bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical-Site Infection Prevention After Hysterectomy: Use of a Consensus Bundle to Guide Improvement
Authors: Burgess Adriane , Fish Megan , Goldberg Seth , Summers Keziah , Cornwell Kim , Lowe Jason 
Published: October 2019

ABSTRACT
Hysterectomy is one of the most commonly performed surgeries in women. Surgical-site infections (SSI) after hysterectomy can lead to increased morbidity and mortality as well as readmission, which is associated with increased costs for health systems. The aim of the project was to improve standardization of preoperative education on infection prevention and incorporate the use of preoperative chlorhexidine (CHG) bathing for patients undergoing hysterectomy to decrease rates of SSI. Data on SSI after hysterectomy were reviewed. Tracer methodology was used to identify gaps in the preoperative process by comparing the current process to the Council on Patient Safety in Women's Health Care Patient Safety Bundle “Prevention of Surgical Site Infection after Gynecologic Surgery.” After implementation, survey data were collected on adherence to the washing protocol, and SSI data were monitored. Survey results reflected high compliance with the CHG washing protocol, provision of patient education, and overall patient satisfaction with the process. Before implementation in 2016, we reported 8 deep or organ/space SSI to the National Healthcare Safety Network. After implementation in 2018, we reported 3 deep or organ/space SSI. Standardizing infection prevention processes to align with safety bundles improves the quality of care provided to patients.
PAEA End of Rotation™ Exams Accurately Identify Students at Risk of Physician Assistant National Certifying Exam Failure
Authors: Buchs Shalon R. , Baginski Robert , Coombs Jennifer M. , Duffy Diane , Garbas Breann , Honda Trenton , Moloney-Johns Amanda , Mazur Ziemowit , Murfin Melissa , Statler Michel , Thurnes Tracey 
Published: October 2019

Purpose
Physician Assistant Education Association (PAEA) End of Rotation™ exams are used by programs across the country. However, little information exists on the predictive ability of the exams' scale scores and Physician Assistant National Certifying Exam (PANCE) performance. The purpose of this study was to evaluate End of Rotation exam scores and their relationship with poor PANCE performance (PPP).

Methods
In an IRB-approved, multi-center, multi-year study, associations between PAEA End of Rotation exam scale scores and PANCE scores were explored. A taxonomy of nested linear regression models with random intercepts was fit at the program level. Fully adjusted models controlled for year, timing of the exam, student age, and gender.

Results
Fully adjusted linear models found that 10-point increases in End of Rotation exam scores were associated with a 16.8-point (95% confidence interval [CI]: 14.1-19.6) to 23.5-point (95% CI: 20.6-26.5) increase in PANCE score for Women's Health and Emergency Medicine, respectively. Associations between exams did not significantly vary (P = .768). Logistic models found End of Rotation exam scores were strongly and consistently associated with lower odds of PPP, with higher exam scores (10-point increase) associated with decrements in odds of PPP, ranging between 37% and 48% across exams. The effect estimate for the Emergency Medicine exam was consistently stronger in all models.

Conclusions
PAEA End of Rotation exam scores were consistently predictive of PPP. While each End of Rotation exam measures a specialty content area, the association with the overall PANCE score varied only by a change in odds of low performance or failure by a small percentage. Low End of Rotation exam scores appear to be consistent predictors of PPP in our multi-center cohort of physician assistant students.
Acute pancreatitis in oldest old: a 10-year retrospective analysis of patients referred to the emergency department of a large tertiary hospital
Authors: Quero Giuseppe , Covino Marcello , Ojetti Veronica , Fiorillo Claudio , Rosa Fausto , Menghi Roberta , Laterza Vito , Candelli Marcello , Franceschi Francesco , Alfieri Sergio 
Published: October 2019

Objective
Contrasting results are reported on the clinical course of acute pancreatitis (AP) in the geriatric population. The aim of this study is to compare the AP clinical outcomes between patients aged from 65 to 79 years and those over 80 years.

Methods
A total of 115 patients over 80 years (oldest old) were compared to a group of 236 patients aged 65–79 years (elderly). Clinicodemographic, biochemical, and radiological data were reviewed. The primary outcome was to compare the overall mortality. Secondary outcomes included intensive care unit (ICU) admission, in-hospital length of stay (LOS), and need for surgical procedures.

Results
Laboratory values at admission were similar between the two groups. Over 80 patients presented a lower rate of abdominal symptoms (68.7% vs. 81.4%; P = 0.008), a higher mortality (14.8% vs. 3.5%; P = 0.003), and ICU admission (13.9% vs. 3.8%; P = 0.001) rates. Median LOS was comparable between the two groups. Multivariate analysis identified age [odds ratio (OR): 3.56; 95% confidence interval (CI): 1.502–8.46; P = 0.004], a higher Ranson score (OR: 3.22; 95% CI: 1.24–8.39; P = 0.016), and the absence of abdominal pain (OR: 2.94; 95% CI: 1.25–6.87; P = 0.013) as independent predictors of mortality. Conversely, only age (OR: 3.83; 95% CI: 1.55–9.44; P = 0.003) and a more severe AP (OR: 3.56; 95% CI: 1.95–6.89; P = 0.041) were recognized as influencing ICU admission. Only the operative treatment (OR: 2.805; 95% CI: 1.166–5.443; P = 0.037) was evidenced as independent risk factor for LOS (OR: 3.74; 95% CI: 1.031–6.16; P = 0.003).

Conclusion
Oldest old patients have a higher mortality and ICU admission rate as compared to the other subgroups of elderly. Early diagnosis and prompt treatment are key elements to improve outcomes in this frailer population.
Surgical versus endoscopic resection of large sessile duodenal and papillary lesions
Authors: Xu Mengque , Wu Jiaguo , Yu Liangliang , Liu Xing , Wang Xianfa , Dai Ning 
Published: October 2019

Background
Data on the endoscopic resection of duodenal and papillary lesions less than 15 mm in size have been well supported by systematic studies. However, for large sessile lesions of the duodenum or papilla (LSL-D/P), surgery is often performed despite significant morbidity and mortality. This study aimed to compare the outcomes and costs between endoscopic and surgical resection of such lesions.

Methods
Patients who underwent endoscopic or surgical resection of LSL-D/P at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University from 2013 to 2017 were retrospectively analyzed. Endoscopic and surgical outcomes and costs were compared.

Results
A total of 68 lesions were evaluated (47.1% of patients were male; mean lesion size 25 mm); 46 were treated by endoscopic resection, and 22 were managed by surgical resection. At the initial procedure, complete resection was achieved in 93.4%. Major complications (perforation, delayed bleeding, pancreatitis, infections and admission to the ICU) occurred in 15.3% of the endoscopic group and 22.6% of the surgical group. For recurrence at the first surveillance endoscopic examination, there was a 12.1% recurrence rate in the endoscopic group and a 5.3% recurrence rate in the surgical group (P = 0.654). Compared with surgical resection, regardless of lesion location, endoscopic resection had a shorter procedural time and hospital stay, a lower morbidity rate and was less costly.

Conclusion
In centers specialized in complex endoscopic resection, patients with LSL-D/P would likely benefit from advanced endoscopic management, which offers a lower morbidity profile and reduced costs.
Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States
Authors: Giannouchos Theodoros V. , Washburn David J. , Kum Hye-Chung , Sage William M. , Ohsfeldt Robert L. 
Published: October 2019

Background:
Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals.

Objective:
The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and contextual factors associated with such behavior.

Research Design:
We used the 2011–2014 Healthcare Cost and Utilization Project State Emergency Department Databases data on all outpatient ED visits in New York, Massachusetts, and Florida. We studied all adult ED users with ≥5 visits in a year and defined multisite use as visits to ≥3 different sites. We estimated predictors of multisite use with multivariate logistic regressions.

Results:
Across all 3 states, 1,033,626 frequent users accounted for 7,613,077 ED visits. Of frequent users, 25% were multisite users, accounting for 30% of the visits studied. Frequent users with at least 1 visit for mental health or substance use-related diagnosis were more likely to use multiple sites. Uninsured frequent users and those with public insurance were associated with less use of multiple EDs than those with private coverage while lacking consistent coverage by the same insurance within each year were associated with using multiple sites.

Conclusions:
Health policy interventions to reduce duplicative or unnecessary ED use should apply a population health perspective and engage multiple hospitals. Community-level preventive approaches and a stronger infrastructure for mental health and substance use are essential to mitigate multisite ED use.
An update on treatment of voice-gender incongruence by otolaryngologists and speech-language pathologists
Authors: Pasternak Kevin , Francis David O. 
Published: October 2019

Purpose of review
The current review provides an update of literature published in the past 2 years related to treatment of voice-gender incongruence in the gender expansive population, commonly referred to as transgender voice modification.

Recent findings
Four main themes have emerged in research during the review period. These include comparison of surgical and behavioral techniques for raising pitch, with consistent findings of a greater increase in fundamental frequency (F0) following endoscopic glottoplasty compared with cricothyroid approximation. Voice therapy similarly can increase pitch (F0), often to degrees commensurate with surgical approaches. A second theme identifies the perceptual correlates of gender in voice and communication, highlighting recent findings that perception of gender relates primarily to nonpitch-related features of voice. A third theme is the importance of considering patient-reported outcomes in treatment and research. Finally, several recent studies challenge the assumption that transmasculine individuals taking HRT are satisfied with their voice and communication.

Summary
Speech-language pathologists and otolaryngologists should work collaboratively to treat voice-gender incongruence. Together, we should consider treatment evidence, individual patient goals, and validated patient-reported outcome measures when recommending treatment and evaluating outcomes. Understanding the nuance of how each individual defines benefit is critical to clinicians whose aim is to personalize and optimize treatment of voice-gender incongruence. This is particularly important as management broadens to include individuals across the gender spectrum.
Mammography Self-efficacy Scale and Breast Cancer Fear Scale
Authors: Alyami Mohsen , Al-Sharef Abdullah , Al-Aseri Mai , Henning Marcus 
Published: October 2019

Background
Early screening for breast cancer (BC) is critical for improving health outcomes and reducing mortality. Research has shown that self-efficacy and fear of BC can influence patients’ screening behaviors. Validated measures to assess these constructs among Saudi women are lacking.

Objective
The aim of this study was to assess the psychometric properties of the Arabic versions of the Champion Mammography Self-efficacy Scale (CMSES) and Champion Breast Cancer Fear Scale (CBCFS) in a sample of Saudi women.

Methods
The CMSES and CBCFS were back-translated into Arabic using an established translation protocol. Reliability was assessed using Cronbach’s α coefficients. Construct validity was evaluated using exploratory and confirmatory factor analytical procedures.

Results
The findings from the factor analysis confirmed the unidimensional structure of both scales as reported by the original authors. Additionally, both scales exhibited high internal consistency (Cronbach’s α coefficients) of .91 for the modified CMSES-Arabic and .94 for the CBCFS-Arabic.

Conclusions
This article provided initial evidence of reliability and construct validity for the modified CMSES-Arabic and the CBCFS-Arabic.

Implications for Practice
Nurses and other allied health professionals can now use these measures to better understand how self-efficacy and fear of BC are related to compliance with cancer screening among Saudi women and in other Arabic-speaking contexts. The scales could also be useful for developing and testing the effectiveness of interventions aimed at improving mammography testing rates.
Impact of Behavior Management Training on Nurses' Confidence in Managing Patient Aggression
Authors: de la Fuente Margarita , Schoenfisch Ashley , Wadsworth Barbara , Foresman-Capuzzi Joyce 
Published: October 2019

OBJECTIVE
The aim of this study was to evaluate the impact of behavior management training on nurses' confidence in managing aggressive patients.

BACKGROUND
Nurses are at a high risk of experiencing violence directed toward them by patients.

METHODS
This quality improvement project used a pre-and-post study design. A survey was administered within 1 month before behavior management training and 1 month after training, capturing participants' demographic and work characteristics, as well as their experiences with patient/visitor-perpetrated violence. Confidence was measured using the Confidence in Coping with Patient Aggression Instrument. Open-ended questions sought participants' thoughts on workplace violence prevention initiatives.

RESULTS
Thirty-eight confidence scores were assessed. Nurses' confidence in coping with patient aggression was significantly higher after behavior management training. Nurse participants described the training as “timely,” “helpful,” and “beneficial.”

CONCLUSION
With an increased understanding of violent behavior stages and warning signs, a nurse is better able to manage a potentially violent situation.
Preparing Nurse Managers for Authentic Leadership
Authors: Frasier Nora 
Published: October 2019

OBJECTIVE:
This study examined the impact of a pilot leadership development program on nurse managers' (NMs') use of authentic leadership behaviors.

BACKGROUND:

Nurse managers often receive little or no formal training. Literature suggests formal leadership development programs can enhance their leadership competency. A leadership development program was designed and pilot tested to determine effectiveness in enhancing authentic leadership competency.

METHODS:
A cross-sectional study used a convenience sample of 16 NMs who participated in the pilot program.

RESULTS:
Measurable increases in authentic leadership behaviors were demonstrated in both the self-assessments (mean scores increased in 3 of 4 subscales) and RN direct report assessments (mean scores increased in all 4 subscales), with statistical significance achieved in 1 self-awareness behavior.

CONCLUSIONS:
The pilot program demonstrated merit as a tool to enhance NMs' authentic leadership behaviors. Managers perceived greater self-awareness, and direct reports perceived positive change in managers' use of authentic leadership behaviors.
Chief Nursing Officers' Perspectives on Hospital-Based Building or Remodeling Projects
Authors: Keys Yolanda 
Published: October 2019

OBJECTIVE
This descriptive survey explores the experiences of chief nursing officers (CNOs) who have participated in hospital-based building or remodeling projects.

BACKGROUND
As a pivotal member of the leadership team for facility projects, CNOs are often charged with contributing to decisions regarding placement of technology connections, selection of design elements to prevent healthcare-associated infections, choice of location for supplies, and management of construction change orders.

METHODS
A descriptive survey approach guided telephone interviews with 12 CNOs from across the United States. Credibility was achieved through peer debriefing and member checking. Transferability was demonstrated through detailed description; dependability and confirmability were demonstrated through an audit trail of the data collection and analysis processes.

RESULTS
Three main themes were identified, and a list of practice implications was developed.

CONCLUSIONS
CNOs can use the recommendations from this study as a starting point for future building or remodeling projects.
First Responses to the Symptoms of Sexually Transmitted Infections and Treatment-Seeking Behavior Among Men Who Have Sex With Men in 13 Cities in China
Authors: Li Jing , Yue Xiaoli , Wang Yajie , Gong Xiangdong 
Published: October 2019

Background
Data are scarce on sexually transmitted infection (STI) treatment-seeking behavior among men who have sex with men (MSM) in China. The purpose of the study was to characterize the first response to STI symptoms, treatment-seeking behavior, and its associated factors among MSM in China.

Methods
A cross-sectional study with convenience sampling design was conducted in 13 cities from April to July 2017. Face-to-face interviews were conducted to collect information on demographics, STI symptoms, and treatment-seeking behavior. Logistic regression analysis was conducted to evaluate variables associated with not seeking treatment.

Results
Among 3925 recruited participants, 628 (16.0%) reported STI symptoms in the past 12 months and were included in the analysis. Upon or after being notified of the symptoms, MSM sought help from various sources or self-tested using rapid testing kits. Only 322(51.3%) went to see a doctor in clinic. In multiple logistic regression analyses, younger age, lower income, less STI knowledge (adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.2–2.5), not knowing own STI risk (AOR, 1.8; 95% CI, 1.2–2.7), no symptoms of anogenital ulcers (AOR, 2.3; 95% CI, 1.3–3.8) or anogenital warts (AOR, 2.4; 95% CI, 1.6–3.7), no syphilis testing in the past 12 months (AOR, 2.1; 95% CI, 1.5–3.0) were associated with higher probability of not seeking treatment in clinics.

Conclusions
We found a high prevalence of STI symptoms among MSM and only half sought treatment. Prevention efforts should promote STI education, testing, and adequate treatment-seeking behavior.
Unilateral Lateral Rectus Paralysis Showing Incomplete “V” Sign’ on 18F-FDG PET/CT
Authors: Parihar Ashwin Singh , Vadi Shelvin Kumar , Kumar Rajender , Singh Harmandeep , Takkar Aastha , Mittal Bhagwant Rai , Lal Vivek 
Published: October 2019

Abstract
Extraocular muscles show physiologic radiotracer uptake on 18F-FDG PET/CT as is encountered in most routine scans. Certain pathologies can cause palsy of one or more of the extraocular muscles, leading to hypometabolism on 18F-FDG PET/CT. We present a case with a classical finding of unilateral hypometabolism of the lateral rectus muscle, disrupting the “V” sign formed due to physiologic uptake. The patient had presented with the complaint of diplopia and was being evaluated further to rule out the possibility of inflammatory/granulomatous infectious etiopathogenesis leading to compression of the abducens nerve resulting in lateral rectus palsy.
Differential 18F-FDG and 18F-Fluciclovine Uptake Pattern in a Patient With Poorly Differentiated Adenocarcinoma of the Lung and Prostate Cancer Biochemical Recurrence
Authors: Nguyen Nghi C. , Muthukrishnan Ashok , Mountz James M. 
Published: October 2019

Abstract
A 72-year-old man with a history of T1cN0M0 prostate adenocarcinoma and rising prostate-specific antigen underwent a fluciclovine PET/CT scan that showed high uptake in several para-aortic nodes, suspicious for prostate cancer. A right upper lobe single pulmonary nodule (SPN), demonstrated only mild uptake, which raised the suspicion for a lung primary. Subsequent FDG PET/CT showed high uptake in the SPN, revealing poorly differentiated adenocarcinoma at biopsy, but with no abnormal uptake in the para-aortic nodes. This case highlights the complementary potential of fluciclovine and FDG PET in patients with a history of prostate cancer biochemical recurrence and SPN.
Complete Spontaneous Regression of Hepatosplenic T-Cell Lymphoma After Surgical Biopsy
Authors: Nakamoto Ryusuke , Okuyama Chio , Oka Satoshi 
Published: October 2019

Abstract

18F-FDG PET/CT for a 74-year-old man with elevated serum soluble interleukin 2 receptor showed multiple intense uptake in the liver, spleen, and bone. A surgical biopsy from 2 of liver tumors confirmed hepatosplenic αβ T-cell lymphoma. One and a half months after biopsy, FDG PET scan was performed again for staging before starting chemotherapy, and it showed the complete disappearance of all of the lesions. The excisional biopsy could be a possible trigger of his spontaneous regression.
Intranasal Bolsters: A Novel Technique for Nasal Bone Stabilization
Authors: Shokri Tom , Hilger Peter A. , Lighthall Jessyka G. 
Published: October 2019

AbstractNasal bone stabilization, in the setting of comminuted nasal fracture or surgical osteotomy, represents a challenging surgical experience. Postoperative shifting of osseous fragments may result in compromised outcomes in an otherwise well-performed procedure. Although prior studies have reported nasal bone fixation with implementation of wires, plates, or halos, these techniques are often difficult to employ routinely. Herein, the authors describe a novel and facile technique for the maintenance of unstable nasal bones using customized intranasal bolsters.
Center-related Bias in MELD Scores Within a Liver Transplant UNOS Region: A Call for Standardization
Authors: Verna Elizabeth C. , Connelly Charles , Dove Lorna M. , Adem Patricia , Babic Nikolina , Corsetti James , Faix James , Hayden Joshua A. , Lifshitz Mark , Stotler Brie , Jin Zhezhen , Mohan Sumit , Emond Jean C. , Hod Eldad A. , Kratz Alexander 
Published: October 2019

Background.
Model for End-Stage Liver Disease (MELD) score–based liver transplant allocation was implemented as a fair and objective measure to prioritize patients based upon disease severity. Accuracy and reproducibility of MELD is an essential assumption to ensure fairness in organ access. We hypothesized that variability in laboratory methodology between centers could impact allocation scores for individuals on the transplant waiting list.

Methods.
Aliquots of 30 patient serum samples were analyzed for creatinine, bilirubin, and sodium in all transplant centers within United Network for Organ Sharing (UNOS) region 9. Descriptive statistics, intraclass correlation coefficients (ICCs), and linear mixed-effects regression were used to determine the relationship between center, bilirubin, and calculated MELD-sodium (MELD-Na) score.

Results.
The mean MELD-Na score per sample ranged from 14 to 38. The mean range in MELD-Na per sample was 3 points, but 30% of samples had a range of 4–6 points. Correlation plots and intraclass correlation coefficient analysis confirmed bilirubin interfered with creatinine, with worsening agreement in creatinine at high bilirubin levels. Center and bilirubin were independently associated with creatinine reported in mixed-effects models. Unbiased hierarchical clustering suggested that samples from specific centers have consistently higher creatinine and MELD-Na values.

Conclusions.
Despite implementation of creatinine standardization, centers within a single UNOS region report clinically significant differences in MELD-Na on an identical sample, with differences of up to 6 points in high MELD-Na patients. The bias in MELD-Na scores based upon center choice within a region should be addressed in the current efforts to eliminate disparities in liver transplant access.