bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Hospitalizations: Are We Missing an Opportunity to Immunize?
Authors: Genies Marquita C. , Lopez Sandra M. , Schenk Kara , Rinke Michael L. , Persing Nichole , Bundy David G. , Milstone Aaron M. , Lehmann Christoph U. , Kim George R. , Miller Marlene R. , Kim Julia M. 
Published: September 2019

OBJECTIVES:Fewer than half of children receive all recommended immunizations on time. Hospitalizations may be opportunities to address delayed immunizations. Our objectives were to assess (1) prevalence of delayed immunizations among hospitalized patients, (2) missed opportunities to administer delayed immunizations, and (3) time to catch up after discharge.METHODS:We conducted a retrospective cohort study investigating immunization status of patients 0 to 21 years of age admitted to an academic children’s center from 2012 to 2013 at the time of admission, at discharge, and 18 months postdischarge. Immunization catch-up at 18 months postdischarge was defined as having received immunizations due on discharge per Centers for Disease Control and Prevention recommendations. χ2 and t test analyses compared characteristics among patients caught up and not caught up at 18 months postdischarge. Analysis of variance and logistic regression analyses compared mean number of immunizations needed and odds of immunization catch-up among age groups. Kaplan-Meier and Cox proportional hazards analyses compared catch-up time by age, race, sex, and insurance.RESULTS:Among 166 hospitalized patients, 80 were not up to date on immunizations at admission, and only 1 received catch-up immunizations before discharge. Ninety-nine percent (79 of 80) were not up to date on discharge per Centers for Disease Control and Prevention recommendations. Thirty percent (24 of 79), mostly adolescents, were not caught up at 18 months postdischarge. Median postdischarge catch-up time was 3.5 months (range: 0.03–18.0 months). Patients 0 to 35 months of age were more likely to catch up compared with those of other ages (hazard ratio = 2.73; P = .001), with no differences seen when comparing race, sex, or insurance.CONCLUSIONS:Pediatric hospitalizations provide important opportunities to screen and immunize children.
Electronic Health Record Classification of Tobacco Smoke Exposure and Cotinine Levels in Hospitalized Pediatric Patients
Authors: Mahabee-Gittens E. Melinda , Merianos Ashley L. , Gordon Judith S. , Stone Lara , Semenova Olga , Matt Georg E. 
Published: September 2019

OBJECTIVES:
Documentation of children’s tobacco smoke exposure (TSE) in the electronic health record (EHR) can have important implications for clinical care. However, it may not be accurate if it is not based on biochemical assessment, the most reliable method of verifying TSE. Our objectives were to compare the accuracy of EHR classification of TSE with cotinine verification and to explore parent and child variables associated with biochemically verified TSE.

METHODS:
Participants were 171 hospitalized pediatric patients (ages 0–17 years; mean age 5.1 [SD 3.7] years) who had EHR documentation of TSE and measured salivary cotinine. Children with cotinine levels &gt;1 ng/mL were classified as having biochemical verification of TSE. Parents reported sociodemographic characteristics, and children’s EHRs were abstracted for TSE status, past medical history, and diagnoses. We conducted χ2 tests to assess the agreement between EHR classification of TSE status and cotinine levels. Then, we assessed the relationship between sociodemographic and clinical variables and cotinine using crude and adjusted logistic regression models.

RESULTS:
Overall, 71% (121 of 171) of EHR classifications were correct on the basis of cotinine levels. Specificity analyses showed that 77% (53 of 69) were correctly identified as exposed to tobacco smoke. Sensitivity analyses showed that 67% (68 of 102) were correctly identified as unexposed. The negative predictive value was 0.61 (53 of 87); 39% (34 of 87) were misclassified as unexposed. The positive predictive value was 0.81 (68 of 84); 19% (16 of 84) were misclassified as exposed.

CONCLUSIONS:
Almost 40% of children were misclassified in the EHR as unexposed to tobacco smoke. Biochemical verification should be used as part of universal TSE screening during pediatric hospitalizations.
Effects of Aqueous and Ethanolic Extracts of Myrtus Communis Leaves on Trophozoites and Cysts of Acanthamoeba: An In Vitro Study
Authors: Nayeri Chegeni Tooran , Ghaffarifa Fatemeh , Khoshzaban Fariba , Dalimi Asl Abdolhosein D , Mirzaian Hoda , Jameie Farnoosh 
Published: September 2019

Background and Aims: Acanthamoeba is a ubiquitous amphizoic organism which can cause lethal diseases such as granulomatous amoebic encephalitis and unfortunately, the infection has now increased in the world. The aim here was to evaluate in vitro anti-Acanthamoeba properties of crude aqueous and ethanolic extracts of Myrtus communis.Materials and Methods: In this experimental research, a clinical isolate of Acanthamoeba was cultured and genotyped. The aqueous and ethanolic extracts of Myrtus communis were prepared. Then, various concentrations of Myrtus communis extracts (1.25, 2.5, 5, and 10 mg/ml) were tested at three different times (24, 48 and 72 hr) on trophozoites and cysts of Acanthamoeba in vitro. The viability of trophozoites or cysts was tested by trypan blue method. Unstained (viable) and stained (nonviable) parasites were evaluated by counting with a neobar lam.Results: The percentage of viablity of trophozoites and cysts after adding ethanolic extract of Myrtus communis was 0% and 8.62%, respectively. Moreover, at 10 mg/ml concentration of aqueous extract of Myrtus communis, 0% trophozoites and 31.10% cysts lived after 72 h.Conclusions: This extract can be used as a safe anti-Acanthamoeba agent against trophozoites and cysts of Acanthamoeba and further investigations are recommended to show the effects of this plant as an antiparasitic drug in animal models and volunteer infected people.
Comparative analysis of the immediate results of the off-pump versus on-pump myocardial revascularization in the elderly patients
Authors: Yusupov A. I. , Vitsukaev V. V. , Sushkov A. I. , Makalskiy P. D. , Zavgorodniy V. N. 
Published: September 2019

Aim: To evaluate efficacy and safety of surgical myocardial revascularization with two internal thoracic arteries in the elderly patients and to identify special aspects and immediate results of the interventions on a working heart and with the use of cardiopulmonary bypass and on a working heart.Materials and methods: This retrospective single center study included patients over 65 years of age with multivessel coronary artery disease who underwent coronary artery bypass grafting with two internal thoracic arteries in a working heart without cardiopulmonary bypass at the Federal Clinical Center of High Medical Technologies of FMBA of Russia from 2015 to 2017 (the study group, n=50) and with cardiopulmonary bypass and cardioplegia (the comparison group, n=51). We analyzed demographic characteristics, preoperative state severity, and special aspects of myocardial damage, operational parameters, rates, and structure of postoperative complications.Results: None of the patients died. Median intraoperative parameters in the study group were better than those in the comparison group: blood loss, 300 vs. 800 mL (p<0.001), duration of the surgery, 190 and 240 min (p<0.001), duration of mechanical ventilation, 3 and 5 hours (p<0.001), respectively. Early postoperative acute renal failure was less frequent in the patients who had undergone surgery without cardiopulmonary bypass (median serum creatinine levels 90 vs. 125 µmol/L (p<0.001)). Postoperative complications were observed in the group of patients operated with cardiopulmonary bypass: three cases of acute cerebrovascular accidents (stroke) and one deep wound infection of the sternum. Mean duration of the hospital stay in the patients operated on a working heart without the use of cardiopulmonary bypass was 7 days versus 9 in the comparison group.Conclusion: Myocardial revascularization without cardiopulmonary bypass is associated with lower rates of postoperative complications, decreased duration of the procedure, decreased blood loss, time on mechanical ventilation and acute renal failure rate, which all results in decreased duration of hospital stay. Bimammary myocardial revascularization without cardiopulmonary bypass could be the method of choice in the elderly patients.
Factors affecting the attitudes of nurses towards change
Authors: Kaya Gulsah , Koc Zeliha , Kiymaz Dilek , Cinarli Tugba 
Published: September 2019

This study was conducted as descriptive with an aim to determine the factors affecting the attitudes of nurses towards change. The study was conducted with the participation of 178 nurses in state hospital between October 10, 2017 and January 30, 2018. The data were collected using a questionnaire consisting of 24 questions, and the Attitude Against Change Scale consisting of 29 items. In the evaluation of the data, descriptive statistics, One-Way Anova, t-test, Kruskal–Wallis test and Mann–Whitney U test were used. The Attitude Against Change Scale score was determined as 56.82 ± 13.52. A meaningful relation was observed between the Attitude Against Change Scale score averages and certain sociodemographic characteristics of nurses (p < 0.05). It was determined in the study that the nurses between the ages of 30 and 39, having 8–15 years of profession had more positive attitudes towards change.
Keywords: Change, attitude towards change, nurse.
Desarrollo de Documentos con un Formato Computable Utilizando el Software Wolfram Mathematica
Authors: Q. Enrique Vílchez , H. Juan Félix Avila 
Published: September 2019

Este es un tutorial sobre la construcción de CDF‘s (Computable Document Format). Se explica en detalle cómo elaborar este tipo de archivos mostrando, entre otras cosas, definiciones, ejemplos ilustrativos, y ejercicios, la descripción de los componentes visuales (o controladores) más importantes y sus opciones. Se supone que el lector tiene un conocimiento medio en el lenguaje Wolfram.
Abstract
This is a tutorial on the construction of CDF‘s (Computable Document Format). It is explained in detail how to elaborate this type of files showing, among other things, definitions, examples and exercises, the description of the most important visual components (or controllers) and their options. It is assumed that the reader has a medium knowledge in the Wolfram language.
Perceção e Atitudes Sobre Prescrição Racional Durante a Formação Médica: Resultados de Grupos Focais com Estudantes de Medicina e Médicos Internos
Authors: Boaventura Isabel , Costa João , Fernandes Ricardo Miguel , Ferreira Joaquim 
Published: September 2019

Introdução: O ensino da farmacologia clínica visa a aquisição de conhecimentos, competências e comportamentos que assegurem a decisão de prescrição de forma racional. Os autores apresentam os resultados de um estudo concebido para avaliar as perceções, atitudes e comportamentos associados ao conceito de prescrição racional ao longo da formação.Material e Métodos: Foram realizados quatro grupos focais com alunos do primeiro, terceiro e quinto ano e jovens internos da formação específica. Utilizou-se um guião semi-estruturado com perguntas abertas e estudos de caso destinados a explorar os comportamentos associados à decisão terapêutica.Resultados: A análise identifica uma evolução de conceitos ao longo da formação académica. As referências a normas de orientação e efetividade emergem a partir do terceiro ano. A segurança e a adaptação às características individuais do doente emergem nos grupos do quinto ano e dos jovens internos. As fontes de informação consideradas mais relevantes foram os estudos de eficácia e revisões sistemáticas, os documentos regulamentares e as plataformas online.Discussão: A revisão da literatura recente aponta para a necessidade de implementar estratégias dedicadas ao desenvolvimento das competências adequadas à prescrição racional. O recurso a grupos focais é uma metodologia a considerar para envolver os discentes na autoavaliação de competências e informar os docentes acerca das perceções e atitudes dos alunos.Conclusão: Esta análise ilustra a sensibilização dos estudantes e jovens médicos para a adaptação da terapêutica às características do doente e a necessidade de reforçar estes conceitos, para que se sintam preparados para a prescrição racional em situações clínicas complexas.
Antibiotic Clinic: Two Years’ Experience in Outpatient Parenteral Antimicrobial Therapy in a Portuguese Hospital
Authors: Rigor Joana , Ferreira Paula Marques , Murteira Fábio , Figueiredo Cristóvão , Vieira Nuno , Oliveira Rosa , Couto Raquel , Mota Margarida 
Published: September 2019

Introduction: Outpatient antimicrobial therapy programs have been in place for more than four decades. They provide safe and effective treatment for a selected group of patients while reducing costs. In Europe in general, and in Portugal in particular, these programs are still a relatively new phenomenon. The aim of this study is to describe our center’s two years’ experience with such a program (Antibiotic Clinic).Material and Methods: The cohort of treatments administered by the Antibiotic Clinic in its first two years of existence (September 12th 2016 to September 11th 2018) was analyzed and data pertaining to patients, infections, infectious agents, antimicrobials and outcomes (infection resolution, adverse events and death) were characterized.Results: The Antibiotic Clinic treated 231 patients in 250 episodes, providing a total of 2357 days of antibiotic treatment. The urinary tract was the most common site (39.2%) and Enterobacteriaceae the most common agents (63.7% of isolates). Infections were resolved in 90.8% of treatments (95.6% of patients), adverse events were few (1.2%) and direct mortality was not found. The dropout rate was 1.6%.Discussion: Infection resolution and adverse event rates were comparable to other centers. High treatment and low dropout rates point to high physician and patient acceptance.Conclusion: Our experience with this program suggests it is a safe and effective alternative to inpatient admission. This is in line with current literature which suggests efforts should be made to expand this treatment modality.
Giant Intramural Hematoma of the Colon in Acquired Factor VIII Inhibitor
Authors: Figueiredo Joana , Borges Nuno , Pascoalinho José , Matos Ricardo 
Published: September 2019

Intramural hematoma of the colon is very rare, particularly when associated with the development of autoantibodies against factor VIII.We report a case of a 66-year-old man with abdominal pain, hematochezia and clots in the left colon, without any radiologic signs of active bleeding or bowel occlusion or analytical changes in routine coagulation screening, but with positive autoantibodies against factor VIII. The clinical instability prompted surgical exploration. An intramural hematoma of the left colon was found, and a left colectomy was performed. The patient was treated with hemoderivatives and corticosteroids with clinical improvement. The diagnosis of spontaneous intramural hematoma might be a challenge, particularly in the absence of clinical suspicion. An early recognition is essential for a positive outcome. This case highlights a rare cause of bleeding and intestinal obstruction, but also the difficulty and relevance of establishing a clinical diagnosis when diagnostic tests are not completely informative.
Adherence in elderly patients with NCDs: Which is the best, educational or social support? A comparative study in Ecuador
Authors: Céspedes Elizabeth Elena Aguirre , Florido Angela Faydé Alfonso , Segovia Edgar León , Solórzano Patricia Ortiz , Lorenzo Sergio Minué , Durán Susana Alvear , Hierro Galo Antonio Sánchez del 
Published: September 2019

Abstract
Background: Adherence to treatment is one of the mainstays of non-communicable diseases adequate control. Non – adherence can affect several aspects to both the patient and the health system. For this reason, it is important to have intervention strategies available to prevent detachment and improve adherence to treatment. The objective of this study is to evaluate the effectiveness of the educational strategy compared with the social and family support for the improvement of adherence in patients with chronic noncommunicable diseases.
Methods: A quasi-experimental study was conducted in 159 participants with diagnosis of arterial hypertension or/and diabetes mellitus type 2 plus polypharmacy. Participants were divided in two groups and strategies: Group A: educational (n = 79) and Group B social/family support (n = 80), follow up three months for each group. For group "A", informative group workshops were assigned; while for group "B" therapeutic agreements were established. Adherence to treatment pre- and post-intervention were evaluated using the four item Morisky Green Levine scale of public domain. At the end of the intervention period, an intra and intergroup analysis were performed and a Z test for difference in proportions was applied; the RR was used as a measure of association, and Chi2 as a measure of significance.
Results: A total of 152 patients complete the intervention. In group A, pre-intervention non-adherence was 58.2%, post-intervention of 45.3% and final reduction of the failure was 12.9% (p<0,001). In group B, pre-intervention non-adherence was 55%, post-intervention 46.8%, and final reduction of adherence failure of 8.2%, (p> 0.05). Statistically significant difference was obtained between the decrease in the failure reached after the application of the educational strategy compared to social / family support strategy (p = 0.001).
Conclusions: Educational strategy is more effective than social/family support strategy, to reduce the failure of therapeutic adherence. There was not association of sociodemographic factors and adherence to treatment.
Short post-surgical antibiotic therapy in spine infections - prospective, randomized, unblinded, non-inferiority trials (SASI Trials)
Authors: Betz Michael , Uçkay Ilker , Schüpbach Regula , Gröber Tanja , Botter Sander , Burkhard Jan , Holy Dominique , Achermann Yvonne , Farshad Mazda 
Published: September 2019

Abstract
Background: There are several open scientific questions regarding the optimal antibiotic treatment of spine infections (SI) with or without an implant. The duration of post-surgical antibiotic therapy is debated.

Methods: We will perform and perform two unblinded randomized -controlled RCTs. We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are non-inferior (10% margin, 80% power, ɑlpha 5%) to existing (long) treatment durations. The RCTs allocate the participants in two arms of 2 x 59 episodes each: 3 vs. 6 weeks of targeted post-surgical systemic antibiotic therapy for implant-free spine infections (two positive microbiological samples); or 6 vs. 12 weeks for implant-related spine infections. This equals a total of 236 adult SI episodes (randomization schemes 1:1) with a minimal follow-up of 12 months. All participants have a concomitant multidisciplinary surgical, re-educational, internist and infectious diseases care. We perform three interim analyses that are evaluated by an independent Study Data Monitoring Committee. Besides the primary outcome remission, we also assess adverse events of antibiotic therapy, changes of the patient’s nutritional status, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, rubor, pain) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples; and remission as the absence of any clinical, laboratory and/or radiological evidence of (former or new) infection.

Discussion: Provided that there is adequate surgical debridement, both RCTs enable to potentially prescribe less antibiotics during the therapy of SI; with potentially less adverse events and reduced overall costs.

Trial registration: ClinicalTrial.gov NCT0408304. Registered on 6 th August 2019.

Protocol version : 2 (5 th July 2019)
Clinical Population Pharmacokinetics/Pharmacodynamics Protocol of Alkaloids from Leaf of Alstonia scholaris on Acute Bronchitis Patients
Authors: Li Rui , Zhang Wan-Tong , Zhao Yun-Li , Sun Ming-Yue , Fan Mao-Rong , Luo Xiao-Dong , Gao Rui , Li Xin-Gang 
Published: September 2019

Abstract
Background Acute tracheobronchitis is the acute tracheobronchial mucosal inflammation caused by biological, physical, chemical stimulation, and accompanied by symptoms of cough and expectoration. The capsule of alkaloids from leaf of Alstonia scholaris (CALAS), an effective part riches in alkaloids, has the antiviral, antibacterial, anti-inflammatory, expectorant, anti-tussive, anti-asthmatic, immunoregulation effects. However, whether the clinical indexes could be improved by the same ingredients and pathways after oral administration, and the changes in the relationship between ingredients and pharmacodynamics indexes, still need further clinical verification.Methods/design This is a prospectively planned, blinded, placebo-controlled, parallel-grouped clinical trial with aggregated population pharmacokinetics/pharmacodynamics (PPK/PD) data. 55 subjects will be randomly allocated into four arms, specifically, 10 of the 55 subjects were selected randomly for the placebo arm who will be orally administered with placebo (Tid), and 45 subjects were randomly assigned to CALAS treatment group (20 mg, 40 mg, 80 mg Tid, 15 subjects per group). The medication, cough and phlegm, body temperature of every subject should be recorded daily during treatment. Each subject will be collected 3-4 blood samples at the following points for PPK/PPD parameters analysis. Blood samples will be acquired pre-dose (0 h) and post-dose at 15 min, 40 min, 1 h, 1.5 h, 2 h, 3 h, 4 h, 6 h, 8 h, 12 h, 24 h, 30 h, 48 h after last dosing. All subjects will receive a laboratory examination and efficacy evaluation on day 8.Discussion A new integrating strategy to explore relationship among drug ingredients, action pathway and clinical efficacy will be established through this study. We aim to explore the mechanism of CALAS in treatment of acute bronchitis on the premise of definite active ingredients and reliable clinical efficacy. It is difficult to be accepted by patients since classical pharmacokinetics (PK) research adopts intensive sampling method, meanwhile, it cannot quantify the variability of PK parameters (Intra-individual variation, interindividual variation and weekly variation). Moreover, extrapolation and prediction of dosage regimen between different species and populations cannot be realized. Therefore, PPK/PPD method, usually taking advantage of sparse data (3-5 time points sampling per patient), which be selected to find out the measurable factors of pathology and physiology that lead to the change of dose-concentration, and guide reasonable dose adjustment to achieve the optimal clinical effects.