a statistically significant relationship with less worsening burnout during crisis. We found evidence that feeling heard mediates psychological safety’s relationship to burnout and process adaptation.

Conclusion
Psychological safety is important but not sufficient for feeling heard. Feeling heard may help mitigate burnout and enable adaptation during uncertainty.

Practice Implications
For health care leaders, expanding beyond psychological safety to also establish a feeling of being heard may further reduce burnout and improve care processes.
Outcomes of cataract surgery complicated by posterior capsule rupture in the European Registry of Quality Outcomes for Cataract and Refractive Surgery
Authors: Segers Maartje H.M. , Behndig Anders , van den Biggelaar Frank J.H.M. , Brocato Lucia , Henry Ype P. , Nuijts Rudy M.M.A. , Rosen Paul , Tassignon Marie-José , Young David , Stenevi Ulf , Lundström Mats , Dickman Mor M. 
Published: February 2022

Purpose:
To analyze the outcomes of cataract surgery complicated by posterior capsule rupture (PCR).

Setting:
European clinics affiliated to the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO).

Design:
Retrospective cross-sectional register-based study.

Methods:
Data were retrieved from the EUREQUO between January 1, 2008, and December 31, 2018. The database consists of data on demographics, intraoperative complications such as PCR, type of intraocular lens (IOL) material, postoperative refraction, corrected distance visual acuity (CDVA), and postoperative complications.

Results:
1 371 743 cataract extractions with complete postoperative data were reported in the EUREQUO. In 12 196 cases (0.9%), PCR was reported. After PCR, patients were more likely to receive a poly(methyl methacrylate) IOL (5.2% vs 0.4%, respectively) or no IOL (1.1% vs 0.02%, respectively) compared with patients without PCR. The refractive and visual outcomes in patients with PCR were significantly worse than in those without PCR (mean CDVA 0.13 ± 0.21 vs 0.05 ± 0.16 logMAR, P < .001; mean absolute biometry prediction error 1.15 ± 1.60 diopters [D] vs 0.41 ± 0.45 D, P < .001). A multivariate linear regression analysis, adjusting for potential explanatory variables, confirmed a statistically significant difference (0.04 logMAR, P < .001, and .70 D, P < .001, respectively). Patients with PCR had significantly more postoperative complications (corneal edema 0.88% vs 0.17%, adjusted odds ratio [aOR], 2.80 95% CI, 2.27-3.45, endophthalmitis 0.11% vs 0.02%, aOR, 4.40 95% CI, 2.48-7.81, uncontrolled intraocular pressure 0.55% vs 0.03%, aOR, 14.58 95% CI, 11.16-19.06, P < .001).

Conclusions:
Patients with PCR had significantly worse visual and refractive outcomes and more postoperative complications than patients without PCR. However, most of these patients achieved better postoperative visual acuity than that preoperatively.