bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study
Authors: Özger Hasan Selçuk , Fakıoğlu Dolunay Merve , Erbay Kübra , Albayrak Aslınur , Hızel Kenan 
Published: April 2020

Abstract
Background
Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use.

Methods
This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment.
SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean ± standard deviation.

Results
It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use.

Conclusions
In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses.
Modulation of SIRT3 expression through CDK4/6 enhances the anti-cancer effect of sorafenib in hepatocellular carcinoma cells
Authors: Jo Hanhee , Park Yusun , Kim Taehun , Kim Jisu , Lee Jong Sook , Kim Seon Yoo , Chung Jee-in , Ko Hae yong , Pyun Jae-Chul , Kim Kyung Sik , Lee Misu , Yun Mijin 
Published: April 2020

Abstract
Background
Hepatocellular carcinoma (HCC) is the leading cause of cancer-related deaths worldwide. The only drug currently approved for clinical use in the treatment of advanced HCC is sorafenib. However, many patients with HCC show reduced sensitivity to sorafenib during treatment. SIRT3, a member of the mammalian sirtuin family, is a tumor suppressor in certain tumor types. However, only few studies have investigated the effects of SIRT3 on tumor prognosis and sorafenib sensitivity in patients with HCC. Here, we aimed to investigate the correlation between SIRT3 expression and glucose metabolism and proliferation in HCC and discover effective compounds that increase endogenous SIRT3 modulation effect of sorafenib.

Methods
To determine the correlation between SIRT3 and glucose related proteins, immunostaining was performed with liver cancer tissue using various antibodies. To investigate whether the expression of SIRT3 in HCC is related to the resistance to sorafenib, we treated sorafenib after the modulation of SIRT3 levels in HCC cell lines (overexpression in Huh7, knockdown in HepG2). We also employed PD0332991 to modulate the SIRT3 expression in HCC cell and conducted functional assays.

Results
SIRT3 expression was downregulated in high glycolytic and proliferative HCC cells of human patients, xenograft model and HCC cell lines. Moreover, SIRT3 expression was downregulated after sorafenib treatment, resulting in reduced drug sensitivity in HCC cell lines. To enhance the anti-tumor effect of sorafenib, we employed PD0332991 (CDK4/6-Rb inhibitor) based on the correlation between SIRT3 and phosphorylated retinoblastoma protein in HCC. Notably, combined treatment with sorafenib and PD0332991 showed an enhancement of the anti-tumor effect in HCC cells.

Conclusions
Our data suggest that the modulation of SIRT3 by CDK4/6 inhibition might be useful for HCC therapy together with sorafenib, which, unfortunately, has limited efficacy and whose use is often associated with drug resistance.
Demographic profile, clinical features, and outcome of peripapillary subretinal hemorrhage: an observational study
Authors: Zou Ming , Zhang Yi , Huang Xi , Gao Sheng , Zhang Junjun 
Published: April 2020

Abstract
Background
To evaluate the etiology, demographic profile, clinical features, and outcomes in patients with peripapillary subretinal hemorrhage (PSH).

Methods
Thirty-eight eyes of 37 consecutive patients with PSH were enrolled in this prospective observational study over 4 years; all were followed for 2 years. The main outcome measures were demographic profile, possible etiology, clinical features, outcome, and prognosis.

Results
Sixty-eight percent (26/38) of eyes were in female patients; the mean patient age was 20 years. Only 1 patient (1/37) showed bilateral involvement. All patients experienced acute onset of PSH. All eyes were myopic and their best-corrected visual acuities ranged from 20/1000 to 20/12.5. The fundus features of affected eyes were classified into 3 groups: (1) PSH alone (4/38 eyes, 10.5%); (2) PSH with intrapapillary hemorrhage (17/38 eyes, 44.7%); (3) PSH with intrapapillary and vitreous hemorrhage (17/38 eyes, 44.7%). PSH occurred in nasal edges of optic discs with a crescent shape and dull-red color. All affected optic discs were small and crowded, exhibiting variable degrees of tilting. The cup of affected optic discs was narrower and deeper than that of normal control discs. Other ancillary tests provided no additional value. After a mean follow-up of 2.85 months, the hemorrhages resolved spontaneously without sequelae. Recurrence of disease was not observed in any patients.

Conclusions
PSH is common in myopic eyes with tilted optic discs. We suspect that these hemorrhages occurred as a result of abrupt movement acting on a morphologically vulnerable optic disc.
Return-to-work-experts for inpatient treatment of patients with mental illnesses– a proof-of-concept-study (RETURN): the study protocol
Authors: Riedl Lina , Blank Daniela , Kohl Monika , Lang Anne , Kehl Victoria , Brieger Peter , Hamann Johannes 
Published: April 2020

Abstract
Background
Patients with mental illnesses often have massive difficulties returning to work after inpatient treatment at a psychiatric clinic and are often at risk of losing their jobs. The psychosocial support for this patient group at the interface of clinic/outpatient care is often insufficient.

Methods/design
The RETURN-study prospectively assesses and surveys 200 patients with mental disorders in a cluster randomized intervention study, i.e. treatment teams and patients from intervention wards receive a return-to-work (RTW) intervention. Patients in control wards obtain treatment as usual (TAU). Pairs of comparable wards (similar patient population, similar staff density) have been identified and then randomized for control and intervention (n = 14 for each condition). On intervention wards return-to-work experts (RTW experts) who focus treatment on the workplace-related needs of patients with mental illnesses have been established. These RTW experts ensure the use of available resources within the framework of work-related discharge management and should lead to a more successful return to the workplace.
The days at work in the year after release will be evaluated in a mixed methods approach as well as the return rate in the year after release, disability days in the year after return, relapse rate after 12 months, cost-benefit ratio of the intervention, analysis of the predictors / barriers for a successful return to the workplace (e.g. psychopathology, cognition, stigma, social-psychiatric support, company support, etc.), possibilities to implement the concept of RTW experts in standard psychiatric care (TAU - treatment as usual), the impact of the RTW experts’ approach on the treatment process in standard psychiatric care.

Discussion
This approach is already internationally established in the field of somatic rehabilitation and supported employment [Am J Psychiatry 171:1183–90, 2014; Lancet 370:1146–52, 2007; Cochrane Database Syst Rev, doi:10.1002/14651858.CD006237.pub3, 2014]; the innovative aspect of this project is to implement and evaluate it in standard psychiatric care in Germany. This project requires no new interventions to be developed and tested, as the techniques of the case manager/job coach is applied to the field of return to work.

Trial registration
The study was registered in Deutsches Register Klinische Studien searchable via its Meta-registry (http://apps.who.int/trialsearch/), Trial registration number: DRKS00016037, Date of registration: 21/12/2018, URL of trial registry record.
The impact of global budget on expenditure, service volume, and quality of care among patients with pneumonia in a secondary hospital in China: a retrospective study
Authors: Guan Xiaodong , Zhang Chi , Hu Huajie , Shi Luwen 
Published: April 2020

Abstract
Background
The Chinese government has begun to dampen the growth of health expenditure by implementing Global Budgets (GB). Concerns were raised about whether reductions in expenditure would lead to a deterioration of quality of care. This paper aims to evaluate the impact of GB on health expenditure, service volume and quality of care among Chinese pneumonia patients.

Methods
A secondary hospital that replaced Fee-For-Service (FFS) with GB in China in 2016 was sampled. We used daily expenditure to assess health expenditure; monthly admission, length of stay (LOS), number of drugs per record and record containing antibiotics to evaluate service volume; record with multiple antibiotics and readmission to assess quality of care. Descriptive analyses were adopted to evaluate changes after the reform, logistic regression and multivariable linear regressions were used to analyze changes associated with the reform.

Results
In 2015 and 2016, 3400 admissions from 3173 inpatients and 2342 admissions from 2246 inpatients were admitted, respectively. According to regression analyses, daily expenditure, LOS, readmission, and records with multiple antibiotic usages significantly declined after the reform. However, no significant relation was observed between GB and the number of drugs per record or record containing antibiotics.

Conclusions
When compared with FFS, GB can curtail health expenditure and improve quality of care. As far as service volume was concerned, LOS and monthly admission declined, while number of drugs per record and record containing antibiotics were not affected.
Individual and community-level factors associated with unmet need for contraception among reproductive-age women in Ethiopia; a multi-level analysis of 2016 Ethiopia Demographic and Health Survey
Authors: Yalew Melaku , Adane Bezawit , Kefale Bereket , Damtie Yitayish 
Published: April 2020

Abstract
Background
There is limited evidence on the unmet need for contraceptives among married reproductive-age women especially in developing countries like Ethiopia. Thus, this study aimed to assess individual and community-level factors associated with unmet need for contraception among reproductive-age women in Ethiopia.

Method
A secondary analysis was done on the 2016 Ethiopian Demographic and Health Survey (EDHS) dataset which were collected cross-sectional. A total of 9056 women who were fecund, married and/or sexually active were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA version 14.0 to identify individual and community-level factors. Adjusted odds ratio with 95% confidence interval was used to show the strength and direction of the association and statistical significance was declared at P value less than 0.05.

Result
Factors significantly associated with unmet need were; ages of women between 45 and 49 years [AOR = 2.25, 95% CI: (1.34, 3.79)], greater than or equal to three living children [AOR = 1.87, 95% CI: (1.40, 2.49)], belong to richer household [AOR = 0.73, 95% CI: (0.54, 0.97)], Muslim followers [AOR = 1.37, 95% CI: (1.02, 1.83)], married more than once [AOR = 1.31, 95% CI: (1.06, 1.62)]. From community level variables: belong to the Somali region [AOR = 0.34, 95% CI: (0.19, 0.61)] were significantly associated with unmet need.

Conclusion
Both individual and community-level factors were significant determinants of unmet need. From individual-level factors: advanced ages of women, many total numbers of living children, live in the richer wealth quintile, being Muslim follower and married more than once and from community-level variables: belong to the Somali region were significantly associated with unmet need for contraception. The findings suggested that health care providers should mainly focus on women nearly on menopauses, who live in the poorest household and who had many numbers of living children and married more than once to decrease the unmet need for contraceptives.
Armed conflict as a determinant of children malnourishment: a cross-sectional study in The Sudan
Authors: Dahab Rihab , Bécares Laia , Brown Mark 
Published: April 2020

Abstract
Background
Children’s nutritional status influences their physical, socioemotional and cognitive development throughout the life course. We aimed to determine the role of armed conflict on the prevalence of childhood malnourishment in The Sudan, and understand the underlying mechanisms using a framework based on the social determinants of health.

Methods
We analysed cross-sectional data from the 2014-Sudan Multiple Indicator Cluster Survey (n = 14,081) to compare the prevalence of malnourishment in states undergoing armed conflict and states free of conflict. Four-level multilevel multivariate modelling was conducted to identify the contribution of the social determinants of malnourishment in explaining the role of armed conflict in child health, with conflict status as the central predictor and progressive adjustments for child-, household- and cluster- and state-level predictors.

Results
Armed conflict is strongly associated with greater risk of severe and moderate underweight among children under-5. Adjusting for key social determinants of health reduced the strength of the association between armed conflict and risk of underweight, but there is statistical evidence of association between armed conflict and risk of severe underweight (OR: 1.60, 95%CI: 1.03–2.49 for the low intensity group).

Conclusion
Conflict-exposed children are particularly vulnerable to malnourishment, and this association is mostly explained by key socio-demographic factors. With the prolonged political instability in The Sudan, sustainable nutritional interventions are necessary to ease hard conditions in conflict-exposed states, and also among disadvantaged families in conflict-free regions.
Interprofessional team-based learning (TBL): how do students engage?
Authors: Burgess Annette , Kalman Eszter , Haq Inam , Leaver Andrew , Roberts Chris , Bleasel Jane 
Published: April 2020

Abstract
Background
Although challenging to integrate within university curricula, evidence suggests that interprofessional education (IPE) positively impacts communication and teamwork skills in the workplace. The nature of Team-based learning (TBL) lends itself to interprofessional education, with the capacity to foster a culture of collaboration among health professional students. Our study was designed to pilot an interprofessional ‘back pain’ TBL module for physiotherapy and medical students, and to explore their experience of the TBL process, using the conceptual framework of ‘knowledge reconsolidation’ to discuss our finding.

Methods
Three hundred and eleven students participated in the TBL session: 222/277 (80%) of Year 1 medical students and 89/89 (100%) of Year 2 physiotherapy students. Students completed one interprofessional Musculoskeletal Sciences TBL session on the topic of ‘back pain’. A questionnaire including closed and open-ended items, was distributed to students immediately following completion of the TBL session. Descriptive statistics were used to analyse the quantitative data. Thematic analysis was used to code and categorise qualitative data into themes. Pre-class quiz scores were compared between the groups using a one-way between groups Analysis of Variance (ANOVA) test with Tukeys Post Hoc test.

Results
In total, 117/311 (38%) of participants completed the questionnaire. Both medicine and physiotherapy students appreciated the opportunity to learn about the curriculum of another healthcare discipline, and their scope of practice; gain multiple perspectives on a patient case from different disciplines; and recognised the importance of multidisciplinary teams in patient care. Students felt having an interprofessional team of facilitators who provided immediate feedback helped to consolidate student learning and promoted clinical reasoning. An analysis of variance revealed no difference between Physiotherapy and Medical students’ pre-class quiz scores.

Conclusion
Our study demonstrated that the small group and task-focused characteristics of TBL provided a student-centred teaching strategy to support the achievement of interprofessional learning goals. Students valued their interactions with other students from a different professional degree, the opportunity to problem solve together, and learn different perspectives on a patient case. The pre-class quiz results demonstrate that both groups of students had a comparative level of prior knowledge to be able to work together on the in-class activities.
Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes
Authors: Zechmeister-Koss Ingrid , Goodyear Melinda , Tüchler Heinz , Paul Jean Lillian 
Published: April 2020

Abstract
Background
A research project, which aims to improve the situation of children of parents with a mental illness (COPMI) is currently underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge regarding the Tyrolean societal and service provision context.

Methods
We collected qualitative (17 interviews among stakeholder and people with lived experience) and quantitative data (e.g. health insurance data) regarding overall societal characteristics, epidemiology of mental illness, currently existing services, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along eight external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate.

Results
We identified that there is awareness of potential challenges related to COPMIs at both a professional and planning level. Additionally, there is a lack of installed support processes and standards to meet these children’s needs across Tyrol. A variety of services are available both for unwell parents, as well as for families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health, differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs.

Conclusions
The societal structures and the current services provide a rich resource for improving identification and support of COPMIs, however considerable coordination and behaviour change efforts will be required due to the fragmentation of the system and professional cultures. The insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in the local organizations.
Experiences of shared decision-making in community rehabilitation: a focused ethnography
Authors: Manhas Kiran Pohar , Olson Karin , Churchill Katie , Vohra Sunita , Wasylak Tracy 
Published: April 2020

Abstract
Background
Shared decision-making (SDM) can advance patient satisfaction, understanding, goal fulfilment, and patient-reported outcomes. We lack clarity on whether this physician-focused literature applies to community rehabilitation, and on the integration of SDM policies in healthcare settings. We aimed to understand patient and provider perceptions of shared decision-making (SDM) in community rehabilitation, particularly the barriers and facilitators to SDM.

Methods
We used a focused ethnography involving 14 community rehabilitation sites across Alberta, including rural, regional-urban and metropolitan-urban sites. We conducted semi-structured interviews that asked participants about their positive and negative communication experiences (n = 23 patients; n = 26 providers).

Results
We found SDM experiences fluctuated between extremes: Getting Patient Buy-In and Aligning Expectations. The former is provider-driven, prescriptive and less flexible; the latter is collaborative, inquisitive and empowering. In Aligning Expectations, patients and providers express humility and openness, communicate in the language of ask and listen, and view education as empowering. Patients and providers described barriers and facilitators to SDM in community rehabilitation. Facilitators included geography influencing context and connections; consistent, patient-specific messaging; patient lifestyle, capacity and perceived outlook; provider confidence, experience and perceived independence; provider training; and perceptions of more time (and control over time) for appointments. SDM barriers included lack of privacy; waitlists and financial barriers to access; provider approach; how choices are framed; and, patient’s perceived assertiveness, lack of capacity, and level of deference.

Conclusions
We have found both excellent experiences and areas for improvement for applying SDM in community rehabilitation. We proffer recommendations to advance high-quality SDM in community rehabilitation based on promoting facilitators and overcoming barriers. This research will support the spread, scale and evaluation of a new Model of Care in rehabilitation by the provincial health system, which aimed to promote patient-centred care.