bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unconventional Facial Entry Points Confirmed Using a 3D CT Reconstruction–Guided Stereotactic Approach to Radiofrequency Thermocoagulation for the Treatment of Trigeminal Neuralgia: A Series of Case Reports
Authors: Guo Zhigang , Wang Zhijia , Li Kai , Du Chao , Zhao Xingli , Cheng Min , Tian Yu 
Published: October 2018

Abstract

Objectives
Patients with trigeminal neuralgia who are refractory to medical therapy may choose to undergo Gasserian ganglion percutaneous radiofrequency thermocoagulation. However, in cases where the foramen ovale is difficult to access due to various anatomical anomalies, the typical estimation of the facial entry point is suboptimal.

Methods
Three-dimensional computed tomography reconstruction imaging performed before surgery revealed anatomical variations in each of the four adult patient cases that made it more difficult to successfully access the foramen ovale (FO) for percutaneous radiofrequency thermocoagulation. Using measurements collected from preoperative imaging that showed each specific anatomical variation in the FO, researchers marked alternate facial entry points that would allow successful probe placement into the FO and recorded the arc angle data in the stereotactic instrument.

Results
Patients were evaluated during follow-up visits ranging from seven to 26 months after surgery and asked to rate postoperative pain using a visual analog scale. These scores decreased from 10 to 3 in all four patients by the third day after the procedure. There were no permanent complications or morbidities from the surgery. One patient experienced mild facial numbness; however, this side effect subsided within three months after surgery. During the follow-up period, no patient reported pain recurrence.

Conclusions
The expectation for clinicians approaching trigeminal nerve block using a peri-oral approach should be to expect a great degree of potential variability in terms of both distances from the corner of the mouth and needle angle taken to successfully navigate the anatomy and access the foramen ovale.
Development and Evaluation of a Systems Thinking Education Strategy for Baccalaureate Nursing Curriculum: A Pilot Study
Authors: Fura Louise A. , Wisser Kathleen Z. 
Published: October 2018

Abstract
Nurse educators are charged to develop and evaluate curricula on systems thinking to prepare future nurses to provide safe nursing care. The goal of this pilot study was to design and evaluate a four-hour educational strategy that prepares future professional nurses to use systems thinking approaches in the delivery of safe patient care. This study exposed prelicensure baccalaureate nursing students to systems thinking principles, which included didactic and experiential activities. A descriptive design was used to determine the effect of an on-campus educational strategy. A paired samples t-test revealed statistical significance from pretest to posttest.
Collaborative Simulation: Enhancing the Transition to Clinical Practice
Authors: Palmer Bobbi J. , Ham Kathy 
Published: October 2018

Abstract
Beginning nursing students typically report anxiety, low self-confidence, and difficulty transferring theoretical knowledge to the clinical setting prior to their first clinical experience. To address these issues, first-semester faculty in a prelicensure, undergraduate nursing program created a collaborative simulation experience (CSE). Implementation prior to the first clinical day provided real-life exposure to patient care, enhanced the transfer of knowledge, decreased anxiety, promoted self-confidence, and allowed faculty to identify students' strengths and weaknesses. Clinical faculty reported enhanced student performance following participation.
Student Perceptions of Stressors and the Value of Coaching in a Baccalaureate Nursing Articulation Program
Authors: Knowlton Mary 
Published: October 2018

Abstract
Regionally Increasing Baccalaureate Nurses (RIBN) is a unique articulation program in North Carolina. The fourth year of RIBN is challenging; students are enrolled as full-time university students while starting part-time employment as new graduate nurses. The aim of this descriptive pilot study was to explore the anticipated and actual stressors related to the fourth year experience and evaluate the impact of monthly coaching sessions. Key stressors identified were academic workload, professional awareness/role transition/workforce adjustment, time management, and obligations to support individuals. The monthly coaching sessions were beneficial in providing a means of debriefing and reframing life events.
The Critical Research Evaluation Tool (CRET): A Teaching and Learning Tool to Evaluate Research for Cultural Competence
Authors: Love Katie L. 
Published: October 2018

Abstract
The aim of this study was to present the Critical Research Evaluation Tool (CRET) which teaches evaluation of the researchers’ worldview, applicability to multicultural populations, and ethics surrounding potential harms to communities. To provide best cultural care nurses’ need to understand how historical/social/political experiences impact health and also influence research. The Student using the CRET reported receiving a strong foundation in research fundamentals, gaining a better understanding of critical frameworks in research, and learning more about themselves and reflecting on their own privileges and biases. The CRET provides nursing students and nursing faculty with a tool for examining diversity and ultimately decreasing health disparity.
After the Gap Analysis: Education and Practice Changes to Prepare Nurses of the Future
Authors: Beauvais Audrey Marie , Kazer Meredith Wallace , Aronson Barbara , Conlon Suzanne E. , Forte Pamela , Fries Kathleen S. , Hahn Judith M. , Hullstrung Russell , Levvis Meg , McCauley Paula , Morgan Patricia Padula , Perfetto Linda , Rebeschi Lisa M. , Solernou Sheila B. , Span Patricia , Sundean Lisa J. 
Published: October 2018

Abstract

AIM
The purpose of the study was to describe the Connecticut Nursing Collaborative-Action Coalition’s work in identifying and addressing gaps between nursing education and practice based on the Institute of Medicine’s Future of Nursing report.

BACKGROUND
Massachusetts Nurse of the Future (NOF) Competencies highlight the knowledge, skills, and attitudes/behaviors required for professional nurses. Integrating these concepts into the educational system will prepare the nursing workforce to respond to current/future health care needs and population health issues.

METHOD
Education and practice partners in four regions conducted a gap analysis of the education to practice transition for new graduate nurses using NOF as a framework for assessment.

RESULTS
Gaps in competencies were similar across regions. However, each organization uniquely addressed curricular gaps to best prepare nurses of the future.

CONCLUSION
Curriculum improvements will provide students the advantage of being prepared for the rapid changes happening in health care.
Continuing the Creativity and Connections: The Massachusetts Initiative to Update the Nurse of the Future Nursing Core Competencies
Authors: Sroczynski Maureen , Conlin Genevieve , Costello Eileen , Crombie Patricia , Hanley Diane , Tobin Marie , Welsh Diane 
Published: October 2018

Abstract

AIM
This article describes the collaborative effort of nursing education and practice to update the Massachusetts Nurse of the Future Nursing Core Competencies.

BACKGROUND
The Nurse of the Future Nursing Core Competencies were published in 2010. With the establishment of the Massachusetts Action Coalition, a primary goal was to continue to promote the integration of these competencies into all education and practice settings throughout Massachusetts and share this process with other states.

METHOD
Through an updated literature review and consultation with subject matter experts, the Nurse of the Future Competency Committee developed a process to ensure that significant practice advances were reflected in each of the competencies.

RESULTS
The updated Nurse of the Future Nursing Core Competencies were published in March 2016.

CONCLUSION
The updated competencies capture the knowledge, attitudes, and skills needed for all nurses to create a culture of health across the continuum of health care.
ReNEW: Wyoming’s Answer to Academic Progression in Nursing
Authors: Anderson Jennifer , Wells Kathy , Mather Charlotte , Burman Mary E. 
Published: October 2018

Abstract

AIM
The aim of the study was to describe Wyoming’s approach to academic progression and its projected impact. The collaborative process used to develop the shared statewide BSN curriculum is described along with recommendations.

BACKGROUND
Successful educational models that address the Institute of Medicine’s recommendation that 80 percent of RNs have a baccalaureate degree by 2020 face numerous challenges, especially in rural states.

METHOD
ReNEW (Revolutionizing Nursing Education in Wyoming) is a creative solution designed to decrease barriers to BSN education and increase motivation through a streamlined shared curriculum building on a strong community college system and the state's one BSN program.

CONCLUSION
Guiding principles, especially addressing the value of both ADN and BSN education, broad-based coalition development and maintenance, statewide structure, and ongoing funding, were keys to success.
NAMS-gallup survey on women's knowledge, information sources, and attitudes to menopause and hormone replacement therapy
Authors: Utian Wulf H. , Schiff Isaac 
Published: October 2018

Abstract
The North American Menopause Society (NAMS) sponsored a Gallup Organization survey of 833 women aged 45-60 to determine attitudes and experience with menopause and various forms of hormone replacement therapy (HRT). The results of this survey are presented herein.
17β-estradiol vaginal tablet versus conjugated equine estrogen vaginal cream to relieve menopausal atrophic vaginitis
Authors: Rioux Jacques Emile , Devlin M. Corinne , Gelfand Morrie M. , Steinberg Wilfred M. , Hepburn Douglas S. 
Published: October 2018

Abstract

Objectives:
The efficacy and safety of 25-μg 17β-estradiol vaginal tablets (Vagifem) were assessed and compared with 1.25-mg conjugated equine estrogen vaginal cream (Premarin Vaginal Cream) for the relief of menopausal-derived atrophic vaginitis, resulting from estrogen deficiency.

Design:
In a multicenter, open-label, randomized, parallel-group study, 159 menopausal women were treated for 24 weeks with either vaginal tablets or vaginal cream. Efficacy was evaluated by relief of vaginal symptoms and concentrations of serum estradiol and follicle-stimulating hormone. Safety was monitored by the incidence of adverse events, evaluation of endometrial biopsies, and clinical laboratory results. Patients also assessed the acceptability of the study medications.

Results:
Composite scores of vaginal symptoms (dryness, soreness, and irritation) demonstrated that both treatments provided equivalent relief of the symptoms of atrophic vaginitis. At weeks 2, 12, and 24, increases in serum estradiol concentrations and suppression of follicle-stimulating hormone were observed in significantly more patients who were using the vaginal cream than in those who were using the vaginal tablets (p < 0.001). Fewer patients who were using the vaginal tablets experienced endometrial proliferation or hyperplasia compared with patients who were using the vaginal cream. Significantly more patients who were using the vaginal tablets rated their medication favorably than did patients who were using the vaginal cream (p ≤ 0.001). Patients who were receiving the vaginal tablets also had a lower incidence of patient withdrawal (10% versus 32%).

Conclusions:
Treatment regimens with 25-μg 17β-estradiol vaginal tablets and with 1.25-mg conjugated equine estrogen vaginal cream were equivalent in relieving symptoms of atrophic vaginitis. The vaginal tablets demonstrated a localized effect without appreciable systemic estradiol increases or estrogenic side effects. Vaginal tablet therapy resulted in greater patient acceptance and lower withdrawal rates compared with vaginal cream therapy.
Estrogen effects on arteries vary with stage of reproductive life and extent of subclinical atherosclerosis progression
Authors: Clarkson Thomas B. 
Published: October 2018

Abstract
The past several years have been marked by confusion and controversy concerning whether estrogens are cardioprotective. The issue is of utmost public health importance because coronary heart disease (CHD) remains the leading cause of death among postmenopausal women. Fortunately, a unifying hypothesis has emerged that reproductive stage is a major determinant of the effect of estrogens on atherosclerosis progression, complications, and plaque vulnerability.

Premenopausal Years:
Premenopausal atherosclerosis progression seems to be an important determinant of postmenopausal atherosclerosis and thus the risk for CHD. Clearly, plasma lipids/lipoproteins influence this progression; however, estradiol deficiency seems to be the major modulator. Both monkeys and women with premenopausal estrogen deficiency develop premature atherosclerosis, an effect that can be prevented in both species by estrogen-containing oral contraceptives.

Perimenopausal/Early Postmenopausal Years:
During this stage, there are robust estrogen benefits. Monkeys given estrogens immediately after surgical menopause have a 70% inhibition in coronary atherosclerosis progression. Estrogen treatment prevented progression of atherosclerosis of women in the Estrogen in the Prevention of Atherosclerosis Trial. A meta-analysis of women younger than 60 years given hormone therapy had reduced total mortality (relative risk = 0.61, 95% CI: 0.39-0.95).

Late Postmenopausal Years:
This stage is one in which there are no or possible deleterious estrogen effects. Monkeys lose CHD benefits of estrogens when treatment is delayed. The increase in CHD events associated with initiating hormone therapy 10 or more years after menopause seems to be related to up-regulation of the plaque inflammatory processes and plaque instability and may be down-regulated by statin pretreatment.
Diagnostic Stability in Bipolar Disorder: A Narrative Review
Authors: Cegla-Schvartzman Fanny B. , Ovejero Santiago , López-Castroman Jorge , Baca-García Enrique 
Published: October 2018

Learning objectives
After participating in this activity, learners should be better able to:
• Evaluate diagnostic stability in bipolar disorder
• Analyze the factors contributing to diagnostic stability

Objective
Diagnostic stability is the degree to which a diagnosis remains unchanged during follow-up. It is an important measure of predictive validity in bipolar disorder (BD). In this study, we review the literature concerning diagnostic stability in BD, analyze the factors contributing to diagnostic stability, and describe the implications of diagnostic boundaries and diagnostic delay.

Methods
A comprehensive literature search of MEDLINE and EMBASE databases was conducted, including all studies published from 1980 to 2016, to evaluate the diagnostic stability of BD. Thirty-seven articles were included: 6 focusing mainly on BD, 18 on psychotic disorders, 10 on depression, and 3 on diagnostic stability in psychiatric disorders in general. Data analysis was performed in standardized fashion using a predefined form.

Results
Despite a high variability of the methodological approaches taken, an acceptable degree of diagnostic stability was found. The most common criteria for evaluating diagnostic stability were prospective consistency and retrospective consistency. The mean prospective and retrospective consistencies were 77.4% and 67.6%, respectively. A large majority of studies were performed in Europe or in North America (67.5%), compared to 21.6% in Asia and only 10.8% in Africa, Oceania, and South America. Extreme ages, female gender, psychotic symptoms, changes to treatment, substance abuse, and family history of affective disorder have been related to diagnostic instability.

Conclusions
Several factors appear to have a negative impact on the diagnostic stability, but the evidence is insufficient to draw any robust conclusions. Nevertheless, despite variable prospective and retrospective consistencies, the overall diagnostic stability is good. Standardized methods need to be used to obtain more accurate assessments of stability.
Preventing Central Line-Associated Bloodstream Infections in the Intensive Care Unit: Application of High-Reliability Principles
Authors: McCraw Beth , Crutcher Terri , Polancich Shea , Jones Pam 
Published: October 2018

ABSTRACT
This department column highlights translation of research into healthcare quality practice. Achieving the highest quality in healthcare requires organizations to understand care delivery and to proactively mitigate risks in care delivery processes. The purpose of this article is to describe a quality initiative that used principles of high reliability to develop a zero tolerance culture for central line–associated bloodstream infections in an intensive care unit at an independent, nonprofit acute care community hospital.
A case report of granulomatous polyangiitis complicated by tuberculous lymphadenitis
Authors: Iijima Yuki , Kobayashi Yoichi , Uchida Yoshinori , Tsutsui Toshiharu , Kakizaki Yumiko , Naganuma Tsukasa , Tsukamoto Katsuhiko , Oyama Toshio , Miyashita Yoshihiro 
Published: October 2018

Abstract

Rational:
Granulomatous polyangiitis (GPA) is a type of vasculitis involving medium and small arteries, typically affecting the upper and lower respiratory tract with coexisting glomerulonephritis. GPA is also characterized by necrotizing granulomatous inflammation and the presence of antineutrophil cytoplasm antibodies (ANCA). So far, various infections have lead to elevation of titers of serum ANCA, making it difficult to diagnose.

Patient Concerns:
We report a 50-year-old woman who was diagnosed as tuberculous lymphadenitis. During the treatment by anti-tuberculosis (TB) drugs, rapidly progressive renal failure and pleurisy had appeared with elevated titer of PR3-ANCA. Renal biopsy revealed crescentic glomerulonephritis.

Diagnosis:
Renal biopsy revealed crescentic glomerulonephritis and diagnosis of GPA was made.

Interventions:
Steroid therapy had been started with continuation of anti-TB drugs.

Outcomes:
Renal dysfunction had gradually recovered and pleurisy had disappeared with decreasing titer of PR3-ANCA.

Lessons:
This is the first report of GPA complicated by TB infection. When we encounter a case with rapidly progressive renal failure during the TB infection, complication of GPA should be suspected as 1 of the different diagnosis.
The association of high D-dimer level with high risk of ischemic stroke in nonvalvular atrial fibrillation patients
Authors: You Li-Rui , Tang Mei 
Published: October 2018

Abstract
This study aimed to explore the relationship of D-dimer level with the risk stratification of ischemic stroke, and determine whether high D-dimer levels could be used as a risk factor of ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF).
This single-center, retrospective study recruited NVAF patients who did not undergo anticoagulant therapy. These patients were divided into 2 groups: ischemic stroke group and no-stroke group. The medical records of each patient were reviewed, demographic and clinical analyses were performed, and the laboratory results were summarized.
A total of 323 eligible in-patients with NVAF, who did not receive anticoagulant therapy, were recruited (206 male and 117 female patients, median age was 75.18 ± 10.46 years old). Among these patients, 78 patients suffered from acute ischemic stroke. D-dimer level increased with age, and was positively correlated with the risk stratification of stroke, CHADS2 score (rs = 0.441, P < .001), and CHA2DS2-VASC score (rs = 0.412, P < .001), even after adjustment for age and gender (rs = 0.422, P < .001). The difference in baseline D-dimer level between these 2 groups was not statistically significant (0.70 vs 0.66 mg/L, P = .330), but this significantly increased when patients suffered from stroke (1.34 vs 0.70 mg/L, P < .001). The D-dimer level after stroke (≥6 months) was also higher than the baseline (1.16 vs 0.68 mg/L, P = .514) in 6 months, and this level nearly returned to baseline level after one year (0.69 vs 0.68 mg/L, P = .158). However, logistic regression revealed that only the D-dimer level at stroke onset and OMI were independent risk factors for ischemic stroke (P < .001), while the increase from baseline D-dimer levels was not an independent risk factor (P = .125).
D-dimer level is positively correlated with the risk stratification of ischemic stroke, but has no predictive value on the occurrence of ischemic stroke in patients with NVAF.
Association of lymphocyte to monocyte ratio with severity of coronary artery disease
Authors: Gong Shu , Gao Ximei , Xu Fubiao , Shang Zhi , Li Shuai , Chen Wenqiang , Yang Jianmin , Li Jifu 
Published: October 2018

Abstract
The aim of this study was to investigate the relationship between lymphocyte to monocyte ratio (LMR) and the severity of coronary artery disease (CAD) by using Gensini score.
A total of 199 patients, who had undergone coronary angiography, were included in the study and retrospectively analyzed. Among them, 49 patients who had normal coronary arteries were selected as the control group. Patients with CAD were divided into 2 groups, those with low Gensini score (≤40) and those with high Gensini score (≥40).
Our results showed that LMR in the severe atherosclerosis group was significantly lower than those of the mild atherosclerosis group and the control group. There was a closely significant correlation between the Gensini score and LMR (r = −0.362, P < .001). Furthermore, multivariate logistic regression analysis demonstrated that LMR (odds ratio, 0.715; 95% confidence interval [CI], 0.551–0.927; P = .012) was independent predictors of severe atherosclerosis. Using an optimal LMR cut-off value of 5.06, LMR predicted severe atherosclerosis with a sensitivity of 57.1% and specificity of 69.7% (area under curve = 0.634; 95% CI, 0.545–0.724; P = .005). Then patients with CAD group was divided into 2 groups according to the LMR value of 5.06. Patients with LMR ≤ 5.06 had worse prognosis, with a higher rate of cardiovascular events during up to 1 year follow-up.
Our study demonstrated that LMR was independently and positively associated with the severity of coronary atherosclerosis, providing a new insight in the application of inflammation index evaluating the severity of CAD. And LMR may be a useful predictor of future cardiovascular events in patients with CAD.