bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: A retrospective study in the Pediatric Intensive Care Unit
Authors: Shi Jingyi , Sun Ting , Cui Yun , Wang Chunxia , Wang Fei , Zhou Yiping , Miao Huijie , Shan Yijun , Zhang Yucai 
Published: June 2020

Abstract
Background Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii presents challenges for clinical treatment and causes high mortality in children. We aimed to assess the risk factors for MDR/XDR Acinetobacter baumannii infection and for overall mortality in this patient population. Methods This retrospective study included 102 pediatric patients who developed MDR/XDR Acinetobacter baumannii infection in the pediatric intensive care unit (PICU) of Shanghai Children’s Hospital in China from December 2014 to May 2018. Results A total of 102 patients with Acinetobacter baumannii infection were enrolled. The median age was 36 (9.6, 98.8) months, and there were 63 (61.8%) male in the case group. The overall mortality rate was 29.4% (30/102), while the Acinetobacter baumannii-associated mortality rate was 16.7% (17/102, 12 bloodstream infections, 4 meningitis and 1 intra-abdominal infection). Bloodstream infections occurred in 28 patients (27.5%), and 10 patients (9.8%) among them had central line-associated bloodstream infections (6 central venous catheters, 2 PICCs, 1 venous infusion port and 1 arterial catheter). Cerebrospinal fluid (CSF) cultures were positive in 4(3.9%) patients. 14(13.7%) patients got positive cultures in ascites and hydrothorax. Lower respiratory isolates (56/102) accounted for 54.9% of all patients. Non-survival patients appeared to have a lower NK cell activity (6.2%±3.61% vs. 9.15%±6.21%, P =0.029), higher CD4+ T cell ratio (39.67%±12.18% vs. 32.66%±11.44%, P = 0.039),and a higher serum level of interlukin-8 (IL-8, 15.25 (1.62, 47.22)pg/ml vs. 0.1 (0.1, 22.99)pg/ml, P=0.01) when Acinetobacter baumannii infection developed. Multivariate logistic analysis indicated that high serum level of Cr (RR, 0.934, 95%CI, 0.890-0.981；P=0.007) and high BUN/ALB level (RR, 107.893, 95%CI, 1.425-870.574; p= 0.005) were associated with high risk of mortality in MDR/XDR Acinetobacter baumannii infected patients. Conclusion MDR/XDR Acinetobacter baumannii infection is a serious concern in pediatric patients with high mortality (29.4%). Bloodstream and central nervous infection accounted for high risk of death. Acute kidney injury is associated with high risk of mortality.
A Policy Analysis of the National Phenylketonuria Screening Program in Iran
Authors: Heidari Alireza , Arab Mohammad , Damari Behzad 
Published: June 2020

Abstract
Background: Phenylketonuria (PKU) screening is a public health measure taken to diagnose and treat the patients with PKU to prevent severe neurological disorders in them. The present study was aimed at analyzing the policies of the national PKU screening (NaPS) program in Iran.Methods: PKU screening program policies were analyzed in compliance with the policy triangle model. Document review and 38 semi-structured interviews were used for data collection. Document review data were analyzed using content analysis, and interview data were analyzed using framework analysis.Results: The national PKU screening (NaPS) program was a decision made at the genetics department of Ministry of Health and Medical Education (MOHME) in Iran. Many internal and external stakeholders were involved in it and valid evidence was used to formulate the policies. Despite some opposition and insufficient support, the program was implemented due to the continuous persistence of parents, interested executives, formulated valid content and a top-down approach. The main barriers included rapid substitution of managers, shortage of Phe-free milk, little awareness of patients’ families, social stigma, and inadequate co-operation of some hospital administrators.Conclusions: The policy triangle framework contributed to explaining the different components of the PKU screening program. A successful PKU screening program requires more stability of senior managers in MOHME, enough human resources and Phe-free milk, educating patients’ families, and commitment of hospitals administrators. Meanwhile, all the stakeholders need to be involved in the program effectively.
What Kinds of Advantages and Disadvantages Is May Merging Health Insurance Funds Bring About? A Qualitative Policy Analysis from Iran
Authors: Bazyar Mohammad , Yazdi-Feyzabadi Vahid , Rahimi Nouroddin , Rashidian Arash 
Published: June 2020

Abstract
Background: Fragmentation in health insurance system is a major concern in health financing. One possible solution to overcome problems resulting from fragmentation is combining risk pools together. This study aims to realize the potential advantages and disadvantages of merging health insurance funds. Methods: In this qualitative study, a purposeful sampling with maximum variation was used to obtain representativeness and rich data. Sixty face-to-face interviews were conducted. The documentary review was used as a supplementary source of data collection. Content analysis using the 'framework method' was used to analyze the qualitative data. Results: The results of this study indicated that there are diverse positive and negative consequences for merging health insurance funds in Iran. These are categorized into seven categories, including governance/stewardship, financing, population, basic benefit package, structure, operational procedures, and interaction with providers. Control of total health care expenditures; improving strategic purchasing; removing duplication in population coverage; centralizing the profile of providers in a single database and reducing fraud and controlling the volume of health care services provided by the providers; interaction of hospitals with single insurance with a single set of instructions for contracting, claiming review and reimbursement; reducing administrative and overhead costs were among the main benefits of merging mentioned by interviewees. The following drawbacks were raised as well: the unwillingness of the social security organization to collect insurance premiums from private workers actively as before; increasing dissatisfaction among population groups enjoying generous basic benefits package at the current situation; risk of financial fraud and corruption due to gathering all premiums in a single bank; and risk of putting more financial pressure on the providers in case of delay in reimbursement by the single-payer. Conclusions: Implementation of merging health insurance schemes in Iran would be influenced by a wide range of potential merits and drawbacks. Thus, to facilitate the process and lessen the opposition of opponents, policy makers should act as brokers taking into account the contextual factors and adopting tailored policies to maximize the benefits and minimize the potential drawbacks of consolidation in Iran.
Predicting developmental dysplasia of the hip in at-risk newborns
Authors: Roposch Andreas , Protopapa Evangelia , Malaga-Shaw Olivia , Gelfer Yael , Humphries Paul , Ridout Deborah , Wedge John H. 
Published: June 2020

Abstract
Background: The development of developmental dysplasia of the hip can be attributed to several risk factors and often in combination with each other. When predicting the likelihood of developing this condition, clinicians tend to over and underestimate its likelihood of occurring.Therefore, the study aim is to determine among at-risk newborns how to best predict developmental dysplasia of the hip (DDH) within 8 weeks post-partum.Methods: Prospective cohort study in secondary care. Patient population included newborns at-risk for DDH – we assessed 13,276 consecutive newborns for the presence of DDH risk factors. Only newborns with at least one of the predefined risk factors and those showing an abnormal examination of the hip were enrolled (n=2,191). For the development of a risk prediction model we considered 9 candidate predictors and other variables readily available at childbirth. The main outcome measure was ultrasonography at a median age of 8 weeks using consensus diagnostic criteria; outcome assessors were blinded. Results: The risk model includes four predictors: female sex (OR=5.6; 95% CI: 2.9-10.9; P<0.001); first degree family history of DDH (OR=4.5; 95% CI: 2.3-9.0; P<0.001), birthweight >4000g (OR=1.6; 95% CI: 0.6-4.2; P=0.34), and abnormal examination of hip (OR=58.8; 95% CI: 31.9, 108.5; P<0.001). This model demonstrated excellent discrimination (C statistic=0.9) and calibration of observed and predicted risk (P=0.35). A model without the variable ‘hip examination’ demonstrated similar performance.Conclusion: The risk model quantifies absolute risk of DDH within 8 weeks postpartum in at-risk newborns. Based on clinical variables readily available at the point of childbirth, the model will enhance parental counselling and could serve as the basis for real time decisions prior to discharge from maternity wards.
A prospective feasibility study of one-year administration of adjuvant S-1 therapy for resected biliary tract cancer in a multi-institutional trial (Tokyo Study Group for Biliary Cancer: TOSBIC01)
Authors: Itano Osamu , Takemura Yusuke , Kishida Norihiro , Tamagawa Eiji , Shinozaki Hiroharu , Ikeda Ken , Urakami Hidejiro , Ei Shigenori , Hayatsu Shigeo , Suzuki Keiichi , Sakuragawa Tadayuki , Ishii Masatsugu , Shito Masaya , Aiura Koichi , Fujisaki Hiroto , Takano Kiminori , Matsui Junichi , Minagawa Takuya , Shinoda Masahiro , Kitago Minoru , Abe Yuta , Yagi Hiroshi , Oshima Go , Hori Shutaro , Kitagawa Yuko 
Published: June 2020

Abstract
Background: Although surgery is the definitive curative treatment for biliary tract cancer (BTC), outcomes after surgery alone have not been satisfactory. Adjuvant therapy with S-1 may improve survival in patients with BTC. This study examined the safety and efficacy of 1 year adjuvant S-1 therapy for BTC in a multi-institutional trial. Methods: The inclusion criteria were as follows: histologically proven BTC, Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1, R0 or R1 surgery performed, cancer classified as Stage IB to III. Within 10 weeks post-surgery, a 42-day cycle of treatment with S-1 (80 mg/m2/day orally twice daily on days 1–28 of each cycle) was initiated and continued up to 1 year post surgery. The primary endpoint was adjuvant therapy completion rate. The secondary endpoints were toxicities, disease-free survival (DFS), and overall survival (OS).Results: Forty-six patients met the inclusion criteria of whom 19 had extrahepatic cholangiocarcinoma, 10 had gallbladder carcinoma, 9 had ampullary carcinoma, and 8 had intrahepatic cholangiocarcinoma. Overall, 25 patients completed adjuvant chemotherapy, with a 54.3% completion rate while the completion rate without recurrence during the 1 year administration was 62.5%. Seven patients (15%) experienced adverse events (grade 3/4). The median number of courses administered was 7.5. Thirteen patients needed dose reduction or temporary therapy withdrawal. OS and DFS rates at 1/2 years were 91.2/80.0% and 84.3/77.2%, respectively. Among patients who were administered more than 3 courses of S-1, only one patient discontinued because of adverse events.Conclusions: One-year administration of adjuvant S-1 therapy for resected BTC was feasible and may be a promising treatment for those with resected BTC. Now, a randomized trial to determine the optimal duration of S-1 is ongoing.Trial registration: UMIN-CTR, UMIN000009029. Registered 5 October 2012-Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009347)
Clouds over IEMs? Perspectives for inherited metabolic diseases in adults from a retrospective cohort study in two Swiss adult metabolic clinics
Authors: Gariani Karim , Nascimento Marina , Superti-Furga Andrea , Tran Christel 
Published: June 2020

Abstract
Background: Inherited metabolic diseases (IMD) are complex medical conditions. Thanks to improvements in diagnosis and treatment, a growing number of pediatric IMD patients reach adulthood. Thus, clinical care of adults with IMD has emerged as a new and challenging reality. This purpose of this study of adults with IMD in an adult metabolic clinic at two academic hospitals (Lausanne and Geneva) was to help inform decisions on the future organization of health care for this group of patients. Methods: All adult patients with a biochemical and/or genetic diagnosis of IMD followed at the clinic were included in the study. Electronic patient records were reviewed for clinical features, diagnostic studies, treatment and long-term outcome. Data of undiagnosed patients referred for suspected IMD were analyzed separately. Results: 126 patients were included in the study. The most prevalent group of diseases was small molecules disorders with 82 (65%) patients, followed by energy defects disorders with 29 (23%) patients and complex molecules disorders with 15 (12%) patients. Overall, 64% of patients were diagnosed before, and 36 % after the age 16 years. Among the 126 cases, 51% suffered from medical complications. 79% of the patients were receiving a specific treatment for their disease. Among the 138 undiagnosed patients referred for suspicion of IMD, investigations lead to a genetic diagnosis in 24 (17%) patients. 19 had confirmation of an IMD, 5 were found to have another genetic condition. Conclusions: This retrospective study reveals significant features of adult IMD cohort. The disorders are heterogeneous, and there is no one-size-fits-all approach – treatment must be tailored to fit each specific disorder in each individual patient. Even patients who are followed at the dedicated clinic are not protected from metabolic decompensations and/or chronic organ-specific complications. While it is commonly assumed that patients with IMD are more stable once they become adults, our data show that the diseases continue to exact a lifelong toll. A coordinated monitoring of target organs by a multidisciplinary team is needed. To ensure that the success in diagnosis and treatment of individuals with IMD is sustained, there is a clear requirement for adequately staffed adult IMD clinics.
Somatic mutation detection efficiency in EGFR: a comparison between High Resolution Melting Analysis and Sanger Sequencing
Authors: Joy Reenu Anne , Thelakkattusserry Sukrishna Kamalasanan , Vikkath Narendranath , Bhaskaran Renjitha , Vasudevan Damodaran , Krishnan Sajitha , Ariyannur Prasanth S. 
Published: June 2020

Abstract
Background: The current study focuses on comparing the mutation detection efficiency of High-Resolution Melt Analysis (HRM) with Sanger Sequencing in EGFR gene.Methods: The minor allele frequency of somatic mutations was titrated against total DNA concentration using Sanger sequencing and HRM. Somatic mutation detection efficiency, for exons 19 & 21 of the EGFR gene, was compared in 116 formalin fixed paraffin embedded tumor tissues, after screening 275 tumor tissues by Sanger sequencing.Results: The limit of detection of minor allele fraction of exon 19 mutation was 1% with Sequencing, and 0.25% with HRM, whereas for exon 21 mutation, 0.25% MAF was detected using both methods. All mutation positive samples detected by Sanger sequencing, were also detected by HRM. About 28% cases in exon 19 and 40% in exon 21, detected as mutated in HRM, were not detected by sequencing. Overall, sensitivity and specificity of HRM were found to be 100% and 67% respectively, and the negative predictive value was 100%, while positive predictive value was 80%.Conclusion: The comparative series study suggests that HRM is a modest initial screening test for somatic mutation detection of EGFR, which must further be confirmed by Sanger sequencing.
Survival benefit of surgical resection after first-line triplet chemotherapy and bevacizumab in patients with initially unresectable metastatic colorectal cancer
Authors: Elshenawy Mahmoud A. , Badran Ahmed , Aljubran Ali , Alzahrani Ahmed , Rauf M. Shahzad , Eldali Abdelmonem , Bazarbashi Shouki 
Published: June 2020

Abstract
Background: Surgical resection of metastatic disease in patients with initially non-resectable colorectal cancer (CRC) has improved overall survival. Intensified chemotherapy regimens have increased the probability of converting unresectable metastasis to resectable. Here we report the result of combining intensive chemotherapy (triplet) and surgical resection of metastatic lesions in patients with metastatic CRC. Patients and methods: Patients with unresectable metastatic CRC were enrolled in phase I/II trial of triplet chemotherapy consisting of Capecitabine, oxaliplatin, Irinotecan, and Bevacizumab. Patients were given 5-8 cycles induction chemotherapy of the above regimen followed by maintenance capecitabine and bevacizumab until disease progression, unacceptable toxicity or patient request. All patients were assessed at a multidisciplinary conference for possible surgical resection of their metastatic disease at the time of inclusion in the trial and two-monthly intervals thereafter. Patients who underwent R0 resection of their metastatic disease received adjuvant oxaliplatin and capecitabine to complete a total of 6 months of chemotherapy. Results: Fifty-three patients were enrolled. The median age was 52 years (range 23-74), 29(55%) were males, ECOG PS 0-1 was 13(66%), 11 (42%) had a right-sided tumor, 29 (55%) had resection of their primary tumor, 22(42%) had a single metastatic site and 8 (15.1%) had a liver-limited disease. Thirteen patients (24.5%) underwent surgical resection of residual metastatic disease +/- the primary tumor with 10 (18.9%) of them were R0. The surgical group had higher incidence of males compared to non-surgical group ( 69.3% vs 47.2%,p = 0.2), equal performance status, lower median number of metastatic sites (1 vs 2, p=0.09), higher mutant Kras (53.8 % vs 34.2%, p=0.3) and higher response rate ( 84.6% vs 56.2%, p=0.3). With a median follow up duration of 89 months, the median PFS for the whole group was 16.1 months [95% confidence interval (CI); 9.1-20] and the median OS was 28.2 months (95% CI; 22.5-53.3). The median PFS for the surgery group was 18.9 months (95% CI; 12.6-not reached) compared to 9.6 months (95% CI; 7.0-18.3) for the non-surgical group, Log-rank p =0.0165. The median OS for both groups was not reached (95% CI; 53.3-not reached) and 23.2 months (95% CI; 17.0-28.4) respectively, Log-rank p=0.0006). Five-year PFS and OS for the surgery group were 46.2% and 67.6% respectively. Conclusions: Patients with unresectable metastatic CRC and fit for triplet chemotherapy should have the benefit of combining this intensified regimen and surgical resection of their metastatic disease if possible. Trial registration: Clinicaltrials.gov, NCT01311050, registered March,06,2011, retrospectively registered. https://ClinicalTrials.gov/show/NCT01311050.
Prevalence and risk factors for mental health problems and suicidal expressions among young male prisoners in Cambodia: A cross-sectional study
Authors: PAT Puthy , Richter-Sundberg Linda , Jegannathan Bhoomikumar , Edin Kerstin , Sebastian Miguel San 
Published: June 2020

Abstract
Background: incarceration and mental health problems are empirically known to have a strong association. Many studies have confirmed the high prevalence of mental health problems among young prisoners in particular, yet none have been conducted in Cambodia. Objectives: this study aimed first to assess the prevalence of mental health problems and suicidal expressions among young prisoners, and second, to determine the risk factors associated with these two outcomes in Cambodia. Method: a cross-sectional study among 572 young male prisoners between the ages of 15 and 24 from three prisons was conducted. Sociodemographic data and detailed information on participants’ profiles were gathered, and the Youth Self-Report (YSR) and the Attitude towards Suicide (ATTS) questionnaires were applied. Results: anxiety-depression affected 52.10% of the respondents with a similar prevalence of withdrawal depression, somatic complaints, social problems, and aggressive behaviours (around 46%). Mental health problems were strongly associated with younger age, lower educational background, and less time spent in prison. Around half (51.05%) considered life to be meaningful while 16.26% had thoughts about their own death, and 12.06% expressed wishes to die. Suicide ideation, planning, and attempts were reported by almost 6.82%, 1.75% and 2.80% of participants respectively. Prisoners who used drugs prior to imprisonment thought about death significantly more than their counterparts while suicide ideation was reported to be significantly lower among prisoners with higher education. Conclusion: the prevalence of mental health problems among young male prisoners was considerably high, while suicide expressions were reported to be lower compared to studies from other countries. This study highlights the need for implementing preventive interventions integrated into the prison health care system to im­prove the mental health of young prisoners.
Double QSSE innovative hospital management model based on JCI standard and its application in private hospital in China
Authors: Yali Zong , Zheng Dawei 
Published: June 2020

Abstract
BackgroundThe Joint Commission on International Accreditation of Health Care Organizations (JCI) standard is a hospital accreditation standard recognized by the medical industry worldwide. However, the previous Chinese hospital management model cannot be fully integrated with the JCI standard. The purpose of this study is to explore a new Chinese hospital management mode that adapts to JCI standard.MethodsThis article retrospectively analyzed the initial results of the operation of the double QSSE management mode at Xuzhou Renci Hospital, a Chinese private hospital from 2016 to 2018. The innovation mode combines the four elements of patients' needs "Quaesitum, Solicitude, Surroundings, and Expenditure" with the four core contents of hospital management "Quality, Service, Staff and Economic operation".ResultsAfter two years implementation of the model, Xuzhou Renci hospital has reached a series of achievements, including being elected as the honest private hospitals and ranking first, achieved the highest grade of "special satisfaction" in the third-party hospital satisfaction survey organized by the government; being rated as "the most beautiful hospital in China" and awarded the title of "the most beautiful hospital in China—the light of the city"; promoted to the third-grade orthopedic hospital in 2019; ranked in the forefront of original non-public hospitals in northern Jiangsu Province in the Chinese hospital competitiveness conference hosted by Asclepius Health in Hong Kong 2019; recognized as the "safe demonstration hospital" in Jiangsu Province 2019.ConclusionThe double QSSE refined management mode has the characteristics of standardization, quantification, comparison, easy assessment and easy replication, which improves not only the patient-centered medical experience, but also the hospital-department quality management system. It is an innovative hospital management mode that conforms to JCI standard and adapts to China's national conditions.