bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concurrent Retropubic Midurethral Sling and OnabotulinumtoxinA for Mixed Urinary Incontinence
Authors: Komar Alix , Bretschneider Carol E. , Mueller Margaret G. , Lewicky-Gaupp Christina , Collins Sarah , Geynisman-Tan Julia , Tavathia Meera , Kenton Kimberly 
Published: December 2020

OBJECTIVE:
To evaluate whether retropubic midurethral sling combined with onabotulinumtoxinA is more effective than sling alone in improving mixed urinary incontinence symptoms.

METHODS:
We conducted a prospective, double-blind, randomized, controlled trial of women with mixed urinary incontinence, planning to undergo midurethral sling. Women were randomly assigned to receive 100 unites of intradetrusor onabotulinumtoxinA or placebo during surgery. Participants completed the PGI-S (Patient Global Impression of Severity), the UDI-6 (Urinary Distress Inventory, Short Form), and the PFIQ-7 (Pelvic Floor Impact Questionnaire–Short Form 7) before and 3 months after surgery, and the primary outcome, PGI-I (Patient Global Impression of Improvement), 3 months postoperatively. Primary outcome was PGI-I score at 3 months for overall incontinence. We considered women “improved” with answers of “very much better” or “much better” on the PGI-I. Assuming a PGI-I response of “improved” in 66% of placebo and 93% of onabotulinumtoxinA participants, 68 women were needed to show a significant difference with 80% power at 0.05 significance level.

RESULTS:
From March 2016 to November 2019, 78 women completed a 3-month follow-up (onabotulinumtoxinA: 41; placebo: 37). Mean age was 51 years (±10). On the PGI-I, the number who “improved” did not differ between groups at 3 months (83% vs 84%, P=1.0). The onabotulinumtoxinA group had less severe urgency symptoms as indicated by median urgency PGI-S scores (1 [interquartile range 1–2] vs 2 [interquartile range 1–3], P=.033) and greater improvement in urgency symptoms based on median urgency PGI-I score (1 [interquartile range 1–3] vs 2 [interquartile range 2–4], P=.028). At 3 months, median UDI-6, PFIQ-7, and PGI-S scores improved significantly from baseline in both groups. Similarly, UDI-6 and PFIQ-7 scores did not differ between groups. More women in the onabotulinumtoxinA arm initiated intermittent self-catheterization, (3% placebo; 12% onabotulinumtoxinA, P=.20) and experienced urinary tract infections (5% placebo; 22% onabotulinumtoxinA, P=.051), but these did not differ statistically.

CONCLUSION:
Concurrent intradetrusor onabotulinumtoxinA injection did not improve overall incontinence symptoms at 3 months compared with placebo among women with mixed urinary incontinence undergoing midurethral sling placement. Women with mixed urinary incontinence undergoing sling report significant improvement in overall incontinence symptoms, regardless of the addition of onabotulinumtoxinA injections, but those receiving concurrent onabotulinumtoxinA injections reported less urgency severity and greater improvement in urgency symptoms at 3 months.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02678377.
Preoperative Pelvic Floor Injections With Bupivacaine and Dexamethasone for Pain Control After Vaginal Prolapse Repair
Authors: Giugale Lauren E. , Baranski Lindsey A. , Meyn Leslie A. , Schott Nicholas J. , Emerick Trent D. , Moalli Pamela A. 
Published: December 2020

OBJECTIVE:
To test the hypothesis that preoperative pelvic floor muscle injections and pudendal nerve blocks with bupivacaine and dexamethasone would decrease postoperative pain after vaginal native tissue prolapse repairs, compared with saline and bupivacaine.

METHODS:
We conducted a three-arm, double-blind, randomized trial of bilateral transobturator levator ani muscle injections and transvaginal pudendal nerve blocks before vaginal reconstructive and obliterative prolapse procedures (uterosacral ligament suspension, sacrospinous ligament fixation, levator myorrhaphy, or colpocleisis). Women were randomized to one of three study medication groups: 0.9% saline, 0.25% bupivacaine, or combination 0.25% bupivacaine with 4 mg dexamethasone. Our primary outcome was a numeric rating scale pain score on postoperative day 1. Using an analysis of variance evaluated at the two-sided 0.05 significance level, an assumed variance of the means of 0.67, and SD of 1.75, we calculated 21 women per arm to detect a 2-point change on the numeric rating scale (90% power), which we increased to 25 per arm to account for 20% attrition and the use of nonparametric statistical methods.

RESULTS:
From June 2017 through April 2019, 281 women were screened and 75 (26.7%) were randomized with no differences in baseline demographics among study arms. There was no significant difference in median pain scores on postoperative day 1 among study groups (median [interquartile range] pain score 4.0 [2.0–7.0] for placebo vs 4.0 [2.0–5.5] for bupivacaine vs 4.0 [1.5–5.0] for bupivacaine with dexamethasone, P=.92).

CONCLUSION:
Preoperative pelvic floor muscle injections and pudendal nerve blocks with bupivacaine and dexamethasone did not improve postoperative pain after vaginal native tissue prolapse procedures.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03040011.
The “Spinal Metastasis Invasiveness Index”
Authors: Kumar Naresh , Ramos Miguel Rafael David , Patel Ravish , Tan Barry Wei Loong , Lopez Keith Gerard , Nolan Colum Patrick , Kumar Aravind , Kumar Dinesh Shree , Liu Gabriel , Benneker Lorin Michael 
Published: December 2020

Study Design.
Retrospective review.

Objective.
The aim of this study was to develop a surgical invasiveness index for metastatic spine tumor surgery (MSTS) that can serve as a standardized tool in predicting intraoperative blood loss and surgical duration; for the purpose of ascertaining resource requirements and aiding in patient education.

Summary of Background Data.
Magnitude of surgery is important in the metastatic spine disease (MSD) population since these patients have a continuing postoperative oncological process; a consideration that must be taken into account to maintain or improve quality of life. Surgical invasiveness indices have been established for general spine surgery, adult deformity, and cervical deformity, but not yet for spinal metastasis.

Methods.
Demographic, oncological, and procedural data were collected from consecutive patients that underwent MSTS. Binary logistic regression, using median values for surgical duration and intraoperative estimated blood loss (EBL), was used to determine statistical significance of variables to be included in the “spinal metastasis invasiveness index” (SMII). The corresponding weightage of each of these variables was agreed upon by experienced spine surgeons. Multivariable regression analysis was used to predict operative time and EBL while controlling for demographical, procedural, and oncological characteristics.

Results.
Two hundred and sixty-one MSD patients were included with a mean age of 59.7-years and near equal sex distribution. The SMII strongly predicted extended surgical duration (R
2 = 0.28, P < 0.001) and high intraoperative blood loss (R
2 = 0.18, P < 0.001). When compared to a previously established surgical invasiveness index, the SMII accounted for more variability in the outcomes. For every unit increase in score, there was a 42-mL increase in mean blood loss (P < 0.001) and 5-minute increase in mean operative time (P < 0.001).

Conclusion.
Long surgical duration and high blood loss were strongly predicted by the newly developed SMII. The use of the SMII may aid in preoperative risk assessment with the goal of improving patient outcomes and quality of life.

Level of Evidence: 4
Long-term Outcome of Ahmed Glaucoma Valve Implantation in Eyes With Intractably Raised Intraocular Pressure Following Pars Plana Vitrectomy
Authors: Pandav Surinder S. , Thattaruthody Faisal , Singh Simar R. , Chandra Kedarisetti K. , Seth Natasha G. , Kaur Savleen , Kaushik Sushmita , Raj Srishti 
Published: December 2020

Precis:
Ahmed glaucoma valve (AGV) implantation led to a significant reduction in intraocular pressure (IOP) and in antiglaucoma medications in vitrectomized eyes in previously nonglaucomatous eyes. The most common indication for vitrectomy was ocular trauma-related complications.

Purpose:
The purpose of this study was to report the long-term outcomes of AGV implantation in patients of uncontrolled IOP after pars plana vitrectomy (PPV).

Materials and Methods:
Medical records of patients (age 18 y and above) who underwent AGV implantation between January 2006 and December 2017 for uncontrolled IOP following PPV with ≥2 years follow-up were reviewed. The underlying etiology for PPV, IOP, best-corrected visual acuity, and number of antiglaucoma medications (AGMs) were recorded at baseline. The main outcomes measures were IOP, number of AGM, best-corrected visual acuity, and postoperative complications. Postoperative complications were classified as early (≤3 mo)/intermediate (>3 mo to ≤1 y), or late (>1 y).

Results:
In all, 78 eyes of 78 patients with a mean age of 38.06±17.83 years were included. The mean follow-up was 70.46±36.96 (range: 24 to 180) months. The main underlying etiology for PPV was trauma (38.4%) followed by rhegmatogenous retinal detachment (28.2%). The mean preoperative IOP was 29.33±9.84 mm Hg with an average of 4.07±1.2 AGM. The mean IOP and number of AGM was significantly reduced in all follow-up visits (P<0.0001) following AGV implantation. The cumulative probability of success was 92.3%, 80.7%, and 74% at 2, 5, and 10 years, respectively. Thirty-one complications were observed in 25 (32%) eyes and reoperation (23 procedures) was performed in 22 (28.2%) eyes.

Conclusions:
AGV implantation had good outcome in patients with intractably elevated IOP following PPV. Trauma-related pathologies were a major contributor to the indications for PPV and had more chances of failure following AGV implantation.
Metabolic syndrome in type 2 diabetic patients: a review of current evidence
Authors: Regufe Virgínia M.G. , Pinto Cristina M.C.B. , Perez Pedro M.V.H.C. 
Published: December 2020

Abstract
The metabolic syndrome (MS) is a set of metabolic disturbances, represented by various cardiovascular risk factors which are generally associated with the central accumulation of fat and the resistance to insulin. Inadequate changes in eating behaviours and weight loss, which are associated to taking part in regular physical activity, are considered to be primary and first choice therapies for the treatment of MS, as they assist in the reduction of the abdominal girth and visceral fat, improve the sensibility to insulin and reduce the plasmatic concentrations of glucose and triglycerides, raise the values of high density lipoproteins and, consequently decrease the risk factors which contribute to the development of type 2 diabetes. The MS is a current discussion theme in the health field as it is related to illnesses/diseases, which not only cause a worldwide high mortality rate but show increasing incidence. Type 2 diabetes is characterised by a deregulation of the carbohydrates, lipids and proteins found in the metabolism and result in diminished secretion of insulin, resistance to insulin or a combination of both. Type 2 diabetes is the most form of diabetes of the first 3 types of diabetes, representing 90% of all cases. Diabetes is a chronic and complex disease which requires a strict medical follow-up so as to reduce the risks and obtain strategies for its control. The fast-epidemiological global evolution which has been registered in the last few years, leads to it being considered one of the pandemics of the 21st century. In this non-systematic and advanced review of the MS in type 2 diabetic patients, several articles were consulted, and some recently published studies were analysed.
Psychometric Properties and Factorial Structure of Vietnamese Version of the Hypertension Self-care Profile Behavior Scale
Authors: Van Truong Pham , Lin Mei-Yu , Chiu Hsiao-Yean , Hou Wen-Hsuan , Tsai Pei-Shan 
Published: December 2020

Background
The Hypertension Self-care Profile Behavior (HTN-SCPB) scale is a self-report instrument with which a patient's self-care behavior can be assessed. However, its psychometric properties for adult patients with hypertension in Vietnam require clarification.

Objective
The aim of this study was to translate the HTN-SCPB scale into Vietnamese and to assess its psychometric properties.

Methods
The study included 220 adult patients with hypertension. To evaluate test-retest reliability, 133 participants were tested twice with a 3-week interval between tests. For construct validity, exploratory factor analysis was used to assess factor structure, and confirmatory factor analysis was used to evaluate the structural model fit of the scale.

Results
Reliability was confirmed by internal consistency (Cronbach α = 0.79) and test-retest reliability (intraclass correlation coefficient, 0.88). The Kaiser-Meyer-Olkin value was 0.75, and Bartlett's test of sphericity was significant (P < .001) and adequate for exploratory factor analysis. A 5-factor structure was obtained, and the factors were named as follows: “advanced self-management skills,” “adverse health behaviors,” “medication adherence,” “diet-related knowledge regarding hypertension,” and “information skills.” Confirmatory factor analysis revealed that the model fit indices were acceptable (root-mean-square error of approximation, 0.07) or slightly less than the good fit values (comparative fit index, 0.85; incremental fit index, 0.85; goodness-of-fit index, 0.88; adjusted goodness-of-fit index, 0.84; and Tucker-Lewis index, 0.82).

Conclusions
The Vietnamese HTN-SCPB scale had satisfactory validity and reliability for assessing self-care behaviors in patients with hypertension in Vietnam.
Mindfulness, Posttraumatic Stress Symptoms, and Posttraumatic Growth in Aid Workers
Authors: Wen Xue , An Yuanyuan , Zhou Yuyang , Du Jiaxuan , Xu Wei 
Published: December 2020

Abstract
Objective: The risk for aid workers to develop posttraumatic mental problems highlights the importance of reducing the harm of posttraumatic stress symptoms (PTSS) and promoting the benefits of posttraumatic growth (PTG). This study examined the negative relationship between mindfulness and PTSS, and the positive relationship between mindfulness and PTG, and further explored the mediating roles of self-acceptance, intrusive rumination, and deliberate rumination. Methods: Aid workers from the Red Cross Organization (N = 298) were recruited in the study. They completed a series of questionnaires assessing mindfulness, self-acceptance, rumination, posttraumatic stress disorder (PTSD), and PTG. Results: Results showed that mindfulness was significantly and negatively associated with PTSD through positively predicting self-acceptance and negatively predicting intrusive rumination. Mindfulness was significantly and positively associated with PTG, although the mediating effect did not exist because the path between self-acceptance and deliberate rumination was impassable. Conclusion: The mechanisms between mindfulness, PTSD, and PTG were further explored. Limitations and implications for trauma intervention and future research were discussed.
The Effects of Maintenance Electroconvulsive Therapy on Hospitalization Rates
Authors: Kocamer Şahin Şengül , Demir Bahadır , Elboğa Gülçin , Altındağ Abdurrahman , Elmalı Enes 
Published: December 2020

Abstract
This study aimed to study the effect of maintenance electroconvulsive therapy (mECT) on hospitalization rates in patients who had been readmitted after acute courses of electroconvulsive therapy (ECT), and determine the most frequently used treatment schedules in mECT. Patients who had undergone mECT treatment for the last 5 years were retrospectively reviewed. Seventy patients were included in the study. The control group of 70 patients was selected from patients who received only acute ECT. Of the patients in the mECT group, 55.8% (39) were female, and 41.4% (29) were diagnosed with major depressive disorder. The mean number of patients hospitalized who received mECT after acute ECT was 0.55 ± 0.87, whereas it was 1.13 ± 1.31 in patients who received only pharmacotherapy after ECT in a covariant analysis adjusted for age and diagnosis. The most commonly used initial treatment protocol of mECT was weekly × 4, biweekly × 2, and monthly × 6. mECT is more effective in reducing hospitalization after acute ECT treatments than using psychotropic drugs alone for maintenance therapy.
Exploring the Association Between Organizational Safety Climate, Failure to Rescue, and Mortality in Inpatient Surgical Units
Authors: Bacon Cynthia Thornton , McCoy Thomas P. , Henshaw Daryl S. 
Published: December 2020

OBJECTIVE
To examine the association between organizational safety climate (OSC), in-hospital mortality (IM), and failure to rescue (FTR) in 2 hospitals, 1 with and 1 without crew-resource-management training.

BACKGROUND
OSC is 1 of the most important organizational factors that promotes safety at work; however, there is a lack of research examining the relationship between OSC and patient deaths in hospitals.

METHODS
We utilized a matched 2-group comparison of surgical patients and surveyed surgical staff to assess the relationship between OSC, FTR, and IM.

RESULTS
The OSC assessment was completed by 261 surgical team members. A total of 1764 patients had at least 1 FTR complication; however, there was no association between OSC with FTR or IM for either hospital.

CONCLUSIONS
Nurse leaders should remain vigilant in building work teams with strong hospital safety climates. More research is needed to explore the relationship between OSC and patient outcomes.
Evaluation of a Bed Reaggregation Initiative at an Urban Academic Medical Center
Authors: Kuczero Jennifer L. , Staffileno Beth A. , Grenier Jennifer M. 
Published: December 2020

BACKGROUND
Hospital flow disruptions have been linked to treatment delays, longer length of stay (LOS), poor patient outcomes, and overburdened staff leading to disengagement.

OBJECTIVE
This project was designed to evaluate and determine if the bed reaggregation was successful at meeting its goals.

METHODS
Donabedian's framework guided the following evaluation points: 1) patient placement accuracy, 2) LOS variance, 3) emergency department (ED) boarding times, 4) hospital bypass hours, 5) operational declination rates, 6) patient satisfaction, and 7) RN engagement. Data were analyzed using pre-post percent change and χ
2 analysis.

RESULTS
Primary placement of patients, LOS variance, and operational declinations improved. Hours on bypass and ED boarding times were not reduced. RN engagement scores varied widely with significant decreases on 2 of the reaggregated units. Patient satisfaction scores varied, but overall did not decrease.

CONCLUSION
Further consideration is needed for improving hospital bypass, ED boarding times, and RN engagement.
An Exploration of Characteristics and Behavioral Traits of DAISY Honorees and Nominees
Authors: Nair Julie McCulloh , Merring Paige , Jones Bradley , Guney Senem 
Published: December 2020

BACKGROUND
In the literature, an abundance of stories exist describing patient situations and caregiver actions, but only 2 studies were identified that outline DAISY honorees' actions and behavioral characteristics.

OBJECTIVE
This study utilized patient nomination data and DAISY honoree insight to identify and gain better understanding of the characteristics and behavioral traits of DAISY nurses.

METHODS
A grounded theory approach and purposive sample were used in this study, which was conducted in 2 phases using 2 different data sets. In phase 1, the NarrativeDx AI platform generated insights from DAISY nomination comments. In phase 2, a survey was administered to DAISY honorees collecting descriptive data that were analyzed in SPSS, whereas insights on DAISY nurses were collected via open-ended responses and analyzed using NVivo software.

RESULTS
Three themes emerged in phase 1 from DAISY nomination data: caring, knowledge/skills, and reliability. A total of 37 DAISY honorees participated in phase 2. Most participants were bachelor's degree–prepared and worked day shift in the emergency department, critical care units, or medical-surgical units; some entered leadership roles post award, and 34% cited nursing as a 2nd career. Four themes emerged from their open-ended responses: engaging in care, environment of care, dedicated to care, and competence of care. Subthemes emerged in both analyses.

CONCLUSIONS
The essence of caring was noted continuously in both nomination and honoree data. Further research aimed at discovering the characteristics and behaviors of DAISY honorees is recommended as examination of these factors may provide a deeper understanding of this exemplary group of nurses. Insights could be incorporated into training and practice programs aimed at increasing patient and nursing satisfaction.
Suicide and Suicide Attempts on Veterans Affairs Medical Center Outpatient Clinic Areas, Common Areas, and Hospital Grounds
Authors: Rajendran Sreevaishali , Mills Peter D. , Watts Bradley V. , Gunnar William 
Published: December 2020

Objectives
Few studies have analyzed suicide deaths and attempts occurring outside inpatient units on other hospital locations. We aimed to quantify and analyze suicide deaths and attempts occurring on Department of Veterans Affairs medical center outpatient clinic areas, common areas, and hospital grounds including parking lots to determine whether a relationship with access to mental health care exists and to elucidate potential mitigation strategies.

Methods
We conducted a retrospective review of patient safety report (n = 3,186), root cause analysis (n = 234), and issue brief (n = 2,064) national databases between January 1, 2015, and December 31, 2018, to identify occurrences of suicides and attempts. Correlation between mental health access times and hospital-specific rates of suicides and attempts was assessed. Qualitative analyses of root causes and mitigation strategies were conducted.

Results
Of 192 reports meeting our location criteria, 42 suicides or attempts occurred in outpatient clinic areas, 39 in common spaces, and 111 on outdoor facility areas. Forty-four reports (23%) pertained to suicides, and 148 (77%) pertained to attempts. The predominate methods were death by firearms (64%) and attempt by drug overdose (38%). We identified a weak yet significant relationship between mental health access times for established patients and rates of on-campus suicides and attempts (r = 0.279, P = 0.0013).

Conclusions
Clinical changes including environmental assessments and interventions, staff training on identifying suicide risk characteristics, policy changes toward improving contraband search techniques, and medications risk assessment, as well as timely access to care may be effective mitigation strategies toward preventing suicides of this nature.