bluuebunny/crossref_metadata_2025_split huggingface dataset:
From Relational Uncertainty to Interpersonal Sensitivity
Authors: Rojas Reyes Jennifer , Arias-Rojas Mauricio 
Published: February 2023

Abstract

AIM
The aim of our study was to understand how nursing students develop interpersonal competencies during a faculty-supervised practicum.

BACKGROUND
Researchers have studied the interpersonal competencies of nursing students in a fragmented way.

METHOD
A constructivist grounded theory approach was used for the study.

RESULTS
Four categories emerged from the data: Coping With Practicum-Related Challenges and Insecurities, Learning to Identify the Interpersonal Dimension of Nursing Care, Pedagogical Influence: Promoting (De)constructive Processes for Learning and Care, and Transforming the Self as a Nurse Through Interpersonal Relationships. A core category, From Relational Uncertainty to Interpersonal Sensitivity: A Transition of the Nursing Self Within Reflective Environments of Practice, also emerged.

CONCLUSION
The interpersonal competencies of nursing students develop in reflective environments within practicums because of interactions with patients and under the influence and modeling of the educator. Acknowledging the importance of interactions with the educator and patients within practicums can contribute to promoting more thoughtful follow-up processes from educators.
Development of Nurse Practitioner Student Self-Perception of Clinical Reasoning and Diagnostic Ability
Authors: Cantero Deborah , Comer Linda , Radecki Melissa 
Published: February 2023

Abstract
Nurse practitioner faculty identified student struggles to gain diagnostic reasoning competence. The National Council of State Boards of Nursing developed a clinical judgment action model (CJAM) for the NCLEX (NextGen) that can be used in prelicensure nursing education to design educational interventions and has potential applicability toward diagnostic reasoning development in nurse practitioner students. The purpose of this project was to evaluate the impact of a didactic education intervention aligned with the CJAM on the development of clinical reasoning cognitive skills. The use of the CJAM demonstrated a positive outcome among nurse practitioner students in clinical reasoning development.
Effect of Telerehabilitation Versus In-Clinic Rehabilitation Delivery on Self-Efficacy in Breast Cancer–Related Lymphedema
Authors: Helm Erin E. , Crowley Brenda , Crowell Tara L. , Galantino Mary Lou 
Published: February 2023

Background:
Individuals with breast cancer–related lymphedema (BCRL) require self-management strategies to reduce risk of infection, exacerbation, and/or progression of lymphedema. The coronavirus pandemic thrust the medical field into the world of telehealth; both patients and providers were forced to reduce in-person treatments and engage in this new platform of rehabilitation delivery. The role of telehealth in promotion of self-management for BCRL is unknown.

Purpose:
This study examines self-efficacy during cancer rehabilitation for in-clinic versus telehealth visits among individuals with BCRL during the pandemic quarantine April to November 2020.

Methods:
Forty women who recently completed oncology rehabilitation for BCRL were asked to complete demographics and 2 Likert surveys, including the Exercise Self-Efficacy Scale (ESES) and the Self-Care Self-Efficacy Scale (SCSE), to compare the efficacy of telehealth versus in-person treatment modalities.

Results:
Thirty-two participants completed the survey and indicated that the percentage of telehealth visits was less than face-to-face visits. Despite this, the participants indicated numerous positive moderately strong correlations between self-care self-efficacy and exercise self-efficacy for both types of visits (P < .05).

Limitations:
Self-report surveys by a convenience sample, multifactorial characteristics of rehabilitation treatment across modes, and varying severity of lymphedema may limit study findings.

Conclusion:
Telehealth provided safe and effective care to participants and bolstered confidence in self-care and self-management of BCRL. Data support that telehealth visits can be considered an essential part of comprehensive cancer rehabilitation care. Future research is needed to establish and optimize practice guidelines in both health delivery systems.
Development and Validation of a Novel Instrument to Measure the Community Well-Being of Residency Programs
Authors: Vermette David , Reardon Juliann L. , Israel Hayley P. , Zhen Shirley , Windish Donna M. , White Marney A. 
Published: February 2023

Purpose
To develop and validate the Residency Community Well-Being (RCWB) instrument, a novel instrument to measure the subjective community well-being of an individual residency program, and to explore differences in RCWB scores between demographic groups.

Method
An initial questionnaire to measure a residency program’s community well-being was developed after literature review. Items were pilot tested, and the questionnaire was reviewed by experts in the fields of residency education, survey design, and sociology. The questionnaire was administered electronically between March and July 2021 to U.S. residents in 18 specialties recruited through convenience and snowball sampling using social media, a listserv, and personal emails to residency program leaders. Three previously validated instruments were administered as well to examine criterion validity: the Professional Fulfillment Index, the Brief Inventory of Thriving, and a single-item burnout measure. Data were analyzed with descriptive statistics, and exploratory factor analysis was performed using principal axis factoring with direct oblimin rotation to reduce the items and identify subscales.

Results
Of the 366 participants who opened and started the survey, 219 completed it (completion rate: 59.8%). Most respondents were women (133, 60.7%), 26–30 years old (132, 60.3%), and White (149, 68.0%). Three subscales emerged with 18 items: program leadership, structures, and practices (PLSP); resident interpersonal relationships (RIR); and resident mistreatment (RM). The Cronbach’s alphas were 0.96 for PLSP, 0.92 for RIR, 0.82 for RM, and 0.95 for the overall RCWB. RCWB score positively correlated with professional fulfillment (r = .52, P < .001) and thriving (r = .45, P < .001) and inversely correlated with burnout (r = −.39, P < .001).

Conclusions
The RCWB instrument demonstrates strong internal consistency and content and criterion validity that shows that a residency program’s subjective community well-being is primarily composed of program leadership quality, supportive interpersonal relationships, and the absence of mistreatment.
Is a Patient Blood Management programme economically reasonable?
Authors: Hof Lotta , Choorapoikayil Suma , Meybohm Patrick , Zacharowski Kai 
Published: February 2023

Purpose of review
The value of healthcare is defined as the achieved health outcome in relation to the incurred costs. Patient Blood Management (PBM) is a multidisciplinary, evidence-based and patient-centred concept to optimize the patient's red blood cell mass, minimize blood loss and bleeding and secure the physiological reserve, including the promotion of evidence-based transfusion strategies. This review describes the healthcare value and cost effectiveness of individual PBM measures as well as the implementation of comprehensive PBM programmes.

Recent findings
Overall, measures improving surgical outcome and reducing hospital length of stay, such as intravenous iron supplementation in iron deficient anaemic patients, use of antifibrinolytic agents for the treatment of bleeding, use of cell salvage, restrictive transfusion strategy, are associated with cost savings.

Summary
Although several individual PBM measures have been shown to be effective and cost-efficient, it remains challenging to compare the results among differing healthcare systems.
Cannabis Use Disorder Treatment Preferences: A Pilot Survey in Current Users of Cannabis
Authors: Lile Joshua A. , Turner Brian W. , Cox David H. , Bonn-Miller Marcel O. , Katz Ned R. , Shellenberg Thomas P. , Stoops William W. , Strickland Justin C. 
Published: February 2023

Objectives
Highly effective treatments for cannabis use disorder (CUD) are lacking, and patient preferences have not been considered during treatment development. We therefore conducted an exploratory crowdsourced survey of individuals reporting current cannabis use and a willingness to cut down or quit their cannabis use, to determine their interest in various treatment aspects.

Methods
Subjects (n = 63) were queried about their willingness to take medications as a function of type, route, and regimen and to participate in adherence monitoring. Subjects were also asked about their willingness to engage in behavioral/psychosocial interventions as a function of type, setting, and duration. Measures theorized to be associated with treatment preferences were also collected, including cannabis use variables, readiness to change, reduction or cessation goal, perceived cessation barriers, and medication use beliefs and behaviors.

Results
Survey responses indicated that efforts to develop CUD medications should focus on nonsynthetic compounds administered orally or by mouth spray no more than once per day to maximize patient acceptance. Remote adherence monitoring and one-on-one outpatient behavioral treatment approaches, especially contingency management, are also anticipated to enhance participation. Most subjects indicated a preference to reduce their cannabis use rather than quit.

Conclusions
These data provide guidance for the development of CUD interventions based on the preferences of individuals interested in treatment for their cannabis use. Additional research is needed to confirm these results in a larger sample and determine if matching CUD patients with their preferred treatments improves success rates.
Individuals Reporting Past 3-month Smoked Stimulant Use Are Placed at Risk for Infection and Injury Amid COVID-19
Authors: Applewhite Dinah , Regan Susan , Mackin Sarah , Schmidt Clare , Duffy Jim , Washington Kenneth , Micklos Nathaneal , Casey Sarah , Sawyer Samantha , Kehoe Laura , Howard Sydney , Yacorps Giovanie , Wakeman Sarah E. 
Published: February 2023

Objectives
Smoking stimulants, such as methamphetamine and “crack” cocaine, can spread infections, including hepatitis C and COVID-19, and lead to injuries, particularly when individuals share or use makeshift pipes. The purpose of the study was to assess the practices of people who inhale (“smoke”) stimulants to guide future clinical harm reduction efforts.

Methods
Anonymous surveys were administered to participants reporting inhalation of crack cocaine and/or methamphetamine in the past 3 months. Participants were eligible if they sought services from an outreach team staffed by a municipal syringe service program (SSP) or if they were patients at a low-threshold substance use disorder treatment program, the Massachusetts General Hospital Bridge Clinic.

Results
The survey was administered to 68 total participants, 30% of whom were recruited in the Massachusetts General Hospital Bridge Clinic and 70% through SSP outreach. Unsafe smoking practices were reported by 93% of participants. Among the 46% of participants surveyed who both smoked and injected stimulants, 61% of those participants stated that they injected instead of smoked stimulants because of lack of access to pipes. Amid COVID-19, 35% of participants adopted safer smoking practices. Most participants reported that they would be more likely to attend an SSP or health center if pipes were provided.

Conclusions
Inhalational practices that place participants at risk of injury and illness are common. Providing safer smoking equipment may promote health and engage individuals in care.
Extended-release Naltrexone Is Not Linked to Hepatotoxicity in Adults Experiencing Homelessness and Alcohol Use Disorder
Authors: Vutien Philip , Kim Nicole J. , Merrill Joseph O. , Duncan Mark H. , Ioannou George N. , Collins Susan E. 
Published: February 2023

Objectives
The use of extended-release naltrexone (XR-NTX) as treatment for alcohol use disorder (AUD) has been limited by a prior black box warning for hepatotoxicity. We performed a secondary analysis of data from a randomized clinical trial to compare serum liver enzyme levels for those randomized to XR-NTX versus placebo.

Methods
The parent study aimed to test the efficacy of combined pharmacobehavioral harm-reduction treatment in improving alcohol and quality-of-life outcomes for adults experiencing homelessness and AUD. We compared the 2 arms that received intramuscular injections of either 380 mg XR-NTX (n = 74) or placebo (n = 77). Outcomes included (a) liver enzyme levels and (b) liver enzyme values categorized as normal (<1× upper limit of normal [ULN]), elevated (1–3× ULN), or high (>3× ULN). We performed multinomial logistic regression and negative binomial generalized estimating equations modeling to assess the effects of treatment group and the time × treatment group interaction on liver enzyme outcomes.

Results
The mean age was 47.9 ± 9.9 years, and the mean baseline alcohol consumption was 23.2 ± 14.0 drinks per day. There were no significant differences in the development of liver enzyme elevations 1 to 3× ULN or more than 3× ULN (all Ps > 0.25) or in the change in liver enzyme values (all Ps > 0.41) between the placebo and the XR-NTX groups over the treatment course.

Conclusions
In our study of adults experiencing homelessness and AUD, receipt of XR-NTX was not associated with hepatotoxicity. These findings support the use of XR-NTX to treat AUD even in patients who are drinking heavily and physiologically dependent on alcohol.
Comparative Study of Opioid Initiation With Tramadol, Short-acting Hydrocodone, or Short-acting Oxycodone on Opioid-related Adverse Outcomes Among Chronic Noncancer Pain Patients
Authors: Acharya Mahip , Hayes Corey J. , Li Chenghui , Painter Jacob T. , Dayer Lindsey , Martin Bradley C. 
Published: February 2023

Objective:
To compare the safety profiles of low and high-dose tramadol, short-acting hydrocodone, and short-acting oxycodone therapies among chronic noncancer pain individuals.

Materials and Methods:
A retrospective cohort study of individuals with back/neck pain/osteoarthritis with an initial opioid prescription for tramadol, hydrocodone, or oxycodone was conducted using IQVIA PharMetrics Plus claims for Academics database (2006 to 2020). Two cohorts were created for separately studying opioid-related adverse events (overdoses, accidents, self-inflicted injuries, and violence-related injuries) and substance use disorders (opioid and nonopioid). Patients were followed from the index date until an outcome event, end of enrollment, or data end. Time-varying exposure groups were constructed and Cox regression models were estimated.

Results:
A total of 1,062,167 (tramadol [16.5%], hydrocodone [61.1%], and oxycodone [22.4%]) and 986,809 (tramadol [16.5%], hydrocodone [61.3%], and oxycodone [22.2%]) individuals were in the adverse event and substance use disorder cohorts. All high-dose groups had elevated risk of nearly all outcomes, compared with low-dose hydrocodone. Compared with low-dose hydrocodone, low-dose oxycodone was associated with a higher risk of opioid overdose (hazard ratio: 1.79 [1.37 to 2.33]). No difference in risk was observed between low-dose tramadol and low-dose hydrocodone (hazard ratio: 0.85 [0.64 to 1.13]). Low-dose oxycodone had higher risks of an opioid use disorder, and low-dose tramadol had a lower risk of accidents, self-inflicted injuries, and opioid use disorder compared with low-dose hydrocodone.

Discussion:
Low-dose oxycodone had a higher risk of opioid-related adverse outcomes compared with low-dose tramadol and hydrocodone. This should be interpreted in conjunction with the benefits of pain control and functioning associated with oxycodone use in future research.
Risk Factors for Early Conversion Total Hip Arthroplasty After Pipkin IV Femoral Head Fracture
Authors: Cichos Kyle H. , White Parker A. , Bergin Patrick F. , Ghanem Elie S. , McGwin Gerald , Hawkins Jacob , Spitler Clay A. 
Published: February 2023

Objectives:
To determine risk factors for early conversion total hip arthroplasty (THA) in Pipkin IV femoral head fractures.

Design:
Retrospective cohort.

Setting:
Two level I trauma centers.

Patients and Intervention:
One hundred thirty-seven patients with Pipkin IV fractures meeting inclusion criteria with 1 year minimum follow-up managed from 2009 to 2019.

Main Outcome Measurement:
Patients were separated into groups by the Orthopaedic Trauma Association/AO Foundation (OTA/AO) classification of femoral head fracture: 31C1 (split-type fractures) and 31C2 (depression-type fractures). Multivariable regression was performed after univariate analysis comparing patients requiring conversion THA with those who did not.

Results:
We identified 65 split-type fractures, 19 (29%) underwent conversion THA within 1 year. Surgical site infection (P = 0.002), postoperative hip dislocation (P < 0.0001), and older age (P = 0.049) resulted in increased rates of conversion THA. However, multivariable analysis did not identify independent risk factors for conversion. There were 72 depression-type fractures, 20 (27.8%) underwent conversion THA within 1 year. Independent risk factors were increased age (P = 0.01) and posterior femoral head fracture location (P < 0.01), while infrafoveal femoral head fracture location (P = 0.03) was protective against conversion THA.

Conclusion:
Pipkin IV fractures managed operatively have high overall risk of conversion THA within 1 year (28.5%). Risk factors for conversion THA vary according to fracture subtype. Hip joint survival of fractures subclassified OTA/AO 31C1 likely depends on patient age and postoperative outcomes such as surgical site infection and redislocation. Pipkin IV fractures subclassified to OTA/AO 31C2 type with suprafoveal and posterior head impaction and older age should be counseled of high conversion risk with consideration for alternative management options.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Reliability of the Modified Radiographic Union Score for Tibia Fractures (mRUST) for Femoral Shaft Fractures
Authors: Schmidt Gregory , Foley David , Simpson Austin , Farooq Hassan , Sharma Ishani , Slaven James , Lopas Luke , Jang Yohan , McKinley Todd , Mullis Brian 
Published: February 2023

Objectives:To evaluate the interobserver and intraobserver reliability of the modified Radiographic Union Score for Tibia Fractures (mRUST) and the effect of rater experience in evaluation of femoral fractures.Design:Retrospective cohort study.Setting:Single Level 1 trauma center.Patients/Participants:Patients 18–55 years of age with a femur shaft fracture.Intervention:Intramedullary nail fixation.Main Outcome Measurement:Interobserver and intraobserver reliability using the intraclass correlation coefficient.Results:The overall interobserver reliability was 0.96. Among fellowship-trained evaluators, the interobserver reliability was 0.94, and it was 0.92 among trainees. The overall intraobserver reliability was 0.98. The intraobserver reliability was 0.97 among fellowship-trained evaluators and 0.96 for trainees.Conclusions:These results show high interobserver and intraobserver reliability of mRUST in the evaluation of radiographic healing for femur shaft fractures treated with intramedullary nail. This high reliability was further demonstrated throughout different postoperative healing time frames. In addition, mRUST appears to be reliable when used both by trainees and experienced surgeons for the evaluation of femur shaft fractures.Level of Evidence:Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Rib Fracture Map in High-Energy Injuries
Authors: Thomas Claire N. , Lindquist Timothy J. , Schroder Lisa K. , Cole Peter A. 
Published: February 2023

Objectives:
To use a novel rib unfurling technology to investigate the locations of multiple rib fractures occurring from high-energy trauma to discern if there are reproducible rib fracture patterns.

Methods:
Patients between the ages of 18 and 48 years presenting to a Level 1 academic trauma center with ≥2 rib fractures after a high-energy mechanism of injury between 2017 and 2019 were identified. Curved planar reformatting of CT scans was used to create two-dimensional unfurled rib images by flattening out the view of the ribs from a CT scan. Rib fractures were placed on a template map using a standardized measurement method, and subsequent frequency and heat maps were created.

Results:
Among 100 consecutive patients, 534 fractures on 454 ribs were identified. The most common high-energy mechanism of injury was motor vehicle accidents (41%). Flail chest occurred in 8% of patients. The mean number of ribs fractured per patient was 4.54 ± 3.14 and included a mean of 5.34 ± 4.38 total fractures. Among all fractures, 50.9% were located on ribs 4 through 7. The most common fracture location was located in the lateral or anterolateral zone of the rib cage.

Conclusions:
Patients with multiple rib fractures from high-energy trauma have rib fractures with locations of common occurrence. An understanding of location and frequency of rib fractures can help inform surgical approaches, prognosis, indications, classifications, and implant design in the management of a complex population of patients with chest wall injury after trauma.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Biomechanical Evaluation of Transverse Patella Fracture Fixation Using Headless Screws: A Comparison of Suture Versus Cable as a Tension Band
Authors: Bric Justin D. , Martin Jill M. , McGrady Linda M. , Wang Mei , Schmeling Gregory J. 
Published: February 2023

Objectives:
To explore the performance of headless screws with FiberWire Suture as a tension band and headless screws with a mini-cable tension band in patella fixation.

Methods:
A transverse osteotomy was created in 6 matched pairs of fresh-frozen cadaver knee joints. One knee was randomly assigned to receive fixation with headless screws plus a cable tension band while the other was fixed with headless screws plus a suture tension band. Using a servo-hydraulic material testing system, the specimens were first tested nondestructively under 20% of the reported mean failure load with a standard technique of cannulated screws with tension band wiring. The specimen was then loaded to 1000 N to test the construct's failure strength. All tests were run under displacement-control with loading threshold. A motion analysis system was used to track the interfragmentary motion to assess fixation stability.

Results:
In the nondestructive loading test, gap displacement under 150 N was 0.10 mm or less for 11 of 12 specimens, and the difference between the 2 groups was not statistically significant. In the destructive test, 3 of 12 specimens maintained reduction (gap <2 mm) at the maximum load of 1000 N. Of the failed specimens, the mean strength was 648 ± 185 N for suture and 784 ± 228 N for cable.

Conclusions:
There was no significant difference in fixation strength or subfailure fragment displacement between the suture and cable tension band techniques when using headless screws.