bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving mammography through effective screening, brief intervention, and referral to treatment at a rural health center
Authors: Percefull Julie , Butler Judith 
Published: January 2020

ABSTRACT

Background:
Screening mammography rates at a rural health center were below state rates, while the countywide rate of breast cancer was above the state and national rates.

Local problem:
Only 25% of patients at the practice site received a screening mammogram within the last 2 years, and standing order usage was 25%. Evidence-based guidelines and decision aids were not used consistently. The aim was to increase the rate of screening mammograms and right care at a rural health center to 55% of eligible patients in 90 days.

Methods:
Implementation consisted of four 2-week plan, do, study, act cycles. Interventions included screening, brief intervention with patient engagement, referral to treatment with case management log tracking, and team engagement. Aggregate data were collected twice weekly.

Intervention:
An electronic health record reminder for mammography screening, a patient mammography decision aid, a case management log, and weekly quality improvement team meetings were the four core interventions used for the project.

Results:
Screening and identification improved by 40%, patient engagement improved by 30%, and case management for right care more than doubled. Overall, the combined mammography and right care rate improved by 40%. Team engagement reached 100% with survey scores for involvement rising to 78%.

Conclusions:
The results obtained indicate the tools and processes implemented effectively increased screening, patient engagement, and case management to improve mammography rates and right care.
Barriers encountered when exploring nurse practitioner postgraduate training programs
Authors: Matlick Garrett L. 
Published: January 2020

ABSTRACT
With the increasing complexity of today's patients, the demand for nurse practitioner (NP) postgraduate training programs is growing. At least 70 such programs exist, yet information about these programs is limited. A sample of 52 program websites were investigated for information of importance to NPs, employers, and NP faculty. Of the postgraduate training program websites studied, information regarding at least one of the elements investigated was absent from the program website. This lack of information availability makes exploring, selecting, or recommending a postgraduate training program difficult. As the number of programs and the number of graduating NP students continue to grow, the existence and consistency of information regarding new and existing programs will be increasingly important for the accuracy of prospective trainee exploration of such programs and for researchers interested in gathering consistent data.
Sedation selection to reduce delirium risk: Why dexmedetomidine may be a better choice
Authors: Mulkey Malissa A. , Everhart D. Erik 
Published: January 2020

ABSTRACT
In 2018, the Society of Critical Care Medicine published the Pain Agitation Delirium Immobility and Sleep Disruption guidelines that recommend protocol assessment-based pain and sedation management. Since the publication of these guidelines, multiple studies and meta-analyses have been conducted comparing sedative options in the Intensive Care Unit (ICU) setting including dexmedetomidine and propofol. Sedatives are on a continuum when it comes to delirium risk. Propofol, like benzodiazepines, causes changes in sleep patterns by suppressing the rapid eye movement sleep stage not seen with dexmedetomidine, worsening the ICU patient's already poor sleep quality. This reduction in sleep quality increases the risk of delirium. As patient advocates, advanced practice nurses play a vital role in minimizing risk of patient harm. Sedative use and management are areas of opportunity for nurses to minimize this risk. When sedatives are needed, daily sedation vacations should be conducted to re-evaluate the minimum required dose. These practices can reduce sedation risks for delirium and allow for bedside screening and early detection.
The Utility of Digital Anal Rectal Examinations in a Public Health Screening Program for Anal Cancer
Authors: Nyitray Alan G. , D'Souza Gypsyamber , Stier Elizabeth A. , Clifford Gary , Chiao Elizabeth Y. 
Published: January 2020

Objectives
There are no uniform screening recommendations for anal cancer. Medical practice guidelines are now available on the use of Digital Anal Rectal Examinations (DARE) for the detection of anal cancer; however, because screening can result in more harm than benefit, our objective was to assess the evidence for use of DARE as a public health screening tool.

Materials and Methods
We conducted a current critical appraisal of anal cancer literature using World Health Organization criteria for assessing the potential utility of a public health screening program.

Results
Digital Anal Rectal Examination satisfies most, but not all, World Health Organization criteria for a public health program that seeks to detect early invasive anal cancer in populations at high risk for anal cancer, most notably HIV-positive men who have sex with men; however, DARE is not appropriate when facilities for treatment are nonexistent. In addition, there are insufficient data on DARE sensitivity and specificity.

Conclusions
The mildly invasive nature of DARE, limited likelihood of adverse procedure-related events, cost-effectiveness and patient acceptability, as well as wide availability of DARE support consideration of its integration into screening for populations at high risk of anal cancer, especially HIV-positive men who have sex with men.
Unplanned hospital readmissions after acute myocardial infarction: a nationwide analysis of rates, trends, predictors and causes in the United States between 2010 and 2014
Authors: Kwok Chun Shing , Capers Quinn , Savage Michael , Gulati Martha , Potts Jessica , Mohamed Mohamed O. , Nagaraja Vinayak , Patwala Ashish , Heatlie Grant , Kontopantelis Evangelos , Fischman David L. , Mamas Mamas A. 
Published: January 2020

Background
Unplanned hospital readmissions are an important quality metric for benchmarking, but there are limited data following an acute myocardial infarction (AMI). This study aims to examine the 30-day unplanned readmission rate, predictors, causes and outcomes after hospitalization for AMI.

Methods
The USA Nationwide Readmission Database was utilized to analyze patients with a primary diagnosis of AMI between 2010 and 2014. Rates of readmissions, causes and costs were determined and multiple logistic regressions were used to identify predictors of readmissions.

Results
Of 2 204 104 patients with AMI, the 30-day unplanned readmission rate was 12.3% (n = 270 510), which changed from 13.0 to 11.5% between 2010 and 2014. The estimated impact of readmissions in AMI was ~718 million USD and ~281000 additional bed days per year. Comorbidities such as diabetes [odds ratio (OR) 1.27, 95% confidence interval (CI) 1.25–1.29], chronic lung disease (OR 1.29, 95% CI 1.26–1.31), renal failure (OR 1.38, 95% CI 1.35–1.40) and cancer (OR 1.35, 95% CI 1.30–1.41) were independently associated with unplanned readmission. Discharge against medical advice was the variable most strongly associated with unplanned readmission (OR 2.40, 95% CI 2.27–2.54). Noncardiac causes for readmissions accounted for 52.9% of all readmissions. The most common cause of cardiac readmission was heart failure (14.3%) and for noncardiac readmissions was infections (8.8%).

Conclusion
Readmissions during the first month after AMI occur in more than one in 10 patients resulting in a healthcare cost of ~718 million USD per year and ~281000 additional bed days per year. These findings have important public health implications. Strategies to identify and reduce readmissions in AMI will dramatically reduce healthcare costs for society.
Elastography and serum markers of fibrosis versus liver biopsy in 1270 Egyptian patients with hepatitis C
Authors: Abdelsameea Eman , Alsebaey Ayman , Abdel-Razek Wael , Ehsan Nermin , Morad Wesam , Salama Mohsen , Waked Imam 
Published: January 2020

Background
Chronic hepatitis C (CHC) is a leading cause of liver fibrosis.

Objective
To compare utility of liver transient elastography, AST-to-platelet ratio index (APRI), fibrosis-4 index (FIB4), Forns Index and Goteborg University cirrhosis index (GUCI) in predicting fibrosis stage assessed by liver biopsy in Egyptian CHC patients.

Methods
One thousand two-hundred and seventy CHC patients undergoing liver biopsy in preparation for therapy and 40 healthy potential living liver donors had transient elastography and calculation of APRI, FIB4, Forns and GUCI scores on the same day or day preceding the biopsy.

Results
Mean age was 39.89 (17–60 years) and most were males (70.7%). All donors had F0 fibrosis, most patients had F1–F2 fibrosis (n = 1011, 79.6%) and 259 (20.4%) had F3–F4 fibrosis. Patients with F3–F4 fibrosis had higher median values of APRI (0.99 vs. 0.46), FIB4 (2.15 vs. 0.95) and Forns (7.34 vs. 4.79) indices, GUCI score (1.16 vs. 0.49) and transient elastography (19.2 vs. 6.2 kPa) (all P = 0.001). For F1 discrimination, AUROC of transient elastography was higher than both Forns and GUCI scores (P = 0.001). APRI, FIB4 and GUCI had lower AUROC than transient elastography for predicting fibrosis stage in F2 and F3 patients (P = 0.001). Transient elastography had the best area under receiver operating characteristic curve for predicting fibrosis stage in F4 patients (P = 0.001). The transient elastography cutoff values (kPa) were F1 (>4.8), F2 (>8.3), F3 (>10.1) and F4 (>13.4). Age, APRI, FIB4, Forns, GUCI and transient elastography were independent predictors of F3–F4 fibrosis.

Conclusion
Liver elastography is superior to APRI, FIB4, Forns and GUCI scores in predicting fibrosis in CHC patients.
Advances in the treatment of biliary tract cancers
Authors: Uson Junior Pedro L.S. , Bogenberger James , Borad Mitesh J. 
Published: January 2020

Purpose of review
To review new treatment and advances in biliary tract cancer (BTC).

Recent findings
In the prespecified per-protocol analysis of the randomized phase III trial BILCAP, adjuvant capecitabine offers overall survival (OS) benefit when compared with observation with statistical significance. In the first-line setting in metastatic BTC, gemcitabine and S-1 had noninferior OS compared with gemcitabine and cisplatin. In a separate phase III study, the triplet of gemcitabine, cisplatin and S-1 (GCS) had superior OS compared with standard gemcitabine and cisplatin. The regimen of modified FOLFOX (fluorouracil, leucovorin and oxaliplatin) regimen can be considered a potential standard option in the second-line setting for patients who failed first-line therapy with gemcitabine-based regimens. Trials in genomically selected patients indicate activity of fibroblast growth factor receptor inhibitors, mutant isocitrate dehydrogenase inhibitors and immune checkpoint inhibitors.

Summary
Capecitabine is a new option for adjuvant treatment in resected BTC. In the metastatic setting, gemcitabine and S-1 or GCS are new options for first-line therapy and modified FOLFOX regimen should be considered as a potential new empirical standard of care in genomically agnostic patients requiring second-line therapy. Future randomized trials will evaluate the role of targeted agents and immunotherapy in advanced BTC, both in monotherapy and in combination.
Novel therapies in myelodysplastic syndromes
Authors: Swoboda David M. , Gesiotto Quinto , Sallman David A. 
Published: January 2020

Purpose of review
Currently, there is a rapid expansion of novel, efficacious therapies for the treatment of patients with myelodysplastic syndromes (MDS) at a rate never seen to date. In this review, we will outline new treatment strategies in MDS focusing on novel hypomethylating agents (HMA) and combinations in addition to targeted and immune-based therapies.

Recent findings
Large-scale gene sequencing and immune-based research has given us a great deal of information regarding the complexity and heterogeneity of MDS. This rapid improvement in our knowledge has provided a framework for development of novel therapies with specific gene and immune-based targets. Additionally, expanding and optimizing our current HMA-based strategies has led us to potentially not only ease administration but also improve outcomes.

Summary
Novel therapies in MDS are greatly needed is a disease state where few options are currently available, particularly in the HMA failure setting. Fortunately, through comprehensive genetic profiling, characterization of novel underlying pathogenic drivers, and understanding of the immune microenvironment, the treatment paradigm of patients with MDS is encouraging.
Driver mutations in acute myeloid leukemia
Authors: Kishtagari Ashwin , Levine Ross L. , Viny Aaron D. 
Published: January 2020

Purpose of review
The mutational landscape of acute myeloid leukemia (AML) has revised diagnostic, prognostic, and therapeutic schemata over the past decade. Recurrently mutated AML genes have functional consequences beyond typical oncogene-driven growth and loss of tumor suppresser function.

Recent findings
Large-scale genomic sequencing efforts have mapped the complexity of AML and trials of mutation-based targeted therapy has led to several FDA-approved drugs for mutant-specific AML. However, many recurrent mutations have been identified across a spectrum from clonal hematopoiesis to myelodysplasia to overt AML, such as effectors of DNA methylation, chromatin modifiers, and spliceosomal machinery. The functional effects of these mutations are the basis for substantial discovery.

Summary
Understanding the molecular and pathophysiologic functions of key genes that exert leukemogenic potential is essential towards translating these findings into better treatment for AML.
An update on systemic therapy for penile cancer
Authors: Resch Irene , Abufaraj Mohammad , Hübner Nicolai A. , Shariat Shahrokh F. 
Published: January 2020

Purpose of review
Whereas substantial advances have been made in systemic tumour therapy in the past decade, the prognosis of advanced squamous cell carcinoma (SCC) of the penis remains disproportionally poor. In this review, we aimed to present an update on systemic therapy of penile SCC highlighting the most recent data and future perspectives.

Recent findings
Lymph node metastases play a key role in treating and assessing the prognosis of patients with penile SCC. Data show longer overall survival with the use of adjuvant chemotherapy in patients with pelvic lymph node metastases and recent analyses lead to the development of a nomogramm predicting overall survival in connection with the use of perioperative chemotherapy. There are two pathways in the pathogenesis of penile cancer, including human papilloma virus related and unrelated, leading to many possible novel therapeutic targets. Other targeted therapies have been evaluated, which show promising results with the use of tyrosine kinase inhibitors.

Summary
Chemotherapy has shown moderate activity in advanced stages of the disease, however, the ideal timing of chemotherapy in patients with lymph node metastases is not entirely clear. Potential targets for future therapies exist, and are already being tested in other malignancies. Owing to the rarity of this condition, a robust evidence is lacking and it is of great importance to pursue further research to unveil several aspects of this disease, particularly in patients with recurrence, lymph node metastases or metastatic disease.
Role of primary retroperitoneal lymph node dissection in stage I and low-volume metastatic germ cell tumors
Authors: Heidenreich Axel , Paffenholz Pia , Nestler Tim , Pfister David , Daneshmand Siamak 
Published: January 2020

Purpose of review
Early-stage testicular cancers are highly curable. Following orchidectomy, management options for stage I disease include active surveillance, nerve-sparing retroperitoneal lymph node dissection (nsRPLND) and primary chemotherapy as recommended by the current guidelines. Primary RPLND has for decades played an integral part of treatment in patients with early-stage testicular germ cell tumors (TGCT), particularly in nonseminomatous germ cell tumors (NSGCT) with focus on reducing the long-term morbidity. We review the role of RPLND in stage I NSCGT as well as stage II A/B NSGCT and as seminoma.

Recent findings
Radiation therapy and systemic chemotherapy are established treatments for seminoma; however, long-term data has demonstrated the association of such therapies with late toxicity including secondary malignancies, hearing loss, cardiovascular disease as well as metabolic syndromes. Given the well established role of RPLND in NSGCTs, clinicians have developed an interest in utilization of surgery for low-volume retroperitoneal metastatic disease. Two prospective clinical trials (SEMS and PRIMETEST) are underway to determine the role of RPLND alone in low volume metastatic seminoma.

Summary
RPLND is a highly effective treatment for early-stage germ cell tumors but represents overtreatment in low-volume stage I disease where active surveillance is recommended. RPLND has shown a promising role in low-volume stage II seminomas. Two phase II clinical trials are underway to further determine the curative potential of this approach.
Impact of Blood Transfusion on the Prevalence of HHpgV-1, HPgV-1, and B19V Among Iranian HCV-infected Patients With Hemophilia
Authors: Agi Elnaz , Hojjatipour Samira , Namvar Ali , Bolhassani Azam 
Published: January 2020

Objective:
Blood-derived products from patient with hemophilia treated by factor VIII concentrates are potential sources of transfusion-transmitted infections, including human immunodeficiency virus, hepatitis, human pegivirus-1 (HPgV-1), B19 virus, and also human hepegivirus-1 (HHpgV-1). In the current study, we investigated the impact of blood transfusion on the prevalence of HHpgV-1, HPgV-1, and B19 virus in plasma of Iranian patient with hemophilia after direct-acting antiviral treatment of hepatitis C virus (HCV) infections for the first time.

Materials and Methods:
A total of 170 patients with hemophilia who received direct-acting antivirals were enrolled in this study. Among them, 92 patients had a history of blood transfusion. The presence of HHpgV-1, HPgV-1, and B19 virus was detected by nested polymerase chain reaction analysis using the conserved primers. The plasmids harboring 5′-UTR and NS3 were used as positive controls for HPgV-1 and HHpgV-1, respectively.

Results:
Our data identified 3 individuals with HHpgV-1 viremia (1.76%), 11 individuals with HPgV-1 viremia (6.47%), and 33 individuals with B19 viremia (19.4%). All patients were negative for hepatitis B virus, human immunodeficiency virus, and HCV infections. These findings indicated lower transmissibility or higher rates of virus clearance for HHpgV-1, HPgV-1, and B19 virus as compared with other bloodborne human flaviviruses such as HCV. However, the prevalence of B19 virus was significantly higher than the other 2 viruses.

Conclusion:
In general, these findings showed that the history of blood transfusion could increase the risk of viral transmission of bloodborne viruses among patient with hemophilia.
Implementation of the m-ISHAPED Tool for Nursing Interdepartmental Handoffs
Authors: Stimpson Megan , Carlin Kristen , Ridling Debra 
Published: January 2020

Background:
Handoffs can pose risks to patients.

Local Problem:
Nurses throughout a children's hospital understood patient handoffs differently, resulting in handoff errors (failures) across departments.

Methods:
Lean principles were used to modify and implement the ISHAPED (Introduction, Story, History, Assessment, Plan, Error Prevention, and Dialogue) tool.

Interventions:
The team implemented a modified ISHAPED (m-ISHAPED) tool to align the content shared and the expectations for interdepartmental handoff.

Results:
Improvements were seen in reported patient safety events from 6.84 to 1.57 per 100 patient days (P < .001) and nurse satisfaction from 81.1% to 90.6% (P < .001).

Conclusions:
A standardized process for interdepartmental nursing handoff was successfully implemented.
Quality Standards of Nursing Care for the Use of Chemical Restraints
Authors: Hupé Catherine , Larue Caroline , Gazemar Valerie , Pépin Catherine , Contandriopoulos Damien 
Published: January 2020

Background:
The use of chemical restraints (CRs) in health care facilities is a complex intervention that raises questions about its effectiveness and whether it is safe and patient oriented.

Purpose:
This review aims to gather nursing quality standards for the use of CR through an innovative method of knowledge synthesis, the realist review, to support the development of a quality evaluation tool.

Methods:
A realist review method was chosen.

Results:
An operational definition of chemical restraint is proposed, a concept seen as synonymous with the management of behavioral symptoms by pharmacological agents with sedative proprieties. Twenty-eight quality standards were identified and presented in a theoretical model.

Conclusions:
These quality standards will allow the evaluation of practices from a nursing perspective for the use of CR in health care settings.
Development of the Nursing Quality Improvement in Practice Tool
Authors: Tschannen Dana , Alexander Catherine , Tovar Elizabeth G. , Ghosh Bidisha , Zellefrow Cindy , Milner Kerry A. 
Published: January 2020

Background:
Frontline nurse engagement in quality improvement (QI) improves nurse-sensitive outcomes; yet research suggests frontline nurses are not engaging in QI.

Purpose:
The purpose of this study was to develop, refine, and psychometrically evaluate the Nursing Quality Improvement in Practice (N-QuIP) tool to measure nurses' competency, engagement, and barriers/facilitators to QI engagement.

Methods:
Item development was guided by an expert panel and literature review. Factor analysis and reliability indices were assessed through 681 surveys completed by nurses at one medical center.

Results:
Cronbach α coefficients were 0.97 (Skill Scale) and 0.90 (Attitude Scale). Kuder-Richardson Formula 20 (KR-20) for knowledge was 0.36. Exploratory factor analysis identified 4 (Skill) and 3 (Attitude) subscales respectively, aligning well with QI competencies.

Conclusions:
Preliminary data suggest that the N-QuIP is a valid and reliable tool for assessing nurse QI competence and engagement. Understanding current knowledge, skills, and attitudes and identified barriers/facilitators can help the development of strategies aimed at increasing QI engagement.
Evaluating the Humpty Dumpty Fall Scale
Authors: Gonzalez Jackie , Hill-Rodriguez Deborah , Hernandez Laura M. , Cordo Jennifer A. , Esteves Jenny , Wang Weize , Salyakina Daria , Sarik Danielle Altares 
Published: January 2020

Background:
The Humpty Dumpty Falls Prevention Program was developed to address an unmet need to identify pediatric patients at risk of a fall event.

Purpose:
The aim of this study was to evaluate the performance of the Humpty Dumpty Fall Scale-Inpatient (HDFS) across a diverse, international pediatric population. In addition, the characteristics of patients who experienced a fall were analyzed.

Methods:
A retrospective, cross-sectional design was used to assess fall risk across 16 hospitals and 2238 pediatric patients. Multiple and simple logistic regressions were performed to evaluate association of individual scale items and total score with falls during hospitalization. Reliability, sensitivity, and specificity of the HDFS were also assessed.

Results:
Several of the HDFS items were significantly associated with the risk of falls in the pediatric population, but specificity of the tool is a concern to consider for future tool enhancement.

Conclusions:
Characteristics for further refinement of the HDFS were identified.