bluuebunny/crossref_metadata_2025_split huggingface dataset:
Descriptive cross-sectional study to assess the knowledge of undergraduate nurses of predictors of palliative care
Authors: Ranga Kajal , Ranga Usha , Rohilla Kusum K. , Kalyani C. Vasantha 
Published: February 2023

ABSTRACT

Background:
The goal of palliative care is to improve the quality of life of patients with life-threatening or terminal illnesses, a subject of great relevance to undergraduate nursing students.

Objectives:
The primary aim of this study was to evaluate undergraduate nurses’ understanding of the components of palliative care, which must be considered while providing care to their patients with life-limiting illnesses. The secondary objective was to identify various factors affecting palliative care knowledge and correlate palliative care knowledge with these factors.

Materials and Methods:
We conducted a descriptive study with a cross-sectional design at the All India Institute of Medical Sciences, Rishikesh, India, from January to June 2022, on 130 undergraduate nursing students. The data collection tools were in two sections. Section I consisted of a bio-demographic variables sheet. Section II, the modified palliative care knowledge questionnaire, contained 20 items, each of could be answered with a “Yes” (score: 1) or “No” (score: 0). The maximum score was 20; a score of ≤10 was considered “poor knowledge of palliative care.”

Results:
All 130 participants were female; the mean age was 21.1 (±1.39 standard deviation) years, and 71 (55%) were second-year B.Sc. students. The majority, i.e., 109 (84%) participants had not done any prior course in palliative care and only 71 (54%) had attended any previous session of palliative care. Most participants (83, 64%) scored between 11 and 15 on the palliative care knowledge questionnaire, which signified a moderate level of understanding. There was a significant correlation between the family income of the participants and their palliative care knowledge scores; P = 0.05.

Conclusions:
Two-thirds of undergraduate nurses have moderate-level knowledge about palliative care. Lack of deeper understanding may be attributable to inadequate palliative care instruction in the nursing school program. To positively impact the students’ attitudes towards death and providing care for the terminally ill, palliative care teaching should be integrated into India’s nursing curriculum.
Elucidation of HER2/neu and Wilms’ tumor 1 immunohistochemical expression in endometrial carcinomas regarding the diagnostic and prognostic significance
Authors: El Kholy Marwa A. , Ali Mohamed Y. , Elkholy Eman A. 
Published: February 2023

Objective
To confirm HER2 neu and Wilms’ tumor 1 (WT1) immunohistochemical expression in endometrial cancer and illustrate its possible diagnostic and prognostic significance in various clinicopathological parameters that both physicians and pathologists may find therapeutically valuable.

Materials and methods
A total of 50 formalin-fixed and paraffin-embedded tissue specimens were acquired and prepared for this investigation from the archival pathology files of Al-Hussein and Al-Zahraa University Hospitals between 2017 and 2020, after obtaining the informed consent and approval of the local ethical committee. The patient’s medical records and histopathologic data such as tumor size, myometrial invasion depth, lymph node invasion, histologic type of tumor, clinical presentation, and International Federation of Gynecology and Obstetrics stage were assessed using hematoxylin-eosin for all sections that were re-evaluated by HER2/neu and WT1 antibodies immunohistochemically.

Results
Positive HER2/neu and WT1 expressions were frequently associated with a worsening condition in patients with endometrial carcinomas (ECs) with a higher grade, stage, and nonendometrioid carcinoma type, reflecting the prognostic relevance of HER2/neu and WT1 expressions, especially in aggressive EC forms. Follow-up and more genetic concordance between EC subtypes could improve the predictive value of HER2/neu and WT1 expression in EC. For advanced endometrial malignancies, tailored chemotherapy may be valuable.

Conclusions
HER2/neu-positive and WT1-positive immunohistochemical staining results are generally coupled to ECs in their advanced forms, which have a higher grade, stage, and nonendometrioid carcinoma type, reflecting their prognostic implications, especially in aggressive EC types. However, additional validation is required before enrolling this panel in clinical settings, which could improve the value of prediction of HER2/neu and WT1 immunohistochemical markers in ECs. Moreover, targeted chemotherapy for aggressive endometrial cancers can be beneficial.
The role of heat shock protein 70 and glypican 3 expression in early diagnosis of hepatocellular carcinoma
Authors: Mohamed Said A. , Tealeb Al-Sayed M.I. 
Published: February 2023

Background
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related deaths in the world and accounts for ~90% of primary liver carcinoma cases. This study aimed to evaluate the combination of two markers (HSP70 and GPC3) immunohistochemical expression in early detection of HCC.

Materials and methods
This study included 56 cases of primary hepatic lesions, five cases of focal nodular hyperplasia, five cases of hepatic adenoma, 33 cases of small vaguely nodular lesions (five of dysplastic nodule and 28 of early HCC), and 13 cases of late HCC.

Results
The sensitivity, specificity, and positive and negative predictive values of HSP70 for HCC detection were 78.2, 100, 100, and 24.1%, respectively. The sensitivity, specificity, and positive and negative predictive values of GPC3 for HCC detection were 60, 100, 100, and 36.8%, respectively. The sensitivity, specificity, and positive and negative predictive values for this combination (HSP70+GPC3) were 100, 100, 100, and 100%, respectively.

Conclusion
The immunoexpression of the two markers HSP70 and GPC3 is valuable in distinguishing between dysplastic nodules and early HCC. When the two markers are positive, the optimal sensitivity and specificity for detection of early HCC are obtained. The results of our study strikingly support the combination of the two markers together in the diagnostic distinction of nonconfirmed hepatic lesions of malignancies but do not support the use of both separately.
Expression of actinin alpha 1 and E-cadherin in oral squamous-cell carcinoma
Authors: Abd El Khalek Safaa M.M. , Abou Gabal Hoda H. , Faheim Reham M. , Hafez Fatma S. 
Published: February 2023

Background
Oral squamous-cell carcinoma (OSCC) is the most common oral malignancy with a dismal prognosis. Exploring markers predict tumor behavior, help in diagnosis, and therapy is crucial. Actinin alpha 1 (ACTN1) is known to be a prognostic biomarker in acute myeloid leukemia. It also plays a role in many tumors. The epithelial–mesenchymal transition has been suggested as one of the mechanisms of action for ACTN1. The role of ACTN1 in OSCC is still unclear. This study aimed at evaluating the role of ACTN1 in OSCC.

Materials and methods
This study was performed on 68 OSCC cases and 68 normal-tissue samples. Immunohistochemical staining of ACTN1 and E-cadherin was done and evaluated. Correlation to clinicopathologic parameters and survival was statistically analyzed.

Results
ACTN1 expression was high in 47 (69.1%) cases. E-cadherin expression was high in 27 (39.7%) cases with a significant inverse correlation between both expressions. Cases with high ACTN1/low E-cadherin expressions were significantly associated with tumor grade, stage, presence of tumor buds, lymph-node metastasis, recurrence, and distant metastasis. They also show statistically significant shorter overall survival and disease-free survival.

Conclusion
ACTN1 is a promising prognostic marker that correlates with tumor staging, node metastasis, and poor survival. It might also serve as a therapeutic target in OSCC. Its role in epithelial–mesenchymal transition is strongly suggested by this study.
Impact of Location on Resectability and Neurological Outcome in Spinal Cutaneous Inclusion Tumors
Authors: Ali Sundus , Sajjad Fauzia , Qasim Adnan , Chaudhary Anwar M. , Azeemi Akmal M. , Shabbir Asif 
Published: February 2023

Background:
Spinal cutaneous inclusion tumors are extremely rare, accounting for less than 1% of intraspinal tumors. The existing literature is scarce; in last two decades, only eight case series have documented more than 10 patients. We tried to figure out if intramedullary and extramedullary locations have an impact on outcomes in terms of extent of resection and neurological recovery.

Materials and Methods:
A retrospective review of intraspinal epidermoid and dermoid tumors operated at our Neurosurgical Department, between May 2006 and May 2021, was made. McCormick grading was used to evaluate the neurological status of all patients at presentation, after surgery, and at the follow-up visit in the outpatient clinic. The neurological status at the last follow-up was taken as final.

Results:
Of 15 cases, eight (53.3%) were males with the age at presentation ranging from 7 to 60 years (mean = 24.4 years). Spinal dysraphism was associated in four patients. The proportion of region involved in descending order was lumbar (46.6%), thoracic/thoracolumbar/lumbosacral (13.3% each) and cervicothoracic/sacrococcygeal (6.6% each) with 11 gross total resections (73.3%) and four subtotal resections (all intramedullary). Two-tailed Fischer’s exact test showed a significant correlation between location, extent of resection, and neurological recovery, whereas histological subtype and region had no significant impact on the outcome.

Conclusions:
To the best of our knowledge, this is the eighth largest study in the last two decades, reporting 15 cases with long-term follow-up. We attempt to bring clarity to the notion of location having no effect on resectablity by specifying location in terms of spinal compartment involved and describing spinal level as region. Overall, our gross total resection rate was lower (73.3%) than other contemporary studies (86.6%–92%), but a subgroup analysis with regard to the location of tumor revealed the intramedullary location to be the primary determinant of the extent of resection.
Identification of change leadership dimensions and components in medical science education to move toward the third-generation universities
Authors: Ramezani Ghobad , Bigdeli Shoaleh , Zarezadeh Yadolah , Sohrabi Zohreh 
Published: February 2023

BACKGROUND:
Change is a multidimensional and pervasive issue in the modern world, and organizations are constantly changing in social, cultural, political, economic, and technological fields. Change leadership is a model that employs a combination of leadership styles to keep the employees and the organization prepared for learning and continuous growth. This study aims to identify the dimensions and components of change leadership in medical sciences education to move toward third-generation universities through a qualitative approach.

MATERIALS AND METHODS:
The present study was an applied explorative qualitative study. Participants included the experts in the field of management and key informants in the field of change leadership and third-generation universities who were selected through purposive sampling. The research tool was semi-structured interviews aimed at the identification of dimensions and components of the change leadership. Interview-guided questions were about change leadership to move toward the third-generation universities followed by probing questions. Colaizzi content analysis technique was used to analyze the data.

RESULTS:
Data from interview transcript analysis resulted in the identification of 335 initial codes, 13 subcategories, and 3 categories or dimensions. The main categories included “change leadership roles and specifications,” “providing a context and preparing for change,” and “change leadership process and path.” Each of the main dimensions included several components.

CONCLUSION:
The importance of leadership in the process of change is since change entails the establishment and institutionalization of new systems and structures which is impossible without an effective leadership style. Leaders have high expectations of their followers and inspire them to strive toward organizational goals and facilitate the realization of the shared vision through encouraging them. As a leadership paradigm for organization performance improvement capable of encouraging employees and building an organizational culture in which ethical procedures are considered behavioral norms, change leadership seeks to predict the environment changes so that it can move in accordance with them.
Asynchronous E-learning after synchronous E-learning in the pathology course. When is the proper time for this transition?
Authors: Manou Evangelia , Lazari Evgenia Charikleia , Thomopoulou Georgia Eleni , Agrogiannis Georgios , Kavantzas Nikolaos G. , Lazaris Andreas C. 
Published: February 2023

BACKGROUND:
Recordings of live streaming e-lessons of pathology at medical school of National and Kapodistrian University of Athens, Greece are uploaded to the e-class portfolio of each student enrolled in the course. We measured the number of views each video received and noticed that this number exceeded the number of enrolled students. Our main aim was to investigate the correlation between the upload of an educational video and the views it got so as to determine when the proper time is for professors to e-share or upload an educational video for the students.

MATERIALS AND METHODS:
We measured the number of views of the recorded e-lessons when all videos were uploaded, with a frequency of 15 days. We used analysis of variances statistical analysis to find the significance of the amount of time each video had been uploaded on the virtual platform of the course. We also applied t-tests to assess the significance of alteration of the number of views related to the amount of time until the examinations.

RESULTS:
Time was a statistically significant factor in the impact of an educational video. The two-factor analysis without interaction measured P ≃ 0.001, proving the strong correlation between time and the increase of views. As the examination date was approaching, there was a statistically significant increase in the number of views of the videotaped e-lessons. Almost 50% of the views of each of the videos took place in the two-week examination period of the course.

CONCLUSIONS:
The educational videos that contained the core learning concepts of the pathology course should be uploaded first. The complex learning points of the pathology course must be available at the beginning of the semester. Additionally, recordings of videos covering the complex learning points of the course should be uploaded as an additional tool of asynchronous e-learning for the students who choose to watch their former e-lessons to prepare for the examinations.
The Profile of Use of Rituximab in Tertiary Care Hospitals of Central India
Authors: Singh Alok , Sahoo Ajaya K. , Biswal Debadulal , Sheth Pranav G. , Dhaneria Suryaprakash , Gupta Dhyuti 
Published: February 2023

Background:
Rituximab, one of the most commonly used biologics, was once approved by the United States Food and Drug Association (US FDA) for the management of different systemic autoimmune disorders, and it is now used extensively in managing off-label indications. There is a scarcity of data regarding its utilization pattern in India

Objective:
To assess rituximab usage pattern in two tertiary care hospitals of Central India

Methods:
A cross-sectional, retrospective study was performed to analyze the data of patients from two tertiary care centers of Central India who had received rituximab between 2019 and 2021. The usage was categorized either for FDA-approved indications or for off-label indications. Multiple logistic regression was applied to evaluate which factors would influence the use of rituximab for an FDA-approved indication

Results:
A total of 79 medical records of patients. The majority of the patients (77.2%) had received rituximab for an FDA-approved indication. The most common approved and off-label indications detected were non-Hodgkin’s lymphoma and autoimmune disorders, respectively. The use of rituximab for an FDA-approved indication was associated with increased age (adjusted odds ratio [AOR] = 1.04, 95% confidence interval [CI] = 0.99–1.1), male sex: AOR = 2.55, 95% CI = 0.74–9.93, malignancy: AOR = 9.39, 95% CI = 1.46–76.12, and diabetes: AOR = 1.38, 95% CI = 0.19–13.74

Conclusions:
The use of rituximab was more common for an FDA-approved indication rather than for an off-label indication. Factors such as advancing age, male sex, and malignancy were frequently associated with the FDA-approved use of rituximab.
Evaluating the Quality of Written Feedback Within Entrustable Professional Activities in an Internal Medicine Cohort
Authors: Madrazo Lorenzo , DCruz Jennifer , Correa Natasha , Puka Klajdi , Kane Sheri-Lynn 
Published: February 2023

ABSTRACT

Background
Whether written comments in entrustable professional activities (EPAs) translate into high-quality feedback remains uncertain.

Objective
We aimed to evaluate the quality of EPA feedback completed by faculty and senior residents.

Methods
Using retrospective descriptive analysis, we assessed the quality of feedback from all EPAs for 34 first-year internal medicine residents from July 2019 to May 2020 at Western University in London, Ontario, Canada. We assessed feedback quality on 4 domains: timeliness, task orientation, actionability, and polarity. Four independent reviewers were blinded to names of evaluators and learners and were randomized to assess each EPA for the 4 domains. Statistical analyses were completed using R 3.6.3. Chi-square or Fisher's exact test and Cochran-Armitage test for trend were used to compare the quality of feedback provided by faculty versus student assessors, and to compare the effect of timely versus not timely feedback on task orientation, actionability, and polarity.

Results
A total of 2471 EPAs were initiated by junior residents. Eighty percent (n=1981) of these were completed, of which 61% (n=1213) were completed by senior residents. Interrater reliability was almost perfect for timeliness (κ=0.99), moderate for task orientation (κ=0.74), strong for actionability (κ=0.81), and moderate for polarity (κ=0.62). Of completed EPAs, 47% (n=926) were timely, 85% (n=1697) were task oriented, 83% (n=1649) consisted of reinforcing feedback, 4% (n=79) contained mixed feedback, and 12% (n=240) had neutral feedback. Thirty percent (n=595) were semi- or very actionable.

Conclusions
The written feedback in the EPAs was task oriented but was neither timely nor actionable. The majority of EPAs were completed by senior residents rather than faculty.
A Redesign of the ACGME Resident/Fellow Survey Through Expert Reviews and Cognitive Interviews
Authors: Artino Anthony R. , Malloy Kathy , Miller Rebecca S. , Kirk Lynne M. , Brigham Timothy P. 
Published: February 2023

ABSTRACTBackgroundSince 2003, the Accreditation Council for Graduate Medical Education (ACGME) has surveyed residents and fellows in its accredited programs. The Resident/Fellow Survey is a screening and compliance tool that programs can also use for continuous quality improvement. However, stakeholders have reported potential problems with the survey's overall quality and credibility.ObjectiveTo redesign the 2006 Resident/Fellow Survey using expert reviews and cognitive interviews.MethodsIn 2018-2019, the ACGME redesigned the Resident/Fellow Survey using an iterative validation process: expert reviews (evidence based on content) and cognitive interviews (evidence based on response processes). Expert reviews were conducted by a survey design firm and an ACGME Task Force; cognitive interviews were conducted with a diverse set of 27 residents and fellows.ResultsExpert reviews resulted in 21 new survey items to address the ACGME's updated accreditation requirements; these reviews also led to improvements that align the survey items with evidence-informed standards. After these changes were made, cognitive interviews resulted in additional revisions to sensitive items, item order, and response option order, labels, and conceptual spacing. In all, cognitive interviews led to 11 item deletions and other improvements designed to reduce response error.ConclusionsExpert reviews and cognitive interviews were used to redesign the Resident/Fellow Survey. The content of the redesigned survey aligns with the updated accreditation requirements and items are written in accordance with evidence-informed standards. Additionally, cognitive interviews resulted in revisions to the survey that seem to improve respondents' comprehension and willingness to respond to individual survey items.
Health Care Utilization and Cost Associated With Urinary Tract Infections in a Privately Insured Spinal Cord Injury Population
Authors: Herrity April N. , Castillo Camilo , Isakov Roman V. , Anele Uzoma A. , Wang Dengzhi , Boakye Maxwell , Ugiliweneza Beatrice 
Published: February 2023

Background
Urinary tract infections (UTIs) are the most common secondary medical complication following spinal cord injury (SCI), significantly impacting health care resource utilization and costs.

Objectives
To characterize risk factors and health care utilization costs associated with UTIs in the setting of SCI.

Methods
IBM’s Marketscan Database from 2000–2019 was utilized to identify individuals with traumatic SCI. Relevant ICD-9 and ICD-10 codes classified individuals into two analysis groups: having ≥ 1 UTI episode or no UTI episodes within 2 years following injury. Demographics (age, sex), insurance type, comorbidities, level of injury (cervical, thoracic, lumbar/sacral), and health care utilization/payments were evaluated.

Results
Of the 6762 individuals retained, 1860 had ≥ 1 UTI with an average of three episodes (SD 2). Younger age, female sex, thoracic level of injury, noncommercial insurance, and having at least one comorbidity were associated with increased odds of UTI. Individuals with a UTI in year 1 were 11 times more likely to experience a UTI in year 2. As expected, those with a UTI had a higher rate and associated cost of hospital admission, use of outpatient services, and prescription refills. UTIs were associated with 2.48 times higher cumulated health care resource use payments over 2 years after injury.

Conclusions
In addition to bladder management-related causes, several factors are associated with an increased risk of UTIs following SCI. UTI incidence substantially increases health care utilization costs. An increased understanding of UTI-associated risk factors may improve the ability to identify and manage higher risk individuals with SCI and ultimately optimize their health care utilization.