bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the effectiveness of point of care tests for malaria and anaemia: A qualitative study across three Ghanaian antenatal clinics
Authors: Palmer Tanith , Aiyenigba Abiola O , Bates Imelda , Okyere Doris Dokua , Tagbor Harry , Ampofo Gifty Dufie 
Published: March 2020

Abstract
Background Anaemia and malaria are both major contributors to maternal and child mortality, and morbidity, with some of the worst outcomes occurring in sub-Saharan Africa. Point of care tests (POCT), if used appropriately, provide a simple, inexpensive form of diagnostic testing, as a reliable alternative when laboratory tests are not readily available. In such resource limited settings, clinical staff tend to rely on symptom-based diagnosis and presumptive treatment. This study uses qualitative methods to identify the current practice of POCT use for malaria and anaemia, to explore the enablers and barriers to effective implementation of these POCT, and to determine how relationships between each of the stakeholder groups may impact on POCT use. Methods Staff (clinical and laboratory) and patients (pregnant women) at three antenatal care facilities within the Ashanti Region of Ghana participated in interviews and focus group discussions (FGDs). An initial coding framework was developed based on the pre-defined objectives of the study. Thematic analysis was used to identify subthemes and categories within each of the key themes. Results At the time data were collected all three facilities used malaria POCT either as an adjunct to microscopy, or as their only form of malaria testing. Although all three facilities were familiar with haemoglobin colour scale (HCS), none of the facilities used them routinely. Clinical staff perceived symptom-based diagnosis was a quick way to diagnosis because access to POCT during consultations was unreliable, but recognized disadvantages associated with symptom-based diagnosis. Perceived advantages of malaria and anaemia POCT were user-friendliness, improved diagnosis and opportunity for patient engagement, as well as lower cost implication for patients. Perceived disadvantages included likelihood of missed diagnosis of mild anaemia, as well as likelihood of human error leading to in accurate diagnosis which could impact on patient trust. Poor communication and lack of trust between staff groups was also identified as a barrier to effective uptake of POCT. Conclusions Consistent supply of POCT as well as staff training and staff and patient engagement, are fundamental to successful uptake of POCT for effective malaria and anaemia management.
Fossil-calibrated molecular phylogeny of atlantid heteropods (Gastropoda, Pterotracheoidea)
Authors: Wall-Palmer Deborah , Janssen Arie W , Goetze Erica , Choo Le Qin , Mekkes Lisette , Peijnenburg Katja T. C. A. 
Published: March 2020

Abstract
The aragonite shelled, planktonic gastropod family Atlantidae (shelled heteropods) is likely to be one of the first groups to be impacted by imminent ocean changes, including ocean warming and ocean acidification. With a fossil record spanning at least 100 Million years (Ma), atlantids have experienced and survived global-scale ocean changes and extinction events in the past. However, the diversification patterns and tempo of evolution in this family are largely unknown. Based on a concatenated maximum likelihood phylogeny of three genes (cytochrome c oxidase subunit 1 mitochondrial DNA, 28S and 18S ribosomal rRNA) we show that the three extant genera of the family Atlantidae, Atlanta, Protatlanta and Oxygyrus, form monophyletic clades. The genus Atlanta is split into two groups, one exhibiting smaller, well ornamented shells, and the other having larger, less ornamented shells. The fossil record, in combination with a fossil-calibrated phylogeny suggest that large scale atlantid extinction was accompanied by considerable and rapid diversification over the last 25 Ma, potentially driven by vicariance events. Now confronted with a rapidly changing modern ocean, the ability of atlantids to survive past global change crises gives some optimism that they may be able to persist through the Anthropocene.
Longitudinal trajectory of disability in community-dwelling older adults: An observational cohort study in South Korea
Authors: Park Yu Rang , Kim Hae Reong , Lee Hea yon , Seong Yoonje , Lee Eunju , Jung Hee-Won , Jang Il-Young 
Published: March 2020

Abstract
Background Disability, which is considered a health-related condition, increases care demands and socioeconomic burdens for both families and communities. To confirm the trend of dynamic longitudinal changes in disability, this study aims to explore how disability is divided by the trajectory method, which deals with time-sequenced data. Additionally, this study examines the differences in demographics, geriatric conditions, and time spent at home among the trajectory groups in community-dwelling older adults. Home time is defined as the period during which the patient was not in hospital or health care facility during their lifetime. Methods Records of 786 community-dwelling older participants were analyzed from the Aging Study of PyeongChang Rural Area, a population-based cohort study that took place over three years. Using 7 domains of activity of daily living and 10 domains of instrumental activity of daily living, participants were grouped into no dependency (0 disabled domain), mild (1 disabled domain), and severe (2 or more disabled domains) disability groups. The longitudinal trajectory group of disability was calculated as a trajectory method. Three distinct trajectory groups were calculated over time: a relatively-stable group (78.5%; n=617), a gradually-aggravated group (16.0%; n=126), and a rapidly-deteriorated group (5.5%; n=43). Results It was found that 78.5% of patients showed relatively no dependence and 5.5% of older adults in rural area showed severe dependence. Through applying the trajectory method, it was shown that the Short Physical Performance Battery (SPPB) score was 10.2 points in the relatively-stable group and 3.1 points in the rapidly-deteriorating group by the 3 rd year. Additionally, home time decrement was more pronounced in the trajectory method (3.33% between the rapidly-deteriorated group and the relatively-stable group), than in the conventional method (2.53% between the no dependency group and the severe-dependent group). Conclusions This study shows the difference in demographics and geriatric conditions (such as SPPB) through the examination of longitudinal trajectory groups of disability in community-dwelling older adults. Significant differences were also found in the amount of home time among the trajectory groups.
The Effect of ten-minute dispatch-assisted cardiopulmonary resuscitation training: a randomized simulation pilot study
Authors: Fukushima Hidetada , Asai Hideki , Seki Tadahiko , Takano Keisuke , Bolstad Francesco 
Published: March 2020

Abstract
Background Immediate bystander cardiopulmonary resuscitation (CPR) is essential for survival from sudden cardiac arrest. Current CPR guidelines recommend that dispatchers assist lay rescuers performing CPR (dispatch-assisted CPR: DACPR), which can double the frequency of bystander CPR. Laypersons, however, are not familiar with receiving CPR instructions from dispatchers. DACPR training can be beneficial for lay rescuers, but this needs to be validated. The aim of this study was to determine the effectiveness of brief DACPR training for lay rescuers in addition to a standard CPR training course. Methods We conducted a randomized DACPR simulation pilot study. Participants with no CPR training within 1 year prior to this study were assigned randomly to one of two 90-minute CPR training courses (DACPR Group: a standard CPR course including DACPR training for 10 minutes or Standard Group: a standard CPR course with a simple lecture of dispatchers’ role). In the DACPR Group, participants practiced DACPR through role-playing of a dispatcher and an emergency caller. Six months after the training, the subjects in both groups performed CPR for 2 minutes under instruction by off-duty dispatchers. Results Out of the 66 participants, 59 (DACPR Group; 30, Standard Group; 29) completed the simulation. The CPR quality was similar between the two groups. However, the median time interval between call receipt and the first dispatch-assisted compression was faster in the DACPR group (108 s vs. 129 s, p = 0.042). Conclusions This brief DACPR training can be effective for lay rescuers to start chest compressions more quickly.
Pulmonary edema lead by circulation overload following shoulder arthroscopy under general anesthesia with nerve block: an observational study
Authors: Zhang Gang , Wan Qihai , Huang Xiaoyan , Luo Chunqiong , Shui Yunhua , Zhang Lan 
Published: March 2020

Abstract
Purpose : Shoulder arthroscopy requires a large of irrigation for a better surgical view, resulting in circulatory overload. This study was performed to p rove whether pulmonary edema will be lead by a large of irrigation . Materials and Methods : General anesthesia with interscalene block was induced before operation. The primary outcome was ultrasound evaluation of B lines from the time before nerve block to the time 10 hours after operation. The secondary outcomes included oxygenation index, arterial partial pressure of carbon dioxide, visual analogue scale, muscle strength grade. Results : A total of 93 patients were evaluated. Before surgery, B lines failed to be detected. While the highest total incidence of B lines was 49.4%, occured at 4 hours after surgery. The highest incidence s of severe and moderate pulmonary edema were 3.2% (P=0.081) and 9.7% (P=0.002), respectively. B lines were also found on both the affected and healthy side. During operation, the incidence of type 1 respiratory failure was 5.4% (P=0.023) and that of both type 1 and 2 respiratory failure were 6.5% (P=0.013). Pain was relieved in 6 hours after surgery (VAS<3). At 12 hours after operation, the VAS of resting and motion were 4.68±2.27, 6.90±2.43, respectively. While the grade of muscle strength was 4.48±0.51 at 12 hours after operation. Conclusions : There is a high incidence of pulmonary edema in shoulder arthroscopy, and ultrasound is an convenient tool to evaluate this complication . Pain is relieved in 6 hours after surgery by nerve block. While muscle strength can also recover at 12 hours after surgery.
Complications of cricothyroidotomy versus tracheostomy in emergency surgical airway management: A systematic review
Authors: Zasso Fabricio Batistella , You-Ten Kong Eric , Ryu Michelle , Losyeva Khrystyna , Tanwani Jaya , Siddiqui Naveed 
Published: March 2020

Abstract
Background Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a “Can’t Intubate, Can’t Oxygenate” (CICO) situation. Surgical airways can be achieved either through a cricothyroidotomy or tracheostomy. The current literature has limited data regarding complications of cricothyroidotomy and tracheostomy in an emergency situation, such as in a CICO scenario. The objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in this situation. Methods This synthesis of literature was exempt from ethics approval. Eight databases were searched from inception to October 2018, using a comprehensive search strategy. Studies were included if they were randomized controlled trials or observational studies reporting complications following emergency surgical airway. Complications were classified as minor (evolving to spontaneous remission or not requiring intervention or not persisting chronically), major (requiring intervention or persisting chronically), early (from the start of the procedure up to seven days) and late (beyond seven days of the procedure). Results We retrieved 2,659 references from our search criteria. Following the removal of duplicates, title and abstract review, 33 articles were selected for full-text reading. 21 articles were finally included in the systematic review. We found no differences in minor, major or early complications between the two techniques. However, late complications were significantly more frequent in the tracheostomy group [OR (95% CI) 0.21 (0.20-0.22), p<0.0001]. Conclusions Our results demonstrate that cricothyroidotomies performed in emergent situations resulted in fewer late complications than tracheostomies. This may be indicative that cricothyroidotomy is safer than tracheostomy as an emergency surgical airway. This finding supports the recommendations from the latest Difficult Airway Society (DAS) guidelines regarding using cricothyroidotomy as the technique of choice for emergency surgical airway in a CICO situation.
Maternal hemodynamics during labor epidural analgesia with and without adrenaline: a secondary analysis of a randomized trial
Authors: Haidl Felix , Tronstad Christian , Rosseland Leiv Arne , Dahl Vegard 
Published: March 2020

Abstract
Background: Pregnancy in general and labor in particular is associated with changes in maternal hemodynamic parameters such as increased cardiac output and heart rate, with peaks during uterine contractions. Adrenaline may be added to labor epidural solutions to enhance efficiency, but the hemodynamic fluctuations may increase. The aim of this study was to compare the hemodynamic changes of epidural drug solution with or without adrenaline 2 µg.ml -1 and to provide pilot data for a larger study. Methods: Forty-one nulliparous laboring women requesting epidural analgesia were randomized to epidural solution of bupivacaine 1mg.ml -1 , fentanyl 2 µg.ml -1 with or without adrenaline 2 µg.ml -1 . The participants were monitored with the Nexfin CC continuous non-invasive blood pressure and cardiac output monitor. The primary outcomes were changes in peak systolic blood pressure and cardiac output at uterine contraction within 30 minutes after epidural activation. The effect of adrenaline was tested statistically by a linear mixed effects model of the outcome variables’ dependency on time, adrenaline and their interaction. Results: The addition of adrenaline to the solution had no statistically significant effect on the temporal changes in peak systolic blood pressure (mean change 0.23 mmHg.min -1 95% CI [-0.17; 0.64] p=0.26), peak cardiac output (mean change 0.0029 l.min -1 .min -1 95 % CI [-0.026; 0.032] 0.84), or heart rate (mean change 0.015 beats.min -1 .min -1 95 % CI [-0.25; 0.28] p=0.91).
The application of preoperative self-anticipating pain scores in predicting surgical pain after elective surgery
Authors: Chang Wei-Shu , Hsieh Yi-Ting , Chen Moa-Chu , Chang Shu-Ching , Chen Tzu-Shan , Chang Yun-Chi , Lam Chen-Fuh , Tsai Yu-Chuan 
Published: March 2020

Abstract
Background Current principles of postoperative pain management are primarily based on the types and extent of surgical intervention. This clinical study measured patient’s self-anticipating pain score before operation, and correlated the scores with the actual pain levels and analgesic requirement after operation. Methods This prospective cross-sectional, observational study recruited consecutive patients who received elective surgery in the E-Da Hospital, Taiwan from June to August 2018. Patients were invited to complete a structured questionnaire during preoperative anesthesia assessment that surveyed patient’s self-anticipating pain level (numeric rating scale, NRS 0-10) for the scheduled procedure. The actual pain score (visual analogue scale, VAS) experienced by the patient and the total equivalent dose of opioids administered after operation were recorded. Results A total of 996 patients were recruited and 1 patients were excluded due to incomplete data. Most of the patients (86%) received general anesthesia and 73.9% of them had prior operation history. Patients with younger ages (<40 years) and those took regular benzodiazepine for sleep disorder anticipated significantly higher pain levels. Male patients anticipated significantly lower NRS than females (odd ratio 1.710; 95% CI 1.254-2.331). Patients who scheduled for laparotomy, orthopedic surgery or long procedures had higher anticipating NRS. Although higher anticipating NRS were associated with higher postoperative VAS scores and higher total equivalent opioid dose for acute pain management, these surgical patients actually experienced less VAS than they anticipated at the post-anesthesia care unit. Conclusion This observational study found that female, younger age (<40 years), regular benzodiazepine user and patients who scheduled for long procedure (>2 h), laparotomy or orthopedic surgery are anticipating significantly higher surgical-related pain. Therefore, appropriate preoperative counseling for analgesic control and elimination of unnecessary anticipating pain levels in these patients would be necessary to improve the quality of anesthesia service and patient’s satisfaction.
Impact of obesity on short- and long-term mortality in patients with sepsis: A retrospective analysis of the large clinical database MIMIC-III
Authors: Wang Danni , Liang Xin , Xia Shiyu , Song Fei , Ru Huangyao , Yin Hui , Li Lixia , Pan Zhiguo , Dai Liangcheng , Su Lei 
Published: March 2020

Abstract
Background The purpose of our study was to explore the relationship between body weight and short- and long-term clinical outcomes in patients with sepsis. Methods We retrospectively analyzed 11,499 patients with sepsis at the Beth Israel Deaconess Medical Center (Boston, MA, USA) registered in the Medical Information Market Intensive Care (MIMIC-III) database from 2001 to 2012. Cox proportional hazards regression assessed the relationships between body mass index and 30-day and 1-year mortality. Results Patients were divided into four groups according to body mass index (underweight: 336 [6.0%]; normal weight: 1,752 [31.4%]; overweight: 1,563 [28.1%]; and obese: 1,920 [34.5%]), 30-day mortality (42.3%, 36.6%, 32.2%, and 29.6%; p<0.001), 1-year mortality, (64.6%, 56.8%, 52.5%, and 46.7%; p<0.001), and in-hospital mortality (35.4%, 34.3%, 31.6%, and 29.9%; p=0.018). In addition, obese patients had notably longer mechanical ventilation periods and intensive care unit and hospital lengths of stay. The Cox proportional hazards regression analysis confirmed that underweight patients had a 13% and 24% increased risk of death within 30 days and 1 year, respectively, compared with normal-weight patients. For overweight patients, these risks were 17% and 14% lower, respectively, than those reported for normal-weight patients. For obese patients, these risks were 22% and 21% lower than those observed in normal-weight patients. Conclusion This retrospective analysis showed that overweight or obese patients showed improved survival within 30 days and 1 year after admission to the intensive care unit.
Impact of guided self-study on learning success in undergraduate physiotherapy students in Switzerland – a feasibility study of a higher education intervention
Authors: Rogan Slavko , Taeymans Jan , Zuber Stefan , Zinzen Evert 
Published: March 2020

Abstract
Background: Guided self-study (G-SS) can be used as a self-directed learning method (andragogy) or self-determined learning (heutagogy) that fosters changes in knowledge and skills in a higher physiotherapy education setting. Until now, there has been no empirical evidence for the use of G-SS in higher physiotherapy education. Furthermore, and to the best of our knowledge, no practical guidelines for G-SS exist for physiotherapy undergraduate students to foster changes in knowledge and skills. This higher education feasibility study aimed to investigate the feasibility to establish a G-SS program in a fulltime undergraduate physiotherapy degree course at the Bern University of Applied Sciences (BFH), Switzerland. In addition, the effectiveness of the G-SS was assessed on changes in knowledge and skills. Method: Fifty-one first-semester physiotherapy students volunteered from BFH. They were randomly divided into a G-SS group or control group (CG). The G-SS group received six cases. Each case was processed in an eight-day cycle. One week in advance, the clinical case (i.e. description of a patient and the symptoms) and learning goals were provided to the students electronically (day 1). The students prepared the cases in groups and were guided (e.g. via Skype) by the tutor during this preparation time (day 2 to 7). The results of the group work were presented and reflected on during a moderated plenum session (90 minutes) at day 8. The primary outcome parameters were i) exposure as the number of G-SS sessions performed over 90 minutes, ii) the responsiveness of students with a previously determined 83% willingness to participate in the G-SS program iii) program differentiation, to illustrate the difference between G-SS content and the curriculum and the total score in the objective structured clinical examination (OSCE) and written exams. Statistical analyses were conducted using an Intention-To-Treat (ITT) approach. Results: All six G-SS sessions on day 8 were performed over 90 minutes. The responsiveness of students as willing to participate in the G-SS program was 23%, clearly below the set 83%, and in terms of program differentiation, no differences were found between G-SS program and normal curriculum content. G-SS as compared to the CG scored significantly better on OSCE (p < 0.01) and on the written exam (p < 0.04). Conclusion: The results showed that this higher education G-SS program in its current form was not feasible. Slight modification of the study protocol (e.g. better time planning in the academic calendar) is needed to improve the student’s responsiveness. The adjustments to the timetable must allow the physiotherapy students to prepare the clinical cases. G-SS have the potential to promote change in knowledge and skills in undergraduate physiotherapy students when students prepare the case, present the case solutions and reflect upon their actions.