bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urban-based Longitudinal Integrated Clerkship: A scoping review
Authors: Roh HyeRin , Yun Jiyoung , Park SongYi 
Published: August 2019

Abstract
Background Reports about longitudinal integrated clerkship (LIC) mostly deal with rural-based LICs. Clinical clerkships usually take place in urban academic medical center (AMC). We need to explore how to implement LIC in urban AMC. Authors reviewed the existing literature focused on urban-based LIC (uLIC) to explore the features and challenges uLIC. 'Method Authors adopted the scoping review framework. Research questions were: (1) What are the characteristics of uLIC studies? (2) How did medical schools implement uLICs? (3) What were the challenges when implementing uLICs? and (4) What gaps exist in uLIC research? Authors reviewed 495 studies from an initial electric database search and selected 27 articles for inclusion, and extracted relevant data and organized the demographic information and details of the uLICs for each of medical school. Authors conducted a thematic analysis on the challenges of uLIC. Results Twenty-five papers were published in the United States. Urban-based LICs were evaluated by participants’ responses (n=13) and students’ learning outcome (n=10). One paper discussed obstacles of uLIC implementation. Fourteen papers were reported by two medical schools (Harvard Medical School, University of California San Francisco College of Medicine). The two medical schools reported student selection methods and six medical schools reported student assessment methods. Challenges related to LICs included preceptors' burden about LIC education, students’ concern about academic achievement, students’ inability to adapt to LICs, shortage of educational resources of AMC, and lack of understanding about LICs. Conclusion Research is needed to understand the long-term outcomes of uLICs and strategies to overcome challenges. Medical schools should prepare student support systems and faculty development programs to facilitate successful implementation of uLICs. Medical schools’ and hospitals’ resources and funding should be taken into careful consideration prior to implementing uLICs.
Treatment effects of Chinese Medicine (Yi-Qi-Qing-Jie Herbal Compound) combined With immunosuppression therapies in patients of IgA Nephropathy with high-risk of ESRD (TCM-WINE): study protocol for a randomized controlled trial
Authors: Li Shen , Li Jin-pu 
Published: August 2019

Abstract
Background: IgA nephropathy (IgAN) is the most common glomerular disease worldwide. It has a high incidence in Asians and is more likely to progress to end-stage renal disease (ESRD). However, for high-risk IgAN clinically characterized by massive proteinuria and renal dysfunction, there has been no international consensus on treatment options. Compared with other developed countries, Chinese IgAN patients are often found to have severe kidney function loss at the initial diagnosis. Yi-Qi-Qing-Jie Formula Granule (a compound recipe of Chinese medicinal herbs, YQF) has shown potential renal protection in our previous clinical studies. To further confirm the efficacy and safety of YQF in the treatment of high-risk IgAN, we design a prospective double-blind randomized placebo-controlled trial.
Methods/Design: The TCM-WINE study is a single-center, prospective, double-blind placebo-randomized controlled trial. We plan to randomize 60 participants with biopsy-proven IgAN to YQF combined group (YQF compound, combined with prednisolone, and cyclophosphamide if necessary) and immunosuppression group (placebo-YQF, combined with prednisolone, and cyclophosphamide if necessary). The two groups will enter 48-week in-trial treatment phase and receive post-trial follow-up till study completion (3-year). All patients will receive optimal supportive care. The primary composite outcome is defined as the first occurrence of a 40% decrease in estimated glomerular filtration rate (eGFR) from the baseline lasting for 3 months, initiating continuous renal replacement treatment or death due to chronic kidney disease (CKD), during the 3-year study phase. Secondary endpoint events are defined as the mean annual eGFR decline rate (eGFR-Slope, ml/min per 1.73 m 2 per year) which is calculated by the eGFR regression curve for each eligible patient, and proteinuria remission (prescribed as proteinuria<0.5g/day) at week 24, 36, 48 during the in-trial phase. Safety monitoring and assessment will be undertaken during the study .
Discussion: TCM-WINE study will evaluate effects and safety of YQF combined therapy compared with immunosuppression monotherapy on basis of optimal supportive treatment in high-risk IgAN. The evidence from this study will provide a novel, effective and safe Chinese characteristics therapy for high-risk IgAN patients.
Trial registration: Clinicaltrials.gov, identifier: NCT03418779. Registered on 18 June 2018.
https://clinicaltrials.gov/show/NCT03418779
Geostatistical analysis and mapping: Social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana Demographic and Health Survey.
Authors: Aheto Justice Moses K. , Yankson Robert , Chipeta Michael Give 
Published: August 2019

Abstract
Background Under-five mortality (U5M) rates are among the health indicators of utmost importance globally. It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. Despite a considerable reduction in U5M was observed globally, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target. Evidence-based targeting and utilization of the available limited public health resources are critical for effective design of intervention strategies that will enhance under-five child survival. We aimed to estimate and map U5M risk, with the ultimate goal of identifying communities at high risk where interventions can be targeted.Methods The 2014 Ghana Demographic and Health Survey data was used in this study. Geostatistical analyses were conducted on 5,801 children residing in 423 geographical clusters. The outcome variable is child survival status (alive or dead). We employed a geostatistical generalised linear mixed model to investigate both measured and unmeasured child specific and spatial risk factors for child survival. We then visualise child mortality by mapping the predictive probability of survival.Results Of the total sampled under 5 children, 280 (4.83%) experienced the outcome of interest. Children born as multiple births were at increased risk of mortality with AOR (9.28, 95% CI: 6.35 – 13.58) compared to singletons. Maternal education AOR (0.80, 95% CI: 0.68 – 0.93) and number of children under 5 within each household AOR (0.34, 95% CI: 0.28 – 0.41) were shown to have a protective effect. The predicted U5M risk in 2014 was at 8.3%. High altitude areas were highly associated with high U5M.Conclusion The analysis found that multiple births and high elevation are highly associated with U5M in Ghana. The high-resolution maps show areas and communities where interventions for U5M can be prioritised to have health impact.
Virtual Reality Video Promotes Advance Care Planning Effectiveness
Authors: Hsieh Wan-Ting 
Published: August 2019

Abstract
Introduction: In 2019, the Patient Autonomy Act has gone into effect, allowing Taiwanese citizens to establish an advance decision(AD) with legal effect. In an effort to secure more realistic and accurate perception of patients as the basis for them to explore their values, a VR video was developed to supplement the traditional way of decision making before advance care planning(ACP).
Methods: Participants were asked to complete pre-test questionnaires and were then asked to read a handout with information about life-sustaining treatment and the legal process of making an effective AD. Participants then viewed a six-minute 360-degree VR video on a portable VR headset with a smartphone inside to play it and then completed the post-test questionnaire followed by feedback on the help of the VR.
Results: Of the 120 participants, 71.1% had heard about of AD. The increased percentage of the certainty of their preferences for the five kinds of life-sustaining treatments before and after participants read the handout and viewed the VR video was noted.
Conclusion and Discussion: The decrease in the number of participants who couldn’t make decision indicates indicate that VR video may be helpful for users to make decision and clarify users’ preference. According to feedback of VR video, highly agreement also lied in its help of equipping users with better understanding of medical scenarios and it is a good decision aid tool for preparing our users before ACP.
Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease
Authors: Yu Xindi , Chen Maolin , Liu Xu , Chen Yiwei , Hao Zedong , Zhang Haibo , Wang Wei 
Published: August 2019

Abstract
Background: The aim of our study was to analyze the risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease (CHD). Methods: We performed a retrospective cohort study, and children with CHD who underwent open-heart surgeries at Shanghai Children’s Medical Center from January 1, 2012 to December 31, 2018 were included. The baseline characteristics of these patients of different ages, including neonates (0-1 months old), infants (1-12 months old) and children (1-10 years old), were analyzed, and the association of risk factors with postoperative nosocomial infection were assessed. Results: A total of 11937 subjects were included in the study. The overall nosocomial infection rate was 11.10%. Nosocomial infection rates in neonates, infants, and children with congenital heart disease were 25.41%, 15.78%, and 5.31%, respectively. Multivariate logistic regression analysis found age (OR 0.804, 95%CI: 0.776-0.834; P<0.001), STS risk grade (OR 1.308, 95%CI: 1.203-1.423; P<0.001), body mass index (BMI)
Single nucleotide polymorphisms associated with postoperative inadequate analgesia after single-port VATS in Chinese population
Authors: Xing Xiufang , Bai Yongyu , Sun Kai , Yan Min 
Published: August 2019

Abstract
Background Postoperative inadequate analgesia following video-assisted thoracoscopic surgery (VATS) is a common and significant clinical problem. While genetic polymorphisms may play role in the variability of postoperative analgesia effect, few studies have evaluated the associations between genetic mutations and inadequate analgesia after single-port VATS.Methods Twenty-eight single nucleotide polymorphisms (SNPs) among 17 selected genes involved in pain perception and modulation were genotyped in 198 Chinese patients undergoing single-port VATS. The primary outcome was the occurrence of inadequate analgesia in the first night and morning after surgery which was defined by a comprehensive postoperative evaluation. Multivariable logistic regression analyses were used to identify the association between genetic variations and postoperative inadequate analgesia.Results The prevalence of postoperative inadequate analgesia was 45.5% in the present study. After controlling for age and education level, association with inadequate analgesia was observed in four SNPS among three genes encoding voltage-gated sodium channels. Patients with the minor allele of rs33985936 ( SCN11A ), rs6795970 ( SCN10A ), and 3312G>T ( SCN9A ) have an increased risk of suffering from inadequate analgesia. While the patients carrying the minor allele of rs11709492 ( SCN11A ) have lower risk experiencing inadequate analgesia.Conclusions We identified that SNPs in SCN9A , SCN10A , and SCN11A play a role in the postoperative inadequate analgesia after single-port VATS. Although future larger and long-term follow up studies are warranted to confirm our findings, the results of the current study may be utilized as predictors for forecasting postoperative analgesic effect for patients receiving this type of surgery.
Incidence and risk factors of a severe Clostridium difficile infection: results of a retrospective cohort study at a tertiary care hospital
Authors: Baier Claas , Valentin Simone , Schwab Frank , Steffens Sandra , Vonberg Ralf-Peter , Chaberny Iris Freya , Ebadi Ella 
Published: August 2019

Abstract
Background Clostridium difficile infection (CDI) is a relevant healthcare burden worldwide and one of the leading causes for nosocomial diarrhea. Besides mild courses, the development of a severe infection can occur and has a relevant impact on healthcare costs and patient outcome.Methods We conducted a retrospective cohort study over a 4 year-long period to analyze the incidence of CDI and the contributing risk factors for a severe course at a tertiary care clinic. Independent risk factors were determined by a multivariable logistic regression analysis.Results A total of 761 CDI cases were identified in the study period, thereof 612 (80.4%) cases were nosocomially acquired. The mean incidence for a CDI was 0.42 cases per 1000 patient-days. A severe CDI occurred in 131 cases (17.2%). Independent risk factors for a severe course were pulmonary disease, a Charlson comorbidity index >3, and a preceding antibiotic therapy within three months with glycopeptides (vancomycin/teicoplanin) and/or aminoglycosides.Conclusions This study highlights the relevant burden of CDI in hospitals. Moreover, it underscores that specific knowledge of risk factors contributing to severe CDI is crucial to optimize treatment, infection prevention measures and to guide clinical monitoring and therapy strategy.
Six Basic Clinical Principles of Primary Care Practice
Authors: Lee John Yang , Liu Yingying 
Published: August 2019

Abstract
BACKGROUND: The features of primary care are well described on the dimension of public health. Primary care clinicians consist of a large portion of health-care workforce. To guide clinical thinking in primary care practice, its basic clinical principles should be synthesized. METHODS: We searched literature in PubMed, MEDLINE, China National Knowledge Infrastructure, and Wanfang Med Online, using the key words of “primary care practice”, “primary care”, “primary health care”, “general practice” in combination with “principle”, “ideal”, “description”, “characteristic” and “feature” to synthesize basic clinical principles of primary care practice. RESULTS: Six basic clinical principles of primary care practice are synthesized. 1. Holistic: includes holism, whole person care, bio-psycho-social model, lateral clinical thinking, and overcoming fragmented specialization. 2. Integrative: consists of combination of orthodox and complementary medicine, coordinated care, and practicing holistic integrated medicine(HIM). 3. Continuous: deals with continuous clinician-patient relationship, seamless services, life-cycle medical services, and full medical care at any time and place. 4. Preventive: contains undifferentiated disease care, health habit counseling, screening for asymptomatic diseases, and immunization. 5. Patient-centered: comprises responsive to individual patient needs and values, people-oriented care, and practicing Patient Centered Medical Home (PCMH). 6. Standardized: involves use of evidence-based medicine (EBM), following the clinical guideline, and applying clinical pathway. CONCLUSION: The six basic clinical principles of primary care practice are holistic, integrative, continuous, preventive, patient-centered and standardized care. They might be the backbone of primary care practice and be recommended to be used to construct the disciplinary knowledge of clinical primary care practice. KEY WORDS: Primary care practice, primary care, primary health care, general practice.
Prevalence, Antimicrobial Resistance, and Relatedness of Salmonella Isolated from Chicken, Pork and the Environment at Abattoirs and Supermarkets in Chongqing, China
Authors: Chen Tingting , Jiang Jiali , Ye Chao , Xie Jianhua , Chen Xia , Xu Dongyi , Zeng Zheng , Peng Yuanyi , Hu Dong-Liang , Fang Rendong 
Published: August 2019

Abstract
Background: Salmonella is one of the most important foodborne pathogens, causing outbreaks of human salmonellosis worldwide. Owing to large scales of consumption markets, pork and poultry that contaminated by Salmonella could pose a tremendous threat to public health. The aim of this study was to investigate the contamination of Salmonella from chicken, pork and the environment in slaughtering and retailing segments in Chongqing, China.
Results: A total of 115 Salmonella isolates were recovered from 1122 samples, with 10.76% (47/437) in slaughterhouses and 10.07% (68/675) in supermarkets. 30 different serotypes were identified, in which S. Derby, S. London and S. Rissen were mostly detected. Antimicrobial susceptibility testing and resistance genes verification were carried out to investigate the relationship between phenotypes and genotypes. Altogether, 75.65% isolates showed resistance to tetracycline, followed by 60.87% to doxycycline and 69.5% to ampicillin. More than half (50.43%) of the isolates were multidrug resistant, which were mostly from supermarkets (P<0.05). According to antibiotic resistance genes detection results, a high correlation between antibiotic phenotypes and genotypes was presented by lactam-, tetracycline-, and sulfonamide-resistant isolates. Multilocus sequence typing results showed 24 out of 115 isolates were ST40, which was the most prevalent. Furthermore, isolates from supermarkets (n=15) had more sequence types than that in slaughterhouses (n=3).
Conclusion: Our study highlighted the fact that Salmonella contamination were more severe in pork production chain than that of chicken. Isolation rates were similar in slaughterhouses and supermarkets for both pork and chicken, but isolates from supermarkets had more MDR profiles and represented a wide range of serotypes and sequence types, indicating that more diverse sources of contamination in retailing.
Prevalence and antibiotic susceptibility of urinary tract infections in febrile children below ten years attending mulago hospital, Uganda
Authors: Ssemambo Ronald , Odongo Isaac , Kungu Joseph 
Published: August 2019

Abstract
Background: Urinary tract infections (UTIs) are one of the most common infections in the pediatrics population. This study was performed to determine the prevalence of urinary tract infections amongst febrile children below 10 years attending Mulago National Referral Hospital, and the susceptibility patterns of the isolated uropathogens to common antibiotics.
Methods: A cross-sectional study of febrile pediatric patients below 10 years from various ward of Mulago National Referral Hospital was conducted between January and May 2019. Biodata and midstream urine samples were collected from 160 children .The urine samples were cultured onto Blood Agar and Cystine Lactose Electrolyte Deficient (CLED) simultaneously. Growth was considered significant when a pure isolate had ≥ 10 5 CFU/mL. Susceptibility to 8 antibiotics was set using the modified Kirby-Bauer disc diffusion technique.
Results: Out of the 160 urine samples analyzed, 29(18.1%) had significant bacterial growth. The frequency of UTIs was significantly higher in girls 20(69.0%) than boys 9(31.0%). Escherichia coli was the most predominant microorganism (41.4%), followed by Klebsiella pneumoniae (20.7%) and Staphylococcus aureus at (13.8%). Overall susceptibility tests exhibited a very high Antibiotic resistance of uropathogens to ampicillin (96.6%), cotrimoxazole (82.8%) and nalidixic-acid. Nitrofurantoin and imipenem showed the lowest resistances of 34.5% and 31.0% respectively. A total of 24(82.8%) isolates were multidrug resistant.
Conclusion: Bacteriuria is a highly prevalent condition amongst febrile children attending Mulago hospital, with Enterobacteriaceae being the most predominant uropathogens. Uropathogens were highly sensitive to nitrofurantoin and imipenem but with significant resistance to ampicillin and cotrimoxazole. This information can be useful in decision making during management of UTIs among children.
Diagnostic Value of Pituitary Volume in Girls with Precocious Puberty
Authors: Wu Su , Yang Yan , Wang Yujiao , Liu Qianqi , Zhu Zi-yang , Gu Wei 
Published: August 2019

Abstract
Background: To investigate the diagnostic significance of pituitary magnetic resonance imaging (MRI) in girls with precocious puberty (PP).
Methods: A total of 288 young female patients who presented to the Clinic of Pediatric Endocrinology for evaluation of PP from January 2015 to December 2017 were enrolled. All the subjects contained 90 girls diagnosed with premature thelarche (PT), 133 girls determined as idiopathic central precocious puberty (ICPP), 35 early pubertal girls, and 30 normal girls. All patients received pituitary MRI.
Results: The largest pituitary volume (PV) and pituitary height were shown in the ICPP and pubertal groups, followed by the PT group. The receiver operating characteristic (ROC) curve analysis showed that PV might be a predictive marker for ICPP, with a sensitivity of 54.10% and a specificity of 72.20% at the cutoff value of 196.01 mm3. By univariate analysis, PV was significantly and positively associated with peak LH, LH/FSH, age, bone age, and BMI (all P < 0.05). However, bone age and peak LH were the only significant predictors of PV by the stepwise multivariate regression analysis (Model: PV = 9.431 * bone age + 1.230 * peak LH + 92.625 [P = 0.000, R2 = 0.159)).
Conclusions: The PV in the ICPP group was significantly higher than that in the PT and control groups, but there was no reliable cutoff value to distinguish ICPP from PT. Pituitary MRI should be combined with clinical and laboratory tests to maximize the diagnostic value of PV for PP.
Comparison of Visual Outcomes for Myopia after Refractive Surgery using Femtosecond Laser-assisted and Epipolis LASIK
Authors: Piao Junjie , Whang Woong-Joo , Joo Choun-Ki 
Published: August 2019

Abstract
Background This prospective cohort study clinically evaluated the visual outcomes after refractive surgery for myopia using femtosecond laser-assisted in situ keratomileusis (femto-LASIK) and epipolis LASIK (flap-off epi-LASIK).Methods Forty eyes of 27 patients were divided into 2 groups in this prospective cohort study. Femto-LASIK flaps were created using a femtosecond laser; epi-LASIK flaps (flap-off) were made using and Epi-K TM epikeratome. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction (MR), corneal asphericity (Q-value), and corneal higher-order aberrations (HOAs) were assessed pre- and postoperatively.Results The improvement in LogMAR UDVA after refractive surgery was statistically significant for both groups ( P < 0.001 for all groups); it was significantly improved for femto-LASIK at 1 day and 1 week postoperatively ( P < 0.001, P = 0.019, respectively). In analysis of the front and total corneal HOAs, there were significant differences in spherical aberrations (Z 4,0 ) between the femto-LASIK and flap-off epi-LASIK groups ( P = 0.016 and P = 0.017, respectively). In analysis of the back corneal HOAs, there were significant differences in vertical coma (Z 3,-1 ) aberration 0.027 ± 0.027 (femto-LASIK) and 0.001 ± 0.034 (flap-off epi-LASIK); horizontal secondary astigmatism (Z 4,2 ) aberration -0.008 ± 0.012 (femto-LASIK) and 0.007 ± 0.018 (flap-off epi-LASIK); oblique tetrafoil (Z 4,-4 ) aberration -0.008 ± 0.029 (femto-LASIK) and 0.015 ± 0.026 (flap-off epi-LASIK), respectively ( P = 0.018, P = 0.007, and P = 0.022, respectively). However, the back corneal HOA changes did not have a significant effect on the total corneal HOA changes.Conclusion Femto-LASIK yielded better early visual outcomes than that by flap-off epi-LASIK, but there was no significant difference between the outcomes of the 2 procedures 1 week postoperatively.