bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosed in operating room with hypertension: a widespread but unseen affliction
Authors: Balci Eda , Demir Asli , Bahcecitapar Melike , Karadeniz Umit 
Published: March 2020

Objective
The present study aims to describe a widely held misconception in the literature concerning preoperative hypertension diagnosis. The blood pressure elevation occurring in the operative room is seen commonly even in subjects considered hitherto fully normotensive. As these patients have a condition which – similar to White Coat Hypertension (WCH) – indicates the presence of hypertension, and thus necessitates more frequent intraoperative checks.

Methods
We have named a condition ‘Diagnosed in Operating Room (DIOR) with Hypertension’, following the preoperative stage at which it is detected.

Result
Our observational study evaluated 718 elective noncardiac surgery adult patients, finding 28% of them (n = 204) to be ‘DIOR-tensive’ and thus at risk for suboptimal intraoperative care.

Conclusion
In addition to recommending a modification to the domain’s best practices, we provide a preliminary description of DIOR hypertension patient identifying characteristics (older, higher body weight and BMI, and higher rates of chronic obstructive pulmonary disease, hypothyroidism and obesity), so that DIOR hypertension patients may be more readily identified, and that future research may build on the findings, and that the operating team may remain generally aware that this problem can occur and be dealt with regardless of the patient’s medical history.
Strategy Configurations Directly Linked to Higher Hepatitis C Virus Treatment Starts
Authors: Yakovchenko Vera , Miech Edward J. , Chinman Matthew J. , Chartier Maggie , Gonzalez Rachel , Kirchner JoAnn E. , Morgan Timothy R. , Park Angela , Powell Byron J. , Proctor Enola K. , Ross David , Waltz Thomas J. , Rogal Shari S. 
Published: March 2020

Background:
The Department of Veterans Affairs (VA) cares for more patients with hepatitis C virus (HCV) than any other US health care system. We tracked the implementation strategies that VA sites used to implement highly effective new treatments for HCV with the aim of uncovering how combinations of implementation strategies influenced the uptake of the HCV treatment innovation. We applied Configurational Comparative Methods (CCMs) to uncover causal dependencies and identify difference-making strategy configurations, and to distinguish higher from lower HCV treating sites.

Methods:
We surveyed providers to assess VA sites’ use of 73 implementation strategies to promote HCV treatment in the fiscal year 2015. CCMs were used to identify strategy configurations that uniquely distinguished higher HCV from lower HCV treating sites.

Results:
From the 73 possible implementation strategies, CCMs identified 5 distinct strategy configurations, or “solution paths.” These were comprised of 10 individual strategies that collectively explained 80% of the sites with higher HCV treatment starts with 100% consistency. Using any one of the following 5 solution paths was sufficient to produce higher treatment starts: (1) technical assistance; (2) engaging in a learning collaborative AND designating leaders; (3) site visits AND outreach to patients to promote uptake and adherence; (4) developing resource sharing agreements AND an implementation blueprint; OR (5) creating new clinical teams AND sharing quality improvement knowledge with other sites AND engaging patients. There was equifinality in that the presence of any one of the 5 solution paths was sufficient for higher treatment starts.

Conclusions:
Five strategy configurations distinguished higher HCV from lower HCV treating sites with 100% consistency. CCMs represent a methodological advancement that can help inform high-yield implementation strategy selection and increase the efficiency and effectiveness of future implementation efforts.
Effects of State-level Medicaid Expansion on Veterans Health Administration Dual Enrollment and Utilization
Authors: O’Mahen Patrick N. , Petersen Laura A. 
Published: March 2020

Objective:
The objective of this study was to examine how pre-Affordable Care Act (ACA) state-level Medicaid expansions affect dual enrollment and utilization of Veterans Health Administration (VA) and Medicaid-funded care.

Research Design:
We employed difference-in-difference analysis to determine the association between pre-ACA Medicaid expansions in New York and Arizona in 2001 and VA utilization. Participants’ dual enrollment in Medicaid and VA, the distribution of their annual hospital admissions and emergency department (ED) visits between VA and Medicaid were dependent variables. We controlled for age, race, sex, disease burden, distance to VA facilities and income-based eligibility for VA services.

Measures:
Secondary data collected from 1999 to 2006 in 2 states expanding Medicaid and 3 demographically similar nonexpansion states. We obtained residency, enrollment and utilization data from VA’s Corporate Data Warehouse and Medicaid Analytic Extract files.

Results:
For low-income Veterans, Medicaid expansion was associated with increased dual enrollment of 4.87 percentage points (99% confidence interval: 4.48–5.25), a 4.63-point decline in VA proportion of admissions (−5.87 to −3.38), and a 11.70-point decrease in the VA proportion of ED visits (−13.06 to −10.34). Results also showed increases in the number of total (VA plus Medicaid) annual per-capita hospitalizations and ED visits among the group of VA enrollees most likely to be eligible for expansion.

Conclusions:
This study shows slight usage shifts when Veterans gain access to non-VA care. It highlights the need to overcome care-coordination challenges among VA patients as states implement ACA Medicaid expansion and policymakers consider additional expansions of public health insurance programs such as Medicare-for-All.
Tumor-to-liver standard uptake ratio using fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography effectively predict occult lymph node metastasis of non–small cell lung cancer patients
Authors: Shi Yun-Mei , Niu Rong , Shao Xiao-Liang , Zhang Fei-Fei , Shao Xiao-Nan , Wang Jian-Feng , Wang Xiao-Song , Liu Bao , Yu Wen-Ji , Wang Yue-Tao 
Published: March 2020

Objectives
We aimed to investigate predictive factors of occult lymph node metastasis and to explore the diagnostic value of various standardized uptake value (SUV) parameters using fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography computed tomography (PET/CT) in predicting occult lymph node metastasis of clinical N0 non–small cell lung cancer patients.

Methods
We retrospectively analyzed PET/computed tomography parameters of tumor and clinical data of 124 clinical N0 non–small cell lung cancer patients who underwent both preoperative 18F-FDG PET/computed tomography and anatomical pulmonary resection with systematic lymph node dissections. The SUVmax, SUVmean, metabolic total volume, and total lesion glycolysis of the primary tumor was automatically measured on the PET/computed tomography workstation. Standardized uptake ratio (SUR) were derived from tumor standardized uptake value divided by blood SUVmean (B-SUR) or liver SUVmean (L-SUR), respectively.

Results
According to postoperative pathology, 19 (15%) were diagnosed as occult lymph node metastasis among 124 clinical N0 non–small cell lung cancer patients. On univariate analysis, carcinoembryonic antigen, cytokeratin 19 fragment, lobulation, and all PET parameters were associated with occult lymph node metastasis. The area under the receiver operating characteristic curve, sensitivity, and negative predictive value of L-SURmax were the highest among all PET parameters (0.778, 94.7%, and 98.4%, respectively). On multivariate analysis, carcinoembryonic antigen, cytokeratin 19 fragment, and L-SURmax were independent risk factors for predicting occult lymph node metastasis. Compared to L-SURmax alone and the combination of carcinoembryonic antigen and cytokeratin 19 fragment, the model consisting of three independent risk factors achieved a greater area under the receiver operating characteristic curve (0.901 vs. 0.778 vs. 0.780, P = 0.021 and 0.0141).

Conclusions
L-SURmax showed the most powerful predictive performance than the other PET parameters in predicting occult lymph node metastasis. The combination of three independent risk factors (carcinoembryonic antigen, cytokeratin 19 fragment, and L-SURmax) can effectively predict occult lymph node metastasis in clinical N0 non–small cell lung cancer patients.
Burden of metastatic bone disease measured on 18F-NaF PET/computed tomography studies as a prognostic indicator in patients with medullary thyroid cancer
Authors: Ueda Cristina E. , Duarte Paulo S. , de Castroneves Luciana A. , Flávio José , Marin G. , Sado Heitor N. , Sapienza Marcelo T. , Hoff Ana O. , Buchpiguel Carlos A. 
Published: March 2020

Purpose
The aim of the study was to assess the association between the burden of metastatic bone disease measured on 18F-NaF PET/computed tomography (CT) studies and the overall survival (OS) of patients with medullary thyroid cancer (MTC).

Methods
We retrospectively analyzed 31 patients with MTC who performed 18F-NaF PET/CT studies to assess skeletal metastases. The outcomes of the patients (dead or alive) were established based on the last information available on their files. In the studies considered positives for skeletal metastases, the burden of metastatic bone disease was established calculating the fluoride tumor volume (FTV). The FTV was defined using isocontour thresholds based on percentages of maximal standardized uptake values (SUVmax) in the lesions. These percentages varied from lesion to lesion and were established by visual analysis. The patients were divided into three groups as follows: without skeletal metastases (n = 11), with low FTV (≤50 cm3; n = 11) and with high FTV (>50cm3; n = 9). The Kaplan–Meier curves were used to analyze the OS in the three groups of patients and the log-rank test was used to determine the statistical significance of the difference between the groups.

Results
There were statistically significant differences in the OS between the group with high FTV and the groups of patients with low FTV (P = 0.036) and without skeletal metastases (P = 0.001). There was not a statistically significant difference between the groups of patients with low FTV and without skeletal metastases (P = 0.147).

Conclusion
In patients with MTC, the burden of metastatic bone disease is associated with OS.
Oncology Nurses' Perspectives and Practices Toward the Delivery of Cancer Survivorship Care in Hong Kong
Authors: Wong Cho Lee , So Winnie K.W. , Choi Kai Chow , Tong Man , Choy Yin Ping , Molassiotis Alex , Yates Patsy , Chan Raymond J. 
Published: March 2020

Background
Despite tremendous progress in understanding the unmet needs of cancer survivors, our understanding of oncology nurses' perspectives and practices in the delivery of survivorship care is inadequate.

Objectives
The aims of this study were to assess oncology nurses' perceptions about their responsibility and frequency of delivery of survivorship care to cancer patients and to examine the factors influencing such care.

Methods
A cross-sectional survey was administered to 81 nurses working in the oncology unit of hospitals in Hong Kong. Participants completed an investigator-developed questionnaire designed to assess oncology nurses' perceptions of responsibility, practices, and barriers regarding the provision of survivorship care for cancer patients.

Results
Results revealed discrepancies between oncology nurses' perceptions of responsibility and practices, with high levels of perceptions of various survivorship care as their responsibility but low levels in delivery of such care. Despite that discussing and managing pain was agreed by most oncology nurses as their responsibility (95.1%), 34.6% of them have never managed survivors' pain. Besides, 33.3% of nurses have never discussed and managed survivors' sexuality issues. Lack of time (79.0%), inadequate educational resources for family members (59.3%), and lack of knowledge and skills (54.4%) were major factors that impeded survivorship care provision.

Conclusions
This study provides further evidence for inadequacies of oncology nurses in delivering survivorship care and their perceived barriers. Further studies are required to enhance our understanding of the strategies for improving the quality of cancer survivorship care.

Implications for Practice
Results underscore the need to develop educational resources and enhance training in survivorship care for oncology nurses.
Exploring Young People’s Experience of Ending Active Cancer Treatment
Authors: Lea Sarah , Martins Ana , Cable Maria , Fern Lorna A. , Morgan Sue , Soanes Louise , Whelan Michael , Taylor Rachel M. 
Published: March 2020

Background
The end of active cancer treatment is described as a stressful period for adolescents and young adults (AYAs). However, research evidence describing the experience of AYAs as they transition from active treatment into follow-up care is scarce.

Objective
We aimed to understand AYAs’ experiences within the first 12 months of ending active treatment.

Methods
Data were collected using semistructured interviews, which were digitally recorded and transcribed verbatim. Qualitative analysis of transcripts was used to identify key themes/subthemes.

Results
Eleven AYAs (8 female participants), diagnosed with cancer aged 17 to 25 years and 19 to 26 years at point of interview, participated. At time of interview, 7 were within 6 months of treatment completion, and in 4 participants, treatment ended 6 to 12 months prior. Three main themes were identified: (1) challenges of social reintegration and self-identity, (2) expectations versus the lived experience of ending treatment, and (3) sudden loss of the safe “bubble” of treatment.

Conclusions
Adolescents and young adults were underprepared for and challenged by the unexpected emotional and physical consequences of ending active cancer treatment.

Implications for Practice
Young people require information and support to prepare for ending active treatment and reintegration to everyday life. Preparation for the short- and long-term physical, social, and psychological impact of a cancer diagnosis even when treatment ends will assist young people in managing this transition. Further research is required to develop and test interventions to provide timely, structured, and equitable information and support at the end of treatment to better prepare AYAs for the challenges they may face as treatment ends.
Defining Expertise in Cancer Nursing Practice
Authors: Krishnasamy Mei , Webb Ursula M. M. , Babos Susannah L. C. , Duong Jessica T. T. , Rohde Jacqueline E. N. , Ting Nathan Y. H. , Milne Donna , Koproski Trista , Mathieson Jac 
Published: March 2020

Background
Thirty-five years ago, Benner defined an expert nurse as one who applies deep knowledge and experience across different contexts and clinical situations. Since that time, there has been little exploration of expertise in cancer nursing.

Objectives
To explore and describe characteristics of expert cancer nurses and to consider whether Benner’s typology of an expert nurse remains relevant in today’s complex oncology settings.

Methods
An exploratory, descriptive study using audio-recorded focus group methodology was undertaken. Audio-recordings were transcribed, and an inductive thematic analysis approach applied to the data. Nurses also documented key characteristics of expert practice on Post-it notes to illustrate dominant characteristics.

Results
Twenty-four registered nurses from a comprehensive cancer center in Australia took part in 1 of 3 focus groups. Seven key themes were identified: knowledge, leadership, adaptability, communication, motivation, patient-centered care, organization, and culture. Key word cloud characteristics included knowledge, compassion, motivation, experience, and communication.

Conclusions
Many of the expert characteristics identified in this study reflect traits common to other nursing specialty groups. Of particular relevance to cancer nurses was “adaptability,” reflecting the complexity of contemporary cancer care and reaffirming Benner’s definition of an expert nurse as one who can fluidly connect knowledge and experience to unfamiliar practice contexts.

Implications for Practice
Understanding characteristics of expert cancer nurses may help inform and support professional practice advancement and guide future research about select characteristics of expert cancer nurses to patient- and system-level outcomes.
A Psychological Nursing Intervention for Patients With Thyroid Cancer on Psychological Distress and Quality of Life
Authors: Wang Shujia , Huang Hui , Wang Liping , Wang Xiaoyan 
Published: March 2020

Abstract
The present research aimed to investigate the impact of a psychological nursing intervention on psychological distress and quality of life of thyroid cancer patients. A total of 286 participants were randomly divided into two groups: a control group (n = 143) and an intervention group (n = 143). In addition to routine nursing care, patients in the intervention group were given additional psychological nursing interventions. A reduced edition of the Profile of Mood States was used to evaluate mood disturbance, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core Questionnaire (version 3.0) was applied to determine the quality of life of patients. The intervention group showed remarkably alleviated depression, anxiety, and mood disturbance when compared to the control group. In addition, global health status, functional status, and symptoms status were significantly improved in the intervention group. In conclusion, our findings suggest that a psychological nursing intervention could reduce psychological distress and enhance the life quality of thyroid cancer patients, which could have clinical value to the treatment of thyroid cancer.
Retrospective Analysis of Fractures and Factors Causing Ambulation Loss After Lower Limb Fractures in Duchenne Muscular Dystrophy
Authors: Yildiz Sulenur , Glanzman Allan M. , Estilow Tim , Flickinger Jean , Brandsema John F. , Tennekoon Gihan , Banwell Brenda L. , Yum Sabrina 
Published: March 2020

ObjectivePrevalence and characteristics of fractures and factors related to loss of ambulation after lower limb fractures were investigated.DesignChart review included height, weight, dual-energy x-ray absorptiometry, corticosteroid use, vitamin D, fracture history, muscle strength, range of motion, and timed performance tests (10 meter walk/run, Gowers, and four steps). Patients were grouped by fracture location and ambulation loss after fracture.ResultsTwo hundred eighty-seven patients with Duchenne muscular dystrophy were identified, 53 of these had experienced fracture. Eighty-one percent were older than 9 yrs at first fracture and 36.4% became nonambulatory after fracture. Dorsiflexion range of motion (fracture side,P= 0.021), quadriceps strength (right side,P= 0.025), and shoulder abduction strength (right, left, and fracture side;P= 0.028,P= 0.027, andP= 0.016) were significantly different within the groups. Patients who became nonambulatory after fracture initially had less dorsiflexion (right, left, fracture side; 2.250vs. −7.290,P= 0.004; 2.670vs. −120,P= 0.001; and 2.410vs. −7.420,P= 0.002) and slower 10-meter walk/run times (7.43 secs vs. 14.7 secs,P= 0.005).ConclusionsFracture represents a significant risk in patients with Duchenne muscular dystrophy; both slower walking speed and ankle contracture confer an increased risk of ambulation loss after fracture.To Claim CME CreditsComplete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME ObjectivesUpon completion of this article, the reader should be able to: (1) Identify the main factors that are associated with ambulation loss after fracture in patients with Duchenne muscular dystrophy; (2) Identify the risk of fracture in the Duchenne muscular dystrophy population; and (3) Articulate the characteristics associated with fracture in patients with Duchenne muscular dystrophy.LevelAdvanced.AccreditationThe Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Functional Outcomes Regarding Facial Artery Musculomucosal Flap for Reconstruction of Partial Glossectomy Defects
Authors: Benjamin Martin , Aliano Kristen , Davenport Thomas , Frank Douglas 
Published: March 2020

Background
The surgical management and reconstruction after ablation of squamous cell carcinoma of the oral tongue and floor of mouth are quite challenging. If not reconstructed properly, the deficits resulting from the extirpation of even relatively small (T1 and T2) tumors of the tongue can impact speech and deglutition via tongue tethering and poor anterolateral mobility. Functional outcome studies regarding the utility of the pedicled facial artery musculamucosal (FAMM) flap for reconstruction of partial glossectomy defects are limited.

Methods
This is a retrospective single institutional study of patients who underwent FAMM flap reconstruction for oral cavity defects resulting from partial glossectomy (2009–2013). Follow-up data included postoperative complications, defect size, operative time, and subjective functional results (tongue mobility, speech, and swallowing capabilities).The MD Anderson Dysphagia Inventory and a limited self-assessment of speech were sent to all living patients in this initial tongue cancer cohort to assess aspects of functional status.

Results
Of the 21 patients studied in this initial FAMM flap cohort, 18 are currently living. The MD Anderson Dysphagia Inventory and a limited self-assessment survey of speech were sent to these individuals 6 months after treatment completion. Eight patients (44%) returned completed questionnaires. All of the respondents disagreed or strongly disagreed with the statement that they felt excluded from others because of their eating habits, 6 of the 8 of the respondents stated that they disagreed or strongly disagreed with the statement that they have to limit their food intake, and none felt that others were irritated by their eating habits. All felt that their speech was either good, very good, or excellent. No surveyed patient reported having job difficulty because of their speech.

Conclusions
The FAMM flap is a reliable alternative for reconstruction of small oral tongue defects without functional deficits and a great alternative to free flap reconstruction of medium-sized defects. The encouragement of patient functional outcome studies and longitudinal follow-up studies need to be conducted in efforts to best tailor a reconstruction plan for patients with oral tongue cancers.