bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histopathological Evidence of Canalicular Agenesis in Patients With Punctal Agenesis: Punctum Update Study 2
Authors: Bothra Nandini , Ali Mohammad Javed 
Published: April 2022

Purpose:
The purpose of this study was to histologically assess the presence and extent of the canalicular tissue in cases of punctal agenesis.

Methods:
A prospective, interventional study was performed on 10 consecutive cases of punctal agenesis over a study period of 6 months. Exclusion criteria included cases with punctal dysgenesis or incomplete punctal canalization, secondary/acquired cases of punctal effacement, or any prior interventions. Following the exploration, the entire specimen of the tissue (length = 8 mm and depth = 3 mm) was sent for histopathological analysis to ascertain the presence and extent of the canalicular tissue.

Results:
The mean age of the patients at the time of exploration was 7.5 years (range 6–10 years). Histopathological analysis showed tissue surfaces lined with stratified squamous epithelium with occasional interspersed goblets cells (conjunctival epithelium), a few chronic inflammatory cells, and muscle fragments. Epithelium suggestive of proximal lacrimal drainage system was absent. Canalicular tissues were found to be absent in all cases of punctal agenesis.

Conclusion:
The present series did not find any histologic evidence of canalicular tissues in cases of punctal agenesis. The findings of this study do not support retrograde approaches in cases of punctal agenesis.
Microbial Metagenomics of the Extubated Lacrimal Stents Following Dacryocystorhinostomy: The Lacriome Paper 4
Authors: Ali Mohammad Javed 
Published: April 2022

Purpose:
To study the metagenome of the microbes present on the extubated lacrimal stents following a dacryocystorhinostomy.

Methods:
A prospective study was performed on 10 consecutive extubated lacrimal stents obtained for the metagenomic analysis from the patients following an endoscopic dacryocystorhinostomy. The stents were extubated at 4 weeks postoperatively under endoscopic guidance and immediately transported on ice to the laboratory. Following DNA extraction and library preparation, a whole shotgun metagenome sequencing was performed on the Illumina platform. The downstream processing and bioinformatics of the samples were performed using multiple software packaged in SqueezeMeta pipeline or MG-RAST pipeline.

Results:
The taxonomic hit distribution across the stent samples showed that bacteria were the most common isolates (mean, 69.70%), followed by viruses (mean, 0.02%) and archaea (0.003%). The 3 major phyla identified were Firmicutes, Actinobacteria, and Proteobacteria. The prevalent organisms include Pseudomonas aeruginosa, Staphylococcus aureus, Corynebacterium accolens, Dolosigranulum pigrum, Citrobacter koserii, Staphylococcus epidermidis, E. coli, and Hemophilus influenza. The functional subsystem profiling demonstrated microbial genes associated with metabolism, cellular, and information processing. The functional subsystem categories were metabolism involving carbohydrates, amino acids, DNA and RNA, cell wall or cell capsule biogenesis, membrane transport, virulence, and defense mechanisms.

Conclusions:
The present study is the first whole metagenome sequencing of the microbes isolated from the extubated lacrimal stents. The stents harbor diverse microbial communities with distinct ecosystem dynamics. Further studies on microbes-host interactions in the early postoperative period would provide valuable insights.
Somatic Changes Perceived by Patients With Heart Failure During Acute Exacerbation
Authors: Okada Akiko , Tsuchihashi-Makaya Miyuki , Nagao Noriko , Ochiai Ryota 
Published: April 2022

Background
Patients with heart failure (HF) often inadequately perceive their symptoms. This may be because the medical terms do not match the somatic changes experienced by patients. To improve symptom perception, healthcare professionals must understand the somatic changes as perceived by patients.

Objective
This study aims to analyze patients' narratives about somatic changes in patients with HF by text mining and to clarify the overall description of somatic changes using patients' expressions.

Methods
Semistructured interviews were conducted on 21 patients hospitalized for acute exacerbation of HF. Qualitative data obtained from the interviews were analyzed by content analysis through text mining.

Results
Among the 21 patients, 76.2% were men. The mean (SD) age was 71.3 (13.7) years. The most frequently used terms were “breath,” “distressed,” “feet,” and “ha-ha (gasping sound)” (46, 40, 29, and 28 times, respectively). The somatic changes noticed by patients could be categorized into medical jargon such as “dyspnea on exertion,” “exercise intolerance,” “fatigue,” “paroxysmal nocturnal dyspnea,” “frequent urination,” “increased sputum,” “weight gain,” “feet and face edema,” “abdominal edema,” and “ankle edema.” However, the expressions of somatic changes used by the patients were diverse.

Conclusions
The findings of patient-specific expressions of symptoms suggest that there is a need to assess symptoms not only using medical jargon but also by focusing on patient-specific expressions.
Perceived Facilitators and Barriers to Treatment Fidelity in Computerized Cognitive Training Interventions
Authors: Algashgari Elham Y. , Jung Miyeon , Von Ah Diane , Stewart Jesse C. , Pressler Susan J. 
Published: April 2022

Background
Computerized cognitive training (CCT) interventions may have an important role in improving cognition among patients with heart failure. Ensuring treatment fidelity of CCT interventions is an essential part of testing their efficacy.

Objective
The aim of this study was to describe facilitators of and barriers to treatment fidelity perceived by CCT intervenors while delivering the interventions to patients with heart failure.

Methods and Results
A qualitative descriptive study was completed with 7 intervenors who delivered CCT interventions in 3 studies. Directed content analysis revealed 4 main themes of perceived facilitators: (1) training for intervention delivery, (2) supportive work environment, (3) prespecified implementation guide, and (4) confidence and awareness. Three main themes were identified as perceived barriers: (1) technical issues, (2) logistic barriers, and (3) sample characteristics.

Conclusion
This study is novel because it was one of the few studies focused on the intervenors' perceptions rather than the patients' perception of using CCT interventions. Beyond the treatment fidelity recommendations, this study found new components that might help the future investigators in designing and implementing CCT interventions with high treatment fidelity.
Palliative Care for Older Adults Hospitalized for Stroke From the Informal Caregivers' Perspectives
Authors: Su Jing Jing , Lin Rose S. Y. , Paguio Jenniffer , Leung Angela Y. M. , Molassiotis Alex 
Published: April 2022

Background
International guidelines have promoted palliative care (PC) for stroke survivors, but definition and implementation have been less than ideal. This practice gap is more prominent in China, where discussion of death remains taboo.

Aim
The aim of this study was to explore the perspectives of PC among caregivers of hospitalized patients with stroke.

Design and Setting
A descriptive qualitative study design was used. Seventeen in-depth interviews with bedside caregivers in a first-rank tertiary hospital (general hospital with bed capacity exceeding 500) in China were analyzed thematically.

Results
“Promoting comfort” stands at the core of PC and was operationalized by “meeting physical care needs,” “ensuring communication,” “providing psychoemotional care,” “providing cognitive stimulation,” and “avoiding discussion on death and dying.” Caregivers who took care of older adults for a long time have described the use of “cognitive stimulation” to promote patients' positive emotional and cognitive reactions. All interviewees avoided mentioning “death” to protect patients' feelings, because they believed discussion of death was hurtful.

Conclusions
The high care demand for patients with stroke is a defining feature of stroke PC and should be recognized in addition to its prognosis estimation to promote this concept. The healthcare system should integrate PC as part of the regular service for patients with severe stroke to shift the focus of care from survival to promotion of comfort. A discussion of the dying process requires sensitivity and should be approached in a discussion of advanced PC planning, which views death as a meaningful transition.
Differentiated Exophytic Vulvar Intraepithelial Lesions: Case Reports and Review of Literature
Authors: Mendlowitz Ariel R. , Hoang Lien N. , McAlpine Jessica N. , Sadownik Leslie Ann 
Published: April 2022

Objectives
The aims of this article were to describe 2 patients with a pathological diagnosis of differentiated exophytic vulvar intraepithelial lesion and to summarize the literature regarding this relatively new diagnosis.

Materials and Methods
The existing literature was searched on December 1, 2021, using the MEDLINE database (1966–2021), and all combinations of the following search terms were used: “differentiated exophytic vulvar intraepithelial lesion” and “differentiated vulvar intraepithelial neoplasia.”

Results
Patients were postmenopausal and reported persistent vulvar itch associated with white hypertrophic plaques. Initial biopsies did not identify differentiated exophytic vulvar intraepithelial lesion. Invasive squamous cell carcinoma was found in both cases after surgical excision.

Conclusions
Differentiated vulvar intraepithelial lesions and invasive squamous cell carcinoma should be considered in the differential diagnosis of vulvar itch associated with hypertrophic plaques in postmenopausal women. Excision of suspicious plaques is recommended for definitive diagnosis.
Risk Prediction of Pancreatic Cancer in Patients With Recent-onset Hyperglycemia
Authors: Chen Wansu , Butler Rebecca K. , Lustigova Eva , Chari Suresh T. , Maitra Anirban , Rinaudo Jo A. , Wu Bechien U. 
Published: April 2022

Background:New-onset diabetes (NOD) has been suggested as an early indicator of pancreatic cancer. However, the definition of NOD by the American Diabetes Association requires 2 simultaneous or consecutive elevated glycemic measures. We aimed to apply a machine-learning approach using electronic health records to predict the risk in patients with recent-onset hyperglycemia.Materials and Methods:In this retrospective cohort study, health plan enrollees 50 to 84 years of age who had an elevated (6.5%+) glycated hemoglobin (HbA1c) tested in January 2010 to September 2018 with recent-onset hyperglycemia were identified. A total of 102 potential predictors were extracted. Ten imputation datasets were generated to handle missing data. The random survival forests approach was used to develop and validate risk models. Performance was evaluated byc-index, calibration plot, sensitivity, specificity, and positive predictive value.Results:The cohort consisted of 109,266 patients (mean age: 63.6 y). The 3-year incidence rate was 1.4 (95% confidence interval: 1.3-1.6)/1000 person-years of follow-up. The 3 models containing age, weight change in 1 year, HbA1c, and 1 of the 3 variables (HbA1c change in 1 y, HbA1c in the prior 6 mo, or HbA1c in the prior 18 mo) appeared most often out of the 50 training samples. Thec-indexes were in the range of 0.81 to 0.82. The sensitivity, specificity, and positive predictive value in patients who had the top 20% of the predicted risks were 56% to 60%, 80%, and 2.5% to 2.6%, respectively.Conclusion:Targeting evaluation at the point of recent hyperglycemia based on elevated HbA1c could offer an opportunity to identify pancreatic cancer early and possibly impact survival in cancer patients.
Chronic Pancreatitis in Females is Not Associated With Adverse Pregnancy Outcomes
Authors: Rana Atul , Sharma Sanchit , Qamar Sumaira , Zangmo Rinchen , Gopi Srikanth , Agarwal Samagra , Sharma Kandala Aparna , Singh Namrata , Gunjan Deepak , Saraya Anoop 
Published: April 2022

Background:
The effects of chronic pancreatitis (CP) on pregnancy and vice versa have not been studied well. We aimed to study the impact of CP on pregnancy-related outcomes and the effect of pregnancy on clinical profile of CP.

Study and Goals:
We did a retrospective analysis of all female patients of CP of child-bearing age (above 18 y). The pregnancy-related outcomes of patients with CP were compared with the age-matched 115 controls from the low-risk pregnancy group identified using a simplified antepartum high-risk pregnancy scoring form. The clinical course of CP during pregnancy was compared with the pre-pregnancy course.

Results:
Among the 338 eligible patients, 46 patients were included after exclusions. All these 46 patients had at least 1 conception and 41 had at least 1 completed pregnancy with a total of 117 conceptions and 96 completed pregnancies. The pregnancy-related outcomes in patients with CP like abortions (21.7% vs. 11.3%; P=0.087), preterm deliveries (14.6% vs. 10.4%; P=0.47), antepartum course (82.7% vs. 82.6%; P=0.58), stillbirths (4.9% vs. 4.3%; P=0.88), cesarean section (36.6% vs. 34%; P=0.849) were comparable with controls. There was overall improvement in the severity and frequency of pain during pregnancy as compared with the pre-pregnancy symptoms (P=0.001).

Conclusion:
CP is not associated with adverse pregnancy outcomes. Also, there is trend toward improvement in the clinical symptoms because of CP during the pregnancy.
Relational Coordination Among Military and Civilian Nurses and Physicians in an Army Hospital
Authors: House Sherita , Crandell Jamie , Stucky Christopher , Wilmoth Margaret 
Published: April 2022

OBJECTIVE
The aim of this study was to explore whether demographic characteristics and professional roles are associated with relational coordination (RC) among nurses and physicians.

BACKGROUND
The increased race, age, and gender diversity in the nursing and medical workforce raises questions regarding how well nurses and physicians communicate and interact. Relational coordination is a unique framework to enhance teamwork and care coordination among healthcare professionals.

METHODS
An exploratory cross-sectional study was conducted in a military hospital. The study variables were examined using multiple regression.

RESULTS
Two-hundred eighty-nine participants completed the survey. Professional role, race, age, gender, and experience were not associated with RC. Rank and education were significantly associated with RC. Enlisted service members reported higher RC between roles, and participants with graduate degrees reported lower RC within roles.

CONCLUSION
Hospital leaders can implement RC to foster inclusivity and teamwork among healthcare professionals despite demographic characteristics and professional roles.
Clinical Nurse Specialist and Clinical Nurse Leader Dyad
Authors: Racelis Mary Carol , Hallberg Elizabeth , Filer Rachel , Gross Megan , Brownlee Camille , Stifter Janet , Losurdo Holly , Cook Heather 
Published: April 2022

Purpose/Objectives
This article describes an innovative clinical nurse specialist (CNS) and clinical nurse leader (CNL) dyad partnership model. Complexity science framework and clinical exemplars demonstrate how the CNS and CNL roles function synergistically to stabilize complex patient care.

Description of the Project/Program
In spring of 2020, the COVID-19 crisis presented an immediate opportunity to leverage the increased demand for clinical change by leading, designing, and capturing the value of CNS-CNL dyad to achieve goals.

Outcome
The exemplars outline how the partnership promoted translation of knowledge to care for 21 new patient populations and created training for the complex respiratory management during the 6-month project. Rapid response utilization increased from an average of 5 to 10 per month. There was no change in the number of code blue activations on the unit. The third exemplar promoted personal protective equipment clarity and attention to nurse safety. Twelve percent of total staff (n = 104) were diagnosed with COVID-19. Staffing remained stable with 1% resignations (n = 3).

Conclusion
The CNS-CNL dyad revealed an infrastructure built to withstand forces of institutional change. The clinical exemplars provide details for leaders to understand how these separate roles partner to translate knowledge and skills and sustain complex change to meet quality goals.
Diagnostic Value of Advanced Metal Artifact Reduction Magnetic Resonance Imaging for Periprosthetic Joint Infection
Authors: Inaoka Tsutomu , Kitamura Noriko , Sugeta Masayuki , Nakatsuka Tomoya , Ishikawa Rumiko , Kasuya Shusuke , Sugiura Yoshiya , Nakajima Arata , Nakagawa Koichi , Terada Hitoshi 
Published: April 2022

Purpose
This study aimed to evaluate the diagnostic value of magnetic resonance imaging with multiacquisition variable–resonance image combination selective for periprosthetic joint infection (PJI).

Materials and Methods
Magnetic resonance imaging around metal joint prostheses including multiacquisition variable–resonance image combination selective at 1.5 T (from April 2014 to August 2020) was retrospectively evaluated by 2 radiologists for detection of abnormal findings (joint effusion, capsular thickening, pericapsular edema, soft-tissue fluid collection, soft-tissue edema, bone marrow edema pattern around the implant [BME pattern], lymphadenopathy, and others) and overall image impression for PJI. Regarding the soft-tissue fluid collection, presence of communication to the joint or capsular-like structure was evaluated. Clinical assessments were recorded. Positive predictive values (PPVs), negative predictive values (NPVs), and odds ratios (ORs) for PJI were calculated for the abnormal findings. Overall image impression for PJI was evaluated. χ2, Fisher exact, t, and Mann-Whitney U tests and receiver operating characteristic analysis were used. Interobserver agreement was assessed with κ statistics.

Results
Forty-three joints in 36 patients (mean ± SD age, 75.4 ± 8.8 years; 30 women; hip [n = 29], knee [n = 12], and elbow [n = 2]) were evaluated. Eighteen joints (42%) were clinically diagnosed as PJI. The findings suggesting PJI were capsular thickening (PPV, 70%; NPV, 90%; OR, 20.6), soft-tissue fluid collection (PPV, 81%; NPV, 81%; OR, 19.1), soft-tissue edema (PPV, 67%; NPV, 89%; OR, 17), pericapsular edema (PPV, 76%; NPV, 81%; OR, 13.7), and joint effusion (PPV, 55%; NPV, 100%; OR, 12). Soft-tissue fluid collection without capsular-like structure (PPV, 83%; NPV, 74%; OR, 14.4) or with communication to the joint (PPV, 75%; NPV, 71%; OR, 7.3) suggested PJI. The combinations of joint effusion, capsular thickening, pericapsular edema, soft-tissue fluid collection, and soft-tissue edema highly suggested PJI. Regarding the BME pattern, the combination with soft-tissue edema raised the possibility of PJI (PPV, 73%; NPV, 69%; OR, 5.9). Regarding the interobserver agreements for each abnormal finding, κ values were 0.60 to 0.77. Regarding the overall image impression, weighted κ value was 0.97 and areas under the receiver operating characteristic curve were 0.949 (95% confidence interval, 0.893–1.005) and 0.926 (95% confidence interval, 0.860–0.991) with no significant difference (P = 0.534).

Conclusions
The findings suggesting PJI were capsular thickening, soft-tissue fluid collection, soft-tissue edema, pericapsular edema, and joint effusion. The combinations of them highly suggested PJI. Regarding the BME pattern, the combination with soft-tissue edema raised the possibility of PJI.
Factors of Engagement in Synchronous Online Learning Conversations and Distance Debriefing
Authors: Mosher Cynthia J. , Morton Alex , Tarbet Amanda , Palaganas Janice C. 
Published: April 2022

Summary Statement
The COVID-19 pandemic propelled remote simulation and online distance debriefings. Like in-person debriefings, faculty seek to facilitate effective reflective discourse. The online learning environment, however, presents challenges to learner engagement that differ considerably from in-person debriefing, yet little research exists in this area. In an effort to identify factors that influence debriefing engagement in the online environment, we conceptualized distance debriefings as complex social interactions and performed a realist review of the literature for evidence in the fields of online learning, healthcare simulation, instructional design, and other teaching and learning fields to see whether we might discern factors that influence engagement in online learning conversations that might inform online distance debriefing best practices. Eighteen articles were found through our search of 5 online databases (MEDLINE, CINAHL, ERIC, Google Scholar). We conducted iterative purposeful searching and continued to do so throughout the review to try to identify any additional studies that would contribute to our understanding. A thematic analysis of the findings of our included articles revealed indicators categorized using the community of inquiry framework, enabling us to understand and explain them in the context of online learning and propose their application to distance debriefing engagement. We also propose a new dimension to the framework: internal and external factors of engagement. Our findings demonstrate that online learning can positively influence engagement of learners if essential factors are implemented. These factors may inform recommendations for best practices toward learner engagement during healthcare simulation distance debriefing.
Preparing and Presenting Validation Studies
Authors: Calhoun Aaron W. , Scerbo Mark W. 
Published: April 2022

Summary Statement
Simulated environments are frequently used for learner assessment, and a wide array of assessment instruments have been created to assist with this process. It is important, therefore, that clear, compelling evidence for the validity of these assessments be established. Contemporary theory recognizes instrument validity as a unified construct that links a construct to be assessed with a population, an environment of assessment, and a decision to be made using the scores. In this article, we present a primer on 2 current frameworks (Messick and Kane), define the elements of each, present a rubric that can be used by potential authors to structure their work, and offer examples of published studies showing how each framework has been successfully used to make a validity argument. We offer this with the goal of improving the quality of validity-related publications, thereby advancing the quality of assessment in healthcare simulation.