bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advancing Point-of-Care Ultrasound Training in Medical Schools: Ultrasound-Guided Subclavian Vein Access Training Using Formalin-Embalmed Cadavers
Authors: Loveless Bosten A. , Muir Maxton W. , Limov Abigail L. , Fritsch Alexa R. , Thomas Rebecca J. , Yancey Taylor J. , Skidmore Chad J. , Zapata Isain , Nigh Andrew D. , Mason Nena Lundgreen 
Published: April 2022

OBJECTIVES:
This brief report examines the feasibility of using formalin-embalmed cadavers in training medical students to use ultrasound guidance to access the subclavian. This novel educational approach is discussed in the context of the ongoing integration of point-of-care ultrasound training into medical education. Additionally, this report explores how cadavers can provide practical, effective, and hands-on skills training opportunities for medical students to learn to perform common clinical procedures under ultrasound guidance.

DESIGN:
This report presents subjective and objective data evaluating the utility of teaching medical students to perform ultrasound-guided subclavian vein access on formalin-embalmed cadavers.

SETTING:
Rocky Vista University College of Osteopathic Medicine in Ivins, UT.

SUBJECTS:
Twenty-five first-year medical students at Rocky Vista University.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Pre and posttraining questionnaires were administered to assess each participant’s self-confidence in using ultrasonography to access the subclavian vein of a cadaver. A statistically significant increase in participant self-confidence was observed across all questionnaire items from pre to posttraining. Objective evaluation consisted of a supervised skills test. Participants were evaluated on their ability to visualize the subclavian vein with ultrasound and achieve flashback of blood/embalming fluid into a syringe. During skills testing, the number of needle sticks and the time taken to achieve flashback were recorded for each participant. Twenty-three of the 25 participants were able to successfully complete the skills testing assessment.

CONCLUSIONS:
The formalin-embalmed cadaver can be a readily available and effective learning tool for medical education programs seeking to provide training opportunities in ultrasound-guided clinical procedures. The use of cadavers allows learners to train in a low stress and anatomically authentic environment without risk of patient discomfort.
Perioperative Tissue Oximetry-driven Fluid Resuscitation Improves Flap Perfusion in Autologous Free Tissue Breast Reconstruction
Authors: Karamanos Efstathios , Ahmad Hassan , Hazboun Rajaie , Lue Melinda , Saad Noah , Wang Howard 
Published: April 2022

Introduction:
The use of tissue oximetry for monitoring following free tissue transfer has become a common practice to facilitate early detection of poor flap perfusion. We hypothesized that T stat readings may guide fluid administration in the postoperative period and improve perfusion in patients undergoing autologous breast reconstruction.

Methods:
Patients undergoing free flap breast reconstruction from 2015 to 2018 were reviewed. Mean percutaneous oximetry readings of the first four postoperative days were recorded. The mean change at 24 hours from the original reading was calculated (∆TO). The study population was divided in two groups based on whether administration of intravenous fluids (IVFs) was increased/maintained (group 1) or decreased (group 2) after postoperative day 1.

Results:
A total of 120 patients were identified. The mean age was 53, and mean BMI was 33. Overall, patients for whom fluid administration was decreased experienced an increase in their tissue perfusion, while patient who received a bolus or maintained the same rate of IVF experienced a decrease. Patients who had a negative ∆TO experienced a statistically significant difference between groups 1 and 2 at 24 and 72 hours (–4 versus +3 and –11 versus +13, respectively). For patients with a positive ∆TO, although decreasing fluids resulted in higher readings, it did not reach statistical significance at 24 or 72 hours (0 versus +2 and +4 versus +6, respectively).

Conclusions:
In patients undergoing free tissue breast reconstruction, tissue oximetry readings may be used as a novel guide for postoperative fluid management.
Temporal stability of self-reported visual back pain trajectories
Authors: Nim Casper Glissmann , Kongsted Alice , Downie Aron , Vach Werner 
Published: April 2022

Abstract
Low back pain (LBP) follows different pain trajectories, and patients seem to recognize their trajectory. This allows self-reported visual pain trajectories (SRVTs) to support patient–provider communication. Pain trajectories appear stable over time for many patients, but the evidence is sparse. Our objectives were to investigate the (1) temporal stability of SRVTs over 1 year concerning pain intensity and course patterns and (2) association of transitions between SRVTs and changes in pain and disability. This study used data from 2 prospective primary care cohorts: the Danish Chiropractic LBP Cohort (n = 1323) and the GLA:D Back cohort (n = 1135). Participants identified one of the 8 SRVTs at baseline and 12-month follow-up, each asking about LBP trajectories the preceding year. Trajectories were described using 2 subscales (intensity and pattern). Temporal stability was quantified by “stability odds ratios” (ORs), depicting the likelihood of staying in the same SRVT after 12 months compared with baseline, and by “preference ORs,” depicting the likelihood of choosing a specific alternative SRVT at follow-up. Both ORs compare the observed proportion with the chance level. Finally, we examined associations between transitioning to a different trajectory and changes in clinical outcomes. Approximately 30% stayed in the same SRVT. The stability ORs were all >1. The preference ORs indicated that transitions occurred mainly to similar SRVTs differing in only 1 subscale. Transitions to less or more intense SRVTs were associated with changes in clinical outcomes in the expected direction. Despite distinctly different SRVTs identified, individuals reported relatively stable LBP phenotypes but with potential for change.
Predictors of Self-care Among Chinese Patients With Chronic Heart Failure
Authors: Zhang Zeyu , Koirala Binu , Gong Guilan , Bai Xue , Mao Jing , Davidson Patricia M. 
Published: April 2022

Background
Self-care is important for improving the health outcomes of individuals with chronic heart failure (CHF). However, predictors of self-care behaviors remain unclear in Chinese society.

Objective
The aims of this study were to explore predictors of self-care in Chinese patients with CHF and clarify the complex relationships between predictors and self-care behaviors guided by the Situation-Specific Theory of Heart Failure Self-Care.

Methods
A cross-sectional study was conducted among individuals hospitalized with CHF in China. Person, problem, and environmental factors pertaining to self-care were collected by a questionnaire survey. Self-care was assessed by the Self-Care of Heart Failure Index version 6. Direct and indirect relationships between factors and self-care behaviors and the mediating role of self-care confidence were analyzed by the structural equation model.

Results
In total, 204 participants were involved in this study. The Situation-Specific Theory of Heart Failure Self-Care model demonstrated a good fit (root mean square error of approximation, 0.046; goodness of fit index, 0.966; normed fit index, 0.914; comparative fit index, 0.971). Inadequate self-care capabilities were common among Chinese patients with CHF. Person-related factors (female gender, higher monthly income and educational level), problem-related factors (severe New York Heart Association function class and better instrumental activities of daily living), and environmental factors (better social support and living in more developed areas) were significant predictors of better self-care behaviors (P < .05). These associations were partly or fully mediated by self-care confidence.

Conclusion
The Situation-Specific Theory of Heart Failure Self-Care can be used to guide research and practice in patients with CHF. Interventions and policies on promoting self-care in Chinese population living with CHF are encouraged, particularly for underserved populations.
Linkage of Optimism With Depressive Symptoms Among the Stroke Survivor and Caregiver Dyads at 2 Years Post Stroke
Authors: Chung Misook L. , Miller Jennifer L. , Lee Suk Jeong , Son Youn-Jung , Cha Geunyeong , King Rosemarie B. 
Published: April 2022

Background
Depressive symptoms are substantial among stroke survivors and their caregivers in poststroke management. Optimism and social support are known to protect against depressive symptoms. However, little is known about how optimism and social support contribute to depressive symptoms among stroke survivor–caregiver dyads. The study's purpose was to examine actor and partner effects of optimism on depressive symptoms through perceived social support among stroke survivors and caregiver dyads in the chronic stage of rehabilitation.

Methods
Stroke survivors and caregivers (N = 105 dyads) completed the survey at 2 years of follow-up after the first stroke. Depressive symptoms, optimism, and perceived social support were assessed using the Center for Epidemiologic Studies-Depression, the Life Orientation Test, and the Interpersonal Support Evaluation List. The Actor-Partner Interdependence Model Extended to Mediation analysis was used to test the indirect effect of optimism on depressive symptoms through perceived social support.

Results
Higher optimism was significantly associated with lower depressive symptoms for caregivers (direct actor effect, −0.6844; 95% confidence interval [CI], −0.9844 to −0.3844) and stroke survivors (direct partner effect, −0.4189; 95% CI, −0.0789 to −0.0889). Perceived social support availability significantly mediated the association between optimism and depressive symptoms for stroke survivors (indirect effect, −0.1957; 95% CI, −0.3923 to −0.0670). Caregiver perceived social support availability was also a significant mediator between caregivers' optimism and stroke survivors' depressive symptoms (indirect effect, 0.1658; 95% CI, 0.0559–0.3128).

Conclusions
Intervention improving dyad members' optimism and social support would be beneficial to improve depressive symptoms of the stroke survivors and caregivers in chronic stroke management.
Workplace Bullying and Incivility in Physical Therapist Education Programs
Authors: Schwarz Brandy , Miller Haylie 
Published: April 2022

Introduction.
Workplace bullying and incivility have been recognized as significant problems in both clinical and academic environments. These negative behaviors can lead to disengagement, stress, and lost productivity. The purposes of this study were to 1) identify predictors of bullying experiences and 2) assess the prevalence of being bullied among faculty and staff working in physical therapist education programs across the United States.

Review of Literature.
More than one-third of US workers are bullied or have witnessed bullying in the workplace. When these disruptive behaviors occur within the context of physical therapist education, the impact can be detrimental to teaching and learning, clinical practice, and individual well-being.

Subjects.
Participants included 529 Doctor of Physical Therapy faculty and staff.

Methods.
Respondents completed the uncivil workplace behavior questionnaire—revised and negative acts questionnaire—revised.

Results.
Survey results revealed that 32.5% of academic faculty had experienced bullying within the last 6 months.

Discussion and Conclusion.
The prevalence of bullying and incivility in academic physical therapy programs approaches that of the general workforce in the United States. Physical Therapy education programs must take an active role in preventing, recognizing, and managing uncivil behaviors in the academic environment.
Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps
Authors: Fatima Hala , Tariq Tooba , Gilmore Ashley , Kim Hak Nam , Tang John , Ghabril Marwan , Abdeljawad Khaled 
Published: April 2022

Objectives:
Pedunculated polyps (PPs) in the colon are usually resected with hot snare polypectomy to prevent immediate postpolypectomy bleeding (IPPB). This study aimed to evaluate the safety of CSP of <10 mm PPs.

Materials and Methods:
Patients undergoing colonoscopy from February 18, 2019, to April 24, 2020, and were found to have at least 1 ≤10 mm PP resected with CSP were included prospectively in a continuous quality improvement project to assess the risk of IPPB and delayed postpolypectomy bleeding. Polyp location, size, and pathology, as well as the method of resection, were recorded. In addition, we assessed the occurrence and severity of IPPB and the need for intervention.

Results:
We found 239 eligible polyps in 182 patients. The mean (SD) age was 58.8 (8.3) years, and 61% were males. IPPB occurred in 72 of 239 polyps, corresponding to a per-polyp bleeding percentage of 30.1% and in 65 of 182 patients, equating to a per-patient bleeding rate of 35.7%. We successfully treated bleeding by endoscopic hemostasis in 57%; the remaining 31 polyps (43%) did not require endoscopic intervention. There was no association between IPPB with age, gender, or use of aspirin or antithrombotic agents. In the bivariate model, polyp size and pathology were not associated with the risk of IPPB. Right-sided polyps were associated with a reduced risk of IPPB in the bivariate model by 61% (odds ratio=0.39; 95% confidence interval, 0.21-0.74; P=0.0057). In the multivariate model, choking the polyp base decreased the likelihood of IPPB by 97% (odds ratio=0.03; 95% confidence interval, 0.00-0.86; P=0.0459). There were no instances of delayed bleeding, perforation, or postpolypectomy syndrome.

Conclusions:
CSP can be used for resection of ≤10 mm PPs. It is associated with a lower risk of immediate bleeding than the common perception among gastroenterologists.
Clinical Adverse Events and Device Failures Reported for the Captivator and Duette Endoscopic Mucosal Resection (EMR) Systems
Authors: Hagenstein Lauren D. , Dubrouskaya Katsiaryna , Ramai Daryl , Adler Douglas G. 
Published: April 2022

Introduction:
Endoscopic mucosal resection (EMR) is a widely used technique for the removal of precancerous or select cancerous mucosal-based lesions. Two systems used for EMR of upper gastrointestinal lesions are the Duette EMR kit and the Captivator EMR kit. The aim of this study is to analyze the reports submitted to the Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for patient-related adverse events and device failures associated with these EMR kits.

Methods:
We analyzed postmarketing data from the FDA MAUDE from August 2004 to August 2021.

Results:
Eighty-four MAUDE reports were found in the study period from August 2004 to August 2021. In total, device issues comprised 36.9% of the reports (n=31) and patient adverse events comprised 63.09% of the reports (n=53). Device issues that were reported included, but were not limited to, band placement/deployment failure (8.1%), suture breakage (7.31%), and snare breakage (4.94%). Patient adverse events that were reported included, but were not limited to, bleeding (25.9%), perforation (7.31%), and snare breakage (4.94%).

Conclusion:
Captivator EMR and Duette EMR have similar patterns of technical failure and clinical adverse events. More MAUDE reports exist for Duette EMR, possibly due to its longer duration of commercial availability.
Advancing Nursing Leadership Science Through an Innovative Research-Practice Partnership
Authors: Nelson-Brantley Heather V. , Prestia Angela , Warshawsky Nora E. , Ferren Melora 
Published: April 2022

ABSTRACT
The Association for Leadership Science in Nursing and American Organization for Nursing Leadership Foundation have formed a new research-practice collaborative. The collaborative allows for a synergistic approach to the advancement of leadership science. This article discusses the impetus for the collaborative, its structure, and how its synergy of research and practice expertise provides immense opportunity for robust, practice-relevant research.
Selecting an Instrument for Assessing the Risk of Patient Violence Across a Healthcare System
Authors: Emmerling Sheryl A. , Croland Jennifer A. , Nimtz-Rusch Kelly L. 
Published: April 2022

ABSTRACT
Physical violence is one of the leading causes of nurse injury in the workplace. Studies indicate patients most often incite the violence and both patient and organization factors contribute to violent events. It has been suggested that an assessment be done upon admission to identify those patients at risk for violent behavior. To implement this intervention, organizations must objectively select a screening instrument that is accurate, easy to use, and appropriate for multiple patient populations.
Changes in Testing and Diagnoses of Sexually Transmitted Infections and HIV During the COVID-19 Pandemic
Authors: Chang Jennifer J. , Chen Qiaoling , Dionne-Odom Jodie , Hechter Rulin C. , Bruxvoort Katia J. 
Published: April 2022

Abstract
We evaluated changes in rates of testing and diagnoses of sexually transmitted infections during the 2017–2020 period at Kaiser Permanente Southern California. During the COVID-19 pandemic period, we observed profound reductions in testing and fewer diagnoses of chlamydia, gonorrhea, and HIV compared with prepandemic periods, but syphilis diagnoses rates increased by 32%.
Career Development in Pediatric Emergency Medicine
Authors: Chumpitazi Corrie E. , Allister Lauren , Cho Christine , Hoffmann Jennifer A. , Hsu Deborah , Iyer Maya , Mangold Karen , Marino Meg , Randell Kimberly A. , Ponce Haley , Hariharan Selena 
Published: April 2022

Objectives
The Women in Pediatric Emergency Medicine (PEM) subcommittee of the American Academy of Pediatrics Section on Emergency Medicine identified 2 top priorities for 2021: career development and mentorship/sponsorship. The objective of this study was to catalog and delineate the career development domains for women physicians in PEM.

Methods
After a review of the literature to identify the key areas for gaps for women in PEM, we used Q sort methodology to elicit domains for this subcommittee to address by survey of a national sample.

Results
One hundred fourteen discrete potential areas of interest for career development were identified by the working group based on salient themes from the literature and personal experiences. Forty-one Women in PEM subcommittee members (27%) completed the survey. The career development topics were sorted into the domains of personal (40.4%; n = 46), administrative (28.1%; n = 32), research (10.5%; n = 12), teaching (10.5%; n = 12), service (7.0%; n = 8), and clinical (3.5%; n = 4).

Conclusions
This study demonstrates that the career development needs of women in PEM include a range of personal, teaching, research, administrative, clinical, and service domains. However, more than two-thirds of the career development topics were categorized into just 2 domains, administrative and personal.
The Feasibility of Using Point-of-Care Ultrasound During Cardiac Arrest in Children
Authors: Leviter Julie I. , Chen Lei , O'Marr Jamieson , Riera Antonio 
Published: April 2022

Introduction
Resuscitation guidelines emphasize minimal interruption of compressions during cardiopulmonary resuscitation. Point-of-care ultrasound (POCUS) enables the clinician to visualize cardiac contractility and central artery pulsatility. The apical 4-chamber (A4), subxiphoid (SX), and femoral artery views may be used when defibrillator pads or active compressions preclude parasternal cardiac views. We hypothesized that clinicians can rapidly obtain interpretable POCUS views in healthy children from the A4, SX, and femoral positions.

Methods
A prospective study of pediatric emergency medicine providers in an urban academic hospital was performed. Stable patients of 12 years or younger were scanned. Sonologists were each allotted 10 seconds to acquire A4, SX, and femoral views. Two attempts at each view were allowed. The primary outcome was whether cardiac and femoral artery scans were interpretable for contractility and pulsatility, respectively. The secondary outcome was whether cardiac scans were interpretable for effusion or right ventricular strain. A POCUS expert reviewed scans to confirm interpretability.

Results
Twenty-two sonologists performed a total of 50 scans on 22 patients. A view that was interpretable for contractility was obtained on the first attempt in 86% of A4 and 94% of SX scans. A femoral view that was interpretable for pulsatility was obtained on the first attempt in 74% of scans. Expert review was concordant with sonologist interpretation.

Conclusions
Pediatric emergency medicine physicians can obtain interpretable cardiac and central artery views within 10 seconds most of the time. Point-of-care ultrasound has the potential to enhance care during pediatric resuscitation. Future studies on the impact of POCUS pulse checks in actual pediatric resuscitations should be performed.
Significance of lymph node fine needle aspiration for the diagnosis of HIV-associated lymphoma in a low-resource setting
Authors: Vogt Samantha L. , Maloma Lucia , Xian Rena R. , Ambinder Richard F. , Philip Vinitha , Patel Moosa , Martinson Neil A. , Omar Tanvier 
Published: April 2022

Objective:
Fine needle aspiration (FNA) is an early step in the work-up of lymphadenopathy in people living with HIV (PLWH). We set out to characterize the FNA cytology in PLWH and report on the time to lymphoma diagnosis through the FNA clinics in the public healthcare system in Johannesburg, South Africa.

Design:
Retrospective review of laboratory database

Methods:
A retrospective chart review of patients undergoing FNA through the department of cytopathology at the National Health Laboratory Service (NHLS) was undertaken. Results of FNAs performed between March to May 2018 were reviewed. Medical record chart abstraction included general demographics, HIV status, site and results of FNA, prior history of malignancy and other laboratory data.

Results:
Five hundred and thirty-nine lymph node FNAs were performed on PLWH. Pathological findings included tuberculosis 47% (252), inadequate sampling 14% (75), reactive adenopathy 13% (71), benign pathology 12% (63), suspicious for lymphoproliferative neoplasm 8% (45), other malignancy 4% (21) and inflammation 2% (n = 12). Only 53% (24) of lymphomas were confirmed by biopsy. Those not confirmed had a high mortality (57%) and loss to follow-up rate (29%) over the following year. The median diagnostic interval exceeded 8 weeks from time of FNA to lymphoma diagnosis.

Conclusions:
FNA is an important screening modality in this high HIV and TB burden region. Patients with cytology suggestive for lymphoma, but without biopsy confirmation, have a high mortality rate suggesting undiagnosed lymphoma. A better understanding of the barriers to appropriate diagnostic triage for lymphoma is needed.