bluuebunny/crossref_metadata_2025_split huggingface dataset:
Creating inclusive health care environments: Health care stories from the trans population
Authors: Daly Amy , Champion Jane Dimmitt 
Published: September 2020

Background:
Transgender people face a multitude of health care access barriers that create wide disparities in health. Transgender people have more untreated acute and chronic conditions than the cisgender population.

Purpose:
The purpose of this study was to describe positive and negative experiences of transgender people when accessing health care.

Methodological orientation:
Qualitative methods including semi-structured interviews and content analysis for identification of themes.

Sample:
Nine transgender people ranging in age from 20 to 35 years who currently reside in a metropolitan area of the Southwestern United States.

Conclusions:
The interviews contained candid stories about the participants' health care experiences and included perspectives about provider knowledge, provider communication, and provider office interactions. Findings identified health care disparities among transgender people related, in part, to negative experiences in the health care environment. Some of these negative experiences arose from the uncertainty of providers' transgender-specific health care knowledge and anxiety about dysphoria-triggering communication in the health care environment.

Implications for practice:
These findings enhance practice by offering insight into how health care providers and personnel interactions influence the experience of transgender patients and help health care providers and personnel understand situations that create anxiety and dysphoria in transgender patients.
Parent-reported toilet training practices and the role of pediatric primary care providers
Authors: Sejkora Ellen K. D. , Igler Eva C. , Davies W. Hobart 
Published: September 2020

ABSTRACT

Background:
Toilet training is a universal developmental milestone and a stressful period for families with few empirically based guidelines.

Purpose:
This study identified currently used methods of toilet training and sources used for parental guidance.

Methodological orientation:
A descriptive, qualitative design was used.

Sample:
Participants included 479 parents of children aged 2–6 years.

Conclusions:
Parents described diverse toilet training strategies, most of which were behavioral and inconsistent with recommendations of the American Academy of Pediatrics. Most children were toilet trained between 24 and 36 months within 5 weeks. Forty-one percent of parents relied on the Internet for toilet training information, and fewer than half reported involvement of their child's primary care provider.

Implications for practice:
Parents in the community would likely benefit from additional education and anticipatory guidance from primary care providers about normative toilet training. Further work is needed to understand the effectiveness of different methods of training and improve adherence to AAP recommendations.
Standardizing mammogram screening in primary care: Integrating an evidence-based approach
Authors: Go Lacrisha , Sandhu Prabjot 
Published: September 2020

ABSTRACT

Background:
Mammogram screening for surveillance and detection of breast cancer has been long recognized as a preventive health measure in primary care for women. However, a clear consensus on when to start screening individual women, based on age and risk factors, lacks guidance. Reputable organizations uphold varying breast cancer screening (BCS) guidelines for women potentiating the risk for fragmented and inconsistent practices among health care providers (HCPs).

Objectives:
This review aims to evaluate the current literature on the possible risks, benefits, and limitations associated with BCS for women between 40 and 49 years and to discuss the need for a more individualized, evidence-based approach to BCS.

Data sources:
A comprehensive systematic review of eight articles, along with five clinical practice guidelines published within the past 10 years that address advantages and disadvantages of receiving mammography for women in their fourth decade was completed.

Conclusions:
There is insufficient evidence to promote adherence to any single clinical practice guideline for the benefit of all patients. Further high-level research is needed, as well as the assessment of individual risk factors influencing breast cancer development and screening outcomes.

Implications for practice:
There is a significant need for further education for HCPs and the development of tools that incorporate a BCS shared decision-making process. Current practice lacks the ability to easily screen individual patients with a method that identifies the appropriate age to screen and addresses the benefits, risks, and limitations of mammography.
How advanced practice registered nurse practice barriers impact health care access in Michigan
Authors: Sheehan Ann , Jones Angella , McNerlin Cindy , Iseler Jackeline , Dove-Medows Emily 
Published: September 2020

ABSTRACT
Despite the Affordable Care Act increasing the number of insured individuals in Michigan, many individuals cannot access care as the state continues to have a provider shortage that is likely to get worse. It is well documented that when individuals lack primary care access, their health suffers. Advanced practice registered nurses (APRN) could help reduce the state's health care shortage, as the care they provide is safe, cost effective, and high quality. Unfortunately, Michigan's APRN practice restrictions limit these professionals from autonomously providing care to the underserved and rural populations that need them the most. Indeed, Michigan is behind other states that offer full practice authority to APRNs, and its health outcomes reflect this stance. Eliminating the restrictive practice environment in Michigan will give citizens better access to primary care.
Exploring novice nurse practitioner job satisfaction
Authors: Auffermann Kristin , O'Keefe Rachael , Smith Tyson , Cohn Tanya 
Published: September 2020

ABSTRACT

Background:
With the continued increase in new nurse practitioners expected over the next 5 years and beyond, more individuals will experience nurse practitioner role transition. It is beneficial to nurse practitioners, patients, and the health care industry to understand factors relating to job satisfaction during role transition.

Purpose:
The purpose of this study was to contribute to the understanding of the transition period of new nurse practitioners by exploring demographics and job satisfaction during the first 6 months to 2 years of practice.

Methods:
This nonexperimental quantitative study employed convenience sampling with survey methodology. Twenty-one Facebook groups/pages were posted on once a week for 6 weeks. Demographic information was collected, and personal experiences were measured with the Misener Nurse Practitioner Job Satisfaction Scale.

Results:
Practice setting, formal orientation programs, and intent to leave current position were related to overall nurse practitioner job satisfaction during the transition period (p < .05). Satisfaction with time and benefits varied among demographic groups (p < .05).

Implications for practice:
Novice nurse practitioners are mostly satisfied in their new role. However, turnover intention in this population is high and orientation programs are lacking, warranting further study.
Development and testing of an advanced practice clinical advancement program within an academic medical center
Authors: Kapu April N. , Card Elizabeth , Jackson Heather , Kinch Jill , Lupear Buffy Krauser , LeBar Kiersten , Moore Deonna , Terrell Michelle , Dubree Marilyn 
Published: September 2020

ABSTRACT

Background:
Faculty advanced practice registered nurses (APRNs) and physician assistants (PAs) employed by Vanderbilt University Medical Center (VUMC) have historically participated in rank promotion tracks for recognition of professional accomplishments in education, practice, and research. However, there has not been a clinical advancement program for nonfaculty practitioners. Satisfaction, engagement, and health surveys indicated VUMC APRNs and PAs were seeking opportunities for professional growth and development. Many health care organizations have incorporated clinical advancement programs as key recruitment and retention strategies. With a growing number of nonfaculty APRNs and PAs, VUMC began to explore the development, implementation, and evaluation of a clinical advancement program.

Purpose:
A VUMC Clinical Advancement Task Force was created to explore, develop, implement, and evaluate an advanced practice clinical advancement pilot.

Methods:
Two teams were selected to participate in a 6-month pilot. Presurveys and postsurveys were conducted, and postpilot focus groups were held with participating practitioners. A 9-square tool was developed as a rubric for evaluating the practitioner's progress. Applications, leader assessments, and recommendations were housed in a secure database for a selected advancement committee to evaluate.

Results:
Of 23 participants, 47% indicated satisfaction with professional development opportunities, when compared with 84% postpilot. Postpilot focus groups further improved the tool and the process for the program.

Implications for practice:
Opportunities for advancement/professional development positively influence APRN and PA perceptions of job satisfaction. This program could be tested with other APRN and PA teams for impact on job satisfaction, engagement, and retention.
Knowledge, attitudes, and perceptions of nurse practitioners about antibiotic stewardship
Authors: Hamilton Robert M. , Merrill Katreena C. , Luthy Karlen E. , Nuttall Craig 
Published: September 2020

ABSTRACT

Background:
Antibiotic stewardship (ABS) is a set of strategies to optimize antimicrobial use while reducing antibiotic resistance, improving patient outcomes, and decreasing unnecessary costs. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts.

Purpose:
The purpose of this study was to describe the knowledge, attitudes, and perceptions of NPs toward ABS.

Methods:
A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey. Descriptive statistics were used to assess normality.

Results:
A total of 194 NPs completed the questionnaire (88% female; 70% master's degree). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). Nurse practitioners based their antibiotic decisions on the antibiogram (63%) in their setting, whereas 56% indicated they start with broad spectrum and tailor antibiotic choices after cultures are received. Nurse practitioners understood that inappropriate antibiotic use causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important (94%) and felt confident in using antibiotics (86%). However, 94% agreed that antibiotics are overused nationally, and only 62% thought antibiotics were overused in their setting.

Implications for practice:
Nurse practitioners recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.
Education initiatives in cognitive debiasing to improve diagnostic accuracy in student providers: A scoping review
Authors: Griffith Patricia B. , Doherty Caroline , Smeltzer Suzanne C. , Mariani Bette 
Published: September 2020

ABSTRACT

Background:
The high prevalence of diagnostic errors by health care providers has prompted medical educators to examine cognitive biases and debiasing strategies in an effort to prevent these errors. The National Academy of Medicine hypothesized that explicit diagnostic reasoning education of all health care professionals can improve diagnostic accuracy.

Objectives:
The purpose of this scoping review is to identify, analyze, and summarize the existing literature on student health care providers' use of cognitive debiasing strategies to reduce diagnostic error.

Data sources:
The review was guided by the Joanna Briggs Institute methodology for scoping reviews. A systematic search of PubMed, CINAHL, PsychINFO, and Scopus databases for debiasing strategies in student provider education yielded 33 studies.

Conclusions:
The 33 studies included in this review represent four categories of debiasing strategies: increased medical knowledge or experience (seven studies), guided reflection (eight studies), self-explanation of reasoning (nine studies), and checklists to expand diagnosis considerations (seven studies). The studies were inclusive of medical students and residents; no studies included nurse practitioner (NP) students. Guided reflection, the most clearly defined and implemented strategy, showed the most promise for improvement of diagnostic accuracy. Educational interventions were wide ranging in content and delivery but did yield a path for future research.

Implications for practice:
There are myriad debiasing strategies student providers may use to mitigate cognitive bias. Structured reflection and education initiatives demonstrated the most consistent improvements in diagnostic accuracy. Future studies on debiasing strategies must include NP students to understand their response to these initiatives.
Predictors of hemorrhagic stroke in older persons taking nonsteroidal anti-inflammatory drugs: Results from the Food and Drug Administration Adverse Event Reporting System
Authors: McDonald Deborah Dillon , Srisopa Pornpan 
Published: September 2020

ABSTRACT

Background:
Hemorrhagic strokes have not declined in the United States despite a decline worldwide.

Purpose:
To identify hemorrhagic stroke risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs), other medications associated with increased risk for hemorrhagic stroke, and diabetes, cardiovascular disease, gender, and age.

Methods:
A post hoc design was used to examine predictors of hemorrhagic stroke for adults of age 65 years and older from the Food and Drug Administration Adverse Events Reporting System database. The initial sample consisted of all cases reported during the third quarter of 2016 and the second quarter of 2018 with an NSAID as the primary suspect for the adverse drug event (ADE). An additional 397 cases with warfarin as the primary suspect were included in the final sample (N = 3,784) to test for bias from including only NSAID as the primary ADE suspect cases. Extracted data included the primary ADE (hemorrhagic stroke or other ADE), age, gender, primary suspect drug (NSAID or warfarin), and presence of a second NSAID, rivaroxaban, warfarin, clopidogrel, antidepressants (selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants), inhaled corticosteroids, diabetes, or cardiovascular medications. Logistic regression was used to predict hemorrhagic stroke.

Results:
Aspirin and warfarin increased the risk for hemorrhagic stroke by 3.458 and 3.059, respectively. Presence of an additional NSAIDs reduced the risk by 48%.

Implications for practice:
Hemorrhagic stroke risk specific to older adults may provide helpful estimates for practitioners as they weigh the risk benefit of prescribing aspirin as an antiplatelet therapy for older adults.
Hearing Loss in Enlarged Vestibular Aqueduct: A Prognostic Factor Systematic Review of the Literature
Authors: Saeed Haroon Shakeel , Kenth Jonny , Black Graeme , Saeed Shakeel R. , Stivaros Stavros , Bruce Iain A. 
Published: September 2020

Objective:
There is a need to highlight individual prognostic factors determining hearing loss in enlarged (wide) vestibular aqueduct, as currently clinicians cannot counsel parents about the expected clinical course, nor provide individualized hearing rehabilitation plans following identification at newborn screening. We apply a novel methodology to specifically outline and assess the accuracy of prognostic factors reporting for hearing loss in enlarged vestibular aqueduct.

Data Sources:
A preferred reporting items for systematic reviews and meta-analyses compliant systematic review (Prospero ID: CRD42019151199), with searches applied to Medline, EMBASE, and Cochrane. Studies with longitudinal design were included between 1995 and 2019.

Study Selection:
The CHARMS-PF tool was used to assess robustness of prognostic factor study designs.

Data Extraction:
The QUIPS tool was used to assess for individual study risk of bias.

Data Synthesis & Results:
Seventy papers were suitable for data extraction. In the six studies with low risk of bias, the domains of enlarged vestibular aqueduct (EVA) morphology, age, hearing thresholds, sex, head trauma, and genotype provided exploratory prognostic factors for hearing loss associated with enlarged vestibular aqueduct. Overall, study heterogeneity and risk of bias precluded reporting by forest plots and meta-analysis.

Conclusions:
The majority of exploratory prognostic factor studies for hearing loss associated with enlarged vestibular aqueduct are hampered by risk of bias. However, this systematic review identifies potential independent prognostic factors which should be measured, and adjusted for, in subsequent confirmatory studies utilizing multivariate analysis. This would determine the true independent prognostic effects associated with hearing loss in enlarged vestibular aqueduct, while facilitating prognostic model development and the ability to predict individual hearing loss trajectory.
Audiologic Outcome of Cochlear Implantation in Children With Cochlear Nerve Deficiency
Authors: Yousef Medhat , Mesallam Tamer A. , Garadat Soha N. , Almasaad Ayna , Alzhrani Farid , Alsanosi Abdulrahman , Hagr Abdulrahman 
Published: September 2020

Objective/Hypothesis:
The aim of this study was to investigate cochlear implantation (CI) outcome in children with nerve deficiency.

Study Design:
Retrospective chart review.

Methods:
A total of seven children with prelingual profound deficiency (hypoplasia or aplasia) were included. A control group of 10 CI children with no cochlear nerve anomalies was also included. In addition to implant stimulation levels, children's performance on pure-tone audiometry, speech reception measure, and auditory and speech skills ratings were compared across groups. Additionally, pre- and postoperative audiologic results were evaluated for the group with nerve deficiency.

Results:
In general, children with nerve deficiency performed poorer than those without nerve deficiency on all tested measures. Stimulation levels were considerably higher and more variable than the control group. Results further showed that performance was dependent on the diameter of the internal auditory canal.

Conclusion:
Overall, cochlear implantation outcome in children with auditory nerve deficiency is poorer and extremely more variable than those without nerve deficiency. However, three of the patients had a noticeable improvement in auditory performance postimplantation suggesting that CI is a viable option in this population but expected benefit can be dependent on the status of the cochlear nerve.
Liver Stiffness Measured by Either Magnetic Resonance or Transient Elastography Is Associated With Liver Fibrosis and Is an Independent Predictor of Outcomes Among Patients With Primary Biliary Cholangitis
Authors: Osman Karim T. , Maselli Daniel B. , Idilman Ilkay S. , Rowan Daniel J. , Viehman Jason K. , Harmsen William S. , Harnois Denise M. , Carey Elizabeth J. , Gossard Andrea A. , LaRusso Nicholas F. , Lindor Keith D. , Venkatesh Sudhakar K. , Eaton John E. 
Published: September 2020

Goals:
We aimed to describe the diagnostic and prognostic performance of transient elastography (TE) and magnetic resonance elastography (MRE) in patients with primary biliary cholangitis (PBC).

Background:
The diagnostic performance of TE and MRE in detecting advanced fibrosis in PBC and in predicting outcomes independent of existing serologic prognostic markers is incompletely understood.

Materials and Methods:
Five hundred thirty-eight consecutive patients with PBC at 3 centers with liver stiffness (LS) measurements by TE (n=286) or MRE (n=332) were reviewed. LS cutoffs for predicting fibrosis stages were determined by receiver operating characteristic curves among those with a liver biopsy (TE, n=63; MRE, n=98). Cox proportional hazard regression modeling was used to identify associations between covariates and hepatic decompensation.

Results:
The optimal LS thresholds for predicting histologic stage F4 were 14.40 kPa (area under the curve=0.94) for TE and 4.60 kPa (area under the curve=0.82) for MRE. Both TE and MRE outperformed biochemical markers for the prediction of histologic advanced fibrosis. Optimal LS thresholds to predict hepatic decompensation were 10.20 kPa on TE and 4.30 kPa on MRE. LS by TE and MRE (respectively) remained predictors of hepatic decompensation after adjusting for ursodeoxycholic acid responsiveness [hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.05-1.24 and HR, 1.68; 95% CI, 1.28-2.19] and the GLOBE score (HR, 1.13; 95% CI, 1.07-1.19 and HR, 2.09; 95% CI, 1.57-2.78).

Conclusion:
LS measurement with either TE or MRE can accurately detect advanced fibrosis and offers additional prognostic value beyond existing serologic predictive tools.
Procedural bleeding risk, rather than conventional coagulation tests, predicts procedure related bleeding in cirrhosis
Authors: Janko Natasha , Majeed Ammar , Commins Isabella , Kemp William , Roberts Stuart K. 
Published: September 2020

Background
Standard coagulation parameters are used to guide prophylactic blood product transfusion prior to invasive procedures in cirrhotic patients despite limited high-quality evidence.

Aims
We aimed to describe coagulation parameters and prophylactic blood product use in cirrhotic patients having invasive procedures, and the influence of both on periprocedural bleeding.

Methods
We conducted a cohort study of cirrhotic patients undergoing invasive procedures at a referral hospital. Procedures were classified into low or moderate-high bleeding risk. Prophylactic blood component was defined as fresh frozen plasma, cryoprecipitate or platelet transfusion prior to procedures. Univariate and multivariate logistic regression was performed to identify factors associated with procedure-related bleeding.

Results
We identified 566 procedures in 233 cirrhotic patients. Prophylactic blood product was given before 16% of high-risk and 11% of low-risk procedures (P = 0.18). Eight (8.3%) high-risk procedures were complicated by postprocedural bleeding, six of which occurred in patients without significant coagulopathy. The bleeding rate for low-risk procedures was 0.4%. For patients with international normalized ratio >1.5, platelet count <50 x 109/L, or both, the rate of bleeding was comparable between those given and not given prophylactic blood products (3.1 vs. 1.9%; P = 0.63). After adjusting for age, sex, platelet count, international normalized ratio, acute kidney injury, sepsis and model of end-stage liver disease, the only factor significantly predicting procedure-related bleeding was the procedural bleeding risk category (P < 0.01).

Conclusions
Procedure-related bleeding in cirrhotic patients cannot be accurately predicted by INR or platelet count, nor prevented by blood component prophylaxis using these parameters. Procedure-related bleeding is best predicted by the bleeding risk status of procedures.