bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Residential Aged Care Nurse-Led After-Hours Initiative, Enhancing nurse assessment and decision making.
Authors: Moloney Clint , Hunnik Madeleine Van , Hope Carol , Terry Victoria , Issac Hancy 
Published: November 2019

Abstract
Background Current staffing levels and current care standards have been linked to negative clinical outcomes for Residents in living in Residential aged care. Low levels of confidence have impounded a Registered Nurses ability to meet many acute challenges found in this environment. The utilisation of Emergency Department transfers for acute ill residents is an increasing epidemic. This research project aimed to contemporise, adapt, implement and evaluate a set of Clinical Practice Guidelines (CPGs) and a Nurse Practitioner Role in Residential Aged Care adapted with permission from Waitemata District Health Board New Zealand [1, 2]. The purpose of the CPGs was to empower clinical staff in Residential Aged Care Facilities (RACFs), to recognise early clinical deterioration, provide safe evidence based care to residents, and prevent unnecessary transfers of residents to an acute hospital emergency departments.Methods Action research was chosen for this research because it was not only cyclic/participative in nature, but it provided a progressive evaluation of the CPGs implementation and the current context as it related to past, progressive, and post implementation nurse decision making practices. A total of 4 Focus groups with an average of eight respondents were recruited to this study (Total participants, 16 RNs and 16 PCWs).Results Focus group data showed unequivocal evidence of increased confidence among staff in implementing the care guidelines, communicating with fellow professionals, and assessing incidents. The CPGs and NP intervention was successful in engaging staff and developing their confidence with assessment of acute resident issues. Additional longitudinal research is required to better understand the influences of these interventions on ED presentations.Conclusions Research needs to better explore the direct correlation between PCW knowledge, skills, and training, and a failure to rescue residents experiencing an adverse event. This should also encompass more research scrutiny on the impact of poor communication practices between PCWs and the RN. The role NPs play in reducing ED utilisation needs greater long term evaluation to better ascertain clinical care and economic benefits.
Effect of body mass and physical activity on future long-term care use
Authors: Nizalova Olena , Gousia Katerina , Forder Julien 
Published: November 2019

Abstract
Background Obesity and physical activity rates are known predictors of disability and functional limitations, and, in turn, use of health care. In this study, we aim to explore whether obesity and physical inactivity also are significant risk factors for future long-term care needs (both informal and formal care). Methods We use multinomial logistic regression analysis on data from the English Longitudinal Study of Ageing (ELSA) respondents aged 65 and older between 2002 and 2011. Selection issues are tackled using the rich set of control variables, exploiting the data’s longitudinal structure and accounting for loss to follow-up (including death). Control factors include functional limitations (related to ADLs, iADLs and mobility)) and specific existing health conditions, notably diabetes, high blood pressure and cardio-vascular diseases. Results We find that obese older people are 25% more likely to receive informal or privately paid care in two years’ time, but this does not hold for formal care. People who are physically active are 38% less likely to be using any care in two years’ time, with the strongest effect for formal care use. Sensitivity analysis suggests that the results are not driven by either prediabetes or any link between obesity and subjective health, depression, or unobserved heterogeneity.Conclusions This study indicates obesity’s importance in future care costs and provides rationale for promoting a healthier weight for economic benefits, in relation not only to health care, but also long-term care.
Management of patients with early stage lung cancer – why do some patients not receive treatment with curative intent?
Authors: Lawrenson Ross , Lao Chunhuan , Brown Leonie , Moosa Lucia , Chepulis Lynne , Keenan Rawiri , Kidd Jacquie , Middleton Karen , Conaglen Paul , de Groot Charles , Aitken Denise , Wong Janice 
Published: November 2019

Abstract
Backgrounds This study aims to understand the factors that influence whether patients receive potentially curative treatment for early stage lung cancer. Methods Patients included those diagnosed with early stage lung cancer in 2011-2018 and resident in the New Zealand Midland Cancer Network region. Logistic regression model was used to estimate the odds ratios of having curative surgery/ treatment. The Kaplan Meier method was used to examine the all-cause survival and Cox proportional hazard model was used to estimate the hazard ratio of death. Results In total 419/583 (71.9%) of patients with Stage I and II disease were treated with curative intent - 272 (46.7%) patients had curative surgery. Patients not receiving potentially curative treatment were older, were less likely to have NSCLC, had poorer lung function and were more likely to have an ECOG status of 2+. Current smokers were less likely to be treated with surgery and more likely to receive treatment with radiotherapy and chemotherapy. Those who were treated with surgery had a 2-year survival of 87.8% (95% CI: 83.8%-91.8%) and 5-year survival of 69.6% (95% CI: 63.2%-76.0%). SABR has equivalent effect on survival compared to curative surgery (hazard ratio: 0.77, 95% CI: 0.37-1.61). Conclusions The majority of patients with stage I and II lung cancer are managed with potentially curative treatment – mainly surgery and increasingly with SABR. The outcomes of those being diagnosed with stage I and II disease and receiving treatment is positive with 70% surviving 5 years.
Policy Making Challenges in the scope of Oral Health in Developing Countries A Qualitative Study of the Islamic Republic of Iran
Authors: Mohammadpour Mohammad , Bastani Peivand , Ghanbarzadegan Arash , Bahmai Jamshid 
Published: November 2019

Abstract
Background As the strategies proposed for oral health improvement in developed countries do not adapt for the setting of the developing ones, this study is to identify the challenges of oral health policy making in developing countries.Methods It was a qualitative study conducted in 2019 in Iran as a middle-eastern developing country. The study population included all the experts who have enough experience in the scope and have the eagerness to participate. Snowball sampling was used to include the participants and after 12 semi-structured interviews saturation was achieved. Guba and Lincoln criteria containing acceptability, validity, reliability, and transferability were used to assure the study reliability and finally five-stage framework analysis method was used to analyze the data.Results The analysis of the results of the interviews resulted in the identification of 7 main themes and 20 sub-themes as the main challenges of achieving oral health in a developing country. The main themes identified were: policy making, implementing, educational, stewardship, prevention, insurance, and resource allocating. Conclusion: According to the present results, it seems that national coverage of oral health and the integration of these services in prevention ones and serious attention to the private sector can be considered as the most important strategies for achieving improved oral health.
Laser tooth preparation for pit and fissure sealing
Authors: Schwimmer Yair , Beyth Nurit , Ram Diana , Davidovich Esti 
Published: November 2019

Abstract

Background Considerable evidence shows that sealing dental pits and fissures contributes to caries prevention in children and adolescents. Various approaches are available for pit and fissure sealing. Sealants can be inserted with or without mechanical preparation; etching can be applied, with or without bonding. Lasers can be used as an alternative for mechanical preparation. In this study, we systematically evaluated the retention and micro-leakage of pit and fissure sealants, comparing mechanical preparation and Er:Yag laser enamel preparation. For each of these preparations we compared sealants without etching to those with etching, with and without bonding.Methods Sixty extracted sound third molars were classified into 6 groups: A. bur mechanical preparation and sealant application; B. bur mechanical preparation, etching and sealant; C. bur mechanical preparation, etching, bonding and sealant; D. laser mechanical preparation and sealant; E. laser mechanical preparation, etching and sealant application; F. laser mechanical preparation, etching, bonding and sealant. Pit and fissure sealing were evaluated by assessing the retention and micro-leakage of the sealant.Results All the groups showed dye micro-leakage beneath the sealants. Less micro-leakage was observed for the groups that used bur (groups A, B, C) than laser (groups D, E, F): 41 versus 44 specimens. The number of specimens without micro-leakage decreased as follows: group E (24), group A (18), groups B and F (17), group C (14) and group D (5). The difference in penetration between group D and the other groups was statistically significant, p<0.001, chi square.Conclusion Mechanical preparation is important and increases the retention of sealants, especially when using etching material; bonding can help the retention. We recommend preparing sealant with laser, without etching and bonding before its application.
Management of urinary tract infections what do doctors recommend and patients do? An observational study in German primary care
Authors: Gágyor Ildikó , Strube-Plaschke Stephanie , Rentzsch Katrin , Himmel Wolfgang 
Published: November 2019

Abstract
Background Urinary tract infections (UTIs) in women are usually managed in primary care with antibiotics. However, many women seem to prefer to handle UTI symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs) and other remedies. The aim of this study was to compare UTI management as recommended by physicians with the patients’ management at home. Methods This prospective study in German primary care is based on clinical data from local practices and patient questionnaires. Participating women completed a baseline data sheet in the practice; their urine sample was tested by a dipstick in the practice and cultured by a laboratory. The women reported treatment and symptom-related impairment on an eight-item symptom questionnaire daily for 7 days. Using growth curve models, we analysed the influence of time on the total severity score to examine how symptoms changed across days. We then examined whether symptom severity and symptom course differed between patients who took antibiotics or NSAIDs. Results A total of 120 patients (mean age of 43.3 ± 16.6 years) were enrolled. The urine dipstick was positive for leucocytes in 92%, erythrocytes in 87%, and nitrites in 23%. Physicians prescribed antibiotics for 102 (87%) women and recommended NSAIDs in 14 cases. According to the women’s reports, only 60% (72/120) took antibiotics, while the remainder took NSAIDs and other remedies. Symptoms declined from day 0 to day 6, irrespective of whether women decided to take an antibiotic, NSAIDs, none or both, as confirmed by a significant curvilinear time effect (B = 0.06, SE = 0.005, p < .001). The symptom course, however, was moderated by taking antibiotics so that the change in symptom severity was somewhat more pronounced in women taking antibiotics (B = 0.06) than in the remainder (B = 0.04). Conclusion A substantial proportion of women did not follow their physicians’ treatment recommendations, and many used NSAIDs. All women had a good chance of recovery irrespective of whether they decided to take antibiotics. A sensitive listening to patient preferences in the consultation may encourage physicians to recommend and prescribe symptomatic treatment more often than antibiotic medicines.
Children with Autism spectrum disorder are associated with gut microbiota disorder
Authors: Sun Hairong , You Zhong , Jia Libo , Wang Fang 
Published: November 2019

Abstract
Purpose The aim of this study was to evaluate the occurrence and clinical characteristics of autism spectrum disorder (ASD) associated to the stable state of the gut microbiota. Methods A total of 9 children with ASD and 6 healthy children used as control were selected and feces samples were collected from all of them. The 16S gene ribosomal RNA sequencing was used to analyze the difference in gut microbiota between healthy control children and ASD patients. Results The results of 16S sequencing based on operational taxonomic units (OTUs) analysis showed that the ASD group and the healthy control (HC) group had a large difference in the abundance of microbiota at the level of family, genus and species. The abundance of Bacteroidales and Selenomonadales was significantly lower in the ASD group than in the HC group (p=0.0110 and p=0.0076, respectively). The abundance of Ruminococcaceae in the ASD group was higher than that in the HC group (p=0.0265), while the amount of Prevotellaceae was significantly lower in the ASD group than in the HC group (p=0.0265). The Tax4Fun analysis based on Kyoto Encyclopaedia of Genes and Genomes (KEGG) data indicated differentially expressed functional pathway between the ASD group and healthy control group associated to the nervous system, environmental information processing and cellular processing. Conclusions The abundance of gut microbiota in the ASD group is different from that in the healthy control children. These differences affect the biological function of the host. These results suggest that a disorder in the gut microbiota may be associated, at least in part, with ASD in children.
The effect of written information and counseling by an APN on resilience in women with vulvar neoplasia during six months after surgical treatment and the influence of social support, recurrence, and age: A secondary analysis of a multicenter randomized controlled trial, WOMAN-PRO-II
Authors: Kofler Sabine , Kobleder Andrea , Ott Stefan , Senn Beate 
Published: November 2019

Abstract
Background Woman with vulvar neoplasia complain after surgical treatment often about physical and psychological distress. Lack of information and support can influence resilience. Whether an information-related intervention through an advanced practice nurse support resilience and which other factors have an influence on resilience in women with vulvar neoplasia has never been investigated.Methods The aim of this study were (a) to analyse whether counseling based on the WOMAN-PRO-II program compared to written information creates a significant improvement in resilience scores of women with vulvar neoplasia and (b) to identify potential predictors for resilience. A randomized controlled trial was carried out in women with vulvar neoplasia (N = 49) six months after a surgical treatment in four Swiss hospitals and one Austrian hospital. Analyses of resilience and its predictors were performed using a linear mixed model.Results The resilience score did not differ significantly between the two intervention three and six months after randomisation (p=0.759). As significant predictors of resilience, age (b=.04, p=0.001), social support (b=.28, p=0.009), counseling time (b=.03, p=0.018), and local recurrence (b=-.56, p=0.009) could be identified in linear mixed models analyses.Conclusion To promote resilience in women with vulvar neoplasia, the WOMAN-PRO II Program should be further developed. Particularly, social support should be extended, e.g. in form of more frequent consultations. The interrelation between recurrence and resilience needs to be further investigated to provide specific counseling for women with recurrence.
A novel framework for classification of selection mechanisms in epidemiological research
Authors: Bjork Jonas , Nilsson Anton , Bonander Carl , Strömberg Ulf 
Published: November 2019

Abstract
Background: Non-participation, losses to follow up and other types of study-specific selection mechanisms can be serious concerns in epidemiological studies. There are also selection processes that result in non-random groupings and changes in the composition of populations. These are continuously on-going irrespectively of whether they are subject to sampling in empirical studies. Such population selections are often overlooked, but may lead to lack of comparability of exposed and unexposed populations or decrease study validity in other ways. The overall aim of this study was to develop a simple but general framework for classifying various types of selection mechanisms of relevance for epidemiological research. Methods: We classify selection mechanisms in three dimensions: i) selection at the population level vs. selection that is study-specific, ii) type of mechanism (selection causing exposure vs. selection in population at risk), iii) timing of the selection (pre-exposure, during exposure or post-outcome). Results: Examples from the epidemiological literature of selection mechanisms are discussed and classified according to the three dimensions of the proposed framework. Conclusions: Increased mechanistic understanding of when, how, and why confusion of effects can occur because of selection is an important step towards improved validity of epidemiological research.
Evidence on the effect of position change on pressure ulcer among hospitalized adult patients in Ethiopia: systematic review and meta-analysis
Authors: Shiferaw Wondimeneh Shibabaw , Aynalem Yared Asmare , Akalu Tadesse Yirga 
Published: November 2019

Abstract
Background Pressure ulcers (PU) aﬀect millions of people worldwide and always occur over bony areas of the body where pressure and tissue distortion is greatest. The national pooled prevalence of pressure ulcer remains unknown. Hence, this meta-analysis aimed to determine the effect of position change on pressure ulcer among hospitalized clients in Ethiopia. Methods Studies were retrieved through search engines in PubMed, Scopus, WHO afro library, Google Scholar, Africa journal online, PsycINFO and web-science following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Analysis was done using STATA version 14 software. Heterogeneity between-study was checked using the I 2 and examined a potential publication bias by visual inspection of the funnel plot and Egger’s regression test statistic. The random-effect model was fitted to estimate the summary effects, odds ratios (ORs), and 95% confidence interval (CIs) across studies. Results Out of the reviewing 401 studies, 7 studies fulfilled the inclusion criteria and were included in the meta-analysis. The estimated pooled prevalence of pressure ulcer in Ethiopia was 11.7% (95% CI (7.28, 16.13%)). Based on the subgroup analysis, the estimated magnitude of pressure ulcer was 15.89% (95% CI: 35.34, 54.04) among studies their sample size were greater than or equals to 250. Those clients who have position change during hospitalization were 82% less likely to develop pressure ulcer [(OR: 0.18 (95% CI (0.07, 0.46)) than their counter part. Conclusion The overall prevalence of pressure ulcer in Ethiopia was relatively high. Position change of the client during hospitalization had paramount benefit to reduce the burden of pressure ulcer. Therefore, policymakers (federal minister of health) could give special attention to minimize the magnitude of pressure ulcer, and to improve the overall quality of healthcare service. Further, meta-analysis study could be conducted to identify individual and health care service related factors to the occurrence of pressure ulcer.
A Drug Identification Model developed using Deep Learning Technologies: Experience of a Medical Center in Taiwan
Authors: Ting Hsien-Wei , Chung Sheng-Luen , Chen Chih-Fang , Chiu Hsin-Yi , Hsieh Yow-Wen 
Published: November 2019

Abstract
Background: Issuing of correct prescriptions is a foundation of patient safety. Medication errors represent one of the most important problems in health care, with ‘look-alike and sound-alike’ (LASA) being the lead error. Existing solutions to prevent LASA still have their limitations. Deep learning techniques have revolutionized identification classifiers in many fields. Aiming to identify blister packages, this study employed a visual-based identification solution, called the deep learning drug identification (DLDI) model, which reduced medication identification errors caused by look-alike drugs. Methods: We collected images of 250 types of blister-packaged drug from the Out-Patient Department (OPD) of a medical center for identification. The deep learning framework of You Only Look Once (YOLO) was adopted for implementation of the proposed deep learning. The commonly-used F1 score, defined by precision and recall for large numbers of identification tests, was used as the performance criterion. This study trained and compared the proposed models based on images of either the front-side or back-side of blister-packaged drugs. Results: Our results showed that the total training time for the front-side model and back-side model was 5 hours 34 minutes and 7 hours 42 minutes, respectively. The F1 score of the back-side model (95.99%) was better than that of the front-side model (93.72%). Conclusions: In conclusion, this study constructed a deep learning-based model for blister-packaged drug identification, with an accuracy greater than 90%. This model outperformed identification using conventional computer vision solutions, and could assist pharmacists in identifying drugs while preventing medication errors caused by look-alike blister packages. By integration into existing prescription systems in hospitals, the results of this study indicated that using this model, drugs dispensed could be verified in order to achieve automated prescription and dispensing.
Level of Quality of Option B+PMTCT Service Provision in Public Health Facilities in Mekelle Zone, Northern Ethiopia: Cross-sectional study
Authors: Ajemu Kiros Fenta , Desta Alem 
Published: November 2019

Abstract
Background Substantial improvements have been observed in coverage and access to maternal health services in Ethiopia. However, quality of care has been lagging behind. Therefore, the aim of the study was to assess quality of OptionB + in Mekelle Zone, Northern Ethiopia.Methods Facility based cross-sectional study involving both quantitative and qualitative methods was conducted from December 2016- January 2017. The quality of service delivery was assessed in 11 public health facilities in Mekelle. Data collection was conducted using facility audit, observation, and client exit interview check list to assess (Input-Process–Output) quality components. Similarly in-depth interview guide was used to gather qualitative data. Data were analyzed using SPSS version 21 software. Descriptive statistics were computed to summarize the study findings and triangulation was made with qualitative findings.Results Overall, 2 (16.7%) of study health facilities full filled all the three quality components but none in 3(25%). The input quality component was better than the others in which 4(33.3%) facilities were rated as good. The process and output quality components were judged as good in 3(25%) study health facilities.Conclusion Only 16.7% of facilities studied were achieved good quality with respect to the three predetermined quality components. Since, assessed items in each quality component were potentially easy to intervene; strengthening program monitoring needed by program managers at each level of the health facilities.