bluuebunny/crossref_metadata_2025 huggingface dataset:
Satisfaction of family members with inpatient psychiatric care and its correlates: a national survey in China
Authors: Jiang Feng , Hu Linlin , Zhao Ruiping , Zhou Huixuan , Wu Yinuo , Rakofsky Jeffrey J. , Liu Tingfang , Liu Huanzhong , Liu Yuanli , Tang Yi-Lang
Published: December 2019

Background

Measuring family members’ satisfaction with inpatient psychiatric care may help improve the quality of healthcare in psychiatric hospitals. This survey aimed to investigate the satisfaction of family members with inpatient psychiatric care and to explore its associated factors, using a newly-developed 5-item questionnaire.

Methods

This study included 1598 family members of psychiatric inpatients in 32 tertiary public psychiatric hospitals in 29 provinces of China. Satisfaction and demographic data were collected by research staff while patient and hospital data were retrieved separately.

Results

We found that the overall satisfaction level was 93.84% (23.46/25). The total satisfaction score in Northeast China was the highest, followed by the East, Middle and West regions (p < 0.001). There was no significant sex difference in total family satisfaction scores. Family members with a lower educational background (elementary school or less) had significantly lower satisfaction. Family members of patients who were diagnosed with schizophrenia were significantly less satisfied with doctor-family communication. In different treatment response subgroups, the marked improvement subgroup had significantly higher total satisfaction scores and subscores. Meanwhile, lower self-payment expenses and a higher number of psychologic treatments offered per day were significantly associated with higher total satisfaction scores and all subscores. Logistic regression showed a higher educational background, more psychologic treatments offered per day, adequacy of professional staffing (higher doctor/bed, nurse/bed and psychologist/bed ratio) were all significantly associated with higher family satisfaction.

Conclusions

We suggest government and hospital managers recruit more mental health professions to improve family satisfaction. If feasible, providing more psychologic treatments to inpatients may also improve families’ satisfaction and involvement.
Sub-national levels and trends in contraceptive prevalence, unmet need, and demand for family planning in Nigeria with survey uncertainty
Authors: Mercer Laina D. , Lu Fred , Proctor Joshua L.
Published: December 2019

Background

Ambitious global goals have been established to provide universal access to affordable modern contraceptive methods. To measure progress toward such goals in populous countries like Nigeria, it’s essential to characterize the current levels and trends of family planning (FP) indicators such as unmet need and modern contraceptive prevalence rates (mCPR). Moreover, the substantial heterogeneity across Nigeria and scale of programmatic implementation requires a sub-national resolution of these FP indicators. The aim of this study is to estimate the levels and trends of FP indicators at a subnational scale in Nigeria utilizing all available data and accounting for survey design and uncertainty.

Methods

We utilized all available cross-sectional survey data from Nigeria including the Demographic and Health Surveys, Multiple Indicator Cluster Surveys, National Nutrition and Health Surveys, and Performance, Monitoring, and Accountability 2020. We developed a hierarchical Bayesian model that incorporates all of the individual level data from each survey instrument, accounts for survey uncertainty, leverages spatio-temporal smoothing, and produces probabilistic estimates with uncertainty intervals.

Results

We estimate that overall rates and trends of mCPR and unmet need have remained low in Nigeria: the average annual rate of change for mCPR by state is 0.5% (0.4%,0.6%) from 2012-2017. Unmet need by age-parity demographic groups varied significantly across Nigeria; parous women express much higher rates of unmet need than nulliparous women.

Conclusions

Understanding the estimates and trends of FP indicators at a subnational resolution in Nigeria is integral to inform programmatic decision-making. We identify age-parity-state subgroups with large rates of unmet need. We also find conflicting trends by survey instrument across a number of states. Our model-based estimates highlight these inconsistencies, attempt to reconcile the direct survey estimates, and provide uncertainty intervals to enable interpretation of model and survey estimates for decision-making.
Airway inflammation after inhalation of nano-sized zinc oxide particles in human volunteers
Authors: Monsé Christian , Raulf Monika , Hagemeyer Olaf , van Kampen Vera , Kendzia Benjamin , Gering Vitali , Marek Eike-Maximilian , Jettkant Birger , Bünger Jürgen , Merget Rolf , Brüning Thomas
Published: December 2019

Background

Workers in the zinc production and processing of galvanized sheet steel are exposed to a complex mixture of particles and gases, including zinc oxide (ZnO) that can affect human health. We aimed to study the effects of short-term controlled exposure to nano-sized ZnO on airway inflammatory markers in healthy volunteers.

Methods

Sixteen subjects (8 females, 8 men; age 19–42, non-smokers) were exposed to filtered air and ZnO nanoparticles (0.5, 1.0 and 2.0 mg/m3) for 4 h, including 2 h of cycling with a low workload. Induced sputum samples were collected during a medical baseline and a final examination and also about 24 h after each exposure. A number of inflammatory cellular and soluble markers were analyzed.

Results

Frequency and intensity of symptoms of airway irritation (throat irritation and cough) were increased in some subjects 24 h after ZnO exposures when compared to filtered air. The group comparison between filtered air and ZnO exposures showed statistically significant increases of neutrophils and interleukin-8 (IL-8), interleukin-6 (IL-6), matrix metalloproteinase (MMP-9) and tissue inhibitors of metalloproteinases (TIMP-1) in sputum starting at the lowest ZnO concentration of 0.5 mg/m3. However, a concentration-response relationship was absent. Effects were reversible. Strong correlations were found between neutrophil numbers and concentrations of total protein, IL-8, MMP-9, and TIMP-1.

Conclusions

Controlled exposures of healthy subjects to ZnO nanoparticles induce reversible airway inflammation which was observed at a concentration of 0.5 mg/m3and higher. The lack of a concentration-response relationship warrants further studies.
The overexpression of peroxiredoxin-4 affects the progression of idiopathic pulmonary fibrosis
Authors: Hanaka Tetsuya , Kido Takashi , Noguchi Shingo , Yamada Sohsuke , Noguchi Hirotsugu , Guo Xin , Nawata Aya , Wang Ke-Yong , Oda Keishi , Takaki Tsutomu , Izumi Hiroto , Ishimoto Hiroshi , Yatera Kazuhiro , Mukae Hiroshi
Published: December 2019

Background

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is life-threatening. Several serum biomarkers, such as Krebs von den Lungen-6 (KL-6) and surfactant protein D (SP-D), are clinically used for evaluating AE-IPF, but these biomarkers are not adequate for establishing an early and accurate diagnosis of AE-IPF. Recently, the protective roles of the members of the peroxiredoxin (PRDX) family have been reported in IPF; however, the role of PRDX4 in AE-IPF is unclear.

Methods

Serum levels of PRDX4 protein, KL-6, SP-D and lactate dehydrogenase (LDH) in 51 patients with stable IPF (S-IPF), 38 patients with AE-IPF and 15 healthy volunteers were retrospectively assessed using enzyme-linked immunosorbent assay. Moreover, as an animal model of pulmonary fibrosis, wild-type (WT) and PRDX4-transgenic (Tg) mice were intratracheally administered with bleomycin (BLM, 2 mg/kg), and fibrotic and inflammatory changes in lungs were evaluated 3 weeks after the intratracheal administration.

Results

Serum levels of PRDX4 protein, KL-6, SP-D and LDH in patients with S-IPF and AE-IPF were significantly higher than those in healthy volunteers, and those in AE-IPF patients were the highest among the three groups. Using receiver operating characteristic curves, area under the curve values of serum PRDX4 protein, KL-6, SP-D, and LDH for detecting AE-IPF were 0.873, 0.698, 0.675, and 0.906, respectively. BLM-treated Tg mice demonstrated aggravated histopathological findings and poor prognosis compared with BLM-treated WT mice. Moreover, PRDX4 expression was observed in alveolar macrophages and lung epithelial cells of BLM-treated Tg mice.

Conclusions

PRDX4 is associated with the aggravation of inflammatory changes and fibrosis in the pathogenesis of IPF, and serum PRDX4 may be useful in clinical practice of IPF patients.
Size-adjusted muscle power and muscle metabolism in patients with cystic fibrosis are equal to healthy controls – a case control study
Authors: Ruf Katharina , Beer Meinrad , Köstler Herbert , Weng Andreas Max , Neubauer Henning , Klein Alexander , Platek Kathleen , Roth Kristina , Beneke Ralph , Hebestreit Helge
Published: December 2019

Background

Skeletal muscle function dysfunction has been reported in patients with cystic fibrosis (CF). Studies so far showed inconclusive data whether reduced exercise capacity is related to intrinsic muscle dysfunction in CF.

Methods

Twenty patients with CF and 23 age-matched controls completed an incremental cardiopulmonary cycling test. Further, a Wingate anaerobic test to assess muscle power was performed. In addition, all participants completed an incremental knee-extension test with31P magnetic resonance spectroscopy to assess muscle metabolism (inorganic phosphate (Pi) and phosphocreatinine (PCr) as well as intracellular pH). In the MRI, muscle cross-sectional area of theM. quadriceps(qCSA) was also measured. A subgroup of 15 participants (5 CF, 10 control) additionally completed a continuous high-intensity, high-frequency knee-extension exercise task during31P magnetic resonance spectroscopy to assess muscle metabolism.

Results

Patients with CF showed a reduced exercise capacity in the incremental cardiopulmonary cycling test (VO2peak: CF 77.8 ± 16.2%predicted (36.5 ± 7.4 ml/qCSA/min), control 100.6 ± 18.8%predicted (49.1 ± 11.4 ml/qCSA/min);p < 0.001), and deficits in anaerobic capacity reflected by the Wingate test (peak power: CF 537 ± 180 W, control 727 ± 186 W; mean power: CF 378 ± 127 W, control 486 ± 126 W; power drop CF 12 ± 5 W, control 8 ± 4 W. all:p < 0.001). In the knee-extension task, patients with CF achieved a significantly lower workload (p < 0.05). However, in a linear model analysing maximal work load of the incremental knee-extension task and results of the Wingate test, respectively, only muscle size and height, but not disease status (CF or not) contributed to explaining variance. In line with this finding, no differences were found in muscle metabolism reflected by intracellular pH and the ratio of Pi/PCr at submaximal stages and peak exercise measured through MRI spectroscopy.

Conclusions

The lower absolute muscle power in patients with CF compared to controls is exclusively explained by the reduced muscle size in this study. No evidence was found for an intrinsic skeletal muscle dysfunction due to primary alterations of muscle metabolism.
Solitary fibrous tumor of the scrotum: a case report and review of the literature
Authors: Chang Tsung-Hsin , Chen Marcelo , Lee Chih-Chiao
Published: December 2019

Background

Solitary fibrous tumor (SFT) is a rare soft tissue tumor originally reported in the pleura. Although it has been reported in various extra-pleural sites, the occurrence of SFT in the scrotum is extremely rare. Herein, we present a 48-year-old man who had scrotal SFT. There are very few reported cases of genitourinary SFTs, this is only the fifth report of SFT of the scrotum in the English medical literature.

Case presentation

In this study, we report on a 48-year-old man who presented with a 5 × 8 cm scrotal mass between his testes. Physical examination revealed a 4.7 × 8.5 cm lobulated tumor mass located between his testicles. Surgical excision of the tumor with scrotal approach was done and pathology reported a SFT. The patient was alive without tumor recurrence or distant metastasis during ongoing follow-up for 9 months post-operatively..

Conclusion

Scrotal SFTs are very rare and only five cases have been reported in English literature to date. Treatment often involves surgical resection, and a definite diagnosis is made with the help of immunohistochemistry. The current general consensus for the management of SFTs is long-term follow-up after surgical excision of the tumor.
The effect of the waiting room’s environment on level of anxiety experienced by children prior to dental treatment: a case control study
Authors: Fux-Noy Avia , Zohar Maayan , Herzog Karin , Shmueli Aviv , Halperson Elinor , Moskovitz Moti , Ram Diana
Published: December 2019

Background

In addition to visit purpose, one of the environmental factors that can cause anxiety prior to dental treatment includes the waiting room experience, specifically the amount of time spent awaiting treatment and the waiting room environment. The purpose of this study was to compare the effect of the waiting room’s environment on the level of anxiety experienced by children in multisensory and traditional waiting rooms.

Methods

Case control study. Test group waited for treatment in a multisensory waiting room, which consisted of a lighting column that children could touch and climb; as well as, rhythmic music played on loudspeakers. Control group waited for treatment in a traditional waiting room. Study participants were asked to answer the “Venham Picture Test”, a dental anxiety scale, while in the waiting room prior to entering the treatment room. Chi-squared, Fisher’s Exact tests, and linear regression were utilized. Ap-value less than 0.05 was considered statistically significant.

Results

No significant difference in dental anxiety scores was found between the test and control groups according to waiting room type (p > .05). Dental anxiety was significantly higher in patients who had longer waiting time prior to treatment (p = 0.019). In addition, dental anxiety was significantly associated with visit purpose (p < .001): children waiting for dental examination or those scheduled for dental treatment with conscious sedation were less anxious than children waiting for emergency treatment.

Conclusions

A sensory adapted waiting room environment may be less important in reducing children’s anxiety prior to dental treatment. Children’s dental anxiety can be reduced by preventing emergency treatments, scheduling routine dental visits and decreasing waiting time.

Trial registration

TRN
NCT03197129, date of registration June 20, 2017.
Unmet need for family planning and associated factors among currently married reproductive age women in Tiro Afeta District, South West Ethiopia, 2017: cross-sectional study
Authors: Solomon Tesfaye , Nigatu Mamo , Gebrehiwot Tsegaye Tewelde , Getachew Biniam
Published: December 2019

Background

Unmet need for family planning in Oromia region was very high (28.9%) compared to other regions in Ethiopia. To address problems associated with unmet need for family planning locally available evidences are essential, however, there were no clear evidences on unmet need for family planning in Tiro Afeta district. This study aims to assess the magnitude and associated factors of unmet need for family planning among currently married women in Tiro Afeta district, South West Ethiopia, 2017.

Methods

Community based cross sectional study was conducted in April, 2017. A total of 348 currently married women of reproductive age were enrolled from eight villages selected by simple random sampling and using proportional to size allocation. Data were entered using EpiData 3.1 and analyzed by SPSS version 22. Adjusted odds ratios at 95% confidence interval with p-value of < 0.05 were considered as significant variables.

Results

Unmet need for family planning among currently married women in Tiro Afeta was 26.1%. Factors significantly associated with unmet need for family planning were: never use of family planning before survey (AOR: 5.09, 95% CI: 2.73–9.50); multiparity (AOR: 3.02, 95% CI: 1.56–5.85); perceived husband’s attitude as disapproval (AOR: 2.75, 95% CI: 1.43–5.26); lack of counseling from health workers (AOR: 2.07, 95% CI: 1.11–3.85); and unavailability of Radio and/or Television in the house (AOR: 2.05, 95% CI: 1.15–3.66).

Conclusion

Unmet need for family planning in Tiro Afeta was higher than national average but lower than Oromia region. Never use of family planning, women’s parity, husband’s attitude towards contraceptives, women counseling and unavailability of Radio and/or Television in the respondent’s home were significantly associated factors with unmet need for family planning. Therefore, the service providers and the district health office should strengthen counseling and partner involvement to reduce unmet need for family planning.
Dying too soon or living too long? Withdrawing treatment from patients with prolonged disorders of consciousness after Re Y
Authors: Huxtable Richard
Published: December 2019

Background

In the ruling inY[2018], the UK Supreme Court has confirmed that there is no general requirement for the courts in England and Wales to authorise the withdrawal of clinically assisted nutrition and hydration from patients with prolonged disorders of consciousness. The perceived requirement, which originated in a court ruling in 1993, encompassed those in the vegetative state and those in the minimally conscious state. The ruling inYconfirms that the court may still be approached to decide difficult or contested cases, but there is otherwise no routine requirement that the judges be approached.

Main body

There is much to welcome in this ruling, particularly as it means that these decisions for these patients are no longer (unusually) singled out for a judicial decision, with all the financial and emotional costs that court proceedings can entail. However, there is also a risk that the ruling might have unwelcome consequences. First, there is the possibility that patients might die too soon, particularly if doctors should now adopt the courts’ previous reasoning, which has suggested that patients in the vegetative state lack interests, so treatment may – perhaps must – be withdrawn. Secondly, there is the converse possibility that patients might live too long, since empirical research suggests that – whether intentionally or not – patients’ families, clinicians, and the health system appear to promote treatment-by-default.

Conclusion

Rather than adopt general positions, which may be contestable and potentially risky, this article argues, on a pluralistic basis, that the individual patient should be the focus of any decision made in his or her ‘best interests’. The existing legal framework in England and Wales, which is provided by the Mental Capacity Act 2005, already points in this direction, although more efforts may be needed to ensure that those involved in making these decisions are suitably educated and supported. Fortunately, new guidance from the British Medical Association could help clinicians and families to make decisions in the future, which are appropriate for the incapacitated individual patient in question.
The implementation of natural language processing to extract index lesions from breast magnetic resonance imaging reports
Authors: Liu Yi , Liu Qing , Han Chao , Zhang Xiaodong , Wang Xiaoying
Published: December 2019

Background

There are often multiple lesions in breast magnetic resonance imaging (MRI) reports and radiologists usually focus on describing the index lesion that is most crucial to clinicians in determining the management and prognosis of patients. Natural language processing (NLP) has been used for information extraction from mammography reports. However, few studies have investigated NLP in breast MRI data based on free-form text. The objective of the current study was to assess the validity of our NLP program to accurately extract index lesions and their corresponding imaging features from free-form text of breast MRI reports.

Methods

This cross-sectional study examined 1633 free-form text reports of breast MRIs from 2014 to 2017. First, the NLP system was used to extract 9 features from all the lesions in the reports according to the Breast Imaging Reporting and Data System (BI-RADS) descriptors. Second, the index lesion was defined as the lesion with the largest number of imaging features. Third, we extracted the values of each imaging feature and the BI-RADS category from each index lesion. To evaluate the accuracy of our system, 478 reports were manually reviewed by two individuals. The time taken to extract data by NLP was compared with that by reviewers.

Results

The NLP system extracted 889 lesions from 478 reports. The mean number of imaging features per lesion was 6.5 ± 2.1 (range: 3–9; 95% CI: 6.362–6.638). The mean number of imaging features per index lesion was 8.0 ± 1.1 (range: 5–9; 95% CI: 7.901–8.099). The NLP system demonstrated a recall of 100.0% and a precision of 99.6% for correct identification of the index lesion. The recall and precision of NLP to correctly extract the value of imaging features from the index lesions were 91.0 and 92.6%, respectively. The recall and precision for the correct identification of the BI-RADS categories were 96.6 and 94.8%, respectively. NLP generated the total results in less than 1 s, whereas the manual reviewers averaged 4.47 min and 4.56 min per report.

Conclusions

Our NLP method successfully extracted the index lesion and its corresponding information from free-form text.
Forecasting one-day-forward wellness conditions for community-dwelling elderly with single lead short electrocardiogram signals
Authors: Fan Xiaomao , Zhao Yang , Wang Hailiang , Tsui Kwok Leung
Published: December 2019

Background

The accelerated growth of elderly population is creating a heavy burden to the healthcare system in many developed countries and regions. Electrocardiogram (ECG) analysis has been recognized as effective approach to cardiovascular disease diagnosis and widely utilized for monitoring personalized health conditions.

Method

In this study, we present a novel approach to forecasting one-day-forward wellness conditions for community-dwelling elderly by analyzing single lead short ECG signals acquired from a station-based monitoring device. More specifically, exponentially weighted moving-average (EWMA) method is employed to eliminate the high-frequency noise from original signals at first. Then, Fisher-Yates normalization approach is used to adjust the self-evaluated wellness score distribution since the scores among different individuals are skewed. Finally, both deep learning-based and traditional machine learning-based methods are utilized for building wellness forecasting models.

Results

The experiment results show that the deep learning-based methods achieve the best fitted forecasting performance, where the forecasting accuracy and F value are 93.21% and 91.98% respectively. The deep learning-based methods, with the merit of non-hand-crafted engineering, have superior wellness forecasting performance towards the competitive traditional machine learning-based methods.

Conclusion

The developed approach in this paper is effective in wellness forecasting for community-dwelling elderly, which can provide insights in terms of implementing a cost-effective approach to informing healthcare provider about health conditions of elderly in advance and taking timely interventions to reduce the risk of malignant events.
A Bayesian decision support sequential model for severity of illness predictors and intensive care admissions in pneumonia
Authors: Baez Amado Alejandro , Cochon Laila , Nicolas Jose Maria
Published: December 2019

Background

Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality in the USA. Our objective was to assess the predictive value on critical illness and disposition of a sequential Bayesian Model that integrates Lactate and procalcitonin (PCT) for pneumonia.

Methods

Sensitivity and specificity of lactate and PCT attained from pooled meta-analysis data. Likelihood ratios calculated and inserted in Bayesian/ Fagan nomogram to calculate posttest probabilities. Bayesian Diagnostic Gains (BDG) were analyzed comparing pre and post-test probability. To assess the value of integrating both PCT and Lactate in Severity of Illness Prediction we built a model that combined CURB65 with PCT as the Pre-Test markers and later integrated the Lactate Likelihood Ratio Values to generate a combined CURB 65 + Procalcitonin + Lactate Sequential value.

Results

The BDG model integrated a CUBR65 Scores combined with Procalcitonin (LR+ and LR-) for Pre-Test Probability Intermediate and High with Lactate Positive Likelihood Ratios. This generated for the PCT LR+ Post-test Probability (POSITIVE TEST) Posterior probability: 93% (95% CI [91,96%]) and Post Test Probability (NEGATIVE TEST) of: 17% (95% CI [15–20%]) for the Intermediate subgroup and 97% for the high risk sub-group POSITIVE TEST: Post-Test probability:97% (95% CI [95,98%]) NEGATIVE TEST: Post-test probability: 33% (95% CI [31,36%]) . ANOVA analysis for CURB 65 (alone) vs CURB 65 and PCT (LR+) vs CURB 65 and PCT (LR+) and Lactate showed a statistically significant difference (Pvalue = 0.013).

Conclusions

The sequential combination of CURB 65 plus PCT with Lactate yielded statistically significant results, demonstrating a greater predictive value for severity of illness thus ICU level care.
Multi-level models for heart failure patients’ 30-day mortality and readmission rates: the relation between patient and hospital factors in administrative data
Authors: Roshanghalb Afsaneh , Mazzali Cristina , Lettieri Emanuele
Published: December 2019

Background

This study aims at gathering evidence about the relation between 30-day mortality and 30-day unplanned readmission and patient and hospital factors. By definition, we refer to 30-day mortality and 30-day unplanned readmission as the number of deaths and non-programmed hospitalizations for any cause within 30 days after the incident heart failure (HF). In particular, the focus is on the role played by hospital-level factors.

Methods

A multi-level logistic model that combines patient- and hospital-level covariates has been developed to better disentangle the role played by the two groups of covariates. Later on, hospital outliers in term of better-than-expected/worst-than-expected performers have been identified by comparing expected cases vs. observed cases. Hospitals performance in terms of 30-day mortality and 30-day unplanned readmission rates have been visualized through the creation of funnel plots. Covariates have been selected coherently to past literature. Data comes from the hospital discharge forms for Heart Failure patients in the Lombardy Region (Northern Italy). Considering incident cases for HF in the timespan 2010–2012, 78,907 records for adult patients from 117 hospitals have been collected after quality checks.

Results

Our results show that 30-day mortality and 30-day unplanned readmissions are explained by hospital-level covariates, paving the way for the design and implementation of evidence-based improvement strategies. While the percentage of surgical DRG (OR = 1.001; CI (1.000–1.002)) and the hospital type of structure (Research hospitals vs. non-research public hospitals (OR = 0.62; CI (0.48–0.80)) and Non-research private hospitals vs. non-research hospitals OR = 0.75; CI (0.63–0.90)) are significant for mortality, the mean length of stay (OR = 0.96; CI (0.95–0.98)) is significant for unplanned readmission, showing that mortality and readmission rates might be improved through different strategies.

Conclusion

Our results confirm that hospital-level covariates do affect quality of care, and that 30-day mortality and 30-day unplanned readmission are affected by different managerial choices. This confirms that hospitals should be accountable for their “added value” to quality of care.
Prescribing errors in electronic prescriptions for outpatients intercepted by pharmacists and the impact of prescribing workload on error rate in a Chinese tertiary-care women and children’s hospital
Authors: Yang Jian-hui , Liao Yu-fang , Lin Wu-bin , Wu Wen
Published: December 2019

Background

Prescribing errors may, influenced by some risk factors, cause adverse drug events. Most studies in this field focus on errors in prescriptions for hospital inpatients, with only a few on those for outpatients. Our study aimed to explore the incidence of prescribing errors in electronic prescriptions and illustrate the trend of prescribing workload and error rate over time.

Methods

The cross-section study was performed between September, 2015 and November, 2015. Prescribing errors were intercepted by pharmacists using a prescription reviewing system under which prescriptions with errors were transferred to a specific computer and recorded by another pharmacist and the incidence of total prescribing errors and severe errors was then calculated. A subgroup analysis was conducted in accordance to the number of drug orders, the age group of patients, the seniority of physicians, the specialty of physicians, the working day when prescriptions were issued, and the prescribing workload of physicians. A time-series analysis was employed to analyze the trend of prescribing workload and error rate, and the correlation between them.

Results

Totally, 65,407 patients were included in this study and 150,611 prescriptions with 294,564 drug orders (including 584 different drugs) were reviewed for identification of errors. A total of 534 prescribing errors (an error rate of 0.34%) were identified. Severe errors accounted for 13.62% of total errors. The subgroup analysis showed prescriptions of multiple drug orders, for pediatric patients aged 29 days to 12 years, from physicians specializing in ophthalmology and otorhinolaryngology, or prescribing on weekdays were more susceptible to errors. A time-series analysis demonstrated no correlation between prescribing workload and error rate which increased at the end of each working shift while prescribing workload decreased.

Conclusion

Less than 1% of the studied prescriptions came with errors among which one in seven were severe ones. But prescribing errors were in no relation to workloads. What’s more, further studies are needed to investigate pharmacist-led intervention to reduce prescribing errors.
Patients’ perception of communication at the interface between primary and secondary care: a cross-sectional survey in 34 countries
Authors: Scaioli Giacomo , Schäfer Willemijn L. A. , Boerma Wienke G. W. , Spreeuwenberg Peter , van den Berg Michael , Schellevis François G. , Groenewegen Peter P.
Published: December 2019

Background

Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients’ perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients.

Methods

We conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients’ perceptions of communication at the interface between primary and secondary care.

Results

In total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients’ perceptions of information shared by GPs with medical specialists, and the patients’ perceptions of the GPs’ awareness of the results of treatment by medical specialists. Patients whose GPs stated that they ‘seldom or never’ send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they ‘seldom or never’ receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care.

Conclusion

Generally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.
Factors associated with health care provider knowledge on abortion care in Ethiopia, a further analysis on emergency obstetric and newborn care assessment 2016 data
Authors: Taddele Tefera , Getachew Theodros , Taye Girum , Getnet Misrak , Defar Atkure , Teklie Habtamu , Gonfa Geremew , Humnessa Sheleme , Teshome Aster , Akale Zenebe , Mormu Kasahun , Bekele Abebe
Published: December 2019

Background

Abortion is one of the major direct causes of maternal death, accounting for 7.9% globally. In Africa, 5.5 million women have unsafe abortions annually. Although maternal deaths due to complications of abortion have declined in Ethiopia, women still die from complications. Few studies have focused on providers’ clinical knowledge. This study investigates the level of health workers’ knowledge of comprehensive abortion care and its determinants in Ethiopia.

Methods

Data from the national emergency obstetric and newborn care (EmONC) assessment was used. A total of 3804 facilities that provided institutional deliveries in the 12 months before the assessment were included. Provider knowledge was assessed by interviewing a single provider from each facility. Criteria for selection included: having attended the largest number of deliveries in the last one or two months. A summary knowledge score was generated based on the responses to three knowledge questions related to immediate complications of unsafe abortion, how a woman should be clinically managed and what the counselling content should contain. The score was classified into two categories (< 50% and > =50%). Logistic regression was used to determine individual and facility-level factors associated with the summary knowledge score.

Result

A total of 3800 providers participated and the majority were midwives, nurses and health officers. On average, providers identified approximately half or fewer of the expected responses. The multivariate model showed that midwives and nurses (compared to health officers), being female, and absence of training or practice of manual vacuum aspiration were associated with lower knowledge levels. Important facility level factors protective against low knowledge levels included employment in Addis Ababa, being male and having internet access in the facility.

Conclusion

To increase knowledge levels among providers, pre- and in-service training efforts should be particularly sensitive to female providers who scored lower, ensure that more midlevel providers are capable of performing manual vacuum aspiration as well as provide special attention to providers in the Gambella.
A survey of knowledge and use of telehealth among veterinarians
Authors: Watson Kylie , Wells Julia , Sharma Manoj , Robertson Stanley , Dascanio John , Johnson Jason W. , Davis Robert E. , Nahar Vinayak K.
Published: December 2019

Background

As usage of digital information and communication technologies continues to grow, the incorporation of telehealth and telemedicine has become a topic of interest in the veterinary industry. Veterinary telemedicine presents the opportunity to expand veterinary medicine by increasing access to healthcare services for clients and patients and improving medical quality. The objective of this study was to assess veterinarians’ knowledge and utilization of telehealth and telemedicine.

Results

Seventy-six veterinarians participated in the study and both qualitative and quantitative analyses were performed on the data collected. Several key themes emerged from the qualitative analysis of open-ended questions, including telecommunication, Doctor of Veterinary Medicine (DVM)-patient services, and remote interaction, among others. Through coding and qualitative analysis, researchers identified a lack of knowledge of the American Veterinary Medical Association (AVMA) definitions of telehealth and telemedicine. Specifically, a notable amount of participants were unaware of the distinction between the two practices per AVMA guidelines. Quantitative analyses revealed that the largest group of respondents reported sometimes utilizing telehealth and telemedicine in practice, with no distinct difference in utilization among the different age demographics of participants.

Conclusions

These observations indicate a need for interventions both in veterinary school and continuing education programs with the purpose of increasing both knowledge and utilization of telehealth and telemedicine among veterinarians. While these recommendations serve as a starting point, future studies are needed to further enhance the understanding of veterinary telehealth and telemedicine in practice.
C1 inhibitor in canine intravascular hemolysis (C1INCH): study protocol for a randomized controlled trial
Authors: Goggs Robert , Behling-Kelly Erica
Published: December 2019

Background

Immune-mediated hemolytic anemia (IMHA) is a common disease that affects all breeds of dogs and is associated with significant morbidity and mortality. Intravascular hemolysis of erythrocytes in IMHA is caused by complement activation and is often fatal. No current treatments target complement activation in canine IMHA. Human C1esterase (C1-INH) reduces canine complement-mediated hemolysis in vitro, and a recent pharmacokinetic analysis of an FDA licensed formulation of C1-INH in dogs confirmed that a 50 IU/kg dose of C1-INH is safe to administer to dogs, and effectively inhibits canine complement mediated hemolysis ex-vivo. The C1INCH randomized controlled trial will evaluate the efficacy of this drug in dogs with intravascular hemolysis.

Methods

We will conduct a multicenter, placebo-controlled double-blind randomized clinical trial of C1-INH in dogs with intravascular hemolysis due to IMHA. We will randomize 18 dogs to receive three doses of intravenous C1-INH or saline in 24 h. Immunosuppressive and antithrombotic therapies will be standardized. Primary outcome measures will be changes in plasma free hemoglobin, serum concentrations of LDH, bilirubin, and haptoglobin. Using patient samples, we will evaluate complement activation in canine IMHA using a novel C5b-9 ELISA assay, flow cytometric detection of C3b on RBC, and by measurement of residual plasma complement activity. Secondary outcome measures will be survival to hospital discharge, duration of hospitalization, number and volume of red blood cell transfusions, and rescue therapy requirements. We will monitor dogs for adverse drug reactions. Sample size was estimated from pilot data on LDH and hemolysis index (HI) in dogs with IMHA. To detect 2-way differences between the upper and lower 50% of the LDH and HI values of equivalent size with 80% power atP < 0.05 will require 9 dogs in each arm.

Discussion

We anticipate that IV administration of C1-INH will significantly inhibit complement mediated hemolysis in dogs with intravascular IMHA, as determined by blood biomarker measurements (decreased plasma hemoglobin, LDH and bilirubin, increased haptoglobin). We expect this will translate into significant reductions in transfusion requirements and duration of hospitalization.

Trial registration

This trial has been prospectively registered with the AVMA registry (AAHSD005025).
Effect of ovarian steroids on vascular endothelial growth factor a expression in bovine uterine endothelial cells during adenomyosis
Authors: Lupicka Martyna , Zadroga Anna , Szczepańska Agata , Korzekwa Anna Justyna
Published: December 2019

Background

Adenomyosis is a uterine dysfunction defined as the presence of endometrial glands within the myometrium. There is evidence that proangiogenic factors may play a role during the development of adenomyosis; however, exact mechanism remains unknown. The aim of the study was to determine the action of vascular endothelial growth factor A (VEGFA) in uterine tissue and uterine vascular endothelial cells during adenomyosis.

Results

Uterine tissues were collected and examined for the presence and extent of adenomyosis. Gene and protein expression of VEGFA and its two receptors (VEGFR1 and VEGFR2) was evaluated with quantitative polymerase chain reaction and Western blotting, respectively, in endometrium and myometrium during adenomyosis. Immunolocalization of VEGFA and its receptors within uterine tissues during adenomyosis was also determined. In an in vitro experiment, endothelial cells from non-adenomyotic bovine uteri were treated with media conditioned by non-adenomyotic or adenomyotic uterine slices treated with 17-beta-oestradiol (E2) or progesterone (P4). Both gene and protein expression of VEGFR2 were elevated in endometrium in stages 3–4 of adenomyosis. Protein expression of VEGFA and VEGFR2 as well as VEGFA secretion were increased in endothelial cells treated with media conditioned by adenomyotic uterine slices after E2 treatment.

Conclusions

Results suggest that VEGFA signalling is an important component, next to E2, that enhances VEGFA action and participates in adenomyosis development in cows.
Region-based interaction detection in genome-wide case-control studies
Authors: Zhang Sen , Jiang Wei , Ma Ronald CW , Yu Weichuan
Published: December 2019

Background

In genome-wide association study (GWAS), conventional interaction detection methods such as BOOST are mostly based on SNP-SNP interactions. Although single nucleotides are the building blocks of human genome, single nucleotide polymorphisms (SNPs) are not necessarily the smallest functional unit for complex phenotypes. Region-based strategies have been proved to be successful in studies aiming at marginal effects.

Methods

We propose a novel region-region interaction detection method named RRIntCC (region-region interaction detection for case-control studies). RRIntCC uses the correlations between individual SNP-SNP interactions based on linkage disequilibrium (LD) contrast test.

Results

Simulation experiments showed that our method can achieve a higher power than conventional SNP-based methods with similar type-I-error rates. When applied to two real datasets, RRIntCC was able to find several significant regions, while BOOST failed to identify any significant results. The source code and the sample data of RRIntCC are available at http://bioinformatics.ust.hk/RRIntCC.html.

Conclusion

In this paper, a new region-based interaction detection method with better performance than SNP-based interaction detection methods has been proposed.
HiSSI: high-order SNP-SNP interactions detection based on efficient significant pattern and differential evolution
Authors: Cao Xia , Liu Jie , Guo Maozu , Wang Jun
Published: December 2019

Background

Detecting single nucleotide polymorphism (SNP) interactions is an important and challenging task in genome-wide association studies (GWAS). Various efforts have been devoted to detect SNP interactions. However, the large volume of SNP datasets results in such a big number of high-order SNP combinations that restrict the power of detecting interactions.

Methods

In this paper, to combat with this challenge, we propose a two-stage approach (called HiSSI) to detect high-order SNP-SNP interactions. In the screening stage, HiSSI employs a statistically significant pattern that takes into account family wise error rate, to control false positives and to effectively screen two-locus combinations candidate set. In the searching stage, HiSSI applies two different search strategies (exhaustive search and heuristic search based on differential evolution along with χ2-test) on candidate pairwise SNP combinations to detect high-order SNP interactions.

Results

Extensive experiments on simulated datasets are conducted to evaluate HiSSI and recently proposed and related approaches on both two-locus and three-locus disease models. A real genome-wide dataset: breast cancer dataset collected from the Wellcome Trust Case Control Consortium (WTCCC) is also used to test HiSSI.

Conclusions

Simulated experiments on both two-locus and three-locus disease models show that HiSSI is more powerful than other related approaches. Real experiment on breast cancer dataset, in which HiSSI detects some significantly two-locus and three-locus interactions associated with breast cancer, again corroborate the effectiveness of HiSSI in high-order SNP-SNP interaction identification.
Prediction of comorbid diseases using weighted geometric embedding of human interactome
Authors: Akram Pakeeza , Liao Li
Published: December 2019

Background

Comorbidity is the phenomenon of two or more diseases occurring simultaneously not by random chance and presents great challenges to accurate diagnosis and treatment. As an effort toward better understanding the genetic causes of comorbidity, in this work, we have developed a computational method to predict comorbid diseases. Two diseases sharing common genes tend to increase their comorbidity. Previous work shows that after mapping the associated genes onto the human interactome the distance between the two disease modules (subgraphs) is correlated with comorbidity.

Methods

To fully incorporate structural characteristics of interactome as features into prediction of comorbidity, our method embeds the human interactome into a high dimensional geometric space with weights assigned to the network edges and uses the projection onto different dimension to “fingerprint” disease modules. A supervised machine learning classifier is then trained to discriminate comorbid diseases versus non-comorbid diseases.

Results

In cross-validation using a benchmark dataset of more than 10,000 disease pairs, we report that our model achieves remarkable performance of ROC score = 0.90 for comorbidity threshold at relative risk RR = 0 and 0.76 for comorbidity threshold at RR = 1, and significantly outperforms the previous method and the interactome generated by annotated data. To further incorporate prior knowledge pathways association with diseases, we weight the protein-protein interaction network edges according to their frequency of occurring in those pathways in such a way that edges with higher frequency will more likely be selected in the minimum spanning tree for geometric embedding. Such weighted embedding is shown to lead to further improvement of comorbid disease prediction.

Conclusion

The work demonstrates that embedding the two-dimension planar graph of human interactome into a high dimensional geometric space allows for characterizing and capturing disease modules (subgraphs formed by the disease associated genes) from multiple perspectives, and hence provides enriched features for a supervised classifier to discriminate comorbid disease pairs from non-comorbid disease pairs more accurately than based on simply the module separation.