bluuebunny/crossref_metadata_2025_split huggingface dataset:
The current surgical treatment of pancreatic cancer in China: a national wide cross-sectional study
Authors: Wu Wenming , Jin Gang , Wang Chunyou , Miao Yi , Wang Huaizhi , Lou Wenhui , Yu Xianjun , Sun Bei , Li Haimin , Qin Renyi , Wu Zheng , Wang Weilin , Xu Kesen , Wang Lei , Liang Tingbo , Hao Chunyi , Huang Heguang , Li Yixiong , Tan Guang , Zhao Yongfu , Hao Jihui , Wang Yifan , Peng Chenghong , Liu Xubao , Ou Jinrui , Yuan Chunhui , Wang Xuefeng , Yang Yinmo , Cai Shouwang , Guo Kejian , Jiang Jianxin , Yu Xiao , Wei Junmin , Li Fei , Wu Xinmin , Zhao Yupei 
Published: March 2019

Abstract

Objective:
The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future.

Methods:
This study is a national, multicenter, cross-sectional study in China. Information regarding pancreatic cancer patients undergoing surgical treatment from 34 high-volume tertiary IIIA level hospitals was collected and analyzed from the March 1, 2016 to the February 28, 2017.

Results:
In total, 2200 pancreatic cancer patients were enrolled from 34 tertiary IIIA level hospitals in 16 provinces across China. The male-to-female ratio was 1.5. More than 80% of the patients were between 50 and 70 years old. The top 4 symptoms were epigastric discomfort, abdominal pain, jaundice, and weight loss. Carbohydrate antigen 19-9 and carcinoembryonic antigen were elevated in 70.9% and 27.1% of patients, respectively. A multidisciplinary team (MDT) discussion was carried out for 35.0% of patients before surgery. The proportion of minimally invasive pancreatic surgeries was approximately 20%. A total of 83.4% of the operations achieved R0 resection, and the incidence of grade 3/4 postoperative complications was 7.7%. Only 13.4% of the patients received postoperative adjuvant chemotherapy. The percentage of pathological stage I tumors was only 24.5%.

Conclusion:
The majority of pancreatic cancer patients undergoing surgical resection in China are in an advanced stage. The MDT consultations for pancreatic cancer have not been widely carried out. R0 resection has been achieved in most cases, with relatively low incidence of serious complications, but minimally invasive pancreatic surgery should be further promoted. The application of postoperative chemotherapy remains low. This national, multicentre, cross-sectional study comprehensively presents the current status of pancreatic cancer patients undergoing surgical treatment and shows the road to improve survival of these patients in the future.
Pancreatic cancer surgery with vascular resection: current concepts and perspectives
Authors: Rebelo Artur , Michalski Christoph W. , Ukkat Jörg , Kleeff Jörg 
Published: March 2019

Abstract
Pancreatic cancer is a devastating disease and resection at an early disease stage is the best chance of cure. Less than 20% of all patients present with a resectable tumor, while another 20% to 30% have locally advanced pancreatic cancer and the majority of the patient suffer from metastatic disease. Recently, it has been recognized that there is a 4th group of patients with so-called borderline resectable disease. Here, the tumor approaches or infiltrates the vascular axis (superior mesenteric vein/portal vein and/or superior mesenteric/hepatic artery/celiac trunk). While a large number of tumors with suspected venous infiltration can be resected with concomitant venous resection and reconstruction, arterial infiltration has been considered a contraindication to resection. Neoadjuvant treatment with combination chemotherapy protocols with or without radiotherapy has allowed for higher resection rates even in patients with arterial invasion. Here, we review the contemporary literature on extensive pancreatic cancer surgery with vascular resection and reconstruction.
Guidelines for Rehabilitation and Return to Play After Cervical Surgery in a General Athletic Population: A Delphi Analysis
Authors: Robben Elise , Kempeneers Kristof , De Groef An , Depreitere Bart , Peers Koen 
Published: March 2019

Objective:
Decisions concerning the rehabilitation process and return to play (RTP) after cervical spine surgery in a general sporting population can be difficult and may be influenced by several factors. Moreover, no clear guidelines for this are currently available. The aim of this study was to create tentative guidelines for rehabilitation and RTP after cervical surgery in a general sporting population.

Design:
Five-step Delphi analysis.

Settings:
Primary, secondary, and tertiary medical practitioners.

Participants:
Panel of Belgian neurosurgeons, orthopedic surgeons, physiotherapists, and physical and rehabilitation medicine practitioners.

Assessment:
Round 1 (R1) was a brainstorm phase. A comprehensive list of answers from R1 was validated in round 2 (R2). In round 3 (R3), experts ranked these items in a chronological order. Contraindications and criteria to start each rehabilitation step were linked in round 4 (R4). In round 5 (R5), panelists ranked theses about contraindications and criteria on a 5-point Likert scale.

Main Outcome Measures:
Theses scoring ≥10% “oppose” or “strongly oppose” were rejected.

Results:
The response rate was 100% (n = 15) for R1, 93% (n = 14) for R2, 73% (n = 11) for R3, 53% (n = 8) for R4, and 67% (n = 10) for R5. In R5, 25 theses on absolute and relative contraindications and criteria were endorsed.

Conclusions:
This Delphi analysis resulted in contraindications and criteria for the rehabilitation process and RTP after cervical surgery in a general athletic population. Tentative guidelines and timetable are proposed. Key messages from these guidelines are (1) Rehabilitation should start before surgery with education; (2) Rehabilitation should be patient-tailored; and (3) An unstable arthrodesis is an absolute contraindication for RTP.
Does Concussion Affect Perception–Action Coupling Behavior? Action Boundary Perception as a Biomarker for Concussion
Authors: Eagle Shawn R. , Nindl Bradley C. , Johnson Caleb D. , Kontos Anthony P. , Connaboy Chris 
Published: March 2019

Background:
After a concussion, athletes may be at increased risk of musculoskeletal injuries. Altered perception of action boundaries (ABP), or the limits of one's action capabilities, is one possible mechanism for this increase in injury risk after concussion.

Objective:
To evaluate differences in symptoms, neurocognitive, vestibular/oculomotor, and action boundary function between subjects with no concussion history (NoHx) and concussion history (ConcHX).

Design:
Cross-sectional study.

Setting:
Laboratory at the University of Pittsburgh.

Participants:
ConcHx (n = 22; age: 21.8 ± 3.0 years, height: 174.0 ± 8.3 cm, and mass: 77.8 ± 14.8 kg) and NoHx athletes (n = 24; age: 21.6 ± 2.0 years, height: 176.0 ± 10.0 cm, and mass: 72.0 ± 15.3 kg).

Intervention:
Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Post-Concussion Symptom Scale (PCSS), Vestibular–Ocular Motor Screening (VOMS) tool, and the Perception–Action Coupling Task (PACT). The PACT measures the accuracy of ABP.

Main Outcome Measures:
Neurocognitive domain scores, PCSS, VOMS subdomain symptom gain, ABP accuracy, and actualization.

Results:
ConcHx reported 2.7 ± 1.5 previous concussions occurring on average 263.8 ± 228.9 days prior. ConcHx was higher on several VOMS items including vertical/horizontal saccades (P = 0.001; P = 0.05), vertical/horizontal vestibular–ocular reflex (P < 0.001; P = 0.04), and visual motion sensitivity (P < 0.001). Average PACT movement time (P = 0.01) and reaction time (P = 0.01) were longer in ConcHx.

Conclusions:
These findings provide preliminary support for impaired vestibular/oculomotor function and ABP in ConcHx compared with NoHx. The current results may enhance our understanding of the mechanisms for increased musculoskeletal injury risk after concussion.
Increased access to nurse practitioner care in rural Nebraska after removal of required integrated practice agreement
Authors: Holmes LeAnn R. , Waltman Nancy 
Published: March 2019

ABSTRACT
Nebraska is a largely rural state with many communities defined as medically underserved by primary care providers. In 2014, the state legislature voted to eliminate the requirement for an integrated practice agreement (IPA) between nurse practitioners (NPs) and physicians. This report describes changes in access to primary health care in rural and underserved areas of Nebraska after removal of the IPA barrier to practice. The report compares the number of primary care NPs working in medically underserved areas before and after the legislation that ended the required IPA. In addition, anecdotes will be provided of NP and patient experiences in rural, NP-owned practices in Nebraska after IPA requirements were eliminated.
Postpartum dyspnea in a breast cancer survivor
Authors: Stanley Angela Y. , Lin Andrew H. , Fajardo Johana 
Published: March 2019

ABSTRACT

Breast cancer is the most common cancer among women and the second leading cause of cancer death in the world. As treatments advance and survival increases among breast cancer survivors, we will continue to see more obstetric patients exposed to anthracycline drugs. Anthracycline toxicity risk is dose dependent, and any exposure to anthracyclines places obstetric patients at risk to cardiotoxicity. In this case report, we explore the potential chemotherapy toxicities of anthracycline exposure.
Use of PHQ-9 and pharmacogenetic testing in clinical practice
Authors: Kierce Erica D. , Vanderhoef Dawn M. , Connors Laurie M. 
Published: March 2019

ABSTRACT

Background:
This project evaluated the clinical use of pharmacogenetic testing in an outpatient psychiatric practice, integrated a standardized measure for assessing depressive symptoms, and captured data regarding treatment efficacy.

Local Problem:
According to the Centers for Disease Control and Prevention (2016), more than 10% of all outpatient office visits include a depression-related diagnosis. Patients who require more medication trials to experience remission of depressive symptoms are more likely to relapse in the follow-up period than those who do not (National Institute of Mental Health, 2001).

Methods and Interventions:
Baseline Patient Health Questionnaire-9 (PHQ-9) scores and medication regimens were recorded for 15 adults with major depressive disorder who completed pharmacogenetic testing. Repeat PHQ-9 scores and medication regimens were recorded at follow-up appointments within 6 weeks post-pharmacogenetic testing and compared with baseline data.

Results:
The PHQ-9 scores ranged from a 5-point reduction to a 2-point increase in depressive symptoms at follow-up appointment. The PHQ-9 scores were lower at follow-up screening for 14 participants. Six of the 15 participants were on a single medication, with significant drug–gene interactions. Medications with significant drug–gene interactions were eliminated from the regimen for three of the six patients. For the remaining three patients, providers deemed it to be reasonable to continue the medications with significant drug–gene interactions.

Conclusions:
Pharmacogenetic testing is a useful clinical tool for guiding medication selection but does not replace provider judgment. Drug–gene interaction testing results should be considered in addition to patient preference, medication cost, possible side effects, and immediate clinical needs.
Improving influenza immunization rates in the uninsured
Authors: Falcone Aimee L. 
Published: March 2019

ABSTRACT

Background and Purpose:
Infection from influenza virus causes tens of thousands of deaths annually in the United States, costing millions to manage hospital complications. Barriers exist for patients to choose the influenza vaccine, which is proven to effectively reduce incidence of infection and complications from influenza virus. A significant percent of uninsured patients are at high risk of these complications because of chronic illness. This article examines the literature for evidence of effective interventions to increase influenza uptake rate in the uninsured adult population.

Methods:
Literature review of data sources including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, and the Cochrane Database of Systematic Reviews.

Conclusions:
Effective interventions include free vaccines, mass communication efforts, implementing an influenza questionnaire, training health care workers, using a vaccine facilitator, implementing a standing orders policy and opt-out policy, scheduling year-round appointments, clinicians recommending the vaccine, clinician audit and feedback, tracking in an electronic medical record, and narrative communication techniques.

Implications for practice:
To reduce influenza-related costs, and improve health outcomes, it is imperative that nurse practitioners use evidence-based interventions in the practice setting to increase influenza uptake rates in the adult uninsured population.
Health care system changes supporting the development of the nurse practitioner role in Tanzania
Authors: Mboineki Joanes Faustine , Chen Changying 
Published: March 2019

ABSTRACT

Background and purpose:
Accessibility to health care services remains a global challenge, and this has affected the quality of services delivered. This has affected the quality of health care services. Poor accessibility to health care services in Tanzania has hindered the achievements of health care system goals. The development of the nurse practitioner (NP) role has not yet received enough attention to resolve current existing and emerging problems facing the Tanzanian health care system. This study assessed the health care system changes that support the development of the NP role in Tanzania.

Methods:
A descriptive, cross-sectional study design was used to collect quantitative data. Purposive and convenience sampling techniques were used to collect data from 237 health care providers using a semi-structured questionnaire. Data were entered into SPSS version 20 and analyzed using descriptive statistics and Chi-square test for independence (Pearson Chi-square, χ2).

Conclusions:
Although the government of Tanzania has made some improvements in access to health care services, the rural health care facilities still suffer from an extreme shortage of skilled health care providers. This has forced the government to allow medical attendants to treat patients when they are not licensed to do so. The development of the NP role should be able to address the shortage of skilled health care providers in rural health care facilities.

Implications for practice:
The development of the NP role will improve the accessibility to health care services in rural primary health care facilities.
Nutrition knowledge, attitudes, and self-regulation as predictors of overweight and obesity
Authors: Balani Roula , Herrington Heidi , Bryant Emily , Lucas Colleen , Kim Son Chae 
Published: March 2019

ABSTRACT

Background and purpose:
Nutrition knowledge, attitudes, and eating self-regulation are important determinants of overweight and obesity. Eating self-regulation is the link between eating intention and behavior. However, the extent to which these factors influence overweight and obesity has not been thoroughly studied. The study examined nutrition knowledge, attitudes, and eating self-regulation as predictors of overweight and obesity among adults in a community setting.

Methods:
A total of 313 adults participated in an online survey, which included the General Nutrition Knowledge Questionnaire–Revised, the Nutrition Attitudes Questionnaire, and the Self-Regulation of Eating Behavior Questionnaire. Descriptive statistics, Kendall's tau tests, and multivariate logistic regression procedures were performed.

Conclusions:
More than half of the participants were either overweight or obese (56.5%). The mean nutrition knowledge score was 74.1%, and only 28.1% correctly identified the body mass index for obesity. Positive predictors of overweight and obesity included poor eating self-regulation of giving up too easily on eating intentions (odds ratio [OR] = 3.81), male gender (OR = 2.0), and age (OR = 1.03), whereas nutrition attitudes were a negative predictor (OR = 0.74).

Implications for practice:
The odds of overweight or obesity were nearly four times greater for those who gave up too easily on their eating intentions. Nurse practitioners can play a critical role in establishing healthy dietary habits to maintain weight control by promoting good eating self-regulation, despite the current obesogenic environment. After assessing patient readiness and motivation, it is important to help patients make eating self-regulation as manageable as possible to promote long-term weight management.
Fibromyalgia treatment and management considerations for nurse practitioners
Authors: Stournaras Dana , Petrovic Kimberly 
Published: March 2019

ABSTRACT
The purpose of this case study is to examine the role of the nurse practitioner in the management and treatment of a 35-year-old female patient diagnosed with several conditions, including fibromyalgia posttraumatic stress disorder, anxiety, and depression. Fibromyalgia is a chronic, nonprogressive rheumatic condition with cardinal symptoms of widespread pain and fatigue; it affects more than 5 million people in the United States. This case study examines the nurse practitioner's role in managing fibromyalgia. Benzodiazepines and opioids may be prescribed for treatment of symptoms but prove ineffective, thus contributing to dependency issues. Controversy exists over classification of fibromyalgia as a rheumatologic condition versus a mental health disorder. Fibromyalgia frequently is accompanied by anxiety and depression, making this illness difficult to diagnose and treat.
The hands that cradle: A pilot study of parent adverse childhood experience scores
Authors: Haltom John Patrick , Card Elizabeth , Wells Nancy , Lowen Deborah E. 
Published: March 2019

ABSTRACT
The purpose of this study was to gather population-specific data within a pediatric hospital and contribute to understanding the intergenerational continuity of adverse childhood experiences (ACEs). This descriptive study aimed at measuring the ACE scores of parents or caretakers whose child was a suspected victim of abuse or neglect. The “Finding Your ACE Score questionnaire was used to determine participants' scores.” Fifteen participants enrolled in the study (N = 15), and 86.7% had exposure to ACEs. Statistical significance was found when comparing ACE scores with reported income levels (p = .051). This study supports previous findings of ACEs being present in a variety of populations, and it presents practice implications for advance practice registered nurses (APRNs) in various practice settings. Findings support that research regarding how to assess and treat ACEs throughout family members is both necessary and difficult. Additional data regarding the intergenerational continuity of ACEs might influence how APRNs deliver family-specific assessment, treatment, and prevention of ACEs throughout generations of family members.
Children's fears 2–13 months after sibling NICU/PICU/emergency department death
Authors: Roche Rosa M. , Brooten Dorothy , Youngblut JoAnne M. 
Published: March 2019

ABSTRACT

Background and purpose:
Sibling loss can heighten children's fears. Approximately two million children in the United States experience the death of a sibling each year, leaving 25% of them in need of clinical intervention and more than 50% with significant behavioral problems. Fear, guilt, anxiety, and even distance from parents are some of the reactions that children feel after experiencing the loss of a sibling. The purpose of this study was to describe children's fears 2–13 months after their sibling's death. Fears were examined by children's age, gender, race/ethnicity, and time.

Methods:
Children completed two open-ended questions about fears and five fear items on the Spence Children's Anxiety Scale. The sample consisted of 132 children.

Results:
Children's top fears across age, gender, and race/ethnicity were daily situations (such as darkness, high places, and violent situations), bugs, animals, and medical examinations. Girls had more total fears than boys. These included fears of bugs and situations with parents and siblings. Boys and Hispanic children had more fears of daily situations. Black children had more fears of animals, whereas White children had more fears of bugs and medical examinations.

Implications for practice:
Children identify many fears after sibling death, including but not limited to fantasy creatures, common daily situations, bugs, animals, and medical examinations likely related to their sibling's death. Identifying children's fears early can help nurse practitioners assist families in better understanding and responding to children's behavior after sibling death.
A Single-Center Case Series Describing Tracheobronchial Bonastent Implantation
Authors: Avasarala Sameer K. , Sethi Sonali , Machuzak Michael , Almeida Francisco A. , Gildea Thomas R. 
Published: March 2019

Background:
The Bonastent is one of the newest self-expanding metallic tracheobronchial prostheses being used in the central airways. Experience with this stent is limited; there is a gap in literature. We report herein a case series of Bonastent implantation across a variety of tracheobronchial pathologies.

Methods:
All adult patients who had a Bonastent implanted within the tracheobronchial tree between November 2017 through May 2018 were included in this case series. Data were derived from a combination of sources: electronic medical records and a Research Electronic Data Capture–based bronchoscopy registry. Demographic, procedural, and short-term outcome data were collected for each patient.

Results:
Thirteen Bonastents were implanted in 11 patients during the observational period. Seven patients were male (64%); the mean age was 62.2 years. The most common indication was nonmalignant airway obstruction in a transplanted lung (n=6, 56%). Over half of all stents (n=8) were implanted in the bronchus intermedius. Three patients (27%) had clinically significant obstruction from their Bonastent.

Conclusion:
The Bonastent is the newest self-expanding metallic endotracheobronchial stent on the market. Like any other stent, it has its advantages and drawbacks. Interestingly, we noted 3 instances of tissue ingrowth through the covered portion of the stent. Larger studies with a longer follow-up periods are needed to assess long-term efficacy and safety of this relatively novel stent.