bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment Patterns and Sequences of Pharmacotherapy for Patients Diagnosed with Depression in the United States: 2014 through 2019
Authors: Kern David M. , Cepeda M. Soledad , Defalco Frank , Etropolski Mila 
Published: October 2019

Abstract
Background : Understanding how patients are treated in the real-world is vital to identifying potential gaps in care. We describe the current pharmacologic treatment patterns for the treatment of depression. Methods : Patients with depression were identified from four large national claims databases during 1/1/2014-1/31/2019. Patients had ≥2 diagnoses for depression or an inpatient hospitalization with a diagnosis of depression. Patients were required to have enrollment in the database ≥1 year prior to and three years following their first depression diagnosis. Treatment patterns were captured at the class level and included selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, other antidepressants, anxiolytics, hypnotics/sedatives, and antipsychotics . Treatment patterns were captured during all available follow-up. Results : We identified 269,668 patients diagnosed with depression . The proportion not receiving any pharmacological treatment during follow-up ranged from 31% to 54%. Of the treated, approximately half received ≥2 different classes of therapy, a quarter received ≥3 classes and 10% received 4 or more. SSRIs were the most common first-line treatment; however, many patients received an anxiolytic, hypnotic/sedative, or antipsychotic prior to any antidepressive treatment. Treatment with a combination of classes was relatively uncommon across all treatment lines. Conclusions : Many patients diagnosed with depression go untreated and many others receive a non-antidepressant medication class as their first treatment. More than half of patients received more than one type of treatment class during the study follow up, suggesting that the first treatment received may not be optimal for most patients.
Leucine-rich α2-glycoprotein-1 upregulation in plasma and kidney of patients with lupus nephritis
Authors: Yang Yi , Luo Ran , Cheng Yichun , Liu Tingting , Dai Wei , Li Yueqiang , Ge Shuwang , Xu Gang 
Published: October 2019

Abstract
Background Increased leucine-rich α2-glycoprotein-1 (LRG1) has been observed in various inflammatory and autoimmune diseases. We aimed to explore the expression and role of LRG1 in lupus nephritis (LN).Methods Plasma LRG1 (pLRG1) was measured by enzyme-linked immunosorbent assay in 101 patients with renal biopsy-proven LN and 21 healthy controls (HC). Relationships between pLRG1 and clinical and pathological characteristics were analyzed. The expression of LRG1 in peripheral blood leukocytes and kidney was detected by flow cytometry, immunohistochemistry and immunofluorescence, respectively. Further cell experiments were focused on the role of LRG1.Results We found that LRG1 was expressed in plasma, some peripheral blood leukocytes, proximal tubule and several inflammatory cells. The levels of LRG1 in plasma, peripheral blood leukocytes and kidney were elevated in LN patients as compared to HC. Plasma expression levels of LRG1 correlated positively with renal function and renal disease activity, and reflect specific pathologic lesions in the kidneys of patients with LN. Interleukin-1β and interleukin-6, not tumor necrosis factor-α and interferon γ induced the LRG1 expression in human renal tubular epithelial cell line. Moreover, stimulation of recombinant human LRG1 could inhibit late apoptosis, promote proliferation and regulate expression of inflammatory factors and cytokines.Conclusions Plasma expression levels of LRG1 were associated with renal function, disease activity, and pathology in LN. It might also be involved in renal inflammation, proliferation and apoptosis of endothelial cells. LRG1 might be a potential prognosis novel predictor in LN patients.
Objective evaluation of postoperative changes in real-life activity levels in the postoperative course of lumbar spinal surgery using wearable trackers
Authors: Inoue Masahiro , Orita Sumihis , Inage Kazuhide , Suzuki Miyako , Fujimoto Kazuki , Shiga Yasuhiro , Kanamoto Hirohito , Abe Koki , Kinoshita Hideyuki , Norimoto Masaki , Umimura Tomotaka , Sato Takashi , Sato Masashi , Suzuki Masahiro , Enomoto Keigo , Eguchi Yawara , Akazawa Tsutomu , Aoki Yasuchika , Kawasaki Yohei , Ohtori Seiji 
Published: October 2019

Abstract
Background: Lumbar spinal disease causes disability in daily activities. Operative treatments are aimed at pain relief and rapid return to routine activity. Patient-based outcome measures are used to evaluate pathology and therapeutic effects associated with lumbar spinal disease. However, it remains unknown how much such treatment improves the activity levels.
The purpose of current study was to evaluate the changes in activity levels before and after lumbar spinal surgery using a wearable activity tracker and to compare the relationship between the results and the patient-based outcomes.
Methods: Sixty patients who underwent lumbar surgery were studied. The physical activity of participants was objectively evaluated using a wearable Micro-Motion logger system (Actigraph). We measured the amount of activity before and at 1, 3, 6, and 12 months after the surgery to evaluate postoperative changes. Additionally, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Oswestry Disability Index, Roland-Morris Disability Questionnaire and Visual analog scale were measured as a patient-based outcomes of pain and ADL-related scores and the corresponding relationships with the actual activity levels were evaluated.
Results: The amount of actual activity decreased significantly 1 month after the surgery compared to that during the preoperative period, which then improved after 3 months postoperatively ( p < 0.01). Furthermore, there was a significant improvement 6 months after the surgery compared to that during the preoperative period ( p < 0.05). Moreover, the change in activity amount for each period was strongly correlated, regardless of the period. In contrast, a significant improvement was observed at 1 month after the surgery in almost all items of the patient-based questionnaires ( p < 0.05).
Conclusions: The objective activity tracker demonstrated that lumbar surgery results in the amount of activity decreasing 1 month just after the surgery followed by gradual postoperative recovery within 3 months. In contrast, patient-based outcomes showed improvement in 1 month, which was significantly different from the change in actual activity, indicating the gap between the patient-oriented clinical score and their actual activities.
Short-term and long-term unintended impacts of a pilot reform on Beijing's zero markup drug policy: a propensity score-matched study
Authors: Zeng Jianying , Chen Xiwen , Fu Hongqiao , Lu Ming , Jian Weiyan 
Published: October 2019

Abstract
Background In September 2012, Beijing, the capital of China, selected five tertiary hospitals as pilots to remove the previously allowed 15% markup for drug sales. However, while most research demonstrated the significant decrease in drug sales, the core issue of high health expenditure was not well solved because of the unintended policy impact. This study aimed to empirically evaluate the short-term and long-term unintended impacts on controlling medical expenses of Beijing’s zero markup drug policy from 2012 to 2015.Methods This study extracted 2012-2015 individual-level data from the Beijing Urban Employee Basic Medical Insurance (UEBMI) database and performed a propensity score-matched analysis to evaluate the short-term and long-term impacts on controlling medical expenses. All inpatients in the 5 pilot reform hospitals were selected as the intervention group, while inpatients in other tertiary hospitals were selected as the control group.Results A total of 520,996 inpatients were extracted in this study. For patients in the pilot hospitals, the total expenditures per admission decreased from 17,140.3 yuan in 2012 to 15,430.1 yuan in 2013 and then increased to 16,789.8 yuan in 2015. Expenditure on drugs reduced from 5,811.7 yuan in 2012 to 3,903.4 yuan in 2015. However, a significant substitution effect of medical consumables was first observed in the third quarter of 2014, which undermined the impact of the policy. In the long-term, the intervention group and control group demonstrated the same trend.Conclusion After the zero markup drug policy, expenditure on drugs revealed a continuous decline. However, the decline in total expenditure was weakened by the substitution effect of medical consumables in the long term.
“The Hardest Job You Will Ever Love”: Nurse Recruitment, Retention, and Turnover in the Nurse-Family Partnership Program in British Columbia, Canada
Authors: Campbell Karen A , Borek Natasha Van , Marcellus Lenora , Landy Christine Kurtz , Jack Susan M 
Published: October 2019

Abstract
Background: Nurse turnover is a significant issue and complex challenge for all sectors of healthcare and is exacerbated by a global nursing shortage. Nurse-Family Partnership is a community health program for first-time pregnant and parenting girls and young women living in situations of social and economic disadvantage, delivered exclusively by public health nurses and only within a research context in Canada. The aim of this article is to explore and describe factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada.
Methods: Interpretive description was used to guide sampling, data collection and analytic decisions in this qualitative component drawn from the British Columbia Healthy Connections Project mixed methods process evaluation. Semi-structured, individual interviews were conducted with 28 public health nurses who practiced in and then exited Nurse-Family Partnership.
Results: Nurses were motivated to join this program because they wanted to deliver an evidence-based program for vulnerable young mothers that fit with their personal and professional philosophies and offered nurse autonomy. Access to program resources attracted nursing staff, while delivering a program that prioritizes maintaining relationships and emphasizes client successes was a positive work experience. Opportunities for ongoing professional development/ education, strong team connections, and working at full-scope of nursing practice were significant reasons for nurses to remain in Nurse-Family Partnership. Personal circumstances (retirement, family/health needs, relocation, career advancement) were the most frequently cited reasons leading to turnover. Other factors included: involuntary reasons, organizational and program factors, and geographical factors.
Conclusions: Public health organizations that deliver Nurse-Family Partnership may find aspects of job embeddedness theory useful for developing strategies for supporting recruitment and retention and reducing nurse turnover. Hiring nurses who are the right fit for this type of program may be a useful approach to increasing nurse retention. Fostering a culture of connectivity through team development along with supportive and communicative supervision are important factors associated with retention and may decrease turnover. Many involuntary factors were specific to being in a study environment. Program, organizational, and geographical factors affecting nurse turnover are modifiable.
Prediction of patients with a tumor proportion score &gt;50% who do not respond to first-line monotherapy with pembrolizumab
Authors: Morita Mitsunori , Tamiya Motohiro , Fujimoto Daichi , Tamiya Akihiro , Suzuki Hidekazu , Hirano Katsuya , Fukuda Yasushi , Yokoyama Toshihide , Kominami Ryota , Kanazu Masaki , Uchida Junji , Hara Satoshi , Yamashita Syuji , Tomioka Hiromi 
Published: October 2019

Abstract
Background: Pembrolizumab is effective as first-line therapy against advanced non-small cell lung cancer (NSCLC) in patients with programmed death ligand-1 (PD-L1) expression levels ≥50%. However, it is not effective in all patients, and the factors predicting responses among this population remain unknown.
Methods: We retrospectively analyzed patients with NSCLC and a PD-L1 tumor proportion score (TPS) >50%, who received first-line monotherapy with pembrolizumab from February 1, 2017 to April 30, 2018. The study included 11 hospitals, which participated in the Hanshin Oncology clinical Problem Evaluation group (HOPE). We analyzed the differences between responders and non-responders in terms of age, sex, performance status score, degree of progression, histological type, smoking history, expression of PD-L1, use of steroids prior to treatment, metastasis site, and laboratory data.
Results: A total of 205 patients were included in this study. Of those, 108 patients exhibiting complete or partial response were defined as responders. Those exhibiting progressive disease (N=52) were defined as non-responders. In the univariate analysis, Eastern Cooperative Oncology Group performance status score ≥2 (p=0.0832), stage IV disease or recurrence (p=0.0487), PD-L1 TPS 50–89% (p=0.0657), use of steroids prior to the administration of pembrolizumab (p=0.0243), malignant pleural effusion (p=0.0032), and baseline C-reactive protein (CRP) levels >1.0 mg/dL (p=0.0390) were significantly associated with non-response to treatment.
In the multivariate analysis, use of steroids prior to the administration of pembrolizumab (odds ratio [OR]: 5.86; 95% confidence interval [CI]: 1.32–31.8; p=0.0200), malignant pleural effusion (OR: 2.68; 95% CI: 1.15–6.35; p=0.0228), and baseline CRP >1.0 mg/dL (OR: 2.17; 95% CI: 1.03–4.68; p=0.0402) were significantly associated with non-response to treatment.
Conclusion: In real-world patients with NSCLC and a PD-L1 TPS ≥50%, use of steroids prior to treatment, malignant pleural effusion, and baseline CRP levels >1.0mg/dL reduced the effectiveness of first-line monotherapy with pembrolizumab.
The survival impact of concurrent chemotherapy and primary tumor radiotherapy on stage IV squamous non-small-cell lung cancer
Authors: Geng Yichao , Zhang Qiu-Ning , Hu Yin-Xiang , Ma Zhu , Ouyang Wei-Wei , Su Sheng-Fa , Li Qing-Song , Li Hui-qin , Wang Xiaohu , Lu Bing , Liu Ruifeng , Luo Hongtao , Wei Shihong , Wang Lina 
Published: October 2019

Abstract
Objective: To analyse the impact of survival with three-dimensional radiotherapy for stage IV squamous non-small cell lung cancer (NSCLC). Methods: Data for 629 eligible patients who received three-dimensional radiotherapy between 2002 and 2016 were retrospectively analyzed.161 of 183 cases were included pre-protocol. Patients received platinum-doublet chemotherapy with concurrent irradiation of the primary tumour. Primary endpoints were overall survival (OS) and progress-free survival (PFS). Results: Of 161 patients, the 1-, 2-, 3- and 5-year OS rates and median survival time (MST) were 45.7%, 14.1%, 11.2%, 2.2% and 11months, respectively. Using contrastive analysis PTV dose ≥63 Gy and <63 Gy, the 1-, 2-,3- and 5-year overall survival (OS) rates and median survival time (MST)were 48.9% vs 43.3%, 21.8% vs 8.2%, 18.4% vs 4.4%, 5.1% vs 0%, and 12 months vs 11months ( χ 2 = 7.222, P=0.007). Contrastive analysis patients received radical concurrent chemoradiation therapy, and the 1-, 2-, 3- and 5-year overall survival (OS) rates and median survival time (MST) were 54.3% vs. 37.2%, 27.2% vs. 7.5%, 24.9% vs. 4.8%, 8.3% vs. 0%, and 14 months vs. 10 months ( χ 2 = 13.180, P=0.000). Multivariate analysis showed that PTV ≥63 Gy was an independent favourable factor for survival. Conclusion: Concurrent chemotherapy and three-dimensional radiotherapy to the primary tumour in stage IV squamous NSCLC could prolong survival, and with increasing intensity of comprehensive treatment, OS gradually improved. PTV ≥63 Gy is the independent prognostic factors for OS.
[Key Words] Stage IV; Squamous non-small cell lung cancer (NSCLC); Concurrent chemoradiotherapy; Overall survival
Determinants of an Evidence-Based Practice Environment: An Interpretive Description
Authors: Duff Jed , Cullen Laura , Hanrahan Kirsten , Steelman Victoria 
Published: October 2019

Abstract
Background Despite the available research to inform nursing practice many patients still fail to receive care that is evidence-based. A number of evidence-based practice (EBP) models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a deeper understanding was gained the emphasis of the study shifted towards understanding the determinants of the EBP environment.Method The study was conducted in a 800 bed comprehensive academic medical centre with a 25 year history of using the Iowa Model of EBP. Semi-structured in-depth interviews were conducted with twelve nurses from various roles to ascertain their perspectives and experiences of using the model. The interview transcripts were reviewed alongside relevant published literature and internal documents in a process of synthesising, theorising, and conceptualising. Data were collected during the first four months of 2019.Results The determinants of the local EBP environment were clustered into four themes: 1) The importance of a shared model to guide staff through the EBP process; 2) Support for EBP in the form of education, hands-on training, and knowledge infrastructure; 3) Active team facilitation by direct care nurses, nurse managers, nurses specialists, and nurse scientists; and 4) A culture and leadership that encourages EBP.Conclusion Introducing an EBP model is an important first step for an organisation to improve consistent and reliable evidence-based care; to be most effective, this should be done in conjunction with efforts to optimise the EBP environment.
The Relationship between Course Experience and Academic Engagement in Medical Students: a descriptive-correlational study
Authors: Haghgoo Amin , Asady Hadi , Armoon Bahram , Bayat Amir-Hossein 
Published: October 2019

Abstract
Background One of the essential activities in improving the quality and effectiveness of teaching is to pay attention to the course experience (CE) and academic engagement (AE) of students in their academic process. The aim of this study was to determine the relationship between CE and AE among Iranian nursing students.Methods This is a descriptive-correlational study. The present study was carried out on 124 anesthesia and operating room nursing students who were selected using simple random sampling in the year 2017. The research tools included standard demographic, CE, and AE questionnaires. Data analysis was carried out using descriptive tests, independent t-test, and Pearson correlation in SPSS ver. 24.Results The results of Pearson correlation analysis on the relationship between the subscales of CE, including good teaching, clear goals, appropriate assessment, appropriate workload, independence, and generic skills with AE showed a statistically significant relationship between all remaining subscales, except for the proper workload sub-scale (P=0.234).Conclusions The results of this study showed a significant positive correlation between the CE and AE. Therefore, steps can be taken to improve the quality of the educational system using active and student-centered teaching methods.
Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study
Authors: Chen Yao , Hu Yanyan , Zhang Jin , Shen Yue , Huang Junling , Yin Jun , Wang Ping , Fan Ying , Wang Jianli , Lu Su , Yang Yilin , Yan Lei , Li Keyong , Song Zhenju , Tong Chaoyang , Du Shilin 
Published: October 2019

Abstract
Background : Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis.

Methods : A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14 + monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively.

Results: A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90.

Conclusions : Urinary and deep venous catheterization increased the risk of secondary infection, in which underlying immunosuppression might also play a role. Secondary infection affected the prognosis of septic patients and prolonged in-hospital length of stay.
Predictors of catheter-related bladder discomfort after gynaecological surgery
Authors: Li Shuying , Song Liping , Ma Yushan , Lin Xuemei 
Published: October 2019

Abstract
Background: Urinary catheterization is universally used during surgery, and the incidence of postoperative catheter-related bladder discomfort (CRBD) is very high during recovery. We conducted this study to identify the incidence and predictors of postoperative CRBD after gynaecological surgery in the post-anesthesia care unit (PACU). Methods: This was a prospective observational study. Patients undergoing gynaecological surgery under general anesthesia with intra-operative urinary catheterization were enrolled. We collected the clinical data, incidence and severity of CRBD, and postoperative pain for the patients. Predictive factors of CRBD were analysed by univariate and multivariate analysis. Results: A total of 407 patients were included in this study. The incidence of CRBD after gynaecological surgery was 64.6% (mild CRBD: 22.8%; moderate CRBD: 34.2%; and severe CRBD: 7.6%). Univariate analysis showed that age, type of surgery, type of laparoscopic surgery, additional analgesics, and postoperative pain were influencing factors for CRBD. Based on multivariate logistic regression analysis, age ≥50 years, uterus-related laparoscopic surgery, and lack of additional analgesics were independent predictors of moderate or severe CRBD. Conclusions: This observational study revealed that the incidence of CRBD after gynaecological surgery in PACU was very high and it was a very distressing experience for patients. We suggested that drug prophylaxis should be used to the patients with high risk of CRBD in gynaecological surgery.
Efficacy and safety of tetramethylpyrazine phosphate on pulmonary hypertension: study protocol for a randomized controlled study
Authors: Wang Jian , Chen Yuqin , He Wenjun , Ouyang Haiping , Liu Chunli , Hong Cheng , Wang Tao , Yang Kai , Lu Wenju 
Published: October 2019

Abstract
Introduction Tetramethylpyrazine (TMP), one of the active ingredients from the traditional Chinese herbal medicine Rhizoma Chuanxiong (Chuanxiong), has been clinically used for the prevention and treatment on cardiovascular diseases. The benefits of TMP are largely attributed to its anti-oxidize and vasodilative activities. However, the efficacy of TMP in the treatment of pulmonary hypertension(PH) is unknown, in this study, we hypothesized that TMP treatment has a therapeutic effect on PH patients.