bluuebunny/crossref_metadata_2025_split huggingface dataset:
Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (Change-3) - Process evaluation of a complex intervention
Authors: Poß-Doering Regina , Kuehn Lukas , Kamradt Martina , Glassen Katharina , Thomas Fleischhauer , Kaufmann-Kolle Petra , Koeppen Martina , Wollny Anja , Altiner Attila , Wensing Michel 
Published: December 2020

Abstract
Background: Antimicrobial resistance remains a global challenge. In Germany, the national health agenda supports measures that enhance the appropriate, guideline-oriented use of antibiotics. The study “Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (CHANGE-3)” aimed at a sustainable reduction of antimicrobial resistance through converting patterns of prescribing practice and use of antibiotics and an increase in health literacy in primary care patients, practice teams, and in the general public. Embedded in a cluster-randomized trial of a multifaceted implementation program, a process evaluation focused on the uptake of program components to assess the fidelity of the implementation program in the CHANGE-3 study and to understand utilization of its educational components.Methods: A mix of qualitative and quantitative methods was used. Semi-structured telephone interviews were conducted with General Practitioners, Medical Assistants, patients treated for respiratory tract infection and outreach visitors who had carried out individual outreach visits. A two-wave written survey (T1: 5 months after start, T2: 16 months after start) was conducted in general practitioners and medical assistants. Qualitative data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze survey data.Results: Uptake of intervention components was heterogenous. Across all components, the uptake reported by General Practitioners varied from 20% to 88% at T1 and 31% to 63% at T2. Medical Assistants reported uptake from 22% to 70% at T1 and 6% to 69% at T2. Paper-based components could by and large be integrated in daily practice (64% to 90% in T1; 41% to 93% in T2), but uptake of digital components was low. A one-time outreach visit provided thematic information and feedback regarding actual prescribing, but due to time constraints were received with reluctance by practice teams. Patients were largely unaware of program components, but assumed that information and education could promote health literacy regarding antibiotics use. Conclusions: The process evaluation contributed to understanding the applicability of the delivered educational components with regards to the appropriate use of antibiotics. Future research efforts need to identify the best mode of delivery to reach the targeted population.Trial registration: ISRCTN, ISRCTN15061174. Registered 13 July 2018 – Retrospectively registered, http://www.isrctn.com/ISRCTN15061174
Do Cognitive Performance and Physical Function Differ between Individuals with Motoric Cognitive Risk Syndrome and those with Mild Cognitive Impairment?
Authors: Cheng Fang-Yu , Chang Yuanmay , Cheng Shih-Jung , Shaw Jin-Siang , Lee Chuo-Yu , Chen Pei-Hao 
Published: December 2020

Abstract
Background Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI. Methods A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into two groups, MCR (n=33) and MCI (n=44) groups, based on definition criteria from previous studies. The priority was to assign a diagnosis of MCR first, followed by MCI. Hence, “pure” MCI had no overlap with MCR syndrome. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured. Results Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group. Conclusions We noted that cognitive performance and physical function were lower in MCR individuals than MCI but without MCR syndrome. However, the conclusions were based on the enrollment procedure of participants prioritizes the MCR syndrome. Because of the overlap of MCR and MCI, future studies should use different enrollment strategies to further clarify the status of these two populations.
Evaluating the Effects of Electronic Health Records System Adoption on the Performance of Malaysian Health Care Providers
Authors: Salleh Mohd Idzwan Mohd , Abdullah Rosni , Zakaria Nasriah 
Published: December 2020

Abstract
Background: The Ministry of Health of Malaysia has invested significant resources to implement an electronic health record (EHR) system to ensure the full automation of hospitals for coordinated care delivery. Thus, evaluating whether the system has been effectively utilized is necessary, particularly regarding how it predicts the work performance of health care providers. Methods: Convenience sampling was employed for data collection in three government hospitals for seven months. A standardized efficacy survey for EHR systems was administered to primary health care providers (specialists, medical officers, and nurses) as they participated in medical education programs. Empirical data were assessed by employing partial least squares-structural equation modeling for hypothesis testing.Results: The results demonstrated that knowledge quality had the highest score for predicting performance and had a large effect size, whereas system compatibility was the strongest component of system quality. The findings indicated that EHR systems supported the clinical tasks and workflows of care providers, which increased system quality, whereas increased quality of knowledge improved user performance. Conclusion: Given these findings, knowledge quality and effective use should be incorporated into the evaluation of EHR system efficacy in health institutions. Data mining features can be integrated into current systems for easily and systematically generating health populations and disease trend analysis, improving clinical knowledge of care providers and aiding in maintaining their productivity. The validated survey instrument can be further tested with empirical surveys in other public and private hospitals with different interoperable EHR systems.
Pregnancy and childbirth during the COVID-19 pandemic in Poland: qualitative evidence from expert interviews.
Authors: Pustułka Paula , Buler Marta 
Published: December 2020

Abstract
Background: The COVID-19 outbreak has significantly altered the provisions and shape of medical services for expecting mothers worldwide. In Poland, the country where pregnancy and childbirth are subject to comparably greater medicalization, those shifts are particularly tangible. This study aimed at capturing how maternal health professionals tackle care over pregnant and birthing women during a pandemic, highlighting possible long-term implications for the expecting and new mothers. Methods: This is a qualitative study which addresses the themes around the emerging implications of the viral outbreak. Semi-structured expert interviews were conducted with 46 individuals working in either medical or adjacent sectors connected with reproductive medicine. In this analysis, 7 digital experts were excluded as observers rather than field practitioners. Among 38 interviews, 5 have been conducted with OB-GYNs, 13 with midwives, 6 with doulas, 14 broadly-conceived category of maternal support experts. The recorded data were input into thematic grids and meticulously transcribed prior to being subject to an inductive, thematic analysis. Results: The findings revealed that the context of the heightened medicalization of pregnancy and hospital care during birth in Poland, resulted in strong restrictions and immediate fall back to a clinical care model. The majority claimed that the COVID-19 pandemic exacerbated the implications of the decades of Polish maternal health recommendations contradicting the WHO regulations. Professionals’ anxieties concern limited access to services assisting women during pregnancies. While those linked to hospitals pointed out physiological risks, other maternal support experts drew attention to the effects of stress and uncertainty on maternal mental health. Conclusions: Experts face various challenges when providing care to pregnant and birthing women in Poland. They underscore both the information chaos surrounding recommendations and procedures, and see the pandemic as a moment of reflection, mostly being vocal in their critiques of the over-medicalized Polish care model. The interviewed maternal health experts believe that the pandemic will have multifaceted consequences that are being exacerbated by a sudden cessation of extensive degree of medicalization during pregnancy, and a fallback to alienation during intervention-focused hospital deliveries.
Development of the Hausa version of the Pain Catastrophizing Scale: Translation, cross-cultural adaptation and psychometric evaluation in mixed urban and rural patients with chronic low back pain
Authors: Ibrahim Aminu A. , Akindele Mukadas O. , Kaka Bashir , Mukhtar Naziru B. 
Published: December 2020

Abstract
Background: Catastrophizing has been recognized as an important contributor to chronicity in individuals with chronic pain syndromes including low back pain (LBP). The Pain Catastrophizing Scale (PCS) is perhaps the most widely used questionnaire to evaluate the degree of pain catastrophizing. However, its use is limited in Hausa-speaking countries due to the lack of a validated translated version.Objective: To translate and cross-culturally adapt the PCS into Hausa (Hausa-PCS) and evaluate its psychometric properties in mixed urban and rural patients with chronic LBP.Methods: The original PCS was translated and cross-culturally adapted into Hausa in accordance with established guidelines. To evaluate its psychometric properties, a consecutive sample of 200 patients with chronic LBP was recruited from urban and rural Nigerian hospitals. Validity was evaluated by exploring content validity, factorial structure (confirmatory factor analysis [CFA]), construct validity (Spearman’s rho) and known-groups validity. Reliability was evaluated by calculating internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and limits of agreement with 95% confidence interval (LOA95%).Results: The Hausa-PCS was comprehensible with good content validity. The CFA confirmed a 3-factor structure similar to the original English version. The concurrent validity was supported as 83% (5/6) of the a priori hypotheses were confirmed. Known-groups comparison showed that the questionnaire was unable to differentiate between male and female or urban and rural patients (p > 0.05). Internal consistency and ICC were adequate for the Hausa-PCS total score (α = 0.84; ICC = 0.90) and the subscale helplessness (α = 0.78; ICC = 0.89) but for the subscales rumination (α = 0.69; ICC = 0.68) and magnification (α = 0.41; ICC = 0.43). The LOA95% for the Hausa-PCS total score was between –8.10 and +9.75, with SEM and MDC of 3.47 and 9.62 respectively. Conclusion: The Hausa-PCS was successfully developed and psychometrically adequate in terms of factorial structure, construct validity, internal consistency and test-retest reliability when applied in mixed urban and rural patients with chronic LBP. However, the internal consistency and reliability coefficients (ICC) for the individual subscales are questionable. Thus, we support the use of the total score when evaluating pain catastrophizing for clinical or research purposes.
Impact of four-dimensional cone-beam computed tomography on target localization for gastric mucosa-associated lymphoid tissue lymphoma radiotherapy: reducing planning target volume
Authors: Shimohigashi Yoshinobu , Toya Ryo , Saito Tetsuo , Kono Yumiko , Doi Yasuhiro , Fukugawa Yoshiyuki , Watakabe Takahiro , Matsumoto Tadashi , Kai Yudai , Maruyama Masato , Oya Natsuo 
Published: December 2020

Abstract
Background: Radiotherapy of gastric mucosa-associated lymphoid tissue (MALT) lymphoma should be delivered to the entire stomach with planning target volume (PTV) that accounts for variations in stomach volume, respiratory movement, and patient set-up error. In this study, we evaluated whether the use of four-dimensional cone-beam computed tomography (4D-CBCT) reduces the PTV. Methods: Eight patients underwent radiotherapy with 15 fractions of gastric MALT lymphoma using 4D-CBCT. PTV structures of 5–30 mm margins (5 mm intervals) from the clinical target volume (CTV) delineated based on the 4D-CT images (CTV-4D) were generated. For the target localization, we performed matching based on skin marking (skin matching), bone anatomy (bone matching), and stomach anatomy (4D soft-tissue matching) based on registration between planning CT and 4D-CBCT images from 10 phases. For each patient, we calculated the covering ratio (CR) of the stomach with variable PTV structures, based on the 4D-CBCT images, with a total of 150 phases [CR (%) = (number of covering phases / 150 phases) × 100], for three target localization methods. We compared the CR values of the different target localization methods and defined the PTV with an average CR of ≥ 95 % for all patients. Results: The average CR for all patients increased from 17.9 % to 100 %, 19.6 % to 99.8 %, and 33.8 % to 100 %, in the skin, bone, and 4D soft-tissue matchings, respectively, as the PTV structures increased from 5 to 30 mm. The CR obtained by 4D soft-tissue matching was superior to that obtained by skin (P = 0.013) and bone matching (P = 0.008) for a PTV structure of 15 mm margin. The PTV required an additional margin of 20 mm (average CR: 95.2 %), 25 mm (average CR: 99.1 %), and 15 mm (average CR: 98.0 %) to CTV-4D for the skin, bone, and 4D soft-tissue matchings, respectively. Conclusions: This study demonstrates that the use of 4D-CBCT reduces the PTV when applying 4D soft-tissue matching, compared to skin and bone matchings. Additionally, bone matching does not reduce the PTV as compared with traditional skin matching.
Delirium is associated with high mortality in older adult patients with acute decompensated heart failure
Authors: Pak Misun , Hara Masahiko , Miura Shoko , Furuya Motohide , Tamaki Masatake , Okada Taiji , Watanabe Nobuhide , Endo Akihiro , Tanabe Kazuaki 
Published: December 2020

Abstract
Background: Delirium is associated with high mortality after cardiac surgery. However, evidence on the epidemiology of delirium in patients with acute decompensated heart failure (ADHF) is limited. This study aimed to assess the incidence and prognostic impact of delirium in patients with ADHF.Methods: This single-center prospective observational study enrolled 132 consecutive patients with ADHF. We utilized the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and classified the patients into two groups according to the presence or absence of delirium. The primary endpoint was 90-day all-cause mortality. The prognostic impact and risk factors of delirium were evaluated using multivariable Cox and logistic regression analyses, respectively. Results: The median patient age was 83 (interquartile range, 75–87) years. Approximately 51.5% were men. Delirium occurred in 36 (27.3%) patients, and hyperactive delirium was the most frequent type (86.1%). The 90-day all-cause mortality was higher in the patients with delirium than in those without (21.6% versus 3.9%, log-rank p=0.002). Delirium was associated with higher mortality with an adjusted hazard ratio of 6.8 (95% confidence interval, 1.1–42.6, p=0.042). The risk factors associated with delirium included advanced age, male sex, higher clinical frailty scale score, and dementia.Conclusions: Delirium was associated with a higher 90-day all-cause mortality in the older adult patients with ADHF. Hyperactive delirium was the most common subtype.
Effects of Whole Body Vibration exercise on Lumbar-Abdominal Muscles Activation for patients with chronic low back pain
Authors: dong yulin , wang huifang , Zhu Yan , Chen Binlin , Zheng Yili , liu xiaochen , qiao jun , wang xueqiang 
Published: December 2020

Abstract
Background: Whole body vibration (WBV) training as an intervention method can cure chronic low back pain (CLBP). Different WBV parameters exert different effects on lumbar-abdominal muscle performance. Currently, there is a lack of study researched the influence of WBV training on patients with CLBP by lumbar–abdominal muscle activity. Therefore, this study aimed to investigate how WBV and exercise and their interactions influence lumbar-abdominal muscle activity in patients with CLBP.Methods: a group of ambulatory patients with chronic low back pain. Muscle activities of the multifidus (MF), erector spinae (ES), abdominal oblique externus muscle (AOE) and the rectus abdominis muscle (RA) were measured by surface electromyography, whereas participants performed 4 different exercises (single bridge, plank, side stay and V crunch) during three whole body vibration conditions and a no-vibration condition in a single experimental session. Results: Compared with the same exercises without whole body vibration, muscle activity increased when whole body vibration was added to the exercises. MF；the WBV frequency (P=0.002,) and exercise (P<0.001) presented significant effects on the root mean square of MF, whereas exercise * frequency (P=0.044) also resulted in significant interaction effects. ES: the significant differences were detected at WBV frequency (P<0.001), exercise (P<0.001), the interaction effect of exercise and frequency (P=0.225) was no significant. RA: the significant difference was detected at WBV frequency (P=0.018), the effect of exercise (P=0.590) and the exercise * frequency interaction (P=0.572) were no significant. AOE: the significant difference was detected at WBV frequency (P<0.001), the effect of exercise (P=0.152) and the exercise * frequency interaction (P=0.380) were no significant.Conclusion: Adding whole body vibration to exercise could increase muscle activation of lumbar–abdominal muscle in patients with CLBP. The optimum frequency for lumbar–abdominal muscles is 15 Hz. The best exercises include plank for multifidus and erector spinae, V crunch for rectus abdominis and single bridge for abdominal oblique externus.
Two novel QTLs for harvest index contribute to high yield production in rice (Oryza sativa L.)
Authors: Saito Hiroki , Fukuta Y. , Obara Mitsuhiro , Tomita Asami , Ishimaru Tsutomu , Sasaki Kazuhiro , Fujita Daisuke , Kobayashi Nobuya 
Published: December 2020

Abstract
Background Harvest index (HI) is a measure of the biological success of forming harvestable products. However, our understanding of the genetic basis of HI in rice (Oryza sativa L.) is limited, because it is a complex trait consisting of various yield-related traits and physiological attributes. YTH183 is a high yielding line with large panicles and high HI derived from a cross between the Indica Group variety IR 64 and the NPT line IR 69093-41-2-3-2 (YP5).Results Here, we detected two novel QTLs for HI, designated qHI5.1 on chromosome 5 and qHI8.1 on chromosome 8 by using 155 recombinant inbred lines (RILs) derived from the cross between IR 64 and YTH183. The YTH183 allele at qHI5.1 contributed to wide grain, resulting in heavy grain weight and panicle weight, and was consistently effective under the different environmental conditions of subtropical (Ishigaki) and temperate (Tsukuba) regions. Genetic polymorphism revealed that qHI5.1 was identical to GSE5/GW5, which is known to control the grain weight. On the other hand, although qHI8.1 functioned additively with qHI5.1 for higher HI, it did not show any significant effect on grain or panicle weight. In addition, its effects on HI were shown only in the first seasons at Ishigaki but not at Tsukuba or in the second season at Ishigaki. Conclusion Our results indicate that qHI5.1 controls the grain size, regardless of whether environmental conditions are of subtropical or temperate regions, while qHI8.1 might be involved in controlling the physiological processes of source ability or the translocation of photosynthesis products from vegetative organs to grains depending on environmental conditions during the maturing stage. These QTLs will be useful genetic resources for future breeding programs to break through the ceiling of maximum yield in Indica Group varieties.
The continuing evolution of community-associated MRSA ST93-IV in Australia
Authors: Pang Stanley , Daley Denise A , Sahibzada Shafi , Mowlaboccus Shakeel , Stegger Marc , Coombs Geoffrey W 
Published: December 2020

Abstract
Background The global emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has seen the dominance of specific clones in different regions around the world with the PVL-positive ST93-IV as the predominant CA-MRSA clone in Australia. In this study we applied a genome-wide association study (GWAS) approach on a collection of Australian ST93-IV MRSA genomes to identify genetic traits that may have assisted the ongoing transmission of ST93-IV in Australia. We also compared the genomes of ST93-IV bacteraemia and non-bacteraemia isolates to identify potential virulence factors associated with bacteraemia.Results Based on single nucleotide polymorphism phylogenetics we identified two distinct ST93-IV clades circulating concurrently in Australia. One of the clades contained isolates primarily isolated in the northern regions of Australia whilst isolates in the second clade were distributed across the country. Analyses of the ST93-IV genome plasticity over a 15-year period (2002-2017) revealed an observed gain in accessory genes amongst the clone’s population. The GWAS analysis on the bacteraemia isolates identified two genes that have also previously been associated to this kind of infection. Conclusions The emergence of a ST93-IV clade containing additional virulence genes may explain the high prevalence of ST93-IV infections amongst the indigenous population living in the northern regions of Australia. In summary, this study has shown ST93-IV is evolving with multiple additional genes possibly contributing to its dominance in the Australian community.