bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis and Management of Acral Pigmented Lesions
Authors: Ingrassia Jenne P. , Stein Jennifer A. , Levine Amanda , Liebman Tracey N. 
Published: August 2023

BACKGROUND
Survival outcomes in acral lentiginous melanoma (ALM) are worse than for cutaneous melanoma. Diagnostic delays are believed to contribute to worse outcomes in ALM, including advanced-stage disease at initial presentation. Acral lentiginous melanoma, especially in its early stages, may be difficult to discern from benign pigmented acral lesions.

OBJECTIVE
The purpose of this article is to provide a comprehensive review of the diagnosis and management of acral pigmented lesions.

MATERIALS AND METHODS
A literature review was performed. The outcomes included were the clinical and dermoscopic features and the management frameworks and considerations for acquired and congenital melanocytic nevi, acral melanosis, nonmelanocytic pigmented lesions, and ALM.

RESULTS
Original research studies were primarily included. The use of dermoscopy, such as the 3-step algorithm and blotch (irregular), ridge pattern (parallel), asymmetry of structures, asymmetry of colors, furrow pattern (parallel), fibrillar pattern (BRAAFF) checklist, increases the diagnostic accuracy of acral pigmented lesions with high specificity and sensitivity. Short-term digital dermoscopic surveillance can be used to manage acral lesions, and histopathology should be collected when there is a concern for ALM.

CONCLUSION
The use of dermoscopy and an understanding of how to manage acral lesions may limit the number of biopsies performed on the acral skin, decrease the time to diagnosis, and facilitate early detection of ALM.
The ECLiPSE Procedure as an Alternative to Mastopexy following Implant Removal
Authors: Wilssens Nicholas , Singla Apresh , Hoffman Stuart , Graham Susannah , Jayatilleke Nipu , Lajevardi Sepehr , Barker Anthony , Deva Anand K. 
Published: August 2023

Background:
With the rise in number of breast implant removals for a variety of indications, strategies to improve aesthetic outcomes, while minimizing scars and operating time, will prove to be of benefit. We present here a novel periareolar sickle skin excision as a good option for women with mild to moderate ptosis and central loss of breast volume following implant removal/capsulectomy.

Methods:
The ECLiPSE (Explant, Capsulectomy, Lift using Periareolar Sickle skin Excision) was utilized in 53 patients with a median follow-up of 24 weeks.

Results:
The majority of these patients had breast implants for cosmetic augmentation and the most common indication for implant removal was capsular contracture (n = 47, 88.7%). Forty-six patients (86.8%) scored a high or very high satisfaction with the outcome of the procedure.

Conclusion:
We believe that the ECLiPSE procedure is a useful option that can produce a reasonable aesthetic outcome following implant removal/capsulectomy while minimizing visible scarring.
Engagement with the HCV care cascade among high-risk groups: A population-based study
Authors: Erman Aysegul , Everett Karl , Wong William W.L. , Forouzannia Farinaz , Greenaway Christina , Janjua Naveed , Kwong Jeffrey C. , Sander Beate 
Published: August 2023

Background:
HCV elimination requires a thorough understanding of the care cascade. A direct-acting antiviral (DAA)-era description of the care cascade has not been undertaken in Ontario, Canada’s most populous jurisdiction. Our primary objective was to describe the current population-level care cascade in the general Ontario population and among key risk groups ─ baby boomers, immigrants, and individuals experiencing residential instability. The secondary objective was to identify predictors of engagement.

Methods:
We conducted a population-based cohort study of Ontario residents undergoing HCV testing between January 1, 1999, and December 31, 2018, and mapped the care cascade [antibody-diagnosed, RNA tested, RNA positive, genotyped, treated, achieved sustained virologic response, reinfected/relapsed] as of December 31, 2018. The cascade was stratified by risk groups. Cause-specific hazard modeling was used to identify demographic, and socioeconomic predictors of engagement with key steps of the cascade.

Results:
Among 108,428 Ontario residents living with an HCV antibody diagnosis, 88% received confirmatory RNA testing; of these, 62% tested positive and 94% of positive tests were genotyped. Of those with confirmed viremia, 53% initiated treatment and 76% of treated individuals achieved sustained virologic response, while ~1% experienced reinfection or relapse. Males, older birth cohorts, long-term residents, those with a history of substance use disorder and social marginalization (eg, material deprivation, residential instability), and those initially diagnosed in the pre-DAA era exhibited lower rates of engagement with almost every step of HCV care.

Conclusions:
Despite DAA era improvements, treatment initiation remains a major gap. HCV screening and linkage-to-treatment, particularly for those with a history of substance use disorder and social marginalization, will be needed to equitably close gaps in HCV care in the province.
Tools for assessing labour pain: a comprehensive review of research literature
Authors: Zhang Erina W. , Jones Lester E. , Whitburn Laura Y. 
Published: August 2023

AbstractThe experience of pain associated with labour is complex and challenging to assess. A range of pain measurement tools are reported in the literature. This review aimed to identify current tools used in research to assess labour pain across the past decade and to evaluate their implementation and adequacy when used in the context of labour pain. A literature search was conducted in databases MEDLINE and Cumulative Index of Nursing and Allied Health Literature, using search terms relating to labour, pain, and measurement. A total of 363 articles were selected for inclusion. Most studies (89.9%) assessed pain as a unidimensional experience, with the most common tool being the Visual Analogue Scale, followed by the Numerical Rating Scale. Where studies assessed pain as a multidimensional experience, the most common measurement tool was the McGill Pain Questionnaire. Only 4 studies that used multidimensional tools selected a tool that was capable of capturing positive affective states. Numerous variations in the implementation of scales were noted. This included 35 variations found in the wording of the upper and lower anchors of the Visual Analogue Scale, some assessment tools not allowing an option for “no pain,” and instances where only sections of validated tools were used. It is clear that development of a standardised pain assessment strategy, which evaluates the multidimensions of labour pain efficiently and effectively and allows for both positive and negative experiences of pain to be reported, is needed.
Behavioral Sleep Interventions and Cardiovascular Risk Factors
Authors: McCarthy Christine Eileen , McAteer Claire A. , Murphy Robert , McDermott Clodagh , Costello Maria , O'Donnell Martin 
Published: August 2023

Background/Objectives
Chronic sleep disturbance has been consistently associated with cardiovascular disease. We sought to determine whether behavioral interventions to improve sleep have been associated with improvements in 4 common cardiovascular disease risk factors: hypertension, diabetes mellitus (DM), obesity, and smoking.

Methods
Randomized controlled trials evaluating the prospective effect of behavioral sleep interventions on (a) blood pressure in participants with hypertension/prehypertension, (b) glycemic control in participants with DM/pre-DM, (c) anthropometrics in participants who were overweight/obese, and (d) smoking status in smokers were eligible. Where feasible, we undertook random-effects meta-analyses of standardized mean differences in cardiovascular disease risk factor change.

Results
Overall, 3 trials met the inclusion criteria for blood pressure, 4 for glycemic control, 9 for overweight/obesity, and 2 for smoking. On meta-analysis, interventions with sleep as the sole behavioral target were associated with a significant reduction in hemoglobin A1c% (−0.84; 95% confidence interval [CI], −1.34 to −0.34), but not a significant reduction in systolic blood pressure (−0.18; 95% CI, −0.55 to 0.20) versus controls. In addition, any interventions with sleep as a behavioral target were associated with significant reductions in hemoglobin A1c% (−0.71; 95% CI, −1.01 to −0.42) and weight (−0.78; 95% CI, −1.11 to −0.45), but not systolic blood pressure (−0.72; 95% CI, −1.82 to 0.37). Trials evaluating smoking status were not amenable to meta-analysis.

Conclusion
Behavioral interventions to improve sleep were associated with improved glycemic control in patients with DM. It is also possible that these interventions improve weight in individuals who were overweight/obese. A low number of trials and small sample sizes indicate that further large, well-designed randomized controlled trials of interventions are warranted.
Rapid-Response Electroencephalography in Seizure Diagnosis and Patient Care: Lessons From a Community Hospital
Authors: Eberhard Eleanor , Beckerman Samuel R. 
Published: August 2023

ABSTRACT

BACKGROUND: Nonconvulsive seizures are a major source of in-hospital morbidity and a cause of unexplained encephalopathy in critically ill patients. Electroencephalography (EEG) is essential to confirm nonconvulsive seizures and can guide patient-specific workup, treatment, and prognostication. In a 208-bed community hospital, EEG services were limited to 1 part-time EEG technician and 1 EEG machine shared between inpatient and outpatient settings. Its use was restricted to typical business hours. A nursing-led quality improvement (QI) project endeavored to enhance access to EEG by introducing a point-of-care rapid-response EEG program. METHODS: For this project, a multidisciplinary protocol was developed to deploy a Food and Drug Administration–cleared, point-of-care rapid-response EEG platform (Ceribell Inc) in a community hospital's emergency department and inpatient units to streamline neurodiagnostic workups. This QI project compared EEG volume, study location, time-to-EEG, number of cases with seizures captured on EEG, and hospital-level financial metrics of diagnosis-related group reimbursements and length of stay for the 6 months before (pre-QI, using conventional EEG) and 6 months after implementing the rapid-response protocol (post-QI). RESULTS: Electroencephalography volume increased from 35 studies pre-QI to 115 post-QI (3.29-fold increase), whereas the median time from EEG order to EEG start decreased 7.6-fold (74 [34-187] minutes post-QI vs 562 [321-1034] minutes pre-QI). Point-of-care EEG was also associated with more confirmed seizure diagnoses compared with conventional EEG (27/115 post-QI vs 0/35 pre-QI). This resulted in additional diagnosis-related group reimbursements and hospital revenue. Availability of point-of-care EEG was also associated with a shorter median length of stay. CONCLUSION: A nurse-led, rapid-response EEG protocol at a community hospital resulted in significant improvements in EEG accessibility and seizure diagnosis with hospital-level financial benefits. By expanding access to EEG, confirming nonconvulsive seizures, and increasing care efficiency, rapid-response EEG protocols can enhance patient care.
Comparison of outcomes with stapler versus hand-sewn closure of the pancreatic stump following minimally invasive distal pancreatectomy: a retrospective cohort study
Authors: Qian Tao , Huang Kaiquan , Chen Wen , Bai Xueli , Gao Shunliang , Shen Yan , Zhang Min , Wu Jian , Yu Jun , Ma Tao , Liang Tingbo 
Published: August 2023

Background:
Pancreatic fistula after distal pancreatectomy is a common and potentially lethal complication. The optimal closure method for the pancreatic remnant during minimally invasive distal pancreatectomy (MDP) remains unclear.

Methods:
Data of consecutive patients who underwent MDP in our institution between July 2018 and June 2021 were collected. The outcomes of MDP with stapler and hand-sewn closure were compared. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF) per the International Study Group of Pancreatic Surgery definition.

Results:
Of the 384 patients (stapler closure, 339; hand-sewn closure, 45) enrolled, 249 developed CR-POPF (grades B and C: 242 and 7 patients, respectively). The rates of grade B and grade C POPF in the stapler group were similar to the corresponding rates in the hand-sewn group (64.6% and 1.5% vs 51.1% and 4.4%, P = .078 and P = .223, respectively). No differences between the stapler and hand-sewn groups were observed regarding the median operation time (207 vs 222 minutes, P = .139), incidence of major complications (16.5% vs 20.0%, P = .559), and mortality (0.2% vs 0%, P = 1.000). The independent risk factors of CR-POPF were abdominal abscess, prolonged operation time, and transection site (P = .004, .006, and .001, respectively).

Conclusion:
The incidence and severity of CR-POPF by stapler closure of the pancreatic stump were comparable to those associated with hand-sewn closure in MDP in this retrospective cohort. Randomized controlled trials are needed to verify this finding.
Competency-based curriculum in nurse practitioner education
Authors: Arends Robin 
Published: August 2023

ABSTRACT
Professional nursing standards and guidelines form the foundation for nurse practitioner curriculum. Nurse educators should understand the role these professional standards and guidelines have in the development of curriculum. Recently, nursing education has moved to a competency-based education with the release of the new American Association of Colleges of Nursing Essentials and the National Organization of Nurse Practitioner Faculties Nurse Practitioner Role Core Competencies. Competency-based curriculum allows for a common understanding of the knowledge, skills, and experiences nurse practitioner graduates require for entry to practice. Competency-based education also provides consistent and uniform expectations for novice nurse practitioners on entry to practice. With the change to a competency-based curriculum, nurse educators can review and revise curriculum through refinement of courses, student learning objectives, assignments, and evaluations. Nurse educators have a responsibility to critically analyze student assignments and evaluations to ensure competencies are met multiple times through a variety of methods. In addition, nurse educators have the opportunity to use assignments that meet multiple competencies to modernize student learning. Refinement and revision lead to enhanced student critical thinking and provide opportunities for real-world training to improve student outcomes.
Predictive factors for early requirement of respiratory support through phone call to Emergency Medical Call Centre for dyspnoea: a retrospective cohort study
Authors: Balen Frederic , Lamy Sebastien , Fraisse Sarah , Trinari Julie , Bounes Vincent , Dubucs Xavier , Charpentier Sandrine 
Published: August 2023

Background
Acute dyspnoea is a common symptom in Emergency Medicine, and severity assessment is difficult during the first time the patient calls the Emergency Medical Call Centre.

Objective
To identify predictive factors regarding the need for early respiratory support in patients who call the Emergency Medical Call Centre for dyspnoea.

Design, settings and participants
This retrospective cohort study carried out in the Emergency Medical Call Centre of the University Hospital of Toulouse from 1 July to 31 December 2019. Patients over the age of 15 who call the Emergency Medical Call Centre regarding dyspnoea and who were registered at the University Hospital or died before admission were included in our study.

Outcome measure and analysis
The primary end-point was early requirement of respiratory support [including high-flow oxygen, non-invasive ventilation (NIV) or mechanical ventilation after intubation] that was initiated by the physicians staffed ambulance before admission to the hospital or within 3 h after being admitted. Associations with patients’ characteristics identified during Emergency Medical Call Centre calls were assessed with a backward stepwise logistic regression after multiple imputations for missing values.

Main results
During the 6-month inclusion period, 1425 patients called the Emergency Medical Call Centre for respiratory issues. After excluding 38 calls, 1387 were analyzed, including 208 (15%) patients requiring respiratory support. The most frequent respiratory support used was NIV (75%). Six independent predictive factors of requirement of respiratory support were identified: chronic β2-mimetics medication [odds ratio (OR) = 2.35, 95% confidence interval (CI) 1.61–3.44], polypnea (OR = 5.78, 95% CI 2.74–12.22), altered ability to speak (OR = 2.35, 95% CI 1.55–3.55), cyanosis (OR = 2.79, 95% CI 1.81–4.32), sweats (OR = 1.93, 95% CI 1.25–3) and altered consciousness (OR = 1.8, 95% CI 1.1–3.08).

Conclusion
During first calls for dyspnoea, six predictive factors are independently associated with the risk of early requirement of respiratory support.
Endemic statistical paradoxes in epidemiologic studies distort knowledge on prostate cancer: mitigation and caution of fallacies in prostate cancer causal epidemiological studies
Authors: Cussenot Olivier , Fromont Gaelle , Cancel-Tassin Géraldine , Hamdy Freddie C. , Martin Richard M. 
Published: August 2023

Purpose of review
Many studies on epidemiology of prostate cancer (PCa) are based on a diagnosis of PCa using PSA (prostate-specific antigen) level. However, biases can distort the interpretation of the results, which in turn limits policy and decision making on public health prevention strategies or clinical guidelines. The main confusion is to interpret the posterior probability of the outcome following the exposure as a change in the prevalence of the disease outcome, whereas this change reflects only the predictive values of the PSA test induced by the exposure of interest.

Recent findings
Many studies report potential causal factors involved in PCa risk. However, the lack of integration of how physiological changes in PSA values are associated with the exposures being investigated, they explain in part contradictory and controversial results on PCa risk factors in the literature.

Summary
A strategy to perform case--control studies based on PSA stratification is suggested to avoid misinterpretation related to PSA misclassification. Real data are analysed, and we show that we can exploit the mechanism of selection biases using different modalities of controls recruitment based on biomarker stratification to distinguish real from false causal factors.
Ectopia cordis with multiple ventricular septal defect and sternal cleft in a newborn: a case report
Authors: Goli Rasoul , Majidi Balaneji Sahar , Hosseinpour Leila , Abbasi Mahdiyeh , Feizi Milad , Nafe Parihan , Faraji Navid , Heydari Bisafar Mojgan , Arad Mansour 
Published: August 2023

Introduction and importance:
Ectopia cordis is a rare type of malformation where the heart is not located normally. It may be partially or completely located outside the thoracic cavity and can be associated with other congenital abnormalities.

Case presentation:
This case report is of a 34-week- and 6-day-old female fetus with a birth weight of 2040 g, a height of 41 cm, and a head circumference of 32 cm. The initial physical examination revealed a responsive newborn with an externalized heart outside the chest, with pericardium protection. In addition, a thoracic wall defect was detected suggesting incomplete formation of the septum bone. Moreover, in this case, the echocardiography report showed a multiple ventricular septal defect.

Conclusion:
The management of ectopia cordis is a challenge for any obstetrician and pediatric surgeon due to its rarity. It causes mental agony and anxiety to the parents. With an early diagnosis, termination of pregnancy can be one of the options. Once it is diagnosed late, it needs a multidisciplinary approach, and the services of a very experienced pediatric surgeon to improve the prognosis.
Dumble cystic lymphangioma as an underlying cause of vague abdominal complaints in a 2-year-old girl: case report
Authors: Atqiaee Khashayar , Samady Khanghah Ali , Mohajerzadeh Leily , Mardi Ali , Khayat Zahiri Farhad , Barin Sajjad 
Published: August 2023

Introduction:
Lymphatic malformations (LM) refer to very rare hamartomatous benign lymphatic ectasias with an incidence of 1:250 000. They almost involve children more than adults, and among them, infants under one age are mostly affected. Macrocytic LM is found to be more than 2 cm in diameter or 2×2 cm2 in volume. The proper treatment for mesenteric LM is complete surgical excision unless there is vital structure involvement.

Case presentation:
The authors report a mesenteric macrocytic LM in a 2-year-old girl complaining of vague abdominal discomfort and persistent vomiting in which ultrasonography revealed a cystic masse with seromucous components. She then underwent exploratory laparotomy. The operation and the follow-up duration were uneventful.

Discussion:
LMs are rare benign lesions of vascular origin with lymphatic differentiation, according to the latest International Society for the Study of Vascular Anomalies (ISSVA 2018). Under light microscopy, these malformations are characterized by their thin-walled endothelium and lymphatic tissue.
These mobile lesions are incidentally found or appear with intestinal obstruction or acute abdomen scenarios.

Conclusion:
Although benign, the LMs have the potential for invasion and recurrence. Thus, the examiner physician must keep such intra-abdominal lesions in mind.
1 Year-follow-up of transforaminal surgical approach in the management of migrated disc herniation: a cross-sectional study
Authors: Do Hung Manh , Doan Ha Thi-Ngoc , Nguyen Long Hoang 
Published: August 2023

Background:
Transforaminal percutaneous endoscopic lumbar discectomy (TPELD) recently confirms its superiority compared to typical open discectomy in the treatment of very high-grade migrated disk herniation. In Vietnam, this technique has been applied in recent years; however; lack of reports and evidence.

Objectives:
In this study, the authors would like to share their surgical experience and report the initial results in their center, after successfully performing TPELD for very high-grade migrated disk herniation in 40 patients.

Patients and methods:
Forty patients, who underwent TPELD to remove the nucleus of very high-grade migrated disk herniation, were enrolled in this study. The study was carried out from April 2019 to April 2021. Preoperative and postoperative MRI were compared to demonstrate the removed disk. Postoperative visual analog score, oswestry disability index, and modified Macnab criteria were obtained after 1 month, 6 months, and 1 year and were compared.

Results:
There were no major complications related directly to this technique. Seven patients were operated at L3-4, 28 patients at L4-5, and 5 patients at l5-S1. Mean visual analog score for leg pain improved from 7.36±0.64 preoperatively to 1.22±1.16 at 6 months postoperatively and 1.34±1.47 at 1 year postoperatively (P<0.01). The mean preoperative oswestry disability index improved from 67.1±8.79 preoperatively to 12.1±13.48 at 1 year postoperatively (P<0.01). Excellent or good global outcomes were obtained in 95%.

Conclusions:
TPELD is a minimally invasive treatment with effective and safe results of very high-grade migrated disk herniation. Improvement of several pain scores can be observed in the 12-month follow-up after surgery.