bluuebunny/crossref_metadata_2025_split huggingface dataset:
KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS THERAPEUTIC LIFESTYLE CHANGES IN THE MANAGEMENT OF HYPERTENSION IN KHARTOUM STATE (2020)
Authors: Abdalla Ahmed Ali , Mirghani Kamil 
Published: April 2021

Objective:
Hypertension (HTN) has long been recognised as a major risk factor for coronary artery diseases, stroke and kidney disease. Despite a myriad of new pharmacological agents, a significant portion of hypertensive patients’ blood pressure remains uncontrolled in the Sudan, an important, often underutilised treatment approach is therapeutic lifestyle changes (TLC). This study aimed to assess the attitude, practice and barriers of patients to therapeutic lifestyle changes in the management of hypertension in a third world country in Khartoum locality in 2016.

Design and method:
The study was cross-sectional descriptive. Data was collected via structured interviews using a questionnaire, full coverage of patients attending Ahmed Gasim and Alshaab hospitals for follow up in a certain time period was carried out, this amounted to a sample of 112, Descriptive and inferential statistics were utilised for data analysis.

Results:
112 patients were identified for participation in this study, a slight female preponderance (54.5%), older age with 58% in the 55–70 years’ age group, when assessed for knowledge on lifestyles and habits that affect blood pressure, respondents were most familiar with the fact that salt consumption affects blood pressure, 93.8% answering correctly. After Knowledge scores were calculated, only 31.3% of participants had above average knowledge on blood pressure and TLC. The lifestyle change respondents were least adherent to was regular exercise with 59.8% of participants admitting to not exercising most days. Participants most frequent response to why they aren’t implementing a certain change was that they didn’t feel it mattered enough, the same answer being most frequent for each lifestyle change.

Conclusions:
In conclusion, this study demonstrated that hypertensive patients are generally knowledgeable on hypertension and the importance of therapeutic lifestyle changes in its management, particularly the importance of minimizing salt intake. The researcher believes that novel approaches are needed to help motivate patients in a third world country such as Sudan diagnosed with hypertension apply their knowledge regarding TLC.
Integration of Virtual Simulation Into a Web-Based Nursing Dosage Calculation Course
Authors: Donahue Nadine 
Published: April 2021

Abstract
This article describes an innovative approach to student learning using virtual simulation in a web-based dosage calculation nursing course. This new technology was implemented in a baccalaureate generic nursing program. The project was designed to improve student test scores and increase self-confidence. Using this technology allowed students to practice their skills and receive feedback in real time. Feedback from students was mostly favorable. Higher performing students found it repetitive; lower performing students showed improvement in their scores.
Efficacy of a Simulation Program to Improve Clinical Judgment and Clinical Competence Among Graduate Nurses
Authors: Cantrell Mary Ann , Mariani Bette , Lengetti Evelyn 
Published: April 2021

Abstract

AIM
This two-group feasibility study tested the efficacy of a four-scenario simulation program to improve clinical judgment and clinical competence among graduate nurses.

BACKGROUND
Clinical judgment and clinical competence are underdeveloped among new-to-practice nurses.

METHOD
Clinical judgment was compared between the intervention group (n = 17) and a control group (n = 26) in the practice setting at two time points.

RESULTS
The simulation program had a large effect on the intervention group’s clinical judgment (η2 = .143) and clinical competence (η2 = .153). There were no statistically significant differences for each outcome at baseline as compared to the final scenario for the intervention group. There was no statistical significance between the intervention and control groups in clinical judgment in the practice setting at each measurement time.

CONCLUSION
Replication of the study with a randomized controlled trial and large sample size is warranted.
Nursing Student Perceptions of Academic and Clinical Integrity
Authors: Devine Christine Ann , Chin Elizabeth Danells , Sethares Kristen A. , Asselin Marilyn E. 
Published: April 2021

Abstract

AIM
This study aimed to explore how nursing students define and describe academic and clinical integrity and to identify social and psychological influences on student decisions to act with integrity.

BACKGROUD
Nursing students are exhibiting a decline in academic and clinical integrity. Academic dishonesty often correlates to clinical dishonesty, subsequently impacting patient care quality and safety. Student perceptions and understanding of integrity are unknown.

METHOD
A qualitative descriptive approach guided this study. A purposive sample of 19 traditional baccalaureate nursing students was recruited to participate in one-hour face-to-face interviews.

RESULTS
All participants defined academic and clinical integrity as honest, ethical, and accountable behavior. Additional subthemes of characteristics, facilitators and barriers, and outcomes of acting with integrity emerged.

CONCLUSION
Students recognize the positive characteristics of integrity and their effects on personal growth and optimal patient outcomes. These findings can inform faculty in developing and supporting a culture of integrity.
Under the Skin: The Relationship Between Subcutaneous Injection and Skin Infections Among People Who Inject Drugs
Authors: Freibott Christina E. , Phillips Kristina T. , Anderson Bradley J. , Stewart Catherine , Liebschutz Jane M. , Stein Michael D. 
Published: April 2021

Objectives:
People who inject drugs (PWID) are at increased risk for numerous negative health outcomes. Subcutaneous injections (aka skin popping) can result in greater risk of skin and soft tissue infections (SSTIs), but less is known about PWID who choose this route of administration. This study compares subcutaneous injectors to intravenous injectors, characterizes those who inject subcutaneously, and examines whether subcutaneous injection is associated with SSTIs in the past year.

Methods:
A cohort of hospitalized PWID (n = 252) were interviewed regarding injection-related behaviors, history of SSTI, and knowledge of subcutaneous injection risk. We examined differences between those who do and do not inject subcutaneously and used a negative binomial regression model to estimate adjusted odds associating subcutaneous injection and SSTI.

Results:
Participants averaged 38 years, with 58.3% male, 59.5% White, 20.6% Black, and 15.9% Latinx. PWID who performed subcutaneous injection were not demographically different from other PWID; however, the mean rate of past year SSTIs was higher for persons injecting subcutaneously than for those who did not (1.98 vs 0.96, P < 0.001). Persons injecting subcutaneously did not differ from those who injected intravenously in terms of their knowledge of subcutaneous injection risk (P = 0.112) and knowledge score was not associated with SSTIs (P = 0.457).

Conclusions:
PWID who perform subcutaneous injections are demographically similar to other PWID but had higher rates of past year SSTIs. Knowledge of subcutaneous injection risk was not associated with SSTI risk.
Inpatient Opioid Use Disorder Treatment by Generalists is Associated With Linkage to Opioid Treatment Programs After Discharge
Authors: Tierney Hannah R. , Rowe Christopher L. , Coffa Diana A. , Sarnaik Shashi , Coffin Phillip O. , Snyder Hannah R. 
Published: April 2021

Objectives:
Describe clinical and demographic associations with inpatient medication for opioid use disorder (MOUD) initiation on general medicine services and to examine associations between inpatient MOUD initiation by generalists and subsequent patient healthcare utilization.

Methods:
This is a retrospective study using medical record data from general medicine services at an urban safety-net hospital before an inpatient addiction consultation service. The patients were adults hospitalized for acute medical illness who had an opioid-related ICD-10 code associated with the visit. Associations with MOUD initiation were assessed using multivariable logistic regression. Hospital readmission, emergency department use, linkage to opioid treatment programs (OTP), and mortality at 30- and 90-days postdischarge were compared between those with and without hospital MOUD initiation using χ
2 tests.

Results:
Of 1,284 hospitalized patients with an opioid-related code, 59.81% received MOUD and 31.38% of these were newly initiated in-hospital. In multivariable logistic regression, Black race, mood disorder, psychotic disorder, and alcohol use disorder were negatively associated with MOUD initiation, while being aged 25–34, having a moderate hospital severity of illness score, and experiencing homelessness were positively associated. There were no bivariate associations between MOUD initiation and postdischarge emergency department use, hospital readmission, or mortality at 30- and 90-days, but those initiated on MOUD were more likely to present to an OTP within 90 days (30.57% vs 12.80%, P < 0.001).

Conclusions:
MOUD prescribing by inpatient generalists may help to increase the number of patients on treatment for opioid use disorder after hospital discharge. More research is needed to understand the impact of inpatient MOUD treatment without addiction specialty consultation.
Pretreatment With Mifepristone Compared With Misoprostol Alone for Delivery After Fetal Death Between 14 and 28 Weeks of Gestation
Authors: Allanson Emma R. , Copson Sean , Spilsbury Katrina , Criddle Sonya , Jennings Belinda , Doherty Dorota A. , Wong Antonia M. , Dickinson Jan E. 
Published: April 2021

OBJECTIVE:
To assess the efficacy of pretreatment with mifepristone before misoprostol, compared with misoprostol alone, for termination of pregnancy after a fetal death in the second trimester.

METHODS:
This prospective, double blind, placebo-controlled trial randomized women requiring a termination of pregnancy after fetal death between 14 and 28 weeks of gestation to placebo or 200 mg mifepristone orally 24–48 hours before the termination of pregnancy with misoprostol (400 micrograms every 6 hours vaginally for women at 24 weeks of gestation or less, and 200 micrograms every 4 hours vaginally for women at 24 weeks of gestation or more). Based on a median labor with misoprostol alone in the second trimester of 13 hours, a sample size of 116 women per group was planned to compare the primary outcome of time from administration of misoprostol to delivery. The trial was ceased after 66 women were enrolled secondary to prolonged time to achieve recruitment.

RESULTS:
From April 2013 to November 2016, 66 women were randomized (34 to placebo and 32 to mifepristone). There were no differences in the characteristics between the two groups. The median time for the primary outcome of administration of misoprostol to delivery in the placebo group was 10.5 hours, compared with 6.8 hours in the treatment group (hazard ratio 2.41 95% CI 1.39–4.17, P=.002). Women in the placebo group required more doses of misoprostol (3.4 vs 2.1, P=.002) and more misoprostol overall (1,181.8 micrograms, vs 767.7 micrograms, P=.003). There was no difference in maternal complications between the two groups. Women in the mifepristone group reported improved perception of the procedure.

CONCLUSION:
The sequential use of mifepristone and misoprostol for the termination of pregnancy after fetal deaths between 14 and 28 weeks of gestation reduces the time to delivery, compared with the use of misoprostol alone, with no worsening of maternal complications.

CLINICAL TRIAL REGISTRATION:
Australian New Zealand Clinical Trials Registry, ACTRN12612000884808.
Racial and Ethnic Disparities in Death Associated With Severe Maternal Morbidity in the United States
Authors: Guglielminotti Jean , Wong Cynthia A. , Friedman Alexander M. , Li Guohua 
Published: April 2021

OBJECTIVE:
To analyze racial and ethnic disparities in failure to rescue (ie, death) associated with severe maternal morbidity and describe temporal trends.

METHODS:
This was a retrospective cohort study using administrative data. Data for delivery hospitalizations with severe maternal morbidity, as defined by the Centers for Disease Control and Prevention, were abstracted from the 1999–2017 National Inpatient Sample. Race and ethnicity were categorized into non-Hispanic White (reference), non-Hispanic Black, Hispanic, other, and missing. The outcome was failure to rescue from severe maternal morbidity. Disparities were assessed using the failure-to-rescue rate ratio (ratio of the failure-to-rescue rate in the racial and minority group to the failure-to-rescue rate in White women), adjusted for patient and hospital characteristics. Temporal trends in severe maternal morbidity and failure to rescue were assessed.

RESULTS:
During the study period, 73,934,559 delivery hospitalizations were identified, including 993,864 with severe maternal morbidity (13.4/1,000; 95% CI 13.3–13.5). Among women with severe maternal morbidity, 4,328 died (4.3/1,000; 95% CI 4.2–4.5). The adjusted failure-to-rescue rate ratio was 1.79 (95% CI 1.77–1.81) for Black women, 1.39 (95% CI 1.37–1.41) for women of other race and ethnicity, 1.43 (95% CI 1.42–1.45) for women with missing race and ethnicity data, and 1.08 (95% CI 1.06–1.09) for Hispanic women. During the study period, the severe maternal morbidity rate increased significantly in each of the five racial and ethnic groups but started declining in 2012. Meanwhile, the failure-to-rescue rate decreased significantly during the entire study period.

CONCLUSION:
Despite improvement over time, failure to rescue from severe maternal morbidity remains a major contributing factor to excess maternal mortality in racial and ethnic minority women.
Anticoagulation Therapy in Patients With Coronavirus Disease 2019: Results From a Multicenter International Prospective Registry (Health Outcome Predictive Evaluation for Corona Virus Disease 2019 [HOPE-COVID19])
Authors: Santoro Francesco , Núñez-Gil Ivan J. , Viana-Llamas María C. , Maroun Eid Charbel , Romero Rodolfo , Fernández Rozas Inmaculada , Aparisi Alvaro , Becerra-Muñoz Victor Manuel , García Aguado Marcos , Huang Jia , Maltese Ludovica , Cerrato Enrico , Alfonso-Rodriguez Emilio , Castro Mejía Alex Fernando , Marin Francisco , Raposeiras Roubin Sergio , Pepe Martino , Moreno Munguia Victor H. , Feltes Gisela , Navas Jesus Varas , Cortese Bernardo , Buzón Luis , Liebetrau Cristoph , Ramos-Martinez Raquel , Fernandez-Ortiz Antonio , Estrada Vicente , Brunetti Natale Daniele 
Published: April 2021

OBJECTIVES:
No standard therapy, including anticoagulation regimens, is currently recommended for coronavirus disease 2019. Aim of this study was to evaluate the efficacy of anticoagulation in coronavirus disease 2019 hospitalized patients and its impact on survival.

DESIGN:
Multicenter international prospective registry (Health Outcome Predictive Evaluation for Corona Virus Disease 2019).

SETTING:
Hospitalized patients with coronavirus disease 2019.

PATIENTS:
Five thousand eight hundred thirty-eight consecutive coronavirus disease 2019 patients.

INTERVENTIONS:
Anticoagulation therapy, including prophylactic and therapeutic regimens, was obtained for each patient.

MEASUREMENTS AND MAIN RESULTS:
Five thousand four hundred eighty patients (94%) did not receive any anticoagulation before hospitalization. Two-thousand six-hundred one patients (44%) during hospitalization received anticoagulation therapy and it was not associated with better survival rate (81% vs 81%; p = 0.94) but with higher risk of bleeding (2.7% vs 1.8%; p = 0.03). Among patients admitted with respiratory failure (49%, n = 2,859, including 391 and 583 patients requiring invasive and noninvasive ventilation, respectively), anticoagulation started during hospitalization was associated with lower mortality rates (32% vs 42%; p < 0.01) and nonsignificant higher risk of bleeding (3.4% vs 2.7%; p = 0.3). Anticoagulation therapy was associated with lower mortality rates in patients treated with invasive ventilation (53% vs 64%; p = 0.05) without increased rates of bleeding (9% vs 8%; p = 0.88) but not in those with noninvasive ventilation (35% vs 38%; p = 0.40). At multivariate Cox’ analysis mortality relative risk with anticoagulation was 0.58 (95% CI, 0.49–0.67) in patients admitted with respiratory failure, 0.50 (95% CI, 0.49–0.67) in those requiring invasive ventilation, 0.72 (95% CI, 0.51–1.01) in noninvasive ventilation.

CONCLUSIONS:
Anticoagulation therapy in general population with coronavirus disease 2019 was not associated with better survival rates but with higher bleeding risk. Better results were observed in patients admitted with respiratory failure and requiring invasive ventilation.
Clinical consequences of asymptomatic cytomegalovirus in treated human immunodeficency virus infection
Authors: Schnittman Samuel R. , Hunt Peter W. 
Published: April 2021

Purpose of review
Despite antiretroviral therapy (ART)-mediated viral suppression, people with human immunodeficiency virus (HIV) (PWH) have increased morbidity and mortality. Immune activation and inflammation persist on ART and predict these complications. Over 90% of PWH have cytomegalovirus (CMV) co-infection, and CMV is considered a plausible contributor to this persistent immune activation.

Recent findings
A detailed understanding of the link between CMV and multimorbidity is needed, particularly as research moves toward identifying potential targeted therapeutics to attenuate inflammation-mediated morbidity and mortality in treated HIV. We review the literature on the association between CMV and immune activation as well as multiple end-organ complications including cardiovascular disease, venous thromboembolic disease, metabolic complications, gastrointestinal dysfunction, central nervous system involvement, birth sex-related differences, and the relation to the HIV reservoir. We conclude with a discussion of ongoing therapeutic efforts to target CMV.

Summary
As CMV is a plausible driver of multiple comorbidities through persistent immune activation in treated HIV, future research is needed and planned to address its causal role as well as to test novel therapeutics in this setting.
Changes in Intraocular Pressure During Hemodialysis: A Meta-analysis
Authors: Chen Szu-Han , Lu Da-Wen , Ku Wan-Chen , Chuang Lan-Hsin , Ferng Shyang-Hwa , Chen Yi-Ju , Lu Yi-Hsuan , Chai Pony Yee-Chee 
Published: April 2021

Précis:
Acetate dialysate causes elevation of intradialytic intraocular pressure (IOP) and contributed to the rise of IOP in the early years of hemodialysis (HD). Glaucoma, narrow-angle, or impaired aqueous outflow is another moderator causing a rise of intradialytic IOP.

Purpose:
Severe IOP elevation during HD has been described in many case reports. However, the results of primary studies are conflicting. This meta-analysis examined the impact of HD on IOP and explored the potential moderators.

Methods:
Medline, PubMed, Embase, Web of Science, and Cochrane were systematically searched. Before-after studies reporting the change of IOP during HD were included. Intradialytic IOP changes were calculated based on 4 different definitions: highest-baseline, lowest-baseline, max-baseline, and end-baseline IOP difference. Standardized mean difference (SMD) was pooled using the random-effects model.

Results:
Fifty-three studies involving 1903 participants and 2845 eyes were included. Overall data pooling showed no significant rise in intradialytic IOP. However, subgroup analysis showed an intradialytic IOP rise before 1986 (SMD: 0.593; 95% confidence interval: 0.169-1.018; max-baseline IOP difference as representative; most studies using acetate dialysate), no change between 1986 and 2005 (using both acetate and bicarbonate), and a decline after 2005 (SMD: −0.222; 95% confidence interval: −0.382 to −0.063; entirely using bicarbonate). Multivariable meta-regression showed only the type of dialysate, but not publication year or other potential factors, as a significant moderator. Glaucoma was found to be another significant moderator independent of the dialysate effect in bivariate meta-regression.

Conclusions:
IOP elevation in the early years of HD with the use of acetate dialysate is less of a clinical problem following its substitution with bicarbonate dialysate. However, physicians should still be cautious of potential IOP changes in the HD population with glaucoma.
Effects of Functional Foot Orthoses and Taping Interventions on Pain, Function, and Plantar Pressure for Adult Hallux Valgus: A Literature Review
Authors: Glasoe Ward M. , Allen Mary K. , Harris Joseph R. , Higgins Madeline M. , Jewett Susan M. , Rucker Michael J. 
Published: April 2021

ABSTRACT

Introduction
No recent review of the literature has investigated the effects of dynamic weight-bearing interventions for hallux valgus (HV) deformity, nor has research identified a preferred conservative treatment. This review studied the effectiveness of functional foot orthoses or taping in adults seeking care for HV. The outcomes examined were pain, function, and change in plantar pressures.

Materials and Methods
The literature was searched up to February 1, 2019, to identify relevant studies that treated adult HV with functional foot orthoses or taping and reported outcomes of pain, function, or the redistribution of plantar pressures. Pain and function were evaluated with a standardized mean difference effect size calculation; change in plantar pressures attributed to interventions was reported descriptively.

Results
Seven studies were identified for review. Five studies reported improved (pooled effect size, ≥0.89) pain or function outcomes for up to 6 months. Two studies that reported only plantar pressure measurements identified reduced loading under the first metatarsophalangeal joint.

Conclusions
Treatment with functional foot orthoses and taping reduced pain and function impairments in patients with HV over the short term (6 months), with no adverse outcomes reported. Although the actual mechanism is unknown, studies reporting plantar pressures indicate that load is transferred away from the area of deformity. Foot orthoses were identified as the preferred treatment, with tape considered an option for clinical assessment or temporary pain relief. Because of the progressive nature of deformity, the impairments, although improved with treatment (pooled effect size, ≥0.89), may not necessarily be lasting.