bluuebunny/crossref_metadata_2025_split huggingface dataset:
A scoping review of cohort studies assessing traditional Chinese medicine interventions
Authors: Duan Yuting , Xu Zhirui , Deng Jingjing , Lin Yanjia , Zheng Yan , Chen Juexuan , Tang Xiaoyu , Zhang Xuan , Tang Chunzhi , Miao Jiangxia , Bian Zhaoxiang 
Published: November 2020

Abstract
Backgrounds
Identifying topics and assessing the reporting quality of Traditional Chinese Medicine (TCM) cohort studies.

Methods
A scoping review of the literature was performed. A descriptive approach to summarize the core study characteristics was prepared, along with structured tables and figures to identify salient points of differences noted across studies. The reporting quality of TCM cohort studies was assessed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)-cohort checklist.

Results
A total of 199 TCM cohort studies were included. The largest number of TCM cohort studies was conducted in Mainland China (70.9%). The TCM cohort study was first published in 2003. The top three diseases studied were Acquired Immune Deficiency Syndrome (AIDS), Stroke, and Asthma. As for the intervention methods, Chinese herbal medicine formulas (60.3%), acupuncture (14.1%) and single herbs (12.6%) accounted for the majority, followed by moxibustion (4.0%) and qigong (2.0%). The overage sufficient reporting rate of included TCM cohort studies according to the STROBE-cohort checklist was 42.9%. Comparing with Chinese literature, the reporting rates of English literature in most items were higher.

Conclusion
For the application of cohort studies to inform the effects of TCM interventions, the interventions assessed and conditions studied were diverse, the reporting quality was unsatisfied.
Revealing active components, action targets and molecular mechanism of Gandi capsule for treating diabetic nephropathy based on network pharmacology strategy
Authors: Zhang Qiqiang , Ye Qing , Huang Xiaohui , Xu Ajing , Liu Yan , Qi Jia , Zhang Hai , Zhang Jian 
Published: November 2020

AbstractBackgroundGandi capsule is a traditional Chinese herbal formula used to promote blood circulation and removing blood stasis in clinical. Our previous study has shown that it reduces proteinuria with routine treatment in diabetic nephrophy (DN), but its pharmacological action mechanism is still unknown.MethodsTo facilitate the identification of components, a component database of Gandi capsule and target database of DN were established by ourselves. The components absorbed in blood circle were identified in rat plasma after oral administration of Gandi capsule by UHPLC-QQQ-MS/MS. The potential targets were screened by using Libdock tolls in Discovery studio 3.0. Then Pathway and Network analyses were used to enrich the screened targets. The possible targets were verified by using a surface plasmon resonance (SPR) test and the molecular mechanism focusing these targets for treating DN was clarified by western blot.ResultsSix components in Gandi capsule were identified detected in rat plasma after oral administration by UHPLC-QQQ-MS/MS. After molecular docking analyses in KEGG and Discovery studio, four protein targets including HNF4A, HMGCR, JAK3, and SIRT1, were screened out, and proved as effective binding with baicalin, wogonoside by SPR. And the molecular mechanism was clarified that baicalin and wogonoside inhibit the effect of high glucose (HG)-induced decreased cell viability and podocin expression, and strengthen the activation p-AKT, p-PI3K, and p-AMPK.ConclusionBaicalin and wogonoside were screened out to be the active compounds in Gandi capsule and can ameliorate HG-induced podocyte damage by influencing the AMPK and PI3K-AKT signaling pathways by binding with HNF4A, HMGCR, JAK3, and SIRT1.Graphical abstract
Electives in the medical curriculum – an opportunity to achieve students’ satisfaction?
Authors: Ramalho Ana Rita , Vieira-Marques P. M. , Magalhães-Alves C. , Severo M. , Ferreira M. A. , Falcão-Pires I. 
Published: November 2020

Abstract
Background
Electives are perceived by medical students as a valuable, highly regarded experience, allowing them to customize learning experiences and enabling them to early differentiate during medical training. The present work aims to uncover students’ major determinants of satisfaction and how they interfere with their future elective choices in order to identify the best approach to implement electives in medical curricula.

Methods
A cross-sectional study was conducted through a written evaluation survey concerning the electives available in the academic year 2015–2016. Our institution provides 106 electives to students from the 2nd to the 5th year. Students’ satisfaction was assessed through a validated questionnaire with eight sentences expressing opinions related to electives global satisfaction. Data from 538 inquiries from 229 students were analyzed quantitatively using regression and correlation models, and qualitatively through phenomenography.

Results
Quantitative analysis of the questionnaires allowed to establish both: 1) The determinants of students’ satisfaction with electives, which were Agreement with teaching and learning methodologies, followed by Agreement with assessment methodologies employed, Perception of the workload demanded and Requirement for continuous work and 2) The predictors of students preferences in the following years, namely, Agreement with assessment methodologies employed, Classes attendance and Ranking of the allocated elective established in the previous year. Qualitative analysis of questionnaires revealed that students consider electives as being innovative and interesting, claiming that some, for their relevant content, could be integrated into the medical core curriculum.

Conclusions
Our work raises awareness on the best practices when it comes to electives’ organization to meet students’ satisfaction. We can conclude that medical schools should measure students satisfaction as a tool to organize and predict future needs of electives and placements when designing and implementing this alternative student-centred curriculum or even to improve the existing practices regarding electives in medical courses.
Levelling the playing field: students’ motivations to contribute to an amnesty of assessment materials
Authors: Gondhalekar Anjali R , Rees Eliot L , Ntuiabane Daniel , Janjua Osman , Choa George , Eboreime Oziegbe , Sturrock Alison 
Published: November 2020

Abstract
Background
‘Exam recall’ is a recognised phenomenon whereby students recall and record questions after leaving the examination hall. This poses two main problems. First, as these questions are only available to peers of the students who recall the questions, these individuals have an unfair advantage. Secondly, the distribution of these recalled questions poses a threat to the validity and defensibility of assessments.
To address the first of these problems, we developed an amnesty enabling students to submit assessment material to an on-line site. This study sought to explore which factors influence students’ contributions to an amnesty of assessment material.

Methods
We conducted a qualitative study using semi-structured focus groups. We used convenience sampling and recruited participants from all years of our undergraduate medical programme. The focus groups were facilitated by a medical student peer to reduce the power imbalance and encourage participants to discuss candidly. The focus groups were audio recorded and transcribed verbatim.
Two researchers independently analysed all transcripts using thematic analysis and the research team met regularly to discuss emergent findings. Nvivo was used to assist with thematic analysis of the transcripts.

Results
Twenty-six individuals participated in six focus groups. Six themes were identified through the analysis, which were categorised into motivating factors and de-motivating factors.
Motivating factors were a perception that this would overcome inequity, a fear of repercussions, and the perceived usefulness of resources. Factors that prevented students contributing were a culture of competition, a lack of incentives, and mistrust of the medical school.

Conclusions
The establishment of an amnesty was acceptable to students and they were motivated to contribute materials. The competitive nature of medical careers and the stakes of summative assessments meant that students felt that some peers might still not contribute their materials. Students felt that the school were listening to their concerns and this led to a better dialogue between students and faculty.
Physicians’ attitudes in relation to end-of-life decisions in Neonatal Intensive Care Units: a national multicenter survey
Authors: Chatziioannidis Ilias , Iliodromiti Zoi , Boutsikou Theodora , Pouliakis Abraham , Giougi Evangelia , Sokou Rozeta , Vidalis Takis , Xanthos Theodoros , Marina Cuttini , Iacovidou Nicoletta 
Published: November 2020

Abstract
Background
End-of-life decisions for neonates with adverse prognosis are controversial and raise ethical and legal issues. In Greece, data on physicians’ profiles, motivation, values and attitudes underlying such decisions and the correlation with their background are scarce. The aim was to investigate neonatologists' attitudes in Neonatal Intensive Care Units and correlate them with self-reported practices of end-of-life decisions and with their background data.

Methods
A structured questionnaire was distributed to all 28 Neonatal Intensive Care Units in Greece. One hundred and sixty two out of 260 eligible physicians answered anonymously the questionnaire (response rate 66%). Demographic and professional characteristics, self-reported practices and opinions were included in the questionnaire, along with a questionnaire of 12 items measuring physicians’ attitude and views ranging from value of life to quality of life approach (scale 1–5).

Results
Continuation of treatment in neonates with adverse prognosis without adding further therapeutic interventions was the most commonly reported EoL practice, when compared to withdrawal of mechanical ventilation. Physicians with a high attitude score (indicative of value of quality-of-life) were more likely to limit, while those with a low score (indicative of value of sanctity-of-life) were more likely for continuation of intensive care. Physicians’ educational level (p:0.097), involvement in research (p:0.093), religion (p:0.024) and position on the existing legal framework (p < 0.001) were factors that affected the attitude score.

Conclusions
Physicians presented with varying end-of-life practices. Limiting interventions in neonates with poor prognosis was strongly related to their attitudes. The most important predictors for physicians' attitudes were religiousness and belief for Greek legal system reform.
Defining culturally safe primary care for people who use substances: a participatory concept mapping study
Authors: Urbanoski Karen , Pauly Bernadette , Inglis Dakota , Cameron Fred , Haddad Troy , Phillips Jack , Phillips Paige , Rosen Conor , Schlotter Grant , Hartney Elizabeth , Wallace Bruce 
Published: November 2020

Abstract
Background
People who use substances experience high levels of substance-related stigma, both within and outside of health care settings, which can prevent people from help-seeking and contribute further to health inequities. Recognizing and respecting how political, social, economic, and historical conditions influence health and health care, cultural safety, with origins in addressing Indigenous racism, is a potential strategy for mitigating stigma and marginalization in health care. Using a participatory research approach, we applied the concept of cultural safety to develop a model of safe primary care from the perspective of people who use substances.

Methods
People who use or used substances were involved in all phases of the research and led data collection. Study participants (n = 75) were 42.5 years old on average; half identified as female and one quarter as Indigenous. All were currently using or had previous experience with substances (alcohol and/or other drugs) and were recruited through two local peer-run support agencies. Concept mapping with hierarchical cluster analysis was used to develop the model of safe primary care, with data collected over three rounds of focus groups.

Results
Participants identified 73 unique statements to complete the focus prompt: “I would feel safe going to the doctor if …” The final model consisted of 8 clusters that cover a wide range of topics, from being treated with respect and not being red-flagged for substance use, to preserving confidentiality, advocacy for good care and systems change, and appropriate accommodations for anxiety and the effects of poverty and criminalization.

Conclusions
Developing a definition of safe care (from the patient perspective) is the necessary first step in creating space for positive interactions and, in turn, improve care processes. This model provides numerous concrete suggestions for providers, as well as serving as starting point for the development of interventions designed to foster system change.
Use of the supportive care framework to explore haematological cancer survivors’ unmet needs: a qualitative study
Authors: Herrmann Anne , Mansfield Elise , Tzelepis Flora , Lynagh Marita , Hall Alix 
Published: November 2020

Abstract
Background
Some sub-types of haematological cancers are acute and require intensive treatment soon after diagnosis. Other sub-types are chronic, relapse over many years and require life-long cycles of monitoring interspersed with bouts of treatment. This often results in significant uncertainty about the future, high levels of depression and anxiety, and reduced quality of life. Little is known about how to improve care for haematological cancer survivors. This study explored qualitatively, in a sample of haematological cancer survivors, (i) their unmet needs experienced as a result of their disease and treatment; and (ii) strategies that may help address these needs.

Methods
Semi-structured interviews were conducted with 17 adult haematological cancer survivors. Data was analysed using qualitative content analysis. The Supportive Care Framework guided data collection and analysis.

Results
Participants had a mean age of 57 years (SD 13). Most were male (n = 10, 59%). Five themes emerged from the data: (i) changes in unmet needs across the care trajectory (with greatest unmet needs experienced soon after diagnosis, at discharge from hospital and with cancer recurrence); (ii) informational unmet needs requiring improved patient-centred communication; (iii) uncertainty about treatment and the future; (iv) coordinated, tailored and documented post-treatment care planning as a strategy for optimal care delivery; and (v) ongoing support services to meet psychosocial and practical unmet needs by involving peer support, less bureaucratic transport services and flexible work arrangements.

Conclusions
To our knowledge, this is the first qualitative investigation using the Supportive Care Framework to explore unmet needs of haematological cancer survivors. Our findings offer fresh insights into this important area of study. Written, take-home care plans which provide simple but tailored guidance on where to seek additional support may help decrease uncertainty and feelings of vulnerability post-treatment for adult haematological cancer survivors. Future research should further develop and test strategies aimed at addressing unmet needs of haematological cancer survivors identified in this study.
Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare
Authors: Augustsson Hanna , Churruca Kate , Braithwaite Jeffrey 
Published: November 2020

Abstract
Introduction
Improving the quality of healthcare has proven to be a challenging task despite longstanding efforts. Approaches to improvements that consider the strong influence of local context as well as stakeholders’ differing views on the situation are warranted. Soft systems methodology (SSM) includes contextual and multi-perspectival features. However, the way SSM has been applied and the outcomes of using SSM to stimulate productive change in healthcare have not been sufficiently investigated.

Aim
This scoping review aimed to examine and map the use and outcomes of SSM in healthcare settings.

Method
The review was based on Arksey and O’Malley’s framework. We searched six academic databases to January 2019 for peer-reviewed journal articles in English. We also reviewed reference lists of included citations. Articles were included if they were empirical studies focused on the application of SSM in a healthcare setting. Two reviewers conducted the abstract review and one reviewer conducted the full-text review and extracted data on study characteristics, ways of applying SSM and the outcomes of SSM initiatives. Study quality was assessed using Hawker’s Quality Assessment Tool.

Result
A total of 49 studies were included in the final review. SSM had been used in a range of healthcare settings and for a variety of problem situations. The results revealed an inconsistent use of SSM including departing from Checkland’s original vision, applying different tools and involving stakeholders idiosyncratically. The quality of included studies varied and reporting of how SSM had been applied was sometimes inadequate. SSM had most often been used to understand a problem situation and to suggest potential improvements to the situation but to a lesser extent to implement and evaluate these improvements.

Conclusion
SSM is flexible and applicable to a range of problem situations in healthcare settings. However, better reporting of how SSM has been applied as well as evaluation of different types of outcomes, including implementation and intervention outcomes, is needed in order to appreciate more fully the utility and contribution of SSM in healthcare.
Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study
Authors: Tong Tammy Y. N. , Appleby Paul N. , Armstrong Miranda E. G. , Fensom Georgina K. , Knuppel Anika , Papier Keren , Perez-Cornago Aurora , Travis Ruth C. , Key Timothy J. 
Published: November 2020

AbstractBackgroundThere is limited prospective evidence on possible differences in fracture risks between vegetarians, vegans, and non-vegetarians. We aimed to study this in a prospective cohort with a large proportion of non-meat eaters.MethodsIn EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up (≈ 2010). Participants were categorised into four diet groups at both time points (with 29,380 meat eaters, 8037 fish eaters, 15,499 vegetarians, and 1982 vegans at baseline in analyses of total fractures). Outcomes were identified through linkage to hospital records or death certificates until mid-2016. Using multivariable Cox regression, we estimated the risks of total (n = 3941) and site-specific fractures (arm,n = 566; wrist,n = 889; hip,n = 945; leg,n = 366; ankle,n = 520; other main sites, i.e. clavicle, rib, and vertebra,n = 467) by diet group over an average of 17.6 years of follow-up.ResultsCompared with meat eaters and after adjustment for socio-economic factors, lifestyle confounders, and body mass index (BMI), the risks of hip fracture were higher in fish eaters (hazard ratio 1.26; 95% CI 1.02–1.54), vegetarians (1.25; 1.04–1.50), and vegans (2.31; 1.66–3.22), equivalent to rate differences of 2.9 (0.6–5.7), 2.9 (0.9–5.2), and 14.9 (7.9–24.5) more cases for every 1000 people over 10 years, respectively. The vegans also had higher risks of total (1.43; 1.20–1.70), leg (2.05; 1.23–3.41), and other main site fractures (1.59; 1.02–2.50) than meat eaters. Overall, the significant associations appeared to be stronger without adjustment for BMI and were slightly attenuated but remained significant with additional adjustment for dietary calcium and/or total protein. No significant differences were observed in risks of wrist or ankle fractures by diet group with or without BMI adjustment, nor for arm fractures after BMI adjustment.ConclusionsNon-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures. This is the first prospective study of diet group with both total and multiple specific fracture sites in vegetarians and vegans, and the findings suggest that bone health in vegans requires further research.
The first assessment to detect Mycoplasma hyopneumoniae by sampling laryngeal swabs to investigate sow stability in South Korea
Authors: Oh YuSik , Baek JongHyuk , Lee JoongBok , Cho Sun-Hee , Park Changhoon 
Published: November 2020

AbstractBackgroundMycoplasma hyopneumoniae (M. hyopneumoniae), a representative pathogen causing swine enzootic pneumonia, generally infects piglets vertically. However, it is difficult to ascertain theM. hyopneumoniaeinfection state of sows due to limited detection methods. This report investigated sow herd stability by applying nested PCR to laryngeal swabs of suckling pigs, which is reportedly the most sensitive method.ResultsM. hyopneumoniaewas detected in 14 farms (63.6%) and 127 piglets (6.5%). The prevalence of sows likely to transmitM. hyopneumoniaein herds (11.1%) was calculated. In addition, there was a significant difference in detection rates among farms depending on herd size, gilt replacement rate, acclimation method, and antibiotic usage, suggesting various parameters that influence sow stability.ConclusionsThe results demonstrated that laryngeal swabs from suckling pigs have provided useful information regarding vertical transmission from sows in South Korean farm conditions. This result demonstrated that farms with larger herd sizes, higher gilt replacement rates, and a practice of naturally exposing gilts for acclimation had higher detection rates in weaning piglets, indicating an unstable sow infection state.