bluuebunny/crossref_metadata_2025_split huggingface dataset:
End-of-Life Care Among Patients With Kidney Failure on Maintenance Dialysis: A Retrospective Population-Based Study
Authors: Hafid Shuaib , Isenberg Sarina R. , Fernandes Aleisha , Gallagher Erin , Webber Colleen , Joseph Meera , Sood Manish M , Bruni Adrianna , Davis Janet L. , Warmels Grace , Downar James , Gayowsky Anastasia , Jones Aaron , Manuel Doug , Tanuseputro Peter , Howard Michelle 
Published: September 2024

Background: Nephrologists routinely provide end-of-life care for patients with kidney failure (KF) on maintenance dialysis. Involvement of primary care and palliative care physicians may enhance this experience. Objective: The objective was to describe outpatient care patterns in the last year of life and the end-of-life acute care utilization for patients with KF on maintenance dialysis. Design: Retrospective cohort study using population-level health administrative data. Setting & Participants: Outpatient and inpatient care during the last year of life among patients who died between 2017 and 2019, receiving maintenance dialysis in Ontario, Canada. Measurements: The primary exposure is patterns of physician specialties providing outpatient care in the last year of life. Outcomes include outpatient encounters in the last year of life, acute care visitation in the last month of life, and place of death. Methods: We reported the count and percentage of categorical outcomes and the median (interquartile range) for numeric outcomes. We produced time series plots of the mean monthly percentage of encounters to different specialties stratified by physician specialty patterns. We evaluated differences in outcomes by physician specialty patterns using analysis of variance (ANOVA) and Pearson’s chi-square tests ( P < .05, two-tailed). Results: Among 6866 patients, the median age at death was 73, 36.1% were female, and 87.8% resided in urban regions. Three patterns emerged: a primary care, nephrology, and palliative care triad (25.5%); a primary care and nephrology dyad (59.3%); and a non-primary care pattern (15.2%). Palliative care involvement is concentrated near death. Of all, 81.4% spent at least 1 day in hospital or emergency department in the last month, but those with primary care, palliative care, and nephrology involvement had the fewest acute care deaths (65.8%). Limitations: Outpatient care patterns were defined using physician billing codes, potentially missing care from other providers. Conclusions: Nephrology and primary care predominantly manage outpatient care in the last year of life for patients with KF on maintenance dialysis, with consistent acute care use across care patterns except for the place of death. Future research should explore associations between patterns of care and end-of-life outcomes to identify the most optimal model of care for patients with KF on maintenance dialysis.
Valued technical and non-technical skills among disaster responders: a cross sectional study of disaster responders involved in the earthquake in Türkiye and Syria January 2023
Authors: Westman Anja , Kurland Lisa , Hugelius Karin 
Published: September 2024

Abstract
Introduction
Disaster responders are an important part of disaster response. However, despite large efforts to train disaster responders, there is a limited scientific knowledge regarding which competences and skills such responders value and lack during a real mission. The aim of this study was to investigate used and needed skills among disaster responders responding to the earthquake in Türkiye and Syria 2023

Methods
A cross-sectional study using a non-randomized sample was conducted, collected between March and July, 2023. The participants were recruited through invitations distributed to international organizations, and the data were gathered through a web-based survey. The data were analyzed using descriptive and comparative statistics.

Results
A total of 525 participants involved in the disaster response in Türkiye or Syria in February 2023 were included. The most common valued skills were teamwork skills (n = 252, 59%), technical knowledge (n = 204, 48%), leadership skills (n = 105, 24%) and communication skills (n = 114, 17%). Women valued stress management (n = 33, 26%) more than leadership (n = 24, 19%) Technical knowledges were more valued among first-time responders (n = 168, 82%) compared to experienced responders (n = 108, 54%, p-value < 0.001). The most reported lacked skills were mental preparedness (n = 237, 53%), knowledge of the management system of international response (n = 132, 30%), stress management (n = 105, 24%) and leadership (n = 102, 23%).

Conclusion
The results showed slightly different needs in the various phases of a response, as well as some differences between men and women. Improving mental preparedness was not one of the most highly valued skills, but it was one of the skills that was most lacking; this discrepancy is an interesting finding. More in-depth analysis and additional studies are needed to further understand how best to prepare disaster responders and how their training can include the desirable skills. Further studies should be focused on the experience and knowledge of qualified disaster responders. This knowledge could also be of use when recruiting since several of the non-technical skills are not only gained solely through specific training.
Dental anxiety and dental care - a comparison between Albania and Germany
Authors: Cunoti Nertsa , Qorri Rezart , Irmscher Lisa , Qorri Erda , Magerfleisch Laura , Berth Hendrik 
Published: September 2024

Abstract
Background
The present study is the first in Albania on dental fear and dental anxiety and also in the field of psychosocial medicine. The purpose of this study was to find out whether there are differences in dental anxiety using the Dental Anxiety Scale, their level of psychological distress using the Brief Symptom Inventory-18 and the evaluation of oral health among Albanian and German patients.

Methods
This study was conducted in the period from December 2019 to July 2020, a sample of N = 263 patients (133 Germans, 130 Albanians) using the Dental Anxiety Scale questionnaires to determine anxiety before dental treatment and the Brief Symptom Inventory-18 to evaluate psychological distress. Moreover, the patients answered questions regarding their oral health and dental care. In Germany, there were four refusals to entrance in the study due to various reasons, in contrast to Albania, where there were no refusals at all For the purposes of this study, data on both populations aged 14 years and older were used.

Results
The questionnaires results were calculated for all participants. The current subjective health status of Albanian patients was assessed to be significantly worse than that of German patients (p < 0,000). Germans were more susceptible to signs of Anxiety (p < 0,000), Depression and Somatization and scored higher on the Dental Anxiety Scale and the Global Severity Index (p < 0,000) than Albanian patients. Additionally Albanian patients scored significantly lower on the preventive care index (p < 0,000). Despite an elevated DAS anxiety level, German patients reported going to the dentist more frequently than Albanian patients.

Conclusion
The results showed that between both populations differences in dental anxiety, psychological distress and oral health exists. Patients from Germany report more psychological distress and described more dental anxiety compared to Albanian patients. Albanian patients reported not utilization on oral health care.The implementation of educational programs and preventive measures, would contribute to raising awareness about the importance of oral health and increased use of dental services.
Development of a maturity model for demand and capacity management in healthcare
Authors: Myrberg Karin , Wiger Malin , Björkman Annica 
Published: September 2024

Abstract
Background
The aim of this paper is to develop a maturity model (MM) for demand and capacity management (DCM) processes in healthcare settings, which yields opportunities for organisations to diagnose their planning and production processes, identify gaps in their operations and evaluate improvements.

Methods
Informed by existing DCM maturity frameworks, qualitative research methods were used to develop the MM, including major adaptations and additions in the healthcare context. The development phases for maturity assessment models proposed by de Bruin et al. were used as a structure for the research procedure: (1) determination of scope, (2) design of a conceptual MM, (3) adjustments and population of the MM to the specific context and (4) test of construct and validity. An embedded single-case study was conducted for the latter two - four units divided into two hospitals with specialised outpatient care introducing a structured DCM work process. Data was collected through interviews, observations, field notes and document studies. Thematic analyses were carried out using a systematic combination of deductive and inductive analyses - an abductive approach - with the MM progressing with incremental modifications.

Results
We propose a five-stage MM with six categories for assessing healthcare DCM determined in relation to patient flows (vertical alignment) and organisational levels (horizontal alignment). Our application of this model to our specific case indicates its usefulness in evaluating DCM maturity. Specifically, it reveals that transitioning from service activities to a holistic focus on patient flows during the planning process is necessary to progress to more advanced stages.

Conclusion
In this paper, a model for assessing healthcare DCM and for creating roadmaps for improvements towards more mature levels has been developed and tested. To refine and finalise the model, we propose further evaluations of its usefulness and validity by including more contextual differences in patient demand and supply prerequisites.
Registered nurse case managers’ work experiences with a person-centered collaborative healthcare model: an interview study
Authors: Hjelm Markus , Andersson Anna , Ujkani Venera , Andersson Ewa Kazimiera 
Published: September 2024

Abstract
Background
Multimorbidity is increasingly acknowledged as a significant health concern, particularly among older individuals. It is associated with a decline in quality of life and psychosocial well-being as well as an increased risk of being referred to multiple healthcare providers, including more frequent admissions to emergency departments. Person-centered care interventions tailored to individuals with multimorbidity have shown promising results in improving patient outcomes. Research is needed to explore how work practices within integrated care models are experienced from Registered Nurse Case Managers’ (RNCMs) perspective to identify areas of improvement. Therefore, the aim of this study was to describe RNCMs’ work experience with a person-centered collaborative healthcare model (PCCHCM).

Methods
This study used an inductive design. The data were collected through individual interviews with 11 RNCMs and analyzed using qualitative content analysis.

Results
Data analysis resulted in four generic categories: ‘Being a detective, ‘Being a mediator’, ‘Being a partner’, and ‘Being a facilitator of development’ which formed the basis of the main category ‘Tailoring healthcare, and social services to safeguard the patient’s best.’ The findings showed that RNCMs strive to investigate, identify, and assess older persons’ needs for coordinated care. They worked closely with patients and their relatives to engage them in informed decision-making and to implement those decisions in a personalized agreement that served as the foundation for the care and social services provided. Additionally, the RNCMs acted as facilitators of the development of the PCCHCM, improving collaboration with other healthcare professionals and enhancing the possibility of securing the best care for the patient.

Conclusions
The results of this study demonstrated that RNCMs tailor healthcare and social services to provide care in various situations, adhering to person-centered care principles and continuity of care. The findings underline the importance of implementing integrated care models that consider the unique characteristics of each care context and adapt different case managers’ roles based on the patient’s individual needs as well as on the specific needs of the local setting. More research is needed from the patients’ and their relatives’ perspectives to deepen the understanding of the PCCHCM concerning its ability to provide involvement, security, and coordination of care.
Comparative effects of curcumin, nano curcumin and their combination on reproductive traits and spawning performance of red tilapia (Oreochromis Niloticus X O. Mossambicus)
Authors: Eissa El-Sayed Hemdan , Hendam Basma M. , Dighiesh Hagar Sedeek , Abd Elnabi Heba E. , Abd El-Aziz Yasmin M. , Eissa Moaheda E. H. , Abdelnour Sameh A. , Ghanem Sara F. 
Published: September 2024

AbstractCurcumin, the main polyphenol component of turmeric powder, has garnered increasing attention as an effective supplement in fish diets. A comparative trial was conducted to evaluate the impacts of dietary supplementation with different forms of curcumin (free, in combination, or nanoparticles) on hemato-biochemical parameters, reproductive capacity, and related gene expressions of red tilapia (Oreochromis niloticus x O. mossambicus) broodstock. Fish (n = 168) were fed an isonitrogenous (30% CP), isocaloric (18.72 MJ kg − 1) diet containing basal diet (Control), 60 mg kg-1 of either free curcumin (Cur), curcumin/nano-curcumin blend (Cur/NCur), or nano-curcumin (NCur) for 56 days. Red tilapia broodstock (155 ± 5.65 g) were stocked at a male: female ratio of 1:3. Blood samples and gonads were collected to assess hemato-biochemical parameters, reproductive capacity, and related gene expression at the end of the feeding trial. The results indicated that the values of hematological parameters (RBCs, WBCs, hemoglobin), total protein, albumin values, and reproductive hormones (T, LH, and FSH) were significantly increased, while liver function enzymes were decreased in the NCur group (P < 0.05). Reproductive performances (GSI, gonad maturation, total number of fry per female) were significantly improved in the NCur group compared with those in other groups (p < 0.05). The expression of reproductive genes (CYP19A1A, FSHR, LHR, FOXL2A, ESR1, ESR2A, and PGR) were significantly up‐regulated in the gonads of fish fed NCur. Collectively, feeding red tilapia diets containing NCur led to noticeably better results followed by Cur/NCur blend, then free Cur compared to the control diet. These results indicate the superiority of NCur over its free or blended form, suggesting that a diet containing about 60 mg/kg of NCur is beneficial for enhancing hemato-biochemical parameters, improving reproductive performance, and enhancing the gonadal architecture of red tilapia.
Functional benefit of joint surgery in patients with non-vascular Ehlers-Danlos syndrome: results of a retrospective study
Authors: Abihssira Sharon , Benistan Karelle , Nourissat Geoffroy 
Published: September 2024

Abstract
Background
Ehlers-Danlos syndrome (EDS) is a hereditary disease characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Hypermobile EDS (hEDS is the more frequent subtype. Joint surgery may benefit certain patients after failure of medical treatments, but there is no consensus on the optimal surgical management of patients with hEDS. The aims of this retrospective study were to chart the surgical management of patients with hEDS, to determine the role of arthroscopy and to evaluate the functional results of joint surgery, including the reintervention rates.

Results
A total of 69 patients with non-vascular EDS were evaluated (60 female; 87%). Mean (SD) age at first surgery was 25.6 ± 11.1 years. Among the 69 patients, first surgeries were carried out on the knee (n = 50; 39.4%), ankle (n = 28; 22.0%), shoulder (n = 22; 17.3%), wrist (n = 18; 14.2%) and elbow (n = 9; 7.1%). One-fifth of all first operations (20.8%) were carried out by arthroscopy, most often on the knee (36% of knee surgery cases). At the time of primary surgery, the surgeon was alerted to the diagnosis or suspicion of hEDS in only 33.9% of patients. The rate of reoperations (2 to ≥ 5) was 35.7% (10/28) for the ankle, 40.9% (9/22) for the shoulder, 44.4% (4/9) for the elbow, 50% (9/18) for the wrist and 60% (30/50) for the knee. Local or regional anaesthesia was badly tolerated or ineffective in 27.8%, 36.4% and 66.6% of operations on the wrist, shoulder and elbow, respectively. Overall, the majority of patients (> 70%) were satisfied or very satisfied with their surgery, particularly on the non-dominant side. The lowest satisfaction rate was for shoulder surgery on the dominant side (58.3% dissatisfied).

Conclusions
Surgery for joint instability has a greater chance of success when it is carried out in patients with a known diagnosis of EDS before surgery. The majority of patients were satisfied with their surgery and, with the exception of the knee, there was a low rate of reoperations (≤ 50%). Arthroscopic procedures have an important role to play in these patients, particularly when surgery is performed on the knee.
Spontaneous hepatic hemorrhage as presentation of metastasized papillary thyroid carcinoma: a case report
Authors: Thomasson Jacob , Andersson Bodil , Thompson Lo Hallin , Williamsson Caroline 
Published: September 2024

Abstract
Background
Spontaneous hepatic hemorrhage is a rare condition, most commonly diagnosed in patients with hepatocellular carcinoma or hepatic adenomas, and is seldom caused by metastatic disease. In this case report, we present a patient with spontaneous hepatic hemorrhage due to hepatic metastasis of papillary thyroid carcinoma, an exceptionally rare occurrence.

Case presentation
The patient was a 77-year-old white male with a history of atrial fibrillation treated with apixaban. He presented at a local hospital with abdominal pain and nausea. A CT scan revealed a hepatic lesion in segment 3 with an adjacent hematoma. He was referred to our tertiary center and treated conservatively. Further evaluation revealed an intrathoracic goiter containing a tumorous process diagnosed as a papillary thyroid carcinoma (PTC), and the patient subsequently underwent thyroidectomy. A biopsy of the hepatic lesion confirmed it as a PTC metastasis. Due to worsening abdominal pain and anorexia, the patient underwent subacute hepatic segmental resection. Postoperatively, he developed iodine-refractory disease with disseminated metastasis and passed away 22 months after the initial admission.

Conclusions
To our knowledge, this is the first recorded case of metastasized papillary thyroid carcinoma presenting with spontaneous hepatic hemorrhage—adding to the list of rare causes for this condition.
Pain assessment from facial expression images utilizing Statistical Frei-Chen Mask (SFCM)-based features and DenseNet
Authors: Alphonse Sherly , Abinaya S. , Kumar Nishant 
Published: September 2024

AbstractEstimating pain levels is crucial for patients with serious illnesses, those recovering from brain surgery, and those receiving intensive care etc. An automatic pain intensity estimator is proposed in this study that gathers information about pain and intensity from the user’s expressions. The faces in the database are first cropped using a ‘Chehra’ face detector, which performs well even in wildly uncontrolled environments with a wide range of lighting and position fluctuations. The suggested technique extracts the beneficial and distinct patterns from facial expressions using novel Statistical Frei-Chen Mask (SFCM)-based features and DenseNet-based features. As it offers quick as well as accurate pain identification and pain intensity estimation, the Radial Basis Function Based Extreme Learning Machine (RBF-ELM) is employed for pain recognition and pain intensity level estimation using the characteristics. All the data is kept, updated and protected in the cloud because availability and high-performance decision-making are so important for informing physicians and auxiliary IoT nodes (such as wearable sensors). In addition, cloud computing reduces the time complexity of the training phase of Machine Learning algorithms in situations where it is possible to build a complete cloud/edge architecture by allocating additional computational resources and memory in use. The facial expression images from the UNBC-McMaster Shoulder Pain Expression Archive and 2D face dataset are used to test the proposed method. The measurement of pain intensity uses four stages. When compared to the results from the literature, the proposed work attains enhanced performance.
Characteristics of high-dose benzodiazepine use: nationwide cohort study on new benzodiazepine users with 5-year follow-up
Authors: Särkilä Hanna , Taipale Heidi , Tanskanen Antti , Kurko Terhi , Taiminen Tero , Tiihonen Jari , Sund Reijo , Saastamoinen Leena , Hietala Jarmo , Niemelä Solja 
Published: September 2024

Background
A nationwide register-based cohort study from Finland including 48 124 incident benzodiazepines and related drug (BZDR) users aged 18–65 years who initiated use in 2006 and were not dispensed BZDRs during 2004–2005. The follow-up was 5 years or until death, whichever occurred first.

Aims
To investigate sociodemographic and clinical factors associated with high-dose use of BZDRs (i.e. Z-drugs) among new BZDR users.

Method
The temporal BZDR dose was calculated as a point estimate every 6 months after initiation as defined daily doses (DDDs) per day, based on the PRE2DUP method (an approach based on mathematical modelling of personal drug purchasing behaviours). Sociodemographic and clinical factors associated with dose categories were studied using multinomial logistic regression.

Results
During the 5-year follow-up, very high-dose BZDR use was observed in 7.4% (n = 3557) and medium high-dose use in 25.5% (n = 12 266) of the users (corresponding to ≥30 mg and 10–29 mg in diazepam equivalents, respectively). Very high-dose use was more common among men compared with women (10.9% versus 4.6%). Very high-dose use patterns were especially observed in younger age groups (18- to 25-year-olds). Compared with oxazepam, initiating BZDR use with clonazepam (adjusted odds ratio 3.86, 95% CI 3.24–4.60), diazepam (2.05, 1.78–2.36) or alprazolam (1.76, 1.52–2.03) was associated with increased odds for very high-dose use. Both medium high-dose and very high-dose BZDR use were associated with a lower level of education. In all, 58% of very high-dose use occurred in BZDR users who received their first prescription from general practitioners.

Conclusions
Clinicians should be aware of the dose escalation risk especially when prescribing diazepam, alprazolam or clonazepam for psychiatric indications. If BZDRs are needed, our findings suggest favouring oxazepam.