bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cutaneous Manifestations of Sexually Transmitted Infections
Authors: Stuhlman Meredith , Farmer Cameron , Welch Elizabeth J. , Russell Nancy G. 
Published: September 2024

ABSTRACT
Mucocutaneous manifestations of human papillomavirus (HPV) are common and vary in presentation, depending on HPV type and anatomical site. It is important for nurses to understand common presentations of HPV on the skin and identify these in practice. This article reviews the epidemiology and pathophysiology of common mucocutaneous manifestations of HPV as well as current treatment recommendations, risk factors, and prevention strategies.
Remifentanil Target-controlled Infusion Versus Standard of Care for Conscious Sedation During Ultrasound-guided Transbronchial Needle Aspiration and Biopsy
Authors: Scarlata Simone , Scaduto Valentina , Paglione Lucio , Pascarella Giuseppe , Strumia Alessandro , Bruno Federica , Antonelli Incalzi Raffaele , Carassiti Massimiliano , Agrò Felice Eugenio , Costa Fabio 
Published: September 2024

Background:
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has become an important tool in the diagnosis and staging of mediastinal lymph node lesions in lung cancer. Adequate sedation is an important part of the procedure as it provides patient comfort and potentially increases diagnostic yield. The sedation modality varies among centers and includes moderate sedation/conscious sedation, deep sedation, and general anesthesia. The object of this study will be the evaluation of patient’s comfort and level of satisfaction with the involved health care providers (bronchoscopist and anesthesiologist) of remifentanil administration in target-controlled infusion (TCI) for conscious sedation in patients undergoing EBUS‑TBNA, with a prospective randomized study design versus the of standard sedation protocol with midazolam and/or fentanest and/or propofol.

Methods:
This study was carried out at the “Campus Biomedico di Roma” University Hospital between September 2021 and November 2021, with a total number of 30 patients enrolled who met the eligibility criteria, randomly divided into 2 groups: group 1 “REMIFENTANIL TCI” (experimental group) where the patients performed the EBUS-TBNA procedure under conscious sedation with infusion of remifentanil TCI with a target between 3 ng/mL and 6 ng/mL and group 2 “STANDARD” (control group) with patients undergoing conscious sedation with the association of midazolam and/or fentanest and/or propofol in refracted boluses based on clinical needs. Complications, safety, and level of satisfaction of the operator, the anesthesiologist, and the patient were evaluated.

Results:
The results show that sedation with remifentanil in TCI can improve the comfort level of patients, reducing the risks associated with the procedure (lower frequency of oversedations and hypotension), allowing for greater intraprocedural safety. Furthermore, the level of satisfaction of the anesthesiologist and that of the operator appears to be significantly higher in the Remifentanil group.

Conclusion:
The execution of a mild to moderate sedation with Remifentanil in TCI in patients undergoing EBUS is safe, tolerated, and allows to obtain greater intraprocedural comfort. Further studies and larger and more representative samples are obviously needed to confirm and strengthen the validity of a remifentanil TCI-based sedation in endoscopic diagnostics.
Videodistraction to reduce agitation in elderly patients in the emergency department: an open label parallel group randomized controlled trial
Authors: Güvec Enver , Koedel Uwe , Horster Sophia , Pedersen Vera , Völk Stefanie , Waldow Michaela , Weber Florian , Klein Matthias 
Published: September 2024

Background and importance
Agitation of elderly patients in the emergency department (ED) often complicates workup and therapy.

Objective
In this study, we investigated if agitation in the ED can be reduced by showing calming video sequences in elderly agitated patients.

Designs
Prospective randomized intervention study.

Settings and participants
ED patients aged ≥65 years were screened for the risk of agitation/delirium using the 4-A’s test (4-AT) test. In case of ≥4 4-AT points, patients were scored using the Richmond Agitation-Sedation Scale (RASS) and the Nursing Delirium Screening Scale (Nu-DESC). They were included in the study if RASS was ≥+2 and Nu-DESC ≥ 4 after informed consent of the legal representative. Patients were then randomized to the intervention or control group. A total of n = 57 patients were included in the study.

Intervention
Patients in the intervention group were exposed to projections of calming video sequences for 60 min. Patients in the control group received standard care.

Outcome measures and analysis
Changes in RASS and Nu-DESC were assessed 30 and 60 min after the intervention was started.

Main results
A total of 57 patients were included in the study, with 30 patients in the intervention group and 27 patients in the control group. Before the intervention, the median (interquartile range) RASS scores were comparable between the intervention group [3 (2–3)] and the control group [3 (2–3)]. After 30 min of exposure to calming video sequences, patients in the intervention group showed significantly lower RASS and Nu-DESC scores compared to the control group [RASS: 1 (0–1) vs. 2 (1.5–3), P < 0.001; Nu-DESC: 3 (2–4) vs. 5 (4–6), P < 0.001]. This difference persisted at 60 min [RASS: 0 (0–1) vs. 2 (1–2.5), P < 0.001; Nu-DESC: 2 (2–3) vs. 5 (4–6), P < 0.001]. Additionally, fewer patients in the intervention group required additional sedating or antipsychotic medication (1/30) compared to the control group (9/27), with this difference being statistically significant (P = 0.004).

Conclusion
In this randomized controlled trial, the use of calming video sequences in elderly patients with agitation in the ED resulted in significant reductions in agitation and the need for additional sedative or antipsychotic medication.
Path Analysis: Interrelationships Between Nurse Manager Competencies, Practice Environment Perceptions, and Frontline Nurses' Intent to Stay
Authors: Pabico Christine , Park Shin Hye , Swartwout Ellen , Warshawsky Nora E. 
Published: September 2024

OBJECTIVE
To examine the correlation between nurse manager (NM) competencies, work environment (Practice Environment Scale of the Nursing Work Index [PES-NWI]), and frontline nurses' intent to stay; the direct effect of NM competency on frontline nurses' intent to stay; and the indirect effect of NM competency on frontline nurses' intent to stay, mediated by PES-NWI.

BACKGROUND
PES-NWI and NMs' competency can impact frontline nurses' intent to stay.

METHODS
Cross-sectional study with secondary analysis of NM Competency and NDNQI® (National Database of Nursing Quality Indicators®) RN Survey data with path analysis for effects of the model's variables.

RESULTS
Positive, weak correlations between NM competencies and frontline nurses' practice environments were found; NM competencies and frontline nurses' intent to stay were not correlated. Paths were NM competency/PES-NWI (β = 0.20, P = 0.001) and PES-NWI/intent to stay (β = 0.55, P < 0.001); NM competency/intent to stay was not significant. Indirect effect of NM competency on frontline nurses' intent to stay was mediated through PES-NWI (β = 0.11, P = 0.002; 95% confidence interval, 0.05-0.17).

CONCLUSIONS
Investing in NMs' competency can help create supportive work environments and frontline nurses' intent to stay.
Accredited Public Health Department Characteristics Associated With Workforce Gaps Identified in Workforce Development Plans
Authors: Burns Ashlyn , Kampman Haleigh , Karnik Harshada , Leider Jonathon P. , Yeager Valerie A. 
Published: September 2024

Objective:
When pursuing accreditation by the Public Health Accreditation Board, local health departments (LHDs) must submit a workforce development plan (WDP). The purpose of this study was to examine LHD characteristics associated with workforce gaps identified and strategies implemented by LHDs.

Design:
We conducted a qualitative content analysis of all WDPs submitted to the Public Health Accreditation Board between March 2016 and November 2021.

Setting:
We examined WDPs from all accredited LHDs (n = 183) at the time of data collection in January 2022. A majority of LHDs had more than 50 staff members (n = 106, 57.9%), had a decentralized governance structure (n = 164, 89.6%), had county-level jurisdictions (n = 99, 54.1%), and served rural populations (n = 146, 79.8%).

Main Outcome Measures:
For each overarching theme, we constructed 2 binary variables indicating whether the LHD identified a workforce gap or strategy among any subthemes within each overarching theme. Logistic regressions were used to examine relationships between LHD characteristics and identification of a workforce gap or strategy for each theme.

Results:
Few LHD characteristics were significantly associated with gaps identified or strategies implemented by LHDs. LHDs applying for reaccreditation had higher odds (adjusted odds ratio [AOR], 2.44; confidence interval [CI], 1.04-5.83) of identifying a leadership gap and of identifying a recruitment gap (AOR, 2.94; CI, 1.11-7.52) compared to LHDs applying for accreditation for the first time. LHDs serving urban populations had higher odds (AOR, 2.83; CI, 1.32-6.25) of identifying a recruitment strategy compared to LHDs that only served suburban/rural populations.

Conclusions:
Overall, many workforce gaps reported by LHDs were universally observed irrespective of LHD characteristics. While most LHDs identified strategies to address gaps, our findings also reveal workforce areas where LHDs reported gaps without an accompanying strategy, indicating areas where LHDs could use more technical assistance and support.
Site-Based and Digital Cohort Participation Among Transgender Women in the Eastern and Southern United States: Findings From the LITE Study
Authors: Reisner Sari L. , Humes Elizabeth , Stevenson Megan , Cooney Erin E. , Adams Dee , Althoff Keri N. , Radix Asa , Poteat Tonia C. , Mayer Kenneth H. , Cannon Christopher M. , Malone Jowanna , Wawrzyniak Andrew , Rodriguez Allan E. , Schneider Jason , Haw J. Sonya , Wirtz Andrea L. ,   the American Cohort to Study HIV Acquisition Among Transgender Women (LITE) Study Group
Published: September 2024

Background:
Transgender women (TW) are highly burdened by HIV. There is increasing interest in digital (ie, through Internet-based interfaces) HIV research; yet few studies have assessed potential biases of digital compared with site-based data collection. This study examined differences in characteristics between TW participating through site-based versus digital-only modes in an HIV incidence cohort.

Methods:
Between March 2018 and Aug 2020, a multisite cohort of 1312 adult TW in the eastern and southern United States was enrolled in site-based and exclusively digital modes. We evaluated differences in baseline demographics, sociostructural vulnerabilities, health care access, gender affirmation, mental health, stigma, social support, and HIV acquisition risk comparing site-based vs digital modes using χ2 tests and Poisson regression modeling with robust standard errors.

Results:
The overall median age was 28 (interquartile range = 23–35) years and more than half identified as people of color (15% Black, 13% Multiracial, 12% Another Race, 18% Latina/e/x). A higher proportion of site-based (vs. digital mode) participants resided in the northeast, were younger, identified as people of color, experienced sociostructural vulnerabilities, had a regular health care provider, received medical gender affirmation, endorsed mental health symptoms and stigma, reported HIV acquisition risk but also greater experience with biomedical HIV prevention (preexposure and postexposure prophylaxis), and had larger social networks (all P < 0.05).

Conclusions:
Site-based and digital approaches enrolled TW with different demographics, life experiences, and HIV acquisition risks. A hybrid cohort model may achieve a more diverse and potentially representative sample of TW than either site-based or online cohorts alone for HIV research.
68Ga-DOTATATE PET/CT Versus 18F-FDG PET/CT in TENIS Syndrome: A Head-to-Head Comparison With Elevated and Suppressed TSH Levels in Papillary Thyroid Carcinoma—A Pilot Study
Authors: Almeida Ludmila Santiago , Santos Allan , Assumpção Lígia , Costa Tiago Oliveira , Araujo Maidane , Lima Mariana , Zantut-Wittmann Denise Engelbrecht , Etchebehere Elba 
Published: September 2024

Background
TENIS syndrome is characterized by reduced expression of sodium-iodine symporter, rising serum thyroglobulin (Tg) levels, and negative whole-body 131I scans. In such patients, somatostatin receptor imaging with 68Ga-DOTATATE PET/CT (somatostatin receptor [SSR] PET/CT) and 18F-FDG PET/CT (FDG PET/CT) can identify metastases and were compared under 2 conditions: elevated (eTSH) and suppressed (sTSH) TSH serum levels. Potential candidates for peptide receptor radionuclide therapy (PRRNT) were identified in 15 patients prospectively enrolled. All patients underwent 4 examinations. Images were blindly evaluated for differences in SUVmax values and lesion detectability. Reference standard consisted of neck ultrasound, CT, MRI, PET/CT, biopsy, and follow-up. Three patients were received PRRNT.

Results
sTSH SSR PET/CT detected a greater number of cervical (P = 0.0253 and P = 0.0176) and distant LNs (P = 0.0253 and P = 0.0391) when compared with sTSH FDG PET/CT, respectively, in a per-patient and on a per-lesion based analysis. Likewise, eTSH SSR PET/CT detected a greater number of patients with local recurrences (P = 0.0455) and distant LN metastases (P = 0.0143). Per-lesion analysis revealed greater number of cervical and distant LNs (P = 0.0337 and P = 0.0039, respectively) when compared with eTSH FDG PET/CT. There was no difference in detection of distant metastases by both tracers for lung and bone metastases (κ = 1). Both skeletal and pulmonary lesions were also detected by conventional CT part of FDG or DOTATATE PET/CT scans. TSH stimulation had no additional value in a per-patient analysis for both FDG and DOTATATE PET scans (κ varying from 0.6087 to 1). However, TSH stimulation led to more lesion identifications in DOTATATE PET/CT; most of those metastases were not confirmed by the reference standard leading to a decrease in specificity (84% vs 74%). One of 3 patients submitted to 3 cycles of PRRNT presented with a visual partial response, a 20% reduction in quantitative analyses, and stable disease regarding Tg and TgAb levels.

Conclusions
Patients with TENIS syndrome can be imaged with SSR PET/CT as well as FDG PET/CT with high overall accuracy regardless of TSH levels (86% to 92% and 92% to 85%, respectively, with eTSH and sTSH). SSR PET/CT detected a greater number of locoregional and distant LN metastases than FDG PET/CT with both sTSH and eTSH. One of 3 patients submitted to PRRNT presented a partial response to treatment. Our findings may impact in patient restaging, management, and theranostics strategies with radiolabeled somatostatin analogs.
Classification and Treatment of Complications Related to Titanium and Biodegradable Miniplates Using the Lip-Split Transmandibular Approach for Oral and Oropharyngeal Oncological Surgery
Authors: Chen Wei-liang , Tao Yu-peng , Huang Zi-xian , Chen De-tao 
Published: September 2024

Background:
There is a lack of classified definitions and corresponding treatment principles for complications related to titanium miniplate (TMP) and biodegradable miniplate (BMP).

Aims:
This study proposes a classification system for complications related to TMP and BMP osteosynthesis and evaluates the effectiveness of the classification system in the treatment of the complications.

Methods:
One hundred forty-two patients with advanced-stage oral cavity and oropharynx squamous cell carcinoma (SCC) underwent oncological surgery via lip-split transmandibular (LTM) approach including midline, paramedian, stair-step, and triangle. 54.9% of patients were treated with TMP, and 45.1% were treated with BMP for osteosynthesis. The classification of complications is divided into grades 0, 1, 2, and 3. Grade 0 is defined as having no complications. The evaluation criteria for treating complications were significant improvement, partial improvement, and no improvement.

Results:
All patients underwent en bloc resection of the tumor with histologically negative margins via the LTM approach. The overall success rate of the flap is 98.6%. 25.3%, 48.6%, 14.8%, and 11.3% of patients were treated with midline, paramedian, stair-step, and triangular osteotomy approaches, respectively. A significant increase in the number of paramedian osteotomies was observed compared with other types of osteotomy (P < 0.05). Grades 0, 1, 2, and 3 developed in 54.2%, 12.0%, 14.8%, and 19.0% of patients, respectively. No significant differences in the grade of complications were observed between the TMP group and the BMP group. Sixty-five patients with complications, grades 1, 2, and 3 occurred in 26.2%, 32.3%, and 41.5% of patients. The midline, paramedian, stair-step, and triangle osteotomy approaches were used in 26.1%, 47.7%, and 10.8%, respectively. The incidence of complications in the paramedian osteotomy was significantly higher than that in the other osteotomy (P < 0.05). 83.1% of patients showed significant improvement, 10.8% showed partial improvement, and 6.1% showed no improvement. No significant differences in the treatment outcomes were observed between the TMP group and the BMP group.

Conclusions:
The incidence of complications in paramedian osteotomy is also significantly higher than 3 types of osteotomy, and 83.1% of patients showed significant improvement in complications. The complication classification system related to TMP and BMP osteosynthesis are easy to implement and feasible in clinical practice.
A Prospective European Trial Comparing Laparotomy, Laparoscopy, Robotic-Assisted, and Transanal Total Mesorectal Excision Procedures in High-Risk Patients with Rectal Cancer
Authors: Rouanet Philippe , Guerrieri Mario , Lemercier Pablo , Balik Emre , Cotte Eddy , Spinelli Antonino , Gómez-Ruiz Marcos , Wolthuis Albert , Bertani Emilio , Dubois Anne ,   on behalf the RESET study group
Published: September 2024

Objective:
To compare total mesorectal excision (TME) techniques combined with sphincter-sparing procedure in high-risk patients (HRPs).

Background:
TME is the standard treatment for rectal cancer, but can be challenging in HRPs. The available surgical approaches must be compared, especially in HRPs.

Methods:
Prospective, observational, multicenter trial to compare laparotomy (OTME), laparoscopy (LTME), robotic-assisted surgery (RTME), and transanal surgery (TaTME) in HRPs. The composite primary outcome included circumferential radial margin (CRM) ≥1mm, TME grade II-III, and absence of Clavien-Dindo grade III-IV complications. Three propensity score analyses were performed (LTME vs. RTME, RTME vs. TaTME, LTME vs. TaTME).

Results:
1078 HRPs (75% of men, median body mass index of 27 kg/m2, 50% of tumors in the lower third of the rectum) underwent surgery. The RTME and TaTME groups included patients with more advanced and lower tumors and coloanal anastomosis (P<0.001). Operative time was longer for RTME surgery (P<0.001). Conversion rate was similar for minimally invasive procedures (4.5%). The global R0 resection rate was 96% without difference among techniques. The primary outcome rates were 82.4%, 64.3%, 74.7%, and 80.3% for LTME, OTME, RTME, and TaTME, respectively. None achieved the expected success rate (85%), and propensity score analyses found no differences. Operative results were similar between high- and low-volume inclusion centers only for RTME.

Conclusions:
The RESET trial yielded high-quality results despite focusing on HRPs. Minimally invasive procedures showed similar sphincter-sparing procedure outcomes, but LTME included patients with more favorable tumors. Oncologic and functional outcomes will be evaluated at 2 years (ClinicalTrials.gov, ID: NCT03574493).
Analysis of Surgeon and Program Characteristics Associated with Success on American Board of Surgery Examination Outcomes
Authors: Barry Carol L , Jones Andrew T , Rubright Jonathan D , Ibáñez Beatriz , Abouljoud Marwan S , Berman Russell S , Berry Cherisse , Dent Daniel L , Buyske Jo 
Published: September 2024

BACKGROUND:
Existing research exploring predictors of success on American Board of Surgery (ABS) examinations focused on either resident or residency program characteristics, but limited studies focus on both. This study examines relationships between both resident and program characteristics and ABS qualifying (QE) and certifying examination (CE) outcomes.

STUDY DESIGN:
Multilevel logistic regression was used to analyze the relationship between resident and program characteristics and ABS QE and CE first attempt pass and eventual certification. Resident characteristics were gender, international medical graduate (IMG) status, and previous performance, measured by the first attempt US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge and Step 3 scaled scores. Program characteristics were size, %female, %IMG, and program type. The sample included surgeons with QE and CE data from 2007 to 2019 and matched USMLE scores.

RESULTS:
Controlling for other variables, previous medical performance positively related to all ABS examination outcomes. The relationships between USMLE scores and success on ABS examinations varied but were generally strong. Other resident characteristics that predicted ABS examination outcomes were gender and IMG (QE first attempt pass). The only program characteristic that significantly predicted ABS outcomes was %IMG (QE and CE first attempt pass). Despite statistical significance, gender, IMG, and %IMG translated to small differences in predicted probabilities of ABS examination success.

CONCLUSIONS:
This study highlights resident and program characteristics that predict success on ABS examinations. USMLE scores consistently and strongly related to ABS examination success, providing evidence that USMLE scores relate to future high-stakes consequences like board certification. After controlling for previous performance, gender, IMG, and program %IMG significantly related to ABS examination success, but effects were small.