bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are physicians on the same page about do-not-resuscitate? To examine individual physicians’ influence on do-not-resuscitate decision-making: a retrospective and observational study
Authors: Chen Yen-Yuan , Su Melany , Huang Shu-Chien , Chu Tzong-Shinn , Lin Ming-Tsan , Chiu Yu-Chun , Lin Kuan-Han 
Published: December 2019

Abstract
Background
Individual physicians and physician-associated factors may influence patients’/surrogates’ autonomous decision-making, thus influencing the practice of do-not-resuscitate (DNR) orders. The objective of this study was to examine the influence of individual attending physicians on signing a DNR order.

Methods
This study was conducted in closed model, surgical intensive care units in a university-affiliated teaching hospital located in Northern Taiwan. The medical records of patients, admitted to the surgical intensive care units for the first time between June 1, 2011 and December 31, 2013 were reviewed and data collected. We used Kaplan–Meier survival curves with log-rank test and multivariate Cox proportional hazards models to compare the time from surgical intensive care unit admission to do-not-resuscitate orders written for patients for each individual physician. The outcome variable was the time from surgical ICU admission to signing a DNR order.

Results
We found that each individual attending physician’s likelihood of signing do-not-resuscitate orders for their patients was significantly different from each other. Some attending physicians were more likely to write do-not-resuscitate orders for their patients, and other attending physicians were less likely to do so.

Conclusion
Our study reported that individual attending physicians had influence on patients’/surrogates’ do-not-resuscitate decision-making. Future studies may be focused on examining the reasons associated with the difference of each individual physician in the likelihood of signing a do-not-resuscitate order.
Impact evaluation of contracting primary health care services in urban Bangladesh
Authors: Albis Manuel Leonard F. , Bhadra Subrata K. , Chin Brian 
Published: December 2019

Abstract
Background
The Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness.

Methods
The effect of the project was estimated through propensity score matching between project and non-project areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation.

Results
Over the six-year period, UPHCP-II improved the health status of the population in project areas compared to non-project areas. The study found significant improvement in health outcomes in terms of reduced diarrhea and acute respiratory infection in children, which explains the downward trend in child mortality rate. Moreover, the project also improved antenatal care and skilled birth attendance. Contraceptive prevalence and HIV/AIDS awareness and avoidance increased, and sexually transmitted infections decreased.

Conclusions
UPHCP-II was effective in achieving its health outcome targets, while previous studies show that it was efficient in the delivery of health care and clients were highly satisfied because health facilities were in close proximity, and doctors and staff were perceived as responsive in delivering high quality of care. The results of this study could help inform future design and implementation of urban health interventions that involve contracting primary health care service delivery in Bangladesh and other similar settings.
How well is the electronic health record supporting the clinical tasks of hospital physicians? A survey of physicians at three Norwegian hospitals
Authors: Schopf Thomas Roger , Nedrebø Bente , Hufthammer Karl Ove , Daphu Inderjit Kaur , Lærum Hallvard 
Published: December 2019

Abstract
Background
The electronic health record is expected to improve the quality and efficiency of health care. Many novel functionalities have been introduced in order to improve medical decision making and communication between health care personnel. There is however limited evidence on whether these new functionalities are useful. The aim of our study was to investigate how well the electronic health record system supports physicians in performing basic clinical tasks.

Methods
Physicians of three prominent Norwegian hospitals participated in the survey. They were asked, in an online questionnaire, how well the hospital’s electronic health record system DIPS supported 49 clinical tasks as well as how satisfied they were with the system in general, including the technical performance. Two hundred and eight of 402 physicians (52%) submitted a completely answered questionnaire.

Results
Seventy-two percent of the physicians had their work interrupted or delayed because the electronic health record hangs or crashes at least once a week, while 22% had experienced this problem daily. Fifty-three percent of the physicians indicated that the electronic health record is cumbersome to use and adds to their workload. The majority of physicians were satisfied with managing tests, e.g., requesting laboratory tests, reading test results and managing radiological investigations and electrocardiograms. Physicians were less satisfied with managing referrals. There was high satisfaction with some of the decision support functionalities available for prescribing drugs. This includes drug interaction alerts and drug allergy warnings, which are displayed automatically. However, physicians were less satisfied with other aspects of prescribing drugs, including getting an overview of the ongoing drug therapy.

Conclusions
In the survey physicians asked for improvements of certain electronic health record functionalities like medication, clinical workflow support including planning and better overviews. In addition, there is apparently a need to focus on system stability, number of logins, reliability and better instructions on available electronic health record features. Considerable development is needed in current electronic health record systems to improve usefulness and satisfaction.
Gametocyte clearance in children, from western Kenya, with uncomplicated Plasmodium falciparum malaria after artemether–lumefantrine or dihydroartemisinin–piperaquine treatment
Authors: Omondi Protus , Burugu Marion , Matoke-Muhia Damaris , Too Edwin , Nambati Eva A. , Chege William , Musyoka Kelvin B. , Thiongo Kelvin , Otinga Maureen , Muregi Francis , Kimani Francis 
Published: December 2019

Abstract
Background
The efficacy and safety of artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DP) against asexual parasites population has been documented. However, the effect of these anti-malarials on sexual parasites is still less clear. Gametocyte clearance following treatment is essential for malaria control and elimination efforts; therefore, the study sought to determine trends in gametocyte clearance after AL or DP treatment in children from a malaria-endemic site in Kenya.

Methods
Children aged between 0.5 and 12 years from Busia, western Kenya with uncomplicated Plasmodium falciparum malaria were assigned randomly to AL or DP treatment. A total of 334 children were enrolled, and dried blood spot samples were collected for up to 6 weeks after treatment during the peak malaria transmission season in 2016 and preserved. Plasmodium falciparum gametocytes were detected by qRT-PCR and gametocyte prevalence, density and mean duration of gametocyte carriage were determined.

Results
At baseline, all the 334 children had positive asexual parasites by microscopy, 12% (40/334) had detectable gametocyte by microscopy, and 83.7% (253/302) children had gametocytes by RT-qPCR. Gametocyte prevalence by RT-qPCR decreased from 85.1% (126/148) at day 0 to 7.04% (5/71) at day 42 in AL group and from 82.4% (127/154) at day 0 to 14.5% (11/74) at day 42 in DP group. The average duration of gametocyte carriage as estimated by qRT-PCR was slightly shorter in the AL group (4.5 days) than in the DP group (5.1 days) but not significantly different (p = 0.301).

Conclusion
The study identifies no significant difference between AL and DP in gametocyte clearance. Gametocytes persisted up to 42 days post treatment in minority of individuals in both treatment arms. A gametocytocidal drug, in combination with artemisinin-based combination therapy, will be useful in blocking malaria transmission more efficiently.
CT and MRI manifestations of mediastinal cavernous hemangioma and a review of the literature
Authors: Bai Yu , Zhao Guoshu , Tan Yongming 
Published: December 2019

Abstract
Background
The cavernous hemangioma of mediastinum (CHM) is a rare benign lesion caused by congenital vascular dysplasia. However, its incidence is extremely low, and patients often lack relevant clinical symptoms. So we analyzed retrospectively some cases to investigate the imaging features of cavernous hemangioma of mediastinum (CHM) and improve the diagnostic accuracy.

Methods
The CT/MRI imaging features and clinical information of 19 patients with CHM were analyzed retrospectively.

Results
The lesions of 18 CHM patients were single. Twelve cases in the anterior mediastinum and 8 in the posterior mediastinum. The diameter of CHM ranges from 2.0 to 7.0 cm. Thirteen cases were oval-shaped or round, 4 cases were lobulated, and 2 cases were irregular. Phleboliths or nodular calcification were identified in four cases. High signal of T2WI lipid suppression in two cases and blood vessel shadows were observed in two cases. After contrast-enhanced scan, the nodular enhancement of arteries were identified in 14 cases and contrast agent was further filled of the venous phase, where “fast in and slow out” feature was performed. One case showed inhomogeneous enhancement, one case performed “fast in and slow out” feature of multiphase-enhanced MRI. Besides, aberrant veins can be seen in or around the lesion among five cases.

Conclusions
CHM is more frequently located at the anterior mediastinum than at the posterior mediastinum. The performance of phleboliths, high signal on T2WI fat suppression and DWI, the nodular enhancement of the artery, venous and delayed phase filling, enhanced “fast in and slow out,” and aberrant veins in the lesion are helpful for the diagnosis and differential diagnosis. Multiple period contrast-enhanced CT and MRI scan is helpful for the diagnosis of CHM.
Shortcomings of ultrasound-guided fine needle aspiration in the axillary management of women with breast cancer
Authors: Attieh Michel , Jamali Faek , Berjawi Ghina , Saadeldine Mothana , Boulos Fouad 
Published: December 2019

AbstractBackgroundUltrasound, along with ultrasound-guided fine needle aspiration, is currently used for the axillary evaluation of breast cancer patients in order to identify candidates for axillary lymph node dissection. The aim of this study is to evaluate the accuracy of this tool in correctly identifying patients who may or may not benefit from axillary clearance in light of the ACOSOG Z0011 trial recommendations.MethodsOne hundred one patients (65 with positive US-FNA with corresponding axillary lymph node dissection (ALND), and 36 with negative US-FNA with corresponding ALND/sentinel lymph node biopsy) were studied for the number of involved axillary lymph nodes, tumor clinicopathologic features, and axillary radiologic findings.ResultsFrom the positive US-FNA group, 43% of patients had two or fewer positive lymph nodes upon ALND pathologic examination. In the US-FNA negative group, the negative predictive value for detecting axillary disease was 72.7%. With both groups combined, the sensitivity, specificity, PPV, and NPV of US-FNA for selecting patients based on axillary disease burden were 86%, 51.7%, 57%, and 83.3%, respectively.ConclusionBased on Z0011 guidelines, US-FNA is not a reliable tool in triaging patients in need for ALND and leads to overtreatment of 43% patients when positive, while depriving a small but significant percentage of patients from necessary therapy, when negative.
Chronological changes and trend of breast cancer clinics and pathology among Iranian women during 22 years from the largest breast cancer registry in Iran
Authors: Tahmasebi Sedigheh , Tajali Mahsa , Akrami Majid , Arasteh Peyman , Zangouri Vahid , Nobandegani Aida Salehi , Hosseini Seyed Morteza , Safari Afsoon , Talei Abdolrasoul 
Published: December 2019

AbstractBackground and objectiveWe evaluated clinicopathological changes of breast cancer (BC) during a 22-year time period among the Iranian population.MethodsThis study is part of the largest BC registry in Iran. Patients were categorized as those diagnosed with BC during 1993–2005, 2006–2011, and 2012–2017 and compared regarding baseline characteristics and socioeconomical determinants, and obstetrical/gynecological and BC characteristics.ResultsOverall, 688, 1871, and 3020 patients entered the 1993–2005, 2006–2012, and 2012–2017 year groups, respectively. Mean (SD) age at first presentation of BC increased throughout the year groups (47.40 ± 10.34, 49.12 ± 11.70, and 49.43 ± 12.07 years, respectively;p< 0.001). Mean (SD) tumor size increased from 1993–2005 to 2006–2011 and decreased onto 2012–2017 (2.82 ± 1.69, 2.91 ± 1.49, and 2.66 ± 1.52 cm, respectively;p< 0.001). Number of individuals with stage 4 and grade 3 BC also showed an increasing pattern (p< 0.001). Tumor necrosis rates showed an increase onto 2011–2017 (43%, 47.3%, and 56%, respectively;p< 0.001). ER positive (62.4%, 73.4%, and 77.1%, respectively;p< 0.001) and PR positive individuals (59.5%, 64.3%, 72.6%, respectively;p< 0.001) showed an increasing trend. HER2 positive expression rates increased from 1993–2005 to 2005–2011 (24.5% and 31.5%, respectively) and decreased onto 2012–2017 (31.5% and 26.8%, respectively,p< 0.001). Number of involved lymph nodes increased (5.70 ± 6.56, 5.65 ± 6.00, and 5.95 ± 6.99, respectively;p< 0.001). Pattern of BC invasion and recurrence showed significant change (p< 0.001).ConclusionClinical and pathological characteristics may be showing a changing pattern among the Iranian population.
Low molecular weight heparins use in pregnancy: a practice survey from Greece and a review of the literature
Authors: Papadakis E. , Pouliakis A. , Aktypi Α. , Christoforidou A. , Kotsi P. , Αnagnostou G. , Foifa A. , Grouzi E. 
Published: December 2019

Abstract
Background
Use of LMWH in pregnancy is not only limited to VTE management, but it extends, to the management of vascular gestational complications and the optimization of IVF pregnancies despite the lack of concrete scientific evidence. In this context, we conducted the present study aiming to gain insights regarding the use of LMWH during pregnancy and puerperium. We recorded indication for use, diagnostic work-up as well as the safety and efficacy of the treatment, trying to elucidate the clinical practice in our country.

Methods
We analyzed data regarding 818 pregnant women received LMWH during 2010–2015.Our cohort had a median age of 33.9 years and a BMI of 23.6.There were 4 groups: those with a history of VTE [Group-A: 76], those with pregnancy complications [Group-B: 445], those undergoing IVF [Group-C: 132] and those carrying prothrombotic tendency (thrombophilia, family history of VTE, other) [Group-D: 165]. Mean duration of LMWH administration was 8.6 ± 1.5 months. Out of the total number, 440 received LMWH in fixed prophylactic dose, 272 in higher prophylactic-weight adjusted dose and 106 in therapeutic dose. Moreover, 152 women received in addition low-dose acetylsalicylic acid (ASA). 93.8% of pregnancies were single and 6.2% were multiple ones. Live births occurred in 98.7% of pregnancies.

Results
Anticoagulation was efficacious and well tolerated. Seventeen VTE events were recorded; 7 of them antepartum and 10 postpartum. No major bleeding events were observed while 13 clinical relevant non-major bleeding events were recorded. Regarding gestational vascular complications, 28 IUGR events were recorded, as well as 48 cases of preterm labor of which 12 were concomitant with IUGR (25%). Six early pregnancy losses were recorded; there were 3 fetal deaths and 3 cases of pre-eclampsia/eclampsia.

Conclusions
LMWHs are used extensively during pregnancy and puerperium in Greece for VTE treatment and prophylaxis and for a variety of other indications as well. Although the drug has been shown to be both safe and efficacious, its use for some indications has no proven scientific evidence. In order to clearly define the role of LMWHs in pregnancy, beyond thromboprophylaxis, large prospective studies are required, which could be based on the conclusions of this study.
The effects of maternity waiting homes on the health workforce and maternal health service delivery in rural Zambia: a qualitative analysis
Authors: Kaiser Jeanette L. , Fong Rachel M. , Ngoma Thandiwe , McGlasson Kathleen Lucile , Biemba Godfrey , Hamer Davidson H. , Bwalya Misheck , Chasaya Maynards , Scott Nancy A. 
Published: December 2019

Abstract
Background
Maternity waiting homes (MWHs) are a potential strategy to address low facility delivery rates resulting from access-associated barriers in resource-limited settings. Within a cluster-randomized controlled trial testing a community-generated MWH model in rural Zambia, we qualitatively assessed how MWHs affect the health workforce and maternal health service delivery at their associated rural health centers.

Methods
Four rounds of in-depth interviews with district health staff (n = 21) and health center staff (n = 73) were conducted at intervention and control sites over 24 months. We conducted a content analysis using a mixed inductive-deductive approach. Data were interpreted through the lens of the World Health Organzation Health Systems Framework.

Results
Nearly all respondents expressed challenges with understaffing and overwork and reported that increasing numbers of facility-based deliveries driven by MWHs contributed substantively to their workload. Women waiting at MWHs allow staff to monitor a woman’s final stage of pregnancy and labor onset, detect complications earlier, and either more confidently manage those complications at the health center or refer to higher level care. District, intervention, and control site respondents passionately discussed this benefit over all time points, describing it as outweighing challenges of additional work associated with MWHs. Intervention site staff repeatedly discussed the benefit of MWHs in providing a space for postpartum women to wait after the first few hours of clinical observation through the first 48 h after delivery. Additionally, intervention site staff perceived the ability to observe women for longer before and after delivery allowed them to better anticipate and plan their own work, adjust their workloads and mindset accordingly, and provide better and more timely care. When understaffing and overwork were frequently discussed, this satisfaction in providing better care was a meaningful departure.

Conclusions
MWHs may benefit staff at rural health centers and the health system more broadly, allowing for the provision of more timely and comprehensive obstetric care. We recommend future studies consider how MWHs impact the workforce, operations, and service delivery at their associated health facilities. Considering the limited numbers of skilled birth attendants available in rural Zambia, it is important to strategically select locations for new MWHs.

Trial registration
Clinicaltrials.gov, NCT02620436. Registered December 3, 2015, https://clinicaltrials.gov/ct2/show/NCT02620436
Drug utilization and cost associated with inflammatory bowel disease management in Saudi Arabia
Authors: AlRuthia Yazed , Alharbi Othman , Aljebreen Abdulrahman M. , Azzam Nahla A. , Almadi Majid A. , Bahari Ohud H. , Almalki Khalid A. , Atham Abdulaziz T. , Alanazi Ahmed S. , Saeed Maria , HajkhderMullaissa Baraa , Alsenaidy Mohammad , Balkhi Bander 
Published: December 2019

Abstract
Background
There has been an increase in incidence and prevalence of inflammatory bowel disease (IBD) outside the western countries. Treatment costs are an essential component for healthcare planning and priority setting. The utilization patterns and annual administration and cost of IBD medications are largely unknown in countries with an increasing incidence of disease, Saudi Arabia being an example.

Aim
To evaluate the use of non-biologic and biologic agents and their associated annual administration costs in a sample of patients with Crohn’s disease (CD) and ulcerative colitis (UC) in Saudi Arabia.

Methods
Single-center retrospective chart review was performed to determine the use of biologic and non-biologic medications among IBD patients in a tertiary care hospital in Riyadh, Saudi Arabia. Daily and the annual acquisition cost of different IBD therapeutic agents was calculated. The utilization rates and cost of each type of medication by CD and UC patients were compared.

Results
Data of 258 CD patients and 249 UC patients were analyzed. Infliximab and adalimumab were the most commonly prescribed biologics among the study sample, however, their utilization rates were significantly higher among CD than UC patients (36.82% vs. 11.24%, and 20.54% vs. 9.64%, respectively, P < 0. 01). Azathioprine utilization rate was also higher among CD patients compared to their UC counterparts (71.71% vs. 40.16%, respectively, P < 0.01). However, the utilization rate of mesalazine in the UC patients was significantly higher than their CD counterparts (85.53% vs. 14.34% for CD, P < 0.01). The annual cost of biologics (including administration and lab test cost) ranged from 5572 USD for ustekinumab to 18,424 USD for vedolizumab. On the other hand, the annual cost of non-biologics ranged from 16 USD for prednisone to 527 USD for methotrexate.

Conclusion
Biologics are extensively used in the management of IBD, particularly CD, and their utilization costs are significantly higher than non-biologics. Future studies should examine the cost effectiveness of IBD medications especially in countries with increasing incidence such as Saudi Arabia.