bluuebunny/crossref_metadata_2025_split huggingface dataset:
Content Validation of Quality and Safety Education for Nurses Prelicensure Clinical Evaluation Instruments
Authors: Altmiller Gerry 
Published: February 2019

Background
Clinical evaluation is a high-stakes assessment that requires valid and reliable instruments that are understandable to faculty and students.

Purpose
This article describes the development of Quality and Safety Education for Nurses (QSEN)–based clinical evaluation instruments to measure competency in prelicensure clinical courses. The goal was to establish content validation for the items included on each and appropriately level requisite behaviors to demonstrate increasing progression in clinical performance expectation from fundamentals to senior nursing clinical courses.

Methods
Based on their area of expertise, nurse educators were recruited into panels of 5 to 7 members each to review and rate items for relevance for each course-specific clinical evaluation instrument using the Content Validity Index.

Results
Two rounds of rigorous review yielded 6 content-validated instruments.

Conclusions
The QSEN-based clinical evaluation instruments provide standardized language framed in quality and safety that demonstrate evolving sophistication, complexity, and expectation in student clinical performance.
Innovative Model to Recognize Previous Military Training of BSN Students
Authors: McLain Rhonda M. , Moore Randy , Hites Lisle 
Published: February 2019

Background
Many of our military transitioning to civilian life are expertly trained medics, corpsmen, and health care specialists.

Problem
The medical training of these veterans does not follow traditional degree granting academic protocols. These individuals seeking formal academic credentials to work in the nonmilitary sector are often forced to start their health education over from the beginning.

Approach
An innovative model was developed for waiving the requirements for specific nursing courses for veteran-students. Using a skills self-assessment tool and a validation process, veteran-students are able to demonstrate their knowledge, training, and experience.

Outcomes
As part of the program, 32 veteran-students have validated out of 65 courses for 115 credit hours. All students have successfully progressed through the BSN program.

Conclusion
This skills validation model represents a model that can be implemented for students entering a nursing program with a variety of health care backgrounds.
Stroke Characteristics, Risk Factors, and Outcomes in Transgender Adults
Authors: LaHue Sara C. , Torres Dolores , Rosendale Nicole , Singh Vineeta 
Published: February 2019

Objectives:
To describe the clinical characteristics and risk factors of male-to-female transgender (transwomen) patients with acute stroke.

Methods:
The study population included all patients admitted for stroke at San Francisco General Hospital from October 1, 2010 through August 31, 2017 who self-identified as transwomen. Patient charts were reviewed by the study coauthors for demographics, stroke risk factors, stroke characteristics, and clinical outcomes. Means, percentiles, and ranges were calculated.

Results:
Eight transwomen (average age, 50±9 y; range, 38 to 61 y) were admitted for stroke (average NIHSS, 8; range, 0 to 27). The majority of patients presented subacutely. The most common type of stroke was ischemic stroke (4, 50%), followed by intracerebral hemorrhage (2, 22%), transient ischemic attack (1, 13%), and concurrent ischemic stroke with subarachnoid hemorrhage (1, 13%). While traditional stroke risk factors were present, these patients also disproportionally had alternative risk factors: stimulant use (5, 63%), tobacco use (5, 63%), hepatitis C (5, 63%), human immunodeficiency virus (3, 38%), and prior stroke or transient ischemic attack (2, 25%). Six patients (75%) used estradiol (oral or injection) or conjugated estrogen as part of gender-affirming treatment at the time of stroke; one patient used estrogen remotely. Only 2 patients (33%) were prescribed their hormone therapy on discharge.

Conclusions:
Understanding unique vulnerabilities of the transgender community for cerebrovascular events is essential to provide culturally appropriate counseling for harm reduction.
Case Report: Focal Choroidal Excavation Underlying Combined Hamartoma of the Retina and Retinal Pigment Epithelium
Authors: Wang Qian , Liu Jing Hua , Jiao Xuan , Wei Wen Bin , Lu Hai 
Published: February 2019

SIGNIFICANCE
There are few reports of focal choroidal excavation (FCE) in combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). This report documents a case of this rare condition and suggests that there might be a relationship between FCE and CHRRPE.

PURPOSE
The purpose of this study was to describe a case of FCE underlying CHRRPE.

CASE REPORT
A 6-year-old Chinese boy presented with a 2-month history of decreased vision in his left eye. Fundus examination of the left eye showed an elevated fibrotic mass in the macular area with pigment disturbance. Optical coherence tomography revealed a cup-shaped FCE in the macula with thickening and disorganization of multiple retinal layers and overlying epiretinal proliferation in the left eye. A diagnosis of FCE within CHRRPE was made, and periodic review was recommended.

CONCLUSIONS
There may be an association or a causal relationship between CHRRPE and FCE. It is plausible that FCE in the setting of CHRRPE is a developmental abnormality that occurs after birth because of a weakening of the retinal pigment epithelium and thinning of the choroid beneath the tumor. Continued monitoring for FCE progression and potential choroidal neovascularization is indicated.
The Effect of Microblepharon Exfoliation on Clinical Correlates of Contact Lens Discomfort
Authors: Siddireddy Jaya Sowjanya , Tan Jacqueline , Vijay Ajay Kumar , Willcox Mark D. P. 
Published: February 2019

SIGNIFICANCE
Microblepharon exfoliation improved eyelid signs and tear film characteristics after a single in-office treatment in symptomatic contact lens wearers.

PURPOSE
The purpose of this study was to assess the effect of two eyelid hygiene treatments—microblepharon exfoliation and a hypoallergenic foam cleanser (LidHygenix)—on clinical signs of the eyelids, meibomian glands, and tear film in contact lens discomfort.

METHODS
A randomized, interventional, unmasked, crossover trial was conducted on 30 experienced daily-wear soft contact lens wearers. Assessment of clinical signs of the eyelid margin, meibomian gland morphology and secretion, and tear film biophysical properties was performed (baseline 1), and participants were randomly assigned to receive one of the two treatments (microblepharon exfoliation or foam cleansing using LidHygenix) as a single in-office procedure. Symptoms were evaluated using the Contact Lens Dry Eye Questionnaire-8 immediately after treatment, and assessment of all the study variables was repeated at the follow-up visit 7 to 10 days after treatment. After 28 to 30 days of washout, participants returned for reassessment of the study variables (baseline 2) and were crossed over to receive the alternate treatment. Follow-up was repeated 7 to 10 days after the second treatment.

RESULTS
Seven to 10 days after treatment with microblepharon exfoliation, symptomatic wearers showed significant improvement in anterior blepharitis (mean difference, 0.60; P = .04), lid wiper staining (0.50; P = .06), and lid-parallel conjunctival folds (0.68, P = .02) along with orifice capping (median difference, 0.65; P < .001), foam (0.90; P < .001), secretion volume (0.69; P < .001), quality (0.74; P < .001), and expressibility (0.49; P = .002), which were also clinically significant changes. However, in tear properties, significant improvements were observed in tear volume (LidHygenix, −1.25 mm; microblepharon exfoliation, −1.62 mm), break-up time (−0.14 seconds; −0.14 seconds), tear evaporation rate without contact lenses (21.52 g m−2 h; 45.43 g m−2 h), and lipid layer thickness (−20.61 nm; −25.13 nm) after both treatments but in symptomatic lens wearers only (P < .05).

CONCLUSIONS
Microblepharon exfoliation improved eyelid signs and tear film characteristics in symptomatic contact lens wearers after a single in-office treatment.
CRISPR/Cas9-Mediated BRCA1 Knockdown Adipose Stem Cells Promote Breast Cancer Progression
Authors: Zhao Ruya , Kaakati Rayan , Liu Xinjian , Xu Lingfan , Lee Andrew K. , Bachelder Robin , Li Chuan-Yuan , Hollenbeck Scott T. 
Published: February 2019

Background:
The tumor microenvironment within the breast is rich in adipose elements. The interaction between adipose cells and breast cancer is poorly understood, particularly as it pertains to patients with genetic susceptibility to breast cancer. This study focuses on the phenotype of human adipose-derived stem cells with the BRCA1 mutation and the effect they may have on breast cancer cell behavior.

Methods:
CRISPR/Cas9 was used to generate de novo BRCA1-knockdown human adipose-derived stem cells. The effect of the BRCA1 knockdown on the adipose-derived stem cell phenotype was compared to wild-type adipose-derived stem cells and patient-derived breast adipose-derived stem cells with known BRCA1 mutations. Interactions between adipose-derived stem cells and the MDA-MB-231 breast cancer cell line were evaluated.

Results:

BRCA1-knockdown adipose-derived stem cells stimulated MDA-MB-231 proliferation (1.4-fold increase on day 4; p = 0.0074) and invasion (2.3-fold increase on day 2; p = 0.0171) compared to wild-type cells. Immunofluorescence staining revealed higher levels of phosphorylated ataxia telangiectasia-mutated activation in BRCA1-knockdown cells (72.9 ± 5.32 percent versus 42.9 ± 4.97 percent; p = 0.0147), indicating higher levels of DNA damage. Beta-galactosidase staining demonstrated a significantly higher level of senescence in BRCA1-knockdown cells compared with wild-type cells (7.9 ± 0.25 percent versus 0.17 ± 0.17 percent; p < 0.0001). Using quantitative enzyme-linked immunosorbent assay to evaluate conditioned media, the authors found significantly higher levels of interleukin-8 in BRCA1-knockdown cells (2.57 ± 0.32-fold; p = 0.0049).

Conclusions:
The authors show for the first time that the BRCA1 mutation affects the adipose-derived stem cell phenotype. Moreover, CRISPR/Cas9-generated BRCA1-knockdown adipose-derived stem cells stimulate a more aggressive behavior in breast cancer cells than wild-type adipose-derived stem cells. This appears to be related to increased inflammatory cytokine production by means of a DNA damage-mediated cell senescence pathway.
The Ideal Nipple Reconstruction Shield
Authors: Staruch Robert M. T. , Din Asmat H. , See Marlene S. , Mohanna Pari-Naz 
Published: February 2019

Summary:
Reconstruction of the nipple-areola complex is the culmination of a long road for patients who have suffered breast cancer. The postoperative dressing of the reconstructive nipple must protect it from mechanical forces, trauma, and infection. A broad array of dressings has been used for the reconstructed nipple. The authors propose the use of a readily available adhesive eye protector as a simple and cost-effective dressing for the reconstructed nipple-areola complex.
Theories of Etiopathogenesis of Breast Implant–Associated Anaplastic Large Cell Lymphoma
Authors: Rastogi Pratik , Riordan Edward , Moon David , Deva Anand K. 
Published: February 2019

Summary:
Breast implant–associated anaplastic large cell lymphoma is a malignancy of T lymphocytes that is associated with the use of textured breast implants in both esthetic and reconstructive surgeries. Patients typically present with a delayed seroma 8–10 years following implantation or—less commonly—with a capsular mass or systemic disease. Current theories on disease pathogenesis focus on the interplay among textured implants, Gram-negative bacteria, host genetics, and time. The possible roles of silicone leachables and particles have been less well substantiated. This review aims to synthesize the existing scientific evidence regarding breast implant–associated anaplastic large cell lymphoma etiopathogenesis.
Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE): Initial Report of Findings, 2012–2018
Authors: McCarthy Colleen M. , Loyo-Berríos Nilsa , Qureshi Ali A. , Mullen Erin , Gordillo Gayle , Pusic Andrea L. , Ashar Binita S. , Sommers Katie , Clemens Mark W. 
Published: February 2019

Background:
In January of 2011, the US Food and Drug Administration released a safety communication regarding the potential association between breast implants and anaplastic large cell lymphoma (ALCL). In August of 2012, the American Society of Plastic Surgeons, The Plastic Surgery Foundation, and the Food and Drug Administration signed a cooperative research and development agreement to develop a patient registry entitled the “Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology” (PROFILE).

Methods:
The first report of the registry findings is presented here.

Results:
From August of 2012 to March of 2018, a total of 186 distinct cases of breast implant–associated ALCL (BIA-ALCL) in the United States were reported to PROFILE. At the time of this present analysis, complete detailed case report forms have been received for 89 (48%) cases. Median time from implantation of any device to BIA-ALCL diagnosis was 11.0 years (range = 2–44 years; n = 89). At the time of presentation, 96% of cases had local symptoms and 9% had concurrent systemic symptoms. The most common local symptom was a periprosthetic fluid collection seen in 86% of patients. All patients had a history of a textured device; there were no patients who had a smooth-only device history. At the time of initial case report submission, 3 deaths were reported.

Conclusions:
The PROFILE Registry has shown to be an essential tool in unifying the collection of data pertaining to BIA-ALCL. These data have broadened our understanding of the disease and emphasize the critical importance of detailed tracking of BIA-ALCL cases.
Exploratory Investigation of a Brief Cognitive Behavioral Intervention and Transcranial Direct Current Stimulation on Odor Sensitivity
Authors: Houghton David C. , Uhde Thomas W. , Borckardt Jeffrey J. , Cortese Bernadette M. 
Published: February 2019

ABSTRACT

Objective
Enhanced odor sensitivity is a phenomenon that potentially underlies conditions such as multiple chemical sensitivity (MCS). Currently, there are no treatments that have been shown to effectively decrease odor sensitivity. Given similarities of odor hypersensitivity/MCS to pain sensitization disorders such as fibromyalgia, there may be a potential for interventions that improve pain tolerance to modulate odor sensitivity.

Methods
This exploratory study randomized 72 healthy community adult volunteers to receive one of six treatments in between two assessments of thermal pain tolerance and odor threshold. Participants were randomized to receive either cathodal, anodal, or sham transcranial direct current stimulation (tDCS) aimed at dorsolateral prefrontal cortex. In addition, participants were provided a brief cognitive behavioral intervention (CBI) for pain consisting of task framing, cognitive restructuring, and distraction technique training, or a control intervention consisting of information about pain.

Results
Persons who received a brief CBI showed significantly increased odor thresholds (reduced sensitivity) during intervention (F (1,62) = 7.29, p = .009, ηp
2 = .11), whereas the control intervention was not associated with altered odor thresholds. Moreover, in those who received brief CBI, more severe anxiety associated with larger reductions in odor sensitivity (ρ = .364, p = .035). There was no effect of tDCS (F (2,62) = .11, p = .90) nor interaction between tDCS and CBI (F (2,62) = .32, p = .73).

Conclusions
Given the connection between anxiety and MCS, results suggest that CBT techniques for somatic processes may show promise in treating conditions characterized by increased sensitivity to odors (e.g., MCS).
A Mixed-Method Study of Practitioners' Perspectives on Issues Related to EHR Medication Reconciliation at a Health System
Authors: Rangachari Pavani , Dellsperger Kevin C. , Fallaw David , Davis Ian , Sumner Michael , Ray Walter , Fiedler Shashana , Nguyen Tran , Rethemeyer R. Karl 
Published: February 2019

Background:
In an effort to reduce medication discrepancies during transitions of care and improve accuracy of the patient's medication list, AU Health conducted a study to identify a comprehensive set of issues related to electronic health record (EHR) medication reconciliation (MedRec) from the perspective of practitioners directly involved in the EHR MedRec process.

Methods:
An exploratory mixed-method design was used. The 2-round study included 15 individual interviews, followed by a survey of 200 practitioners (ie, physicians, nurses, and pharmacists) based in the outpatient and inpatient medicine service at AU Health.

Results:
Thematic analysis of interview data identified 55 issue items related to EHR MedRec under 9 issue categories. The survey sought practitioners' importance rating of all issue items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue categories, all of which were rated “important” or higher (on average), by over 70% of all respondents: (1) care coordination (CCI); (2) patient education (PEI); (3) ownership and accountability (OAI); (4) processes-of-care (PCI); (5) IT-related (ITRI); and (6) workforce training (WTI). Significance testing of importance rating by professional affiliation revealed no statistically significant differences for CCI and PEI, and some statistically significant differences for OAI, PCI, ITRI, and WTI.

Conclusion:
There were 2 key gleanings from the issues related to EHR MedRec unearthed by this study: (1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and (2) there was a sociotechnical dimension to many of the issues, creating an added layer of complexity. These gleanings, in turn, provide insights into best practices for managing both (1) clinical transitions of care in the EHR MedRec process and (2) sociotechnical challenges encountered in EHR MedRec implementation.
Evaluation of Adaptive Statistical Iterative Reconstruction-V Reconstruction Algorithm vs Filtered Back Projection in the Detection of Hypodense Liver Lesions: Reader Performance and Preferences
Authors: Dimmitt Amanda M. , Pelz Jessica A. , Albertson Megan E. , Samson Kaeli K. , Muinov Lyudmila M. , Oliveto Jennifer M. , Hansen Neil J. 
Published: February 2019

Objective
The aim of the study was to evaluate diagnostic accuracy and readers' experience in the detection of focal liver lesions on computed tomography with Adaptive Statistical Iterative Reconstruction-V (ASIR-V) reconstruction compared with filtered back projection (FBP) scans.

Methods
Fifty-five patients with liver lesions had FBP and ASIR-V scans. Two radiologists independently reviewed both sets of computed tomography scans, identifying and characterizing liver lesions.

Results
Adaptive Statistical Iterative Reconstruction-V scans had a reduction in dose length product (P < 0.0001) with no difference in image contrast (P = 0.1805); image noise was less for the ASIR-V scans (P < 0.0001) and contrast-to-noise ratio was better for ASIR-V (P = 0.0002). Both readers found more hypodense liver lesions on the FBP (P = 0.01) scans. Multiple subjective imaging scores were significantly less for the ASIR-V scans for both readers.

Conclusions
Although ASIR-V scans were objectively better, our readers performed worse in lesion detection on them, suggesting a need for better education/experience with this technology during implementation.
Apparent Diffusion Coefficient of the Placenta and Fetal Organs in Intrauterine Growth Restriction
Authors: Abdel Razek Ahmed Abdel Khalek , Thabet Mahmoud , Salam Eman Abdel 
Published: February 2019

Purpose
This study aimed to assess apparent diffusion coefficient (ADC) of the placenta and fetal organs in intrauterine growth restriction (IUGR).

Materials and methods
A prospective study of 30 consecutive pregnant women (aged 21–38 years with mean age of 31.5 years and a mean gestational week of 35 ± 2.3) with IUGR and 15 age-matched pregnant women was conducted. All patients and controls underwent diffusion-weighted magnetic resonance imaging. The ADCs of the placenta and fetal brain, kidney, and lung were calculated and correlated with neonates needing intensive care unit (ICU) admission.

Results
There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney (P = 0.001, 0.001, 0.04, and 0.04, respectively) between the patients and the controls. The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to detect IUGR were 1.45, 1.15, 1.80, and 1.40 × 10−3 mm2/s, respectively, with areas under the curve (AUCs) of 0.865, 0.858, 0.812, and 0.650, respectively, and accuracy values of 75%, 72.5%, 72.5%, and 70%, respectively. Combined ADC of the placenta and fetal organs used to detect IUGR revealed an AUC of 1.00 and an accuracy of 100%. There was a significant difference in ADC of the placenta and fetal brain, lung, and kidney between neonates needing admission and those not needing ICU admission (P = 0.001, 0.001, 0.002, and 0.002, respectively). The cutoff ADCs of the placenta and fetal brain, lung, and kidney used to define neonates needing ICU were 1.35, 1.25, 1.95, and 1.15 × 10−3 mm2/s with AUCs of 0.955, 0.880, 0.884, and 0.793, respectively, and accuracy values of 86.7%, 46.7%, 76.7%, and 70%, respectively. Combined placental and fetal brain ADC used to define neonates needing ICU revealed an AUC of 0.968 and an accuracy of 93.3%.

Conclusion
Combined ADC of the placenta and fetal organs can detect IUGR, and combined ADC of the placenta and fetal brain can define fetuses needing ICU.
“Nightmares–Family Medicine” Course Is an Effective Acute Care Teaching Tool for Family Medicine Residents
Authors: Gilic Filip , Schultz Karen , Sempowski Ian , Blagojevic Ana 
Published: February 2019

Introduction
Simulation is an effective method for teaching acute care skills but has not been comprehensively evaluated with family medicine (FM) residents. We developed a comprehensive simulation-based approach for teaching acute care skills to FM residents and assessed it for effectiveness.

Method
We compared the effectiveness of our standard acute care simulation training [Acute Care Rounds (ACR)] to a more comprehensive simulation-based acute care program, Nightmares–Family Medicine (NM). We used a self-reported comfort scale as well as video-captured performance on an acute care Objective Structured Clinical Examination (OSCE). Seventy-seven of our FM residents in their postgraduate year 1 between July 2012 and June 2015 participated in the study. Wilcoxon matched pairs and one-tailed t tests analysis was used for analyzing the comfort scale, Whitney-Mann, and χ2 for the OSCE performance.

Results
Nightmares–Family Medicine's initial 2-day session significantly improved the resident's self-assessment scores on all 20 items of the questionnaire (P < 0.05). Time-matched ACR improved 11 of 20 items (P < 0.05) level. Follow-up NM sessions improved 5 to 8 of 20 items (P < 0.05). Follow-up ACR sessions improved 1 to 5 of 20 items (P < 0.05). The means taken at the end of postgraduate year 1 year were higher for 13 of 20 items in the NM group (P < 0.05) as compared with ACR group. The NM group scored significantly higher on both the mean scores of OSCE individual categories (P < 0.01) and the Global Assessment Score (P < 0.05). Significantly less NM residents failed the OSCE (n = 1/30, 3.3% vs n = 8/37, 21.6%, P < 0.05).

Conclusions
“Nightmares–Family Medicine” course is very effective at teaching acute care skills to FM residents and more so than our previous curriculum.