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BACKGROUND Intracorporeal anastomosis is associated with several short-term benefits. However, it is a technically challenging procedure with potential risks. OBJECTIVE To investigate differences in short-term complications and long-term incisional hernia rates after robotic right colectomy with intracorporeal versus extracorporeal anastomoses and standardized extraction sites. DESIGN Historical cohort study. SETTING Single surgeon, single institution. PATIENTS All patients undergoing robotic right colectomy with intracorporeal anastomosis and a Pfannenstiel extraction site or extracorporeal anastomosis with a vertical midline extraction site from 2013-2017 were eligible. Exclusion criteria were conversion to laparotomy for tumor-related reasons or lack of follow-up. INTERVENTION Intracorporeal or extracorporeal anastomosis, based on availability of the robotic stapler and appropriate bedside assistance. MAIN OUTCOME MEASURES The primary outcome was incisional hernia, diagnosed either clinically or on postopeoreal anastomosis with a vertical midline extraction site. The intracorporeal approach was also associated with a decreased length of stay, but an increase in incisional surgical site infections. These findings have implications for healthcare utilization and patient-centered outcomes. See Video Abstract at http//links.lww.com/DCR/B147.BACKGROUND People living with HIV have high rates of anal human papillomavirus infection and anal precancer/cancer. OBJECTIVE (1) Determine human papillomavirus subtype distribution among people living with HIV with anal high-grade squamous intraepithelial lesions. (2) Compare clinicopathological characteristics of anal high-grade squamous intraepithelial lesions patients by human papillomavirus 16 status. (3) Investigate high-risk human papillomavirus negative anal high-grade squamous intraepithelial lesions cases. DESIGN In this retrospective study, 700 people living with HIV with biopsy-proven anal high-grade squamous intraepithelial lesions were reviewed for demographics, cytological diagnoses, and human papillomavirus testing results for human papillomavirus 16, 18, and 12 other high-risk types. For human papillomavirus-negative subjects, corresponding biopsies were genotyped using real-time PCR. SETTINGS A large urban HIV clinic system and major referral center for anal cancer screening PATIENTS Median illomavirus types rather than individual types. CONCLUSIONS Nearly all people living with HIV and anal high-grade squamous intraepithelial lesions test positive for high-risk human papillomavirus on anal swabs; negative results may be due to sampling error, L1-based PCR assay or human papillomavirus types not captured by standard clinical assays. Human papillomavirus 16-positive anal high-grade squamous intraepithelial lesions patients are indistinguishable from others based on demographic and clinical characteristics, underscoring the potential role of human papillomavirus testing for anal cancer screening. See Video Abstract at http//links.lww.com/DCR/B208.BACKGROUND This is a secondary data analysis of an original study describing the lived experiences of Hispanic/Latinx nursing students as they acculturate into the profession of nursing. METHOD The original study described the experiences of 11 Hispanic/Latinx new graduates from three baccalaureate nursing programs in the southeastern United States. A secondary data analysis using a theoretical thematic analytical approach with data gathered in the original study was done to determine the utility of the theory of cultural marginality in understanding these student experiences. RESULTS Findings support aspects of the theory, including marginal living, cross-cultural conflict recognition, and adjustment responses of poise and integration. Personal and contextual influences also impact the acculturation process for these nursing students. CONCLUSION The theory of cultural marginality is valuable and provides important context for understanding the process that Hispanic/Latinx nursing students experience as they acculturate into nursing.This quasi-experimental study used a convenience sample of nursing students (n = 49) to evaluate the effectiveness of mindfulness meditation on anxiety. Students participated in mindfulness meditation sessions and completed the State-Trait Anxiety Inventory. A statistically significant reduction in trait anxiety was found in the intervention group (p = .000); state anxiety decreased but not significantly. In contrast, anxiety increased significantly in the comparison group, but progression was not significantly different between groups. Trait anxiety may decrease with mindfulness meditation.Incentivizing nursing students in associate degree programs (ADN) and facilitating transition into RN-to-BSN studies has been a goal of the nursing profession. One partnership has established an "early decision" model for students who want to declare their intent to seek a BSN while earning the ADN. This article discusses how the model creates a relationship between the college, the university, and the student to support the student's transition to the university and academic success.Caring for persons at the end of life has dramatically changed in the last 20 years. Improved chronic illness management and aggressive life-sustaining measures for once-fatal illnesses have significantly increased longevity. People with life-limiting illnesses and their families are asked to make complex and difficult decisions about end-of-life, palliative, and hospice care. The purpose of this study was to discover and describe the culture care expressions, patterns, and practices influencing rural Appalachian families making decisions at the end of life. The qualitative, ethnonursing research method was used to analyze data from 25 interviews. The 4 themes discovered provide insights that could help improve this underserved population's access to palliative and hospice care, which in turn could help them experience a dignified death. Recommendations for health care providers could help reduce rural Appalachians' health disparities and promote meaningful, culturally congruent end-of-life care.Although there is an increased need for delivery of bereavement care, many health care providers in acute care hospital settings feel inadequately prepared to deliver quality grief support, have lack of time, and have inexperience in provision of bereavement care. As a result, although families would like health care providers to offer bereavement support, they are inadequately trained and susceptible to burnout, resulting in families not having their needs met. The purpose of this qualitative study was to uncover the social process occurring in a bereavement education workshop titled "How to Care, What to Say" offered to health care providers. The goal of the workshop was to improve delivery of care for the dying and their family by providing holistic care to the family before, during, and after the death of a loved one. Past grief workshop participants who cared for the bereaved were interviewed, and data were analyzed and synthesized using constructivist grounded theory. Individual interviews and focus group data revealed participants' perceptions, learnings, and potential integration of the workshop into practice. The overarching theory of providing bereavement care that emerged from the data is "a relational process of understanding knowledge, self-awareness, moral responsibilities, and advancing grief competencies of providing holistic grief support."Hospice volunteers are a high-risk group for anxiety and depression owing to their frequent exposure to patients at the end of life and their subsequent deaths. Resilience is known to be a powerful factor that affects the occurrence of anxiety and depression; however, research on this subject is scarce. find more We investigated the relationship of resilience with anxiety or depression in hospice volunteers. A total of 145 volunteers were included in the analysis. Participants completed self-reported scales, including the Korean version of the Connor-Davidson Resilience Scale, the State-Trait Anxiety Inventory, Patient Health Questionnaire-9, and the Professional Quality of Life Scale version 5. Pearson correlation coefficients were analyzed to identify the relationship of compassion satisfaction and compassion fatigue with anxiety or depression. A PROCESS macro mediation analysis was used to investigate the mediation effects of compassion satisfaction and compassion fatigue on the relationship between resilience and anxiety or depression. There were significant associations of compassion satisfaction and compassion fatigue with anxiety and depression. The relationship between resilience and anxiety/depression was mediated by compassion fatigue, which had indirect effects on anxiety and depression. Efforts to reduce compassion fatigue and increase resilience could help prevent anxiety and depression in hospice volunteers.A growing population of persons with a serious illness will place higher demands on health care professionals to provide the palliative care needed. A Palliative Care Advanced Practice Registered Nurse (APRN) Externship was developed and implemented as a novel way to increase access to palliative care with the potential to be replicated in multiple locations. Two APRN cohorts with a total of 10 APRNs participated in a 1-week educational program, including both classroom and clinical experiences, in 1 such site. The effectiveness of the program was evaluated by participants through an electronic survey and debriefings. Active learning experiences included role play, case studies, and clinical observation and were rated as highly valuable by participants. An important theme concerning the validation of current practice was identified. Future externship programs should be refined by incorporating participant feedback and continuing to use a variety of techniques to engage learners with diverse learning styles.OBJECTIVES In the present study, we investigated whether mastoid pneumatization affects facial canal dimensions and distances of facial tympanic segment and scutum, and lateral semicircular (LSS) canal and scutum. METHODS One hundred sixty-one temporal multidetector computed tomography scans were reviewed. Patients with unilateral sclerotic mastoid pneumatization (no aeration) (group 1, n = 81) and unilateral total mastoid pneumatization (100.0% aeration) (group 2, n = 80) were included. Facial canal dimensions at the labrythine, tympanic, and mastoid segments; facial canal dehiscence and length; and facial tympanic segment-scutum and LSS canal-scutum distances were evaluated. RESULTS In the present study, facial canal dimensions of labyrinthine, tympanic, and mastoid segments in total pneumatized mastoid group were significantly lower than sclerotic mastoids on axial and coronal images (P 0.05). The LSS canal-scutum distance of the females was lower than those of the males (P less then 0.05). Facial canal dehiscence ratio was 11.3% and 11.1% in sclerotic and total pneumatized mastoids, respectively. The mean ± SD length of the dehiscence was 2.46 ± 1.29 mm in pneumatized mastoids and 1.92 ± 0.68 mm in sclerotic mastoids. CONCLUSIONS In cholesteatoma cases, scutum erosion may occur. Because facial tympanic segment and scutum distance decreased in sclerotic mastoids compared with completely pneumatized ones, maximum care must be taken in the operations for avoiding to damage facial canal and nerve. Revision cases may be more difficult because of distorted anatomy. However, in pneumatized mastoids, the mean length of the facial canal was more than 2 mm, which must be kept in mind during operations.
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