bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical Inactivity as an Early Sign of Frailty in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia
Authors: Chua Ling L. , Azanan Mohamad S. , Oh Lixian , Ariffin Hany 
Published: February 2023

Young adult survivors of childhood leukemia have been reported with increased likelihood of age-related comorbidities compared with the general population. We compared the prevalence of frailty in young adult survivors of childhood acute lymphoblastic leukemia (n=58, median age=23 y, median survival time=18 y) with age-matched and sex-matched controls without history of cancer. Frailty phenotypes were determined using Fried frailty model. Association between frailty status and cardiometabolic conditions, systemic inflammation, and T-cell immunophenotype changes were also examined. Frailty and prefrailty were more common among survivors compared with controls (58.6% vs. 34.5%, P=0.019). Physical inactivity (39.7%) was the most frequently observed frailty criterion among the survivors. Prevalence of cardiometabolic conditions was comparable between the robust and frail/prefrail survivors. Robust survivors had a higher level of T-cell activation than the prefrail/frail survivors (P<0.05), but no significant difference was observed for systemic inflammatory markers (IL-6 and C-reactive protein) and percentage of terminally differentiated T cells. Signs of frailty, especially physical inactivity, was detected in childhood acute lymphoblastic leukemia survivors early in their third decade of life. Survivors who were prefrail/frail also had altered T-cell activation; however, the role of such changes in T-cell phenotype in the etiology of frailty warrant further investigation.
Association Between Falling and Activities of Daily Living Measured by the Longshi Scale in Patients Poststroke
Authors: Li Dongxia , Zha Fubing , Wang Yulong 
Published: February 2023

Background:
Activities of daily living comprise an important risk factor for falls among patients who have suffered a stroke.

Purpose:
To investigate the incidence of falls in patients with stroke, categorized by their Longshi grades (bedridden, domestic, community), and to explore their risk factors for falls.

Methods:
A cross-sectional descriptive design was used. Patients completed a survey during face-to-face interviews.

Results:
Of the 869 participants, 15.7% experienced a fall. Those in the domestic Longshi group had the highest rate of falls. Approximately 30% experienced either a moderate or severe injury as a result of falling. In addition, being older than 70 years was significantly correlated with fall risk. Intermediate Longshi grades, from moderately dependent to slightly dependent, were also positively correlated with falls.

Conclusion:
Patients with stroke in the domestic Longshi group have a higher rate of falls. The risk of falling increased significantly in those with intermediate Longshi grades.
The Relationship Between Workplace Incivility and Patient Safety in Pediatric Nurses
Authors: Aljuaid Noof H. , Alharbi Manal F. 
Published: February 2023

Background:
Workplace incivility may directly influence nurses' involvement in patient safety; however, research on this topic in the pediatric setting has yet to be established.

Purpose:
The purpose of this study was to address the prevalence of workplace incivility in pediatric settings in Saudi Arabia (SA) and examine its impact on patient safety culture.

Methods:
A cross-sectional study design was used. Surveys, including the Nursing Incivility Scale and Hospital Survey on Patient Safety Culture, were sent to nurses across 6 pediatric units in Taif, SA.

Results:
A total of 300 nurses completed the surveys. A significant negative modest correlation was found between incivility and patient safety domains (P < .05). A higher stress score was associated with older age (>35 years), Saudi nationality, and subdegree education.

Conclusion:
This study found that pediatric nurses experience high rates of incivility, mostly originating from patients and their families.
Evolving the Assessment of Clinical Judgment
Authors: Delle Janelle M. , Cross Lacey , Weaver Angela , Jessee Mary Ann 
Published: February 2023

Background:
Nurses make decisions about care individually and as part of a team. Collective competence, the effective team management of patient care situations, is partially dependent on nurses' individual confidence and clinical judgment competence.

Purpose:
To describe individual and team-based facilitators and barriers to collective competence in teams of senior baccalaureate-level prelicensure nursing students during a team-based simulation.

Methods:
With a cross-sectional design, the study used a 26-item survey based on the National Council of State Boards of Nursing (NCSBN)-Clinical Judgment Measurement Model (CJMM) (α= .86) to assess individual student confidence and perceptions of clinical judgment competence while observation of team dynamics and task completion assessed collective competence.

Results:
Closed-loop communication and role assignment were facilitators of collective competence when present and barriers when absent. Additional barriers were lack of student confidence and perceived competence with Layers 3 and 4 of the NCSBN-CJMM.

Conclusions:
Team-based simulation strategies can be effectively used to assess collective clinical judgment competence.
Introspective Learning From Interprofessional Virtual Grand Rounds
Authors: Buelow Janet R. , Tillman Paula , Taggart Helen 
Published: February 2023

Background:
Interprofessional collaboration in health care settings improves patient safety and outcomes, yet collaboration among health professionals requires specific competencies and skills. Providing nursing students with interprofessional learning experiences with multiple health professions is possible yet challenging.

Problem:
Opportunities for effective online interprofessional learning are lacking.

Approach:
This article explores nursing students' reflections on how an interprofessional learning experience, Virtual Grand Rounds (VGRs), influenced their personal development and provided meaningful learning that they can use in their practices as professional nurses. Thematic analysis was done on the open-ended questions in students' final reflection assignment.

Outcomes:
Analysis of student reflections identified 5 learning themes including the value of teamwork and collaboration, the importance of communication skills, professional identity, plans to engage diverse health professions, and the desire for future learning.

Conclusions:
Student reflections indicate the VGR was an effective method for nursing students to experience collaboration with multiple health professions without disrupting curriculums.
Interprofessional Simulation Learning Game Increases Socialization and Teamwork Among Students of Health Professions Programs
Authors: Fusco Nicholas M. , Foltz-Ramos Kelly , Ohtake Patricia J. , Mann Catherine 
Published: February 2023

Background:
Interprofessional (IP) socialization is important to develop early in the training of health professions students.

Purpose:
This study compared changes in health professions students' IP socialization and readiness to function in IP teams and sought to understand students' participation experiences using a simulation learning game (Friday Night at the ER [FNER]).

Methods:
The single-center study targeted students in 13 health professions programs using a mixed-methods design. Student teams engaged in open discussion, played the game, and participated in team debriefing.

Results:
IP socialization increased from fairly great to great extent among all students. Qualitative analyses revealed 3 overarching themes supporting the development of IP communication and systems-based thinking. Program evaluation data revealed that students highly valued this experience as being effective and important to their professional development.

Conclusions:
An IP experience consisting of FNER gameplay and structured debriefing can improve IP socialization and lay the foundation for the development of IP skills among early health professions students.
Enhancing Nurse Roles in Community Health (ENRICH)
Authors: Lawlor Mary Ann C. , L. Mitchell Rebecca , Burant Patricia A. , Quinn Griffin Mary , Dolansky Mary A. 
Published: February 2023

Background:
Low numbers of new graduate nurses entering careers in primary care settings are insufficient to meet the demand of the current nursing shortage. The Enhancing Nurse Roles in Community Health (ENRICH) Fellowship is aimed at increasing undergraduate nursing students' exposure to population health concepts by providing opportunities to practice in primary care settings.

Purpose:
The purpose of this study was to implement and evaluate an undergraduate nursing fellowship program to enhance competency development in the primary care setting.

Methods:
Fellows received targeted exposure to population health content and immersive primary care experiences through participation in 150 dedicated clinical hours in primary clinics, coupled with up to 250 hours of dedicated curriculum.

Results:
Students who participated in the ENRICH Fellowship showed increased knowledge, improved perception of skills performance, and changed attitudes about population health and primary care nursing.

Conclusion:
Participation in a population health-based fellowship that includes targeted curricular content and primary care–based clinical experiences during an undergraduate nursing program improves knowledge, attitudes, and competency-based skills related to primary care and population health.
Effective Interventions for Nursing Student Burnout
Authors: Burleson Shannon , Thomas Lisa , DeBoor Stephanie 
Published: February 2023

Background:
Burnout in nursing students negatively impacts students' health, decreases academic success, increases attrition, and threatens the quality of patient care.

Purpose:
To identify empiric research evaluating the effectiveness of interventions to prevent nursing student burnout.

Methods:
This scoping review examined the PubMed, CINAHL, PsycINFO, and Google Scholar databases to identify original studies evaluating burnout interventions in nursing students.

Results:
Of the 258 studies identified in the primary search, 208 were screened and 29 were selected for full-text review. Five quantitative reports and 1 qualitative study met the inclusion criteria. Effective interventions included recreational music-making, mindfulness-based and resilience education, integral-caring-holistic-science curriculum, Acceptance and Commitment Training, and progressive muscle relaxation. Statistically significant reductions in burnout were reported in all 5 of the quantitative studies.

Conclusion:
This review demonstrates a need for further research. Burnout interventions should be embedded in the nursing curriculum to yield a more sustainable profession.
Relationship of Organizational Support, Psychological Capital, and Engagement Among Clinical Nursing Teachers
Authors: Kong Ling-Na , Liao He-Ping , Liu Dun-Xiu , Chen Shuo-Zhen 
Published: February 2023

Background:
Clinical nursing teachers play a critical role in nursing education, and their engagement is important to ensure the quality of clinical teaching.

Purpose:
To describe the level of engagement and determine the relationships among organizational support, psychological capital, and engagement among clinical nursing teachers.

Methods:
A cross-sectional study was conducted among 246 clinical nursing teachers, from 4 teaching hospitals in China, using a self-report questionnaire. The questionnaire measured organizational support, psychological capital, and work engagement.

Results:
Clinical nursing teachers reported a medium level of engagement in teaching. Both organizational support and psychological capital had positive effects on teachers' engagement. Psychological capital partially mediated the relationship between organizational support and engagement.

Conclusions:
Measures to improve organizational support and psychological capital are essential to enhance the engagement among clinical nursing teachers.
Primary Central Nervous System Vasculitis Following Alemtuzumab Treatment for Multiple Sclerosis
Authors: Varela Lucía , Pappolla Agustín , Heriz Alejandra , Márquez Rocío , Vega Otto , Christiansen Silvia , Rugiero Marcelo , Midaglia Luciana , Salerno Annalaura , Tintoré Mar , Rovira Àlex 
Published: February 2023

Introduction:
Cerebral vasculitides are often devastating conditions that require immediate diagnosis and treatment.

Case report:
We report a pathologically proven clinical case of primary central nervous system vasculitis in a 50-year-old man with a diagnosis of relapsing-remitting multiple sclerosis after alemtuzumab therapy, which required additional immunosuppression to control this life-threatening condition.

Conclusion:
In patients presenting subacute neurological deterioration after alemtuzumab therapy, primary central nervous system vasculitis should be considered as a differential diagnosis among other autoimmune conditions.
Case Report: Nyctalopia Due to Severe Liver Cirrhosis–induced Vitamin A Deficiency
Authors: Chen Shuyi , Quan Amy Jill 
Published: February 2023

SIGNIFICANCE
Vitamin A is a micronutrient critical for retinal function. Patients with a deficiency may notice a progressive decline in night vision as rod photoreceptors become unable to regenerate rhodopsin. Although uncommon in developed nations, vitamin A deficiency should be considered in symptomatic patients with chronic, severe liver disease.

PURPOSE
This report presents a rare case of night blindness secondary to poor vitamin A metabolism due to severe liver cirrhosis.

CASE REPORT
A 62-year-old White woman presented with progressively worsening vision in dim lighting over the past 6 to 8 months. She was asymptomatic in daylight but “blind in the dark” to the extent that she was afraid to go outside at night. She had no personal or family history of night blindness or retinal disorders. Ocular health was unremarkable with dilation. Given her medical history of severe nonalcoholic liver cirrhosis, malabsorption of vitamin A was suspected and subsequently confirmed by the very low vitamin A level in her serum analysis. The patient was sent to endocrinology for evaluation, and appropriate repletion therapy was implemented. Subjective improvement in symptoms, along with better performance on visual field testing, was noted after initiating oral vitamin A supplementation for 5 months.

CONCLUSIONS
Although vitamin A deficiency is a relatively rare disorder in the United States, it should be suspected in patients with severe liver disease or other conditions causing malabsorption who experience a loss of night vision.
Fetal Age Assessment From Primary Teeth and Long Bones
Authors: Crumpton Mark W. , Mileusnic-Polchan Darinka , Lewis James , Heidel R. Eric , Marks Murray K. 
Published: February 2023

Abstract
This study evaluated traditional and expedited methods for assessing the age of fetal remains. Because of their rare occurrence, the discovery of fresh, decomposing, disfigured, or skeletal fetuses engenders heightened awareness by forensic pathologists primarily tasked with age estimation in relation to viability. With decomposed complete or isolated fetal remains, dentists focus on primary molar mineralization, whereas anthropologists perform long bone measurements along with discernment of other indicators of skeletal maturity to obtain an age estimation.
The results of this study are 4-fold: (1) The “best” technique for harvesting fetal tooth buds and long bones is the dissection of the developing tooth buds with maceration for the long bones. (2) Metric analysis was applied to the tooth buds and long bones for age estimation, and the findings were correlated. (3) There is a statistically significant difference between known age and dental age and between dental age and long bone age. The difference between known age and long bone age is not statistically significant, but a type II error exists because of the small sample size. (4) A central incisor staging technique for fetuses younger than 26 weeks was developed as a supplement to the molar staging system of Kraus and Jordan (1965).
Randomization to a Liberal Versus Conservative Oxygenation Target: Redox Responses in Critically Ill Children
Authors: Jones Gareth A. L. , Eaton Simon , Orford Michael , Ray Samiran , Wiley Daisy , Ramnarayan Padmanabhan , Inwald David , Grocott Michael P. W. , Griksaitis Michael , Pappachan John , O’Neill Lauran , Mouncey Paul R. , Harrison David A. , Rowan Kathryn M. , Peters Mark J. ,   the Oxy-PICU Investigators of the Paediatric Critical Care Society Study Group (PCCS-SG)
Published: February 2023

RATIONALE:Optimal systemic oxygenation targets in pediatric critical illness are unknown. A U-shaped relationship exists between blood oxygen levels and PICU mortality. Redox stress or iatrogenic injury from intensive treatments are potential mechanisms of harm from hyperoxia.OBJECTIVES:To measure biomarkers of oxidative status in children admitted to PICU and randomized to conservative (oxygen-hemoglobin saturation [Spo2] 88–92%) versus liberal (Spo2> 94%) peripheral oxygenation targets.DESIGN:Mechanistic substudy nested within the Oxygen in PICU (Oxy-PICU) pilot randomized feasibility clinical trial (ClinicalTrials.gov: NCT03040570).SETTING:Three U.K. mixed medical and surgical PICUs in university hospitals.PATIENTS:Seventy-five eligible patients randomized to the Oxy-PICU randomized feasibility clinical trial.INTERVENTIONS:Randomization to a conservative (Spo288–92%) versus liberal (Spo2> 94%) peripheral oxygenation target.MEASUREMENTS AND MAIN RESULTS:Blood and urine samples were collected at two timepoints: less than 24 hours and up to 72 hours from randomization in trial participants (March 2017 to July 2017). Plasma was analyzed for markers of ischemic/oxidative response, namely thiobarbituric acid-reactive substances (TBARS; lipid peroxidation marker) and ischemia-modified albumin (protein oxidation marker). Total urinary nitrate/nitrite was measured as a marker of reactive oxygen and nitrogen species (RONS). Blood hypoxia-inducible factor (HIF)–1a messenger RNA (mRNA) expression (hypoxia response gene) was measured by reverse transcription- polymerase chain reaction. Total urinary nitrate/nitrite levels were greater in the liberal compared with conservative oxygenation group at 72 hours (median difference 32.6 μmol/mmol of creatinine [95% CI 13.7–93.6];p< 0.002, Mann-Whitney test). HIF-1a mRNA expression was increased in the conservative group compared with liberal in less than 24-hour samples (6.0-fold [95% CI 1.3–24.0];p= 0.032). There were no significant differences in TBARS or ischemia-modified albumin.CONCLUSIONS:On comparing liberal with conservative oxygenation targets, we show, first, significant redox response (increase in urinary markers of RONS), but no changes in markers of lipid or protein oxidation. We also show what appears to be an early hypoxic response (increase in HIF-1a gene expression) in subjects exposed to conservative rather than liberal oxygenation targets.
Continuous Venovenous Hemofiltration Performed by Neonatologists With Cardio-Renal Pediatric Dialysis Emergency Machine to Treat Fluid Overload During Multiple Organ Dysfunction Syndrome: A Case Series
Authors: Regiroli Giulia , Loi Barbara , Pezza Lucilla , Sartorius Victor , Foti Anna , Barra Pasquale Fabio , Centorrino Roberta , Di Nardo Matteo , De Luca Daniele 
Published: February 2023

OBJECTIVES:
A new device is available for neonates needing extracorporeal renal replacement therapy. We reviewed the use of this device (in continuous venovenous hemofiltration [CVVH] mode) in term or preterm neonates affected by multiple organ dysfunction syndrome (MODS) with fluid overload.

DESIGN:
Case series.

SETTING:
Academic specialized referral neonatal ICU (NICU) with expertise on advanced life support and monitoring.

PATIENTS:
Neonates with MODS and fluid overload despite conventional treatments and receiving at least one CVVH session.

INTERVENTION:
CVVH with the Cardio-Renal Pediatric Dialysis Emergency Machine.

MEASUREMENTS AND MAIN RESULTS:
Ten (three preterm) neonates were treated using 18 consecutive CVVH sessions. All patients were in life-threatening conditions and successfully completed the CVVH treatments, which almost always lasted 24 hr/session, without major side effects. Three neonates survived and were successfully discharged from hospital with normal follow-up. CVVH reduced fluid overload (before versus after represented as a weight percentage: 23.5% [12–34%] vs 14.6% [8.2–24.1%]; p = 0.006) and lactate (before versus after: 4.6 [2.9–12.1] vs 2.9 mmol/L [2.3–5.5 mmol/L]; p = 0.001). CVVH also improved the Pao
2 to Fio
2 (before vs after: 188 mm Hg [118–253 mm Hg] vs 240 mm Hg [161–309 mm Hg]; p = 0.003) and oxygenation index (before vs after: 5.9 [3.8–14.6] vs 4 [2.9–11]; p = 0.002). The average cost of CVVH in these patients was minor (≈3%) in comparison with the median total cost of NICU care per patient.

CONCLUSIONS:
We have provided CVVH to critically ill term and preterm neonates with MODS. CVVH improved fluid overload and oxygenation. The cost of CVVH was minimal compared with the overall cost of neonatal intensive care.
A Randomized Trial of Incentivization to Maximize Retention for Real-Time Symptom and Activity Monitoring Using Ecological Momentary Assessment in Pediatric Concussion
Authors: Corwin Daniel J. , Orchinik Julia , D'Alonzo Bernadette , Agarwal Anish K. , Pettijohn Kevin W. , Master Christina L. , Wiebe Douglas J. 
Published: February 2023

ObjectiveThe aims of this study were to determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) after pediatric concussion, and assess the feasibility of tracking concussed youth using EMA from the emergency department (ED) setting.MethodsThis study was a randomized controlled trial of participants ages 13 to 18 years with concussion presenting to an urban, academic pediatric ED within 5 days of injury. Participants were randomized to 1 of 4 incentive arms: 2 dynamic (loss-based and streak) and 2 control flat-rate (monetary and electronic device). Participants reported symptoms 3 times per day and cognitive activity once each evening for 3 weeks. Physical activity (step count) and sleep were monitored using a Fitbit (kept by participants in the device flat-rate arm). The primary outcome was proportion of prompts to which participants responded. Secondary outcomes included differential response rates by demographics, and comparison of outcome determination between EMA and subsequent clinical visits.ResultsThirty participants were enrolled, with a median age of 15.5 years and 60% female. Median cumulative proportion of prompts responded to was 68.3% (interquartile range, 47.6%–82.5%) in the dynamic arms versus 54.0% (interquartile range. 20.6%–68.3%) in the flat-rate arms,P= 0.065. There were nonsignificant differences in median response by sex (65.9% for female vs 40.0% for male,P= 0.072), race/ethnicity (61.9% for non-Hispanic White vs 43.7% for non-Hispanic Black participants,P= 0.097), and insurance (61.9% for private insurance vs 47.6% for public insurance,P= 0.305). Recovery at 3 weeks was discernible for all but 2 participants (93.3%) using EMA data, compared with only 9 participants (30.0%) (P< 0.001) from clinical visits.ConclusionsDynamic incentivization showed higher rates of response to tridaily symptom prompts compared with flat-rate incentivization. These data show tracking concussed youth using EMA from the ED is feasible using a dynamic incentivization strategy, with improved ability to discern outcomes compared with prospective monitoring using follow-up clinical visits.