bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recognizing and responding to sex-trafficked minors in the healthcare setting
Authors: Quincy Brenda L. , Falteisek Kylie , Johnston Jennifer 
Published: August 2020

ABSTRACT
Nearly 6,100 reports of sex trafficking were made to the United States Human Trafficking Hotline in 2017; 29% of those reports involved minors. Physician assistants (PAs), especially those working in emergency medicine and primary care, are among the few frequently accessed healthcare providers who have the opportunity for a private conversation with a sex trafficking victim or survivor. PAs must be able to recognize the risk factors and signs of trafficking and respond in a trauma-informed, survivor-centered manner. Connecting trafficking victims, survivors, and at-risk youth with wraparound services is critical to their well-being.
An NP's guide to current physical activity recommendations
Authors: Hudson Geoffrey M. , Hauff Caitlyn , Hayes Katey , Fruh Sharon 
Published: August 2020

Abstract:
Physical inactivity is a public health crisis that contributes to many of the chronic diseases that affect Americans. This review emphasizes the beneficial health implications of physical activity along with the dangers of sedentary lifestyles. It also provides advice tailored to NPs to help their patients become more physically active.
Organizational Characteristics Associated With ICU Liberation (ABCDEF) Bundle Implementation by Adult ICUs in Michigan
Authors: Barr Juliana , Ghaferi Amir A. , Costa Deena Kelly , Hedlin Haley K. , Ding Victoria Y. , Ross Corine , Pun Brenda T. , Watson Sam R. , Asch Steven M. 
Published: August 2020

Objectives:
The ICU Liberation (ABCDEF) Bundle can help to improve care and outcomes for ICU patients, but bundle implementation is far from universal. Understanding how ICU organizational characteristics influence bundle implementation could inform quality improvement efforts. We surveyed all hospitals in Michigan with adult ICUs to determine whether organizational characteristics were associated with bundle implementation and to determine the level of agreement between ICU physician and nurse leaders around ICU organizational characteristics and bundle implementation.

Design:
We surveyed ICU physician and nurse leaders, assessing their safety culture, ICU team collaboration, and work environment. Using logistic and linear regression models, we compared these organizational characteristics to bundle element implementation, and also compared physician and nurse leaders’ perceptions about organizational characteristics and bundle implementation.

Setting:
All (n = 72) acute care hospitals with adult ICUs in Michigan.

Subjects:
ICU physician and nurse leader pairs from each hospital’s main ICU.

Interventions:
We developed, pilot-tested, and deployed an electronic survey to all subjects over a 3 month period in 2016.

Results:
Results from 73 surveys (28 physicians, 45 nurses, 60% hospital response rate) demonstrated significant variation in hospital and ICU size and type, organizational characteristics, and physician/nurse perceptions of ICU organization and bundle implementation. We found that a robust safety culture and collaborative work environment that uses checklists to facilitate team communication are strongly associated with bundle implementation. There is also a significant dose-response effect between safety culture, a collaborative work environment, and overall bundle implementation.

Conclusions:
We identified several specific ICU practices that can facilitate ABCDEF Bundle implementation. Our results can be used to develop effective bundle implementation strategies that leverage safety culture, interprofessional collaboration, and routine checklist use in ICUs to improve bundle implementation and performance.
Gender Differences in Outcomes of Patients With Mesothelioma
Authors: Alpert Naomi , van Gerwen Maaike , Flores Raja , Taioli Emanuela 
Published: August 2020

Background:
Mesothelioma is a rare and deadly form of cancer, linked to asbestos exposure. Although the United Kingdom has banned asbestos, the incidence rate remains high. Previous research has indicated that female individuals have better survival than male individuals, but this has never been examined in the United Kingdom.

Materials and Methods:
Pleural mesothelioma cases from 2005 to 2014 were extracted from the United Kingdom Lung Cancer Dataset. Multivariable logistic regression was used to assess the clinical and demographic factors associated with gender. A multivariable Cox proportional hazards model and propensity matching methods were used to assess gender differences in overall survival while accounting for potential confounders.

Results:
There were 8479 (87.8%) male and 1765 (17.2%) female individuals included in the analysis. Female individuals were significantly younger, with more epithelial histology than male individuals. Female individuals had significantly better overall survival (adjusted hazard ratio, 0.85, 95% confidence interval, 0.81-0.90). Results remained similar when stratifying by age and performance status, and when limiting to patients with epithelial histology.

Conclusions:
The study increases knowledge about gender differences in mesothelioma survival and is the first to directly examine this in the United Kingdom. It further disentangles the effects of age, histology, and health status. Increased estrogen may improve survival and could provide a potential target for future therapies.
Does the mean 24-h pulse rate from ambulatory blood pressure monitoring reflect the mean 24-h ventricular rate from Holter electrocardiogram in atrial fibrillation patients?
Authors: Tong Hui-yu , Yu Jian-hua , Hong Kui , Chen Jing , Liu Hong-yu , Su Hai 
Published: August 2020

Background
Ambulatory blood pressure monitoring (ABPM) on the oscillometric method is applicable in patients with atrial fibrillation, but the mean pulse rate is or not similar to the ventricular rate from the Holter in atrial fibrillation patients remains unknown.

Methods
This study included 228 persistent atrial fibrillation patients who received simultaneous 24-h ABPM and 24-h Holter. The mean 24-h pulse rate and the mean 24-h ventricular rate were calculated, and mVR-mPR was used to reflect the difference between them. The SD of 24-h pulse rate values was calculated as SD-pulse rate. Furthermore, according to the SD-pulse rate, the patients were divided into ≤5, 6–10, 11–15 and >15 bpm subgroups.

Results
For the total population, the mean 24-h pulse rate is positively correlated with the mean 24-h ventricular rate, and the Bland–Altman plot showed quite wide 95% limits. As the SD-pulse rate increased, the 24-h mVR-mPR also increased. The mean 24-h mVR-mPR was 0.5 bpm when SD-pulse rate ≤5, 3.5 bpm when SD-pulse rate of 6–10, 7.6 bpm when SD-pulse rate of 11–15, and 12.5 bpm when SD-pulse rate >15 bpm, respectively. Meanwhile, in the SD-pulse rate 0–10 subgroup, the 95% limits were only from −13.8 to 19.7 bpm, while in the >10 subgroup, these values were from −19.5 to 36.5 bpm.

Conclusion
The mean 24-h pulse rate should not be used to represent the true ventricular rate for all atrial fibrillation patients. However, when lower the SD-pulse rate, the mVR-mPR becomes smaller.
Self-reported practices of doctors and nurses for the measurement of blood pressure
Authors: Kirhan İdris , Kir Seher , Dilek Melda 
Published: August 2020

Background
Hypertension is one of the most common health problems worldwide and can be diagnosed with an accurate blood pressure measurement (BPM). We aim to evaluate the self-reported practices of family physicians and nurses for BPM.

Methods
This study was conducted in the form of a survey administered through face-to-face interviews with 131 physicians and 371 nurses. The survey included questions about devices, patients, and BPM techniques.

Results
The mean age was 31 ± 7.4 years. The most commonly used device was the aneroid model (47.8%). The majority of participants reported that they had sufficient technical knowledge about the devices (81.1%), and the devices were regularly calibrated (77.5%). Only 44.8% reported that they had asked patients about caffeine or nicotine use. About half of those in both groups (54%) performed BPM only once during a presentation. The most commonly used position during BPM was sitting. BPM was performed mostly on one arm without preference for any side (67.5%). Approximately half of the respondents reported that they performed BPM by actively supporting the arm at the heart level.

Conclusion
We found physicians and nurses had lack of adherence to proper techniques related to the use of appropriate positions and other relevant situations that should be considered during BPM. Accurate BPM is the most important factor for proper diagnosis and treatment of hypertension. Thus, BPM should be performed in accordance with the designated guidelines and can be performed with accurate results only as a result of repeated comprehensive training programs.
Real-world Comorbidity Burden, Health Care Utilization, and Costs of Nonalcoholic Steatohepatitis Patients With Advanced Liver Diseases
Authors: Wong Robert J. , Kachru Nandita , Martinez Diane J. , Moynihan Meghan , Ozbay A. Burak , Gordon Stuart C. 
Published: August 2020

Goals:
This study evaluates the real-world comorbidity burden, health care resource utilization (HRU), and costs among nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) patients with advanced liver diseases [compensated cirrhosis (CC), decompensated cirrhosis (DCC), liver transplantation (LT), hepatocellular carcinoma (HCC)].

Background:
NAFLD/NASH is a leading cause of liver diseases.

Materials and Methods:
Adult NAFLD/NASH patients were identified retrospectively from MarketScan Commercial claims (2006-2016). Following initial NAFLD/NASH diagnosis, advanced liver diseases were identified using the first diagnosis as their index date. Mean annual all-cause HRU and costs (2016 USD) were reported. Adjusted costs were estimated through generalized linear models. Cumulative costs were illustrated for patient subsets with variable follow-up for each stage.

Results:
Within the database, 485,774 NAFLD/NASH patients met eligibility criteria. Of these, 93.4% (453,564) were NAFLD/NASH patients without advanced liver diseases, 1.6% (7665) with CC, 3.3% (15,833) with DCC, 0.1% (696) with LT, and 0.1% (428) with HCC. Comorbidity burden was high and increased as patients progressed through liver disease severity stages. Compared with NAFLD/NASH without advanced liver diseases (adjusted costs: $23,860), the annual cost of CC, DCC, LT, and HCC were 1.22, 5.64, 8.27, and 4.09 times higher [adjusted costs: $29,078, $134,448, $197,392, and $97,563 (P<0.0001)]. Inpatient admissions significantly drove increasing HRU.

Conclusion:
Study findings suggest the need for early identification and effective management of NAFLD/NASH patients to minimize comorbidity burden, HRU, and costs in the privately insured US population.
Prevalence and risk factors of low health literacy in residents of Anhui province
Authors: Wang Chao , Zhou Lan 
Published: August 2020

Abstract
This survey aimed to evaluate the prevalence of low health literacy and correlations of demographic characteristics with low health literacy risk in residents of Anhui province.
A total of 5120 residents of Anhui province were interviewed in this cross-sectional survey, and 4816 (94.1%) gave valid responses. Sociodemographic characteristics were collected. Health literacy and its 3 subscales, including basic knowledge and concepts, lifestyle, and health-related skill, were assessed. Low health literacy was defined as <80.0% of the total score or score of each subscale.
Mean total health literacy score was 62.7±17.2 (maximum 100 points), and was 31.5 ± 9.0 (maximum 47 points), 17.0 ± 4.8 (maximum 28 points), and 14.2 ± 4.1 (maximum 25 points) in terms of basic knowledge and concepts score, lifestyle score, and health-related skill score, respectively. The prevalence of low health literacy was 81.4%, and was 71.3% in terms of basic knowledge and concepts subscale, 87.9% with regard to lifestyle subscale, and 86.3% in view of health-related skill subscale. In addition, older age (P = .001), male (P < .001), decreased education level (P < .001), lower annual household income (P < .001), and location at rural area (P < .001) associated with increased risk of low health literacy. Moreover, multivariate logistic regression revealed that male, lower education level, and location at rural area were independent risk factors of low health literacy (all P < .05).
The prevalence of low health literacy is high in residents of Anhui province, and male, lower education level, as well as location at rural area are independent risk factors of low health literacy.
Correlation of microRNA-335 expression level with clinical significance and prognosis in non-small cell lung cancer
Authors: Huo Wen , Zhang Man , Li Chunhua , Wang Xinying , Zhang Xiuli , Yang Xiaona , Fei Haitao 
Published: August 2020

Abstract
Although treatments have improved significantly in recent years, the prognosis of patients with non-small cell lung cancer (NSCLC) remains poor. miR-335 has been demonstrated to play the antitumor role in several cancer types. Its expression was reduced in NSCLC tissues relative to noncancerous adjacent tissues. Furthermore, downregulation of miR-335 in A459 lung cancer cells promoted cell proliferation. In the present study, we aimed to investigate the clinical significance and prognostic value of miR-335 in NSCLC.
The lung cancer tissues and adjacent nontumor lung tissues were obtained from 131 patients who underwent the primary surgical resection at Lianyungang First People's Hospital. Student t test was used to distinguish differences between groups. χ
2 test was involved for analysis of clinicopathological data. The overall survival was analyzed by the Kaplan-Meier method and the log rank test. Multiple Cox proportional hazards regression analysis was carried out to identify the independent factors that had a significant impact on patient survival.
miR-335 was significantly lower in NSCLC samples compared to non-cancerous samples (P < .001). The expression level of miR-335 was significantly correlated with tumor histology (P = .028), lymph node metastasis (P = .002), differentiation degree (P < .001), and pathological TNM stage (P < .001). The log-rank test indicated that patients with decreased miR-335 expression experienced poor overall survival in NSCLC (P = .029).
The results of the present study indicated that miR-335 was down-expressed in NSCLC, and is associated with tumor progression and poor prognosis, suggesting that the expression of miR-335 might be an independent prognostic factor of overall survival in patients with NSCLC.
Value of plasma homocysteine to predict stroke, cardiovascular diseases, and new-onset hypertension
Authors: Feng Yuanyuan , Kang Kai , Xue Qiqi , Chen Yafen , Wang Wei , Cao Jiumei 
Published: August 2020

Abstract
The influences of hyperhomocysteinemia on cardiovascular diseases (CVDs), stroke and new-onset hypertension are unclear. The aim of the study is to explore the associations of homocysteine levels with stroke, CVDs, and new-onset hypertension in Chinese individuals.
This retrospective cohort study included outpatients and inpatients from the Department of Geriatrics at Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine from January to December 2000. They were divided based on their homocysteine (Hcy) levels in 2000: Q1 (<10 μmol/L), Q2 (10–15 μmol/L), and Q3 (>15 μmol/L) and according to whether they had hypertension at baseline. Information about stroke, mortality and major adverse cardiac events, and newly onset hypertension was gathered in December each year until 2017. The effects of Hcy levels on the risk for stroke and CVDs among all patients, and new-onset hypertension among patients without hypertension at baseline were evaluated.
After adjustment for confounders, compared with the Q1 group (Hcy <10 μmol/L), when the Hcy increased to 10 to 15 μmol/L, the risks for stroke, CVDs, and new-onset hypertension significantly increased, and the hazard ratio and 95% confidence interval were 2.02 (1.35–3.05, P = .001), 2.22 (1.32–3.76, P = .003), and 7.20 (4.52–11.48, P < .001), respectively. Hcy improved the predictive capability of traditional risk factors for stroke. The optimal cut-off value of Hcy for predicting stroke was 13.4 μmol/L (sensitivity: 70.9%, specificity: 62.2%).
Hcy 10 to 15 μmol/L is significantly associated with the risks for stroke, mortality and major adverse cardiac events, and hypertension. The best cut-off point of Hcy for predicting stroke is 13.4 μmol/L.
Comparison of tendon suture fixation and cortical screw fixation for treatment of distal tibiofibular syndesmosis injury
Authors: Song Liuhong , Liao Zhifu , Kuang Zhongqiang , Qu Shiyan , Zhang Wei , Yuan Yang , Fang Teng 
Published: August 2020

Abstract
This study aimed to investigate the effectiveness of tendon suture fixation versus cortical screw fixation for the treatment of distal tibiofibular syndesmosis injury.
This study recruited 42 patients with Danis-Weber type B, C1 and C2 fractures concomitant with lower tibiofibular syndesmosis injury, who were randomly assigned to 2 groups according to treatment with cortical screw fixation (n = 21) and tendon suture fixation (n = 21). Operation time, intraoperative blood loss, time to full weight-bearing activity, medical cost, ankle function, and ankle pain were compared between the 2 groups.
The operation time was significantly less with cortical screw fixation (57.1 ± 5.3 min) than with tendon suture fixation (63.3 ± 6.3 min; p = 0.01), but there was no significant difference in intraoperative blood loss. The time until full weight-bearing was possible was significantly longer after cortical screw fixation (10.9 ± 2.7 weeks) than after tendon suture fixation (7.1 ± 1.9 weeks; P < .001). The medical cost was much greater for cortical screw fixation (1861.6 ± 187.3 USD) than for tendon suture fixation (1209.6 ± 97.6 USD; P < .01). The rate of excellent and good ankle function at 3 months after surgery was significantly higher with tendon suture fixation (71.4%) than with cortical screw fixation (33.3%; P = .03).
Tendon suture fixation is associated with quicker recovery of ankle function, shorter time to full weight-bearing, and lower medical cost to the patient compared with screw fixation. Our findings suggest that tendon suture fixation is an effective method for the treatment of tibiofibular syndesmosis injury.
Comparing effectiveness of radical prostatectomy versus external beam radiotherapy in patients with locally advanced prostate cancer
Authors: Zhou Xianghong , Jin Kun , Qiu Shi , Jin Di , Liao Xinyang , Tu Xiang , Zheng Xiaonan , Li Jiakun , Yang Lu , Wei Qiang 
Published: August 2020

Abstract
Currently, the standard management for locally advanced prostate cancer (PCa) is still controversial. In our study, we aimed to compare the survival outcomes of radical prostatectomy (RP) versus external beam radiotherapy (EBRT).
We conducted analyses with a large cohort of 38,544 patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016). Propensity score matching, Kaplan-Meier method, and Cox proportional hazard regression were used to reduce the influence of bias and compare the overall survival (OS) and cancer specific survival (CSS). Several different sensitivity analyses including inverse probability of treatment weighting and standardized mortality ratio weighting were used to verify the robustness of the results.
Totally, 33,388 men received RP and 5,156 men received EBRT with cT3-4N0M0 PCa were included in this study. According to the Kaplan-Meier curves, RP performed better in both OS and CSS compared with EBRT (P < .0001). In the adjusted multivariate Cox regression, RP also showed better OS and CSS benefits (OS: HR=0.50; 95% confidence interval [CI]: 0.46–0.54; P < .0001 and CSS: HR=0.43; 95% CI: 0.38–0.49; P < .0001). After propensity score matching, RP is still the management that can bring more survival benefits to patients. (OS: HR=0.46; 95% CI: 0.41–0.51; P < .0001 and CSS: HR = 0.41; 95% CI: 0.34–0.48; P < .0001).
Our research demonstrated the significantly better survival benefits of RP over EBRT in patients with locally advanced PCa. The results of this study will provide more evidence to help clinicians choose appropriate treatment strategies.
Clinical features of 18 perivascular epithelioid cell tumor cases
Authors: Jia Rongfei , Jiang Ling , Zhou Yuhong , Wang Yan , Guo Xi , Ji Yuan , Ni Xiang , Yang Xiaoyan 
Published: August 2020

Abstract
To investigate the biological behavior and clinical characteristics of perivascular epithelioid cell tumor (PEComa).
Eighteen PEComa patients admitted to Zhongshan Hospital and the Central Hospital of Xuhui District in China from January 2006 to October 2018 were included. All patients were diagnosed based on pathological findings and treated with surgical resection or medication.
Among the 18 patients, 1 underwent lymph node biopsy for multiple enlarged lymph nodes and 17 underwent mass resection. The median disease-free survival was 22 months after the first resection and over 12 months following a second resection. Treatment with mechanistic target of rapamycin (mTOR) inhibitors was effective for patients with unresectable or metastatic lesions. The median progression-free survival was approximately 13 months.
Surgery is the predominant treatment approach for PEComa and patients can benefit from multiple operations. mTOR inhibitors are considered for patients with multiple lesions or intolerance to surgery. Anti-angiogenetic drugs can be selected when mTOR inhibitors fail to control the illness.
Anesthesia management of a premature neonate during minimally invasive sclerotherapy of a large chest wall mass
Authors: Luo Xi , Xie Min , Ma Yushan , Jiang Xiaoqin 
Published: August 2020

Abstract

Rationale:
The most common critical incidents in pediatric anesthesia are perioperative respiratory adverse events (PRAE), which occur more often in neonates and account for one-third of anaesthesia-related cardiac arrests. It is crucial to maintain an open stable airway during anesthesia in neonates, as this population has a low oxygen reserve, small airways, and the loss of protective airway reflexes under general anesthesia.

Patient concerns:
A 6-day-old premature newborn underwent minimally invasive sclerotherapy under general anesthesia. For high-risk premature neonates, the selections of the anesthesia and airway device are extremely important, as those factors directly affect the prognosis.

Diagnoses:
B ultrasound and computed tomography (CT) revealed a large mass from the left chest wall to axilla, which was suspected to be a lymphocele.

Interventions:
Minimally invasive sclerotherapy was performed under inhalation anesthesia. After the initiation of anesthesia, a laryngeal mask was placed to control airway. Anesthesia was maintained intraoperatively via sevoflurane inhalation with spontaneous breathing. No accidental displacements or PRAE occurred.

Outcome:
The operation and anesthesia process was stable and safe. The patient discharged at 2 days postoperatively.

Lessons:
Minimally invasive sclerotherapy in a premature neonate is an operation with an extremely short operation time and minimal trauma, but a very high anesthesia risk and risk of PRAE. Anesthesia management is very important in a premature neonate undergoing a very short surgery under general anesthesia. Total sevoflurane inhalation general anesthesia and laryngeal mask airway control with spontaneous breathing may be an ideal option to reduce PRAE during very short surgery in a premature neonate.