bluuebunny/crossref_metadata_2025_split huggingface dataset:
General practice trainee strategies for seeking in-consultation assistance from supervisors, and their perceptions of patient-related barriers to help-seeking: a survey study
Authors: Sturman Nancy , Tapley Amanda , Driel Mieke van , Holliday Elizabeth , Ball Jean , Davey Andrew , Fielding Alison , Fitzgerald Kristen , Spike Neil , Magin Parker 
Published: April 2020

Abstract
Background General practice (GP) trainees may seek supervisor assistance when hesitant to complete patient consultations independently. Trainees describe patient-related barriers to this in-consultation help-seeking, despite its key role in supervisory oversight. Little is known, however, about trainee strategies for seeking assistance, or the frequency and associations of trainee concerns about these barriers. Methods Australian GP trainees rated their frequency of use of five specific strategies for obtaining in-consultation assistance, perceived change in patient impressions of their competence after this assistance, and relative trainee comfort presenting patients outside, compared to within, patients’ hearing. Statistical analyses included descriptive statistics and multivariable logistic regression. Results Responses were received from 778 Australian GP trainees (response rate 89%). Help-seeking strategies did not differ between trainees at different training stages, except for greater use of electronic messaging in later stages. In-consultation assistance was most commonly provided by phone between trainee and supervisor consulting rooms, or outside the trainee’s patient’s hearing. Supervisor assistance in the trainee’s room face-to-face with the patient was reported as either never or rarely obtained by 12% of respondents. More trainees (25%) perceived that patient impressions of their competence increased after help-seeking than perceived that these impressions decreased (19%). Most trainees (55%) preferred to present patients outside their hearing. Trainee age was the only variable associated with both patient-related barriers. Conclusion Supervisors appear to have considerable influence over trainee help-seeking barriers and strategies, including whether or not face-to-face in-consultation supervision is sought. In-consultation supervision may actually increase trainee perceptions of patient impressions of their competence. Many supervisors and trainees may benefit from additional educational and workplace interventions to facilitate comfortable and effective trainee help-seeking in front of patients. More work is required to understand the clinical and educational implications of different help-seeking strategies when trainees require ‘just in time’ supervisor assistance.
Construction of a Semi-automatic ICD-10 Coding System
Authors: Zhou Lingling , Cheng Cheng , Ou Dong , Huang Hao 
Published: April 2020

Abstract
Background The International Classification of Diseases, 10th Revision (ICD-10) has been widely used to describe the diagnosis information of patients. Automatic ICD-10 coding is important because manually assigning codes is expensive, time consuming and error prone. Although numerous approaches have been developed to explore automatic coding, few of them have been applied in practice. Our aim is to construct a practical, automatic ICD-10 coding machine to improve coding efficiency and quality in daily work. Methods In this study, we propose the use of regular expressions (regexps) to establish a correspondence between diagnosis codes and diagnosis descriptions in outpatient settings and at admission and discharge. The description models of the regexps were embedded in our upgraded coding system, which queries a diagnosis description and assigns a unique diagnosis code. Like most studies, the precision (P), recall (R), F-measure (F) and overall accuracy (A) were used to evaluate the system performance. Our study had two stages. The datasets were obtained from the diagnosis information on the homepage of the discharge medical record. The testing sets were from October 1, 2017 to April 30, 2018 and from July 1, 2018 to January 31, 2019. Results The values of P were 89.27% and 88.38% in the first testing phase and the second testing phase, respectively, which demonstrate high precision. The automatic ICD-10 coding system completed more than 160,000 codes in 16 months, which reduced the workload of the coders. In addition, a comparison between the amount of time needed for manual coding and automatic coding indicated the effectiveness of the system-the time needed for automatic coding takes nearly 100 times less than manual coding. Conclusions Our automatic coding system is well suited for the coding task. Further studies are warranted to perfect the description models of the regexps and to develop synthetic approaches to improve system performance.
MiR-137 Boosts the Neuroprotective Effect of Endothelial Progenitor Cell Derived-Exosomes in Oxyhemoglobin Treated SH-SY5Y Cells Partially via COX2/PGE2 Pathway
Authors: Li Yuchen , Wang Jinju , Chen Shuzhen , Wu Pei , Xu Shancai , Wang Chunlei , Shi Huaizhang , Bihl Ji 
Published: April 2020

Abstract
Background: We have previously verified the beneficial effects of exosomes from endothelial progenitor cells (EPC-EXs) in ischemic stroke. However, the effects of EPC-EXs in hemorrhagic stroke have not been investigated. Additionally, miR-137 is reported to regulate ferroptosis and to be involved in the neuroprotection against ischemic stroke. Hence, the present work explored the effects of miR-137-overexpressing EPC-EXs on apoptosis, mitochondrial dysfunction, and ferroptosis in oxyhemoglobin (oxyHb)-injured neurons.Methods: The lentiviral miR-137 was transfected into EPCs and then the EPC-EXs were collected. RT-PCR was used to detect the miR-137 level in EPCs, EXs and neurons. The uptake mechanisms of EPC-EXs in neurons were explored by the co-incubation of Dynasore, Pitstop 2, Ly294002 and Genistein. After the transfection of different types of EPC-EXs, flow cytometry and expression of cytochrome c and cleaved caspase-3 were used to detect the apoptosis of oxyHb-injured neurons. Neuronal mitochondrial function was assessed by reactive oxygen species (ROS) level, mitochondrial membrane potential (MMP) depolarization, and cellular ATP content. Cell ferroptosis was measured by lipid peroxidation, iron overload, degradation of glutathione and glutathione peroxidase 4. Additionally, recombinational PGE2 was used to detect if activation of COX2/PGE2 pathway could reverse the protection of miR-137 overexpression.Results: The present work showed 1) EPC-EXs could be taken in by SH-SY5Y cells via caveolin-/clathrin-mediated pathways and macropinocytosis; 2) miR-137 was decreased in neurons after oxyHb treatment, and EXs miR-137 could restore the miR-137 levels; 3) EXs miR-137 worked better than EXs in reducing the number of apoptotic neurons and pro-apoptotic protein expression after oxyHb treatment; 4) EXs miR-137 are more effective in improving the cellular MMP, ROS and ATP level; 5) EXs miR-137 , but not EXs, protected oxyHb-treated neurons against lipid peroxidation, iron overload, degradation of glutathione and glutathione peroxidase 4; 6) EXs miR-137 suppressed the expression of the COX2/PGE2 pathway, and activation of the pathway could partially reverse the neuroprotective effects of EXs miR-137 .Conclusion: MiR-137 overexpression boosts the neuroprotective effects of EPC-EXs against apoptosis and mitochondrial dysfunction in oxyHb-treated neurons. Furthermore, EXs miR-137 rather than EXs can restore the decrease in miR-137 levels and inhibit ferroptosis, and the protection mechanism might involve the miR-137-COX2/PGE2 signaling pathway.
Correlated factors of acute oral mucosal and skin reaction induced by radiotherapy in hypopharyngeal carcinoma
Authors: Yan Wang , Lu Xiaoxu , Huang Rong , Li Tianyuan , Tang Tian , Liu Wenhang , Wu Hui 
Published: April 2020

Abstract
Background This present retrospective single center study was intended to investigate the factors associated with acute radiation oral mucositis or dermatitis during hypopharyngeal carcinoma radiotherapy.Methods From May 2012 to December 2018, previously untreated 93 patients with hypopharyngeal squamous cell carcinoma received radiotherapy in Affiliated Cancer Hospital of Zhengzhou University were enrolled. Radiation Therapy Oncology Group (RTOG) scoring criteria were used for assessing the severity of toxicities. Patients are therefore classified into “mild reaction group” (G0~G1) and “acute reaction group” (G2~G4). Single variate was applied to screen out factors with significant difference between mild and acute reaction groups, multivariate analysis was used to detect independent risk factors from those related. A total of 16 medical and laboratory indexes were included to examine, i.e., gender, age, smoking history, primary site, history of hypotension and diabetes, treatment modalities, dose, T (tumor) staging, N (reginal lymph node) staging, as well as hemoglobin value (1 week before radiotherapy). Relevant data used for the study were collected from clinical records.Results Total of 93 subjects completed radiotherapy. Acute mucositis occurred in 75 patients, and 27 cases developed acute radiation dermatitis. Smoking history, post-operative radiotherapy, concurrent chemotherapy, T staging, N staging, total dose (Gy) for GTV, single fraction dose (Gy) for GTV, and hemoglobin value (1 week before radiotherapy) showed significant differences between G0~G1 and G2~G4 groups of oral mucosa reaction; significant differences between mild and acute dermatitis reaction groups were found in diabetes history, hemoglobin value, age, total dose (Gy). Multivariate analysis showed that higher hemoglobin value ( OR = 1.120, P = 0.031), smoking history ( OR = 0.070, P = 0.031) were independent risk factor of acute OM; significant relationships for acute skin reaction were found with hemoglobin value ( OR = 1.059, P = 0.034) and older age ( OR = 1.068, P = 0.036).Conclusion Multivariate analysis showed higher hemoglobin value and smoking history to be the most relevant factors independently predicting grades 2 or higher OM; higher hemoglobin value and older age were found to be significantly associated with acute skin reaction.
Improved health-related quality of life in patients treated with topical sirolimus for facial angiofibroma associated with tuberous sclerosis complex
Authors: Hatano Takashi , ohno Yuki , Imai YU , Moritake Jun , Endo Katsuhisa , Tamari Mayumi , Egawa Shin 
Published: April 2020

Abstract
Background : Tuberous sclerosis complex (TSC) is a rare autosomal dominant disorder forming hamartomas throughout the body. Facial angiofibromas (FAs) occur in 75% of TSC patients, which are often enlarged, impairing the appearance of the face, and reducing the patient's quality of life (QOL). The aim of this study was to characterize the impact of topical sirolimus treatment on the health-related QOL in patients with FA associated with TSC. Methods : We investigated a total of 33 patients who received sirolimus gel treatment for FA associated with TSC and assessed the changes in the health-related QOL using the Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey. SF-36 surveys were performed before and after three months of treatment. The conditions of the patients after using the sirolimus gel were categorized into the following three categories: "improved," "unchanged," and "aggravated." Adverse events were investigated using the CTCAE v5.0-JCOG. Results : After 3 months of sirolimus gel treatment, three scale scores of the SF-36, vitality (VT), social function (SF), and mental health (MH), were significantly improved compared to before the treatment. The VT and SF in patients who had improved FA were significantly better than those in the other patients. There were no significant differences in any scale scores between patients with and without adverse events at three months after the initiation of sirolimus gel treatment. Conclusions : This is the first report regarding improved health-related quality of life in patients treated with sirolimus gel for FA associated with TSC by using the SF-36. The three scale scores associated with mental health were significantly improved compared to before the treatment. The health-related QOL in patients receiving sirolimus gel treatment is more strongly affected by the treatment efficacy than adverse events.
Oxycodone versus other opioids analgesia after laparoscopic surgery: a meta-analysis
Authors: Li Yan , Dou Zhi , Yang Liqiang , Wang Qi , Ni Jiaxiang , Ma Jun 
Published: April 2020

Abstract
Background Intravenous opioids are administered for management of visceral pain after laparoscopic surgery. Whether oxycodone has an advantage over other opioids in the treatment of visceral pain is not yet clear. Methods This article evaluates the analgesic efficiency and adverse events of oxycodone and other opioids including alfentany, sufentanyl, fentanyl and morphine for the treatment of post laparoscopic surgery visceral pain. This review was conducted according to the methodological standards described in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. The PubMed, Embase and Cochrane libraries were searched in December 2019. Results Ten studies were included in this review. The sample size was 815 participants. The results showed that compared with morphine and fentanyl, oxycodone had a more potent analgesic efficacy at the first day after laparoscopic surgery, especially during the first 0.5h. There was no significant difference in sedation between the two groups. Compared to morphine and fentanyl, oxycodone was more likely to increase the risk of dizziness and drowsiness. The overall patients satisfaction had no significant difference between oxycodone versus other opioids. Conclusions Oxycodone is a superior analgesic within 24h after laparoscopic surgery with careful regards to its adverse effects.
Effect of fecal microbiota transplantation on neurological restoration in a spinal cord injury mouse model: involvement of brain-gut axis
Authors: Jing Yingli , Yu Yan , Bai Fan , Wang Limiao , Yang Degang , Zhang Chao , Qin Chuan , Yang Mingliang , Zhang Dong , Zhu Yanbing , Li Jianjun , Chen Zhiguo 
Published: April 2020

Abstract
Background: Spinal cord injury (SCI) patients display disruption of gut microbiome and gut dysbiosis exacerbate neurological impairment in SCI models. Cumulative data support an important role of gut microbiome in SCI. Here, we investigated the hypothesis that fecal microbiota transplantation (FMT) may exert a neuroprotective effect on SCI mice. Results: We found that FMT facilitated functional recovery, promoted neural axonal regeneration, improved animal weight gain and metabolic profiling, and enhanced intestinal barrier integrity and GI motility. High-throughput sequencing revealed that levels of phylum Firmicutes, genus Blautia, Anaerostipes and Lactobacillus were reduced in fecal samples of SCI mice, and FMT remarkably reshaped gut microbiome. Also, FMT-treated SCI mice showed increased amount of fecal short-chain fatty acids (SCFAs), which correlated with alteration of intestinal permeability and locomotor recovery. Furthermore, FMT down-regulated IL-1β/NF-κB signaling in spinal cord and NF-κB signaling in gut. Conclusion: Our study demonstrates that reprogramming of gut microbiota by FMT improves locomotor and GI functions in SCI mice, possibly through the anti-inflammatory functions of SCFAs.
Magnitude Of Rise In Proneurotensin Is Related To Amount Of Triglyceride Appearance In Blood After A Standardized Oral Intake Of Both Saturated And Unsaturated Fat
Authors: Fawad Ayesha , Fernandez Celine , Bergmann Andreas , Struck Joachim , Nilsson Peter M , Bennet Louise , Orho-Melander Marju , Melander Olle 
Published: April 2020

Abstract
Background: In rodents, neurotensin contributes to high fat diet induced obesity by facilitation of intestinal fat absorption. The effect of oral lipid load on plasma proneurotensin and relationship with plasma triglycerides in humans is unknown.Aim: To investigate the acute effects of an oral lipid load (including both cream and olive oil) on proneurotensin and plasma triglycerides and their interrelationships in healthy individuals.Setting/ Methods: Twenty-two healthy subjects were given 150 ml of full milk cream (54g fat) and 59 ml of pure olive oil (54 g fat) in the fasted state at two different occasions separated by at least 1 week in random order. Venous blood samples were drawn at fasting,and hourly up to 4 hours after fat ingestion. We compared post-ingestion values of proneurotensin and plasma triglycerides with fasting levels. Further, post ingestion Area Under the Curve (AUC) of proneurotensin was correlated with the AUC of plasma triglycerides.Results: Rise of plasma proneurotensin and plasma triglycerides were observed after ingestion of cream with maximum increase at 2 hours for proneurotensin [mean (95% confidence interval)] of 22 (12-31) pmol/L (P<0.001) and at 3 hours for triglycerides of 0.60 (0.43-0.78) mmol/L (P<0.001). Similarly, plasma proneurotensin and plasma triglycerides increased after ingestion of olive oil with maximum increase of proneurotensin at 3 hours of 62 (46-78) pmol/L (P<0.001) and plasma triglycerides at 3 hours of 0.32 (0.18-0.45) mmol/L (P<0.001). The post lipid load AUC for proneurotensin correlated significantly with the AUC for plasma triglycerides both after cream (r=0.49, P=0.021) and olive oil (r=0.55, P=0.008), respectively.Conclusion: Proneurotensin increases after an oral lipid load of both cream and olive oil and the degree of rise of post-ingestion proneurotensin is significantly related to the rise of post-ingestion plasma triglycerides. Our human data support recent results from animal studies suggesting that neurotensin contributes to intestinal absorption of lipids into the blood stream.
Enhancing Clinical Reasoning Skills through Structured Reflection Models
Authors: ALMOMANI EMAD ALI , Attallah Karim 
Published: April 2020

Abstract
Background:Clinical reasoning is an essential skill to all health care practitioners. McGlynn et al, 2015 mention that lower level of clinical reasoning skills are associated with higher rates of medical and diagnostic errors.. To enhance the clinical reasoning through reflection Hamad Medical Corporation (HMC) – Qatar established a new educational initiative under the title of reflective learning conversation and debriefing.Method:A prospective cross sectional exploratory of mixed methodology research conducted at Qatar- Hamad Medical Corporation (HMC) – In the critical care and trauma units. Anonymous self-reported questionnaires were collected from 236 critical care and trauma nurses who attended the reflective learning conversation and debriefing activities. Semi structured Interviews conducted for 10 nurses who facilitated the reflective learning conversation and debriefing activities. Content analysis and thematic analysis were applied.Results:Attending the reflective learning conversations and debriefing educational activities have a significant positive impact on the clinical reasoning skills of the critical care and trauma nurses. Moreover, attending the group level reflection, feeling threatened, are limitations and barriers for the reflective learning conversation and debriefing. Additionally, reflective practice can be encouraged and enhanced through; having reflective conversation and debriefing models and guidelines, and reflecting on both good and bad experiences.Conclusion:There is a positive correlation between the clinical reasoning and the structured reflections in the format of reflective learning conversation and debriefing. Reflective practice can be enhanced through attending the reflective learning conversation and debriefing activities. There are some limitations and challenges to the reflective learning conversation and debriefing method.
The association of erythropoietin-stimulating agents and increased risk for AV-fistula dysfunction in hemodialysis patients. A retrospective analysis.
Authors: Waerme Anna VB , Hadimeri Henrik , Nasic Salmir , Stegmayr Bernd 
Published: April 2020

Abstract
Background Patients in maintenance hemodialysis (HD) need a patent vascular access for optimal treatment. Recommended first choice is a native arteriovenous fistula (AVF). Complications of AVF are frequent and include thrombosis, stenosis and infections leading to worsening of dialysis efficacy. Purpose The aim was to investigate if there are significant variables associated with dysfunctional AVF: s that could be intervened to adjust. Methods This retrospective observational study included 153 chronic HD patients referred to a total of 473 radiological investigations due to clinically suspected complications of their native AVF. Another group of chronic HD patients (n=52) who had a native AVF, but were without history of previous complications for at least 2 years were used as controls. Statistical analyses used were ANOVA, logistic regression, parametric and non-parametric methods such as Student's T-test and Mann-Whitney test. Results Among Cases at least one significant stenosis (>50% of the lumen) was detected in 348 occasions. Subsequent PTA was performed in (71%, n=248). Median erythropoiesis- stimulating agent (ESA) weekly doses were higher in the Cases than in the Controls (8000 IU vs 5000, p<0.001). Cases received higher doses of intravenous iron/week than the Controls before the intervention (median 50 mg vs 25 mg, p=0.004) and low molecular weight heparin (LMWH, p=0.028). In comparison to the Controls, Cases had a lower level of parathyroid hormone (median 25 vs 20 ρmol/L, p=0.009). In patients with diabetes mellitus, HbA1c was higher among Cases than Controls (50 vs 38 mmol/mol, p<0.001). There was no difference between the groups regarding variables such as blood hemoglobin, serum CRP or plasma ferritin. Conclusion The study indicated that AVF problems were related to higher doses of ESA, iron administration and LMWH. Optimizing glycemic control in patients with diabetes mellitus may be beneficial.