bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multicenter Investigation of Caring Behaviors and Burnout Among Oncology Nurses in China
Authors: Shen Aomei , Wang Ying , Qiang Wanmin 
Published: December 2018

Background
Job burnout could negatively affect nursing care provided. However, little is known about burnout and caring behaviors among oncology nurses in China.

Objectives
The aims of this study were to investigate the status of burnout and caring behaviors among oncology nurses in China, to examine the relationship between them, and to identify factors that affect caring behaviors.

Methods
A nationwide multicenter study was performed in 6 public cancer hospitals in June 2016. Data were collected through an online survey with instruments of a sociodemographic and occupational characteristics questionnaire, the Caring Behavior Inventory, and the Maslach Burnout Inventory. Descriptive statistics, independent-samples t tests or 1-way analysis of variance, Pearson correlation analyses, and multiple regression analyses were applied.

Results
A total of 3100 oncology nurses were invited to participate; 3014 valid questionnaires were returned. The percentages of oncology nurses experiencing high levels of emotional exhaustion, depersonalization, or diminished personal accomplishment were 30.16%, 19.97%, and 47.28%, respectively. Caring Behavior Inventory scores were significantly and negatively correlated with emotional exhaustion, depersonalization, and diminished personal accomplishment. Depersonalization, diminished personal accomplishment, level of family concern, and original nursing degree level showed significant negative influence on caring behaviors.

Conclusions
Burnout (depersonalization and diminished personal accomplishment), family concern, and original nursing degree were negatively related to oncology nurses' caring behaviors.

Implications for Practice
Initiatives in oncology nursing in China are needed that focus on improving job burnout and emphasize humanistic oncology nursing care, such as caring nurses' personal factors, creating a harmonious working environment, strengthening coping skills, and building a caring organizational culture.
Trajectory Patterns and Factors Influencing Self-management Behaviors in Chinese Patients With Breast Cancer
Authors: Wu Fulei , Howell Doris , Fang Qiong , Chen Jing , Yuan Changrong 
Published: December 2018

Background
Self-management plays an important role in improving quality of life among patients with breast cancer. Self-management behaviors change with treatment periods, and the trajectory varies in patients with different demographic and psychosocial characteristics. However, the trajectory patterns and the predictive factors have not been fully studied.

Objectives
The aim of this study was to identify the trajectory patterns of self-management behaviors in Chinese patients with breast cancer and their predictive factors.

Methods
A total of 128 patients with breast cancer were recruited. Demographic and disease-related information, self-management behaviors, self-efficacy, coping modes, emotional distress, and social support were investigated across 5 time points. Growth mixture modeling was used to identify the trajectory patterns of self-management behaviors. Logistic regression was used to determine the predictors for membership.

Results
The best-fit growth mixture modeling revealed a 2-class model; model fit indices were all in acceptable ranges. Class 1 and 2 were named as the group of “stable” (34.38%) and the group of “sharply decreased” (65.62%), respectively, based on the tendency of change. Modified radical mastectomy, avoidance coping mode, anxiety, and low self-efficacy level were predictors of the patients' membership to the sharply decreased group.

Conclusion
Our study proved the heterogeneity of self-management behaviors and the influencing effect of treatment and psychosocial factors on the development of self-management behaviors in Chinese patients with breast cancer.

Implications for Practice
Health professionals should pay more attention to patients who are at higher risk of developing a poor self-management pattern. Targeted interventions should be developed across subpopulations and treatment periods accordingly.
Methodology Aspects of Nausea Measuring During Pelvic Radiotherapy
Authors: Enblom Anna E. , Steineck Gunnar , Börjeson Sussanne 
Published: December 2018

Background
Nausea seems underreported during pelvic radiotherapy.

Objective
The aims of this study were to investigate if a 5-week recall measure of nausea covering the entire radiotherapy period was comparable with accumulated daily nausea measurements and to investigate if the measuring method affected potential difference in quality of life (QoL) between nauseated patients and patients free from nausea.

Methods
This longitudinal methodology study covered 200 patients (mean age, 64 years; 84% women; 69% had gynecological cancer). The patients graded QoL (Functional Assessment of Cancer Therapy–General). They registered nausea daily and at a 5-week recall at the end of radiotherapy.

Results
The nausea-intensity category scale and visual analog scale correlated well (Spearman correlation coefficient = 0.622). According to the 5-week recall, 57 of 157 answering patients (36%) experienced nausea during the radiotherapy period. Using the daily nausea measurements, 94 of 157 patients (60%) experienced nausea (relative risk, 1.65; 95% confidence interval, 1.29–2.10). Of these 94 nauseated patients, 39 (42%) did not report nausea using the 5-week recall. The nauseated patients experienced worse QoL (physical/functional subscores) than patients free from nausea whether nausea was registered daily or at the 5-week recall.

Conclusions
Almost half, 42%, of the patients who experienced nausea according to daily nausea measurements did not report having had nausea according to the 5-week recall. Nauseated patients graded worse QoL than patients who were free from nausea.

Implications for Practice
Nursing professionals should measure nausea repeatedly to identify patients at risk of nausea and worsened QoL, to be able to deliver evidence-based antiemetic treatment strategies.
Changes in Fatigue, Psychological Distress, and Quality of Life After Chemotherapy in Women with Breast Cancer
Authors: Oh Pok-Ja , Cho Jung-Ran 
Published: December 2018

Background
Chemotherapy leads to various symptoms and psychological distress, which contribute to a significant decrease in the quality of life of the patients.

Objectives
The aim of this study was to identify changes and interrelationships in the fatigue-depression-anxiety symptom cluster and quality of life during the cancer care trajectory in women with breast cancer.

Methods
Fifty women participated in the study and completed questionnaires at 3 different times: prechemotherapy, postchemotherapy, and 6 months after the completion of chemotherapy. The assessment tools were the Functional Assessment of Cancer Therapy–Fatigue Scale, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy–Breast Cancer version 4 Scale. Data were analyzed using descriptive and repeated-measures analysis of variance statistics.

Results
A significant increase in fatigue (F = 41.95, P < .001) and psychological distress (F = 26.55, P < .001) from prechemotherapy to postchemotherapy was noted. Improvement was observed 6 months after the completion of chemotherapy. A positive or negative change in fatigue was associated with the same in psychological distress. Quality of life (F = 65.22, P < .001) also showed similar change patterns as observed with fatigue and psychological distress. Fatigue had a greater impact on quality of life at postchemotherapy, but psychological distress had a greater impact at prechemotherapy and at the 6-month follow-up.

Conclusion
These results suggest that chemotherapy is highly associated with the fatigue-depression-anxiety symptom cluster and quality of life in women with breast cancer.

Implications for Practice
Nursing intervention is needed to relieve the intensity of the fatigue-depression-anxiety symptom cluster and thus improve the quality of life of patients undergoing chemotherapy from before treatment to follow-up.
Low Chlamydia and Gonorrhea Testing Rates Among Men Who Have Sex With Men in Guangdong and Shandong Provinces, China
Authors: Wu Dan , Li Katherine T. , Tang Weiming , Ong Jason J. , Huang Wenting , Fu Hongyun , Lee Amy , Wei Chongyi , Tucker Joseph D. 
Published: December 2018

Background
Although periodic chlamydia and gonorrhea testing is recommended for men who have sex with men (MSM), little is known about testing rates in China. This study examines chlamydia and gonorrhea testing rates and testing correlates among Chinese MSM.

Methods
An online survey of MSM was conducted in August 2017. Men 16 years or older who had ever had sex with a man were enrolled through a gay social networking mobile application. We asked men about their sexual behaviors, community engagement in sexual health, and previous testing for chlamydia, gonorrhea, and HIV. Multivariable logistic regressions were used to examine the association of testing with community engagement and recent HIV testing.

Results
Of 1031 men, 819 (79.5%) were younger than 30 years, and 263 (25.5%) reported condomless sex in the past 3 months. In total, 294 (28.5%) men tested for chlamydia, 315 (30.6%) men tested for gonorrhea, and 817 (79.2%) men tested for HIV. One hundred twenty-five (42.5%) men who received chlamydia testing and 134 (42.5%) men who received gonorrhea testing had substantial community engagement. Compared with men with no/minimal community engagement, men with substantial community engagement had greater odds of chlamydia testing (adjusted odds ratio [AOR], 2.8; 95% confidence interval [CI], 1.9–4.3) and gonorrhea testing (AOR, 2.9; 95% CI, 2.0–4.4). Men with recent HIV testing were more likely to have received chlamydia testing (AOR, 1.5; 95% CI, 1.1–2.0) and gonorrhea testing (AOR, 1.6; 95% CI, 1.2–2.1).

Conclusions
Chlamydia and gonorrhea testing levels are low among Chinese MSM. Integrating chlamydia and gonorrhea test promotion strategies into HIV prevention programs that engage MSM communities may help bridge the gap.
Auditory Global Positioning System and Advanced Driver Assistance Systems: A Safer Alternative to Bioptic Telescopes for Drivers Who Are Visually Impaired?
Authors: Wilkinson Mark E. , McGehee Daniel V. 
Published: December 2018

ABSTRACT
This work challenges the standard of the past 40 years, which required the use of a bioptic telescope by individuals with vision loss wanting to be licensed to drive in most states in the United States.
Driving continues to be the key to independence for many individuals, particularly older drivers who live in an area where public transportation is limited or nonexistent. For the past 40 years, the most frequently option to allow drivers who are visually impaired to maintain driving privileges was to require them to use a bioptic telescope. Bioptic telescopes were felt to be necessary for wayfinding when driving. In addition, it was thought that a person could look through a bioptic telescope and still be aware of the driving environment around him/her. Human factor research has shown that the assertion that an individual can attend to two tasks simultaneously is not possible. Taking one's eyes off the road for as little as 2 seconds can lead to lane position breakdown. In 2018, wayfinding can now be more easily accomplished with the use of ubiquitous technologies like Global Positioning System systems on our telephones and in our cars. Driver distraction principles support safer alternatives to bioptic telescopes because these audio options allow the drivers to maintain their eyes and their attention on the road and the traffic around them. The switching of view within the bioptic spectacles is attentionally demanding, and the visual field restriction of such devices reduces overall situation awareness by narrowing the driver's attention.
Bayesian Methods in the Field of Rehabilitation
Authors: Quintela-del-Río Alejandro , Rodríguez-Romero Beatriz , Robles-García Verónica , Arias-Rodríguez Pablo , Cudeiro-Mazaira Javier , Martínez-Rodríguez Alicia 
Published: December 2018

Abstract
Bayesian techniques, as an alternative method of statistical analysis in rehabilitation studies, have some advantages such as handling small sample sizes, allowing incorporation of previous experience of the researchers or clinicians, being suitable for different kinds of studies, and managing highly complex models. These characteristics are important in rehabilitation research. In the present article, the Bayesian approach is displayed through three examples in previously analyzed data with traditional or frequentist methods. The studies used as examples have small sample sizes and show that the Bayesian procedures enhance the statistical information of the results. The Bayesian credibility interval includes the true value of the corresponding parameter diminishing uncertainty about the treatment effect. In addition, the Bayes factor value quantifies the evidence provided by the data in favor of the alternative hypothesis as opposed to the null hypothesis. Bayesian inference could be an interesting and adaptable alternative statistical method for physical medicine and rehabilitation applications.
Small Numbers of CD4+ T Cells Can Induce Development of Lymphedema
Authors: Ly Catherine L. , Cuzzone Daniel A. , Kataru Raghu P. , Mehrara Babak J. 
Published: December 2018

Background:
CD4+ T cells have been implicated in the pathology of lymphedema. Interestingly, however, there have been case reports of lymphedema development in patients with low levels of CD4+ T cells because of immunosuppression. In this study, the authors sought to delineate the effect of relative CD4+ T-cell deficiency on the development of lymphedema in a mouse model.

Methods:
A mouse model of relative CD4+ T-cell deficiency was created through lethal total body irradiation of wild-type mice that then underwent bone marrow transplantation with progenitors harvested from CD4 knockout mice (wild-type/CD4 knockout). Irradiated CD4 knockout mice reconstituted with wild-type mouse-derived progenitors (CD4 knockout/wild-type), and unirradiated CD4 knockout and wild-type mice were used as controls. All mice underwent tail skin and lymphatic excision to induce lymphedema, and analysis was performed 6 weeks later.

Results:
Wild-type/CD4 knockout chimeras were not protected from developing lymphedema. Despite a global deficit in CD4+ T cells, these mice had swelling, fibrosis, inflammation, and impaired lymphatic transport function indistinguishable from that in wild-type and CD4 knockout/wild-type mice. In contrast, unirradiated CD4 knockout mice had no features of lymphedema after lymphatic injury.

Conclusions:
Relatively small numbers of bone marrow and peripheral CD4+ T cells are sufficient to induce the development of lymphedema. These findings suggest that lymphatic injury results in expansion of CD4+ T-cell populations in lymphedematous tissues.
A Rapid Protocol for Intraoperative Assessment of Peripheral Nerve Myelinated Axon Count and Its Application to Cross-Facial Nerve Grafting
Authors: Wang Wenjin , Kang Sung , Coto Hernández Iván , Jowett Nate 
Published: December 2018

Background:
Donor nerve myelinated axon counts correlate with functional outcomes in reanimation procedures; however, there exists no reliable means for their intraoperative quantification. In this article, the authors report a novel protocol for rapid quantification of myelinated axons from frozen sections, and demonstrate its applicability to surgical practice.

Methods:
The impact of various fixation and FluoroMyelin Red staining strategies on resolved myelin sheath morphology from cryosections of rat and rabbit femoral and sciatic nerves was assessed. A protocol comprising fresh cryosection and rapid staining was developed, and histomorphometric results were compared against conventional osmium-postfixed, resin-embedded, toluidine blue–stained sections of rat sciatic nerve. The rapid protocol was applied for intraoperative quantification of donor nerve myelinated axon count in a cross-facial nerve grafting procedure.

Results:
Resolution of myelinated axon morphology suitable for counting was realized within 10 minutes of tissue harvest. Although mean myelinated axon diameter appeared larger using the rapid fresh-frozen as compared to conventional nerve processing techniques (mean ± SD; rapid, 9.25 ± 0.62 μm; conventional, 6.05 ± 0.71 μm; p < 0.001), no difference in axon counts was observed on high-power fields (rapid, 429.42 ± 49.32; conventional, 460.32 ± 69.96; p = 0.277). Whole nerve myelinated axon counts using the rapid protocol herein (8435.12 ± 1329.72) were similar to prior reports using conventional osmium processing of rat sciatic nerve.

Conclusions:
A rapid protocol for quantification of myelinated axon counts from peripheral nerves using widely available equipment and techniques has been described, rendering possible intraoperative assessment of donor nerve suitability for reanimation.
The Timing of Alloplastic Cranioplasty in the Setting of Previous Osteomyelitis
Authors: Kwiecien Grzegorz J. , Aliotta Rachel , Bassiri Gharb Bahar , Gastman Brian , Zins James E. 
Published: December 2018

Background:
Management of cranial osteomyelitis is challenging and often includes débridement of infected bone and delayed alloplastic cranioplasty. However, the optimal interval between the removal of infected bone and definitive reconstruction remains controversial. The authors investigated the optimal time for definitive reconstruction and factors influencing cranioplasty reinfection.

Methods:
A retrospective review of 111 alloplastic cranioplasties for osteomyelitis between 2002 and 2015 was performed. Patients were divided into four subgroups based on timing of reconstruction: group 1, less than 3 months; group 2, 3 to 6 months; group 3, 6 to 12 months; and group 4, more than 12 months. Multivariate logistic regression was used to calculate the probability of cranioplasty reinfection based on risk factors. Median follow-up was 45.9 months (range, 12.4 to 136.9 months).

Results:
The combined reinfection rate was 23.4 percent. The reinfection rate in group 1 was 39.6 percent; group 2, 12.5 percent; group 3, 8.0 percent; and group 4, 0.0 percent (p < 0.001). The mean interval between the infected bone removal and cranioplasty was shorter in patients with reinfection than in patients without reinfection (2.2 ± 3.9 months versus 6.1 ± 8.3 months; p < 0.001). The strongest independent predictors of reinfection were chemotherapy (OR, 10.1; 95 percent CI, 2.9 to 35.2), composite defect requiring scalp reconstruction at the time of cranioplasty (OR, 3.3; 95 percent CI, 1.2 to 8.9), and early reconstruction. Each month of delay in reconstruction reduced the reinfection rate by 10 percent (OR, 0.9 per each month of delay; 95 percent CI, 0.8 to 1.0). Cranioplasty material was not significant.

Conclusions:
Early alloplastic cranioplasty following osteomyelitis carries an unacceptably high risk of reinfection. This risk decreases by 10 percent with each month of delay. The authors’ regression model can be used to predict the probability of reinfection for all time periods.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Quality of Randomized Controlled Trials for Surgical Treatment of Carpal Tunnel Syndrome: A Systematic Review
Authors: Long Chao , Azad Amee D. , desJardins-Park Heather E. , Fox Paige M. 
Published: December 2018

Background:
Randomized controlled trials are considered the gold standard in evidence-based medicine. The authors conducted a systematic review to evaluate the quantity, quality, and trends of randomized controlled trials that assess surgical treatment of carpal tunnel syndrome.

Methods:
The authors identified randomized controlled trials comparing two or more surgical interventions for carpal tunnel syndrome in PubMed, Cochrane, Scopus, Google Scholar, and Clinicaltrials.gov. Two independent reviewers evaluated articles for inclusion, extracted data, and assessed randomized controlled trial quality using the Jadad score.

Results:
Of 2253 identified studies, 58 met full inclusion criteria. They were published between 1985 and 2015, with a significant increase over time (p = 0.003). They were most frequently published in Journal of Hand Surgery (European Volume) [n = 15 (25.9 percent)]. Most randomized controlled trials were single-center studies [n = 54 (93.1 percent)] conducted in the United Kingdom [n = 13 (22.4 percent)] or the United States [n = 10 (17.2 percent)], with a mean study size of 80.1 ± 55.5 patients. Funding source was unknown in 62.1 percent (n = 36). Three-quarters [n = 44 (75.9 percent)] of randomized controlled trials did not define the primary outcome measure(s). Less than 30 percent (n = 17) of randomized controlled trials conducted a power analysis. Only four studies with patients reported lost to follow-up provided an explanation for each patient. Six randomized controlled trials (10.3 percent) conducted intention-to-treat analysis. The mean Jadad score was 2.14 ± 1.26, with no significant improvement over time (p = 0.245).

Conclusions:
Despite the significant increase in the number of randomized controlled trials published studying surgical treatment of carpal tunnel syndrome over time, a mean Jadad score of 2.14 with no change over time indicates a need for improvement in quality. Proper study design is key to avoiding introduction of bias and ensuring the validity of conclusions drawn.
Component Restoration in the Unilateral Intermediate Cleft Tip Rhinoplasty: Technique and Long-Term Outcomes
Authors: Ayeroff Julia R. , Volpicelli Elizabeth J. , Mandelbaum Rachel S. , Pfaff Miles J. , Asanad Samuel , Bradley James P. , Lee Justine C. 
Published: December 2018

Background:
The intermediate cleft tip rhinoplasty is performed in childhood to address residual tip asymmetries during the most critical period of psychosocial development. The authors describe and evaluate long-term outcomes of that approach for the unilateral cleft lip and palate patient based on the concept of individual restoration of each abnormal anatomical component.

Methods:
Photomorphometric analyses of unilateral cleft lip and palate patients (n = 50) who underwent intermediate cleft tip rhinoplasty using the component restoration technique were evaluated preoperatively (time 0) and postoperatively at less than 1 year (time 1), 1 to 3 years (time 2), and more than 3 years (time 3) and compared to age-matched unilateral cleft lip and palate control patients. Nasal relationships (alar symmetry, nasal tip protrusion–to–alar base width ratio, and height-to-width dimensions for the cleft and noncleft nostrils) were compared over time using a linear mixed-effect model.

Results:
At time 0, both groups demonstrated similar nasal relationships, with the exception of a wider cleft-side nostril in relationship to height in the rhinoplasty group. The component restoration technique improved all four nasal relationships at all postoperative time points compared with time 0 in a statistically significant manner, whereas control patients did not demonstrate significant changes at the corresponding ages. Long-term differences at time 3 revealed a trend toward improved alar symmetry and cleft-side and non–cleft-side nostril dimensions, and a significant improvement in the nasal tip protrusion–to–alar base width ratio in intermediate cleft tip rhinoplasty–treated versus control patients (p = 0.002).

Conclusion:
The component restoration technique for the unilateral intermediate cleft tip rhinoplasty improves nasal relationships toward normal immediately and in a sustained manner for at least 3 years.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.