bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparisons of Stroke Knowledge and Health Behaviors in Patients With Hypertensive Stroke at Different Recurrence Risk Strata
Authors: Li Jing-Jing , Tan Ju-Xiang , Zhu Fen-Yan , Wu Zhen , Ruan Heng-Fang , Li Zhuo-Ran , Wan Li-Hong 
Published: February 2021

Background
Risk factor management via behavioral change contributes substantially to secondary stroke prevention. The health belief model identified self-perceived risk as a significant factor in behavior change. In previous studies, people have tended to incorrectly estimate their risk of stroke. Little is known about the differences in stroke knowledge and health behaviors in patients who have had a stroke with different risks of stroke recurrence in China.

Objective
The aims of this study were to determine the accuracy of self-perceived risk of stroke recurrence and to compare stroke knowledge and health behaviors in patients with hypertensive stroke at different recurrence risk strata.

Methods
Baseline data from 174 patients in the Comprehensive Reminder System based on the Health Belief Model (CRS-HBM) study were used. Self-perceived risk was assessed via the susceptibility subcategory of the Short-Form Health Belief Model Scale, and actual risk was stratified using the Essen Stroke Risk Score.

Results
Only 27.0% of the patients estimated their risks of stroke recurrence accurately. Patients who perceived themselves to be at higher risk had better knowledge of warning signs. Compared with patients who underestimated their risk of stroke recurrence, those who accurately estimated or overestimated their risk less likely to smoke.

Conclusions
Most patients incorrectly estimated their risk of stroke recurrence. Communicating with patients about their future risk of recurrent stroke may help improve their stroke knowledge and health behaviors. Implementation of the Comprehensive Reminder System based on the Health Belief Model focusing on risk education aimed at prevention of stroke recurrence is warranted in China.
Barriers and Facilitators to Pre-exposure Prophylaxis Uptake Among Black Women: A Qualitative Analysis Guided by a Socioecological Model
Authors: D'Angelo Alexa B. , Davis Ewart Leah N. , Koken Juline , Bimbi David , Brown Justin T. , Grov Christian 
Published: February 2021

Abstract
Black women experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) is a once-daily pill that can prevent HIV transmission. To enhance PrEP uptake among Black women, it is essential to examine their perceptions of PrEP. In 2018, 33 Black women in New York City completed interviews about their attitudes, knowledge, and perceived barriers and facilitators to PrEP use. Emergent themes were organized using a socioecological model. Participants identified barriers at the sociocultural level, including stigma, medical mistrust, and health care avoidance. At the community level, health care access issues and limited community knowledge were reported. Partner-level barriers included trust in partners and meaning attributed to PrEP use within the context of monogamy. Individual-level barriers included low perceived risk and concerns about PrEP's safety and efficacy. Our findings can inform future PrEP research with Black women, as well as PrEP implementation efforts aimed at increasing uptake among this population.
A Review of Recent HIV Prevention Interventions and Future Considerations for Nursing Science
Authors: Threats Megan , Brawner Bridgette M. , Montgomery Tiffany M. , Abrams Jasmine , Jemmott Loretta Sweet , Crouch Pierre-Cedric , Freeborn Kellie , Kamitani Emiko , Enah Comfort 
Published: February 2021

Abstract
As our knowledge of HIV evolved over the decades, so have the approaches taken to prevent its transmission. Public health scholars and practitioners have engaged in four key strategies for HIV prevention: behavioral-, technological-, biomedical-, and structural/community-level interventions. We reviewed recent literature in these areas to provide an overview of current advances in HIV prevention science in the United States. Building on classical approaches, current HIV prevention models leverage intimate partners, families, social media, emerging technologies, medication therapy, and policy modifications to effect change. Although much progress has been made, additional work is needed to achieve the national goal of ending the HIV epidemic by 2030. Nurses are in a prime position to advance HIV prevention science in partnership with transdisciplinary experts from other fields (e.g., psychology, informatics, and social work). Future considerations for nursing science include leveraging transdisciplinary collaborations and consider social and structural challenges for individual-level interventions.
Holistic Admissions and Underrepresented Minorities in Physician Assistant Programs
Authors: Coplan Bettie , Todd Michael , Stoehr James , Lamb Gerri 
Published: February 2021

Purpose
The purpose of this study was to assess holistic review use in physician assistant (PA) programs and determine whether a relationship between holistic review and underrepresented minority (URM) matriculation exists.

Methods
Using data from the 2016–2017 Physician Assistant Education Association annual survey of PA programs, we examined the frequency of holistic review use across PA programs. Bivariate correlation analyses and binary logistic regression were used to examine relationships between holistic review practices and program percentages of first-year underrepresented racial and ethnic minority students.

Results
Most PA programs (169/219 [77.2%]) reported using holistic review, and its use modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.16, 95% confidence interval [CI] = 0.02–0.30) or Hispanic (rho = 0.20, 95% CI = 0.06–0.33). Using several holistic review elements related to program commitment to diversity modestly correlated with percentage of students who were underrepresented racial minorities (rho = 0.25, 95% CI = 0.10–0.39) or African American (rho = 0.20, 95% CI = 0.04–0.34). Additionally, the odds of a first-year student being an underrepresented racial or ethnic minority were slightly higher in PA programs using holistic review (OR = 1.56, 95% CI = 1.23–1.99 and OR 1.33, 95% CI = 1.09–1.62, respectively).

Conclusions
PA program use of holistic review practices was modestly associated with percentage of URM students. Further research is needed to identify elements that are most effective.
Using Data Mining for the Early Identification of Struggling Learners in Physician Assistant Education
Authors: Black Erik W. , Buchs Shalon R. , Garbas Breann 
Published: February 2021

Purpose
Despite the importance of early intervention and remediation, the relatively short duration of physician assistant education programs necessitates the importance of early identification of at-risk learners. This study sought to ascertain whether machine learning was more effective than logistic regression in predicting remediation status among students, using the limited set of data available before or immediately following the first semester of study as predictor variables and academic remediation as an outcome variable.

Methods
The analysis included one institution and student data from 177 graduates between 2017 and 2019. We employed one data mining model, random forest trees, and compared it to a traditional predictive analysis method, logistic regression. Due to the small sample size, we employed leave-one-out cross-validation and bootstrap aggregation.

Results
Data provided evidence that the random forest algorithm correctly identified individuals who would later experience academic intervention with a 63.3% positive predictive value, whereas logistic regression exhibited a positive predictive value of 16.6%.

Conclusions
This single-institution study indicates that predictive modeling, employing machine learning, may be a more effective means than traditional statistical methods of identifying and providing assistance to learners who may experience academic challenges.
Uncovering Ethical Dilemmas in International Service-Learning: A Grounded Theory
Authors: Dholakia Kripa , Willgens Annette , Rubertone Patricia P. , Ebaugh David 
Published: February 2021

Introduction.
International Service-Learning (ISL) is a model of experiential learning offered by Doctor of Physical Therapy (DPT) programs in the United States. Over the past several years, the number of these experiences has grown rapidly.

Review of Literature.
Recent evidence has uncovered detrimental impacts of short-term health-related experiences, such as ISL, on the host community; however, to date, ethical situations arising in ISL in DPT education have not been explored. From the perspective of the American Physical Therapy Association (APTA's) Code of Ethics and the Realm-Individual Process-Situation (RIPS) model of ethical decision making, the aims of this study were to (1) explore the experiences, perceptions, and insights of faculty, students, and alumni, who attended an ISL experience and (2) analyze their ethical nature.

Subjects.
Ten students, 6 faculty members, and 5 alumni from 4 DPT programs participated. All participants, except one alumnus, traveled to the same Central American country and partnered with the same host organization for the ISL experience.

Method.
This study used a constructivist grounded theory approach.

Results.
Data analyses indicated that ISL as experienced by participants in this study did not align with APTA's ethical principles 2A, 3B, and 8B. Furthermore, the RIPS situational analysis indicated that the primary themes arising from this study reflected ethical issues/problems and an ethical temptation, with an overarching ethical silence.

Discussion and Conclusion.
In their desire to be altruistic and provide global experiential opportunities to students, educators may overlook ethical situations arising from ISL. Research demonstrating the benefit of ISL to patients and the host community, and to establish best practice standards to minimize detrimental impacts to the host should be undertaken.
Responsiveness of Health-Related Quality of Life Patient-Reported Outcome Measures in Women Receiving Conservative Treatment for Urinary Incontinence: A Systematic Review
Authors: Bernard Stéphanie , Pellichero Alice , McLean Linda , Moffet Hélène 
Published: February 2021

Background:
Responsive patient-reported outcome measures (PROMs) are able to detect change induced by a treatment. It is unknown whether PROMs on urinary incontinence (UI) are responsive in a conservative management setting.

Objective:
To systematically review the responsiveness of recommended PROMs (grade A) for the assessment of health-related quality of life in women receiving conservative treatment for UI.

Study Design:
Systematic review.

Methods:
A literature search was conducted on MEDLINE, EMBASE, and CINAHL. Selection criteria included women with UI undergoing conservative treatment, grade A-recommended PROM measuring the impact of UI on health-related quality of life, at least 1 responsiveness index, and original results. Two reviewers independently performed screening, data extraction, and methodological quality assessment using COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). A descriptive analysis was conducted.

Results:
Five studies, including 5 PROMs, were retained (n = 672 participants). Participants had mixed UI (n = 3 studies) or stress UI (n = 2 studies). Flaws in methodological quality were identified (n = 1 study) for the assessment of responsiveness (COSMIN Box I) and (n = 3 studies) for interpretability (Box J). Highest internal responsiveness was found for the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ-UI SF) (standardized response mean: 2.07, effect size = 2.12) and highest external responsiveness was found for the Protection Amount Frequency Adjustment Body Image Questionnaire (PRAFAB-Q) (area under the curve: 0.96).

Conclusion:
Four questionnaires presented at least 1 high responsiveness index (Urinary Incontinence Specific Quality of Life Instrument [I-QOL], PRAFAB-Q, ICIQ-UI SF, and International Consultation on Incontinence Questionnaire—Lower Urinary Tract Symptoms Quality of Life Modules [ICIQ-LUTSqol]). While the ICIQ-UI presented the highest overall responsiveness index, the PRAFAB-Q, an informative and brief questionnaire for clinical use, had the highest index with the highest methodological quality. There is a need to further confirm responsiveness of PROMs in this population and context.
Case-based learning: Facilitating nurse practitioner clinical learning with virtual patient cases
Authors: Moore Jeanne , Montejo Leigh 
Published: February 2021

ABSTRACT
Through unfolding patient case studies, case-based learning has the potential to facilitate nurse practitioner (NP) student application of didactic knowledge to clinical practice, thus narrowing the theory–practice gap. The purpose of this study was to investigate NP student experience using virtual patient cases to supplement clinical learning. Bloom's cognitive taxonomy served as the framework. Seven students enrolled in the final semester of a distance family NP program completed 45 virtual patient cases over an 8-week period. Case topics covered a variety of primary care problems. Usability of the virtual learning platform was measured by the System Usability Scale. Clinical learning value was measured by the Student Satisfaction and Self-Confidence in Learning Scale. Students rated their perceived ability to manage common primary care problems at the start and end of the 8-week period. Students found the virtual learning platform highly usable and were satisfied and self-confident with their learning. Student perceived ability to manage common primary care problems increased for all virtual case topics from start to end of course. This study provides further evidence that well-designed virtual patient cases have the potential to effectively supplement NP student clinical learning. These results are important as NP faculty look for alternative forms of clinical learning to supplement direct care clinical experiences.
Measuring the contribution of clinical rotations to skills confidence in primary care nurse practitioner students
Authors: MacDonald Brent , Floyd Olivia , Dowd-Green Caitlin , Bertram Amanda , Fingerhood Marianne , Sharps Phyllis , Stewart Rosalyn W. 
Published: February 2021

ABSTRACT
Primary care providers (PCPs) are essential components of a health care system, but there are shortages of PCPs. Nurse practitioners (NPs) are essential in meeting the needs of an increased demand for primary care, but there is a wide variety in the training offered to NP students. The purpose of this analysis is to determine student self-reported comfort in a variety of care delivery, covering primary care topics, including knowledge and skills. We conducted a preclinical and postclinical survey. Surveys were obtained before and at the conclusion of two clinical rotations in Baltimore, MD. Students were a part of a Health Resources and Services Administration–funded program to prepare NP students to practice in urban, underserved settings. Seventeen NP students NP students responded to both our pre- and postsurveys. Overall, student comfort increased in many focus areas, but no change was seen in important domains, including interpreting imaging studies, filling out common forms, and interpreting certain diagnostic tests. Further study of student skills and confidence at the conclusion of their study would be beneficial in determining if these gaps persist at entry into NP practice. Given wide variation in NP student training programs, it would be additionally beneficial to understand how these differences impact student skills and confidence during their clinical rotations and on entry to practice. Well rounded, broad-based education is necessary for the development of highly trained PCPs; greater understanding of student confidence, knowledge, and skills can assist educators in assuring that all NPs enter practice as safe and competent providers.
Development of the novice nurse practitioner role transition scale: An exploratory factor analysis
Authors: Barnes Hilary , Faraz Covelli Asefeh , Rubright Jonathan D. 
Published: February 2021

ABSTRACT

Background:
Novice nurse practitioner role transition (NNPRT) can be described as stressful and turbulent, leading to decreased job satisfaction and increased intent to leave. No published instrument exists to measure NNPRT. Thus, researchers, educators, and administrators are limited in their ability to measure the concept and therefore understand the factors that lead to a successful, or unsuccessful, role transition experience. An instrument with evidence of validity and reliability is needed to conduct large-scale and systematic examinations of NNPRT.

Purpose:
The purpose of this study was to develop and examine the initial factor structure of a novel instrument that measures NNPRT.

Methods:
Initial item development was guided by concept analysis, literature review, and qualitative data. Face and content validity were established from expert review. Using pilot data from 89 novice nurse practitioners (NPs), an exploratory factor analysis (EFA) was conducted to examine the instrument's internal factor structure.

Results:
The NNPRT Scale includes 40 items that measure an individual's perception of their role transition experience. The EFA revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation.

Implications for practice:
In an evolving health care system, provider well-being is at the center of workforce, educational, and organizational conversations. Understanding how to optimize the workforce and prepare NPs for health care delivery is increasingly important. The NNPRT Scale will allow for large-scale examinations of the factors that influence NP role transition, as well as assess interventions to prepare and support novice NPs' transitions.
Assessment for sexually transmitted infections in men who have sex with men attending a nurse-run HIV preexposure prophylaxis clinic
Authors: Stockton Janice M. 
Published: February 2021

ABSTRACT

Background:
Male-to-male sexual contact remains the primary mode of transmission for HIV and other sexually transmitted infections (STIs) in the United States. Reported STI rates in men who have sex with men (MSM) taking HIV preexposure prophylaxis (PrEP) are higher than expected, possibly due to decreased condom use while on PrEP or more frequent STI screening with routine PrEP care.

Local problem:
Hamilton County, located in southwestern Ohio, consistently has the highest rates of gonorrhea and syphilis and second highest rate of chlamydia in the state. The purpose of this project was to incorporate Centers for Disease Control and Prevention (CDC)–recommended comprehensive STI evaluations for MSM attending a nurse-run PrEP clinic in southwestern Ohio.

Methods:
Seventy-five MSM seen for PrEP between January 1, 2017, and May 15, 2019, were included in the STI testing program. Of these, 59 were included in outcome evaluation.

Intervention:
Sexually transmitted infection testing was performed every three months, including HIV and syphilis, with chlamydia/gonorrhea testing performed at all potentially exposed sites.

Results:
During the evaluation period, 43 STIs occurred in 18 patients (30.5%). Affected sites for gonorrhea included 10 oropharynx, eight anorectal, and two genitourinary; for chlamydia, it included one oropharynx, 12 anorectal, and one genitourinary. All extragenital infections were asymptomatic.

Conclusions:
Sexually transmitted infection results in this population are consistent with those reported in other PrEP centers and reinforce importance of three-point chlamydia/gonorrhea testing as part of comprehensive STI evaluation. Implementing CDC screening recommendations in PrEP programs has been effective in identifying and treating STIs. Incorporating sexual history and comprehensive testing may help providers in other settings identify patients who need more frequent HIV/STI screening and prevention services.
Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty
Authors: Ranguis Sebastian C. , Leonard Colin G. , James Adrian L. 
Published: February 2021

Objective:
To compare outcomes and complications of endoscopic lateral graft (LGT) and interlay (IT) tympanoplasty.

Study Design:
Prospective observational cohort study of totally endoscopic ear surgery (TEES) tympanoplasty.

Setting:
Pediatric tertiary referral center.

Patients:
One hundred fourteen surgeries for children with tympanic membrane perforation without cholesteatoma.

Intervention:
Porcine-derived collagen graft tympanoplasty using either LGT or IT.

Main Outcome Measures:
Closure rates of perforation, hearing outcomes (four-tone average air conduction [AC] and air bone gap), and complications that required further surgery were assessed 12 months postoperatively.

Results:
Perforation closure rates did not differ between LGT (52/59 (88%)) and IT (45/51 (88%)), (Fisher's exact p = 1.00) (four ears lost to follow-up). AC thresholds (p = 0.32) and air bone gap (p = 0.88) improved similarly after surgery with LGT (median 8.8 dB) and IT (median 7.5 dB). The proportion of ears with serviceably normal hearing (AC ≤ 30 dB HL) postoperatively was similar (LGT 40/49 (82%), IT 36/46 (78%), Fisher's exact p = 0.80). Following IT, three (6%) ears developed inclusion cholesteatoma requiring revision surgery. One (2%) LGT ear developed blunting after myringitis.

Conclusions:
IT and LGT provide similar perforation closure rates and hearing outcomes. When choosing between these two techniques to repair pediatric tympanic membrane perforations, LGT would seem to be preferable than IT due to the risk of inclusion cholesteatoma after IT. There is a small risk of anterior blunting after LGT.
Comparison of Speech Recognition With an Organ of Corti Versus Spiral Ganglion Frequency-to-Place Function in Place-Based Mapping of Cochlear Implant and Electric-Acoustic Stimulation Devices
Authors: Dillon Margaret T. , Canfarotta Michael W. , Buss Emily , O’Connell Brendan P. 
Published: February 2021

Objective:
To compare acute speech recognition with a cochlear implant (CI) alone or electric-acoustic stimulation (EAS) device for place-based maps calculated with an organ of Corti (OC) versus a spiral ganglion (SG) frequency-to-place function.

Patients:
Eleven adult CI recipients of a lateral wall electrode array.

Intervention:
Postoperative imaging was used to derive place-based maps calculated with an OC versus SG function.

Main Outcome Measure:
Phoneme recognition was evaluated at initial activation with consonant-nucleus-consonant (CNC) words presented using an OC versus a SG place-based map.

Results:
For the 9 CI-alone users, there was a nonsignificant trend for better acute phoneme recognition with the SG map (mean 18 RAUs) than the OC map (mean 9 RAUs; p = 0.071, 95% CI [≤−1.2]). When including the 2 EAS users in the analysis, performance was significantly better with the SG map (mean 21 RAUs) than the OC map (mean 7 RAUs; p = 0.019, 95% CI [≤−6.2]).

Conclusions:
Better phoneme recognition with the SG frequency-to-place function could indicate more natural tonotopic alignment of information compared with the OC place-based map.
A prospective, randomized investigation is currently underway to assess longitudinal outcomes with place-based mapping in CI-alone and EAS devices using the SG frequency-to-place function.