bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching Strategies and Tools for Ensuring Safe and Quality Care: A Scoping Review
Authors: Marcomini Ilaria , Terzoni Stefano , Destrebecq Anne 
Published: April 2021

Abstract

AIM
The aim of this scoping review was to map teaching strategies incorporating Quality and Safety Education for Nurses (QSEN) competencies and assessment tools based on the QSEN framework.

METHOD
The search was conducted through MEDLINE, Embase, Scopus, and Web of Science databases and carried out through the framework developed by Arksey and O'Malley and revised by Levac et al.

RESULTS
Thirty-one studies were included. Among QSEN competences, patient-centered care, safety, and teamwork and collaboration were most frequently incorporated into teaching strategies. Most assessment tools aimed at capturing the achievement of QSEN competencies after a classroom learning experience.

CONCLUSION
The scoping review made it possible to identify various teaching strategies and assessment tools developed on the QSEN framework. Further studies are needed to test teaching strategies to facilitate students’ acquisition of QSEN competencies in clinical environments.
A Proactive Curriculum With Remediation Intervention Tool for Nursing Education Success
Authors: Wallace Laura J. 
Published: April 2021

Abstract
Mastering the Content is a proactive curriculum whose At-Risk Student Identification Criteria-Based Remediation Interventions Tool leads to nursing student success. The curriculum integrates active learning strategies and problem-solving activities throughout the nursing program to develop clinical judgment. Remediation includes guided metacognitive learning tool construction, individualized student support, and study plans to increase learning and decrease attrition. The curriculum and interventions tool were developed based on evidence gathered from a meta-analysis of research on best practices in basic RN prelicensure program remediation success and one nursing program’s successful implementation of best practices.
Escape Into a Nursing Career: An Active Recruitment Strategy for Prospective Students
Authors: Goodman Joely T. , Landgren Amy 
Published: April 2021

Abstract
A purpose of this activity was to determine if an escape room activity could familiarize prospective students with information about a program, nurture an interest in a nursing career, and expose individuals to active teaching strategies. Ten prospective nursing students participated in an escape room recruitment activity that introduced them to aspects of nursing care. The activity decreased participants’ nervousness about beginning the nursing program. Escape rooms are an active and engaging strategy that can be used to introduce prospective students to nursing and facilitate team building for groups.
Efficacy of Sclerotherapy With Polidocanol (Ethoxysclerol) in Primary Aneurysmal Bone Cysts in Children and Adolescents
Authors: Jasper Jorrit , van der Heijden Lizz , van Rijswijk Carla S.P. , van de Sande Michiel A.J. 
Published: April 2021

Background:
Aneurysmal bone cysts (ABC) are rare benign osseous lesions that can be locally aggressive. Traditionally, curettage with or without bone grafting is the treatment of choice. Recent data suggest that percutaneous sclerotherapy is a safe alternative to surgery. We present our experience with percutaneous sclerotherapy. Primary study aims were success rate, risk factors for treatment failure, and complications.

Methods:
In this single-center retrospective study (January 2003 to June 2019), 70 patients were treated with percutaneous sclerotherapy for primary ABC at various skeletal sites. Median age was 11 years (range: 3 to 17 y). Median follow-up was 40 months (range 18 to 144 mo). Clinical and radiologic assessments were performed until cyst healing.

Results:
Successful healing was seen in 58 of 70 patients (83%) after 1 or more injections with polidocanol. In 12 patients (17%), definitive curettage was performed after previous sclerotherapy, which was considered failure of primary sclerotherapy treatment. Trends toward increased risk for >3 treatments or treatment failure included age younger than 5, epiphyseal plate involvement, and lower leg lesions. The only complication was anaphylaxis in 1 patient shortly after injection of polidocanol/contrast agent and ropivacaine, with full recovery after short resuscitation.

Conclusions:
Our results show that percutaneous sclerotherapy with polidocanol has high efficacy in the treatment of primary ABC, with a low complication rate. Our only complication may have been an immediate allergic reaction to polidocanol/contrast agent or ropivacaine. Trends toward increased risk for treatment failure were age younger than 5, epiphyseal plate involvement, and lower leg lesions.

Level of Evidence:
Level IV—therapeutic study.
Diagnostic delay in moderately/poorly differentiated breast cancer types
Authors: Elfgen Constanze , Baumgartner Sabrina , Varga Zsuzsanna , Reeve Kelly , Tausch Christoph J. , Bjelic-Radisic Vesna , Fleisch Markus , Güth Uwe 
Published: April 2021

Background
Diagnostic delay of breast cancer related to the false-negative assessment of the healthcare provider leads to tumor progression and might worsen the outcome. Previous studies found some factors associated with provider-related diagnostic delay; however, tumor biology has tended not to be considered. The aim of our study was to find differences in diagnostic delay of poorly differentiated breast cancer types.

Methods
Data of 970 patients with newly diagnosed moderately/poorly differentiated (G2/3) breast cancer at the age ≥40 years was retrospectively analyzed regarding breast cancer type, diagnostic delay and its consequence, clinical factors and physician’s assessment. Multivariate analysis was used to evaluate associated factors with diagnostic delay.

Results
We observed a diagnostic delay in 3.8% (n = 37) of all patients. Mean delay time was 128 days, and clinically relevant tumor growth was observed in 43.2% of these cases. Delay was significantly higher in the group of triple-negative breast cancer (9.9% versus 2.7, 5.3 and 1.8% in hormonal receptor (HR)+/human epidermal growth factor receptor 2 (HER2)−, HR−/Her2+ and HR+/Her2+, respectively; P value <0.001). Age, breast density and reason for presentation were not correlated to diagnostic delay.

Conclusion
Patients with triple-negative breast cancer are at higher risk of receiving a false-negative assessment and experiencing a diagnostic delay. Our results emphasize the importance of a detailed consideration of clinical risk factors and provider training and suggest a broad indication for a core needle biopsy.
Comparison of the Prevalence and Clinical Characteristics of Epiretinal Membrane in Pseudoexfoliation and Primary Open-angle Glaucoma
Authors: Lee Jin Yeong , Sung Kyung Rim , Kim Yoon Jeon 
Published: April 2021

Purpose:
The purpose of this study was to investigate and compare the prevalence and clinical characteristics of epiretinal membrane (ERM) in patients with pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG).

Methods:
In this retrospective observational study, 211 PXG eyes, 210 age-matched normal eyes, and 220 POAG eyes were included. The presence and staging of ERM (stage 1, 2, and 3 or greater) were independently assessed by 2 observers. Univariate and multivariate linear regression analyses were performed to assess the factors associated with visual field (VF) mean deviation (MD) in PXG eyes.

Results:
Among 211 PXG eyes, 40 (19.0%) had an ERM, while 4.1% of POAG and 2.4% of normal eyes had an ERM (P<0.001). Retinal nerve fiber layer thickness (69.4 vs. 70.4 μm, P=0.477) and VF MD (−7.7 vs. −10.4 dB, P=0.098) were not different between POAG and PXG eyes but macular thickness was greater (259.5 vs. 271.5 μm, P=0.006) in PXG eyes than in POAG. Both lower retinal nerve fiber layer thickness (β=0.337, P<0.001) and the presence of an ERM (β=−4.246, P=0.002) were independently associated with worse VF MD in PXG eyes.

Conclusions:
The prevalence of ERM was significantly greater in PXG eyes than in age-matched normal or POAG eyes. The presence of ERM affected VF in PXG eyes.
The Reality of Hearing Preservation in Cochlear Implantation: Who Is Utilizing EAS?
Authors: Perkins Elizabeth , Lee Jaclyn , Manzoor Nauman , O’Malley Matthew , Bennett Marc , Labadie Robert , Rivas Alejandro , Haynes David , Gifford René 
Published: April 2021

Objective:
To report the proportion of subjects successfully fit with combined electroacoustic stimulation (EAS) compared with those with preserved hearing (HP) after cochlear implantation (CI). In addition, to 1) report the trends in HP and EAS fit rates over time and 2) identify and characterize those patients who preferred the electric only condition.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
Two hundred five postlingually deafened adults with bilateral SNHL and a preoperative low-frequency pure-tone average 80 dB HL or better in the ear to be implanted.

Interventions:
Subjects underwent CI from 2013 to 2018 with routine pre- and postoperative audiometric testing performed at 6- and 12-months.

Main Outcome Measures:
Percentage of patients fit with EAS, low-frequency pure-tone average, and threshold shift.

Results:
Overall, 141 patients (78.6%) had HP at activation and 42.6% were fit with EAS. Rates of EAS fitting improved from 36.4% in 2013 to 69.0% in 2018. 93.5% of patients had hearing preserved in 2018 compared with 57.9% in 2013. Six patients rejected EAS after a trial period either because of discomfort or poor sound quality. Eight patients had EAS removed because of loss of aidable hearing over time (between activation to 12 mo).

Conclusions:
Despite the high percentages of HP in the literature, EAS may be under-utilized in the adult CI population. Moving toward a universal definition of HP across institutions may better represent the potential for EAS fitting and a clinical measure capable of identifying patients best suited to benefit from EAS.
Age-related Patterns of Vestibular Dysfunction in Dizziness and Imbalance: A Review of Vestibular Testing Results Among 1,116 Patients
Authors: Nimmo Zachary M. , Hwa Tiffany P. , Naples James G. , Shah Ravi , Brant Jason A. , Eliades Steven J. , Bigelow Douglas C. , Ruckenstein Michael J. 
Published: April 2021

Objective:
To characterize differences in vestibular testing results among patients presenting with balance-related complaints; to stratify patterns of testing abnormalities by age.

Study Design:
Retrospective chart review.

Setting:
Academic Balance Center at a Tertiary Referral Center.

Patient Population:
All patients who underwent vestibular testing in a 1-year period from 2017 to 2018.

Main outcome measure:
Balance function test results.

Results:
We reviewed 1,116 patients with age ranging from 11 to 94 years, including 521 patients ≥60 years. Most patients had at least 1 abnormal result, with only 21% of patients ≥60 years and 43% of patients <60 years yielding no test abnormalities (p < 0.001). Among 754 individuals with abnormal testing results, caloric testing did not show any significant difference between age groups. Patients ≥60 years of age were more likely to demonstrate abnormalities on saccadic and horizontal tracking eye movements (p < 0.01; sacc 20.8% vs 6.3%; HT 9.2% vs 4.7%), as well as positional and Dix-Hallpike testing with videonystagmography (p < 0.001; pos 52.3% vs 37.5%, DH 14.4% vs 6.8%). On computerized dynamic posturography, there were significantly more abnormal composite scores in the older group for both sensory organization and motor control testing (p < 0.001; SOT 31.8% vs 8.8%, MCT 7.6% vs 1.8%).

Conclusion:
Among patients presenting balance-related complaints, a majority demonstrate at least one abnormality on vestibular testing. While caloric abnormalities occur across the life span, patients ≥60 years of age are more likely to have abnormal results in random saccades, positional, Dix-Hallpike testing, and posturography, with greater effect sizes in tests of central function. While the causes of imbalance and vertigo remain multifactorial, vestibular dysfunction can be considered a major contributor to balance dysfunction in the elderly population and should be thoroughly evaluated.
Quality Improvement in Otologic Surgery Postoperative Instructions
Authors: Sluder Camille E. , Liu Yuan F. , Meyer Ted A. , Rizk Habib G. , Lambert Paul R. , McRackan Theodore R. 
Published: April 2021

Objective:
To examine and improve patient satisfaction with otologic surgery postoperative instructions.

Study Design:
Patients undergoing outpatient otologic surgery were compared over two different time periods, before (phase 1) and after (phase 2) modifying postoperative instructions. Key-informant interviews were conducted by phone on postoperative day 7. All patient-initiated communications after surgery were documented.

Setting:
Tertiary, academic hospital.

Patients:
Patients undergoing outpatient otologic surgery.

Interventions:
Otologic surgery.

Main Outcome Measures:
Satisfaction ratings of different postoperative instruction categories (1–10, completely useless to perfectly helpful), including wound care, pain medication, non-pain medication, showering and bathing, activity restrictions, diet restrictions, follow-up appointment, and contact for questions; comments/critiques from patients; and patient-initiated communications.

Results:
Seventy eight patients were included in phase 1 and 52 in phase 2. Patient characteristics and distribution of surgeries were similar between phases. Rating for instructions were high in both phases (phase 1: 8.98[1.50], phase 2: 9.27[1.04], d = 0.216 [−0.271, 0.698]). More patients in phase 2 thought the instructions were adequate and clear (80.0% versus 55.6% in phase 1, d = 0.641 [0.011, 1.271]), and there were fewer critiques per patient (0.09 versus 0.15, d = −0.537 [−1.034, −0.040]) compared with phase 1. There was a shift in phase 2 communications away from wound care questions (17.5% versus 38.9%, d = −0.606 [−1.112, −0.099]) toward questions regarding medications (27.5% versus 6.7%, d = 0.921 [0.325, 1.516]).

Conclusion:
An evidence-based postoperative instructions template led to more patients believing that the instructions were clear, fewer critiques being given, and a shift toward more actionable questions rather than those with answers already addressed in written instructions.
Benefit of Bilateral Cochlear Implantation on Phonological Processing Skills in Deaf Children
Authors: Lee Youngmee 
Published: April 2021

Hypothesis:
Children with bilateral cochlear implants (CIs) would have better phonological processing skills than children with unilateral CIs because those with bilateral CIs have better speech perception abilities in noisy environments and higher levels of central auditory system development than those with unilateral CIs.

Background:
Previous studies have focused on the performance of children with bilateral CIs on standardized clinical assessments. However, these tests are not sufficiently sensitive to explain better speech and language outcomes in children with bilateral CIs than children with unilateral CIs. Thus, this study focused on phonological processing skills at more central levels of analysis that reflect the operation of cognitive processes.

Method:
Twenty children with bilateral CIs and 20 children with unilateral CIs, aged 4 to 6 years, participated in this study. The children completed the experience-dependent tasks and phonological processing tasks. The experience-dependent tasks involved the monosyllabic word, articulation, and receptive vocabulary tests. The phonological processing tasks involved the phonological awareness, phonological memory, and rapid automatic naming tasks. Task performance was compared between the unilateral and bilateral CI groups.

Results:
Children with unilateral CIs performed similarly to children with bilateral CIs on all three experience-dependent tasks. However, children with bilateral CIs significantly outperformed children with unilateral CIs on all three phonological processing tasks. Among the phonological processing tasks, the rapid automatic naming task scores differentiated children with unilateral CIs from children with bilateral CIs.

Conclusions:
Bilateral cochlear implantation may positively impact the phonological processing skills of deaf children.
Stapes and Stapes Revision Surgery: Preoperative Air-Bone Gap Is a Prognostic Marker
Authors: Sharaf Kariem , Grueninger Ivo , Hilpert Annalena , Polterauer Daniel , Volgger Veronika , Manz Kirsi , Canis Martin , Hempel John Martin , Müller Joachim 
Published: April 2021

Objective:
Stapes surgery is considered an effective treatment in otosclerosis, but controversy remains regarding predictors of surgical outcome.

Study Design:
Retrospective cohort study.

Setting:
Tertiary referral center.

Patients:
One hundred sixty three cases of stapes surgery between 2012 and 2019 were reviewed.

Main Outcome Measures:
Primary outcome measures were relative hearing improvement (relHI), defined as preoperative minus postoperative air conduction divided by preoperative air-bone gap (ABG), as well as relative ABG closure (relABGc), defined as preoperative ABG minus postoperative ABG divided by preoperative ABG. Univariate and multivariate linear regression analyses were performed to determine independent predictors for these outcomes.

Results:
Higher preoperative bone conduction (BC) and primary surgery (compared with revision) were independently associated with increased relHI (p = 0.001 and p = 0.004, respectively). Lower preoperative BC, higher preoperative ABG, primary surgery, and age were independently associated with increased relABGc (p = 0.0030, p < 0.001, p = 0.0214, and p = 0.0099, respectively). Sex did not predict surgical outcome. In patients with less than 20 dB preoperative ABG, likelihood of negative relABGc was increased (compared with 20–30 dB or >30 dB preoperative ABG, p = 0.0292, Fisher's exact test). This tendency was not significant for relHI (p = 0.074).

Conclusions:
Our findings demonstrate that calculating HI and ABGc in relation to preoperative ABG can reliably predict outcomes of stapes surgery. Both primary and revision stapes surgery are effective treatment options, but relative improvement is higher in primary cases. Preoperative BC, preoperative ABG, and age predict surgical outcomes as well. Otosclerosis patients with low preoperative ABG, especially less than 20 dB, should be counseled and selected cautiously regarding stapes surgery.
Evaluation of Long-term Cholesteatoma Recidivism: Using the JOS, EAONO-JOS, and STAMCO Cholesteatoma Staging Systems
Authors: Eggink Maura C. , de Wolf Maarten J.F. , Ebbens Fenna A. , Dikkers Frederik G. , van Spronsen Erik 
Published: April 2021

Objective:
To assess the prognostic value of the Japanese Otological Society (JOS), EAONO-JOS, and STAMCO classifications in predicting the severity of acquired cholesteatoma and to identify other factors that could influence residual and recurrent cholesteatoma, as well as adverse events (AE).

Method:
A retrospective chart review of patients undergoing primary cholesteatoma surgery in our tertiary referral center. Primary outcome measures were based on three groups of follow-up (FU): Group A, studying residual cholesteatoma, FU > 52 weeks of last-look surgery or magnetic resonance imaging, diffusion-weighted imaging; group B, studying recurrent disease, FU > 52 weeks of last outpatient clinic visit; and group C, studying AE, FU > 12 weeks after surgery. Cholesteatomata were staged according to the JOS, EAONO-JOS, and STAMCO classifications. Kaplan–Meier curves were used to determine the prognostic value of the various classifications and to identify other determining factors, while correcting for FU.

Results:
FU was found to be a significant confounder. No correlation was found between staging and the occurrence of residual or recurrent disease, nor the occurrence of AE. Type of surgery was a significant determinant of all three primary outcome measures. A higher age was associated with a lower risk of residual disease.

Conclusion:
In our population the JOS, EAONO-JOS, and STAMCO classifications have limited prognostic value. Three main confounders were identified that pose a challenge in developing a universal classification: FU, surgery type, and age. Cholesteatoma staging should be postponed until a system is developed which significantly correlates cholesteatoma stage to cholesteatoma severity, to have implications for management strategies.
Delayed Facial Palsy After Resection of Vestibular Schwannoma: An Analysis of Long-term Facial Nerve Outcomes
Authors: Tawfik Kareem O. , Coulter Michael , Alexander Thomas H. , Saliba Joe , Mastrodimos Bill , Cueva Roberto A. 
Published: April 2021

Objectives:
1) Identify clinical factors associated with delayed facial palsy (DFP) after microsurgical resection of vestibular schwannoma. 2) Determine whether DFP predicts worse facial nerve (FN) outcomes.

Methods:
Adult patients (≥18 yrs) who underwent vestibular schwannoma resection between February 2008 and December 2017 were retrospectively reviewed. Postoperative House-Brackmann (HB) FN function was assessed on the day of surgery, daily during patients’ inpatient admissions, and at postoperative clinic visits. Follow-up exceeded ≥12 months for all patients. DFP was defined as a decline (≥1 HB grade) in FN function (relative to the preoperative state) occurring between postoperative days 1 and 30.

Results:
Two hundred ninety-one patients were analyzed. Mean age was 51.5 years (±12.3) and mean tumor size 20.6 mm (±10.8). Immediate FP occurred in 61 (21%) patients, and DFP occurred in 112 (38%) patients. Tumor size was largest in patients with immediate FP (p < 0.0001). On univariate analysis, DFP was associated with better final FN outcomes (OR 0.447, p = 0.0101) compared with immediate FP. Multivariate analysis, however, showed that timing of FP was no longer significant, whereas larger tumor size and preoperative HB2 function predicted worse FN outcomes (OR 2.718, p < 0.0001 and OR 9.196, p = 0.0039, respectively). In patients with DFP, longer time to onset of palsy predicted more favorable FN outcomes.

Conclusions:
When accounting for tumor size, the timing of onset of postoperative facial palsy does not predict final FN outcomes. In patients who develop DFP, the longer the interval between surgery and onset of weakness, the better the chances of good long-term FN function.