bluuebunny/crossref_metadata_2025_split huggingface dataset:
Registered Nurses´ Views on Telephone Nursing for Patients with Respiratory Tract Infections in Primary Healthcare – A qualitative interview Study
Authors: Kaminsky Elenor , Aurin Ingrid Edvardsson , Hedin Katarina , Andersson Lisbet , Andre Malin 
Published: May 2020

Abstract
Background: Telephone nursing in primary healthcare has been suggested as a solution to the increased demand for easy access to healthcare, increased number of patients with complex problems, and lack of general practitioners. Registered nurses’ assessments may also be of great importance for antibiotic prescriptions according to guidelines. The aim of this study was to describe registered nurses’ views of telephone nursing work with callers contacting primary healthcare centres regarding respiratory tract infections.Methods: A descriptive, qualitative study was performed through interviews with twelve registered nurses in Swedish primary healthcare. Results: The overarching themes for registered nurses’ views on telephone nursing were captured in two themes: professional challenges and professional support. These included three and two categories respectively: Communicate for optimal patient information; Differentiate harmless from severe problems; Cope with caller expectations; Use working tools; and Use team collaboration. Optimal communication for sufficiently grasping caller symptoms and assess whether harmful or not, without visual input, was underlined. This generated fear of missing something serious. Professional support used in work, were for example guidelines and decision support tool. Colleagues and teamwork collaboration were requested, but not always offered, support for the interviewed registered nurses.Conclusions: The study deepens the understanding of telephone nursing as an important factor for decreasing respiratory tract infection consultations with general practitioners, thus contributing to decreased antibiotic usage in Sweden. To cope with the challenges of telephone nursing in primary healthcare centres, it seems important to systematically introduce the use of the available decision support tool, and set aside time for inter- and intraprofessional discussions and feedback. The collegial support and team collaboration asked for is likely to get synergy effects such as better work environment and job satisfaction for both registered nurses and general practitioners. Future studies are needed to explore telephone nursing in primary healthcare centres in a broader sense to better understand the function and the effects in the complexity of primary healthcare.
Isolation and Characterization of Uropathogenic Escherichia coli (UPEC) from Red Panda (Ailurus fulgens)
Authors: Liu Songrui , Li Yunli , Yue Chanjuan , Zhang Dongsheng , Su Xiaoyan , Yan Xia , Yang Kuixing , Chen Xin , Zhuo Guifu , Cai Tong , Liu Jiangfeng , Peng Xi , Hou Rong 
Published: June 2020

Abstract
Background Disease prevention and control is a significant part of the ex-situ conservation of the endangered red panda (Ailurus fulgens), with bacterial infection being one important threat to the health of the captive population. To date, there are no systematic and detailed publications about E. coli-associated disease in red pandas. This study was conducted to determine the cause of death, etiology and pathogenesis in a captive red panda through clinical symptoms, complete blood count, biochemical analysis, pathological diagnosis, antimicrobial susceptibility test, mouse pathogenicity test, and bacterial whole genome sequencing. Results A bacterial strain confirmed as Escherichia coli ( E. coli ) was isolated from one captive red panda post mortem. This strain is resistant to most of the β-lactam antibiotics and a small number of aminoglycoside medications. The mouse pathogenicity test results showed that the strains isolated post mortem from mice were identical to that in the red panda, and the pathological findings were similar to those seen in the red panda. Whole-genome sequencing of the E. coli isolated from the red panda showed the complete sequences of the chromosome was 4.99 Mbp. PapA , PapG , OmpA , OmpU and other virulence factors were specific to Uropathogenic Escherichia coli (UPEC). Among the virulence factors, P pili, type I pili and iron uptake system related factors were associated with nephrotoxicity. Conclusion The red panda died of septicemic bacterial infection which was identified as Uropathogenic Escherichia coli . The pathogenic mechanisms of the strain are closely related to the expression of specific virulence genes.
Understanding Women’s Perspectives on Breast Cancer is essential for cancer control: Knowledge, Risk Awareness, and Care-seeking in Mwanza, Tanzania
Authors: Chao Christina A. , Huang Liuye , Visvanathan Kala , Mwakatobe Kisa , Masalu Nestory , Rositch Anne 
Published: June 2020

Abstract
Background: Breast Cancer is the most common cancer in women worldwide. Since 2008, Mwanza, Tanzania, has worked to provide comprehensive cancer services through its Zonal consultant hospital. New national guidelines focused on clinical breast exam requires that women be aware of and seek care for breast concerns.. Therefore, this study aims to understand breast cancer awareness in Mwanza and describe women-level barriers, care-seeking behavior, and perspectives on breast cancer.Methods: A community-based survey was administered to conveniently sampled women aged 30 and older to assess women’s perspectives on breast cancer and care-seeking behavior.Results: Among 1,129 women with a median age of 37 (IQR: 31-44) years, 73% have heard of cancer and 10% have received breast health education. Women self-evaluated their knowledge of breast cancer (from 1-none to 10-extremely knowledgeable) with a median response of 3 (IQR: 1-4). Only 14% felt they knew any signs or symptoms of breast cancer. Encouragingly, 56% of women were fairly-to-very confident they would notice changes in their breasts, with 24% of women practicing self-breast examination and 21% reporting they had received a past breast exam. Overall, 74% said they would be somewhat-to-very likely to seek care if they noticed breast changes, with 96% noting severity of symptoms as a motivator. However, fear of losing a breast (40%) and fear of a poor diagnosis (38%) were most frequent barriers to care seeking. In assessing knowledge of risk factors, about 50% of women did not know any risk factors for breast cancer whereas 42% of women believed long term contraceptive use a risk factor. However, 37% and 35% of women did not think that family history or being older were risk factors, respectively.Conclusions: The success of efforts to improve early diagnosis in a setting without population-based screening depends on women being aware of breast cancer signs and symptoms, risks, and ultimately seeking care for breast concerns. Fortunately, most women said they would seek care if they noticed a change in their breasts, but the low levels of cancer knowledge, symptoms, and common risk factors highlight the need for targeted community education and awareness campaigns.
Measuring Clinical Uncertainty and Equipoise by Applying the Agreement Study Methodology to Patient Management Decisions
Authors: FAHED Robert , DARSAUT Tim E. , FARZIN Behzad , CHAGNON Miguel , Raymond Jean 
Published: June 2020

Abstract
Background: Clinical uncertainty and equipoise are vague notions that play important roles in contemporary problems of medical care and research, including the design and conduct of pragmatic clinical trials. Our goal was to show how the reliability study methods normally used to assess diagnostic tests can be applied to particular management decisions to measure the degree of clinical uncertainty and equipoise regarding the use of rival management options prior to the conduct of randomized trials.Methods: We first illustrate how we have used the reliability study methodology to measure uncertainty in clinical decision-making regarding mechanical thrombectomy in acute stroke. We then follow the layout provided by standard guidelines to review how the various design elements of diagnostic reliability studies can be adapted to assess the repeatability of management decisions and measure clinical uncertainty.Results: The example shows how this methodology can be used to show disagreement in decisions for thrombectomy, and justify that sufficient clinical uncertainty exists to warrant the conduct of additional randomized trials. The general method we propose is that a sufficient number of diverse individual cases sharing a similar clinical problem and covering a wide spectrum of clinical presentations be assembled into a portfolio that is submitted to a variety of clinicians who routinely manage patients with the clinical problem. Clinicians are asked to independently choose one of the predefined management options, which are selected from those that would be compared within a randomized trial that would address the clinical dilemma. Intra-rater agreement can be assessed at a later time with a second evaluation. Various professional judgments concerning individual patients can then be compared and analyzed using kappa statistics or similar methods. Interpretation of results can be facilitated by providing examples or by translating the results into clinically meaningful summary sentences. Conclusions: Measuring the uncertainty regarding management options for clinical problems may reveal substantial disagreements, provide an empirical foundation for the notions of clinical uncertainty and equipoise, and inform or facilitate the design/conduct of clinical trials to address the clinical dilemma.
A method to audit and score implementation of knowledge translation (KT) interventions in large health regions – an observational pilot study using rectal cancer surgery in Ontario
Authors: Simunovic Marko , Fahim Christine , Coates Angela , Urbach David , Earle Craig , Grubac Vanja , Brouwers Melissa , O'Brien Mary Ann , Baxter Nancy 
Published: June 2020

Abstract
Background: Across Ontario, since the year 2006 various knowledge translation (KT) interventions designed to improve the quality of rectal cancer surgery have been implemented by the provincial cancer agency or by individual researchers. Ontario is divided administratively into 14 health regions. We piloted a method to audit and score for each region of the province the KT interventions implemented to improve the quality of rectal cancer surgery. Methods: We interviewed stakeholders to audit KT interventions used in respective regions over years 2006 to 2014. Results were summarized into narrative and visual forms. Using a modified Delphi approach, KT experts reviewed these data and then, for each region, scored implementation of KT interventions using a 20-item KT Signature Assessment Tool. Scores could range from 20-100 with higher scores commensurate with greater KT intervention implementation. Results: There were thirty interviews. KT experts produced scores for each region that were bimodally distributed, with an average score for 2 regions of 78 (range 73-83) and for 12 regions of 30.5 (range 22-38). Conclusion: Our methods efficiently identified two groups with similar KT Signature scores. Two regions had relatively high scores reflecting numerous KT interventions and the use of sustained iterative approaches in addition to those encouraged by the provincial cancer agency, while 12 regions had relatively low scores reflecting minimal activities outside of those encouraged by the provincial cancer agency. These groupings will be used for future comparative quantitative analyses to help determine if higher KT signature scores correlate with improved measures for quality of rectal cancer surgery.
Disparities in utilization of sexual and reproductive health services among high school adolescents from youth friendly service implemented and non-implemented areas of South Ari district, South Omo zone, Southern Ethiopia: a comparative cross-sectional study.
Authors: Haile Bayu , Shegaze Mulugeta , Feleke Tesfaye , Glagn Mustefa , Andarge Eshetu 
Published: June 2020

Abstract
Background: In recent years, much effort was made to improve access to sexual and reproductive health services (SRH) to adolescents and youths in Ethiopia particularly through establishment of youth friendly service (YFS) corners as part of the existing health care facilities. The existing evidences focused on the utilization of SRH services at YFS alone. There is a dearth of evidence which compares the SRH service use between the YFS implemented and non-implemented areas so that evidences can be drawn to suggest on the successes of the expansion of youth friendly corners. Methods: A school-based comparative cross-sectional study with multistage cluster sampling method was employed. Self-administered questionnaire was used to collect data and the collected data were entered in to Epi data version 4.4.1 software and then exported to SPSS version 20 for analysis. χ2 test was used to see significant difference in magnitude of SRH service utilization between YFS implemented and non-implanted areas. The association between the SRH services utilization and the independent variables was examined using binary logistic regression. Finally, variables having p-value less than or equal to 0.05 in the multivariable logistic regression model were considered as statistically significant.Results: There was a significant difference in the rate of SRH service utilization between YFS implemented (33.8%) and YFS non- implemented (9.9%) areas (χ2=37.49, p<0.001). Higher educational status of mothers (AOR=2.588, 95 % CI: 1.220, 5.491), having open discussion with family (AOR=3.175, 95%CI: 1.624, 6.206), good knowledge (AOR= 4.511, 95% CI: 2.458, 8.278) and having positive attitude (AOR= 5.084, 95% CI: 2.764, 9.352) were positively associated with SRH services utilization.Conclusion: Compared with high schools from YFS implemented areas, the magnitude of utilization of SRH services was significantly lower among students from high schools where health facilities had not yet implemented YFS. There is a need for more efforts to scale up SRH services in YFS non implemented areas among stakeholders at different hierarchies. Such interventions should target on improving open discussion at family level, knowledge and attitude on SRH issues and women education at large.
Prevalence, antimicrobial susceptibility pattern, and associated factors of Salmonella and Shigella among food handlers in Adigrat University student’s cafeteria, Northern Ethiopia, 2018
Authors: Legese Haftom , Kahsay Tsega , Gebrewahd Aderajew , Berhe Brhane , Fseha Berhane , Tadesse Senait , Gebremariam Guesh , Negash Hadush , Mardu Fitsum , Tesfay Kebede , Adhanom Gebre 
Published: June 2020

Abstract
Background

Food handlers play a significant role in the transmission of foodborne infection. Salmonella and Shigella are the most common foodborne pathogens and their infections are a major public health problem globally. Thus, this study was aimed to determine the prevalence, antimicrobial susceptibility patterns, and associated factors of Salmonella and Shigella among food handlers.

Methodology

A cross-sectional study was conducted from March to August 2018 at Adigrat University student cafeteria, Northern Ethiopia. Data on socio-demographic and associated factors were collected using a structured questionnaire. Fresh stool samples were collected from 301 food handlers and transported to Adigrat University Microbiology Laboratory. Bacterial isolation and antimicrobial susceptibility test were performed using standard bacteriological methods. Data analysis was performed using SPSS version 22 and P < 0.05 with a corresponding 95% confidence interval was considered statistically significant.

Results

A total of 301 food handlers were included in this study. The majority of study participants were females 265 (88.0%). About 22 (7.3%) and 11 (3.7%) of food handlers were found to be positive for Salmonella and Shigella respectively. Hand washing after using a bathroom with water only, hand washing after using the bathroom, hand washing after touching dirty materials, hand washing before food handling and fingernails status were significant associated factors identified. None of the Salmonella and Shigella isolates was sensitive to ampicillin. On the other hand, low resistance was found for chloramphenicol, ceftriaxone, and ciprofloxacin.

Conclusion

The present study revealed that the prevalence of Salmonella and Shigella among food handlers was 22 (7.3%) and 11 (3.7%) respectively. Such colonized food handlers can contaminate food, drinks and could serve as a source of infection to consumers via the food chain. This indicates that there is a need for strengthened infection control measures to prevent Salmonella and Shigella transmission in the students’ cafeteria.
Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour
Authors: Etherington Nicole , Rodrigues Isabel Braganca , Giangregorio Lora , Graham Ian D. , Hoens Alison M , Kasperavicius Danielle , Kelly Christine , Moore Julia E. , Ponzano Matteo , Presseau Justin , Sibley Kathryn M. , Straus Sharon 
Published: June 2020

Abstract
Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.
Locoregional recurrence patterns in women with breast cancer who have not undergone post-mastectomy radiotherapy
Authors: Zhao Xuran , Tang Yu , Wang Shulian , Yang Yong , Fang Hui , Wang Jianyang , Jing Hao , Zhang Jianghu , Sun Guangyi , Chen Siye , Jin Jing , Song Yongwen , Liu Yueping , Chen Bo , Qi Shunan , Li Ning , Tang Yuan , Lu Ningning , Ren Hua , Li Ye-Xiong 
Published: June 2020

Abstract
Background : To analyze the patterns of locoregional recurrence in breast cancer patients after mastectomy. Methods : The retrospective study included 7073 women with breast cancer without post-mastectomy radiotherapy: 4604 (65.1%) had pT1-2N0 disease (low risk); 2042 (28.9%), pT1-2N1 (intermediate risk); and 427 (6.0%), pT3-4 and/or pN2-3, or pT1-2N1 after neoadjuvant chemotherapy (high risk). The distribution of cumulative locoregional recurrence was analyzed. The local recurrence and regional recurrence rates were estimated by the Kaplan-Meier method, and differences were compared with the log-rank test. Multivariate analysis was performed using Cox logistic regression analysis. Results: In the median follow-up of 63.0 months, 469 patients had locoregional recurrence: chest wall recurrence in 238 cases (50.7%), supraclavicular/infraclavicular nodes in 236 (50.3%) cases, axilla in 92 (19.6%), and internal mammary nodes in 50 (10.7%) cases. The 5-year local recurrence and regional recurrence rates were 2.5% and 4.4%, respectively. Subgroup analysis of the three risk groups and five molecular subtypes (luminal A, luminal B-Her2 negative, luminal B-Her2 positive, Her2-enriched, and triple negative) also showed that the chest wall and supraclavicular/infraclavicular nodes were the most common recurrence sites. Age, tumor location, T stage, N stage, and hormone receptor status were independent prognostic factors for both local recurrence and regional recurrence (p < 0.05). Conclusions: The chest wall and supraclavicular/infraclavicular nodes are common sites of locoregional recurrence in breast cancer, irrespective of disease stage or molecular subtype, and the prognostic factors for local recurrence and regional recurrence are similar. Therefore, chest wall and supraclavicular/infraclavicular nodes irradiation should always be considered in post-mastectomy radiotherapy.
Humanism in the narratives of first-year medical students
Authors: Tavares Luciana , Enns Sylvia , Ayres José Ricardo , Tempski Patricia 
Published: May 2020

Abstract
Background: The importance of the humanistic dimension in the medical profession and how socialization during medical programs can promote humanism or have dehumanizing effects are largely discussed in the medical education literature. Reflection exercises can facilitate student engagement in humanistic attitudes.Method: We performed a qualitative study using the narratives of first-year medical students. The data were analyzed through content analysis. The narratives were used as a strategy to stimulate students' reflection and to understand their perspectives and values at the beginning of the medical program. We asked to them tell us about their role models, professional ideals and previous dehumanizing experiences, in contrast to their experiences of good health care.Results: The study included 167 participants: 67 females (40.1%) and 100 males (59.9%). The participants' average age was 20 years. The analysis of the narratives showed three emergent categories: sociopolitical and economic aspects of medicine, medical humanities and experiences of humanism and dehumanization in health care. In their narratives, the students expressed the desire to become doctors, the desire to help people and improve their lives, and the intention to emulate good role models and contribute to the development of the Brazilian healthcare system. The students indicated that a way to promote humanism in healthcare was to cultivate an integral vision of the human being that includes perceiving his or her context, personal history and complexity. The students emphasized the importance of "going beyond the technical dimension" in the relationship between physician and patient. Some students recognized the transdisciplinary aspects of medicine.Conclusions: The students in their first year of the medical program have a clear understanding of humanism in medical practice, regardless of their social and economic conditions, age, gender, and religion. The students' narratives expressed their expectations for a more humane and fair society characterized by respect, solidarity, and compassion. The use of narratives is a strategy to help students develop critical thinking and to help us get to know our students better: who they are, what they think, and how they feel.