bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of “Magnet Journey to Nursing Excellence Program” in Russia and Armenia
Authors: Aiken Linda H. , Poghosyan Lusine 
Published: June 2009

Abstract Objective: To provide an outcomes‐evaluation of an intervention to strengthen professional nursing practice in Russian and Armenian hospitals. Design: The Nursing Quality Improvement Initiative using the ANCC Forces of Magnetism to develop professional nurse practice was implemented in four hospitals in Russia and Armenia. Cross‐sectional survey data were collected at two time points from 840 nurses in Wave 1 and 859 nurses in Wave 2. Comparisons were undertaken between targeted units in each hospital compared to nontargeted units, and each hospital served as its own control in surveys that took place in years 1 and 3 of the demonstration. Methods: Descriptive information on nurse samples was derived from survey items. Changes in characteristics of nurse practice environments, nurse‐reported patient care quality, and nurse burnout in Russia and Armenia, overall and separately for targeted and nontargeted units, were tested using chi‐square statistics and difference of means tests. Findings: Practice environment features such as nurses' involvement in hospital affairs, better collegial relationships with physicians, more support for nursing care from administrators, and continuity of nursing care improved after the intervention. Resource adequacy indicators did not change over the demonstration period. Changes in indicators of patient care quality were favorable, though differences in changes in targeted and nontargeted units were equivocal. Conclusions: Changes consistent with evolving professional nursing practice were associated with program implementation. Forces of magnetism appear to have the same potential for transforming nursing practice in countries with fewer resources as in wealthier Western countries. Clinical Relevance: Magnet Recognition, an evidence‐based best practice for improving the nursing‐care environment developed in Western countries, was feasible to implement in countries with transitioning economies, limited resources, and truncated professional nursing education.
Case Management Workforce in the United States
Authors: Park Eun‐Jun , Huber Diane L. 
Published: June 2009

Abstract Purpose: The purpose of this study was to investigate and compare characteristics of the case management (CM) workforce in the US by age, years of experience, and original profession. Design: This study was an exploratory, descriptive secondary analysis of demographic and job characteristics of 24,085 certified case managers (CCMs). Methods: Descriptive statistics, Chi‐square tests, and correlation coefficients were calculated. Findings: The majority of the case‐management workforce is made up of RNs (93.3%). The CCMs were older, with a mean age of 55.0 years, than were those in their original profession and started to work as CCMs late in their careers. The educational level of RN‐CCMs was lower than that of CCMs from other professions. Also, job titles and work settings of CCMs were diverse, with different focus areas depending on clients' needs. The distribution of CCMs was associated with the number of managed‐care enrollees. Conclusions: Profiles of CCMs in this study are valuable for clinical practice and can assist with deployment of the CM workforce. Clinical Relevance: To develop and deploy CCMs better matched to societal healthcare needs, characteristics of CCMs should be precisely understood. Managing the CM workforce is expected to be critical because of a shortage of RN workers and aging‐of‐the‐workforce issues in the US.
Nurses' Perceptions of Safety Culture in Long‐Term Care Settings
Authors: Wagner Laura M. , Capezuti Elizabeth , Rice Julie C. 
Published: June 2009

Abstract Purpose: To describe perceptions of workplace safety culture among nurses employed in long‐term care (LTC) settings. Design: A cross‐sectional survey. Respondents were licensed nurses (N=550) with membership in gerontological nursing professional organizations in the United States (n=296), Canada (n=251), and other (n=3). Methods: An anonymous, self‐administered, mail‐in questionnaire, which included the Hospital Survey on Patient Safety Culture as well as questions about individual and institutional characteristics. The survey included key aspects of safety culture, such as work setting, supervisor support, communication about errors, and frequency of events reported. Findings: Nurse‐managers reported significantly more positive safety culture perceptions compared with licensed staff nurses. Additionally, licensed nurses employed in government‐run facilities had significantly less positive safety culture perceptions compared with those working in nonprofit organizations. Conclusions: Interventions designed to improve safety culture in LTC settings should be focused on the concerns of licensed staff nurses and the improvement of communication between these nurses and their managers. Clinical Relevance: Enhancing safety culture in long‐term care settings may facilitate improvements in resident safety. Assessment of workplace safety culture is the first step in identifying barriers that nurses face to provide safe resident care.
National Validation of the NACNS Clinical Nurse Specialist Core Competencies
Authors: Baldwin Kathleen M. , Clark Angela P. , Fulton Janet , Mayo Ann 
Published: June 2009

Abstract Purpose: To validate the 75 core National Association of Clinical Nurse Specialists' (NACNS) clinical nurse specialist (CNS) competencies among practicing CNSs. Specific aims were to (a) determine the extent to which 75 core CNS competencies were used in current CNS practice, (b) determine the importance of those competencies to practicing CNSs, and (c) identify gaps between CNS core competencies and role expectations in current practice. Design: A survey design was used with both paper‐and‐pencil and online instruments. The survey included 150 items and three open‐ended questions. Methods: A convenience sampling method was used, which targeted practicing CNSs. Findings: Respondents (N=505) were practicing CNSs who entered the field as RNs between 1956 and 2006. The survey had a high degree of internal consistency reliability (0.967%) between the subscales. The 75 NACNS core competencies were found to be useful and important for CNSs. A few gaps were identified between CNS core competencies and CNS role expectations in current practice. Conclusions: No one method for validating competencies will be satisfactory for all situations; however, the processes and methods used in this study were well suited to accomplish the goal of validating CNS core competencies. The process described here may be instructive to leaders of other national and international professional organizations interested in developing and evaluating competencies. Core competencies are useful and important to currently practicing CNSs. Clinical Relevance: The CNS role is growing internationally. Core CNS competencies can be a framework for CNS role development, education, and practice. As described here, a competency validation survey is one way to assure that CNSs are meeting healthcare needs.
Trust, Mistrust, Racial Identity and Patient Satisfaction in Urban African American Primary Care Patients of Nurse Practitioners
Authors: Benkert Ramona , Hollie Barbara , Nordstrom Cheryl K. , Wickson Bethany , Bins‐Emerick Lisa 
Published: June 2009

Abstract Purpose: To analyze relationships between cultural mistrust, medical mistrust, and racial identity and to predict patient satisfaction among African American adults who are cared for by primary‐care nurse practitioners using Cox's Interaction Model of Client Health Behaviors. Design: A descriptive‐correlational study was conducted with a convenience sample of 100 community‐dwelling adults. Methods: Participants completed the Cultural Mistrust Inventory; Group Based Medical Mistrust Scale; Black Racial Identity Attitude Scale; Trust in Physician Scale; Michigan Academic Consortium Patient Satisfaction Questionnaire; and provided demographic and primary care data. Analysis: Correlations and stepwise multiple regression techniques were used to examine the study aims and correlational links between the theoretical constructs of client singularity, client‐professional interaction, and outcome. Findings and Conclusions: Cox's model indicated a complex view of African American patients’ perspectives on nurse practitioners. Participants simultaneously held moderate cultural mistrust of European American providers and mistrust of the health care system, and high levels of trust and satisfaction with their nurse practitioners. One racial identity schema (conformity) and trust of nurse‐practitioner (NP) providers explained 41% of variance in satisfaction. Clinical Relevance: An African American patient's own attitudes about racial identity and the client‐professional relationship have a significant effect on satisfaction with primary care.
Bitumen products induce skin cell apoptosis in chronically exposed road pavers
Authors: Rapisarda Venerando , Carnazza Maria L. , Caltabiano Candida , Loreto Carla , Musumeci Giuseppe , Valentino Matteo , Martinez Giuseppa 
Published: June 2009

Background:  Worker’s exposure to bitumen fumes, via inhalation and skin contamination, is related to adverse effects including an increased risk of lung, stomach and non‐melanoma skin cancers and leukaemia. The two major mechanisms regulating apoptosis include the mitochondria‐mediated intrinsic pathway and the extrinsic pathway induced by death signalling ligands. In a previous study, we showed activation of apoptosis‐regulating proteins BAX and BCL‐2 in road pavers chronically exposed to bitumen fumes. These molecules play a central role in activation of programmed cell death by the intrinsic pathway. In this study, we hypothesized that the apoptosis mechanism could be activated in the skin of road pavers chronically exposed to bitumen fumes also through the extrinsic pathway, via mediation by tumor necrosis factor‐related apoptosis‐inducing ligand (TRAIL) and its death receptor, DR5.Methods:  Skin punch biopsies from 16 occupationally exposed workers and a control group were processed immunohistochemically for TRAIL and DR5. Activation of programmed cell death was also investigated by expression of caspase‐3 and visualization of DNA strand breaks.Results and Conclusion:  TRAIL, DR5 and caspase‐3 overexpression and enhanced Terminal Deoxynucleotidyl Transferase Mediated dUTP Nick End Labeling (TUNEL) positivity were found in chronically bitumen‐exposed skin, suggesting activation of apoptosis as a defence mechanism.
Silver deposits in cutaneous burn scar tissue is a common phenomenon following application of a silver dressing
Authors: Wang Xue‐Qing , Chang Hong‐En , Francis Rod , Olszowy Henry , Liu Pei‐Yun , Kempf Margit , Cuttle Leila , Kravchuk Olena , Phillips Gael E. , Kimble Roy M. 
Published: June 2009

Background:  Silver dressings have been widely and successfully used to prevent cutaneous wounds, including burns, chronic ulcers, dermatitis and other cutaneous conditions, from infection. However, in a few cases, skin discolouration or argyria‐like appearances have been reported. This study investigated the level of silver in scar tissue post‐burn injury following application of Acticoat™, a silver dressing.Methods:  A porcine deep dermal partial thickness burn model was used. Burn wounds were treated with this silver dressing until completion of re‐epithelialization, and silver levels were measured in a total of 160 scars and normal tissues.Results:  The mean level of silver in scar tissue covered with silver dressings was 136 μg/g, while the silver level in normal skin was less than 0.747 μg/g. A number of wounds had a slate‐grey appearance, and dissection of the scars revealed brown‐black pigment mostly in the middle and deep dermis within the scar. The level of silver and the severity of the slate‐grey discolouration were correlated with the length of time of the silver dressing application.Conclusions:  These results show that silver deposition in cutaneous scar tissue is a common phenomenon, and higher levels of silver deposits and severe skin discolouration are correlated with an increase in the duration of this silver dressing application.
Hair counts in scalp biopsy of males and females with androgenetic alopecia compared with normal subjects
Authors: Aslani Fatemeh Sari , Dastgheib Ladan , Banihashemi Bibi Maryam 
Published: June 2009

Background:  Hair counts were studied in scalp biopsy specimens of androgenetic alopecia (AGA) in male and female patients. We also assessed the normal value of hair count in scalp biopsy specimen from Iranians and compared with published data.Methods:  Thirty subjects with clinically normal scalps, 25 male and 28 female patients with AGA were studied. Vertical and horizontal sections of 4‐mm punch biopsy specimens were examined at various levels from the papillary dermis to the subcutis. Hair counts of total, terminal, vellus, anagen and telogen hairs were obtained by ocular micrometer.Results:  Hair counts were not significantly different from published data in American Whites but significantly higher in Iranians compared with Koreans (p < 0.001). There was no significant difference between male and female patients with AGA. Perifollicular inflammation was lower in both the normal subjects and the patients compared with other studies.Conclusion:  In AGA patients, total and vellus hairs were lower and terminal to vellus (T:V) ratio was higher than the results of previous studies in Whites (p < 00.1). T:V ratio of control group was significantly higher in this study compared with previous published data. Perhaps the higher ratio than the reported data could means the onset of miniaturization.
Investigation of the effect of UV irradiation on DNA damage: comparison between skin cancer patients and normal volunteers
Authors: Mabruk Mohamed J. E. M. F. , Toh Lim K. , Murphy Miriam , Leader Mary , Kay Elaine , Murphy Gillian M. 
Published: June 2009

Background:  Susceptibility to environmental carcinogenesis is the consequence of a complex interplay between intrinsic hereditary factors and actual exposure to potential carcinogenic agents. Exposure to sunlight is the primary etiological agent for basal cell carcinoma (BCC).Aim:  The aim of this study was to determine the effects of different ultraviolet (UV) doses on DNA damage in epidermal keratinocytes in vivo and to elucidate if patients with BCC are more susceptible to UV‐induced DNA damage in comparison with normal healthy volunteers in response to solar simulator radiation (SSR).Materials and Methods:  Skin biopsies obtained post‐UV irradiation from both normal healthy volunteers and BCC patients were analyzed for DNA damage, using immunohistochemical approach with TDM‐2 antibody, which binds specifically to cyclobutane pyrimidine dimmers (CPDs).Results:  In both normal volunteers and BCC patients, the peak of CPD‐positive cells occurred at 4.5 h post‐SSR. There was a statistically significant difference in CPD positivity between BCC patients and normal volunteers, at time points (from 4.5 h to 48 h post‐SSR). For a given dose of SSR based on each individual minimal erythema dose (MED), a greater number of CPD‐positive cells could be shown.Conclusions:  This study has shown for the first time and in vivo in human volunteers that BCC patients are more susceptible to UV‐induced DNA damage in comparison with normal healthy volunteers.
Extra‐anogenital bilharziasis cutanea tarda revisited
Authors: Ramdial Pratistadevi K. , Calonje Eduardo , Singh Bhugwan , Sing Yetish , Govender Prashni 
Published: June 2009

Background:  Even in schistosomiasis‐endemic areas, extra‐anogenital bilharziasis cutanea tarda (E‐BCT) is rare. To date, the occurrence of E‐BCT in pre‐existing cutaneous pathology is undocumented. The study was undertaken to document the expanded clinicopathological spectrum and to comment on the putative pathogenetic mechanisms of a Schistosoma hematobium‐associated E‐BCT.Methods:  Eight‐year clinicopathological appraisal of E‐BCT.Results:  The clinical details are as follows. Seventeen specimens from 16 patients formed the study cohort. All specimens showed granulomatous inflammation with eosinophils, aggregates of terminal‐spined S. hematobium ova and variable fibrosis. Copulating worms were identified in three biopsies. In 12/16 patients, E‐BCT occurred in pre‐existing pathology, including recurrent squamous papilloma (1), bilateral hidradenitis suppurativa (1) and scar tissue (10) with 7 showing a keloidal morphology. Prior and current urinary schistosomiasis was present in nine and seven patients, respectively.Conclusion:  E‐BCT, a reflection of prior, re‐infective or inadequately treated urinary schistosomiasis, is deemed to be a function of egg‐laying consequent to the aberrant pathway of worms. Based on E‐BCT occurrence in pre‐existing extra‐anogenital cutaneous fibroinflammatory and cicatricial processes and the presence of adult worms in three extra‐anogenital biopsies in the present study, it is hypothesized that altered tissue mesenchymal repair reactions may promote extra‐anogenital cutaneous worm entrapment and egg‐laying.
Obtaining malignant melanoma indicators through statistical analysis of 3D skin surface disruptions
Authors: Ding Yi , Smith Lyndon , Smith Melvyn , Sun Jiuai , Warr Robert 
Published: June 2009

Background/purpose: It has been observed that disruptions in skin patterns are larger for malignant melanoma (MM) than benign lesions. In order to extend the classification results achieved for 2D skin patterns, this work intends to investigate the feasibility of lesion classification using 3D skin surface texture, in the form of surface normals acquired from a previously built six‐light photometric stereo device.Material and methods: The proposed approach seeks to separate MM from benign lesions through analysis of the degree of surface disruptions in the tilt and slant direction of surface normals, so called skin tilt pattern and skin slant pattern. A 2D Gaussian function is used to simulate a normal region of skin for comparison with a lesion's observed tilt and slant patterns. The differences associated with the two patterns are estimated as the disruptions in the tilt and slant pattern respectively for lesion classification.Results: Preliminary studies on 11 MMs and 28 benign lesions have given Receiver operating characteristic areas of 0.73 and 0.85 for tilt and slant pattern, respectively, which are better than 0.65 previously obtained for the skin line direction using the same samples.Conclusions: This paper has demonstrated an important application of 3D skin texture for computer‐assisted diagnosis of MM in vivo. By taking advantage of the extra dimensional information, preliminary studies suggest that some improvements over the existing 2D skin line pattern approach for the differentiation between MM and benign lesions.
Detection of basal cell carcinoma using color and histogram measures of semitranslucent areas
Authors: Stoecker William V. , Gupta Kapil , Shrestha Bijaya , Wronkiewiecz Mark , Chowdhury Raeed , Stanley R. Joe , Xu Jin , Moss Randy H. , Celebi M. Emre , Rabinovitz Harold S. , Oliviero Margarat , Malters Joseph M. , Kolm Isabel 
Published: June 2009

Background: Semitranslucency, defined as a smooth, jelly‐like area with varied, near‐skin‐tone color, can indicate a diagnosis of basal cell carcinoma (BCC) with high specificity. This study sought to analyze potential areas of semitranslucency with histogram‐derived texture and color measures to discriminate BCC from non‐semitranslucent areas in non‐BCC skin lesions.Methods: For 210 dermoscopy images, the areas of semitranslucency in 42 BCCs and comparable areas of smoothness and color in 168 non‐BCCs were selected manually. Six color measures and six texture measures were applied to the semitranslucent areas of the BCC and the comparable areas in the non‐BCC images.Results: Receiver operating characteristic (ROC) curve analysis showed that the texture measures alone provided greater separation of BCC from non‐BCC than the color measures alone. Statistical analysis showed that the four most important measures of semitranslucency are three histogram measures: contrast, smoothness, and entropy, and one color measure: blue chromaticity. Smoothness is the single most important measure. The combined 12 measures achieved a diagnostic accuracy of 95.05% based on area under the ROC curve.Conclusion: Texture and color analysis measures, especially smoothness, may afford automatic detection of BCC images with semitranslucency.
Sagging of the cheek is related to skin elasticity, fat mass and mimetic muscle function
Authors: Ezure T. , Hosoi J. , Amano S. , Tsuchiya T. 
Published: June 2009

Background/purpose: Facial sagging is associated with aging, although the mechanism remains unclear. The aim of this study was to investigate the mechanism of facial sagging by examining the relationship of sagging severity to changes of skin elasticity, fat mass and facial muscle function at the cheek.Methods: Faces of 108 healthy Japanese female volunteers, aged 20–60 years were photographed at an angle of 45°. Standard scores of sagging severity were established by analyzing the photographs. We examined the correlations of scored sagging levels with skin elasticity measured with a Cutometer MPA 580®, fat content estimated by bioelectrical impedance analysis and facial muscle function (lip sealing force and occlusal force) in middle‐aged female volunteers (30–40 years) with a wide range of sagging scores.Results: Because the upper, lower and lateral areas in the cheek may show severe sagging, a six‐grade score of sagging severity was separately established for each area. Each score was significantly correlated positively with age (20–60 years). In middle‐aged volunteers, the sagging scores in all three areas of the cheek were significantly and negatively associated with skin elasticity. Body fat percentage was significantly and positively correlated with the sagging scores in the lower and lateral areas, although the correlation was only weakly positive in the upper area. Mimetic muscle function, measured in terms of lip sealing pressure, was significantly and negatively correlated with the sagging score only at the upper area of the cheek, but masticatory muscle function, measured in terms of occlusal force pressure, was not associated with the sagging score.Conclusions: Sagging may be associated with the reduction of skin elasticity and mimetic muscle function and increase of fat mass, but the relationships are different in different areas of the cheek.