bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic prescribing among inpatients with infectious and non-infectious indications in obstetrics and gynaecology departments at two tertiary care hospitals in Central India
Authors: Machowska Anna , Landstedt Kristoffer , Lundborg Cecilia Stålsby , Sharma Megha 
Published: January 2020

Abstract
Background: Patients in obstetrics and gynaecology (OBGY) departments are at high risk of life-threatening infection, thus prescribed antibiotics extensively. The use of antibiotics leads to increasing antibiotic resistance (ABR). Antibiotic surveillance is one of the cornerstones to combat ABR. However, surveillance of, department specific antibiotic prescription data is rarely performed, especially in low- and middle-income countries.
Aim: To describe and compare antibiotic prescription patterns among the inpatients at OBGY departments of two tertiary care hospitals, one teaching (TH) and one non-teaching (NTH), in Central India.
Methods: A prospective study was conducted for three years using. Demographics, length of hospital stay, diagnoses and prescribed antibiotics including dose, duration and frequency were recorded for all inpatients during their hospital stay. The patients were divided into, infectious and non-infectious diagnosis categories and further into surgical, non-surgical and possible surgical indications using the International Classification of Disease system version-10.
Results: A total of 5558 patients were included in the study; 2044 (81%) in the TH and 2567 (85%) in the NTH received antibiotics (p<0.001). A majority of the patients with surgical indications were prescribed antibiotics (TH-87%, NTH-100%). Prescribing of the fixed-dose combinations (FDCs) of antibiotics and use of trade names were more common at the NTH. Most of the inpatients who had neither surgery nor any confirmed bacterial infection received antibiotics (TH-71% and NTH-75%). Overall, higher DDD/1000 patients were prescribed in the TH in both categories.
Conclusions: High antibiotic prescribing for the inpatients having no infection indications in both hospitals, as well as frequent prescribing of trade-name, broad-spectrum antibiotics, including the FDCs in the NTH than the TH, are points of concern. Investigation of the underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve the antibiotic prescribing practice.
Long-term effects of group exercise intervention on maximal step-up height in middle-aged female primary care patients with obesity and other cardio-metabolic risk factors
Authors: Nyberg Lillemor Amanda , Sundberg Carl Johan , Wändell Per , Kowalski Jan , Hellenius Mai-Lis 
Published: January 2020

Abstract
Background: Low physical performance is a predictor of morbidity and mortality. This study looks at long-term effects of an exercise intervention on maximal step-up height (MSH) in individuals with low physical function. Furthermore, we studied correlates to changes in MSH. Methods: Female patients (n=101), mean(SD) age of 52(11) years, were recruited for a 3-month group exercise intervention including 2-3 sessions/week of mixed aerobic fitness and strength training. MSH, weight, body mass index (BMI), waist circumference, maximal oxygen consumption (VO₂-max), self-reported health (SF-36) and physical activity (PA) were measured at baseline (T0), after 3 months (T1) and after 14-30(mean 22) months (T2). Relationships between changes in MSH (cm) and age, baseline MSH, time to follow-up, changes in anthropometric measurements, VO₂-max, SF-36 and PA were studied with regression analyses. Results: MSH, significantly, increased from T0 to T1, 27.2(5.7) to 29.0(5.5) cm and decreased to 25.2(5.5) cm at T2. Time to follow-up (B=-0.42, p<0.001) and change in BMI (B=-0.29, p=0.012) correlated significantly to changes in MSH. Waist circumference, VO₂-max, PF and exercise/physical activity levels were significantly improved at T2, while BMI did not change. In a univariate logistic regression model, maintenance of MSH correlated to the extent of mixed training (OR 3.33, 95% CI 1.25-8.89). In a multivariate logistic regression model adjusted for important factors the correlation was not significant. However, MSH was significantly higher in individuals participating in 2-3 session per week compared to one session. Conclusions: A 3-month group exercise intervention increased MSH, improved fitness, decreased risk in female patients with elevated cardio-metabolic risk. After an average of 22 months MSH was reduced while positive effects remained for waist circumference, VO₂-max, physical function and physical activity. However, regular group exercise 2-3 times per week with mixed aerobic fitness and strength training was associated with maintenance of MSH in a subgroup of patients. We suggest that such an intervention including regular support from healthcare professionals is a successful approach for maintaining improved leg-muscle strength among primary care patients.
Prognostic role of time to positivity of blood culture in children with Pseudomonas aeruginosa bacteremia.
Authors: xu huiting , Cheng Jie , Yu Qinghong , Li Qingyuan , Yi Qian , Luo Siying , Li Yuanyuan , Zhang Guangli , Tian Xiaoyin , Cheng Dapeng , Luo Zhengxiu 
Published: January 2020

Abstract
Background: Pseudomonas aeruginosa (P. aeruginosa) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia.Methods: From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock.Results: Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 hours. Early TTP (≤18 hours) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P=0.014), higher incidence of septic shock (52.4% vs12.9%, P=0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P=0.046] and more intensive care unit admission (61.9% vs 22.6%, P=0.008) when compared with late TTP (>18 hours) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P=0.035; OR 4.95, 95%CI 1.26-27.50, P=0.024; respectively). The independent risk factors for septic shock were as follows: TTP ≤18h, Pitt bacteremia scores ≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P=0.032; OR 8.15, 95%CI 1.15-42.43, P=0.014; OR 6.46, 95% CI 1.19-33.19 P=0.031; respectively).Conclusions: Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.Trial registration: Retrospectively registered. File No. (2019)304
Evidence-based intrapartum practice and its associated factors at a tertiary teaching hospital in the Philippines, a descriptive mixed-methods study.
Authors: Masuda Chisato , Ferolin Shirley Kristine , Masuda Ken , Smith Chris , Matsui Mitsuaki 
Published: January 2020

Abstract
Background Evidenced-based practice is a key component of quality care. However, studies in the Philippines have identified gaps between evidence and actual maternity practices. This study aims to describe the practice of evidence-based intrapartum care and its associated factors, as well as exploring the perceptions of healthcare providers in a tertiary hospital in the Philippines. Methods A mixed-methods study was conducted, which consisted of direct observation of intrapartum practices during the second and third stages, as well as semi-structured interviews and focus group discussions with care providers to determine their perceptions and reasoning behind decisions to perform episiotomy or fundal pressure. Univariate and multivariate logistic regression were used to analyse the relationship between observed practices and maternal, neonatal, and environmental factors. Qualitative data were parsed and categorised to identify themes related to the decision-making process. Results A total of 170 deliveries were included. Recommended care, such as prophylactic use of oxytocin and controlled cord traction in the third stage, were applied in almost all the cases. However, harmful practices were also observed, such as intramuscular or intravenous oxytocin use in the second stage (14%) and lack of foetal heart rate monitoring (57%). Of primiparae, 92% received episiotomy and 31% of all deliveries received fundal pressure. Factors associated with the implementation of episiotomy included primipara (adjusted Odds Ratio [aOR] 62.3), duration of the second stage of more than 30 minutes (aOR 4.6), and assisted vaginal delivery (aOR 15.0). Factors associated with fundal pressure were primipara (aOR 3.0), augmentation with oxytocin (aOR 3.3), and assisted delivery (aOR 4.8). Healthcare providers believe that these practices can prevent laceration. The rate of obstetric anal sphincter injuries (OASIS) was 17%. Associated with OASIS were assisted delivery (aOR 6.0), baby weights of more than 3.5 kg (aOR 7.8), episiotomy (aOR 26.4), and fundal pressure (aOR 6.2). Conclusions Our study found that potentially harmful practices are still conducted that contribute to the occurrence of OASIS. The perception of these practices is divergent with current evidence, and empirical knowledge has more influence. To improve practices the scientific evidence and its underlying basis should be understood among providers.
Clinically useful prediction of hospital admissions in an older population
Authors: Marcusson Jan , Nord Magnus , Dong Huan-Ji , Lyth Johan 
Published: January 2020

Abstract
Background: The healthcare for older adults is insufficient in many countries, not designed to meet their needs and is often described as disorganized and reactive. Prediction of older persons at risk of admission to hospital may be one important way for the future healthcare system to act proactively when meeting increasing needs for care. Therefore, we wanted to develop and test a clinically useful model for predicting hospital admissions of older persons based on routine healthcare data. Methods : We used the healthcare data on 40,728 persons, 75-109 years of age to predict hospital in-ward care in a prospective cohort. Multivariable logistic regression was used to identify significant factors predictive of unplanned hospital admission. Model fitting was accomplished using forward selection. The accuracy of the prediction model was expressed as area under the receiver operating characteristic (ROC) curve, AUC. Results: The prediction model consisting of 38 variables exhibited a good discriminative accuracy for unplanned hospital admissions over the following 12 months (AUC 0·69 [95% confidence interval, CI 0·68–0·70]) and was validated on external datasets. Clinically relevant proportions of predicted cases of 40 or 45% resulted in sensitivities of 62 and 66%, respectively. The corresponding positive predicted values (PPV) was 31% and 29%, respectively. Conclusion : A prediction model based on routine administrative healthcare data from older persons can be used to find patients at risk of admission to hospital. Identifying the risk population can enable proactive intervention for older patients with as-yet unknown needs for healthcare.
Fluid Overload After Coronary Artery Bypass Graft in Patients on Maintenance Hemodialysis is Associated with Prolonged Time on Mechanical Ventilation
Authors: Silva Sirlei , Consolim-Colombo Fernanda Marciano , Rodrigues Renata Gomes , Gaiotto Fábio Antonio , Hajjar Ludhmila Abrahão , Moysés Rosa Maria Affonso , Elias Rosilene Motta 
Published: January 2020

Abstract
Background Fluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. Patients on maintenance hemodialysis might be at higher risk. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on hemodialysis, as compared to patients with chronic kidney disease not on dialysis (CKD3-4) and patients with normal renal function (reference group).Methods this is a prospective observational study that included consecutive patients submitted to an isolated and elective coronary artery bypass surgery classified as reference (N=167, normal renal function), CKD3-4 (N=84, estimated glomerular filtration rate 30-60ml/min/1.73m 2 ), and hemodialysis (N=31, maintenance hemodialysis) groups. The same observer followed patients daily from the surgery to the hospital discharge.Results Fluid accumulation correlated with time on mechanical ventilation in patients on hemodialysis (r=0.627, p=0.003), but not in the CKD3-4 group (r=-0.068, p=0.652) and in the reference group (r=-0.085, p=0.363). Multivariate analysis revealed that the fluid accumulation, scores of sequential organ failure assessment-SOFA in the day following surgery, and the group according to renal function were independently associated with ventilation time. Furthermore, in patients on hemodialysis, the time between surgery and the first hemodialysis also accounted for the time on mechanical ventilation.Conclusions Fluid accumulation is an important risk factor for lengthening mechanical ventilation, particularly in patients on hemodialysis. Future studies are warranted to address the ideal timing for initiating dialysis in this scenario in an attempt to reduce fluid accumulation and avoid prolonged ventilation time and hospital stay.
Divergence of pigments in three phylogenetically close Monascus species (M. pilosus, M. ruber, and M. purpureus) based on secondary metabolite biosynthetic gene clusters
Authors: HIGA YUKI , Kim Young-Soo , Altaf-Ul-Amin Md. , Huan Ming , Ono Naoaki , Kanaya Shigehiko 
Published: January 2020

Abstract
Background: Species under the genus Monascus are considered as economically important and have been widely used in the production of yellow and red food colorants. In particular, three Monascus species, namely, M. pilosus , M. purpureus , and M. ruber , are used for food fermentation in the cuisine of East Asian countries such as China, Japan, and Korea. These species have also been utilized in the production of various kinds of natural pigments. Results: We examined the diversity of pigment-related biosynthetic pathways in three Monascus species ( M. pilosus , M. purpureus , and M. ruber ) at the metabolome and genome levels. Illumina MiSeq 300 bp paired-end sequencing generated 17 million high-quality short reads in each species, corresponding to 200 times the genome size. We measured the pigments and their related metabolites using potato dextrose liquid (PDL) media. The colors in the PDL media corresponding to the pigments and their related metabolites produced by the three species are very different from each other. The gene clusters for secondary metabolite biosynthesis of the three Monascus species also diverged, confirming that M. pilosus and M. purpureus are chemotaxonomically different. M. ruber has similar biosynthetic gene clusters for citrinin, monacolin K, and Monascus azaphilone pigments with M. pilosus and M. purpureus. The comparison of secondary metabolites produced also revealed divergence in the three species. Conclusions: Our findings are important for improving the utilization of Monascus species in the food industry and industrial field. However, in view of food safety, we need to determine if the toxins produced by some Monascus strains exist in the genome or in the metabolome.
Pathogenic features of urinary&nbsp;Escherichia coli strains causing Asymptomatic Bacteriuria during Pregnancy
Authors: Mohebi Samane , Hashemizade zahra , Hadadi Mahtab , Kholdi Soudeh , Javadi Kasra , Motamedifar Mohammad 
Published: January 2020

Abstract
Background Asymptomatic bacteriuria is one of the common problems in pregnancy. Pyelonephritis, preterm labor and low birth weight infants have been associated with bacterial infection. Urinary tract infection (UTI) during pregnancy is frequently associated with complications. An observational cross-sectional study including investigated the prevalence of virulence genes, antimicrobial resistance, and its relationship with phylogenetic groups among E. coli strains isolated from pregnant women with asymptomatic bacteriuria who referred to Hafez hospital, Shiraz, Iran.Material and Methods A total of 300 urine samples were screened for Escherichia coli strains. Susceptibility testing was determined by the disk-diffusion method. The phylogenetic groups and 13 virulence genes were identified by PCR. ESBL and AmpC producing isolates were detected using phenotypic methods. PCR was used to identify the bla TEM , bla SHV and bla CTXM genes in ESBL and AmpC-positive isolates.Results Our results revealed that among 300 urine samples, 105 (35%) were positive for E. coli . The data showed that the highest and the lowest resistance rates were observed against nalidixic acid (82.1%), and imipenem (2.8%), respectively. The prevalence of ESBLs and AmpC-β-lactamase, in the E. coli isolates was 41% and 9.5% respectively. bla CTXM was the commonest genotype (93%). Phylogenetic group distribution was as follow: B1 2.8%, A 14.2%, B2 61.9%, and D 4.6%. Our result showed that most of the virulence genes belonged to group B2 and also several virulence genes such as hlyA , cnf-1 , and papGII genes were positively associated with group B2. Conclusion Among E. coli strains isolated from patients with UTIs, different features phylogroups, with special virulence factors, could cause severe infection. Awareness about the Virulence patterns distribution among Phylogenetic groups of UPEC could greatly aid in confine and prevent the development of lethal infection caused by these strains.
How to recover from a bad start: size at metamorphosis affects growth and survival in a tropical amphibian
Authors: Szekely Diana , Cogalniceanu Dan , Szekely Paul , Armijos-Ojeda Diego , Espinosa-Mogrovejo Valentina , Denoel Mathieu 
Published: January 2020

Abstract
Background:In species with complex life cycles, metamorphosing size is a key life-history trait which reflects the complex interactions between costs and benefits of life in the aquatic and terrestrial environments. Whereas the effects of a deteriorating larval habitat (e.g. pond desiccation) on triggering an early metamorphosis have been extensively investigated in amphibians, the consequences of the resulting reduced size at metamorphosis on fitness in the post-metamorphic terrestrial stage remain poorly understood. We tested the hypothesis that a smaller size at metamorphosis negatively affects performance and fitness in the ensuing terrestrial stage. Using as model a tropical amphibian (Ceratophrys stolzmanni) showing a large phenotypic plasticity in metamorphosing traits, we evaluated the effects of froglets' size at metamorphosis on fitness-related trophic and locomotor performance traits, as well as on growth and survival rates. Results: Our results support the hypothesis that a bigger size at metamorphosis is correlated with better survival and performance. Survival rate of large metamorphosing individuals was 95%, compared to 60% for those completing metamorphosis at a small size. Locomotor performance and gape were positively correlated with size, larger animals being more mobile and capable to ingest larger preys. However, smaller individuals achieved higher growth rates, thus reducing the size gap. Conclusions: Overall, size at metamorphosis had a profound impact on short-term fitness, but smaller surviving individuals compensated their initial disadvantages by increasing growth rates.
A systematic review of interventions to improve acute hospital care for people with dementia
Authors: Karrer Melanie , Schnelli Angela , Zeller Adelheid , Mayer Hanna 
Published: January 2020

Abstract
Background People with dementia are confronted with negative consequences due to hospital stays. When developing new interventions to improve the care of people with dementia in acute care hospitals, it is crucial to have a comprehensive overview of the previous interventions tested in this field and to know the investigated outcomes and effects. Methods We conducted a systematic review of interventional studies to provide an overview of interventions targeting the care situation of patients with dementia in acute care hospitals. We included trials with interventional study designs and systematic reviews of interventional studies with no restrictions regarding the outcomes. We searched five electronic databases, conducted a hand search of journals and performed forward and backward citation tracking of the included studies. For risk of bias assessment, we used the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials, ROBANS (for non-randomised controlled trials) and AMSTAR (for systematic reviews). We provide tabular and narrative summaries of the findings. Results Nineteen studies met the inclusion criteria. he findings indicated a broad range of interventions and outcomes. We categorised the interventions into nine intervention types: educational programmes, family-/person-centred programmes, use of specially trained nurses, volunteer programmes, delirium management programmes, special care units and inpatient rehabilitation interventions. Staff outcomes were primarily investigated, followed by patient outcomes. Outcomes for relatives were only reported in three of the included studies. Educational programmes were the most commonly reported intervention type and showed improvements in staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were able to improve patient-related outcomes, e.g. delirium severity, functional performance and rehospitalisation rates. Rehabilitation interventions after hip fractures and special care units for people with dementia showed hardly significant effects. Conclusions Although the included interventional studies were able to show improved outcomes for staff, relatives and patients, the evidence is insufficient to declare which interventions are effective in improving care for people with dementia in acute care hospitals. Future research should focus on patient and family caregiver outcomes. Furthermore, interventions addressing relatives, interprofessional collaboration and the entire practice culture are needed.