bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which is the best treatment of pediatric upper urinary tract stones among extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy and retrograde intrarenal surgery: a systematic review
Authors: He Qing , Xiao Kaiwen , Chen Yuntian , Liao Banghua , Li Hong , Wang Kunjie 
Published: October 2019

Abstract

Background
Although the indications of minimally invasive treatments for pediatric urolithiasis are similar to those in adults, it is still crucial to make the right treatment decision due to the special considerations of children. This review aims to evaluate the efficacy and safety of extracorporeal shockwave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) in the management of pediatric upper urinary tract stones.

Methods
EMBASE, PubMed, and the Cochrane Library were searched from their first available date to March 2018. The studies that meet the inclusive criteria were included. The efficacy and safety of the treatments were assessed by means of meta-analysis of the stone free rate (SFR), complication rate, effectiveness quotient (EQ) and secondary outcome indicators.

Results
A total of 13 comparative studies were identified for data analysis. PCNL presented a significantly higher SFR compared with SWL. Similarly, the single-session SFR of RIRS was significantly higher than SWL. However, no significant difference was found between RIRS and SWL in the overall SFR. There was no significant difference between PCNL and RIRS in the SFR. Furthermore, no significant differences in complication rates were found among the three therapies. Compared with the other two treatments, PCNL had a longer operative time, fluoroscopy time and hospital stay. SWL had a shorter hospital stay, higher retreatment rate and auxiliary rate in comparison with the other two treatments. The present data also showed that PCNL presented a higher EQ than the other two treatments, and RIRS had a lower efficiency than SWL and PCNL. In the subgroup analysis of pediatric patients with stone ≤20 mm, the comparative results were similar to those described above, except for the higher complication rate of PCNL than SWL.

Conclusions
Although SWL as an outpatient procedure provides shorter hospital stay and reduces operative time, it has a lower SFR and higher retreatment rate than the other two treatments. PCNL exhibits a higher SFR and EQ than SWL; nevertheless, it has a longer operative time and fluoroscopy time than the other two procedures. RIRS offers a similar SFR as PCNL but a lower efficiency than PCNL.
Biochemical parameters and oxidative stress markers in Tunisian patients with periodontal disease
Authors: Gharbi Ahmed , Hamila Ali , Bouguezzi Adel , Dandana Azza , Ferchichi Salima , Chandad Fatiha , Guezguez Leila , Miled Abdelhedi 
Published: October 2019

Abstract

Background
Oxidative stress is involved in many diseases including diabetes and cancer. Numbers of studies have suggested its involvement in the pathogenesis of periodontal diseases. The aim of this study was to evaluate the levels of biochemical parameters and oxidative stress markers in plasma of healthy and chronic periodontitis patients.

Methods
One hundred thirty subjects were divided into two groups; patients (mean age = 42 ± 13.6 y.o) and control (mean age = 44.8 ± 12.6 y.o). Patients and healthy subjects were free from any infection, coronary or heart disease, diabetes or liver failure. Total cholesterol, LDLc, HDLc, Triglycerides (TG), creatinine, uric acid (UA), glucose and urea levels as well as the activities of enzymatic antioxidants such as catalase, glutathione reductase (GR) and total antioxidant capacity (TAOC), were measured in plasma samples using colorimetric assays. Statistical differences between groups were determined by Student’s t-test and p ≤ 0.05 was considered as significant.

Results
Periodontitis patients exhibited significant decrease in the activities of catalase, TAOC, GR and TG, cholesterol, LDLc, glucose, HDLc, uric acid levels in plasma samples in comparison with healthy subjects. However, no statistically significant differences in the levels of creatinine and urea were observed between the two groups.

Conclusion
The reduction of plasma antioxidant activities (Catalase, TAOC, GR) may have a role in the pathogenesis of periodontal diseases. Our findings suggest a decrease in the host capacity to control the damage caused by oxidative stress. Therefore, therapeutic strategies, aiming at modulating the oxidative stress could be considered as potential tools for the prevention or treatment of periodontal diseases and their potential systemic effects on the general health.
Efficacy and cost-utility of the eHealth application ‘Oncokompas’, supporting patients with incurable cancer in finding optimal palliative care, tailored to their quality of life and personal preferences: a study protocol of a randomized controlled trial
Authors: Schuit Anouk S. , Holtmaat Karen , Hooghiemstra Nienke , Jansen Femke , Lissenberg-Witte Birgit I. , Coupé Veerle M. H. , van Linde Myra E. , Becker-Commissaris Annemarie , Reijneveld Jaap C. , Zijlstra Josée M. , Sommeijer Dirkje W. , Eerenstein Simone E. J. , Verdonck-de Leeuw Irma M. 
Published: October 2019

AbstractBackgroundPatients with incurable cancer have to deal with a wide range of symptoms due to their disease and treatment, influencing their quality of life. Nowadays, patients are expected to adopt an active role in managing their own health and healthcare. Oncokompas is an eHealth self-management application developed to support patients in finding optimal palliative care, tailored to their quality of life and personal preferences. A randomized controlled trial will be carried out to determine the efficacy and cost-utility of Oncokompas compared to care as usual.Methods136 adult patients with incurable lung, breast, colorectal and head and neck cancer, lymphoma and glioma, will be included. Eligible patients have no curative treatment options and a prognosis of at least three months. Patients will be randomly assigned to the intervention group or the control group. The intervention group directly has access to Oncokompas alongside care as usual, while the waiting list control group receives care as usual and will have access to Oncokompas after three months. The primary outcome measure is patient activation, which can be described as a patient’s knowledge, skills and confidence to manage his or her own health and healthcare. Secondary outcome measures comprise self-efficacy, health-related quality of life, and costs. Measures will be assessed at baseline, two weeks after randomization, and three months after the baseline measurement.DiscussionThis study will result in knowledge on the efficacy and cost-utility of Oncokompas among patients with incurable cancer. Also, more knowledge will be generated into the need for and costs of palliative care from a societal and healthcare perspective.Trial registrationNetherlands Trial Register identifier:NTR 7494. Registered on 24 September 2018.
A screen-based simulation training program to improve palliative care of people with advanced dementia living in residential aged care facilities and reduce hospital transfers: study protocol for the IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) cluster randomised controlled trial
Authors: Tropea Joanne , Johnson Christina E. , Nestel Debra , Paul Sanjoy K. , Brand Caroline A. , Hutchinson Anastasia F. , Bicknell Ross , Lim Wen Kwang 
Published: October 2019

Abstract

Background
Many people with advanced dementia live in residential aged care homes. Care home staff need the knowledge and skills to provide high-quality end-of-life (EOL) dementia care. However, several studies have found EOL dementia care to be suboptimal, and care staff have reported they would benefit from training in palliative care and dementia. Simulation offers an immersive learning environment and has been shown to improve learners’ knowledge and skills. However, there is little research on simulation training for residential care staff.
This article presents the development and evaluation protocol of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) - a screen-based simulation training program on palliative dementia care, targeted at residential care staff. IMPETUS-D aims to improve the quality of palliative care provided to people living with dementia in residential care homes, including avoiding unnecessary transfers to hospital.

Methods
A cluster RCT will assess the effect of IMPETUS-D. Twenty-four care homes (clusters) in three Australian cities will be randomised to receive either the IMPETUS-D intervention or usual training opportunities (control). The primary outcome is to reduce transfers to hospital and deaths in hospital by 20% over 6-months in the intervention compared to the control group. Secondary outcomes include uptake of goals of care plans over 6 and 12 months, change in staff knowledge and attitudes towards palliative dementia care over 6 months, change in transfers to hospital and deaths in hospital over 12 months. For the primary analysis logistic regression models will be used with standard errors weighted by the cluster effects. A mixed methods process evaluation will be conducted alongside the cluster RCT to assess the mechanisms of impact, the implementation processes and contextual factors that may influence the delivery and effects of the intervention.

Discussion
In Australia, the need for high-quality advanced dementia care delivered in residential aged care is growing. This study will assess the effect of IMPETUS-D a new simulation-based training program on dementia palliative and EOL care. This large multisite trial will provide robust evidence about the impact of the intervention. If successful, it will be distributed to the broader residential care sector.

Trial registration
ANZCTR, ACTRN12618002012257. Registered 14 December 2018.
Knowledge and experience of a cohort of HIV-positive and HIV-negative Ghanaian women after undergoing human papillomavirus and cervical cancer screening
Authors: Stuart Arabella , Obiri-Yeboah Dorcas , Adu-Sarkodie Yaw , Hayfron-Benjamin Anna , Akorsu Angela D. , Mayaud Philippe 
Published: October 2019

Abstract

Background
Cervical cancer is the most common cancer in women in Ghana, but knowledge and experience of women who have had cervical screening is under-evaluated. This study examined knowledge and understanding of HPV and cervical cancer and evaluated experiences of screening in a cohort of women of mixed HIV status.

Methods
This was a mixed methods study using questionnaires and focus group discussions, with a knowledge score constructed from the questionnaire. HIV-positive and HIV-negative women were recruited from a larger cervical screening study in Ghana and were interviewed 6 months after receiving screening. Quantitative data was analyzed and triangulated with qualitative data following thematic analysis using the framework approach.

Results
A total of 131 women were included (HIV-positive, n = 60). Over 80% of participants had a knowledge score deemed adequate. There was no difference between HIV-status groups in overall knowledge scores (p = 0.1), but variation was seen in individual knowledge items. HIV-positive women were more likely to correctly identify HPV as being sexually-transmitted (p = 0.05), and HIV negative women to correctly identify the stages in developing cervical cancer (p = < 0.0001).
HIV-positive women mostly described acquisition of HPV in stigmatising terms. The early asymptomatic phase of cervical cancer made it difficult for women to define “what” cancer was versus “what” HPV infection was. All women expressed that they found it difficult waiting for their screening results but that receiving information and counselling from health workers alleviated anxiety.

Conclusions
Knowledge of women who had participated in a cervical screening study was good, but specific misconceptions existed. HIV-positive women had similar levels of knowledge to HIV-negative, but different misconceptions. Women expressed generally positive views about screening, but did experience distress. A standardized education tool explaining cervical screening and relevance specifically of HPV-DNA results in Ghana should be developed, taking into consideration the different needs of HIV-positive women.
Application evaluation of clinical practice guidelines for traditional Chinese medicine: a clinical analysis based on the analytic hierarchy process
Authors: Cai Huayang , Li Hui , Zeng Huizhen , Xu Danping , Ouyang Wenwei , Lv Aiping 
Published: October 2019

Abstract

Background
Clinical Practice Guidelines (CPGs) play an important role in clinical practice, and they require appropriate evaluation, especially in application. This study explores the application evaluation method of CPGs for Traditional Chinese Medicines (TCM). It uses the Analytic Hierarchy Process (AHP) and clinical cases to evaluate the consistency between CPGs of TCM and clinical practice.

Methods
To evaluate the consistency between CPGs of TCM and clinical cases, a 3-level AHP construction was built. Weightings were calculated by collecting questionnaires according to AHP theory. To test the evaluation system, a retrospective study was performed. The study evaluated the China Association of Chinese Medicine’s Guidelines for Diagnosis and Treatment of Common Internal Diseases in Chinese Medicine Diseases of Modern Medicine (CPGs of DTCID) (ZYYXH/T50–135-2008). A total of 150 cases were involved. The evaluation system was used to assess the consistency between CPGs of DTCID and clinical cases of angina pectoris.

Results
The results showed that the overall consistency between CPGs of DTCID and the 150 cases was 42.32 ± 6.94%, ranging from 35.21 to 63.37%. The overall consistency was not affected by age, gender, type of angina pectoris, condition of percutaneous coronary intervention (PCI), or angina classification as determined by the Canadian Cardiovascular Society. The consistencies of each index were as follows: Diagnosis of TCM, 100%; Diagnosis of Western medicine, 100%; Syndrome classification, 38.25 ± 4.40%; Syndrome key point, 34.17 ± 8.15%; TCM Decoction, 31.08 ± 23.64%; TCM particular treatment, 7.92 ± 19.13%; and Recuperation and prevention, 0. The most frequent syndromes were qi-deficiency, phlegm and blood stasis (n = 124) (82.7%). The overall consistency of qi-deficiency, turbid phlegm and blood stasis was lower than the overall consistency of the group without that syndrome. The difference was statistically significant (P < 0.05). 42 cases (28%) applied the TCM decoction recommended by CPGs of DTCID. Of these, Gualouxiebaibanxia decoction was applied in 34 cases. Wendan decoction, the most frequently used, was applied in 64 cases (42.7%).

Conclusion
This study indicates that the AHP system can perform quantitative evaluation of consistency between TCM CPG and clinical practice. It also found the factors affecting the application of TCM CPGs and might indicate the need for revisions of CPGs.
Investigation of answer changes on the USMLE® Step 2 Clinical Knowledge examination
Authors: Ouyang Wenli , Harik Polina , Clauser Brian E. , Paniagua Miguel A. 
Published: October 2019

AbstractBackgroundExaminees often believe that changing answers will lower their scores; however, empirical studies suggest that allowing examinees to change responses may improve their performance in classroom assessments. To date, no studies have been able to examine answer changes during large scale professional credentialing or licensing examinations.MethodsIn this study, we expand the research on answer changes by analyzing responses from 27,830 examinees who completed the Step 2 Clinical Knowledge (CK) examination between August of 2015 and August of 2016.ResultsThe results showed that although 68% of examinees changed at least one item, the overall average number of changes was small. Among the examinees who changed answers, approximately 45% increased their scores and approximately 28% decreased their scores. On average, examinees spent shortest time on the item changes from wrong to right and they were more likely to change their scores from wrong to right than right to wrong.ConclusionsConsistent with previous studies, these findings support the beneficial effects of answer changes in high-stakes medical examinations and suggest that examinees who are overly cautious about changing answers may put themselves at a disadvantage.
Teaching medicine through film: Wiseman's medical trilogy revisited
Authors: Wijdicks Eelco F. M. 
Published: October 2019

Abstract

Background
Between the late 1960s and early 1980s, Frederick Wiseman filmed hundreds of hours in an emergency department, intensive care unit and asylum. These films recorded events as they happened without rehearsal and narration.

Main body
Cinema and Medicine meet each other in feature fiction film and in documentary format. Showing films in hospitals is revealing for both the unexpected audience but also the medical establishment. This paper revisits Wiseman’s edited but explicit films and their revelation of the complexity of care in this era in the United States. Although they offer a narrow view of medical institutions and the issue of informed consent later became problematic, the films provide an intriguing glimpse of US healthcare and decision making. These films are largely unknown but would be an invaluable resource in a masterclass on medical ethics in urgent care and end-of-life decisions.

Conclusions
Despite their flaws, Wisemans’ medical films have a significant educational value. Each documentary can be used in a masterclass on medical ethics. The films provide ample opportunities to discuss core issues in healthcare, professional interactions, and decision making in critically ill patients.
Breast cancer histopathology image classification through assembling multiple compact CNNs
Authors: Zhu Chuang , Song Fangzhou , Wang Ying , Dong Huihui , Guo Yao , Liu Jun 
Published: October 2019

Abstract

Background
Breast cancer causes hundreds of thousands of deaths each year worldwide. The early stage diagnosis and treatment can significantly reduce the mortality rate. However, the traditional manual diagnosis needs intense workload, and diagnostic errors are prone to happen with the prolonged work of pathologists. Automatic histopathology image recognition plays a key role in speeding up diagnosis and improving the quality of diagnosis.

Methods
In this work, we propose a breast cancer histopathology image classification by assembling multiple compact Convolutional Neural Networks (CNNs). First, a hybrid CNN architecture is designed, which contains a global model branch and a local model branch. By local voting and two-branch information merging, our hybrid model obtains stronger representation ability. Second, by embedding the proposed Squeeze-Excitation-Pruning (SEP) block into our hybrid model, the channel importance can be learned and the redundant channels are thus removed. The proposed channel pruning scheme can decrease the risk of overfitting and produce higher accuracy with the same model size. At last, with different data partition and composition, we build multiple models and assemble them together to further enhance the model generalization ability.

Results
Experimental results show that in public BreaKHis dataset, our proposed hybrid model achieves comparable performance with the state-of-the-art. By adopting the multi-model assembling scheme, our method outperforms the state-of-the-art in both patient level and image level accuracy for BACH dataset.

Conclusions
We propose a novel compact breast cancer histopathology image classification scheme by assembling multiple compact hybrid CNNs. The proposed scheme achieves promising results for the breast cancer image classification task. Our method can be used in breast cancer auxiliary diagnostic scenario, and it can reduce the workload of pathologists as well as improve the quality of diagnosis.
An integrated model to evaluate the impact of social support on improving self-management of type 2 diabetes mellitus
Authors: Wang Xiaojia , He Linglan , Zhu Keyu , Zhang Shanshan , Xin Ling , Xu Weiqun , Guan Yuxiang 
Published: October 2019

Abstract

Background
Type 2 Diabetes Mellitus (T2DM) is a chronic disease closely related to personal life style. Therefore, achieving effective self-management is one of the most important ways to control it. There is evidence that social support can help to improve the self-management ability of patients with T2DM, but which social support is more effective has been rarely explored. The purpose of this study is to construct an integrated model to analyze which social support has more significant impact on self-management of T2DM, and provide reasonable suggestions to health care providers on how to effectively play the role of social support.

Methods
We established a social support indicator evaluation system and proposed an integrated model that combines ANP (Analytical Network Process) and CRITIC (CRiteria Importance through Intercriteria Correlation) methods to evaluate the impact of social support on T2DM self-management from both subjective and objective perspectives. The weights calculated by the model will serve as the basis for us to judge the importance of different social support indicators.

Results
Informational support (weighting 49.26%) is the most important criteria, followed by tangible support (weighting 39.24%) and emotional support (weighting 11.51%). Among 11 sub-criteria, guidance (weighting 23.05%) and feedback (weighting 14.68%) are two most relevant with T2DM self-management. This result provides ideas and evidence for health care providers on how to offer more effective social support.

Conclusion
To our knowledge, this is the first study in which Multi-Criteria Decision Making (MCDM) tools, specifically ANP and CRITIC, are used to evaluate the impact of social support on improving self-management of type 2 diabetes. The study suggests that incorporating two sub-indicators of guidance and feedback into the diabetes care programs may have great potential to improve T2DM self-management and further control patient blood glucose and reduce complications.