bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding Erythema Nodosum
Authors: Glover Gypsy , Wilson Jennifer , Leigh Katherine , Miller Barbara 
Published: November 2024

ABSTRACT
Erythema nodosum is a common form of acute nodular septal panniculitis commonly found on the anterior tibial extensor surfaces. Although diagnosis is typically made based on clinical presentation, confirmation is made through biopsy that includes a portion of subcutaneous fat. Erythema nodosum is usually self-limiting, with routine treatment consisting of a conservative approach of supportive measures. Additionally, erythema nodosum is recognized as a cutaneous manifestation of systemic conditions, including inflammatory bowel disease. Dermatology providers should investigate the possibility of underlying inflammatory bowel disease and consider referral to a gastrointestinal specialist when appropriate. Therefore, the purpose of this article was to ensure providers have a thorough understanding of the diagnosis to determine appropriate treatment and identify when critical referrals are warranted. Utilizing an evidence-based, multidisciplinary approach that addresses both the gastrointestinal manifestations of inflammatory bowel disease and the cutaneous symptoms of erythema nodosum will improve both patient outcomes and satisfaction.
Influence of Qigong Wuqinxi on Pain, Sleep, and Tongue Features in Older Adults
Authors: CHOU Tzu-Wei , KUO Che-Chang , CHEN Kuei-Min , BELCASTRO Frank 
Published: November 2024

ABSTRACT

Background
Chronic pain and sleep disorders are commonly seen symptoms in community-dwelling older adults at traditional Chinese medicine (TCM) clinics. TCM modalities such as herbal medication and acupuncture have side effects and usage limitations. Therefore, nonpharmacological and noninvasive interventions may be applied to relieve the symptoms of these conditions.

Purpose
This study was designed to test the effect of Qigong Wuqinxi exercise on chronic pain, sleep quality, TCM constitutions, and tongue features in community-dwelling older adults.

Methods
This was a cluster randomized controlled trial. Older adults in two community care centers who met the inclusion criteria were assigned by drawing lots to either the experimental group (n = 32) or the control group (n = 31). Experimental group members practiced the Qigong Wuqinxi exercise for 50 minutes three times each week for 12 weeks, whereas those in the control group maintained their normal daily routine. Before and after the 12-week study, data on chronic pain, sleep quality, TCM constitutions, and tongue features were collected from all participants to assess the effectiveness of the intervention. Between-group pretest and posttest comparisons were analyzed using independent samples t tests, and within-group differences were analyzed using paired t tests.

Results
The experimental group reported significantly greater average posttest improvements in chronic pain, yang deficiency, phlegm-stasis, thick fur, and red dots than the control group (all ps < .05). The maximum change in pretest to posttest pain scores favored the experimental group (−0.56 ± 0.76 vs. 0.39 ± 1.91, p = .011). Also, the experimental group had a significantly better change in the pain interference index (−3.31 ± 3.30 vs. −0.58 ± 1.91, p < .001). In addition, the experimental group exhibited greater improvements in yang-deficiency tendency (−2.38 ± 4.89 vs. 0.35 ± 4.67, p = .027), phlegm and stasis tendency (−2.19 ± 4.52 vs. 1.77 ± 2.47, p < .001), thick fur (1.44 ± 11.28 vs. 6.03 ± 6.04, p = .049), and red dots (−5.09 ± 21.45 vs. 2.81 ± 4.03, p = .048). However, no significant between-group difference in posttest sleep quality (p = .357) was observed.

Conclusions/Implications for Practice
The Qigong Wuqinxi exercise was found to positively improve chronic pain and TCM constitutions in community-dwelling older adults and may be promoted in community care centers to improve the health status of older adults.
Beyond single-use: a systematic review of environmental, economic, and clinical impacts of endoscopic surgical instrumentation
Authors: Eussen Myrthe M.M. , Moossdorff Martine , Wellens Lianne M. , de Reuver Philip R. , Stobernack Tim , Bijlmakers Leon , Kimman Merel L. , Bouvy Nicole D. 
Published: November 2024

Background:
The evolution of endoscopic surgery has introduced a multitude of instruments, available in both disposable and reusable variants, influencing practices across various surgical specialties. Instrument selection is complex, considering individual preferences and institutional factors such as costs, instrument performance, and factors related to cleaning and sterilization. Notably, environmental sustainability has gained prominence due to the threat of climate change. This review assessed the existing literature to facilitate evidence-informed decision-making, encompassing clinical and economic efficacy, environmental friendliness, and other important criteria.

Materials and Methods:
Following PRISMA guidelines, searches were conducted in Pubmed, Embase, Web of Science, and The Cochrane Library for studies comparing the environmental impact, costs, instrument performance, and contamination risk of disposable versus reusable instruments or new versus reprocessed disposables in endoscopic surgery. Life-Cycle Assessments (LCAs) were included to quantify the climate impact. Exclusions included veterinary studies, general endoscopic procedures, and novel instruments.

Conclusion:
The search yielded 15 809 studies, 53 studies meeting the inclusion criteria: 38 compared disposable versus reusable instruments and 15 examined new versus reprocessed disposables. Reusables and/or reprocessed disposables showed favorable environmental and economic outcomes compared to new disposables. Instrument performance was comparable between the two groups. No studies were identified that investigated the clinical implications of contamination risk of disposables versus reusables. Six studies evaluating the contamination risk of reusables and reprocessed disposables showed residual pollution after cleaning and sterilization, although data on clinical outcome lacked.

Interpretation:
This review underscores the environmental benefits of reusables and favors both reusable and reprocessed disposables for their economic advantages. The lack of clear evidence favoring one type over the other in instrument performance necessitates further research. Addressing contamination risks requires additional studies on the clinical impact of residual substances. Future research should report outcomes on environmental sustainability, costs, instrument performance, and contamination risk.
Trends and disparities in age, sex, ethnoracial background, and urbanization status in adult mortality due to thoracic aortic aneurysm: a retrospective nationwide study in the United States
Authors: Goyal Aman , Saeed Humza , Shamim Urooj , Siddiqui Momina R. , Abdullah  , Arshad Muhammad K. , Jain Hritvik , Daoud Mohamed , Khan Rozi , Bansal Kamna 
Published: November 2024

Introduction:
Thoracic aortic aneurysms (TAA) are a significant health concern, with the true prevalence likely underestimated due to undiagnosed cases. Outcomes in TAA are influenced by factors like age, sex, and comorbidities such as hypertension. This study examines mortality trends and disparities associated with TAA in US adults.

Methodology:
This study analyzed death certificates from 1999 to 2020 using the CDC WONDER Database to identify TAA-related deaths in individuals aged 25 and older using ICD-10 codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1 000 000 and annual percent changes (APCs) were calculated and stratified by year, sex, age group, race/ethnicity, region, and urbanization status.

Results:
Between 1999 and 2020, 47 136 TAA-related deaths were reported among US adults. The AAMR decreased from 16.2 to 8.2 per 1 000 000, with a significant decline from 1999 to 2013 (APC: −5.00; 95% CI: −5.54 to −4.54; P<0.001). Older adults had the highest AAMRs at 44.6 per 1 000 000. Men had higher AAMRs than women (11.2 vs. 9). AAMRs were highest among non-Hispanic (NH) Black (11), followed by NH White (10.3), NH Asian or Pacific Islander (9.5), NH American Indian or Alaska Native (7.8), and Hispanic (5.2) populations. Nonmetropolitan areas had higher AAMRs than metropolitan areas (11 vs. 9.8).

Conclusions:
The analysis showed a significant decline in TAA mortality since 1999, with recent stabilization. However, disparities persist, with higher AAMRs among men, older adults, NH Black adults, and nonmetropolitan residents, highlighting the need for targeted and equitable interventions.
Molecular alterations influencing the prognostic outcome in small pancreatic cancer (≤ 2 cm)
Authors: Takematsu Toru , Hayashi Hiromitsu , Ogawa Daisuke , Nakao Yosuke , Yamao Takanobu , Kitano Yuki , Nakagawa Shigeki , Mima Kosuke , Baba Yoshifumi , Baba Hideo 
Published: November 2024

Abstract

Purpose
Pancreatic cancer (PC) is the most lethal cancer. The prognosis of small PC (tumor smaller than 20 mm) is better than that of larger PC tumors, indicating the importance of detecting early-stage PC for patient outcome. The aim of this study was to elucidate the molecular features in small PC (≤ 20 mm).

Methods
This study included 79 PC tumors (≤ 20 mm in pathological examination) resected between 2004 and 2022. c-Myc, Caveolin-1, Smad4, and Thrombospondin-1 were examined by immunostaining. These molecular alterations were compared in PC patients with tumor size ≤10 mm (n = 11) (14%) and 10 mm < tumor size ≤20 mm (n = 68) (86%). Mutation analyses of KRAS, PIK3CA, and BRAF were performed by pyrosequencing in 22 PCs.

Results
PC with 10 mm < tumor size ≤20 mm showed significantly worse overall survival and disease-free survival than PC with tumor size <10 mm (P = 0.024 and P = 0.028). Tumor c-Myc and stromal Caveolin-1 expressions were significantly increased in tumors larger than 10 mm (P = 0.02 and P = 0.04). c-Myc and Caveolin-1 expressions were associated with poor disease-free survival and overall survival. KRAS, PIK3CA, and BRAF mutation status did not differ between the two groups.

Conclusions
Tumor c-Myc and stromal Caveolin-1 overexpressions were detected in tumors larger than 10 mm. Their overexpressions were associated with worse prognosis even in small PC. These molecular alterations in small PC may be a clue for the detection of early-stage PC.
Theoretically Based Factors Associated With Stroke Family Caregiver Health
Authors: Kum Cleopatra , Jones Holly J. , Miller Elaine L. , Kreitzer Natalie , Bakas Tamilyn 
Published: November 2024

Abstract

Purpose
Most persons who have had strokes are cared for at home by family members—many of whom experience depressive symptoms and quality of life changes as a result of providing care. The objective of this study is to determine theoretically based factors associated with unhealthy days in stroke family caregivers.

Research Design and Methods
Secondary data analysis was conducted using baseline data from a large randomized controlled clinical trial testing the Telephone Assessment and Skill-Building Kit program with 254 family caregivers of persons who have had strokes. Guided by a conceptual model derived from Lazarus’ transactional approach to stress, data were analyzed using multiple regression with unhealthy days as the dependent variable and theoretically based factors as independent variables.

Results
Caregivers were mostly female (78%), White (71%), spouses (47%), or adult children (29%). Caregivers reported nine unhealthy days on average within the past month. A total of 37.8% of the variance in unhealthy days was explained by caregiver task difficulty, level of optimism, threat appraisal, depressive symptoms, and life changes with depressive symptoms being the strongest individual predictor because of shared variance.

Clinical Relevance
Unhealthy days is an important part of stroke family caregiver health. Factors associated with unhealthy days in this study provide areas to consider in future intervention development.
Improving the Discharge Process at the VA Palo Alto Through Change Management and Implementation of Project Re-Engineered Discharge
Authors: Arredondo Kelley , Renfro David R. , Naungayan Aileen , Renfro Denise , Burgos Sharlene , Yarlagadda Sudha , Horstman Molly J. , Naik Aanand D. , Godwin Kyler M. 
Published: November 2024

Abstract
This quality improvement project demonstrates that nursing leadership with Project Re-Engineered Discharge can effect change in the discharge process and improve patient outcomes.
Measurement of Physical Activity Among Hospitalized Older Adults Living With Dementia
Authors: Resnick Barbara , Boltz Marie , Galik Elizabeth , Kuzmik Ashley , McPherson Rachel , Drazich Brittany , Kim Nayeon , Zhu Shijun , Wells Chris L. 
Published: November 2024

Abstract
The purpose of this secondary data analysis was to describe physical activity and the factors associated with physical activity among older adults living with dementia on medical units in acute care settings. Measures included accelerometry data from the MotionWatch 8, behavioral and psychological symptoms associated with dementia, use of psychotropic medications, subjective reports of activities of daily living and other types of physical activity (e.g., walking to the bathroom, participating in therapy), delirium severity, and medications. The majority of the 204 participants were White (70%) and female (62%), with a mean age of 83 years. Over 24 hours of assessment, participants engaged in 15 (SD = 46) minutes of vigorous activity, 43 (SD = 54) minutes of moderate activity, 2 hours 50 (SD = 2) minutes of low-level activity, and 20 (SD = 3) hours of sedentary activity. Subjective walking activities, toileting, evidence of disinhibition, delirium severity, agitation, and use of psychotropic medications were associated with increased physical activity based on the MotionWatch 8. The findings provide information for rehabilitation nurses regarding factors associated with physical activity among patients with dementia admitted to acute care settings as well as some of the challenges associated with measurement of physical activity. Future research needs to continue to explore the impact of behavioral symptoms associated with dementia on physical activity and increase participation in activities that are functionally relevant.
How Do Nurses Assess Cognition in Adults With Neurological Conditions? A Scoping Review
Authors: Xiong Jiayue , Bhimani Rozina , McMahon Siobhan , Chi Chih-Lin , Anderson Lisa 
Published: November 2024

Abstract

Background
According to epidemiological studies, neurological cognitive problems are increasingly prevalent in the aging population, with estimates that the number of people living with cognitive impairment will triple by 2050. Therefore, early detection in rehabilitation settings is needed to manage cognitive changes to ensure that individuals living with these conditions receive care and support that addresses their needs.

Purpose
This scoping review, based on the Arksey and O’Malley method, aims to investigate the cognitive assessments used for patients with neurological conditions in current nursing practice.

Method
PubMed, Ovid Medline, and CINAHL databases were searched to identify relevant articles published from 2017 to 2023 in English. Twenty-four articles met the inclusion criteria. Cognitive assessments were evaluated across acute care/hospital, outpatient/clinic, community, and long-term care/nursing home settings.

Results
The Mini-Mental State Examination is the most frequently used tool across all settings except for long-term care. Cognition includes many different domains such as executive functioning and speed of processing information; however, most tools only capture memory. The nursing profession must expand its standardized nursing vocabulary to capture cognition better.

Conclusions
As rehabilitation nurses navigate diverse clinical environments, recognition of contextual nuances is important in selecting cognitive function measurement tools most suitable for their setting.
Subjective Well-Being, Positive Affect, Life Satisfaction, and Happiness With Multiple Sclerosis
Authors: Chang Julia H. C. , Bethoux Francois , Plow Matthew A. 
Published: November 2024

Abstract

Purpose
People with multiple sclerosis (MS) may face challenges maintaining their subjective well-being, life satisfaction, happiness, and positive emotions. This scoping review’s purpose was to summarize studies on these positive psychological constructs among people with MS.

Methods
Observational and interventional studies that included measures of subjective well-being, life satisfaction, happiness, or positive affect were identified. Variables associated with these constructs were classified using the International Classification of Functioning, Disability and Health (ICF).

Results
The review included 22 observational and 10 interventional studies. Variables were categorized into each of the ICF domains. Cognitive behavior therapy was the most common intervention, with content and dosing varying widely.

Clinical Relevance
Subjective well-being, life satisfaction, happiness, and positive affect are crucial components of community and individual health. The findings of this scoping review highlight the complex interplay between function, personal factors, and environmental conditions in influencing positive psychological constructs. Given the limited evidence, rehabilitation nurses should leverage their skills in delivering holistic care and adopt data-driven approaches to integrate positive psychological strategies into care plans.

Conclusion
Further research is needed to measure and compare interventions aimed at improving these constructs and to examine the influence of personal and environmental factors among diverse MS populations.
Therapy-Led Mobility Education for Nursing Staff as a Fall Prevention Strategy
Authors: Thresher Catherine 
Published: November 2024

Abstract

Purpose
Patient falls are an ongoing challenge in the rehabilitation setting largely because of falls being common among patients during mobility. Rehabilitation nursing staff are responsible for mobilizing patients whenever they are not in therapy, yet are often not trained to carry out complex mobilization techniques in the way therapy staff are.

Methods/Results
The integration of therapy-led mobility clinics into nursing staff orientation, along with change-of-shift safety huddles, was successful as a fall prevention strategy on one acute inpatient rehabilitation unit.

Conclusions
Nursing leadership should leverage therapy expertise in the rehabilitation setting to educate nursing staff on complex mobilization techniques for improved patient outcomes.
Rehabilitation Specialty Hospital Conversion to Support a COVID-19 Pandemic Surge: Nurses’ Perceptions
Authors: Copenheaver Helen C. , Buchko Barbara L. , Adkins Cherie S. 
Published: November 2024

Abstract

Purpose
The purpose of this study was to understand the novel experience of a rehabilitation specialty hospital conversion to acute medical/COVID-19 patient care from the perspective of rehabilitation nurses.

Design
A descriptive qualitative study was conducted.

Methods
Thirty-six nurses employed by the rehabilitation specialty hospital were invited to participate. Narrative data were collected via an online survey and were analyzed using a conventional content analysis approach.

Results
Fifteen (42%) of those eligible participated. The overarching descriptor of the rehabilitation nurses’ experiences was “we did what we had to do.” Three primary descriptors emerged: challenged, conflicted, and compromised. Communication from leadership prominently informed the conversion experience.

Clinical Relevance to the Practice of Rehabilitation Nursing
Expecting rehabilitation specialty nurses to care for a different patient population is an important consideration and requires leadership to understand the distinctive characteristics of the specialty and its approach to care.

Conclusions
Addressing the impact on nursing staff in any disaster requires listening and communicating to provide needed support. Recognizing the characteristics of nursing specialties, the need for self-care among nursing staff and the salience of effective communication are essential during specialty hospital conversions.
Implementing a Critical Thinking Tool to Evaluate Educational Needs for Inpatient Rehabilitation Nurses
Authors: Hill Cynthia , Stutzman Sonja E. , Nairon Emerson B. , Vashisht Ayushi , Olson DaiWai M. 
Published: November 2024

Abstract

Background
Most critical thinking assessment tools are resource intensive and require significant time and money to administer. Moreover, these tools are not tailored to evaluate critical thinking skills among inpatient rehabilitation facility (IRF) nurses. This pilot study explores the efficacy of using short videos to evaluate critical thinking for nurses working in an IRF

Methods
We developed and filmed 3 clinical scenarios representative of common IRF events that require critical thinking on behalf of the nurse. Thirty-one IRF nurses participated in the study and independently scored their own critical thinking skills using a visual analog scale. Using the same scale, nurse managers and assistant managers who worked closely with the nurses also rated the critical thinking ability of each nurse. The nurse then viewed and responded in narrative form to each of the 3 videos. A scoring rubric was used to independently evaluate the critical thinking skills for each nurse based on the nurses' responses.

Results
Nurses rated their own critical thinking skills higher than mangers rated them (m = 85.23 vs 62.89). There was high interrater reliability for scoring video 1k (0.65), video 2k (0.90), and video 3k (0.84).

Conclusion
The results demonstrate efficacy for further study of low-cost alternatives to evaluate critical thinking among neuroscience nurses providing IRF care.
Blood Gene Expression Profiling and Donor-derived Cell-free DNA to Noninvasively Diagnose Clinical and Subclinical Kidney Transplant Rejection: A Real-life Appraisal Study
Authors: Sellarés Joana , Casanova Franc , Perez-Saez M. J. , Cucchiari David , Coloma Ana , Vila Anna , Facundo Carme , Kervella Delphine , Molina Maria , Moreso Francesc , Melilli Edoardo , Diekmann Fritz , Crespo Marta , Bestard Oriol 
Published: November 2024

Background.
Peripheral blood biomarkers aim to noninvasively diagnose kidney allograft rejection, but most lack robust independent validation. TruGraf is intended to exclude subclinical cellular rejection (TCMR), whereas donor-derived cell-free DNA Viracor-TRAC has proven value in excluding antibody-mediated rejection (AMR). We aim to validate both biomarkers for accurate rejection diagnosis in a real-world clinical setting.

Methods.
We prospectively included 230 unselected, consecutive kidney transplants from 6 centers undergoing for-cause and protocol biopsies with paired blood samples from December 2021 to 2022. TruGraf and Viracor-TRAC were blindly run by a central laboratory.

Results.
The incidence of rejection was 22.6% (17.3% surveillance; 27% for-cause biopsies). Inflammation was associated with higher TRAC levels, with AMR/mixed and microvascular inflammation (MVI) showing the highest levels (P < 0.05). TruGraf did not associate with any specific allograft injury. No biomarkers, individually or combined, accurately diagnosed any rejection (area under the receiver operating characteristic curve [AUROC] < 0.65). However, high TRAC levels, when combined with DSA in for-cause biopsies, predicted AMR/mixed rejection or MVI (AUROC = 0.817; P < 0.001), outperforming serum creatinine and DSA (AUROC < 0.65).

Conclusions.
In this large, prospective, observational real-life study, we were unable to validate TruGraf and TRAC to diagnose rejection but found a useful context of use for TRAC to noninvasively diagnose AMR/mixed or MVI in conjunction with DSA in dysfunctioning graft.