bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Surgical Morbidity After Hysterectomy During an Obesity Epidemic
Authors: Davidson Brittany A. , Weber Jeremy M. , Monuzsko Karen A. , Truong Tracy , Havrilesky Laura J. , Moss Haley A. 
Published: March 2022

OBJECTIVE:
To assess 30-day outcomes for hysterectomy by body mass index (BMI) classification and estimate trends in 30-day outcomes by BMI over time.

METHODS:
This is a retrospective cohort study of patients older than age 18 years undergoing hysterectomy with data in the National Surgical Quality Improvement Program database from 2005 to 2018. Exclusions were made for ambiguous indication or route of surgery and missing values in covariates or outcomes of interest. Patient characteristics and outcomes were compared across BMI classifications. Outcomes included operative time, length of stay, and major and minor complications. Multivariable linear regression models were used for continuous outcomes, and modified Poisson regression models were used for binary outcomes. Patients with benign and malignant indications for hysterectomy were analyzed separately. Models were adjusted for age, race, hysterectomy route, hypertension, diabetes, smoking, selected preoperative laboratory values, and cancer type, if applicable.

RESULTS:
Obesity rate increased from 41.2% in 2005–2007 to 51.8% in 2018. Among 319,462 patients, minimally invasive surgery was the most common approach (58.8% vs 24.5% laparotomy vs 16.7% vaginal). Higher BMI classifications were associated with longer operative times (benign indication: average 25.0 minutes longer, 95% CI 22.1–27.9; malignant indication: average 25.1 minutes longer, 95% CI 20.8–29.4) and higher risk of complications compared with normal-weight BMIs, though operative time declined over time for patients with malignant surgical indications. Relative to normal-weight patients, rates of major complications did not increase until a BMI of 40 for hysterectomy for benign indications and 50 for hysterectomy for malignant indications.

CONCLUSION:
Operative times and complications both increase with obesity when performing hysterectomy. Knowledge of evolving risk level at various weight subclassifications can improve shared decision making preoperatively.
Geographic Variation in Apical Support Procedures for Pelvic Organ Prolapse
Authors: Gerjevic Kristen A. , Newton Helen , Leggett Christopher , Skinner Jonathan , Erekson Elisabeth , Strohbehn Kris 
Published: March 2022

OBJECTIVE:
To measure geographic variation in rates of apical support procedures for the treatment of pelvic organ prolapse (POP) among female Medicare beneficiaries.

METHODS:
We conducted a retrospective, cross-sectional study and used 100% Medicare fee-for-service claims to identify a cohort of women aged 65–99 years who had an apical support procedure, defined by Current Procedural Terminology codes, in 2016–2018. We included all vaginal and abdominal approaches (native tissue and mesh colpopexies) and obliterative procedures. We excluded vaginectomies with a diagnosis of gynecologic cancer that did not have a diagnosis for prolapse. We created rates of apical POP procedures by hospital referral region and computed coefficients of variation to measure the degree of geographic variation.

RESULTS:
An average of 26,005 apical POP procedures were performed annually from 2016 to 2018. The majority of patients were aged 65–74 years (64.3%), and 28.5% had concomitant hysterectomy. From 2016 to 2018, there was a mean of 1.79 apical POP procedures per 1,000 female beneficiaries performed across hospital referral regions (95% CI 1.74–1.84). Rate estimates ranged between 0.87 (95% CI 0.63–1.11) apical POP procedures per 1,000 female beneficiaries (Alexandria, Louisiana) and 3.33 (95% CI 2.91–3.74) per 1,000 beneficiaries (Akron, Ohio), a nearly fourfold difference in rates. Variation between hospital referral regions for abdominal apical prolapse procedures was the greatest (coefficient of variation 0.52). Vaginal and obliterative approaches demonstrated less variation between hospital referral regions (respectively, coefficient of variation 0.36 and 0.40).

CONCLUSION:
There is wide geographic variation among hospital referral regions for the treatment of POP. Women may be treated differently based on where they live and seek care, which raises questions about possible overuse in some regions and concerns about underuse and lack of access in other regions.
Preexposure Prophylaxis Acceptability Among Pregnant Individuals and Implications for Human Immunodeficiency Virus Prevention
Authors: Groves Allison K. , Vadaketh Jessica , Raziano Valerie T. , Nkwihoreze Hervette , Short William R. , Momplaisir Florence 
Published: March 2022

OBJECTIVE:
To understand perspectives on and preferences for preexposure prophylaxis (PrEP) for pregnant individuals who are at risk for human immunodeficiency virus (HIV) infection.

METHODS:
In this qualitative study, we purposively sampled and conducted in-depth interviews with pregnant participants at risk of HIV infection (indicated by a recent sexually transmitted infection [STI]) from a U.S. urban obstetrics clinic. Interview questions focused on perceived HIV risk, knowledge and perceptions of PrEP, and preferences for different PrEP formulations. We coded data using deductive and inductive codes, created matrices to explore patterns in findings, and wrote memos to interpret emergent themes.

RESULTS:
Twenty patients were enrolled. Median age of the participants was 24 years (interquartile range 19–26 years), 95.0% were African American, 65.0% were high school graduates, and 70.0% had unplanned pregnancies. Participants had low knowledge of PrEP and most saw themselves at low to no risk of HIV acquisition, despite their recent STI. Further, participants' low HIV risk perception and medication safety concerns reduced PrEP acceptability. Moreover, very few had discussed PrEP with their obstetrician–gynecologists (ob-gyns) during antenatal care, which further affected perceived acceptability. However, participants who did discuss PrEP with their ob-gyns had favorable perceptions of it. These participants indicated that they would choose a formulation based on individual preferences, which were largely shaped by perceived ease of use, acceptability, and prior experience with other medication regimens.

CONCLUSION:
Obstetrician–gynecologists may play an important role in increasing pregnant individuals’ knowledge of and access to PrEP during pregnancy among those who are at risk of HIV acquisition. To maximize uptake and adherence during this time, PrEP formulations should be tailored to individual preferences. Prevention of HIV during this critical life transition is important not only for the long-term health and well-being of pregnant individuals and their infants, but to the plan to end the HIV epidemic in the United States by 2030.
Educational Multimedia Tool Compared With Routine Care for the Uptake of Postpartum Long-Acting Reversible Contraception in Individuals With High-Risk Pregnancies
Authors: Qureshey Emma J. , Chauhan Suneet P. , Wagner Stephen M. , Batiste Oliver , Chen Han-Yang , Ashimi Sunbola , Ross Patti Jayne , Blackwell Sean C. , Sibai Baha M. 
Published: March 2022

OBJECTIVE:
To assess whether an intervention with a multimedia educational tool, compared with routine care, would increase the use of long-acting reversible contraceptives (LARC) at 12 weeks postpartum in individuals with high-risk pregnancies.

METHODS:
In this single-center randomized trial, we assigned individuals aged 13–50 years with high-risk pregnancies to either a multimedia educational tool or routine care. Participants were included during pregnancy through postpartum day 1. Those randomized to the multimedia educational tool (MET) group were provided a tablet with the preloaded 3–5-minute multimedia presentation (https://prezi.com/view/jpFrXaPnnxuqRkcI3A4a/), which was viewed without the presence of research staff and resent by secure email every 4 weeks if undelivered. The primary outcome was uptake of LARC (implant or intrauterine device) within 12 weeks of delivery. The secondary outcomes included overall use of any method of contraception and composite maternal and neonatal adverse outcomes. A priori estimates indicated that 380 participants were needed to detect a 40% difference in use of LARC (baseline 40%; alpha=0.05, power=0.8, assumed loss to follow-up 20%). Relative risk (RR) and number needed to treat (NNT), along with 95% CIs, were calculated.

RESULTS:
From July 2020 through December 2020, 536 persons were screened and 380 randomized as follows: 190 for the multimedia educational tool and 190 for routine care. Demographic characteristics were similar between groups. The primary outcome—available for more than 90% of participants—was higher in the MET group (32.4%) than in the routine care (RC) group (20.9%) (RR 1.55; 95% CI 1.09–2.21; NNT nine, with 95% CI 5–42). Overall use of contraception was also higher in the MET group than in the RC group (RR 1.16; 95% CI 1.03–1.32).

CONCLUSION:
Among individuals with high-risk pregnancies, compared with routine care, use of a multimedia-based educational tool increased the uptake of postpartum LARC by 55%.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, NCT04291040.

FUNDING SOURCE:
Funded in part by Investigator-Initiated studies of Organon.
The importance of surgeon judgment in obtaining early magnetic resonance imaging to prevent delays in care for acute subacromial injury: a retrospective comparative cohort study
Authors: Stevens Trent T. , Hartline Jacob T. , Brolin Tyler J. , Bernholt David L. , Dibaba Daniel T. , Azar Frederick M. , Throckmorton Thomas W. 
Published: March 2022

Background:
The purpose of this study was to evaluate the role of initial assessment of acute subacromial injury by an orthopaedic surgeon to identify surgical lesions that would benefit from early imaging.

Methods:
Patients with subacromial injury were identified. Patients who had MRI ordered at the initial visit for suspicion of a surgical lesion comprised the study group. The remaining patients were treated conservatively.

Results:
A total of 367 patients were identified; 298 (81%) underwent conservative treatment, 84 of whom had later MRI, and 69 (19%) had an MRI ordered initially. In the early MRI group, 31 (44.9%) underwent surgery an average of 85 days from presentation compared to 38 (12.8%) in the conservative group who underwent surgery 140 days from presentation (P=0.019). MRI scan review revealed that 41/69 (59.4%) patients in the early MRI group had full-thickness rotator cuff tear compared with 33/84 (39.3%) in the conservative group with MRI (P=0.020). Partial-thickness tears were noted in 8/69 (11.6%) in the early MRI group. In the conservative group that subsequently had MRI, 17/84 (20.2%) had a partial-thickness tear.

Conclusions:
Nearly 60% of patients undergoing initial MRI based on orthopaedic surgeon judgment had a full-thickness rotator cuff tear, significantly more than patients treated conservatively upon initial evaluation. Patients who first undergo conservative treatment for suspected acute subacromial injury experience a significant delay both in MRI and surgical intervention. Surgeon judgment is an important factor in the decision to obtain MRI in acute subacromial injury to prevent delays in care.

Level of Evidence:
Level III.
The roaring 2020s: a new decade of systemic therapy for renal cell carcinoma
Authors: Srivastava Arnav , Doppalapudi Sai K. , Patel Hiren V. , Srinivasan Ramaprasad , Singer Eric A. 
Published: March 2022

Purpose of review
The genomic and immunologic profiling of renal cell carcinoma (RCC) has provided the impetus for advancements in systemic treatments using combination therapy – either with immune check point inhibitor (ICI) + ICI or with ICI + targeted therapy. This approach has been examined in several landmark trials, treating both clear cell (ccRCC) and nonclear cell (nccRCC) histologies. In this review, we highlight systemic therapy advancements made in this new decade, the 2020s.

Recent findings
Targeting the programmed death receptor 1/PD-L1 pathway has created more tolerable and effective immunotherapy regimens, expanding the applications of ICIs. These new applications, paired with trial data, include ICI monotherapy in nccRCC and adjuvant pembrolizumab in resected, high-risk RCC. In addition, ICI + ICI and ICI + TKI combination therapy have demonstrated oncologic efficacy in advanced ccRCC and sarcomatoid RCC. Similar progress has been noted regarding new targeted therapies. Along the hypoxia inducible factor pathway, belzutifan has received FDA approval in von Hippel-Lindau-associated RCC. In addition, in papillary RCC, agents such as cabozantinib target the MET proto-oncogene pathway and have demonstrated impressive oncologic outcomes.

Summary
The 2020s utilize the molecular profiling of advanced RCC as a scaffold for recent trials in immunotherapy and targeted therapies. Going forward, emphasizing patient-reported outcomes and careful clinical trial construction remain critical to improve systemic therapy in RCC.
ASSOCIATION OF PLASMA ω-3 FATTY ACIDS WITH EARLY AGE-RELATED MACULAR DEGENERATION IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS
Authors: Karger Amy B. , Guan Weihua , Nomura Sarah O. , Weir Natalie L. , Klein Barbara E.K. , Burke Gregory L. , Johnson W. Craig , Tsai Michael Y. 
Published: March 2022

Purpose:
To examine the association between omega-3 polyunsaturated fatty acids, docosahexaenoic acid, and eicosapentaenoic acid and age-related macular degeneration (AMD) in the Multi-Ethnic Study of Atherosclerosis cohort.

Methods:
Multi-Ethnic Study of Atherosclerosis is a multicenter, prospective cohort study designed to identify risk factors for cardiovascular disease in four ethnic groups. Six thousand eight hundred and fourteen participants of White, African American, Hispanic/Latino, and Chinese descent, aged 45–84 years, were recruited, with those found to have cardiovascular disease excluded. Our study population included all Multi-Ethnic Study of Atherosclerosis participants with baseline polyunsaturated fatty acid measurements and retinal photography at Examination 5 (n = 3,772). Fundus photographs were assessed for AMD using a standard grading protocol. Relative risk regression (log link) determined associations between polyunsaturated fatty acid levels and AMD.

Results:
There was a significant association between increasing docosahexaenoic acid levels and increasing docosahexaenoic acid + eicosapentaenoic acid levels with reduced risk for early AMD (n = 214 participants with early AMD, of which n = 99 (46.3%) are non-White). Eicosapentaenoic acid levels alone were not significantly associated with AMD.

Conclusion:
Our analysis suggests increasing levels of docosahexaenoic acid are associated with reduced risk for early AMD in a multiethnic cohort. This represents the first racially diverse study demonstrating an association between omega-3 polyunsaturated fatty acids and AMD risk.
Development of the Port Delivery System with ranibizumab for neovascular age-related macular degeneration
Authors: Adamis Anthony P. , de Juan Eugene 
Published: March 2022

Purpose of review
This review provides background on the remaining unmet needs with antivascular endothelial growth factor (VEGF) therapies for the treatment of neovascular age-related macular degeneration (nAMD). We also discuss the developmental story of the Port Delivery System with ranibizumab (PDS; SUSVIMO, Genentech, Inc., South San Francisco, CA, USA).

Recent findings
Real-world studies have shown that undertreatment is a major reason for continued vision loss in the anti-VEGF era. As a result, there is a need for long-acting anti-VEGF treatment options for patients with nAMD, diabetic macular edema, and other retinal diseases. The PDS is a solid state, refillable, intraocular long-acting drug delivery system that continuously delivers a customized formulation of ranibizumab into the vitreous for 6 months. In a phase 3 trial, the PDS showed equivalent visual acuity improvements with monthly ranibizumab injections in patients with nAMD and adverse events associated with the PDS were well understood and manageable.

Summary
The PDS is the first US Food and Drug Administration-approved treatment for nAMD that provides continuous delivery of an anti-VEGF molecule. The PDS offers a unique drug delivery system that has the potential to serve as a platform to be used with other molecules in the future.
The moderating effect of personality traits on acute tinnitus sensation in idiopathic sudden sensorineural hearing loss
Authors: Huang Chii-Yuan , Cheng Yen-Fu , Yang Albert C , Lin Chia-Ju , Ieong Pak-In , Hsueh Chien-Yu 
Published: March 2022

Background:
People may experience tinnitus after sudden hearing impairment. The details of the relationship between tinnitus improvement and hearing recovery are still unclear. Personality traits may play a role in the modulation of tinnitus sensation. We investigated the moderating effect of personality traits on pretreatment and posttreatment tinnitus sensation in patients with idiopathic sudden sensorineural hearing loss (ISSHL).

Methods:
This prospective longitudinal study enrolled 33 patients diagnosed with unilateral ISSHL and acute tinnitus in 2018-2019 at one institute. Clinical data were collected before and after treatment, including results of pure-tone audiometry (PTA), the Clinical Tinnitus Questionnaire (CTQ), the Tinnitus Handicap Inventory (THI), tinnitus loudness and annoyance (Visual Analog Scale; VAS), the Hospital Anxiety and Depression Scale (HADS), and the Big Five Inventory (BFI)-44.

Results:
Eighteen men and 15 women with an average age of 48.3 ± 15.8 years were enrolled. The pretreatment hearing threshold and THI score were 58.0 ± 27.4 dB HL and 42.9 ± 26.2 (range: 0-88), respectively; the posttreatment values were 39.8 ± 22.4 dB HL and 20.7 ± 22.5 (range: 0-64), respectively. There were significant differences between pretreatment and posttreatment hearing thresholds as well as THI, VAS, and HADS scores (p < 0.001) but not BFI-44 results. Neuroticism and openness had significant positive and negative correlations, respectively, with acute tinnitus stress before treatment (r = 0.561, p = 0.001; r = −0.359, p = 0.040). After 3 months of follow-up, all patients were analyzed separately by dividing them into recovery (n = 16) and nonrecovery groups (n = 14) according to their hearing improvement status by Siegel’s criteria. Neuroticism showed a significant moderating effect on acute tinnitus sensation in the ISSHL recovery group (p < 0.001) but not in the nonrecovery group (p = 0.106).

Conclusion:
Neuroticism and openness may affect acute tinnitus stress in ISSHL patients. Practitioners should consider personality traits when managing ISSHL patients with bothersome tinnitus.
Forensic Mental Health Nurses’ Experiences of Clinical Supervision
Authors: Newman Claire , Eason Michelle , Kinghorn Grant 
Published: March 2022

ABSTRACT

Background
Clinical supervision may support forensic mental health nurses with personal and professional growth in a work environment characterized by therapeutic, ethical, and practical challenges.

Aim
The aim of this study was to describe the experiences of forensic mental health nurses participating in a clinical supervision program.

Methods
Seven forensic mental health nurses and two allied health professionals, working in a high-security forensic mental health hospital, were interviewed regarding their experiences of participating in a clinical supervision program.

Findings
Participants expressed a need for clinical supervision and were motivated to participate in the program. Benefits of clinical supervision experienced by participants included improved communication with their colleagues, being supported in their career development, and developing habits and techniques to reflect on practice issues. Participants described being able to connect with their supervisor, enabled by both trust and confidence in the supervisor's expertise.

Conclusion
Staff showed engagement in the clinical supervision process and expressed experiencing positive outcomes related to personal and professional growth and development.

Implications for Clinical Forensic Nursing Practice
To support nurses with the forensic mental health context-specific challenges they face, organizations should enable and promote access to clinical supervision. Considerations for forensic mental health organizations to increase uptake and effectiveness of clinical supervision include use of externally based clinical supervisors with adequate skills and experience with providing clinical supervision to clinical staff who work in a secure environment.
Using Telehealth Technology to Serve Patients Reporting Sexual Assault
Authors: Shaw Jessica , Feeney Hannah , Meunier-Sham Joan , Petricone Randi , Preiss Rachel M. 
Published: March 2022

ABSTRACT
Many communities across the country are developing, implementing, or already operating programs that provide patients with access to sexual assault nurse examiner (SANE) expertise and care through telehealth technology (e.g., teleSANE or teleSAFE). The speed at which teleSANE programs are proliferating is outpacing the available research and evaluation to inform key decisions on program development and implementation. During the height of the COVID-19 pandemic, the Massachusetts Department of Public Health SANE Program and its National TeleNursing Center decided to rapidly and temporarily convert a set of hospitals from providing in-person SANE care to remote teleSANE care. Several specific changes were made to this program's established teleSANE model for the rapid, temporary conversion. This article reports on findings from an evaluation of the temporary TeleSANE model that provide insight into key decisions that must be made in the development and implementation of teleSANE program features. Communities considering developing or already operating a teleSANE program should be intentional in making program goals, purposes, and values explicit as well as develop their program accordingly.
Improving Access to Postassault Healthcare for College Students: Creating a Campus-Based Sexual Assault Nurse Examiner Program
Authors: Campbell Rebecca , Markowitz Jenifer , Fedewa Tana , Shareef Sameerah , Fenton Danielle , Southard Kimmins 
Published: March 2022

ABSTRACT
National prevalence data indicate that college students are at a high risk for sexual assault, but most institutions of higher education do not provide postassault medical forensic examinations as part of student-facing healthcare services. College sexual assault patients might have access to sexual assault nurse examiners (SANEs) in local hospitals, if they are available where they are attending school, but unfortunately, many student victims do not have options for postassault health services. Creating campus-based SANE programs could address this gap in services and increase access to healthcare. In this article, we describe how we created a free-standing, campus-based SANE program at Michigan State University. We worked with a multidisciplinary community advisory board to identify core guiding principles to inform stakeholder engagement, program location decisions, program policies, training protocols, staffing plans, and collaborative partnerships with other disciplines (e.g., advocacy, law enforcement, prosecution, forensic sciences). We discuss how we navigated opening the program in the midst of the global COVID-19 pandemic and share lessons learned for creating campus-based SANE programs.