bluuebunny/crossref_metadata_2025_split huggingface dataset:
Essential genomic knowledge in graduate nursing practice
Authors: Connors Laurie M. , Schirle Lori , Dietrich Mary S. 
Published: August 2022

ABSTRACT

Background:
Genetics-informed nursing is essential to personalized health care. Advanced practice nurses will increasingly encounter genomic information in clinical care and are expected to have competency.

Purpose:
To examine genomic competency of advanced practice nursing students and faculty in a graduate nursing school.

Methods:
A convenience sample of graduate nursing faculty and students were electronically sent a survey assessing genomic knowledge. In total, 13.98% of faculty (33/236) and 9.87% of students (82/831) completed a demographic questionnaire, perceived genomic competency items, and Genomic Nursing Concept Inventory (GNCI). The GNCI is a 31-question multiple choice questionnaire assessing 18 genomic concepts in four categories (Human Genome Basics, Mutations, Inheritance Patterns, and Genomic Health care). Percentage of correct items was calculated for faculty and students, as were correlations between demographics, perceived genomic competency, and GNCI scores.

Results:
Students' GNCI overall scores were higher than faculty, 54.8% (interquartile range [IQR] 38–72%) vs 48.4% (IQR 32–68%). Both groups demonstrated the lowest scores in Genomic Basics (students 41.7% [IQR 25–67%] and faculty 33.3% [IQR 16–50%]). Students' and faculty's perceived genomic competency correlated with GNCI scores (r = 0.49, p < .001 and r = 0.70, p < .001, respectively). Age (r = −0.40, p < .001), entering nursing school after 2010 (r = 0.47, p < .001), and previous genomics course (r = 0.52, p < .001) were significantly correlated with GNCI total score for students, but not faculty.

Conclusions:
This study indicates that faculty and students in a graduate nursing school perceive and demonstrate low genomic knowledge, particularly in basic genomics. Further exploration into innovative methods to provide basic genomic education is needed.

Implications:
To provide access and equity for personalized genomic-based health care, we must prepare genomics-informed nurses.
Intra‐rater Variability of the Brussels Infants and Toddlers Stool Scale (BITSS) Using Photographed Stools
Authors: Hofman Yvonne Marianne Christine , Vandenplas Yvan , Ludwig Thomas , Ouald Chaib Abdelhalim , Kluyfhout Sandra , Krikilion Jasmina , De Geyter Charlotte , Huysentruyt Koen 
Published: August 2022

Objectives:The Brussels Infants and Toddlers Stool Scale (BITSS) was developed for the assessment of stool consistency in non–toilet‐trained children. This study aimed to (1) investigate the intra‐rater reliability of the BITSS among health care professionals (HCPs) and caregivers (CGs); (2) study a potential learning curve; (3) explore the impact of photo quality on intra‐rater reliability.Methods:Photos of diapers containing stool were assessed twice by 4 HCP (2432 photos) and 8 CGs (492 photos) using the BITTS. Intra‐rater reliability was calculated by the percentage of exact agreement and a κ‐value. A learning effect and the impact of photo quality was explored using mixed linear model and generalized estimating equations.Results:HCPs generated 24,320 stool consistency ratings: 12.1% were scored as watery, 31.0% loose, 29.4% formed, and 27.6% hard. CGs performed 7872 ratings: 9.2% classified as watery, 34.6% loose, 28.9% formed, and 27.3% hard. Intra‐rater reliability (κ) for HCPs ranged from 0.64 [95% confidence interval (CI) = 0.61–0.66] to 0.78 (95% CI = 0.76–0.80) and from 0.68 (95% CI = 0.63–0.73) to 0.94 (95% CI = 0.91–0.97) in the CG group. Both groups had <1% improvement in the odds of identical classification per 50 photos. The percentage of absolute agreement was higher in photos rated as good quality than those that were not (HCPs: 80.3% vs 69.5%, P < 0.001; CGs: 90.4% vs 86.3%, P < 0.001).Conclusions:The BITSS has an excellent intra‐rater reliability for the stool consistency scoring of photographs of stools in diapers, but can be influenced by photo quality. A clinically meaningless learning effect was found.
Patient Safety Training Programs for Health Care Professionals: A Scoping Review
Authors: Amaral Catarina , Sequeira Carlos , Albacar-Riobóo Núria , Coelho Joana , Pinho Lara Guedes , Ferré-Grau Carme 
Published: August 2022

Objective
This study aimed to map the evidence available on patient safety training programs for health professionals.

Methods
A scoping review was carried out. Several studies published between January 2010 and March 2020 in the following databases were investigated: CINAHL; MEDLINE; Nursing & Allied Health Collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane; MedicLatina, via EBSCOhost; World Health Organization; Google Scholar; BVS—Biblioteca Virtual da Saúde; PubMed; B-On; and RCAAP—Repositórios Científicos de Acesso Aberto de Portugal.

Results
A total of 2841 articles were found, 7 were included. Most studies report that the development of patient safety programs for health care professionals provides them with tools and techniques to recognize adverse incidents induced by the professional system/practice; recognize human factors related to patient safety, such as nontechnical skills or tiredness; understand high-risk clinical processes; develop strategies that influence and enhance patient safety culture; promote communication, teamwork, and organizational culture concerning patient safety; analyze other characteristic and emerging topics in patient safety; and develop project proposals to improve patient safety, allowing health care professionals to consolidate their knowledge, leading initiatives to improve patient safety.

Conclusions
There are still few studies that test patient safety training programs, which is a concern given the importance of implementing safe practices. The existing evidence proves the efficacy of the training programs in improving patient safety, although there are some gaps.
Trends in diabetes incidence and associated risk factors among people with HIV in the current treatment era
Authors: Spieler Gabriel , Westfall Andrew O. , Long Dustin M. , Cherrington Andrea , Burkholder Greer A. , Funderburg Nicholas , Raper James L. , Overton Edgar T. , Willig Amanda L. 
Published: August 2022

Objective:
To examine type 2 diabetes mellitus incidence and associated risk factors among people with HIV (PWH).

Design:
A retrospective clinical cohort study of PWH at a Southeastern US academic HIV clinic between 2008 and 2018.

Methods:
PWH who attended at least two clinic visits were evaluated with demographic and clinical data extracted from the electronic medical record (EMR). Diabetes was defined as: hemoglobin A1C ≥6.5% and/or 2 glucose results >200 mg/dl (at least 30 days apart), diagnosis of diabetes in the EMR, or exposure to diabetes medication. Time to diabetes incidence was computed from the entire clinic population for each year. Multivariable Cox proportional hazard regression models with time-dependent covariates were created to evaluate the independent association between covariates and time to incident diabetes.

Results:
Among 4113 PWH, we identified 252 incident cases of diabetes. Incidence increased from 1.04 incidents per 1000 person years (PY) in 2008, to 1.55 incidents per 1000 PY in 2018. Body mass index (hazard ratio [HR] 10.5 (6.2, 17.7)), liver disease (HR 1.9 (1.2, 3.1)), steroid exposure (HR 1.5 (1.1, 1.9)), and use of integrase inhibitors (HR 1.5 (1.1, 2.0)) were associated with incident diabetes. Additional associated factors included lower CD4+ cell counts, duration of HIV infection, exposure to nonstatin lipid-lowering therapy, and dyslipidemia.

Conclusions:
Rapidly increasing incident diabetes rates among PWH were associated with both traditional and HIV-related associated risk factors, particularly body weight, steroid exposure, and use of Integrase Inhibitors. Notably, several of the risk factors identified are modifiable and can be targeted for intervention.
Cryptococcal Antigen Screening and Missed Opportunities for Earlier Diagnosis Among People With HIV and Poor Virologic Control in the Bronx, NY
Authors: Yoon Hyunah , Hemmige Vagish S. , Lee Audrey , Conway-Pearson Liam S. , Pirofski Liise-anne , Felsen Uriel R. 
Published: August 2022

Background:
There is no established cryptococcal antigen (CrAg) screening guideline for people with HIV who are antiretroviral therapy experienced but have poor virologic control. We assessed factors associated with CrAg screening and describe missed opportunities for earlier testing.

Setting:
Ambulatory clinics affiliated with Montefiore Medical Center, Bronx, NY.

Methods:
This was a retrospective chart review of CrAg screening among asymptomatic people with HIV with absolute CD4 counts

200 cells/mm3 and HIV viral loads (VLs) > 200 copies/mL receiving HIV care from 2015 to 2020. We used Cox proportional hazards regression to identify predictors of screening, including longitudinal CD4 count and HIV VL as time-varying covariables. Among cases of diagnosed cryptococcosis, we assessed for opportunities for earlier diagnosis.

Results:
Screening CrAg was performed in 2.9% of 2201 individuals meeting the inclusion criteria. Compared with those not screened, those who were screened had a shorter duration of HIV infection (0.09 vs. 5.1 years; P = 0.001) and lower absolute CD4 counts (12 vs. 24 cells/mm3; P < 0.0001). In a multivariable model stratified by median HIV duration, CD4 < 100 [hazard ratio (HR), 7.07; 95% confidence interval (CI): 2.43 to 20.6], VL > 10,000 (HR, 15.0; 95% CI: 4.16 to 54.0), and a shorter duration of HIV infection (HR, 0.60; 95% CI: 0.42 to 0.86) were associated with screening for those with HIV < 5 years. Among those diagnosed with cryptococcosis (n = 14), 6 individuals had an ambulatory visit in the preceding 6 months but did not undergo screening.

Conclusion:
CrAg screening was infrequently performed in this at-risk population. Those with a longer duration of HIV infection were less likely to undergo CrAg screening, highlighting potential missed opportunities for earlier diagnosis.
Antiretroviral Therapy Adherence During and Postbreastfeeding Cessation Measured by Tenofovir Levels in Hair
Authors: Nematadzira Teacler G. , Murnane Pamela M. , Odiase Osamuedeme J. , Bacchetti Peter , Okochi Hideaki , Tallerico Regina , Chanaiwa Vongai M. , Vhembo Tichaona , Mutambanengwe-Jacob Mercy T. , Louie Alexander , Chipato Tsungai , Gandhi Monica , Stranix-Chibanda Lynda ,   for the IMPAACT PROMISE Study Team
Published: August 2022

Background:
We examined change in antiretroviral treatment (ART) adherence after breastfeeding (BF) cessation using hair tenofovir (TFV) concentrations as an objective metric of medication consumption.

Methods:
A subset of postpartum women in Zimbabwe randomized in IMPAACT PROMISE to take ART while BF and post-BF cessation had hair TFV measured longitudinally. Using linear mixed-effect models, we estimated differences in hair TFV levels after BF cessation, accounting for trends in levels over time regardless of BF status and change in slope after breastfeeding cessation. We also estimated the relative risk of viremia (>50 copies/mL) per doubling of hair TFV concentration.

Results:
Among 55 women (median age 26, interquartile range 24–29 years), hair TFV levels (n = 305) were available for a median of 9 visits per woman between 3 and 29 months postpartum. Hair TFV levels ranged from undetected to 0.25 ng/mg (median 0.04 ng/mg). Controlling for trends since delivery [decline of 2.2% per month, 95% confidence interval (CI): −5.3 to 1.0], TFV levels averaged 24.4% higher (95% CI: −5.1 to 63.1) post-BF cessation than during BF, with no change in slope (0.0% per month, 95% CI: −3.8 to 3.9). Postpartum, 42% of women were ever viremic. Higher TFV levels were strongly protective; relative risk of viremia per doubling of TFV was 0.52 (95% CI: 0.43 to 0.63; P < 0.0001).

Conclusions:
Leveraging an objective metric of ART use, we observed modestly declining adherence across the postpartum period, but no additional decline associated with breastfeeding cessation. High viremia frequency and varying postpartum TFV levels observed highlight the importance of enhanced adherence support with viral load monitoring among postpartum women.
Arthroscopic Disk Repositioning After Failed Open Disk Repositioning
Authors: Zhang Wenhao , Luo Yi , Abdelrehem Ahmed , Liu Xiaohan , Chen Minjie , Yang Chi , Yu Chuangqi , Wang Fang 
Published: August 2022

Purpose:
Open disk repositioning has been long achieving excellent functional and stability outcomes. However, still remains some relapses for whom a second open surgery is often challenging. This study aimed to evaluate the effectiveness of arthroscopic disk reposition as an alternative surgery for unsuccessful cases of anterior disk displacement (ADD) after an initial open disk repositioning.

Materials and Methods:
This retrospective study included all patients who underwent secondary arthroscopy for disk repositioning of the relapsed ADD after an initial open surgery between January 2012 to June 2017. The redo arthroscopic disk repositioning and suturing procedure was the primary predictor input variable in this study. Outcome evaluation was based on both clinical (visual analog scale and maximal interincisal opening) and magnetic resonance imaging data.

Results:
Twenty-seven joints fulfilling the inclusion criteria were included. A significant improvement was detected at 24-month postoperatively compared with the baseline visual analog scale. The maximal interincisal opening showed a statistical improvement from 25.07 mm preoperatively to 38.44 mm at 24-month postoperatively. Twenty-six joints maintained a stable disk position with only 1 joint relapsed to ADD without reduction.

Conclusion:
Arthroscopic disk reposition and suturing technique is a reliable and effective repeat surgery after failed initial open disk repositioning for management of ADD.
Earlobe Reconstruction Using Two Opposed Periauricular Dermal Pedicled Flap
Authors: Ryu Hyeong Rae , Lee Da Woon , Kim Jun Hyuk 
Published: August 2022

There are several flap techniques of earlobe reconstruction. The ideal method should be a 1-stage procedure that is simple, has fewer complications, and has excellent esthetic outcomes with a proper earlobe texture and volume. We report a case of a 45-year-old man presented with skin and soft tissue defect of right ear lobule. He underwent composite graft using 2×1 cm sized stump. Two weeks later, total necrosis of graft site was observed. After that, he underwent 2 opposed periauricular dermal pedicled flap. Each flap caudally based periauricular flaps were elevated and consisted of redundant fat tissue. These flaps were sutured like sandwich and the donor sites were closured by primary repair. There was no complication as flap congestion or hematoma. After 6 months, the patient was satisfied esthetically and there was no need of additional surgical procedure. We introduce new technique of earlobe reconstruction named 2 opposed periauricular flap. This method affords reconstruction of large sized and full-thickness earlobe defect in a simple, easy manner. It provides proper texture and volume as normal earlobe. Also, it is 1-stage method not requiring skin graft or debulking procedure. Therefore, if plastic surgeon reconstructs a large defect of earlobe, our technique can be thought of as one good option.
A Modified Technique for Harvesting Scapular Tip Flap and to Allow 2 Teams to Work at the Same Time
Authors: Cariati Paolo , Arroyo Rodriguez Susana , Ferrari Silvano 
Published: August 2022

Aim:
The main aim of the present report is to describe a modified technique of tip scapular flap harvesting to allow 2 surgical teams to work at the same time and to shorten surgical times.

Materials and Methods:
The medical records of 25 patients that had undergone maxillary or mandibular reconstruction by using a free scapular tip flap were retrospectively reviewed to identify the possible advantages and disadvantages of this type of flap.

Results:
Thirteen patients analyzed in this series underwent maxillary reconstruction with tip scapular flap, while the other 12 patients underwent mandibular reconstruction. No failures, partial failures, or infections were evidenced in this series. Scapular tip flap allowed for acceptable esthetic and functional outcomes. In all cases, the patient was placed supine. No major complications were observed at the donor site during follow-up.

Conclusion:
Scapular tip flap might be extremely useful for head and neck reconstruction. Pedicle length, versatility, and reliability represent the major advantages of this reconstructive recourse. Moreover, the resistance of the scapular vascular system to atherosclerosis could be helpful in patients showing contraindications to free fibula flaps.
Enhancing the clinical supervision experience of staff members working within primary and community care: a best practice implementation project
Authors: Smith Cathryn , Bennett Clare , Morgan Kate , Carrier Judith , Klugarová Jitka , Klugar Miloslav 
Published: August 2022

Objectives:
The project aimed to assess compliance with evidence-based criteria regarding the use of clinical supervision amongst district nurses and to improve knowledge and engagement in clinical supervision activities within the workplace.

Introduction:
It is important to provide clinical support to all healthcare workers that provide opportunities to develop and be listened to in a supervised environment. Clinical supervision is seen as a key element to provide this support. It provides a professional working relationship between two or more members of staff where the reflection of practice and personal emotion can be discussed, which is outlined in many policies and guidelines.

Methods:
A baseline audit was carried out using the JBI Practical Application of Clinical Evidence System program involving 16 participants in one district nursing team in South Wales. The first step involved the development of the project and generating the evidence. Following this, a baseline audit was conducted, and educational training on clinical supervision was undertaken followed by clinical supervision sessions. A postimplementation re-audit was conducted following implementation.

Results:
A total of 16 participants enrolled on the project. Receiving basic training and participating in clinical supervision was much higher than the baseline audit with both increasing to 100% compliance. Furthermore, 94% of participants were aware of clinical supervision activities and 88% knew of existing records on clinical supervision. The project results show a large increase in compliance with all of the criteria.

Conclusion:
Overall the implementation project achieved an improvement in evidence-based practice regarding clinical supervision in primary care.
Medical device-related pressure injury prevention related to fixation of nutritional and derivative probes: a best practice implementation project
Authors: Saibertová Simona , Klugarová Jitka , Klugar Miloslav , Pokorná Andrea 
Published: August 2022

Abstract

Objectives:
The main objective was to improve the provision of clinical care in pressure injury prevention related to the use of medical devices focused on nasogastric probes.

Introduction:
The insertion of nasogastric probes could lead to the formation of medical device-related pressure injuries (MDRPI). The risk increases with the length of the probe insertion and is higher in patients in intensive care. MDRPI prevention is mostly based on appropriate skin and mucosa membrane and tissue monitoring and positioning of the medical devices.

Methods:
The project has been conducted based on JBI Implementation approach for promoting change in healthcare practice. A baseline audit on MDRPI prevention was undertaken and involved 21 nurses and 12 patients using a questionnaire for nurses and a record sheet for patient's monitoring. The intervention included education, clinical practice training, consultation, and other strategies. A follow-up audit was undertaken, including all original participants. Results data on changes in compliance were measured using descriptive statistics embedded in JBI-PACES in the form of percentage changes from baseline.

Results:
There were significantly improved outcomes across all best practice criteria. The level of knowledge of nurses increased. Skin barrier creams and mass-supplied fixation are now used to prevent skin injuries on the nose. The new monitoring and documentation is more accurate and in line with evidence-based practice.

Conclusion:
Overall, the project achieved an improvement in evidence-based practice in the prevention of MDRPI in patients with nasogastric probes based on nurses’ increased level of knowledge and usage of appropriate preventative measures.
Risk of Sexually Transmitted Infections Among U.S. Military Service Members in the Setting of HIV Pre-Exposure Prophylaxis Use
Authors: Blaylock Jason M. , Ewers Evan C. , Bianchi Elizabeth J. , King David B. , Casimier Rosemary O. , Erazo Hector , Grieco Stephen , Lay Jenny , Peel Sheila A. , Modjarrad Kayvon , Beckett Charmagne G. , Okulicz Jason F. , Scott Paul T. , Hakre Shilpa 
Published: August 2022

ABSTRACTBackgroundThe evidence for an increased incidence of sexually transmitted infections (STIs) among patients utilizing HIV pre-exposure prophylaxis (PrEP) has been inconsistent. We assessed the risk of incident STI while on PrEP compared to periods off PrEP among military service members starting PrEP.MethodsIncidence rates of chlamydia, gonorrhea, syphilis, hepatitis C virus, and HIV were determined among military service members without HIV prescribed daily oral tenofovir disoproxil fumarate and emtricitabine for HIV PrEP from February 1, 2014 through June 10, 2016. Hazard ratios for incident STIs were calculated using an Anderson-Gill recurrent event proportional hazard regression model.ResultsAmong 755 male service members, 477 (63%) were diagnosed with incident STIs (overall incidence 21.4 per 100 person-years). In multivariate analysis, male service members had a significantly lower risk of any STIs (adjusted hazard ratio (aHR) 0.24, 95% CI 0.12-0.47) compared to periods off PrEP after adjustment for socio-demographic characteristics and reasons for initiating PrEP. However, when stratifying for site and type of infection, the risk of extragenital gonorrhea infection (pharyngeal: aHR 2.08, 95% CI 0.85-5.11; rectal: aHR 1.36, 95% CI 0.54-3.46) and extragenital chlamydial infection (pharyngeal: aHR 3.33, 95% CL 0.54-20.36; rectal: aHR 1.73, 95% CI 0.93-3.24) was greater on PrEP compared to off PrEP although these values did not reach statistical significance.ConclusionsThe data suggest entry into PrEP care reduced the overall risk of STIs. Service members engaged in PrEP services also receive more STI prevention counseling, which might contribute to decreases in STI risk while on PrEP.