bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impacts of evidence-based nursing combined with enteral nutrition on nutritional status and quality of life in acute cerebral infarction patients: A randomized controlled trial
Authors: Dang Jinfeng , Li Guangling , Wu Qiong , Pian Gaoyan , Wang Zhijun 
Published: December 2023

Objective To explore the impacts of evidence-based nursing (EBN) combined with enteral nutrition (EN) on nutritional status as well as quality of life in acute cerebral infarction (ACI) patients. Methods In this randomized controlled cluster trial, 80 ACI patients admitted to our hospital from January 2021 to December 2022 were selected and randomly separated into study group (SG) and control group (CG), with 40 patients in each group. Patients in CG received routine nursing, and patients in the SG received EBN combined with EN. The neurological function, limb movement ability, nutritional status, anxiety and depression, incidence of complications and quality of life between two groups were compared. Results After intervention, the NIHSS score in the SG was lower than that in the CG (CG = 5.62 ± 0.56, SG = 3.27 ± 0.33. p < .001). The FMA score in the SG was higher compared with the CG (CG = 52.58 ± 5.32, SG = 68.85 ± 6.87. p < .001). The Hb level, TP level and ALB level in the SG were higher relative to the CG ( p < .001). The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores in the SG were lower in comparison with the CG (SAS score: CG = 42.32 ± 4.25, SG = 36.28 ± 3.64; SDS score: CG = 48.27 ± 4.85, SG = 40.06 ± 4.05. p < .001). The incidence of complications in SG was lower than that in CG. Finally, we found that SF-36 scores in the SG in all dimensions were higher than those in the CG (Physiological function: CG = 70.23 ± 7.05, SG = 82.71 ± 8.26. Role function: CG = 66.28 ± 6.64, SG73.39 ± 7.36. Physical pain: CG = 70.67 ± 7.06, SG = 82.69 ± 8.29. General health: CG = 58.74 ± 5.86, SG66.62 ± 6.65. Mental health: CG = 53.68 ± 5.37, SG = 62.39 ± 6.31. Energy: CG = 60.75 ± 6.08, SG = 67.87 ± 6.78. Social function: CG = 76.25 ± 7.25, SG = 85.78 ± 8.59. Emotional function: CG = 61.23 ± 6.15, SG = 75.74 ± 7.56. p < .001). Conclusion EBN combined with EN can improve the nutritional status and the quality of life in ACI patients compared with the traditional routine nursing, and is suggested as a valuable strategy for clinical management of ACI.
Reinforcing mechanisms in compression of LDPE/HDPE foams by the incorporation of ethylene plasma-treated B4C
Authors: Ku-Herrera José de Jesús , Soriano-Corral Florentino , Soria-Arguello Gustavo , Castro Ricardo H. R. , Jiménez-Barrera Rosa Martha , Bolaina-Lorenzo Ena Deyla , Amparán-Estrada Ana Cristina , Durón-Sánchez Lyndon Humberto Israel , Martínez-López Katia Dafne Daniela , Hernández-Murillo Christian Geovanni , Escalera-Velasco Luis Alberto , Vega-Carrillo Héctor René 
Published: December 2023

The role of the incorporation and ethylene plasma surface modification of B4C to reinforce foams based on low-density (LDPE) and high-density (HDPE) polyethylene blends, under compression, is investigated herein. Characterization of B4C was achieved through scanning electron microscopy (SEM), X-ray diffraction, and X-ray photoelectron spectroscopy. Composite foams, containing 0.5, 1.0, and 2.0 wt% of B4C, were characterized by SEM, differential scanning calorimetry, and compression testing. The increase of C-C bonds and the disappearance of oxygen-containing functional groups upon surface treatment confirmed that ethylene polymerizes on B4C forming strong chemical interactions. Both pristine and plasma-treated B4C in LDPE/HDPE foams act as nucleation agents yielding smaller cell size ( d), higher cell density ( N c ), and higher crystallinity ( X c). The reinforcing mechanisms were analyzed considering N c , X c, and the B4C-matrix interactions. The foams reinforced with 2.0 wt% of plasma-treated B4C exhibited the highest improvements, with increments of ∼190% in the elastic modulus, 200% in the yielding strength, and 150% in the toughness at 50% of deformation, retaining the lightweight of the foams without B4C. This study presents valuable insights for developing advanced lightweight foams with improved mechanical properties, particularly for applications in cushioning automotive components, consumer goods, and biomedical devices.
Impacts of ethical climate and ethical sensitivity on caring efficacy
Authors: Tang Fiona Wing Ki , Ng Marques Shek Nam , Choi Kai Chow , Ling Gigi Cheuk Chi , So Winnie Kwok Wei , Chair Sek Ying 
Published: December 2023

Background Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses. Research aim This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on the association between ethical climate and caring efficacy. Research design This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively. Participants and research context The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong. Ethical considerations Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. Results Ethical climate was associated with caring efficacy ( β = 0.340, p < .001) and ethical sensitivity ( β = 0.197, p < .001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy ( β = 0.860, p < .001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect. Conclusions The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses’ caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation.
The Impact of Operative Correction of Equinus in Cerebral Palsy on Gait Patterns
Authors: Horsch Axel , Petzinger Lara , Deisenhofer Julian , Ghandour Maher , Klotz Matthias , Renkawitz Tobias , Putz Cornelia 
Published: December 2023

Background: This study aimed to evaluate gait outcomes and strength following the surgical correction of equinus in cerebral palsy (CP) based on different surgical procedures. We included the Baumann and Strayer procedures, as well as the Achilles tendon lengthening (ATL). Methods: A retrospective analysis was performed in patients with infantile, bilateral CP who received instrumental 3D gait analysis before and after surgical correction (18.66 months postoperatively). Patients were divided into 3 groups: Strayer surgery, Baumann surgery, and ATL. Gait performance and muscle strengths were compared between studied surgeries. Results: A total population of 204 patients (15.43 years) with 341 operated lower limbs (LLs) was analyzed. Dorsiflexion in swing and stance phases significantly improved in all groups postoperatively. The Strayer and the ATL group showed higher postoperative dorsiflexion than the Baumann group. However, no loss of strength was observed with the Baumann method. Maximum power improved in this group postoperatively. An 8.2% loss in calf muscle strength was recorded in the Strayer group. Conclusion: Operative pes equinus treatment successfully improved the gait of children and adults with CP postoperatively. There were differences in postoperative results between studied operative techniques regarding range of motion and power. Level of Evidence: Level III, retrospective cohort study.
Single Exercise for Core Symptoms and Executive Functions in ADHD: A Systematic Review and Meta-Analysis
Authors: Chen Ji-Wei , Zhu Kun 
Published: December 2023

Objectives: A systematic review and meta-analysis of studies of single exercise on core symptoms and executive function in adolescents with ADHD. Methods: Four databases were searched for studies of the effects of single exercise on core symptoms and executive functioning in adolescents with ADHD. Results: Thirteen studies were included, and a single session of exercise had small effect-size improvements in core symptoms and executive function in adolescents with ADHD: 10 to 13 year olds in the early adolescent–elementary school years and 18 to 24 year olds in the late adolescent–college years. Moderate-intensity continuous training, high-intensity interval training, single sessions of less than 30 minutes, and single sessions of 30 minutes and more significantly improved cycling training, attention, inhibition, substance use, and pre-study abstinence. Conclusions: A single session of exercise had an overall ameliorative effect on core symptoms and executive function in adolescents with ADHD.
Measuring Quality Care for Adult ADHD Patients: How Much Does Gender and Gender Identity Matter?
Authors: Clay Tarin , Callen Elisabeth F. , Alai Jill , Goodman David W. , Adler Lenard A. , Faraone Stephen V. 
Published: December 2023

Objective: Studies show adult ADHD presents differently in men and women, however few studies contrast ADHD in cisgender and gender diverse adults. We assessed care differences between these groups using previously identified quality measures (QMs). Methods: Using EHR data, we matched a group of male ADHD patients to a female group. We followed the same procedure with a cisgender group and one identified as gender diverse through a gender dysphoria diagnosis. QM achievement was measured using logistic regression models. Results: Most QMs exhibited increasing achievement over time for all groups. Variations in care quality between males and females persisted, with female patients achieving QMs more often. There were no appreciable differences between the cisgender and gender diverse groups. Conclusion: Though quality care for adult ADHD improved from 2010 to 2020, differences between male and female patients lingered. This effect was not observed in cisgender and gender diverse patients.
Does Indoxyl Sulfate Have a Role in Uremic Pruritus? A Laboratory and Interventional Study
Authors: Akl Essam Mohamed , El-Eraki Jeylan M. , Elfallah Assma A. , Mohamed Nelly H. , Maher Amr M. , Mansour Ahmed E. , Abdelsalam Osama H. 
Published: December 2023

Background: Pruritus is a common complaint in patients with end-stage renal disease. Indoxyl sulfate (IS) is a tryptophan end metabolite extremely renal excreted. Activated charcoal can interfere with IS intestinal absorption. Objectives: To evaluate the serum level of IS and the effect of activated charcoal on uremic pruritus. Materials and Methods: In all, 135 participants were divided into 2 main groups. In total, 45 normal and healthy individuals as a control group and 90 patients on regular hemodialysis; 45 of these patients had uremic pruritus and the other 45 were not complaining of uremic pruritus. Serum IS was measured. Activated charcoal was used by patients with uremic pruritus. The severity of pruritus and Dermatology Life Quality Index (DLQI) were assessed. Results: The serum IS was significantly elevated in uremic patients than in control subjects ( P < .001) and significantly elevated in uremic patients without pruritus ( P < .001). Furthermore, there were positive significant correlations between the serum IS and both severity of pruritus ( P < .001) and DLQI ( P < .001). After activated charcoal usage, there was a significant decrease in IS level with the improvement of pruritus and quality of life of patients. Conclusions: IS may play a role in uremic pruritus. Activated charcoal could be considered a treatment for uremic pruritus.
Inclusion of autistic students in schools: Knowledge, self-efficacy, and attitude of teachers in Germany
Authors: Wittwer Jörg , Hans Sandra , Voss Thamar 
Published: December 2023

To provide inclusive education to autistic students, it is important that teachers possess knowledge about autism, feel competent in teaching autistic students, and have a positive attitude toward the inclusion of autistic students. In this study, we explored knowledge, self-efficacy, and attitude concerning autism among N = 887 teachers in Germany. The results showed that knowledge about autism was only moderate and teachers held some typical misconceptions about autism. Moreover, teachers did not possess overwhelmingly high self-efficacy beliefs whereas their attitude toward inclusion of autistic students was rather positive. Experience with teaching autistic students was associated with more knowledge and higher self-efficacy. Also, female teachers were more knowledgeable about autism and felt more competent in teaching autistic students than male teachers. However, the type of school where teachers were working made hardly any difference in their knowledge, self-efficacy, and attitude. Overall, the results suggest that teachers in Germany need more autism training to increase their knowledge about autism and their self-efficacy beliefs in teaching autistic students. Lay Abstract Nowadays, autistic students are often enrolled in mainstream schools. To successfully include autistic students in general education, teachers need to possess knowledge about autism, feel competent in teaching autistic students, and have a positive attitude toward their inclusion. However, in Germany, little is known about the knowledge, the self-efficacy, and the attitude concerning autism among teachers working at mainstream schools. Therefore, we conducted a study in which we used items to assess knowledge, self-efficacy, and attitude. A total of 887 general education teachers participated in the study. The results showed that the level of knowledge about autism was moderate among teachers. Similarly, teachers did not hold overwhelmingly high self-efficacy beliefs. However, their attitude toward inclusion of autistic students was rather positive. At the same time, teachers who had experience with teaching autistic students possessed more knowledge and higher self-efficacy than teachers who had no experience with teaching autistic students. In addition, female teachers were more knowledgeable about autism and felt more competent in teaching autistic students than male teachers. In contrast, knowledge, self-efficacy, and attitude were rather similar among teachers from different types of schools. The findings suggest that teachers in Germany should possess more knowledge about autism and feel more competent in teaching autistic students. Therefore, it is important to systematically include autism trainings in teacher education programs.
The Novel Surgical Technique in the Cyanoacrylate Closure for Incompetent Great Saphenous Veins
Authors: Lee Changhun 
Published: December 2023

Objective The current Instructions for Use (IFU) of cyanoacrylate closure (CAC) is to start initial injection with the catheter tip positioned 5 cm distal to the sapheno-femoral junction (SFJ) to prevent endovenous glue-induced thrombosis (EGIT). However, this defensive design is responsible for the relatively long stump length. Although clinical studies on the long-term recurrence rate are still lacking, the long stump length can predict a higher long-term recurrence rate compared to other surgical methods. The author developed a novel surgical technique that can overcome the weakness of CAC, and the initial outcomes of this technique are described in this article. Methods This study retrospectively reviewed 25 great saphenous vein (GSV) in 20 patients who underwent CAC for incompetent GSV at our hospital. The procedure from puncturing the GSV to insertion of the catheter is the same as the conventional method. Place the catheter tip 2-3 cm below the SFJ before cyanoacrylate injection. After confirming the position of the SFJ with the longitudinal view of the ultrasound, press the GSV directly above the SFJ transversely with the second to fifth fingertips of the left hand. Then, the ultrasound probe is placed against the distal part of the fingertips, and CA injection is performed while GSV is monitored in real time. Results The mean stump length immediately after surgery was 19.3 (± 7.8) mm, with a range of .0-38.4 mm. The mean stump length after 1 week was 12.3 (± 7.4) mm and the range was .1-35.4 mm. The mean stump length after 1 month was 15.4 (± 10.1) mm, and the range was .0-35.4 mm. There was no case with EGIT or recanalization. Conclusions The author confirmed the possibility of safely reducing stump length with this novel surgical technique, and expect that this method can help overcome the weakness of CAC.
The incidence and risk factors of proximal lower extremity deep vein thrombosis without pharmacologic prophylaxis in critically ill surgical Taiwanese patients: A prospective study
Authors: Lin Ting-Lung , Liu Wen-Hao , Lai Wei-Hung , Chen Ying-Ju , Chang Po-Hsun , Chen I-Ling , Li Wei-Feng , Liu Yueh-Wei , Ley Eric J , Wang Chih-Chi 
Published: December 2023

Background: Venous thromboembolism (VTE) in critically ill patients has been well-studied in Western countries. Many studies have developed risk assessments and established pharmacological protocols to prevent deep venous thrombosis (DVT). However, the DVT rate and need for pharmacologic VTE prophylaxis in critically ill Taiwanese patients are limited. This study aimed to prospectively determine the DVT incidence, risk factors, and outcomes in critically ill Taiwanese patients who do not receive pharmacologic VTE prophylaxis. Methods: We conducted a prospective study in a surgical intensive care unit (SICU) of a tertiary academic medical center in Taiwan. Adult patients admitted to SICU from March 2021 to June 2022 received proximal lower extremities DVT surveillance with venous duplex ultrasound. No patient received pharmacologic VTE prophylaxis. The outcomes were the incidence and risk factors of DVT. Results: Among 501 enrolled SICU patients, 21 patients (4.2%) were diagnosed with proximal lower extremities DVT. In a multivariate regression analysis, hypoalbuminemia (odd ratio (OR) = 6.061, 95% confidence interval (CI): 1.067–34.421), femoral central venous catheter (OR = 4.515, 95% CI: 1.547–13.174), ICU stays more than 10 days (OR = 4.017, 95% CI: 1.270–12.707), and swollen leg (OR = 3.427, 95% CI: 1.075–10.930) were independent risk factors for DVT. In addition, patients with proximal lower extremities DVT have more extended ventilator days ( p = 0.045) and ICU stays ( p = 0.044). Conclusion: Our findings indicate critically ill Taiwanese patients have a higher incidence of DVT than results from prior retrospective studies in the Asian population. Physicians who care for this population should consider the specific risk factors for DVT and prescribe pharmacologic prophylaxis in high-risk groups.
EPidemiology Of Cardiogenic sHock in Scotland (EPOCHS): A multicentre, prospective observational study of the prevalence, management and outcomes of cardiogenic shock in Scotland
Authors: Warren Alex , McCall Philip , Proudfoot Alastair , Gillon Stuart , Abu-Arafeh Ahmad , McKnight Angus John , Mudie Rosemary , Armstrong David , Tzolos Evangelos , Livesey John Andrew , Sinclair Andrew , Baston Veronica , Dalzell Jonathan , Owen Deborah , Fleming Lucy , Scott Ian , Puxty Alex , Lee Matthew MY , Walker Fiona , Hobson Simon , Campbell Euan , Kinsella Michael , McGinnigle Eilidh , Docking Robert , Price Grant , Ramsay Alex , Bauld Richard , Herron Suzanne , Lone Nazir I , Mills Nicholas L , Hartley Louise 
Published: December 2023

Background: Despite high rates of cardiovascular disease in Scotland, the prevalence and outcomes of patients with cardiogenic shock are unknown. Methods: We undertook a prospective observational cohort study of consecutive patients with cardiogenic shock admitted to the intensive care unit (ICU) or coronary care unit at 13 hospitals in Scotland for a 6-month period. Denominator data from the Scottish Intensive Care Society Audit Group were used to estimate ICU prevalence; data for coronary care units were unavailable. We undertook multivariable logistic regression to identify factors associated with in-hospital mortality. Results: In total, 247 patients with cardiogenic shock were included. After exclusion of coronary care unit admissions, this comprised 3.0% of all ICU admissions during the study period (95% confidence interval [CI] 2.6%–3.5%). Aetiology was acute myocardial infarction (AMI) in 48%. The commonest vasoactive treatment was noradrenaline (56%) followed by adrenaline (46%) and dobutamine (40%). Mechanical circulatory support was used in 30%. Overall in-hospital mortality was 55%. After multivariable logistic regression, age (odds ratio [OR] 1.04, 95% CI 1.02–1.06), admission lactate (OR 1.10, 95% CI 1.05–1.19), Society for Cardiovascular Angiographic Intervention stage D or E at presentation (OR 2.16, 95% CI 1.10–4.29) and use of adrenaline (OR 2.73, 95% CI 1.40–5.40) were associated with mortality. Conclusions: In Scotland the prevalence of cardiogenic shock was 3% of all ICU admissions; more than half died prior to discharge. There was significant variation in treatment approaches, particularly with respect to vasoactive support strategy.
The fragility index in randomised controlled trials of interventions for aneurysmal subarachnoid haemorrhage: A systematic review
Authors: Ramesh Aravind V , Munby Henry NP , Thomas Matt 
Published: December 2023

Background: Fragility analysis supplements the p-value and risk of bias assessment in the interpretation of results of randomised controlled trials. In this systematic review we determine the fragility index (FI) and fragility quotient (FQ) of randomised trials in aneurysmal subarachnoid haemorrhage. Methods: This is a systematic review registered with PROSPERO (ID: CRD42020173604). Randomised controlled trials in adults with aneurysmal subarachnoid haemorrhage were analysed if they reported a statistically significant primary outcome of mortality, function (e.g. modified Rankin Scale), vasospasm or delayed neurological deterioration. Results: We identified 4825 records with 18 randomised trials selected for analysis. The median fragility index was 2.5 (inter-quartile range 0.25–5) and the median fragility quotient was 0.015 (IQR 0.02–0.039). Five of 20 trial outcomes (25%) had a fragility index of 0. In seven trials (39.0%), the number of participants lost to follow-up was greater than or equal to the fragility index. Only 16.7% of trials are at low risk of bias. Conclusion: Randomised controlled trial evidence supporting management of aneurysmal subarachnoid haemorrhage is weaker than indicated by conventional analysis using p-values alone. Increased use of fragility analysis by clinicians and researchers could improve the translation of evidence to practice.