bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical student motivation in specialised contexts
Authors: Frumm Stacey M. , Brondfield Sam 
Published: December 2023

AbstractPurposeDuring their clinical years, medical students rotate in diverse environments, each with unique factors motivating or demotivating learning. Student motivation to learn in specialised clinical settings has not been robustly described. One framework to understand motivation to learn is self‐determination theory (SDT), which posits that intrinsic motivation requires fulfilment of three innate psychological needs: competence, relatedness and autonomy. Referencing SDT, the authors aimed to understand factors influencing student motivation to learn in the specialised context of internal medicine (IM) subspecialty consult services, with the goal of optimising teaching and learning during these experiences.MethodFocus groups were conducted with 12 fourth‐year medical students who had completed at least one inpatient IM subspecialty consult elective at the University of California, San Francisco, in 2020–2021. Students discussed factors that promoted and hindered their learning and motivation. The authors performed abductive thematic analysis using SDT as a sensitising framework.ResultsThree themes were identified and provided insight into how student motivation to learn can be supported: teaching at the appropriate level; integration into the team and workflow; and self‐directed learning and career exploration. These themes were overlaid onto the needs of SDT, demonstrating that, in specialised clinical contexts, fulfilment of the needs is interconnected.ConclusionThis study provided insight into how students' innate needs can be satisfied in the learning environment of IM subspecialty consult electives, thereby promoting students' intrinsic motivation. Based on insights from the study, the authors offer recommendations for how educators can optimise student motivation to learn.
Serotype and anti‐microbial resistance trends among bovine Salmonella isolates from samples submitted to a veterinary diagnostic laboratory in central New York, 2007–2021
Authors: Craig Maya J. , Cummings Kevin J. , Aprea Melissa S. , Franklin‐Guild Rebecca J. , Altier Craig 
Published: December 2023

AbstractAimsSalmonella enterica is a leading cause of acute enteritis in people, and dairy cattle are an important reservoir of this pathogen. The objective of this study was to analyse serotype and anti‐microbial resistance trends of Salmonella isolated from dairy cattle in the United States between 2007 and 2021.Methods and ResultsWe collected data for bovine Salmonella isolates obtained from samples submitted to Cornell University's Animal Health Diagnostic Center (AHDC). We analysed 5114 isolates for serotype trends, and a subset of 2521 isolates tested for anti‐microbial susceptibility were analysed for resistance trends. The most frequently identified serotypes were Salmonella Cerro, Dublin, Typhimurium, Montevideo, 4,[5],12:i:‐, and Newport. Among these serotypes, a Cochran–Armitage trend test determined there was a significant increase in the proportion of isolates serotyped as Salmonella Dublin (p < 0.0001) and Montevideo (p < 0.0001) over time. There was a significant decrease in the proportion of isolates serotyped as Salmonella Cerro (p < 0.0001), Typhimurium (p < 0.0001), and Newport (p < 0.0001). For the anti‐microbial resistance (AMR) analysis, we found an overall increase in the proportion of multi‐drug‐resistant isolates over time (p = 0.009). There was a significant increase in the proportion of isolates resistant to ampicillin (p = 0.007), florfenicol (p = 0.0002), and ceftiofur (p < 0.0001) and a marginal increase in resistance to enrofloxacin (p = 0.05). There was a significant decrease in the proportion of isolates resistant to spectinomycin (p = 0.0002), trimethoprim/sulphamethoxazole (p = 0.01), sulphadimethoxine (p = 0.003), neomycin (p < 0.0001), and gentamicin (p = 0.0002).ConclusionsOur results provide evidence of an increase in resistance to key anti‐microbial agents, although the observed trends were driven by the sharp increase in the proportion of Salmonella Dublin isolates over time.
Avoidance of healthcare service use and correlates among HIV-positive patients in Vietnam: a cross-sectional study
Authors: Nguyen Huong Lan Thi , Bui Thu Minh , Dam Vu Anh Trong , Nguyen Tham Thi , Nguyen Hien Thu , Zeng Ga Mei , Bradley Don , Nguyen Quang N , Ngo Toan Van , Latkin Carl A , Ho Roger CM , Ho Cyrus SH 
Published: December 2023

ObjectiveThe prevention of HIV/AIDS is not making sufficient progress. The slow reduction of HIV/AIDS infections needs to prioritise hesitancy towards service utilisation, including treatment duration, social support and social stigma. This study investigates HIV-positive patients’ avoidance of healthcare services and its correlates.DesignA cross-sectional study.SettingThe secondary data analysis used cross-sectional data from a randomised controlled intervention, examining the effectiveness of HIV-assisted smartphone applications in the treatment of HIV/AIDS patients in the Bach Mai and Ha Dong clinics in Hanoi.MethodsSimple random sampling was used to identify 495 eligible patients. Two-tailed χ2, Mann-Whitney, multivariate logistic and ordered logistic regression models were performed.Primary and secondary outcome measuresThe main study outcome was the patients’ healthcare avoidance and frequency of healthcare avoidance. The association of individual characteristics, social and behavioural determinants of HIV patients’ usage of health services was also determined based on the collected data using structured questionnaires.ResultsNearly half of the participants avoid health service use (47.3%), while 30.7% rarely avoid health service use. Duration of antiretroviral therapy and initial CD4 cell count were negatively associated with avoidance of health services and frequency of health service avoidance. Similarly, those with the middle and highest income were more likely to avoid health services compared with those with the lowest income. People having health problems avoided health service use more frequently (OR 1.47, 95% CI 1.35 to 1.61).ConclusionsOur study’s findings identify characteristics of significance in relation to health service avoidance and utilisation among HIV-positive patients. The results highlighted the need to improve satisfaction, adherence and utilisation of treatment. Moreover, identifying ways to address or incorporate those social determinants in new policy may also help the treatment of HIV/AIDS and strategically allocate funding in the changing financial and political climate of Vietnam.Trial registration numberThai Clinical Trials Registry TCTR20220928003.
Attitude of cardiac surgery nurses on kinesiophobia management: a qualitative study
Authors: Wang YuChen , Chen YuHong , Zhang XiaoMin , Liu SiYu 
Published: December 2023

ObjectivesThis study aimed to investigate the knowledge, attitudes and practical experiences of cardiac surgery nurses regarding kinesiophobia management during early mobilisation.DesignUsing a descriptive qualitative research method, 21 cardiac surgery nurses participated in this study from October 2022 to January 2023, and the interview data were analysed using the Colaizzi 7-step analysis method.SettingData were collected through in-depth face-to-face or online interviews in a tertiary hospital located in Nanjing, China.Participants21 cardiac surgery nurses were interviewed from October 2022 to January 2023.ResultsTwo themes were summarised: knowledge, attitude and practice of nurses (high recognition and low participation; low knowledge reserve; low willingness); the promotion and essential elements of kinesiophobia management (efficient health education model; stable medical staff–family caregiver collaboration; simplified clinical protocol; specialist nursing team; clarify the multidisciplinary division of labour).ConclusionThe management of kinesiophobia in patients undergoing cardiac surgery is currently in the developmental phase. It is advisable to give due consideration to emotional support and cognitive training for medical staff. In addition, a workable management plan, consistent with clinical practice, should be formulated through multidisciplinary and medical staff–family caregiver collaboration to optimise patient outcomes.
Comparative efficacy of acupuncture-related therapy for postmenopausal osteoporosis: protocol for Bayesian network meta-analysis
Authors: Xu Tiantian , Deng Bing , Lin Shen , Wang Hongjin , Xu Yunxiang , Chen Guizhen 
Published: December 2023

IntroductionThe review aims to conduct the first network meta-analysis to comprehensively evaluate the application of multiple acupuncture techniques in patients with postmenopausal osteoporosis, ranking the best acupuncture treatment and providing a reference for clinical treatment extensively.Methods and analysisRandomised controlled trials of different acupuncture-related therapies for postmenopausal osteoporosis will be searched in the following databases from 1 January 2002 to 31 December 2022, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Database and China Biomedical Literature Database. Overall, clinical efficacy rate, bone mineral density and a Visual Analogue Scale score are used as the primary outcome indicators. In addition, the secondary outcome indicator is adverse reactions. The entire screening process will be conducted by two independent investigators; meanwhile, Stata (V.14.0) and RevMan (V.5.4) will be used to conduct the network meta-analysis. If the data are permissible and feasible, we will also perform meta-regression and subgroup analyses to address the underlying causes of data inconsistency and heterogeneity in the statistical analyses. Besides, to improve the credibility of this network meta-analysis, we will evaluate the quality of evidence in this research according to the GRADE assessment.Ethics and disseminationEthics approval is not required for network meta-analyses, which do not involve animals’ or people’s welfare. The results of this network meta-analysis will be submitted to a recognised journal for publication.PROSPERO registration numberCRD42023401003.
Quality improvement initiative to improve communication domains of patient satisfaction in a regional community hospital with Six Sigma methodology
Authors: Carsten Brittan F , Bhandari Pawan , Fortney Benjamin J , Wilmes Danielle S , Nelson Cassandra M , Brien Amy L , Walth Rachel M , Anil Gokhan 
Published: December 2023

BackgroundCommunication gaps, whether incomplete or fragmented communication, have been the cause of many disasters in human civilisation. Coordination of healthcare is directly related to proper communication and handoffs among multidisciplinary teams throughout multiple shifts during a patient’s hospitalisation.Local problemPatient surveys and direct patient feedback at Mayo Clinic Health System in Mankato, Minnesota, indicated that patient communication with physicians and nurses had declined in 2017 and 2018. Viewing this as an opportunity for improvement, our leadership initiated several changes to increase physician and nurse communication with patients, which resulted in no notable improvements.MethodsA systematic quality improvement approach was implemented by using Six Sigma methodology. Stakeholders from multidisciplinary teams were assembled as the project team. The five steps of Six Sigma methodology (Define, Measure, Analyse, Improve and Control) were followed to create a quality improvement intervention.InterventionWe developed a standardised and easy-to-use bedside team rounding tool to improve patient communication with physicians and nurses.ResultsPostintervention patient satisfaction top-box scores exceeded target improvements for both physician (from 78.5% to 82.0%, p<0.01) and nurse (from 80.5% to 83.1%, p=0.04) communication domains. Physicians had a 33-point increase in percentile rank (from 41st to 74th percentile rank), and nurses had a 25-point increase in percentile rank (from 59th to 84th percentile rank). This increase in communication ranked our institution at the top of national benchmark organisations.ConclusionsOverwhelmingly positive patient feedback was achieved, and postintervention employee satisfaction was primarily positive when compared with preintervention satisfaction.
Designing a Behaviour Change Wheel guided implementation strategy for a hypoxaemic respiratory failure and ARDS care pathway that targets barriers
Authors: Parhar Ken Kuljit S , Knight Gwen E , Soo Andrea , Bagshaw Sean M , Zuege Danny J , Niven Daniel J , Fiest Kirsten M , Stelfox Henry T 
Published: December 2023

BackgroundA significant gap exists between ideal evidence-based practice and real-world application of evidence-informed therapies for patients with hypoxaemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS). Pathways can improve the quality of care provided by helping integrate and organise the use of evidence informed practices, but barriers exist that can influence their adoption and successful implementation. We sought to identify barriers to the implementation of a best practice care pathway for HRF and ARDS and design an implementation science-based strategy targeting these barriers that is tailored to the critical care setting.MethodsThe intervention assessed was a previously described multidisciplinary, evidence-based, stakeholder-informed, integrated care pathway for HRF and ARDS. A survey questionnaire (12 open text questions) was administered to intensive care unit (ICU) clinicians (physicians, nurses, respiratory therapists) in 17 adult ICUs across Alberta. The Behaviour Change Wheel, capability, opportunity, motivation - behaviour components, and Theoretical Domains Framework (TDF) were used to perform qualitative analysis on open text responses to identify barriers to the use of the pathway. Behaviour change technique (BCT) taxonomy, and Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side effects and safety and Equity (APEASE) criteria were used to design an implementation science-based strategy specific to the critical care context.ResultsSurvey responses (692) resulted in 16 belief statements and 9 themes with 9 relevant TDF domains. Differences in responses between clinician professional group and hospital setting were common. Based on intervention functions linked to each belief statement and its relevant TDF domain, 26 candidate BCTs were identified and evaluated using APEASE criteria. 23 BCTs were selected and grouped to form 8 key components of a final strategy: Audit and feedback, education, training, clinical decision support, site champions, reminders, implementation support and empowerment. The final strategy was described using the template for intervention description and replication framework.ConclusionsBarriers to a best practice care pathway were identified and were amenable to the design of an implementation science-based mitigation strategy. Future work will evaluate the ability of this strategy to improve quality of care by assessing clinician behaviour change via better adherence to evidence-based care.
Association between single leg hop tests and patient reported outcome measures and patellar instability in patients with recurrent patellar dislocations
Authors: Nilsgård Tina Løkken , Øiestad Britt Elin , Randsborg Per-Henrik , Årøen Asbjørn , Straume-Næsheim Truls Martin 
Published: December 2023

ObjectivesTo assess the associations between the single leg hop tests at two premises; baseline and the change after 12 months, and change in patient reported outcome measures and persistent instability after 12 months in patients with recurrent lateral patellar dislocation (RLPD).Methods61 RLPD patients aged 12–30 with a mean (±SD) of 19.2 (±5.3) were assessed at baseline, and at 12 months after treatment with either active rehabilitation alone, or medial patellofemoral ligament reconstruction and active rehabilitation. Single leg hop for distance, triple hop for distance, crossover hop for distance and 6-metre timed hop were performed for both legs, and the Limb Symmetry Index (LSI) was calculated. Persistent patellar instability was self-reported as ‘Yes’ or ‘No’ at 12-month follow-up. Knee function in sport and recreational activities and knee-related quality of life were assessed at baseline and 12 months follow-up using the Knee injury and Osteoarthritis Outcome Score (KOOS).ResultsLSI for the baseline single leg hop for distance and the triple hop for distance was significantly associated with persistent patellar instability at 12 months follow-up with an OR of 0.94 (95% CI 0.88 to 0.99) and OR of 0.91 (95% CI 0.84 to 0.99), respectively. No other statistically significant associations were detected.ConclusionIndividuals with higher LSI values for the single leg hop for distance and triple hop for distance conducted at baseline had lower odds for persistent patellar instability at 12 months follow-up. Clinicians can use results from these hop tests to assess the risk of future recurrent patellar instability prior to treatment.Study designRetrospective cohort study.Trial registration numberNCT02263807.
Cognitive trajectory in the first year after first-ever ischaemic stroke in young adults: the ODYSSEY study
Authors: Schellekens Mijntje M I , Springer Ravi C S , Boot Esther M , Verhoeven Jamie I , Ekker Merel S , van Alebeek Mayte E , Brouwers Paul J A M , Arntz Renate M , van Dijk Gert W , Gons Rob A R , van Uden Inge W M , den Heijer Tom , van Tuijl Julia H , de Laat Karlijn F , van Norden Anouk G W , Vermeer Sarah E , van Zagten Marian S G , Van Oostenbrugge Robert J , Wermer Marieke J H , Nederkoorn Paul J , van Rooij Frank G , van den Wijngaard Ido R , de Kort Paul L M , De Leeuw Frank-Erik , Kessels Roy P C , Tuladhar Anil M 
Published: December 2023

BackgroundLimited data exists on cognitive recovery in young stroke patients. We aimed to investigate the longitudinal course of cognitive performance during the first year after stroke at young age and identify predictors for cognitive recovery.MethodsWe conducted a multicentre prospective cohort study between 2013 and 2021, enrolling patients aged 18–49 years with first-ever ischaemic stroke. Cognitive assessments were performed within 6 months and after 1 year following the index event, covering seven cognitive domains. Composite Z-scores using normative data determined cognitive impairment (Z-score<−1.5). A Reliable Change Index (RCI) assessed cognitive recovery (RCI>1.96) or decline (RCI<−1.96).Results393 patients (median age 44.3 years, IQR 38.4–47.2) completed cognitive assessments with a median time interval of 403 days (IQR 364–474) between assessments. Based on RCI, a similar proportion of patients showed improvement and decline in each cognitive domain, while the majority exhibited no cognitive change. Among cognitively impaired patients at baseline, improvements were observed in processing speed (23.1%), visuoconstruction (40.1%) and executive functioning (20.0%). Younger age was associated with better cognitive recovery in visuoconstruction, and larger lesion volume was related to cognitive recovery in processing speed. No other predictors for cognitive recovery were identified.ConclusionsCognitive impairment remains prevalent in young stroke even 1 year after the event. Most patients showed no cognitive change, however, recovery may have occurred in the early weeks after stroke, which was not assessed in our study. Among initially cognitively impaired patients, cognitive recovery is observed in processing speed, visuoconstruction and executive functioning. It is still not possible to predict cognitive recovery in individual patients.
Association between servant leadership and nurses’ turnover intention: evidence from Jordan
Authors: Alolayyan Main Naser , Nusairat Farid T , Abualhuda Serien A , Azar Suad 
Published: December 2023

BackgroundNurses’ turnover has remained a concern in the healthcare sector worldwide. Nurse managers should adopt appropriate leadership styles that promote a positive working environment. The literature revealed that effective leadership styles have lower turnover rates and higher job satisfaction among nurses in healthcare settings.AimThis research aims to investigate whether a direct association exists between servant leadership and nurse turnover in public and private hospitals. While conventional leadership prioritises organisational success, servant leadership works on employee empowerment, growth and engagement, to secure success and trust among healthcare workers.MethodA quantitative, cross-sectional study has been performed among 400 nurses from private and public hospitals in the northern parts of Jordan. A self-administered written survey was administered to those nurses in their departments. Structural equation modeling (SEM) using was used to analyse the data.ResultsFindings revealed that servant leadership had a negative direct impact on nurse turnover intention. Servant leadership prioritises employee empowerment of nurses in their workplaces.ConclusionHealthcare agencies and healthcare professional organisations could use the study findings to understand better what influences nurses’ decisions and behaviours and what causes them to resign. Further findings of this study may assist nurse managers in developing appropriate retention strategies and reducing the likelihood of nurses resigning.
Ultrasound estimates of the epidural depth in the paramedian sagittal oblique and transverse median planes: the correlation between estimated and actual depth to the epidural space in children with scoliosis
Authors: Choi Yong Seon , Jang Jaewon , Kim Ha Yan , Lee Bora , Kim Eun Jung , Yoon Hei Jin , Lee Jongyun , Kim Hye Jin 
Published: December 2023

IntroductionThe present study aimed to compare the correlation and agreement of epidural depth estimation using ultrasound in the paramedian sagittal oblique (PSO) versus the transverse median (TM) plane relative to the actual epidural depth observed during midline epidural punctures in children with scoliosis.MethodsIn this prospective observational study, we enrolled 55 children aged 3–14 years with thoracolumbar scoliosis (Cobb angle >10°) requesting postoperative epidural analgesia. Ultrasound imaging was performed to estimate the distance from the skin to the epidural space in the bilateral PSO and TM planes. An anesthesiologist performed midline epidural puncture and measured the actual epidural depth from the skin to the epidural space. The correlation and degree of agreement between the ultrasound-estimated and actual epidural depths were investigated using Pearson’s and concordance correlation coefficients. The image quality of the ligamentum flavum and posterior dura mater was compared.ResultsIn the PSO view, where the larger of the two measurements from both sides was used, both Pearson’s and concordance correlation coefficients for comparing the actual epidural and ultrasound-estimated depths were significantly higher than those in the TM view (0.964 vs 0.930, p value=0.002; 0.952 vs 0.892, p value=0.004, respectively). The ligamentum flavum-posterior dura mater unit was more easily distinguished in the PSO view than in the TM view (72.7% vs 38.2%, p value<0.001).ConclusionsThe PSO view can be a reliable guide to facilitate epidural puncture in children with scoliosis with better visualization.Trial registration numberNCT04877964.