bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Mediation and Suppression Effect of Demoralization in Breast Cancer Patients After Primary Therapy: A Structural Equation Model
Authors: PENG Hsiu-Ling , HSUEH Hui-Wen , CHANG Yu-Hsing , LI Ren-Hau 
Published: February 2021

ABSTRACT

Background
Because of the increasing 5-year survival rate of breast cancer, adjustment to breast cancer survivorship is pertinent to the patient's life after diagnosis. Despite the psychological changes occurring during the transitional period (first 5 years after diagnosis) and after primary therapy having a known, critical effect on survivorship status, the data related to this topic are very limited.

Purpose
This study was designed to examine the relationships among demoralization, stress, sleep disturbance, and psychological well-being in women with breast cancer after primary therapy.

Methods
Two hundred eight women with breast cancer (mean age = 51.96 ± 8.27) participated in a cross-sectional study in central Taiwan. Recruitment was conducted using convenience snowball sampling at a local teaching hospital. All of the participants had completed primary therapy and were in the 5-year postdiagnosis period. The average duration of cancer was 28 months. The participants completed the Stress of Breast Cancer after Primary Therapy Scale, Demoralization Scale, Pittsburgh Sleep Quality Inventory, and Ryff's Psychological Well-Being Scale–Short Form. Data were analyzed using a structural equation model to find plausible path relationships among stress, demoralization, sleep disturbances, and psychological well-being.

Results
Demoralization was shown to completely mediate the effect of stress on sleep disturbances. In addition, the predictive effect of sleep disturbances on psychological well-being was overwhelmingly explained by demoralization when competing with sleep disturbances. Furthermore, a positive path was found between stress and psychological well-being because of the suppression effect of demoralization.

Conclusions/Implications for Practice
Demoralization was found to be a mediator that suppressed the relationships among stress, sleep disturbances, and psychological well-being in the adaptation process of patients with breast cancer after primary therapy. This article adds to the limited research on women with breast cancer after primary therapy who are in their initial 5 years of diagnosis. In addition, this study used structural equation model to find the plausible path relationships among the psychological factors involved in the well-being of women with breast cancer. Supporting patients with cancer and effectively reducing their perceived demoralization will be key to transforming stress into personal growth and a facilitator of long-term recovery.
Effect of a Breathing Exercise on Respiratory Function and 6-Minute Walking Distance in Patients Under Hemodialysis: A Randomized Controlled Trial: [RETRACTED]
Authors: ARAZI Tajmohammad , ALIASGHARPOUR Mansooreh , MOHAMMADI Sepideh , MOHAMMADI Nooredin , KAZEMNEJAD Anoushirvan 
Published: February 2021

ABSTRACT

Background
Pulmonary disorders and poor functional capacity are common complications in patients under hemodialysis. Although breathing exercise is frequently prescribed to improve respiratory function, its efficacy in this patient community is not well established.

Purpose
Our study was designed to determine the effectiveness of a breathing exercise on respiratory function and 6-minute walk (6MW) distance in patients under hemodialysis.

Methods
A randomized controlled trial approach was used. The sample consisted of 52 patients under hemodialysis from a university teaching hospital in Iran. The experimental group (n = 26) received the breathing exercise program and was encouraged to perform incentive spirometry for 2 months. The control group (n = 26) received only routine hospital care. The respiratory function test and 6MW test were performed at baseline and at 2 months after the intervention (posttest).

Results
The two groups were homogeneous in terms of respiratory function parameters, 6MW distance, and demographic characteristics at baseline. Forced expiratory volume in 1 second and forced vital capacity were significantly better in the experimental group compared with the control group at 2 months after intervention. No significant difference was found in 6MW distance between the groups at the 2-month posttest.

Conclusions/Implications for Practice
The 2-month breathing exercise effectively improved pulmonary function parameters (forced vital capacity, forced expiratory volume in 1 second) in patients under hemodialysis but did not affect 6MW distance. Hemodialysis nurses should strengthen their clinical health education and apply breathing exercise programs to reduce the pulmonary complications experienced by patients under hemodialysis.
Dual use of Department of Veterans Affairs and community healthcare: Homeless veterans' experiences, perspectives, and perceptions
Authors: Etchin Anna G. , LaCoursiere-Zucchero Terri , McDannold Sarah E. , McInnes D. Keith 
Published: February 2021

ABSTRACT

Background:
Veteran homelessness is a pervasive problem and a high-priority, mission-oriented area of investigation in the United States (US). Most veterans enrolled in healthcare with the Department of Veterans Affairs (VA) carry additional health coverage, which may increase their access to care. For veterans, dual use of VA and non-VA healthcare has potentially positive and negative consequences.

Purpose:
To explore homeless veterans' experiences seeking and obtaining healthcare within and outside the VA.

Methodology:
US homeless veterans were recruited from a large, urban Northeast Healthcare for the Homeless program from two sites. This was a descriptive phenomenological study. Three semistructured focus group interviews were conducted (total n = 21 distinct participants). We used inductive content analysis procedures to identify main themes in the data.

Results:
We found four main themes: dual use decision making, access to care, preferences and perceptions of care, and suggestions for improving VA care. Although veterans in our sample had mixed positive and negative experiences with both systems, positive responses were more common regarding community care than VA. Veterans provided more verbose responses when describing negative VA experiences and more succinct responses for positive experiences.

Conclusions:
We found mixed positive and negative experiences for both healthcare systems, although reports were more positive for non-VA care than VA.

Implications:
Veterans' healthcare concerns and needs appeared difficult to meet. Future research is warranted to improve veteran-centered care access and care experiences.
Impact of a nutrition education program on health behaviors in a university workplace wellness program
Authors: Downes Loureen S. , Buchholz Susan W. , Fogg Louis F. 
Published: February 2021

ABSTRACT

Background:
Obesity is a complex health issue associated with the leading causes of preventable chronic diseases, such as heart disease and type 2 diabetes. As part of an interprofessional team, nurse practitioners can play an integral role in leading worksite interventions to enhance health behavior change. Although worksite nutrition interventions have existed for many years, effective weight management programs are needed in the workplace.

Purpose:
The purpose of this study was to determine the effect of a novel nutrition education program implemented in the workplace on health behaviors (dietary habits and physical activity), motivators and barriers, emotional eating, confidence, and biometrics (body mass index and lipid levels).

Methods:
A total of 96 university employees participated in a one-group pre- and postintervention from 2017 to 2019. The intervention included eight weekly face-face education sessions. We assessed dietary habits, physical activity, motivators and barriers of a healthy lifestyle, emotional eating, confidence levels, body mass index, and lipid levels. Descriptive statistics, chi-square test, one-way analysis of variance, and Wilcoxon rank test were performed.

Results:
The consumption of fruits, vegetables, beans, grains, and physical activity increased significantly. Barriers, body mass index, and triglycerides significantly decreased. There was no significant difference in emotional eating and motivators after the intervention.

Implications for practice:
Nurse practitioners are positioned to lead an interprofessional team to provide nutrition education to help mitigate risk factors for obesity in various settings, including the workplace.
The development and implementation of an advanced practice registered nurse–led prenatal education program for housing insecure women
Authors: McCormack Leslie , Ward Nicole , Bryant-Moore Keneshia , Kalkwarf Shannon , English Beverly , Riley Elizabeth 
Published: February 2021

ABSTRACT
Housing insecurity has been shown to have an impact on the health care system due to negative maternal and neonatal outcomes. Housing insecurity is associated with the social determinants of health under the umbrella of economic stability and neighborhood/physical environments. Research shows that educational programs and support resources can help alleviate this strain for women who are pregnant. This article discusses the development and implementation of an advanced practice registered nurse (APRN)-led, prenatal education group for women facing housing insecurity who are pregnant and high risk. The curriculum was revised and based on a March of Dimes Becoming a Mom with alignment to Maslow's Hierarchy of Needs. The 10-week prenatal education program was created and implemented by a group of APRNs and registered nurses to aid pregnant women facing housing insecurity with coping strategies and education regarding their pregnancy.
Empowering nurse practitioners to make health policy CHANGE: Steps to successful passage of legislation in Utah
Authors: Eden Lacey M. , Merrill Heather , Luthy Karlen E. 
Published: February 2021

ABSTRACT
Nurse practitioners have the skills needed to make meaningful policy change to improve health care. In 2017, the authors championed a bill, House Bill 308 Substitution 2 (HB 308 Sub 2), which passed in the Utah Legislature. This health policy article details the process of successful passage of HB 308 Sub 2 and guides advanced practice registered nurses (APRNs) in enacting legislation. The steps detailed to enact legislation are based on Longest's policy framework (2006). The acronym CHANGE was developed and stands for collecting data, hinge, associations, negotiate, gather, and expect to be the expert. Intricacies of lawmaking are also explained including timing of legislation, the three readings, and lobbying. The CHANGE acronym outlines the following: Collecting data to legitimize the problem and proposed solution. The Hinge refers to the specifics of the proposed solution. Associations involve garnering support from key stakeholders early and often in the legislative process. Negotiate refers to finding a bill sponsor that is trustworthy, negotiates well, and has political capital. Gather public support is a critical step to increase legislatures' constituent communication requesting support for the bill. Expect to be the expert refers to understanding arguments for and against the bill and crafting power statements. Passing of HB 308 Sub 2, through the work of APRNs, provides a step-by-step guide to successful passing of legislation. This guide will empower APRNs across the nation with the knowledge to enact and pass policies to improve health care in our nation.
From bench to bedside: updates in basic science, translational and clinical research on muscle fatigue in cancer cachexia
Authors: Jackson Katherine M. , Cole Calvin L. , Dunne Richard F. 
Published: February 2021

Purpose of review
Cancer cachexia is a syndrome of loss of weight and muscle mass that leads to reduced strength, poor physical performance and functional impairment. Muscular fatigue is a distressing syndrome that patients with cachexia suffer from and can impair quality of life. Here, we review recent updates in muscular fatigue in cancer cachexia research with a focus on mechanisms, biomarkers and potential therapies.

Recent findings
Both in mice and humans, research has shown that muscle fatigue can be independent of muscular atrophy and can happen early in cancer development or in precachexia. Inflammatory pathways, mitochondrial dysfunction and gut microbiota have recently been studied to play an important role in muscle fatigue in preclinical models. Exercise can target these pathways and has been studied as a therapeutic intervention to improve muscle fatigue.

Summary
Heightened inflammation within muscle, altered muscle function and muscle fatigue can begin prior to clinical evidence of cachexia, making early recognition and intervention challenging. The emergence of cachexia mouse models and translational and clinical research studying muscle fatigue will hopefully lead to new therapies targeting the underlying mechanisms of cancer cachexia. Exercise will need to be tested in larger randomized studies before entering into daily practice.
Atypical mycobacterial infections – management and when to treat
Authors: Gill Laura Indira , Dominic Catherine , Tiberi Simon 
Published: February 2021

Purpose of review
Infections caused by nontuberculous mycobacteria (NTM) are increasing for several reasons, including diagnostic advances, increased awareness and a larger at-risk population. NTM pulmonary disease is surpassing tuberculosis (TB) in some low incidence areas. This review summarizes the latest literature and guidelines and aims to be a concise source outlining treatment and management of NTM lung infections, integrating established treatment paradigms with novel pharmacological interventions.

Recent findings
Recent additions to NTM treatment are inhaled liposomal amikacin and the anti-TB drug bedaquiline. Several other new or repurposed treatments are being explored in vitro, in animal models and in clinical trials, including novel beta-lactamase inhibitor/lactam combinations, dual-lactam combinations, efflux pump inhibitors, novel antimicrobials, inhaled clofazimine suspension and bacteriophages.

Summary
Patients with NTM pulmonary disease are mainly female and older with significant delay between diagnosis and treatment being common. Treatment varies according to causative organism, drug susceptibilities, radiological type and disease severity. Underlying chronic conditions, drug intolerances and interactions require careful consideration. In all cases, at least three drugs should be used to minimize acquisition of drug resistance, and all patients should receive a minimum of 12 months of treatment. Expert advice should be taken. NTM treatment is longer than TB treatment, more likely to fail and more likely to cause toxicity. The relatively small numbers of patients affected by each NTM species has limited research. Novel treatments hold promise; nevertheless, it is likely that new solutions for NTM management will stem from the TB pipeline for the foreseeable future.
Severity of liver test abnormalities in coronavirus disease 2019 depends on comorbidities and predicts early in-hospital mortality
Authors: Satapathy Sanjaya K. , Kuntzen Christian , Qiu He , Jiang Yu , Bodenheimer Henry C. , Roth Nitzan C. , Lee Tai-Ping , Hirsch Jamie S. , Trindade Arvind J. , Bernstein David E. ,   for the Northwell Health COVID-19 Research Consortium
Published: February 2021

Background and aims
Liver chemistry abnormalities (LCA) are common in patients with coronavirus disease 2019 (COVID-19), but their causes and clinical impact have not been adequately studied. We assessed the associations between LCA and clinical characteristics, inflammatory serum markers, in-hospital mortality.

Methods
Ten thousand eight hundred fifty-six adult patients with COVID-19 hospitalized in 13 hospitals in New York (1 March to 27 April 2020) were analyzed retrospectively. Abnormalities of liver chemistries [aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, or total bilirubin] were defined as absent, mild-moderate (at least one value up to four times elevated), or severe.

Results
LCA were mild-moderate in 63.9% and severe in 7.6% at admission. Risk factors for severe LCA were male sex and chronic liver disease. Conversely, hypertension and diabetes mellitus were less likely associated with severe LCA. AST elevation correlated weakly to modestly with inflammatory markers. On adjusted analysis, in-hospital mortality was 1.56 times and 1.87 times increased in patients with mild-to-moderate and severe LCA, respectively. Diabetes, hypertension, male sex, and age greater than 60 years was associated with incremental risk of mortality with increase severity of LCA, especially in the first week of hospitalization. HTN was not associated with increased in-hospital mortality unless LCA was present.

Conclusion
Increasing severity of LCA on hospital admission predicts early in-hospital mortality in COVID-19 patients. Mortality associated with the known risk factors, hypertension, diabetes, male sex, and old age was accentuated in the presence of LCA. AST correlated modestly with inflammatory markers.
Hepatocellular carcinoma in patients coinfected with hepatitis B or C and HIV: more aggressive tumor behavior?
Authors: Saud Lisa R. C. , Chagas Aline L. , Maccali Claudia , Pinto Paulo V. A. , Horvat Natally , Alencar Regiane S. S. M. , Tani Claudia M. , Abdala Edson , Carrilho Flair J. 
Published: February 2021

Introduction and objectives
Hepatocellular carcinoma (HCC) is the 6th cause of cancer and hepatitis C (HCV) and B (HBV) viruses are the most frequent risk factors for HCC. Patients coinfected with HCV or HBV and HIV present a faster progression to liver fibrosis and higher incidence of HCC. The aim of this study was to evaluate the survival and clinical outcomes of coinfected patients with HCC comparing with non-HIV patients.

Methods
We conducted a retrospective cohort study, including 267 HCC patients with HCV or HBV infection with or without HIV. The primary endpoint was overall survival. A Kaplan–Meier curve was presented to assess survival function. Clinical and radiologic variables, according to HIV status, were compared by logistic regression.

Results
Among 267 HCC patients, 25 (9.3%) were HIV-positive. In the coinfected group, patients were younger (49.8 vs 61.2 years, P < 0.001), cirrhosis was less predominant (88 vs 96.7%, P = 0.05), a smaller proportion received HCC treatment (60 vs 86.3%, P = 0.001) and the frequency of portal vein tumoral thrombosis was higher (32 vs 11.1%, P = 0.003). The overall mortality rate was higher in the HIV-positive group (92 vs 74.3%), independently of clinical and tumoral variables.

Conclusion
Coinfected patients with HCC presented higher mortality, tumor diagnosis in a younger age, less underlying cirrhosis and a higher frequency of tumoral thrombosis. Further studies are warranted to better understand the role of HIV in hepatocarcinogenesis, in order to improve the management of those patients, particularly regarding screening programs.
Design and verification of individualized follow-up strategy of colonoscopy for postoperative patients with colorectal cancer
Authors: Guo Chunmei , Wu Jing , Jiao Yue , Zhang Qian , Wang Canghai , Wang Yadan , Liu Hong , Zhang Shutian , Wei Nan , Lin Wu , Liu Kuiliang , Shi Haiyun 
Published: February 2021

Background
Current guidelines do not establish an individual scheme for surveillance colonoscopy in postoperative colorectal cancer (CRC) patients.

Aims
The purpose of the study was to screen possible risk factors for the development of metachronous adenoma in postoperative CRC patients and to develop a risk prediction model and verify it.

Methods
Consecutive postoperative patients with CRC were enrolled from April 2007 to December 2013 as the derivation group. Baseline data of patients and clinicopathological features of the tumor were collected, logistic regression analysis was performed, and clinical model was established and was verified internally. The model was externally validated in an independent cohort (validation group) from January 2014 to October 2017 in the same hospital.

Results
A total of 734 patients were included, with average (64.6 ± 11.5) years old. The overall incidence of metachronous adenoma was 35.4%. There was no significant difference in the incidence of metachronous adenoma between the derivation group and validation group (P > 0.05). Age, diabetes mellitus, right colon cancer, moderately to poorly differentiated adenocarcinoma and synchronous adenoma were independent risk factors for metachronous adenoma. The C-index of the metachronous adenoma line chart model was 0.932, and the index decreased by 0.022 after internal verification. The C-index of external validation was 0.910. The Hosmer–Lemeshow test showed that the P value of metachronous adenoma risk prediction model was 0.247.

Conclusions
Individual surveillance strategies should be designed for postoperative patients with CRC. For high-risk patients, it is appropriate to undergo more than two colonoscopies in 36 months after operation.
Serum fibrosis markers could aid in the prediction of factor for successful oral antiviral treatment in hepatitis C
Authors: Sahin Memduh , Sucu Pinar , Serin Erdinc , Yetim Aylin , Alkim Huseyin , Alkim Canan 
Published: February 2021

Background
It has been demonstrated that there may be a relationship between liver fibrosis and serum biomarkers. The aim of this study was to investigate pre- and postoral antiviral therapy levels of these biomarkers and their relationship with other fibrotic parameters in hepatitis C virus (HCV) patients.

Methods
The study group comprised HCV patients who were treated with oral antiviral regimens. Prior to, and 8 months after the treatment, serum biomarkers, including transforming growth factor-β (TGF-β), chitinase-3-like protein 1 (YKL-40), collagen type IV, matrix metalloproteinases (MMPs) and hyaluronic acid levels, were examined and fibrosis-4 (Fib-4) and aspartate aminotransferase to platelet ratio index (APRI) scores were calculated at the same times.

Results
In total, 45 HCV patients (aged between 27 and 86 years) participated. Of these 20 (44.4%) were cirrhotic and 25 (55.6%) were noncirrhotic. The concentrations of YKL-40 (P = 0.01) and TGF-β (P = 0.032) after treatment were significantly higher than the pretreatment values, whereas hyaluronic acid concentrations decreased after treatment (P = 0.001). Noncirrhotic patients had significantly higher (P = 0.03) YKL-40 levels prior to therapy compared to cirrhotic patients. Median MMP-2 concentrations were higher in men than in women (P = 0.001). Prior to treatment, TGF-β, YKL-40 and collagen type IV levels were negatively correlated with Fib-4 scores, whereas only TGF-β and YKL-40 concentrations were negatively correlated with APRI scores.

Conclusion
YKL-40, TGF β and hyaluronic acid may be markers for fibrotic change during oral therapy for HCV. In particular, TGF β concentrations correlated with fibrotic indices. However, these results should be confirmed and validated by further research.