bluuebunny/crossref_metadata_2025_split huggingface dataset:
An objective system for appraising clear aligner treatment difficulty: clear aligner treatment complexity assessment tool (CAT–CAT)
Authors: Long Hu , Wu Zhouqiang , Yan Xinyu , Wang Qingxuan , Liu Lu , Wang Yan , Jian Fan , Liao Lina , Li Xiaolong , Lai Wenli 
Published: November 2020

Abstract

Background
Recent years have witnessed a remarkable evolution of clear aligner technology and clear aligners are becoming more and more versatile in treating orthodontic patients. The aim of this study was to develop an objective evaluation system for assessing clear aligner treatment difficulty.

Methods
A total of 120 eligible patients (100 patients for developing and testing the evaluation system and 20 patients for validating this system) were recruited in this retrospective cross-sectional study. Based on clinical data (dental models, radiographs and photographs), complexity levels of cases were evaluated by two experts and regarded as the gold standard. Difficulty scores were determined through an evaluation system encompassing three domains (dental model analysis, radiographic examinations and clinical examinations). The reliability of the evaluation system was examined through analyzing the agreement between complexity levels and difficulty scores. Moreover, multivariable linear regression test was used to examine the independent association of each variable (e.g. overbite and crowding) with the complexity level.

Results
The results revealed that the assessment of treatment difficulty by this objective evaluation system substantially matched the gold standard (R2 = 0.80). The multivariable regression test revealed that complexity level was significantly associated with difficulty score (p < 0.001), age (p = 0.015), tooth extraction (p < 0.001), treatment stage (p < 0.01) and the number of difficult tooth movement (p = 0.005). This objective evaluation system elaborated in this study was viable and reliable in appraising clear-aligner treatment difficulty in clinical practice.

Conclusions
We suggest orthodontists and general practitioners use this objective evaluation system (CAT-CAT) to appraise clear aligner treatment difficulty and to select appropriate clear aligner patients.
Effect of PTH and corticotomy on implant movement under mechanical force
Authors: Kim Jiyeon , Kim Heon-Young , Kim Won-Ho , Kim Jin-Woo , Kim Min-Ji 
Published: November 2020

AbstractBackgroundOsseointegrated implants are considered as clinically non-movable. Parathyroid hormone (PTH) is known to play a significant role in the regulation of bone remodeling and in intermittent, low doses, result in osteoanabolic effects. This study aimed to investigate the effects of PTH and corticotomy, both under traction force, on osseointegrated implants.MethodsFour implants—two in each hemimandible—were placed in each of the three study mongrels. Each mongrels were designated as control, normal dose PTH (PTH-1), and high dose PTH (PTH-2) groups, with each groups further subdivided into non-surgery implant and surgery implant. After osseointegration, mechanical force with NiTi closed coil springs (500 g) was applied around each implants. Corticotomy was performed around one of four implants in each mongrels. Parathyroid hormone was administered locally on a weekly basis for 20 weeks. Clinical movement of the implants were evaluated with the superimposed 3D- scanned data, bone- microarchitectural and histologic examinations.ResultsSuperimposition analysis showed continuous movement of the non-surgery implant of PTH-1 group. Movement was further justified with lowest bone implant contact (adjusted BIC; 44.77%) in histomorphometric analysis. Upregulation of bone remodeling around the implant was observed in the normal dose PTH group. In the surgery implants, the remarkably higher adjusted BIC compared to the non-surgery implants indicated increased bone formation around the implant surface.ConclusionThe results indicate that the catabolic and anabolic balance of osseointegrated implants in terms of bone remodeling can be shifted via various interventions including pharmacological, surgical and mechanical force.Clinical relevanceUpregulated bone remodeling by PTH and corticotomy under continuous mechanical force showed the possible implications for the movement of osseointegrated dental implant.
COVID-19 and violence: a research call to action
Authors: Evans Dabney P. 
Published: November 2020

Abstract
COVID-19 related guidelines and movement restrictions are designed to protect the public’s health and reduce disease transmission; yet, COVID-19 related restrictions on movement including social distancing, isolation, quarantine, and shelter-in-place orders have an unknown effect on violence and abuse within relationships. As the pandemic has progressed, many have justifiably speculated that such restrictions may pose a danger to the safety and well-being of people experiencing such violence. Early in the pandemic, countries hard hit by COVID-19 began raising the alarm bell about the impacts of the disease on IPV occurrence. Police in China report that 90% of the causes of recent IPV cases could be attributed to the COVID-19 epidemic. Rising fears and anxiety about prolonged movement restrictions, increased economic strain and diminished health care capacity to support survivors are among the potential reasons for such dramatic effects. Under normal circumstances: low income, unemployment, economic stress, depression, emotional insecurity and social isolation are all risk factors for using violence against partners. Many of these factors may worsen in the context of COVID-19. Despite the urgency in addressing COVID-19, existing health concerns like Intimate Partner Violence (IPV) persist—and may well be worsened by the virus. We simply do not yet know the effects of COVID-19 on violence, nor do we know which interventions work best to prevent and respond to it within the context of the pandemic. The vast majority of information available about IPV and violence during the pandemic has been based on anecdotal reports. The call to action for the research community is clear. We must systematically measure the effects of COVID-19 and movement related restrictions on violence. As always when researching violence, serious consideration must be given to ethics and safety. Violence researchers must mobilize to investigate the impacts of COVID-19 on violence and human health.
Examining aptitude and barriers to evidence-based medicine among trainees at an ACGME-I accredited program
Authors: Mahmoud Mai A. , Laws Sa’ad , Kamel Antoun , Al Mohanadi Dabia , Al Mohammed Ahmed , Mahfoud Ziyad R. 
Published: November 2020

Abstract
Background
The aims of Evidence-Based medicine (EBM) are to promote critical thinking and produces better patients’ outcome (Profetto-McGrath J, J Prof Nurs Off J Am Assoc Coll Nurs 21:364-371, 2005). Accreditation Council for Graduate Medical Education (ACGME) competencies require trainees to locate, appraise and apply clinical evidence to patients’ care. Despite the emphasis that ACGME place on EBM, few organizations provide adequate training in EBM. This is even more critical in regions where medical trainees matriculate from diverse backgrounds of undergraduate medical education, where EBM may not be emphasized nor taught at all. EBM practice has a history of research in the West, however, EBM has not been widely studied in the Middle East.

Methods
Clinicians and trainees at Hamad Medical Corporation (HMC) matriculate from many countries in the Middle East and North Africa (MENA) and Asia. Because trainees in Graduate Medical Education (GME) come to HMC from a variety of geographic backgrounds, it is assumed that they also have a variety of experiences and aptitudes in EBM. To assess trainees EBM attitudes and knowledge in the internal medicine department at HMC in Doha, Qatar, the authors surveyed residents and fellows using a two-part survey. The first part was adapted from the evidence-based practice inventory by Kaper to assess trainees’ attitudes and perceptions of EBM. Trainees were also asked to complete the Assessing Competency in Evidence Based Medicine (ACE) tool to evaluate their aptitude in different elements of EBM. The results from the two parts were analyzed.

Results
The average score on the ACE tool among the participants was 8.9 (±1.6). Most participants rated themselves as beginners or intermediate in their EBM capabilities. Higher ACE scores were observed from participants with educational background from South Asia, and among those with more favorable attitudes towards EBM. There was no clear pattern that early incorporation of EBM into practice will result in better ACE score. Participants also reported reasonable abilities in EBM tasks and a favorable work atmosphere for EBM implementation. Lack of knowledge, resources, and time were the most reported barriers to utilizing EBM.

Conclusions
While it is clear that participants are enthusiastic about EBM and see it as a useful method for clinical decision making, their aptitude in EBM is not optimal and there are gaps and barriers for them to practice.
The erosion of ambiguity tolerance and sustainment of perfectionism in undergraduate medical training: results from multiple samplings of a single cohort
Authors: Ndoja Silvio , Chahine Saad , Saklofske Donald H. , Lanting Brent 
Published: November 2020

Abstract
Background
Medicine is a field that is simultaneously factual and ambiguous. Medical students have their first exposure to full time clinical practice during clerkship. While studies have examined medical trainees’ tolerance of ambiguity (TOA), the extent to which TOA is affected by clinical experiences and its association with perfectionism is unknown. The aim of this study was to evaluate the effect of clerkship experience on TOA and perfectionism in medical students.

Methods
This was a multiple sampling, single cohort study of students in their first year of clinical clerkship which is comprised of 6 core rotations. Consenting students completed an online anonymous survey assessing their tolerance of ambiguity (TOA) and perfectionism in their first (pre) and last (post) 12 weeks of their clinical clerkship year. Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) and The Big Three perfectionism scale-short form (BTPS-SF) were used to assess TOA and perfectionism respectively. Pre-Post mean comparisons of TOA and perfectionism were assessed via t-tests.

Results
From a cohort of 174 clinical clerkship students, 51 students responded to pre-survey, 62 responded to post-survey. Clerkship was associated with a significant decrease in TOA (p < 0.00) with mean pre-TOA scores of 59.57 and post TOA of 43.8. Perfectionism scores were not significantly different over time (p > 0.05). There was a moderate inverse correlation between TOA and perfectionism before clerkship (r = 0.32) that increased slightly after clerkship (r = 0.39). Those preferring primary care specialties had significantly lower rigid and total perfectionism scores in pre-clerkship than those choosing other specialties, but this difference was not found post-clerkship.

Conclusion
Exposure to clerkship decreased TOA while perfectionism remained stable in medical students. These results were not expected as exposure has been previously shown to increase TOA. The frequency of rotation changes maintaining a cycle of anxiety may be an underlying factor accounting for these results. Overall these results require further investigation to better characterize the role of clinical exposure on TOA.
Identifying and supporting students at risk of failing the National Medical Licensure Examination in Japan using a predictive pass rate
Authors: Tsunekawa Koji , Suzuki Yasuyuki , Shioiri Toshiki 
Published: November 2020

AbstractBackgroundStudents who fail to pass the National Medical Licensure Examination (NMLE) pose a huge problem from the educational standpoint of healthcare professionals. In the present study, we developed a formula of predictive pass rate (PPR)” which reliably predicts medical students who will fail the NMLE in Japan, and provides an adequate academic support for them.MethodsSix consecutive cohorts of 531 medical students between 2012 and 2017, Gifu University Graduate School of Medicine, were investigated. Using 7 variables before the admission to medical school and 10 variables after admission, we developed a prediction formula to obtain the PPR for the NMLE using logistic regression analysis. In a new cohort of 106 medical students in 2018, we applied the formula for PPR to them to confirm the capability of the PPR and predicted students who will have a strong likelihood of failing the NMLE.ResultsMedical students who passed the NMLE had the following characteristics: younger age at admission, graduates of high schools located in the surrounding area, high scores in the graduation examination and in the comprehensive computer-based test provided by the Common Achievement Test Organization in Japan. However, total score of examination in pre-clinical medical sciences and Pre-CC OSCE score in the 4th year were not correlated with the PPR. Ninety-one out of 531 students had a strong likelihood of failing the NMLE between 2012 and 2017 and 33 of these 91 students failed NMLE. Using the PPR, we predicted 12 out of 106 students will have a strong likelihood of failing the NMLE. Actually, five of these 12 students failed NMLE.ConclusionsThe PPR can be used to predict medical students who have a higher probability of failing the NMLE. This prediction would enable focused support and guidance by faculty members. Prospective and longitudinal studies for larger and different cohorts would be necessary.
Routine measurement of satisfaction with life and treatment aspects in mental health patients – the DIALOG scale in East London
Authors: Mosler Franziska , Priebe Stefan , Bird Victoria 
Published: November 2020

Abstract

Aims
The DIALOG scale has been implemented as a routine patient outcome and experience measure (PROM/PREM) in a mental health trust in East London since 2017. The resulting healthcare dataset was used to estimate satisfaction with life and treatment aspects over time and factors associated with it.

Methods
Variables available from the Trust were DIALOG items, service level, clinical and basic demographic data. Data was extracted in February 2019. Data is described using a range of descriptive statistics and looking at the subgroups: treatment stage, diagnosis, service type. Predictors for average DIALOG scores across patients was explored with clustered linear regression models. A fixed effect model was chosen to estimate the impact of clinical and service related variables on patient’s average DIALOG scores over time. Sensitivity analyses with the whole data set and complete cases were carried out.

Results
Of the original 18,481 DIALOG records 12, 592 were kept after data cleaning (5646 patients). The average DIALOG score was 4.8 (SD 1.0) on the 7-point scale. Average satisfaction with life aspects (PROM) was 4.65 (SD 1.1) and with treatment aspects (PREM) was 5.25 (SD 1.17). Across all 11 items, “job situation” scored lowest (mean 4.05) and “meetings with professionals” highest (mean 5.5). Satisfaction for all items increased over time (average increase 0.47). The largest increase was in “mental health” (0.94) and the smallest in “family relationships” (0.34).

Conclusions
Patients in mental healthcare services were “fairly satisfied” in both life and treatment aspects with improvements seen over time. These results will act as a benchmark for clinical services currently implementing DIALOG across the UK and inform local service developments.
Healthcare providers’ digital competency: a cross-sectional survey in a low-income country setting
Authors: Shiferaw Kirubel Biruk , Tilahun Binyam Chakilu , Endehabtu Berhanu Fikadie 
Published: November 2020

AbstractBackgroundHealthcare providers across all clinical practice settings are progressively relying and adapting information communication technologies to perform their professional activities. In this era of technology, healthcare providers especially in lower income countries should have at least basic digital competency if a successful application of technology is to be achieved. The aim of this study was to assess digital competency of healthcare providers among seven public health centers in North-West Ethiopia.MethodsA cross-sectional study design was applied to assess the basic digital competency of healthcare providers working in seven public health centers in North-west Amhara regional state, Ethiopia. Self-administered questionnaire adopted from the European commission’s digital competency framework for assessing digital competency were used. A multivariable logistic regression was performed to identify factors associated with basic digital competency withp-value< 0.05 as a rule out for statistical significance. The strength of association was explained in terms of coefficient estimate, adjusted odds ratio and a 95% confidence interval (CI).ResultFrom the total of 193 healthcare providers included in the study, 167 of them responded which is a response rate of 86.5%. The majority of respondents 88 (52.7%) were males and the mean age was 28.2 years with a standard deviation of 5.5 years. The result indicated that all items demonstrated an adequate level of internal consistency with Cronbach alpha > 0 .7. Healthcare providers in those public health centers reported that problem solving, safety and communication are the most common challenges encountered. The multivariable logistic regression model indicated that factors such as sex, educational status, profession type, monthly income and years of experience are statistically significant predictors.ConclusionBasic digital competency level of healthcare providers working in public health centers in this setting is relatively low. The results highlight the need to improve digital competency among healthcare providers focusing on the identified skill gaps.
The Integrated Tracking, Referral, and Electronic Decision Support, and Care Coordination (I-TREC) program: scalable strategies for the management of hypertension and diabetes within the government healthcare system of India
Authors: Patel Shivani A. , Sharma Hanspria , Mohan Sailesh , Weber Mary Beth , Jindal Devraj , Jarhyan Prashant , Gupta Priti , Sharma Rakshit , Ali Mumtaj , Ali Mohammed K. , Narayan K. M. Venkat , Prabhakaran Dorairaj , Gupta Yashdeep , Roy Ambuj , Tandon Nikhil 
Published: November 2020

Abstract

Background
Hypertension and diabetes are among the most common and deadly chronic conditions globally. In India, most adults with these conditions remain undiagnosed, untreated, or poorly treated and uncontrolled. Innovative and scalable approaches to deliver proven-effective strategies for medical and lifestyle management of these conditions are needed.

Methods
The overall goal of this implementation science study is to evaluate the Integrated Tracking, Referral, Electronic decision support, and Care coordination (I-TREC) program. I-TREC leverages information technology (IT) to manage hypertension and diabetes in adults aged ≥30 years across the hierarchy of Indian public healthcare facilities. The I-TREC program combines multiple evidence-based interventions: an electronic case record form (eCRF) to consolidate and track patient information and referrals across the publicly-funded healthcare system; an electronic clinical decision support system (CDSS) to assist clinicians to provide tailored guideline-based care to patients; a revised workflow to ensure coordinated care within and across facilities; and enhanced training for physicians and nurses regarding non-communicable disease (NCD) medical content and lifestyle management. The program will be implemented and evaluated in a predominantly rural district of Punjab, India. The evaluation will employ a quasi-experimental design with mixed methods data collection. Evaluation indicators assess changes in the continuum of care for hypertension and diabetes and are grounded in the Reach, Effectiveness, Adoption Implementation, and Maintenance (RE-AIM) framework. Data will be triangulated from multiple sources, including community surveys, health facility assessments, stakeholder interviews, and patient-level data from the I-TREC program’s electronic database.

Discussion
I-TREC consolidates previously proven strategies for improved management of hypertension and diabetes at single-levels of the healthcare system into a scalable model for coordinated care delivery across all levels of the healthcare system hierarchy. Findings have the potential to inform best practices to ultimately deliver quality public-sector hypertension and diabetes care across India.

Trial registration
The study is registered with Clinical Trials Registry of India (registration number CTRI/2020/01/022723). The study was registered prior to the launch of the intervention on 13 January 2020. The current version of protocol is version 2 dated 6 June 2018.
Factors impacting the implementation of a psychoeducation intervention within the mental health system: a multisite study using the consolidation framework for implementation research
Authors: Higgins Agnes , Murphy Rebecca , Downes Carmel , Barry Jennifer , Monahan Mark , Hevey David , Kroll Thilo , Doyle Louise , Gibbons Patrick 
Published: November 2020

Abstract

Background
Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical.

Methods
The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis.

Results
Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. Important factors in the outer setting domain included structural stability within national systems and the peer payment system, while the extent of a recovery-oriented culture, leadership, implementation readiness, and buy-in were influential factors in the inner setting. The characteristics of the intervention in terms of design, evidence-base and adaptability also shaped the intervention’s implementation as did the knowledge, beliefs and self-efficacy of facilitators. In terms of processes, implementation was influenced by the degree of engagement of key individuals who championed and supported the programme. The results highlight that while some of the barriers were specific to the programme, many reflected systemic and structural challenges within health services more generally.

Conclusion
Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.