bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can multifaceted educational intervention improve clinical practice and patient outcomes regarding delirium in nursing homes?
Authors: Jeong Eunhye , Chang Sung Ok 
Published: August 2021

AbstractAimWe aimed to develop and evaluate a multifaceted and evidence‐based delirium educational program for practitioners in nursing home settings.MethodsA pre‐ and posttest comparison group design was employed. The recruited practitioners included nurses and care workers from two nursing homes. The intervention group (n = 51) received the developed delirium educational program for 3 weeks, whereas the control group (n = 23) received a delirium handbook. We examined pre‐ and posttest differences in the scores for delirium knowledge and confidence in providing delirium care. We also examined the nurses' ability to clinically detect delirium in patients and delirium incidence for 8‐week periods both before and after the intervention.ResultsThere were significant improvements in the participants' aptitudes (delirium knowledge and confidence in providing delirium care) and clinical practice (ability to clinically detect delirium in the patients) only in the intervention group; however, there were no significant differences in patient outcomes (incidence of delirium) between either group. Additionally, it was observed that the nurses' improved understanding of distinct clinical features of delirium, such as acute change or fluctuation, was the key factor that directly affected the success of delirium screening.ConclusionsThis study revealed that implementation of a multifaceted and evidence‐based delirium educational program for practitioners in nursing home settings was effective in promoting the knowledge, confidence, and ability to detect delirium. The developed program can also be implemented in settings where most patients are older individuals, such as geriatric care units, or long‐term care hospitals.
Pregnancy after percutaneous ethanol sclerotherapy for uterine arteriovenous fistula: Case report
Authors: Xu Lei , Wang Yu , Yuan Hai , Zhang Shiyi , Wu Xuejun , Huo Ran 
Published: August 2021

AbstractUterine arteriovenous fistula is a rare but life‐threatening gynecologic entity. Meanwhile, long‐term radiation exposure will do serious harm to doctors' health. So we improve the operation method to reduce the radiation exposure time. The patient, a 24‐years‐old woman with a history of dilation and curettage, had long‐term menorrhagia and anemia. Uterine arteriovenous fistula was confirmed by ultrasonography and computed tomography angiograph. Percutaneous anhydrous ethanol sclerotherapy was performed under the guidance of the X‐ray imaging. The patient was followed up for 2 years without recurrence and had normal menstruation. Recently, she is successfully pregnant again. Percutaneous anhydrous ethanol sclerotherapy is a new option treating uterine arteriovenous fistula, which can greatly shorten the irradiation time and reduce the recurrence rate and has no obvious adverse effect on fertility.
Cyclooxygenase‐2 protein expression modulates cell proliferation and apoptosis in solid ameloblastoma and odontogenic keratocyst. An immunohistochemical study
Authors: Escobar Enrico , Peñafiel Cristian , Gómez‐Valenzuela Fernán , Chimenos‐Küstner Eduardo , Pérez‐Tomás Ricardo 
Published: August 2021

AbstractBackgroundCyclooxygenase‐2 protein is a critically important mediator in inflammation that influences proliferation, apoptosis, angiogenesis and metastasis. Previous works showed a relationship between cyclooxygenase‐2 and tumourigenesis in humans and animal models. In epithelial odontogenic tumours and cysts, increased cell proliferation and survival have been linked to its pathogenesis and tumour development. The aim of the present study was to analyse the immunohistochemical expression of cyclooxygenase‐2 in solid ameloblastoma and odontogenic keratocyst and its association with proteins related to cell proliferation and apoptosis.MethodsThis study was conducted on 40 cases from the Pathological Anatomy Service, University of Chile. The cases were diagnosed as solid ameloblastoma (n = 21) and odontogenic keratocyst (n = 19) according to WHO 2017. Slides prepared from paraffin‐embedded sections were immunohistochemically stained for cyclooxygenase‐2, cyclin D1, Ki‐67, p63 and Bcl‐2. Statistical evaluation was performed by the Shapiro–Wilk test, ANOVA Mann–Whitney test and Spearman's correlation coefficient (p < 0.05).ResultsThere were significant differences in the immunoexpression of cyclin D1, Ki‐67 and Bcl‐2 between solid ameloblastoma and odontogenic keratocyst. Likewise, there was a significant difference in the immunoexpression of p63 between follicular and plexiform histological types/subtypes of solid ameloblastoma. Lastly, there were statistical associations between cyclooxygenase‐2 and Ki‐67 for solid ameloblastoma and between cyclooxygenase‐2 and p63 for odontogenic keratocyst.ConclusionA high level of cyclooxygenase‐2 is related to increased cell survival and proliferative activity in solid ameloblastoma and odontogenic keratocyst. This event might contribute to tumoural progression and local invasiveness in these lesions.
School Administrators' Experiences in a 6‐Month Health and Wellness Community of Practice
Authors: Townsley Matt , Waldron Jennifer , Alborn‐Yilek Susan , Schares Denise , Huckstadt Kim , McNamara Scott , Gute Deeanne 
Published: August 2021

ABSTRACTBACKGROUNDA statewide 6‐month school administrator health and wellness program encouraged participants to use a fitness tracker to self‐monitor their physical activity and sleep patterns. The purpose of this study was to examine participants' experience in a school administrator health and wellness program and their perceptions of the impact on health‐related behaviors, including activity/movement, nutrition, and sleep.METHODSEach of the 45 participants completed a semi‐structured interview at three points in the program. Questions were designed to discern school administrators' perceptions of their ideal health and wellness balance at home and work.RESULTSSchool administrators reported new insights into their own well‐being, benefits of social supports in their personal wellness journey, an expanded understanding of their ideal health and wellness balance at home and work, and a stronger sense of serving as a role model who needs to take care of him/herself.CONCLUSIONSAlthough the program was helpful in establishing an ideal health and wellness balance at home and work for some school administrators, future programs should better emphasize nutrition and scaffold opportunities to maintain new habits following program completion.
Optimizing the Agrobacterium tumefaciens-mediated transformation conditions in Colletotrichum lindemuthianum: a step forward to unravel the functions of pathogenicity arsenals
Authors: Nabi A. , Banoo A. , Rasool R.S. , Dar M.S. , Mubashir S.S , Masoodi K.Z. , Shah M.D. , Khan A.A. , Khan I. , Padder B.A. 
Published: August 2021

Abstract
Colletotrichum lindemuthianum is a hemibiotrophic fungal pathogen that causes bean anthracnose and it is rated among the top 10 important diseases infecting beans. Currently our knowledge on molecular mechanisms underlying C. lindemuthianum pathogenesis is limited. About five pathogenicity genes have been identified in C. lindemuthianum using Restricted Enzyme Mediated Integration and the transformation using Agroinfection has not been optimized. In this study, a series of experiments were conducted to optimize the key parameters affecting the Agrobacterium tumefaciens-mediated transformation for C. lindemuthianum. The transformation efficiency increased with increase in spore concentration and co-cultivation time. However, the optimum conditions that yielded significant number of transformants were 106 ml−1 spore concentration, co-cultivation time of 72 h, incubation at 25°C and using a cellulose membrane filter for the co-cultivation. The optimized protocol resulted in establishment of large mutant library (2400). A few mutants were melanin deficient and a few were unable to produce conidia. To determine the altered pathogenicity, two new approaches such as detached leaf and twig techniques proved reliable and require fewer resources to screen the large mutant libraries in a short time. Among the 1200 transformants tested for virulence, 90% transformants were pathogenically similar to wild type (race 2047), 96 and 24 were reduced and impaired, respectively. The altered avirulent transformants can prove vital for understanding the missing link between growth and developmental stages of pathogen with virulence. This platform will help to develop strategies to determine the potential pathogenicity genes and to decipher molecular mechanisms of host–pathogen interactions in more detail.
United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis
Authors: Schol Jolien , Wauters Lucas , Dickman Ram , Drug Vasile , Mulak Agata , Serra Jordi , Enck Paul , Tack Jan ,   the ESNM Gastroparesis Consensus Group
Published: August 2021

AbstractBackgroundGastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction. The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis.MethodsA Delphi consensus was undertaken by 40 experts from 19 European countries who conducted a literature summary and voting process on 89 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation criteria. Consensus (defined as ≥80% agreement) was reached for 25 statements.ResultsThe European consensus defined gastroparesis as the presence of symptoms associated with delayed GE in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms, with often coexisting postprandial distress syndrome symptoms of dyspepsia. The true epidemiology of gastroparesis is not known in detail, but diabetes, gastric surgery, certain neurological and connective tissue diseases, and the use of certain drugs recognized as risk factors. While the panel agreed that severely impaired gastric motor function is present in these patients, there was no consensus on underlying pathophysiology. The panel agreed that an upper endoscopy and a GE test are required for diagnosis. Only dietary therapy, dopamine‐2 antagonists and 5‐HT4 receptor agonists were considered appropriate therapies, in addition to nutritional support in case of severe weight loss. No consensus was reached on the use of proton pump inhibitors, other classes of antiemetics or prokinetics, neuromodulators, complimentary, psychological, or more invasive therapies. Finally, there was consensus that gastroparesis adversely impacts on quality of life and healthcare costs and that the long‐term prognosis of gastroparesis depends on the cause.Conclusions and InferencesA multinational group of European experts summarized the current state of consensus on definition, symptom characteristics, pathophysiology, diagnosis, and management of gastroparesis.
Impact of microbial contamination of haematopoietic stem cells on post‐transplant outcomes: A retrospective study from tertiary care centre in India
Authors: Garg Vikas , Kodan Parul , Pushpam Deepam , Bakhshi Sameer , Kumar Lalit , Sharma Atul , Gupta Gopila , Gupta Nitin 
Published: August 2021

AbstractBackgroundHaematopoietic stem cells (HSC) may act as a source of infection for the recipient due to manipulation at multiple levels from collection to infusion. Due to the high risk of contamination cultures are usually taken during multiple steps. The clinical significance of microbial contamination of HSC on the post‐transplant course and the role of prophylactic antibiotics is relatively unknown.Aims and methodsThe aim of our study is to investigate the incidence of microbial contamination of haematopoietic stem cell and to assess its impact on the post‐transplant febrile neutropenia, engraftment kinetics, hospitalisation and day 100 mortality. Details of all patients admitted in the bone marrow transplantation unit of a tertiary care centre in India between January 2014 and December 2018 were collected from case records.ResultsOf the 1306 stem cell harvests from 503 patients sent for culture, 17 harvests (1.3%) were found to have a culture positive report. Sixteen patients had undergone autologous transplant. Multiple myeloma was most common indication of HSC transplant followed by Non‐Hodgkin Lymphoma (NHL). Twelve of 17 HSC cultures were positive at the time of infusion and five were positive at the time of harvest. The five HSC that were culture positive at the time of harvest were culture negative at the time of infusion. Gram‐positive organisms were isolated in six cultures and gram‐negative in rest. All patients developed febrile neutropenia post‐transplantation between day 1 and day 7. The median time of onset of fever was day +5 (1–7), the median duration of fever was 4 days (2–7), the median duration of antibiotic use was 11 days (9–16). Median day for neutrophil engraftment was 11 days (9–16), the median day for platelet engraftment was 14 days (10–25) and median duration of hospitalisation was 15 days (12–78). All patients were alive at day 100 of transplant.ConclusionThis study shows that there appears to be minimal impact of culture positive HSC on transplant related outcomes in terms of engraftment kinetics, duration of hospitalisation and day 100 mortality. Discarding of contaminated HSC may not be required, though on development of febrile neutropenia appropriate antibiotics should be administered based on sensitivity pattern of HSC culture. Larger prospective studies are needed to determine the clinical relevance of such contaminations. Emphasis should be laid on better infection control practices to minimise contamination rates.
Anthropometric cut-offs to identify hyperglycemia in an Afro-Caribbean population: a cross-sectional population-based study from Barbados
Authors: Wade Alisha N , Hambleton Ian R , Hennis Anselm J M , Howitt Christina , Jeyaseelan Selvi M , Ojeh Nkemcho O , Rose Angela M C , Unwin Nigel 
Published: August 2021

IntroductionBody mass index (BMI) and waist circumference (WC) cut-offs associated with hyperglycemia may differ by ethnicity. We investigated the optimal BMI and WC cut-offs for identifying hyperglycemia in the predominantly Afro-Caribbean population of Barbados.Research design and methodsA cross-sectional study of 865 individuals aged ≥25 years without known diabetes or cardiovascular disease was conducted. Hyperglycemia was defined as fasting plasma glucose ≥5.6 mmol/L or hemoglobin A1c ≥5.7% (39 mmol/mol). The Youden index was used to identify the optimal cut-offs from the receiver operating characteristic (ROC) curves. Further ROC analysis and multivariable log binomial regression were used to compare standard and data-derived cut-offs.ResultsThe prevalence of hyperglycemia was 58.9% (95% CI 54.7% to 63.0%). In women, optimal BMI and WC cut-offs (27 kg/m2 and 87 cm, respectively) performed similarly to standard cut-offs. In men, sensitivities of the optimal cut-offs of BMI ≥24 kg/m2 (72.0%) and WC ≥86 cm (74.0%) were higher than those for standard BMI and WC obesity cut-offs (30.0% and 25%–46%, respectively), although with lower specificity. Hyperglycemia was 70% higher in men above the data-derived WC cut-off (prevalence ratio 95% CI 1.2 to 2.3).ConclusionsWhile BMI and WC cut-offs in Afro-Caribbean women approximate international standards, our findings, consistent with other studies, suggest lowering cut-offs in men may be warranted to improve detection of hyperglycemia. Our findings do, however, require replication in a new data set.
‘Never again will I be carefree’: a qualitative study of the impact of hypoglycemia on quality of life among adults with type 1 diabetes
Authors: Chatwin Hannah , Broadley Melanie , Valdersdorf Jensen Mette , Hendrieckx Christel , Carlton Jill , Heller Simon , Amiel Stephanie , de Galan Bastiaan , Hermanns Norbert , Finke-Groene Katharina , Speight Jane , Pouwer Frans 
Published: August 2021

IntroductionAchieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with significant distress. However, the impact of hypoglycemia on QoL is not fully understood. The aim of this study was to explore how adults with type 1 diabetes are impacted by hypoglycemia in areas of life that are important to their overall QoL.Research design and methodsParticipants responded to a web-based qualitative survey involving a novel ‘Wheel of Life’ activity. Responses were analyzed using reflexive thematic analysis.ResultsThe final sample included 219 adults with type 1 diabetes from Denmark, Germany, the Netherlands, and the UK. They had a mean±SD age of 39±13 years and diabetes duration of 20±14 years. Participants identified eight areas of life important to their overall QoL, including relationships and social life, work and studies, leisure and physical activity, everyday life, sleep, sex life, physical health, and mental health. Participants reported emotional, behavioral, cognitive, and social impacts of hypoglycemia within domains. Across domains, participants described interruptions, limited participation in activities, exhaustion, fear of hypoglycemia, compensatory strategies to prevent hypoglycemia, and reduced spontaneity.ConclusionsThe findings emphasize the profound impact of hypoglycemia on QoL and diabetes self-care behaviors. Diabetes services should be aware of and address the burden of hypoglycemia to provide person-centered care. Clinicians could ask individuals how hypoglycemia affects important areas of their lives to better understand the personal impact and develop tailored management plans.
Spatio-temporal distribution and associated factors of anaemia among children aged 6–59 months in Ethiopia: a spatial and multilevel analysis based on the EDHS 2005–2016
Authors: Hailegebreal Samuel , Nigatu Araya Mesfin , Mekonnen Zeleke Abebaw , Endehabtu Berhanu Fikadie 
Published: August 2021

ObjectivesAnaemia is a global public health problem with major health and socioeconomic consequences. Though childhood anaemia is a major public health problem in Ethiopia, there is limited evidence on the spatio-temporal variability of childhood anaemia over time in the country. Therefore, this study aimed to assess the spatio-temporal distribution and associated factors of childhood anaemia using the Ethiopian Demographic and Health Survey (EDHS) data from 2005 to 2016.DesignSurvey-based cross-sectional study design was employed for the EDHS.SettingData were collected in all nine regions and two city administrations of Ethiopia in 2005, 2011 and 2016.ParticipantsThe source population for this study was all children in Ethiopia aged 6–59 months. A total of 21 302 children aged 6–59 months were included in this study.Outcome measureThe outcome variable was child anaemia status.ResultsThe prevalence of anaemia declined from 53.9% in 2005 to 44.6% in 2011, but it showed an increase in 2016 to 57.6%. The spatial analysis revealed that the spatial distribution of anaemia varied across the regions. The spatial scan statistics analysis indicated a total of 22 clusters (relative risk (RR)=1.5, p<0.01) in 2005, 180 clusters (RR=1.4, p<0.01) in 2011 and 219 clusters (RR=1.4, p<0. 0.01) in 2016, significant primary clusters were identified. The child’s age, mother’s age, maternal anaemia status, wealth index, birth order, fever, stunting, wasting status and region were significant predictors of childhood anaemia.ConclusionsIn this study, childhood anaemia remains a public health problem. The spatial distribution of childhood anaemia varied significantly across the country. Individual-level and community-level factors were associated with childhood anaemia. Therefore, in regions with a high risk of childhood anaemia, individual-level and community-level factors should be intensified by allocating additional resources and providing appropriate and tailored strategies.
Reducing risks associated with medicines and lifestyle in a residential care population with intellectual disabilities: evaluation of a pharmacy review initiative in England
Authors: Thayer Nick , White Simon , Islam Jasmeen , Jones Wesley , Kenzie Stephanie , Kullu Rajni 
Published: August 2021

ObjectivesA collaborative service initiative involving community pharmacists and a specialist mental health pharmacist was developed to provide pharmacist reviews for care home residents with intellectual disabilities (IDs). This study aimed to characterise the medicines and lifestyle risk outcomes of the service and determine how these align with national priority issues in ID.DesignDescriptive statistical analysis of routinely collected service delivery data.SettingResidential care homes in the Wirral, England for people with ID.Participants160 residents.InterventionsPharmacist review of residents’ medicines and lifestyle risk factors between November 2019 and May 2020.Primary and secondary outcome measuresNumbers of medicines prescribed, the nature of pharmacists’ interventions/recommendations and general practitioner (GP)/psychiatrist acceptance.ResultsThe 160 residents were prescribed 1207 medicines, 74% were prescribed ≥5 medicines and 507 interventions/recommendations were made, averaging 3.3 per resident. The highest proportion (30.4%) were lifestyle risk related, while changing and stopping medicines accounted for 17.9% and 12.8%, respectively. Of the recommendations discussed with GPs/psychiatrists, 86% were accepted. Medicines with anticholinergic properties were prescribed for 115 (72%) residents, of whom 43 (37%) had a high anticholinergic burden score. Pharmacists recommended anticholinergic discontinuation or dose reduction for 28 (24%) residents. The pharmacists made interventions/recommendations about constipation management for 10% of residents and about respiratory medicines for 17 (81%) of the 21 residents with respiratory diagnoses.ConclusionsThe findings indicate considerable polypharmacy among the residents and a high level of pharmacists’ interventions/recommendations about medicines and lifestyle risk, most of which were accepted by GPs/psychiatrists. This included anticholinergic burden reduction and improving respiratory disease and constipation management, which are national priority issues. Wider adoption of collaborative pharmacist review models could have similar benefits for residential populations with ID and potentially reduce pressure on other health services.