bluuebunny/crossref_metadata_2025_split huggingface dataset:
Youth StepCare: A pilot study of an online screening and recommendations service for depression and anxiety among youth patients in general practice.
Authors: Parker Belinda , Achilles Melinda Rose , Subotic-Kerry Mirjana , O'Dea Bridianne 
Published: December 2019

Abstract
Background: General Practitioners (GPs) are ideally placed to identify and manage emerging mental illness in young people, however, many report low levels of confidence in doing so. A web-based universal screening service delivered via a mobile tablet, Youth StepCare, was developed to assist GPs in identifying depression and anxiety symptoms in youth patients. This service also provided evidence-based treatment recommendations and fortnightly monitoring of symptoms. The current study assessed the feasibility and acceptability of delivering the Youth StepCare service in Australian general practices. Methods: A 12-week uncontrolled trial was undertaken between August 2018 and January 2019 in two general practices in NSW, Australia. The service was offered to all youth patients aged 14-17 years who visited a participating GP during the screening period with their parent or guardian. Youth patients reported the presence of depressive and anxiety symptoms using the self-report Patient Health Questionnaire-9 and the Generalised Anxiety Disorder Questionnaire-7. New cases were defined as those who reported symptoms but were not currently seeking help from their GP, nor had sought help in the past. Feasibility and acceptability among GPs and practice staff were assessed using a battery of questionnaires. Results: Five GPs and 6 practice staff took part. A total of 46 youth patients were approached, 28 consented and 19 completed the screener (67.9%). Nine reported symptoms of anxiety or depression, two of which were new cases (22.2%). GPs and practice staff were satisfied with the service, reporting that there was a need for the service, and that they would use it again. Conclusions: The Youth StepCare service appears to be a useful tool for identifying youth with unidentified symptoms of mental illness that can be easily embedded into general practice. Further research would benefit from exploring the factors affecting initial GP uptake and a larger trial is required to determine the efficacy of the service on young people’s symptom reduction.
Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness
Authors: Owen-Smith Ashli , Stewart Christine , Sesay Musu M. , Strasser Sheryl M. , Yarborough Bobbi Jo , Ahmedani Brian , Miller-Matero Lisa R. , Waring Stephen C. , Haller Irina V. , Waitzfelder Beth E. , Sterling Stacy A. , Campbell Cynthia I. , Hechter Rulin C. , Zeber John E. , Copeland Laurel A. , Scherrer Jeffrey F. , Rossom Rebecca , Simon Greg 
Published: December 2019

Abstract
Background Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia.Methods Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N=65,750), BD (N=38,117) or schizophrenia or schizoaffective disorder (N=12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses.Results Multivariable models indicated that having a MDD (OR=1.90; 95% CI=1.85–1.95) or BD (OR=1.71; 95% CI=1.66–1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR=0.86; 95% CI=0.82– 0.90). Having a MDD (OR=2.59; 95% CI=2.44–2.75) or BD (OR=2.12; 95% CI=1.97–2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications.Conclusions Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients. Future research is needed to evaluate the effectiveness of involving mental health clinicians in these efforts.
Does the Use of a Closed-Suction Drain Reduce the Effectiveness of an Antibiotic-loaded Spacer in Two-Stage Exchange Arthroplasty for Periprosthetic Hip Infection? A Prospective, Randomized, Controlled Study
Authors: Xu Chi , Jia Cheng-Qi , Kuo Feng-Chih , Chai Wei , Zhang Ming-Hua , Chen Ji-Ying 
Published: December 2019

Abstract
Background: There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. Methods: A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n=160) were collected every 24 hours for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. Results: There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p=0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P=0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. Coli . Conclusions: The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty.
The heterogeneous health state profiles of high-risk healthcare utilizers and their longitudinal hospital readmission and mortality patterns
Authors: Ng Shawn Choon Wee , Kwan Yu Heng , Yan Shi , Tan Chuen Seng , Low Lian Leng 
Published: December 2019

Abstract
Background: High-risk patients are most vulnerable during transitions of care. Due to the high burden of resource allocation for such patients, we propose that segmentation of this heterogeneous population into distinct subgroups will enable improved healthcare resource planning. In this study, we segmented a high-risk population with the aim to identify and characterize a patient subgroup with the highest 30-day and 90-day hospital readmission and mortality.
Methods: We extracted data from our transitional care program (TCP), a Hospital-to-Home program launched by the Singapore Ministry of Health, from June to November 2018. Latent class analysis (LCA) was used to determine the optimal number and characteristics of latent subgroups, assessed based on model fit and clinical interpretability. Regression analysis was performed to assess the association of class membership on 30- and 90-day all-cause readmission and mortality.
Results: Among 752 patients, a 3-class best fit model was selected: Class 1 “Frail, cognitively impaired and physically dependent”, Class 2 “Pre-frail, but largely physically independent” and Class 3 “Physically independent”. The 3 classes have distinct demographics, medical and socioeconomic characteristics (p<0.05), 30- and 90-day readmission (p<0.05) and mortality (p<0.01). Class 1 patients have the highest age-adjusted 90-day readmission (OR=2.04, 95%CI: 1.21-3.46, p= 0.008), 30- (OR=6.92, 95%CI: 1.76-27.21, p=0.006) and 90-day mortality (OR=11.51, 95%CI: 4.57-29.02, p<0.001).
Conclusions: We identified a subgroup with the highest readmission and mortality risk amongst high-risk patients. We also found a lack of interventions in our TCP that specifically addresses increased frailty and poor cognition, which are prominent features in this subgroup. These findings will help to inform future program modifications and strengthen existing transitional healthcare structures currently utilized in this patient cohort.
Neonatal Survival and Determinants of Mortality in Aroresa District, Southern Ethiopia: a Prospective cohort study
Authors: Limaso Alaka Adiso , Dangisso Mesay Hailu , Hibstu Desalegn Tsegaw 
Published: December 2019

Abstract
Background: The first day, week and month of life are the most critical period for the survival of children. In Ethiopia, despite a significant reduction in under-five mortality during the last fifteen years, neonatal mortality remains a public health problem accounting for 47% of under-five mortality. Understanding neonatal survival and risk factors for neonatal mortality could help devising tailored interventions. The aim of this study was to determine the neonatal survival and risk factors for neonatal mortality in Aroresa district, Southern Ethiopia.
Methods: A community based prospective follow up study was conducted among a cohort of term pregnant mothers and neonates delivered from January 1/2018 to March 30/2018. A total of 586 term pregnant mothers were selected with a multistage sampling technique and 584 neonates were followed-up for a total of 28 days, with 12 twin pairs. Data were coded, entered cleaned and analyzed using SPSS version 22. Kaplan–Meier survival curve was used to show pattern of neonatal death in 28 days. Independent and adjusted relationships of different predictors with neonates’ survival were assessed with Cox regression model. The risk of mortality was explored and presented with hazard ratio and 95% confidence interval and P-value less than 0.05 were considered as significant.
Result: The overall neonatal mortality was 41 per 1000 live births. Hazards of neonatal mortality was high for neonates with complications (AHR=3.643; 95% CI, 1.36-9.77), male neonates (AHR=2.71; 95% CI, 1.03-7.09), mother’s perception of baby’s size (AHR=3.46; 95% CI, 1.119-10.704), neonates who had initiated exclusive breast feeding (EBF) after one hour (AHR=3.572; 95% CI, 1.255-10.165) and mothers who had no postnatal care (AHR=3.07; 95% CI, 1.16-8.12).
Conclusion: Neonatal mortality in the study area was 4.1% which was high and immediate action should be taken towards achieving the Sustainable Development Goals. To improve neonatal survival, high impact interventions such as promotion of maternal service utilization, essential newborn care and early initiation of exclusive breast feeding were recommended.
The Effect of TRX vs. Aquatic Exercises on Self-Reported Knee Instability and Affected Factors in Women with Knee Osteoarthritis: A Randomized Controlled Trial
Authors: Asar Shirin , Gandomi Farzaneh , Mozafari Mahsa , Sohaili Freshteh 
Published: December 2019

Abstract
Background: Knee Instability (KI) is described as a sense of knee buckling, shifting, or giving way during the weight bearing activities. High prevalence (60-80%) has been reported for KI amongst the patients with knee osteoarthritis (KOA). In this line, the present study targeted the effect of two interventions on self-reported KI and affected factors. Methods: In this single blind, randomized, and controlled trial, 36 patients with radiographic grading (Kellgren–Lawrence > II) of KOA were selected. Patients were divided into three groups namely, aquatic (n=12), Total Resistance exercises (TRX) (n=12) and control (n=12) by random. Then both 8-week TRX and aquatic exercises were carried out by experimental groups. The following measure were taken before and after interventions: Pain by visual analog scale (VAS), balance by Berg Balance Scale (BBS), quadriceps strength by dynamometer, knee flexion range of motion (ROM) by inclinometer, knee stiffness with Western Ontario and McMaster Universities Osteoarthritis (WOMAC), and self-reported KI with Felson's questionnaire. Results: The results demonstrated that KI, VAS, BBS improved over time both in TRX and aquatic groups significantly (p<0.05), but WOMAC(stiffness), knee flexion ROM, and quadriceps strength were significantly improved over time only for TRX (p<0.05). Post hoc test, also, showed that there were significant differences between interventions and control groups (p<0.05) for the VAS, KI, BBS, but for WOMAC(stiffness), a significant difference was observed only between TRX and control groups (p=0.05). Conclusions: Although TRX and aquatic interventions had a similar effect on the patients’ balance, pain and KI, TRX had more effect on WOMAC(stiffness), quadriceps strength, and knee flexion ROM than aquatic exercises.
Educational roles as a continuum of mentoring’s role in medicine – A systematic review and thematic analysis of educational studies from 2000 to 2018
Authors: Krishna Lalit , Renganathan Yaazhini , Tay Kuang Teck , Tan Benjamin Jia Xing , Chong Jia Yan , Ching Ann Hui , Prakash Kishore , Quek Nicholas Wei Sheng , Peh Rachel Huidi , Chin Annelissa Mien Chew , Taylor David C M , Mason Stephen , Kanesvaran Ravindran , Toh Ying Pin 
Published: December 2019

Abstract
Background: Recent studies have gone to great lengths to differentiate mentoring from teaching, tutoring, role modelling, coaching and supervision in efforts to better understand mentoring processes. This review seeks to evaluate the notion that teaching, tutoring, role modelling, coaching and supervision may in fact all be part of the mentoring process. To evaluate this theory, this review scrutinizes current literature on teaching, tutoring, role modelling, coaching and supervision to evaluate their commonalities with prevailing concepts of novice mentoring.

Methods: A three staged approach is adopted to evaluate this premise. Stage one involves four systematic reviews on one-to-one learning interactions in teaching, tutoring, role modelling, coaching and supervision within Internal Medicine, published between 1st January 2000 and 31st December 2018. Braun and Clarke’s (2006) approach to thematic analysis was used to identify key elements within these approaches and facilitate comparisons between them.
Stage two provides an updated view of one-to-one mentoring between a senior physician and a medical student or junior doctor to contextualise the discussion.
Stage three infuses mentoring into the findings delineated in stage one.

Results: 17499 citations were reviewed, 235 full-text articles were reviewed, and 104 articles were thematically analysed. Four themes were identified – characteristics, processes, nature of relationship, and problems faced in each of the four educational roles.

Conclusions: Role modelling, teaching and tutoring, coaching and supervision lie within a mentoring spectrum of increasingly structured interactions, assisted by assessments, feedback and personalised support that culminate with a mentoring approach. Still requiring validation, these findings necessitate a reconceptualization of mentoring and changes to mentor training programs and how mentoring is assessed and supported.
Communication mediums used by patients and health professionals during access and provision of healthcare in low resource settings: A cross-sectional study
Authors: Dongyele Mathias , Ansong Daniel , Adjei Francis Osei , Xamuzu Evans , Mensah Nicholas Karikari , Owusu Alfred Kwame , Dankwa Bright Atta , Newton Sam Kofi , Odoom Samuel Frimpong , Bonney Joseph , Adjei Duncan , Amusu Anne , Akowuah Emmanuel Kofi , Lartey Kelvin 
Published: December 2019

Abstract
Background: The issue with communication mediums during service provision and for making enquiries to a hospital on the type of services available, availability of physicians and beds at the receiving hospitals, and a reminder system remains a challenge for patients and providers of the health service in sub-Sharan Africa. This present study sought to review the existing healthcare communication mediums from the perspectives of patients and health professionals at the Komfo Anokye Teaching Hospital, Kumasi Ghana. Method: A descriptive cross-sectional design was employed with a multilevel sampling method to select a total of 651 participants consisting of 304 patients, 303 health workers and 44 hospital directorate managers for the study. A well-structured survey questionnaire was used to collect data from respondents. Results: Most hospital staff (66.4%) used a blend of social media and direct means (face-to-face medium) to communicate among themselves whereas 89.8% only communicates with management through meetings sections. Predominantly, 97.4% of the staff communicated by direct means (face-to-face medium) with patients. Almost all management members of the hospital communicated with the general public using letters and official memos. Conclusions: There is evidence of combination of both traditional mediums (face-to-face) and the technological mediums (social media) for communications by health providers and health consumers. However, there is a dissatisfaction with delayed information flow and poor feedbacks with the use of the traditional mediums. Therefore, a digital mobile application communication system is recommended to offer efficient communication within and outside the Ghanaian health facilities. Keywords: Communication, hospital, patients, healthcare.
Psychological interventions for managing postpartum psychosis: A qualitative analysis of women’s and family members’ experiences and preferences
Authors: Forde Rebecca , Peters Sarah , Wittkowski Anja 
Published: December 2019

Abstract
Abstract
Background: Postpartum psychosis is a rare, yet severe disorder, in which early identification and immediate intervention are crucial. Despite recommendations for psychological input, little is known about the types of psychological intervention reported to be helpful. The aim of this study was to explore the experiences, needs and preferences for psychological intervention from the perspective of women with postpartum psychosis and from the perspective of family members.
Methods: Thirteen women and eight family members, including partners were interviewed. The data from these semi-structured interviews were audio-recorded, transcribed and inductively analysed using thematic analysis.
Results: Twelve subthemes were identified and then organised around three main themes: 1) Seeking safety and containment, 2) Recognising and responding to the psychological impact and 3) Planning for the future. These themes highlight the temporal element of recovery from postpartum psychosis, because women’s psychological needs and preferences changed over time. Emphasis was initially placed on ensuring safety, followed by a need to connect, process and adjust to their experiences. Additional needs were reported by women and family when planning for the future, including managing the fear of relapse and help to reach a decision about future pregnancies.
Conclusion: The results illustrate a range of areas in which psychological intervention could be delivered to facilitate and enhance recovery. Further research is needed to develop meaningful and effective psychological interventions and to investigate the most appropriate timing for this to be offered.
Brain SegNet: 3D Local Refinement Network for Brain Lesion Segmentation
Authors: Luo Weijian , Hu Xiaojun , Hu Jiliang , Guo Sheng , Huang Weilin , Scott Matthew R. , Wiest Roland , Dahlweid Michael , Reyes Mauricio 
Published: December 2019

Abstract
MR images (MRIs) accurate segmentation of brain lesions is important for improving cancer diagnosis, surgical planning, and prediction of outcome. However, manual and accurate segmentation of brain lesions from 3D MRIs is highlyexpensive, time-consuming, and prone to user biases. We present an efficient yet conceptually simple brain segmentation network (referred as Brain SegNet), which is a 3D residual framework for automatic voxel-wise segmentation of brain lesion. Our model is able to directly predict dense voxel segmentation of brain tumor or ischemic stroke regions in 3D brain MRIs. The proposed 3D segmentation network can run at about 0.5s per MRIs - about 50 times faster than previous approaches [1,2]. Our model is evaluated on the BRATS 2015 benchmark for brain tumor segmentation, where it obtains state-of-the-art results, by surpassing recently published results reported in [1,2]. We further applied the proposed Brain SegNet for ischemic stroke lesion outcome prediction, with impressive results achieved on the Ischemic Stroke Lesion Segmentation (ISLES) 2017 database.
Treatment of C-section diverticula with hysteroscopic resection in women without childbearing intention: a retrospective cohort study
Authors: Shi Hui , He Jingyan , Gao Yunhe , Qin Shuang , Fan Jiaying , Xiao Qing , Li Kuanrong , Liang Huiying 
Published: December 2019

Abstract
Background: Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding, dysmenorrhea and chronic pelvic pain. Hysteroscopic resection of diverticula is thought to reduce abnormal uterine bleeding and chronic pelvic pain. In this study, we aim to describe the improvement after hysteroscopic resection of cesarean section diverticula (CSD) in women without childbearing intention, and to explore the variables associated with poor prognosis. Methods: A retrospective cohort study of women aged 25-48 with CSD diagnosis by transvaginal ultrasonography (TVS) and hysteroscopy that were enrolled at Guangzhou Women and Children’s Medical Center between June 2017 and December 2018. A total of 124 women met the inclusion criteria and all patients had undergone hysteroscopic resection and accepted a follow-up interview at the 3rd and 6th months postoperatively to record symptom improvement. Result: The mean of intraoperative blood loss and operative time of hysteroscopic resection were (12.94±12.63) ml and (33.63±6.87) min in 124 patients. Overall observed improvement rates of CSD symptom were 47.2% and 65.6% in the first 3 and 6 months, respectively. Multivariable logistic regression models revealed that timing of surgery <14 days was a good prognostic factor associated with both 3-month improvement (OR, 16.59; 95% CI, 2.62-104.90; P=0.003) and 6-month improvement (OR, 15.51; 95%CI, 1.63-148.00; P=0.02); Patients with numbers of cesarean section(CS) ≥2 had a lower rate of improvement after 6 months of CSD repair surgery compared with patients who underwent one CS(OR, 8.29; 95%CI, 1.05-65.75; P=0.04). Conclusions: A hysteroscopic repair might be an appropriate method for CSD in women who no childbearing intentions. The timing of surgery and the number of CS seems to be factors influencing the postoperative improvement of CSD. Keywords: Cesarean section diverticulum; Cohort study; Hysteroscopic; Prognostic factor