bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the conversion rate as it relates to preoperative risk factors and surgeon experience: a retrospective study of 4013 patients undergoing elective laparoscopic cholecystectomy
Authors: Ábrahám Szabolcs , Németh Tibor , Benkő Ria , Matuz Mária , Váczi Dániel , Tóth Illés , Ottlakán Aurél , Andrási László , Tajti. János , Kovács Viktor , Pieler József , Libor László , Paszt Attila , Simonka Zsolt , Lázár György 
Published: March 2021

Abstract
Background
Our aim is to determine the relationships among patient demographics, patient history, surgical experience, and conversion rate (CR) during elective laparoscopic cholecystectomies (LCs).

Methods
We analyzed data from patients who underwent LC surgery between 2005 and 2014 based on patient charts and electronic documentation. CR (%) was evaluated in 4013 patients who underwent elective LC surgery. The relationships between certain predictive factors (patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), acute cholecystitis (AC), abdominal surgery in the patient history, as well as surgical experience) and CR were examined by univariate analysis and logistic regression.

Results
In our sample (N = 4013), the CR was 4.2%. The CR was twice as frequent among males than among females (6.8 vs. 3.2%, p < 0.001), and the chance of conversion increased from 3.4 to 5.9% in patients older than 65 years. The detected CR was 8.8% in a group of patients who underwent previous ERCP (8.8 vs. 3.5%, p < 0.001). From the ERCP indications, most often, conversion was performed because of severe biliary tract obstruction (CR: 9.3%). LC had to be converted to open surgery after upper and lower abdominal surgeries in 18.8 and 4.8% cases, respectively. Both AC and ERCP in the patient history raised the CR (12.3%, p < 0.001 and 8.8%, p < 0.001). More surgical experience and high surgery volume were not associated with a lower CR prevalence.

Conclusions
Patient demographics (male gender and age > 65 years), previous ERCP, and upper abdominal surgery or history of AC affected the likelihood of conversion. More surgical experience and high surgery volume were not associated with a lower CR prevalence.
Effect of Streptococcus anginosus on biological response of tongue squamous cell carcinoma cells
Authors: Xu Yuan , Jia Yuhuan , Chen Liang , Gao Jing , Yang DeQin 
Published: March 2021

Abstract
Background
Streptococcus anginosus (S. anginosus) was reported increased in oral squamous cell carcinoma (OSCC) tissue. The aim of this study was to investigate the response of oral cancer cells in the biological characteristics evoked by the S. anginosus and investigate its potential mechanisms.

Methods
The growth curve and concentration standard curve of S. anginosus were determined, and a series of concentrations of S. anginosus supernatant were applied to OSCC cell lines SCC15, then selected an optimal time and concentration by CCK-8 assay. Then autophagic response, proliferative activity, cell cycle and apoptosis, invasion and migration abilities were evaluated in SCC15.

Results
The results showed that when the ratio of S. anginosus supernatant to cell culture medium was 1:1 and the co-culture time was 16 h, the inhibitory effect on SCC15 was the most obvious; Furthermore, the supernatant of Streptococcus upregulated the autophagy activity of SCC15, thus significantly inhibiting its proliferation, migration and invasion ability. Compared with control groups, the cell cycle showed G1 arrest, S and G2/M phases decreased, and the percentage of apoptotic cells relatively increased (P < 0.05).

Conclusion
S. anginosus reduced the proliferation, migration and invasion of SCC15 cells and promoted cell apoptosis; Moreover, autophagy may be one of the mechanisms in this process.
Motivations to use hormonal contraceptive methods and condoms among HIV-positive and negative women randomized to a progestin contraceptive in Malawi: a qualitative study
Authors: Bula Agatha K. , Hatfield-Timajchy Kendra , Chapola John , Chinula L. , Hurst Stacey A. , Kourtis Athena P. , Tang J. H. 
Published: March 2021

AbstractBackgroundAlthough many countries have been promoting hormonal contraceptives to prevent unintended pregnancy and condom use to prevent HIV transmission, little is known about how women targeted by these messages have interpreted and internalized them. We describe HIV-positive and negative women’s understanding of the benefits of contraception and condoms and their motivations to use them.MethodsThis is a qualitative sub-study from a clinical trial evaluating the effects of progestin contraception on HIV-positive and negative women aged 18–45 years randomly assigned to depot medroxyprogesterone acetate (DMPA) injection or levonorgestrel (LNG) implant. We purposively recruited 41 women to participate in in-depth interviews (IDIs) and focus group discussions (FGDs) after randomization into the main study. We conducted a total of 30 IDIs and 6 FGDs comprised of 4–7 women (N = 32). All women were counselled about potential risks for HIV acquisition/transmission with progestin-only contraception, drug-drug interactions between the implant and efavirenz-based ART, and the need to use condoms with their assigned contraceptive to help prevent pregnancy and HIV acquisition and transmission.ResultsAll women understood that HIV is transmitted through unprotected sex and that HIV transmission can be prevented through condom use but not DMPA injection or LNG implant use. Nearly all HIV-positive women knew or suspected that their partners were also HIV-positive and were most interested in using condoms to prevent infection with a drug-resistant HIV strain to keep their HIV viral load low. Almost all reported that their partners agreed to condom use, but few used them consistently. Most women believed that condoms were effective at preventing both HIV and pregnancy if used consistently. Nearly all women considered contraception and condom use as important in preventing unintended pregnancy and HIV because partner disclosure of HIV status is low.ConclusionOur results showed that both HIV-positive and negative women understood modes of HIV transmission and prevention and were aware that hormonal contraceptives are only effective for preventing pregnancy and not HIV. Although both HIV-negative and positive women were motivated to use condoms to prevent both HIV acquisition and infection with other HIV strains respectively, they all faced challenges from their partners in using condoms consistently.
A potential role for insulin treatment during pregnancy in reducing postpartum psychological distress in maternal obesity: an administrative population health study
Authors: Jarmasz Jessica S. , Anderson Alexandrea , Bock Margaret E. , Jin Yan , Cattini Peter A. , Ruth Chelsea 
Published: March 2021

AbstractBackgroundStudies have found an association between obesity and an increased risk for peripartum depression, which has also been linked to decreased placental lactogen levels. In addition, women with obesity treated for gestational diabetes with insulin were found to have increased levels of placental lactogen. Treatment options exist for perinatal and postpartum depression however they pose a risk to the developing offspring. Thus, prevention as well as markers for early identification of peripartum depression are needed. Therefore, our study objective is to identify the association between insulin treatment in pregnancy and the risk of postpartum psychological distress (abbreviated here as PPD) among cohorts of women with and without obesity.MethodsAdministrative health data (2002/03–2018/19) were used to identify a cohort of women (age 15+ years) who gave birth (N = 250,746) and had no pre-existing mood/anxiety disorders or diabetes (N = 222,863 excluded). Women were then divided into two groups: lean (N = 17,975) and with obesity (N = 9908), which was identified by a recorded maternal weight of > 38 to < 65.6 kg and ≥ 85 to < 186 kg (respectively). The risk of PPD within one year after delivery with and without insulin treatment was assessed by Poisson regression analysis. Models were adjusted for maternal age group (at pregnancy start date) and area-level income (at delivery).ResultsThe unadjusted risk of PPD was higher in the obesity group (8.56%; 95% CI 8.00–9.15) than in the lean group (6.93%; 95% CI 6.56–7.33). When no insulin treatment was given during pregnancy, mothers with obesity had a significantly higher risk of PPD than the lean group (aRR 1.27; 95% CI 1.17–1.39;p < 0.0001). However, when women with obesity and insulin treatment were compared to the lean group with no insulin treatment, no significant difference in the risk of PPD was observed between the groups (aRR 1.30; 95% CI 0.83–2.02;p = 0.248).ConclusionThis is the first study to demonstrate a positive association between insulin treatment in pregnancy among women with obesity and reduced PPD rates, suggesting insulin as a possible preventative measure. However, the biological mechanism behind the observed positive effect of insulin on PPD rates remains to be investigated.
Exploratory study on classification of diabetes mellitus through a combined Random Forest Classifier
Authors: Wang Xuchun , Zhai Mengmeng , Ren Zeping , Ren Hao , Li Meichen , Quan Dichen , Chen Limin , Qiu Lixia 
Published: March 2021

Abstract
Background
Diabetes Mellitus (DM) has become the third chronic non-communicable disease that hits patients after tumors, cardiovascular and cerebrovascular diseases, and has become one of the major public health problems in the world. Therefore, it is of great importance to identify individuals at high risk for DM in order to establish prevention strategies for DM.

Methods
Aiming at the problem of high-dimensional feature space and high feature redundancy of medical data, as well as the problem of data imbalance often faced. This study explored different supervised classifiers, combined with SVM-SMOTE and two feature dimensionality reduction methods (Logistic stepwise regression and LAASO) to classify the diabetes survey sample data with unbalanced categories and complex related factors. Analysis and discussion of the classification results of 4 supervised classifiers based on 4 data processing methods. Five indicators including Accuracy, Precision, Recall, F1-Score and AUC are selected as the key indicators to evaluate the performance of the classification model.

Results
According to the result, Random Forest Classifier combining SVM-SMOTE resampling technology and LASSO feature screening method (Accuracy = 0.890, Precision = 0.869, Recall = 0.919, F1-Score = 0.893, AUC = 0.948) proved the best way to tell those at high risk of DM. Besides, the combined algorithm helps enhance the classification performance for prediction of high-risk people of DM. Also, age, region, heart rate, hypertension, hyperlipidemia and BMI are the top six most critical characteristic variables affecting diabetes.

Conclusions
The Random Forest Classifier combining with SVM-SMOTE and LASSO feature reduction method perform best in identifying high-risk people of DM from individuals. And the combined method proposed in the study would be a good tool for early screening of DM.
Effectiveness of a multidimensional intervention program in improving occupational musculoskeletal disorders among intensive care unit nurses: a cluster-controlled trial with follow-up at 3 and 6 months
Authors: Yang Shuai , Li Li , Wang Liqian , Zeng Jiaqi , Yan Bin , Li Yinglan 
Published: March 2021

Abstract
Background
Intensive care unit (ICU) nurses are at high risk for work-related musculoskeletal disorders (WRMDs). Data on occupational injuries indicate the significance of WRMDs among ICU nurses. Intervention programs have previously been developed to reduce WRMDs, but different intervention methods need to be adopted for different groups of people. This study aimed to evaluate the effectiveness of a multidimensional intervention program to prevent and reduce WRMDs in ICU nurses.

Methods
This study was designed as a two-armed cluster-controlled trial with an intervention group and a control group. The clusters were independent hospital ICUs, and the participants consisted of registered nurses in China. By cluster random sampling, 89 nurses from two ICUs were assigned to the intervention group, and 101 nurses from two other ICUs were assigned to the control group. A multidimensional intervention program based on previous studies was designed. This program combined improving risk perception, health behavior training, and promoting a safe working environment. The multidimensional intervention program was implemented in the intervention group, whereas routine specialist training was implemented in the control group. Baseline and follow-up (3 and 6 months) data were collected using self-reported online questionnaires. The primary outcome was the report rate of WRMDs in the past 7 days. Secondary outcomes were risk perception, application of health behavior, and perception of a safe working environment. The data were statistically analyzed using SPSS 19.0.

Results
A total of 190 nurses provided three recorded outcome measurements (intervention group, N = 89 (94.68%); control group, N = 101 (94.39%)). After 6 months, the intervention group experienced significant improvement relative to the control group in the report rate of WRMDs in the past 7 days (OR = 1.953, p = 0.037), risk perception (OR = 0.517, p < 0.001), application of health behavior (OR = 0.025, p < 0.001), and perception of a safe working environment (OR = 1.637, p = 0.024).

Conclusion
The multidimensional intervention program was superior to routine specialist training in preventing the occurrence of WRMDs in ICU nurses. WRMD training should include multifaceted approaches and pay increased attention to specific department functions.
End-of-life care for people with advanced dementia and pain: a qualitative study in Swedish nursing homes
Authors: Lundin Emma , Godskesen Tove E. 
Published: March 2021

Abstract
Background
Of the Swedish people with advanced dementia, the majority die in nursing homes. Unresolved pain can occur in people with a terminal illness such as dementia. However, pain management in people with advanced dementia is often suboptimal and inadequate, with fewer palliative care interventions than offered to cancer patients. Although they are largely responsible for the care of these people, few studies have addressed the experiences of registered nurses in this respect. Therefore, the aim of this study was to describe the experiences of nurses in caring for people with advanced dementia and pain at the end of life.

Methods
The study had a descriptive explorative design. Individual qualitative, semi-structured interviews were carried out with 13 nurses from 12 nursing homes in Sweden. The results were analysed using thematic content analysis.

Results
The nurses described communicative, relational and organisational challenges. One major issue involved difficulties communicating with the person with advanced dementia, resulting in uncertain pain assessment. Other difficulties involved the differentiation of pain from anxiety, the balance of benefits and risks with morphine administration, and the creation of good relationships with healthcare personnel and the persons’ relatives. Relatives can greatly affect the assessment and management of pain, both because of their ability to interpret pain behaviour and by questioning the care given. Good pain management was facilitated by good communication and relationships with healthcare staff and relatives, extensive professional nursing experience, and already knowing the person with advanced dementia.

Conclusions
This study highlights the need for nursing homes to employ specialist nurses who have been trained in the appropriate knowledge and skills to deal with the challenges of end-of-life care for people with advanced dementia and pain. Additionally, there should be resources and strategies available for providing information to family members and for involving them in the decision-making process, as they are often unfamiliar with the multitude of considerations involved in decisions such as whether to administer morphine or not.
How can healthcare professionals provide guidance and support to parents of adolescents? Results from a primary care-based study
Authors: Jones Lindsey D. , Grout Randall W. , Gilbert Amy L. , Wilkinson Tracey A. , Garbuz Tamila , Downs Stephen M. , Aalsma Matthew C. 
Published: March 2021

AbstractBackgroundThis study explored the rewards and difficulties of raising an adolescent and investigated parents’ level of interest in receiving guidance from healthcare providers on parenting and adolescent health topics. Additionally, this study investigated whether parents were interested in parenting programs in primary care and explored methods in which parents want to receive guidance.MethodsParents of adolescents (ages 12–18) who attended an outpatient pediatric clinic with their adolescent were contacted by telephone and completed a short telephone survey. Parents were asked open-ended questions regarding the rewards and difficulties of parenting and rated how important it was to receive guidance from a healthcare provider on certain parenting and health topics. Additionally, parents reported their level of interest in a parenting program in primary care and rated how they would like to receive guidance.ResultsOur final sample included 104 parents, 87% of whom were interested in a parenting program within primary care. A variety of parenting rewards and difficulties were associated with raising an adolescent. From the list of parenting topics, communication was rated very important to receive guidance on (65%), followed by conflict management (50%). Of health topics, parents were primarily interested in receiving guidance on sex (77%), mental health (75%), and alcohol and drugs (74%). Parents in the study wanted to receive guidance from a pediatrician or through written literature.ConclusionsThe current study finds that parents identify several rewarding and difficult aspects associated with raising an adolescent and are open to receiving guidance on a range of parenting topics in a variety of formats through primary care settings. Incorporating such education into healthcare visits could improve parents’ knowledge. Healthcare providers are encouraged to consider how best to provide parenting support during this important developmental time period.
Multi-level considerations for optimal implementation of long-acting injectable antiretroviral therapy to treat people living with HIV: perspectives of health care providers participating in phase 3 trials
Authors: Mantsios Andrea , Murray Miranda , Karver Tahilin S. , Davis Wendy , Galai Noya , Kumar Princy , Swindells Susan , Bredeek U. Fritz , García Rafael Rubio , Antela Antonio , Gomis Santiago Cenoz , Bernáldez Miguel Pascual , Czarnogorski Maggie , Hudson Krischan , Walters Nicki , Kerrigan Deanna 
Published: March 2021

AbstractBackgroundLong-acting injectable antiretroviral therapy (LA ART) has been shown to be non-inferior to daily oral ART, with high patient satisfaction and preference to oral standard of care in research to date, and has recently been approved for use in the United States and Europe. This study examined the perspectives of health care providers participating in LA ART clinical trials on potential barriers and solutions to LA ART roll-out into real world settings.MethodsThis analysis draws on two data sources: (1) open-ended questions embedded in a structured online survey of 329 health care providers participating in the ATLAS-2 M trial across 13 countries; and (2) in-depth interviews with 14 providers participating in FLAIR/ ATLAS/ATLAS-2 M trials in the United States and Spain. Both assessments explored provider views and clinic dynamics related to the introduction of LA ART and were analyzed using thematic content analysis. The Consolidated Framework for Implementation Research (CFIR) was drawn on as the conceptual framework underpinning development of a model depicting study findings.ResultsBarriers and proposed solutions to LA ART implementation were identified at the individual, clinic and health system levels. Provider perceptions of patient level barriers included challenges with adhering to frequent injection appointments and injection tolerability. Proposed solutions included patient education, having designated staff for clinic visit retention, and clinic flexibility with appointment scheduling. The main provider concern was identifying appropriate candidates for LA ART; proposed solutions focused on patient provider communication and decision making. Clinic level barriers included the need for additional skilled individuals to administer injections, shifts in workflow as demand increases and the logistics of cold-chain storage. Proposed solutions included staff hiring and training, strategic planning around workflow and logistics, and the possibility of offering injections in other settings, including the home. Health system level barriers included cost and approvals from national regulatory bodies. Potential solutions included governments subsidizing treatment, ensuring cost is competitive with oral ART, and offering co-pay assistance.ConclusionsResults suggest the importance of multi-level support systems to optimize patient-provider communication and treatment decision-making; clinic staffing, workflow, logistics protocols and infrastructure; and cost-related factors within a given health system.
Economic impact of enhanced recovery after surgery protocol in minimally invasive cardiac surgery
Authors: Petersen Johannes , Kloth Benjamin , Konertz Johanna , Kubitz Jens , Schulte-Uentrop Leonie , Ketels Gesche , Reichenspurner Hermann , Girdauskas Evaldas 
Published: March 2021

Abstract
Background
ERAS (Enhanced Recovery After Surgery) is a multidisciplinary and integrative approach with the goal of optimizing the postoperative recovery. We aimed to analyze the economic impact of a newly established ERAS protocol in minimally invasive heart valve surgery at our institution.

Methods
ERAS protocol was implemented in 61 consecutive patients who were referred for elective minimally-invasive aortic or mitral valve surgery, between February 1, 2018 and March 31, 2019 (ERAS-group). Another 69 patients who underwent elective minimally-invasive heart valve surgery during the same time period were managed according to the hospital standards (Control-group). A detailed cost comparison analysis was carried out from a hospital perspective using a micro-costing approach.

Results
The total in-hospital stay was significantly shorter in the ERAS-group compared to the Control-group (6.1 ± 2.6 vs 7.7 ± 3.8 days; p = 0.008) resulting in significant cost savings of €1087.2 per patient (p = 0.003). Due to the intensified physiotherapy in the ERAS protocol, the costs for physiotherapy were €94.3 higher compared to the Control-group (p < 0.001). The total costs in the ERAS cohort were €11,200.0 ± 3029.6/patient compared to € 13,109.8 ± 4527.5/patient in the Control-Group resulting in cost savings of €1909.8 patient due to the implementation of the ERAS protocol (p = 0.006).

Conclusion
Implementation of an ERAS-protocol in minimally-invasive cardiac surgery can be carried out safely with a fast postoperative recovery of the patient. ERAS results in a financial benefit of up to €1909 per patient and therefore will play a key role in modern cardiac surgery in the near future.