bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence-Based Practice Curriculum Development for Undergraduate Nursing Students: The Preliminary Results of an Action Research Study in Taiwan
Authors: HUNG Hsiao-Ying , WANG Yu-Wen , FENG Jui-Ying , WANG Chi-Jane , LIN Esther Ching-Lan , CHANG Ying-Ju 
Published: November 2018

ABSTRACT

Background:
Equipping undergraduate nursing students with sufficient competence in evidence-based practice (EBP) is essential to meeting future practice needs. Integrating necessary EBP knowledge and skills systematically into the formal curriculum allows students to obtain better learning experience and outcomes. However, in Taiwan, a systematic nursing curriculum that integrates EBP concepts across the 4-year nursing baccalaureate program has not yet been developed. Moreover, engaging students in the clinical application of evidence remains a key challenge facing nursing education.

Purpose:
This study aimed to construct an EBP undergraduate nursing curriculum and develop clinical scenarios that support EBP teaching.

Methods:
Three cycles of action research, incorporating both focus group interviews and questionnaire surveys, were applied to construct and evaluate the appropriateness and feasibility of the EBP nursing curriculum and relevant teaching strategies.

Results:
An EBP nursing curriculum was constructed that integrates the three levels of learning objectives and corresponding learning outcomes, teaching content, and learning activities. Scenario activities were developed to familiarize students with the EBP process and to maximize their learning with regard to the clinical application of evidence. Next, a preliminary evaluation showed the appropriateness and feasibility of the developed curriculum, which was shown to foster the EBP competency of students and increase their confidence and positive attitudes toward EBP.

Conclusions/Implications for Practice:
A systematic EBP bachelor nursing curriculum with effective pedagogical strategies was developed. The associated process and the elicited information may offer a valuable reference for other nursing schools.
Citation and Characteristic Analysis of Physician Assistant Programs Placed on Accreditation–Probation, 2015–2017
Authors: Snyder Jennifer A. , Skala Taylor 
Published: November 2018

Purpose
The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) is responsible for accrediting the current 236 entry-level physician assistant (PA) programs in the United States. This study analyzes citations levied against PA programs by the ARC-PA and how those citations relate to the commission's ultimate accreditation decisions; in addition, this study compares PA program characteristics and assesses those characteristics as they relate to recent accreditation outcomes.

Methods
This study used citations for specific violations of ARC-PA Standards to analyze the ARC-PA's accreditation decisions from September 2015 through September 2017. The institutional characteristics of programs that received an accreditation–probation decision were compared with those that received an accreditation–continued or accreditation–provisional decision. Where possible, outcome decisions were benchmarked using national data obtained from publications distributed by the Physician Assistant Education Association.

Results
On average, programs that were placed on accreditation–probation during the time frame of this study had received their initial accreditation 16 years before being placed on probation. Altogether, 393 citations were levied against those programs (range: 2–60 citations; median: 13.5 citations). Physician assistant programs that were awarded provisional or continued accreditation were cited for slightly different Standards violations than PA programs that were placed on probation. The average 5-year pass rate for students taking the Physician Assistant National Certifying Examination for the first time was not very different for students from PA programs that were placed on probation and all other programs.

Conclusions
Faculty members, institutions, and entities that support PA program development can use this information to compare PA programs. The results of this study can help PA programs identify areas of frequent noncompliance with the ARC-PA's Standards; provide context that PA programs can use to assess their performance against other programs in the accreditation process; and help PA programs identify areas in need of priority attention nationwide.
Application of Ultrasonic Bone Aspirator for Decompression of the Internal Auditory Canal via the Middle Cranial Fossa Approach
Authors: Kohlberg Gavriel D. , Lipschitz Noga , Tawfik Kareem O. , Walters Zoe , Breen Joseph T. , Zuccarello Mario , Andaluz Norberto , Dinapoli Vincent A. , Pensak Myles L. , Samy Ravi N. 
Published: November 2018

Objective:
Evaluate the safety and efficacy of the ultrasonic bone aspirator (UBA) during middle cranial fossa (MCF) approach to vestibular schwannoma (VS).

Study Design:
Retrospective case series.

Setting:
Tertiary referral center.

Patients:
Charts of 192 consecutive VS patients over 18 years of age were reviewed to identify 65 patients who underwent MCF approach to VS resection between 2006 and 2017. A combination of UBA and high-speed drill (HSD) was used to decompress the internal auditory canal (IAC) in 25 patients and HSD alone was used in the other 40 patients.

Intervention(s):
Use of UBA during vestibular schwannoma surgery via MCF approach for decompression of the IAC.

Main Outcome Measure(s):
Postoperative facial nerve outcomes assessed by the House–Brackmann (HB) facial nerve grading scale. Rates of gross total resection (GTR) and cerebrospinal fluid (CSF) leak.

Results:
There were no significant differences in postoperative facial nerve function, in rate of GTR of tumor, or in rate of CSF leak. In the UBA group 24/25 (96%) had postoperative HB grade I–II compared with 36/40 (90%) in the HSD group (p-value = 0.66). GTR was achieved in 25/25 (100%) in the UBA group compared with 38/40 (95%) in the HSD group (p-value = 1). In the UBA group, there were 0/25 (0%) cases of CSF leak compared with 1/40 (2.5%) in the HSD group (p-value = 1).

Conclusions:
UBA use is a safe and effective alternative or adjunct to HSD during MCF approach to expose the IAC contents. This surgical tool allows for bone removal with low risk of injury to adjacent structures.
The Epidemiology of Otosclerosis in a British Cohort
Authors: Crompton Michael , Cadge Barbara A. , Ziff Joanna L. , Mowat Andrew J. , Nash Robert , Lavy Jeremy A. , Powell Harry R. F. , Aldren Christopher P. , Saeed Shakeel R. , Dawson Sally J. 
Published: November 2018

Objective:To analyse the epidemiology of otosclerosis in a British cohort collected between 2011 and 2017.Design:Retrospective cohort study.Setting:Five UK ENT Departments.Patients:Patients with surgically confirmed otosclerosis.Main Outcome Measures:Questionnaire data documented family history of otosclerosis, age of onset, medical history, and information on associated risk factors for 657 patients. Pre and post-surgical pure-tone audiometry was collected for 154 of these patients.Results:The age of onset, incidence of bilateral disease, tinnitus and vertigo, a higher prevalence of women (65%) than men (35%) are similar to those reported previously for otosclerosis cohorts. No association with measles infection was detected. Patients with a family history (40%) have an earlier age of onset and a higher incidence of bilateral disease and vertigo than non-familial subjects. Pedigree analysis is consistent with an autosomal dominant inheritance with reduced penetrance being apparent in 44/91 pedigrees studied. Women who associate their hearing loss with pregnancy have an earlier age of onset than those that do not (p = 6 × 10−6).Conclusions:This study confirms that otosclerosis is an early adult onset disease that is more prevalent in women than men with a large minority of patients having a family history of otosclerosis. We report new evidence to support a relationship between pregnancy and otosclerosis progression in a proportion of women. In addition, this is the first study to identify differences in severity between familial and non-familial cases of otosclerosis, highlighting the possibility that more than one etiology may be involved.
Utility of Postoperative Magnetic Resonance Imaging in Patients Who Fail Superior Canal Dehiscence Surgery
Authors: Chemtob Raphaelle A. , Epprecht Lorenz , Reinshagen Katherine L. , Huber Alexander , Caye-Thomasen Per , Nakajima Hideko H. , Lee Daniel J. 
Published: November 2018

Objective:
The etiology of symptoms following primary repair of superior canal dehiscence (SCD) may be due to a persistent third window. However, the extent of surgery cannot be seen on postoperative computed tomography (CT) since most repair materials are not radiopaque. We hypothesize that the extent of superior semicircular canal (SSC) occlusion following primary repair can be quantified based on postoperative magnetic resonance imaging (MRI) data.

Study design:
Retrospective series.

Setting:
Tertiary care center.

Patients:
Adult patients with a history of SCD syndrome who 1) report persistent symptoms following primary SCD repair and 2) underwent heavily T2-weighted MRI postoperatively.

Interventions:
Analysis of SSC using 3D-reconstruction of CT co-registered with MRI data.

Main outcome measures:
Arc length of fluid void on MRI and quantification of persistent SCD based on CT/MRI co-registration.

Results:
We identified 9 revision cases from a cohort of 145 SCD repairs at our institution (2002–2017) with CT/MRI data. A fluid void on postoperative MRI (indicating occlusion of the SSC) was observed in all cases (anterior limb: 50.1 degrees [±21.8 SD] and posterior limb 48.1 degrees [±28.5 SD]). Co-registration of CT/MRI revealed a residual defect that was most commonly found along the posterior limb in most patients with persistent symptoms.

Conclusions:
The extent of SCD repair can be determined using reformatted or direct T2-weighted MRI sequences in the plane of Pöschl. Co-registration of CT/MRI may be useful to determine the location of a residual superior canal defect and when present was found most commonly along the posterior limb.
Improve the ethical review of clinical trials on traditional medicine
Authors: Zhao Hongjie , Zhang Junhua , Yang Fengwen , Tan Lizi 
Published: November 2018

Abstract
Recently, there is an increasing number of clinical trials on Traditional Chinese medicine (TCM) published, but the implementation of Clinical Trial Registration (CTR), Ethical Review (ER), and Informed Consent (IC) in clinical trials of TCM is unclear. This study aims to investigate the status of CTR, ER, and IC in clinical trials of TCM.
Clinical trials of TCM published in 10 high-quality Chinese journals in 2016 were selected as a sample. Information of clinical trial registration, ethical review, and informed consent of clinical trials was extracted for analysis. Two authors independently screened the literature and extracted the relevant information.
A total of 659 clinical trials met the criteria and were included for analysis. Only 9 clinical trials reported information of clinical trial registration (1.4%). The number for ethical review and informed consent were 156 (23.7%) and 502 (76.2%).
Trial registration, protocol approval, and informed consent were not well executed. Especially registration and ethical review of clinical trials in TCM should be carefully concerned by researchers, clinicians, and journal editors. Training on methodology of clinical trial should be strengthened.
The combination of apatinib and S-1 for the treatment of advanced gastric cancer in China
Authors: Liu Yan , Zhou Changchun , Zhang Kai , Feng Yikuan , Zhang Ruihua 
Published: November 2018

Abstract

Background:
Apatinib-targeted therapy is considered a promising treatment option for malignancies. This study systematically evaluated the efficacy and safety of the combination of apatinib and S-1 for the treatment of patients with advanced gastric cancer (GC).

Methods:
Clinical trials were searched from the PubMed, Cochrane Library, Embase, CNKI, and Wanfang databases. Outcome measures including therapeutic efficacy, quality of life (QoL), and adverse events were extracted and evaluated.

Results:
Data from 8 trials including 393 patients with advanced GC were included. The results indicated that, compared with S-1 alone, the combination of apatinib with S-1 significantly improved patient partial response rate (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.21–3.02, P = .005), overall response rate (ORR, OR = 2.40, 95% CI = 1.51–3.82, P = .0002), and disease control rate (DCR, OR = 2.78, 95% CI = 1.51–5.10, P = .0010), whereas the rates of complete response (CR, OR = 2.38, 95% CI = 0.93–6.12, P = .07) and stable disease (SD, OR = 0.99, 95% CI = 0.64–1.54, P = .97) and QoL (OR = 1.22, 95% CI = 0.51–2.92, P = .66) did not differ significantly. Moreover, the group receiving the combined therapy had higher rates of hand-foot syndrome (OR = 2.23, 95% CI = 1.19–4.17, P = .01), hypertension (OR = 8.85, 95% CI = 4.07–19.26, P < .00001), albuminuria (OR = 11.25, 95% CI = 3.32–38.06, P = .0001), and hemoglobin reduction (OR = 3.19, 95% CI = 1.32–7.67, P = .010), whereas analysis of other adverse events did not show significant differences (P > .05).

Conclusion:
The combination of apatinib and S-1 is more effective for GC treatment than S-1 alone. However, this combined treatment could lead to increased hand-foot syndrome, hypertension, albuminuria, and hemoglobin reduction. Therefore, the benefits and risks should be considered before treatment.
The multi-vessel and diffuse coronary spasm is a risk factor for persistent angina in patients received anti-angina medication
Authors: Park Sang-Ho , Choi Byoung Geol , Rha Seung-Woon , Kang Tae Soo 
Published: November 2018

Abstract
Coronary artery spasm (CAS) is known to be a risk factor for cardiovascular events. However, there is limited data whether the multi-vessel and diffuse spasm (MVDS) is related to more adverse clinical outcomes compared to the Non-MVDS. The aim of this study is to evaluate the impact of the MVDS on clinical outcomes during a 3-year clinical follow-up period.
A total 2797 patients underwent coronary angiography (CAG) with acetylcholine (ACH) provocation test from Nov 2004 to Oct 2010 were enrolled. It is a single-center, observational, prospective, all-comers registry designed to reflect the “real world” practic. The patients were divided into the 3 groups; the negative spasm (NS) group (n = 1188), the Non-MVDS group (n = 1081), and the MVDS group (n = 528). The incidence of major adverse cardiac events (MACE) and recurrent angina was evaluated up to 3 years. To minimize confounding factors, multivariable Cox-proportional hazards regression analysis was performed.
In the 3-year clinical follow-up, the incidence of total death, myocardial infarction, de novo percutaneous coronary intervention (PCI), cerebrovascular accident and MACE were similar among the 3 groups. However, recurrent angina occurred more frequently in the MVDS group than in the NS group (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.27–3.02; P = .002). Recurrence angina between the MVDS group and the Non-MVDS group was not statistically significant (HR, 1.36; 95% CI, 0.91–2.03; P = .129).
In this study, although the incidence of major adverse cardiovascular events were not different regardless of spasm type, the MVDS was associated with higher incidence of recurrent chest pain requiring repeat CAG during the 3-year follow-up period, suggesting more intensive optimal medical therapy with close clinical follow up would be necessary for this particular subset of patients.
Primary diffuse large B-cell lymphoma as a chest-wall mass
Authors: Zhang Qianwen , Ju Yuanrong , Qu Tao , Wang Tao , Liu Xiaoqin 
Published: November 2018

Abstract

Rationale:
Primary diffuse large B-cell lymphoma of the chest wall is extremely rare. A majority of the pleural lymphomas develop in patients with chronic tuberculous pyothorax. The underlying mechanism might be attributed to the sustained stimulation of chronic inflammation. Surgery followed by adjuvant chemotherapy can improve the outcome in some patients with lymphoma localized only in the chest wall. Thus, an early diagnosis of pyothorax-associated lymphoma is essential as it is a malignant, life-threatening condition.

Patient concerns:
A 79-year-old male complained of left-side chest pain for more than 2 months, which was not alleviated with nitrates and aspirin. The patient presented an intermittent low fever, anorexia, and marasmus, accompanied by tuberculosis 40 years ago and chronic left-side pyothorax. Also, ANCA (antineutrophil cytoplasmic autoantibody)-associated vasculitis occurred for >3years.

Diagnosis:
Computed tomography scan showed a solid mass in the left lateral chest wall. The patient underwent ultrasonic-guided biopsy of the lesion. A diagnosis of primary diffuse large B-cell lymphoma of the chest wall was established after histological examination.

Intervention:
Due to advanced age and poor physical condition, the patient received CHOP chemotherapy at a reduced dose.

Outcomes:
The patient died 5 days after the first cycle of chemotherapy with severe dyspnea and high fever.

Lessons:
The chronic inflammation stimulation might result in the development of lymphoma in the chest wall of patients with long-term pyothorax, vasculitis, or other autoimmune diseases associated with malignancies. The fever, chest pain, or other nonspecific clinical symptoms in these patients should be under intensive focus as it might indicate the development of malignant lymphoma. Thus, histological examination in these patients is essential for accurate early diagnosis.
The time course of cervical alignment after cervical expansive laminoplasty
Authors: Choi Il , Roh Sung Woo , Rhim Seung Chul , Jeon Sang Ryong 
Published: November 2018

Abstract
Retrospective Cohort study
To analyze cervical lordosis angle (CLA) change after cervical expansive laminoplasty (CEL) over time, and to determine optimal cut-off angle for predicting postoperative kyphosis
Postoperative development of sagittal malalignment after laminoplasty is associated with neurological dysfunction and neck pain. However, there is no information on the serial CLA change over time and cut-off angle for predicting postoperative kyphosis
The Cobb angle between C2 and C7 in a series of lateral cervical X-rays in the neutral position was retrospectively reviewed for 36 months. And, the effect of time on CLA after CEL and the risk factors associated with postoperative cervical kyphosis (Cobb's angle ≤0°) were analyzed. Also, the optimal cut-off angle for predicting postoperative kyphosis was determined.
A total of 110 cases of CEL for cervical myelopathy were enrolled from February 2005 to May 2010. The mean cervical alignment changed from 12.3 ± 10.4° (mean ± standard deviation [SD]) at the preoperative evaluation to 8.2 ± 11.6°, 10.6 ± 10.1°, 9.1 ± 10.0°, 8.4 ± 11.2°, 8.5 ± 10.5°, 8.1 ± 9.9°, and 8.7 ± 10.1° at 1, 3, 6, 12, 18, 24, and 36 postoperative months, respectively. The cervical lordosis showed statistically significant decreased at the 1st month, then the lordotic angle was partially restored at the 3rd, and 6th, and then no significant changes after the 6th. The only risk factor for kyphosis development was the preoperative CLA. The optimal cut-off preoperative angle for predicting postoperative kyphosis was 8.5°.
The decrease of CLA after expansive laminoplasty peaked in the 1st month. Some of the lordotic angles were restored in the 3rd and 6th months, before reaching a plateau after the 6th month. The optimal cut-off preoperative angle for predicting postoperative kyphosis was 8.5°.
Level of Evidence of their study: Level 4.
Giant sellar metastasis from renal cell carcinoma
Authors: Shen Zhiwei , Yang Chengxian , Bao Xinjie , Wang Renzhi 
Published: November 2018

Abstract

Rationale:
Sellar metastasis is a rare and complex disease whose clinical features are strongly associated with the primary malignancy. Here, we present a rare case of giant sellar metastasis spread from renal cell carcinoma (RCC).

Patient concerns:
A 30-year-old Chinese woman was admitted to our Hospital, reporting headache, nasal congestion, nausea, vomiting, and a sharp decline in her right eye vision.

Diagnoses:
Brain magnetic resonance imaging (MRI) revealed an invasive sellar mass with cavernous sinus and nasal cavity extension. Additionally, the patient had a medical history of right radical nephrectomy for clear-cell RCC.

Interventions:
The patient underwent a successful subtotal resection of the tumor. Final pathological diagnosis confirmed sellar metastasis from RCC. After surgery, the patient was referred to our medical oncology department and received further systemic therapy.

Outcomes:
No light perception remained in her right eye even after prompt surgical decompression. Follow-up MRI showed subtotal resection of the giant sellar metastasis.

Lesson:
Sellar metastasis, although rare, should be particularly considered for elderly patients with deteriorating visual function and medical histories of cancer.
Impact of carcinoid syndrome symptoms and long-term use of somatostatin analogs on quality of life in patients with carcinoid syndrome
Authors: Halperin Daniel M. , Huynh Lynn , Beaumont Jennifer L. , Cai Beilei , Totev Todor , Bhak Rachel H. , Duh Mei S. , Neary Maureen P. , Cella David 
Published: November 2018

Abstract
To evaluate association of carcinoid syndrome (CS) symptom burden and somatostatin analog (SSA) duration with quality of life (QoL) using Functional Assessment of Cancer Therapy-General (FACT-G) and Patient-Reported Outcomes Measurement Information System (PROMIS-29) instruments.
Adults who received treatment for CS symptoms in the US were recruited to participate in a cross-sectional online survey (July–October, 2016). Demographic, clinical, and QoL questions (FACT-G, 29 CS-related supplemental questions, PROMIS-29) were included. Descriptive and multivariable regression analyses adjusting for demographic and clinical characteristics followed.
Most (98%) of the 117 patients received SSAs in the prior month. Multivariable regression analysis showed ≥4 bowel movements/day (vs <4) and each additional CS symptom was associated with 7.1 (P = .043) and 3.4 (P = .034) point FACT-G total score decreases, respectively. Requiring bed rest (vs normal activity) was associated with significant decreases in FACT-G total score (P < .001). There were similar associations for FACT-G subscales, supplemental questions, and PROMIS-29. After adjustment, FACT-G total score was significantly higher (11.3 points; P = .033) for patients treated with SSA >8 years versus <2.7 years.
CS symptom burden was observed to be associated with lower QoL scores, measured by FACT-G. Patients with >8 years SSA treatment duration versus <2.7 years had higher QoL.