bluuebunny/crossref_metadata_2025_split huggingface dataset:
Personalized surveillance and aftercare for non-metastasized breast cancer: the NABOR study protocol of a multiple interrupted time series design
Authors: Klaassen-Dekker A. , Drossaert C. H. C. , Van Maaren M. C. , Van Leeuwen-Stok A. E. , Retel V. P. , Korevaar J. C. , Siesling S. ,   on behalf of the NABOR project group, Knottnerus B. , Guerrero-Paez C. , Burgers J. , Zeillemaker A. , Vrancken M. J. , Van Hezewijk M. , Siemerink E. , Honkoop A. , Veltman J. , Mann R. , Wiegersma J. , Claassen S. , Van der Lee M. , Van Uden N. 
Published: November 2023

Abstract
Background
Follow-up of curatively treated primary breast cancer patients consists of surveillance and aftercare and is currently mostly the same for all patients. A more personalized approach, based on patients’ individual risk of recurrence and personal needs and preferences, may reduce patient burden and reduce (healthcare) costs. The NABOR study will examine the (cost-)effectiveness of personalized surveillance (PSP) and personalized aftercare plans (PAP) on patient-reported cancer worry, self-rated and overall quality of life and (cost-)effectiveness.

Methods
A prospective multicenter multiple interrupted time series (MITs) design is being used. In this design, 10 participating hospitals will be observed for a period of eighteen months, while they -stepwise- will transit from care as usual to PSPs and PAPs. The PSP contains decisions on the surveillance trajectory based on individual risks and needs, assessed with the ‘Breast Cancer Surveillance Decision Aid’ including the INFLUENCE prediction tool. The PAP contains decisions on the aftercare trajectory based on individual needs and preferences and available care resources, which decision-making is supported by a patient decision aid. Patients are non-metastasized female primary breast cancer patients (N = 1040) who are curatively treated and start follow-up care. Patient reported outcomes will be measured at five points in time during two years of follow-up care (starting about one year after treatment and every six months thereafter). In addition, data on diagnostics and hospital visits from patients’ Electronical Health Records (EHR) will be gathered. Primary outcomes are patient-reported cancer worry (Cancer Worry Scale) and overall quality of life (as assessed with EQ-VAS score). Secondary outcomes include health care costs and resource use, health-related quality of life (as measured with EQ5D-5L/SF-12/EORTC-QLQ-C30), risk perception, shared decision-making, patient satisfaction, societal participation, and cost-effectiveness. Next, the uptake and appreciation of personalized plans and patients’ experiences of their decision-making process will be evaluated.

Discussion
This study will contribute to insight in the (cost-)effectiveness of personalized follow-up care and contributes to development of uniform evidence-based guidelines, stimulating sustainable implementation of personalized surveillance and aftercare plans.

Trial registration
Study sponsor: ZonMw. Retrospectively registered at ClinicalTrials.gov (2023), ID: NCT05975437.
The combination of PD-L1 expression and the neutrophil-to-lymphocyte ratio as a prognostic factor of postoperative recurrence in non-small-cell lung cancer: a retrospective cohort study
Authors: Samejima Hironobu , Kojima Kensuke , Fujiwara Ayako , Tokunaga Toshiteru , Okishio Kyoichi , Yoon Hyungeun 
Published: November 2023

Abstract
Background
While PD-L1 expression and neutrophil-to-lymphocyte ratio (NLR) are prognostic biomarkers for lung cancer, few studies have considered their interaction. We hypothesized that the product of PD-L1 expression (tumor proportion score) and the NLR (PD-L1 × NLR) might be a postoperative prognostic marker reflecting the immune microenvironment of lung cancer.

Methods
We analyzed the association between PD-L1 × NLR and postoperative recurrence-free survival in 647 patients with NSCLC using multivariable Cox proportional hazards models.

Results
In the analysis of PD-L1 × NLR as a categorical variable, the group with PD-L1 × NLR ≥ 25.8 had a significantly higher hazard ratio (HR) than the group with < 25.8 (adjusted HR 1.78, 95% confidence interval [CI] 1.23–2.60). The adjusted HR for PD-L1 × NLR, considered a continuous variable, was 1.004 (95% CI, 1.002–1.006). The risk of postoperative recurrence increased by 1.004-fold for each unit increase in PD-L1 × NLR, and a more than 2-fold increase in risk was observed for values ≥ 170.

Conclusions
PD-L1 × NLR may be used in real-world clinical practice as a novel factor for predicting the risk of postoperative recurrence after lung cancer surgery.
An explorative single-arm clinical study to assess craving in patients with alcohol use disorder using Virtual Reality exposure (CRAVE)—study protocol
Authors: Lütt A. , Tsamitros N. , Wolbers T. , Rosenthal A. , Bröcker A. L. , Schöneck R. , Bermpohl F. , Heinz A. , Beck A. , Gutwinski S. 
Published: November 2023

Abstract
Background
Alcohol use disorder (AUD) belongs to the most burdensome clinical disorders worldwide. Current treatment approaches yield unsatisfactory long-term effects with relapse rates up to 85%. Craving for alcohol is a major predictor for relapse and can be intentionally induced via cue exposure in real life as well as in Virtual Reality (VR). The induction and habituation of craving via conditioned cues as well as extinction learning is used in Cue Exposure Therapy (CET), a long-known but rarely used strategy in Cognitive Behavioral Therapy (CBT) of AUD. VR scenarios with alcohol related cues offer several advantages over real life scenarios and are within the focus of current efforts to develop new treatment options. As a first step, we aim to analyze if the VR scenarios elicit a transient change in craving levels and if this is measurable via subjective and psychophysiological parameters.

Methods
A single-arm clinical study will be conducted including n = 60 patients with AUD. Data on severity of AUD and craving, comorbidities, demographics, side effects and the feeling of presence in VR will be assessed. Patients will use a head-mounted display (HMD) to immerse themselves into three different scenarios (neutral vs. two target situations: a living room and a bar) while heart rate, heart rate variability, pupillometry and electrodermal activity will be measured continuously. Subjective craving levels will be assessed before, during and after the VR session.

Discussion
Results of this study will yield insight into the induction of alcohol craving in VR cue exposure paradigms and its measurement via subjective and psychophysiological parameters. This might be an important step in the development of innovative therapeutic approaches in the treatment of patients with AUD.

Trial registration
This study was approved by the Charité—Universitätsmedizin Berlin Institutional Review Board (EA1/190/22, 23.05.2023). It was registered on ClinicalTrials.gov (NCT05861843).
Low profile posterior lumbar-sacral interbody fusion for lumbosacral degenerative diseases: a technical note
Authors: Pan Aixing , Cheng Fengqi , Ding Zihao , Guan Li , Xie Wenguan , Hai Yong , Liu Yuzeng 
Published: November 2023

Abstract
Background
The purpose of this study was to report our surgical experience in patients with lumbosacral degenerative diseases who underwent posterior decompression and interbody fusion fixed with cortical bone trajectory screw and sacral alar screw, which is known as low-profile posterior lumbosacral interbody fusion (LP-PLSIF).

Methods
Patients with lumbosacral degenerative disease who underwent LP-PLSIF and traditional PLSIF (control group) internally fixed with pedicle screws were included retrospectively. Patients’ demographic data, operative parameters, and perioperative complications were recorded and analyzed.

Results
A total of 18 patients were enrolled in this study, which included 9 patients (5 male and 4 female) who underwent LP-PLSIF, and 9 patients (4 male and 5 female) who underwent traditional PLSIF. There wasn’t a significant difference in the average age between the two groups, 56.78 ± 10.92 years in the LP-PLSIF group and 60.22 ± 8.21 years in the PLSIF group (p = 0.460). The bone mineral density (BMD) of the two groups of patients were -2.00 ± 0.26 T and -2.13 ± 0.19 T, respectively (P = 0.239). The mean postoperative follow-up time was 12.7 months (range, 12–14 months). The mean operation time was 142.78 ± 11.21 min and 156.11 ± 13.41 min in the LP-PLSIF group and PLSIF group respectively (P < 0.05). The average blood loss was 137.78 ± 37.09 ml in the LP-PLSIF group, and 150.00 ± 27.84 ml in the PLSIF group (P = 0.441). The average postoperative drainage was 85.56 ± 37.45 ml and 122.22 ± 22.24 ml in the LP-PLSIF group and control group respectively (P < 0.05). Patients in the LP-PLSIF group had shorter incision length compared with the control group, 61.44 ± 10.56 mm vs. 74.56 ± 10.22 mm (P < 0.05). The average length of hospitalization of 11.33 ± 2.92 days in the LP-PLSIF group, and 11.11 ± 1.62 days in the PLSIF group (p = 0.844). All patients had significant improvement in VAS pain score, ODI, and JOA evaluation. However, patients in the LP-PLSIF group had better improvement in terms of VAS back pain and ODI in the short term after the operation. There were no neurological complications or wound infection. The fusion rate at the last follow-up was 100% (9 of 9) in the LP-PLSIF group, and 88.89% (8 of 9) in the control group based on CT scans. 1 patient in the control group had asymptomatic sacral pedicle screw loosening.

Conclusions
LP-PLSIF is a safe and effective surgical technique for patients with lumbosacral degenerative disease, which has the potential strength of less invasive and better clinical improvement.
A novel hypoxia-associated gene signature for prognosis prediction in head and neck squamous cell carcinoma
Authors: Luo Jingyi , Huang Yuejiao , Wu Jiahe , Dai Lin , Dong Mingyou , Cheng Bo 
Published: November 2023

Abstract
Background
Head and neck squamous cell carcinoma (HNSCC) is the most common malignant tumor of head and neck, which seriously threatens human life and health. However, the mechanism of hypoxia-associated genes (HAGs) in HNSCC remains unelucidated. This study aims to establish a hypoxia-associated gene signature and the nomogram for predicting the prognosis of patients with HNSCC.

Methods
Previous literature reports provided a list of HAGs. The TCGA database provided genetic and clinical information on HNSCC patients. First, a hypoxia-associated gene risk model was constructed for predicting overall survival (OS) in HNSCC patients and externally validated in four GEO datasets (GSE27020, GSE41613, GSE42743, and GSE117973). Then, immune status and metabolic pathways were analyzed. A nomogram was constructed and assessed the predictive value. Finally, experimental validation of the core genes was performed by qRT-PCR.

Results
A HNSCC prognostic model was constructed based on 8 HAGs. This risk model was validated in four external datasets and exhibited high predictive value in various clinical subgroups. Significant differences in immune cell infiltration levels and metabolic pathways were found between high and low risk subgroups. The nomogram was highly accurate for predicting OS in HNSCC patients.

Conclusions
The 8 hypoxia-associated gene signature can serve as novel independent prognostic indicators in HNSCC patients. The nomogram combining the risk score and clinical stage enhanced predictive performance in predicting OS compared to the risk model and clinical characteristics alone.
Separate and combined effects of famine exposure and menarche age on metabolic syndrome among the elderly: a cross-sectional study in China
Authors: Wang Congzhi , Wang Jiazhi , Wan Rui , Yuan Ting , Yang Liu , Zhang Dongmei , Li Xiaoping , Liu Haiyang , Zhang Lin 
Published: November 2023

Abstract
Background
Epidemiological studies have revealed multiple risk factors for metabolic syndrome. However, there are no consistent findings on the association between famine exposure, age at menarche, and the prevalence of metabolic syndrome. This cross-sectional study aimed to reveal the individual and combined effects of famine exposure and age at menarche on the prevalence of metabolic syndrome among elderly women.

Methods
Four thousand seven hundred seventy participants between 60 and 93 years of age were selected from the China Health and Retirement Longitudinal Study. Statistical differences between the baseline characteristics of famine exposure, age at menarche, and metabolic syndrome were evaluated using the t-test, F-test, and Chi-square test. Three multivariable-adjusted logistic regression models were used to test the association between famine exposure, age of menarche, and the odds ratio of metabolic syndrome.

Results
Two thousand one hundred ninety-eight (46.08%) participants had metabolic syndrome, while 2572 (53.92%) participants did not. Furthermore, 3068 (64.32%) women reported onset of menarche under 15 years of age, while 1702 (35.68%) women reported onset of menarche above 16 years of age. Regarding the separate association of famine exposure and age of menarche with metabolic syndrome, in model three, the adolescence/adulthood famine exposure group vs. no famine exposure group odds ratio was 2.45 (95% CI 2.02, 2.97), and the older than 16 years vs. younger than 15 years group odds ratio was 1.23 (95% CI 1.09, 1.39), which was the highest odds ratio among the three models. Regarding the combined association of famine exposure and age of menarche with metabolic syndrome, in model three, among the age of menarche ≤ 15 years group, the adolescence/adulthood famine exposure vs. no famine exposure group odds ratio was 2.45 (95% CI: 1.91, 3.14); among the menarche age ≥ 16 years group, the adolescence/adulthood famine exposure stages vs. exposed group odds ratio was 3.27 (95% CI: 2.44, 4.38), which was the highest odds ratio among the three models.

Conclusion
These findings suggested that famine exposure and age at menarche, either separately or in combination, were positively associated with the prevalence of metabolic syndrome among older women.
Health professionals’ and beauty therapists’ perspectives on female genital cosmetic surgery: an interview study
Authors: Kirkman Maggie , Dobson Amy , McDonald Karalyn , Webster Amy , Wijaya Pramasari , Fisher Jane 
Published: November 2023

Abstract
Background
Female genital cosmetic surgery (FGCS) changes the structure and appearance of healthy external genitalia. We aimed to identify discourses that help explain and rationalise FGCS and to derive from them possibilities for informing clinical education.

Methods
We interviewed 16 health professionals and 5 non-health professionals who deal with women’s bodies using a study-specific semi-structured interview guide. We analysed transcripts using a three-step iterative process: identifying themes relevant to indications for FGCS, identifying the discourses within which they were positioned, and categorising and theorising discourses.

Results
We identified discourses that we categorised within four themes: Diversity and the Normal Vulva (diversity was both acknowledged and rejected); Indications for FGCS (Functional, Psychological, Appearance); Ethical Perspectives; and Reasons Women Seek FGCS (Pubic Depilation, Media Representation, Pornography, Advertising Regulations, Social Pressure, Genital Unfamiliarity).

Conclusions
Vulvar aesthetics constitute a social construct to which medical practice and opinion contribute and by which they are influenced; education and reform need to occur on all fronts. Resources that not only establish genital diversity but also challenge limited vulvar aesthetics could be developed in consultation with women, healthcare practitioners, mental health specialists, and others with knowledge of social constructs of women’s bodies.
Factors influencing multicultural acceptance of Korean nursing students
Authors: Gu Minkyung , Sok Sohyune 
Published: November 2023

Abstract
Background
South Korea has already become a multicultural society due to immigration, marriage, and employment of foreigners, and the use of medical institutions by foreigners is increasing. In order to establish a therapeutic rapport relationship with foreigners, it is necessary to study multicultural acceptance. This study aimed to examine and identify the factors influencing the degree of multicultural acceptance of Korean nursing students.

Methods
This study used a cross-sectional descriptive design. Study participants included 147 nursing students at University in Seoul or Gyeonggi-do, South Korea. Data included demographics, multicultural acceptance, cultural empathy, and multicultural attitude. Data were collected from March to June 2021. Data was analyzed using linear regression model in SPSS PC + version 23.0 statistical software program.

Results
The adjusted R-squared representing the explanatory power of the model was 72.5%. The strongest predictor was cultural empathy (β = 0.55, P < 0.001), followed by multicultural attitude (β = 0.26, P = 0.001), residential area where they lived for the past 5 years (β = 0.19, P = 0.001), accessibility to multicultural internet and media (β = 0.17, P = 0.003), whether they have foreign friends (β = 0.16, P = 0.003), and multicultural education experience (β = 0.02, P = 0.002).

Conclusion
This study suggests that to improve the degree of multicultural acceptance of Korean nursing students, their cultural empathy and multicultural attitude should be strengthened. Nurses need to pay attention the influencing factors to improve the multicultural acceptance of Korean nursing students.
Effect of an educational program about mentorship competencies on nurse mentors’ performance: a quasi-experimental study
Authors: Hagrass Heba Moussa , Ibrahim Sanaa Abd El-Azeem , Anany Rasha Ibrahim El-Sayed , El-Gazar Heba E. 
Published: November 2023

Abstract
Background
Mentorship is a vital part of the nursing profession to improve role transition, job satisfaction, and job retention while facilitating socialization, emotional well-being, and the acquisition of new skills.

Aim
The present study aimed to evaluate the effect of an educational program about mentorship competencies on nurse mentors’ performance at Port Said Healthcare Authority hospitals.

Methods
A quasi-experimental study design (pre-test and post-test one group) was used to conduct the study at seven Healthcare Authority hospitals in Port Said Governorate, Egypt. The study subjects were consisted of a purposive sample of 30 nurse mentors and 60 intern nursing students. Data were collected using three tools consisted of the Mentor Knowledge Questionnaire, Mentor Competencies Instrument (MCI), and Nurse Mentor Performance Assessment. Data analysis was performed using SPSS version 20, Student’s t-test was used to measure differences between the pretest and post-test, and Qualitative categorical variables were compared using the chi-square test. A significant level value was considered when the p-value ≤ 0.05, and Cohen’s d was used to measure the effect size.

Results
the post-test scores of mentorship competencies and performance after implementation of the educational program significantly improved in the studied nurse mentors 56.1 ± 13.2, 60.5 ± 4.9 compared with pre-test scores with 37.1 ± 4.1, 49.7 ± 6.9 (P < 0.001). As determined by Cohen’s d test, the effect size of an educational program is quite large on the nurse mentors’ performance.

Conclusion
The educational program about mentorship competencies was significantly improve mentorship performance of the studied nurse mentors. The study recommended dissemination and generalization of the new and innovative mentorship program to the different stages of nursing education to foster the continued growth and development of nurse mentors and nurse students. Also, recommended developing a valid mentor assessment instrument consisting of and specific to the Egyptian context to assess the Egyptian mentorship model.

Trial Registration Number (TRN)
The study protocol was approved by the Research Ethics Committee of the Faculty of Nursing, Port Said University (code number: NUR 13/2/2022) [10].
Nursing students’ attitudes towards the use of digital technology in the healthcare of older adults- a cross-sectional study in Norway and Sweden
Authors: Leonardsen Ann-Chatrin Linqvist , Hardeland Camilla , Hallgren Jenny , Femdal Ingrid , Thapa Dip Raj , Helgesen Ann Karin , Bååth Carina , Halvorsrud Liv , Grøndahl Vigdis Abrahamsen , Gillsjö Catharina 
Published: November 2023

Abstract
Background
Implementation of digital technology has been suggested as a potential solution to future healthcare challenges. Healthcare personnel’s attitudes are important in the acceptance and implementation of digital technologies.

Aim
The aims of this study were to (1) translate and validate two different questionnaires to Norwegian and Swedish respectively, and then (2) use these to examine nursing students’ attitudes towards digital technology in healthcare, as well as their attitudes towards older adults’ abilities to use digital technology.

Design
Cross-sectional.

Methods
A web-based questionnaire was distributed in first year nursing students in a Norwegian and a Swedish university college, respectively. The questionnaire consisted of the short form of the ‘Information Technology Attitude Scales for Health (ITASH)’ and the ‘Attitudes Towards Older Adults Using Digital technology (ATOAUT-11)’ questionnaire. The questionnaires were translated and validated in both countries. Frequencies, Student’s t-test, and one-way ANOVA were used to analyze the data.

Results
In total 236 students responded to the questionnaire in the period September 2022 to April 2023. Students mainly reported positive attitudes towards digital technology use in general. They most agreed with the items ‘Using digital technology devices makes my communication with other health professionals faster’, ‘The sort of information I can get from the digital technology devices helps me give better care to patient’, and ‘Digital technology skills are becoming more and more necessary for healthcare professionals’. However, they reported more negative attitudes towards older adults using digital technology. They most agreed with the items ‘One needs a lot of patience to explain to an older adult how to use digital technologies’, ‘It’s hard to explain to older adults how to use digital technology’, ‘Using digital technology is harder for most older adults’, and ‘Most older adults fear using digital technology because they fear of being scammed or cheated’.

Conclusion
The ITASH and the ATOAUT-11 is appropriate for use in a Norwegian and Swedish setting. Even if nursing students are positive to digital technology in healthcare in general, they are sceptical to older adults using digital technology. This may impact on their attitudes to using digital technology in the healthcare of older adults. These aspects need emphasis when revising nursing education curricula focusing on developing technological competencies in nursing, and gaining knowledge regarding older adults’ use of digital technology.