bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of the Covid-19 pandemic on the management of gynecologic cancer: a Spanish survey. Observational, multicenter study
Authors: Gracia Myriam , Rodríguez Elena , Diestro María Dolores , Spagnolo Emanuela , García Virginia , Siegrist Jaime , Pérez Yolanda , Zapardiel Ignacio , Hernández Alicia 
Published: September 2023

Abstract
Background
The SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic changed the distribution of healthcare resources, leading in many cases to the suspension of all non-essential treatments and procedures and representing a challenge for medical professionals. The objective of this study was to evaluate whether clinical protocols in gynecologic oncology care were modified as a result of the pandemic and to assess surgeons’ perceptions regarding the management of gynecologic cancers".

Methods
Data were collected through an anonymous and voluntary survey sent via email to healthcare professionals in the field of gynecologic oncology in Spain.

Results
A total of 75 gynecologic oncologists completed the online survey. Of these, 93.2% (69) reported working in public hospitals and 62.5% (45) in tertiary care hospitals. 97.3% (71) were affiliated with hospitals treating patients infected with SARS-CoV-2. 85.1% (63) of the respondents expressed concern about the SARS-CoV-2 pandemic and 52.1% (38) indicated that the pandemic impacted the diagnostic and therapeutic quality of care for oncology patients. SARS-CoV-2 nasopharyngeal swab PCR (Polymerase Chain Reaction) testing was always performed before surgical interventions by 97.3% (71), being considered a best practice in triage by 94.4% (68). 87.5% (63) reported no change in the type of surgical approach during the pandemic. 62.5% (45) experienced limitations in accessing special personal protective equipment for SARS-CoV-2. An impact on the follow-up of patients with gynecologic cancers due to the pandemic was reported by 70.4% (50).

Conclusions
Most of the Spanish gynecologic oncologists who responded to our survey reported that the SARS-CoV-2 pandemic had affected their clinical practice. The primary measures implemented were an increase in telemedicine, restricting outpatient visits to high-risk or symptomatic patients and the use of SARS-CoV-2 screening prior to surgery. No major changes in the surgical approach or management of the treatment of ovarian, endometrial or cervical cancer during the pandemic were reported.
Flavonoid compound from Agrimonia pilosa Ledeb improves adipose insulin resistance by alleviating oxidative stress and inflammation
Authors: Guo Tingwang , Pan Yun , Yang Lin , Chen Gang , Deng Jia , Zhu Liancai 
Published: September 2023

Abstract
Background
Researches and practice of traditional Chinese medicine indicated that Agrimonia pilosa Ledeb could improve insulin resistance (IR) and treat type 2 diabetes (T2DM). To reveal its underling mechanisms, we isolated Flavonoid component (FC) from Agrimonia pilosa Ledeb and elucidated its effects on glucose metabolism to improve IR by suppressing oxidative stress and inflammation.

Methods
Adipocytes or mice IR model was established with overdosed glucose and insulin or high-fat diet. The uptake of 2-NBDG and glucose consumption were measured to verify insulin sensitivity in vitro and vivo. Reactive oxidative species (ROS) were detected by flow cytometry, and superoxide dismutase (SOD) activity as well as the malondialdehyde (MDA) content were also measured. Meanwhile, factors associated with insulin signal pathway including PPARγ, insulin receptor substrate-1 (IRS-1), GLUT4, and oxidative stress including NF-E2-related factor 2 (Nrf2), as well as the related inflammatory cytokines such as NF-κB, IL-1β, IL-6 and TNF-α were tested. Furthermore, the JNK/PI3K/Akt signal pathway was also explored.

Results
FC extracted from Agrimonia pilosa Ledeb ameliorated the impaired glucose metabolism significantly. Further study indicated that FC could regulate the insulin signal pathway to improve insulin resistance. Moreover, it could upregulate PPARγ with the similar efficacy as pioglitazone (Piog) straightway. FC also decreased the endogenous ROS and MDA content, increased SOD activity and Nrf2 expression to facilitate oxidative homeostasis. It attenuated expression and secretion of inflammatory cytokines obviously. At last, our results indicated JNK/PI3K/Akt pathway was regulated by FC in adipocytes and adipose tissue.

Conclusion
FC could ameliorate glucose metabolism and improve IR. It exerted these effects by suppressing oxidative stress and inflammation. FC from Agrimonia pilosa Ledeb has a good prospect to be drugs or functional foods for IR and T2DM.
Healthcare educational debt in the united states: unequal economic impact within interprofessional team members
Authors: Shields Richard K. , Suneja Manish , Shields Bridget E. , Tofte Josef N. , Dudley-Javoroski Shauna 
Published: September 2023

Abstract
Background
Advancing healthcare access and quality for underserved populations requires a diverse, culturally competent interprofessional workforce. However, high educational debt may influence career choice of healthcare professionals. In the United States, health professions lack insight into the maximum educational debt that can be supported by current entry-level salaries. The purpose of this interprofessional economic analysis was to examine whether average educational debt for US healthcare graduates is supportable by entry-level salaries. Additionally, the study explored whether trainees from minoritized backgrounds graduate with more educational debt than their peers in physical therapy.

Methods
The study modeled maximum educational debt service ratios for 12 healthcare professions and 6 physician specialties, incorporating profession-specific estimates of entry-level salary, salary growth, national average debt, and 4 loan repayment scenarios offered by the US Department of Education Office of Student Financial Aid. Net present value (NPV) provided an estimate for lifetime “economic power” for the modeled careers. The study used a unique data source available from a single profession (physical therapy, N = 4,954) to examine whether educational debt thresholds based on the repayment model varied between minoritized groups and non-minoritized peers.

Results
High salary physician specialties (e.g. obstetrics/gynecology, surgery) and professions without graduate debt (e.g. registered nurse) met debt ratio targets under any repayment plan. Professions with strong salary growth and moderate debt (e.g. physician assistant) required extended repayment plans but had high career NPV. Careers with low salary growth and high debt relative to salary (e.g. physical therapy) had career NPV at the lowest range of modeled professions. 29% of physical therapy students graduated with more debt than could be supported by entry-level salaries. Physical therapy students from minoritized groups graduated with 10–30% more debt than their non-minoritized peers.

Conclusions
Graduates from most healthcare professions required extended repayment plans (higher interest) to meet debt ratio benchmarks. For several healthcare professions, low debt relative to salary protected career NPV. Students from minoritized groups incurred higher debt than their peers in physical therapy.
Psychometric properties of Persian version of individual innovativeness scale among nursing students: a cross-sectional study
Authors: Heydari Naval , Rakhshan Mahnaz , Torabizadeh Camellia , Salimi Ghasem 
Published: September 2023

AbstractBackgroundOne of the basic necessities for fostering innovation in nursing students is to study the level of individual innovation using an appropriate tool. This study was conducted with the aim of translation and psychometric analysis of 20-item individual innovativeness scale (IIS) developed by Hurt et al., among Iranian nursing students.MethodsThis cross-sectional study was performed on 140 nursing students between September 2020 and June 2021 in one of the southern cities of Iran. IIS was translated through forward-backward method, and its face validity and content validity were examined quantitatively and qualitatively. Then, its construct validity was measured by exploratory factor analysis, and its stability and internal consistency were examined.ResultsThe evidence of qualitative face validity and content validity of IIS were observed. The impact score was higher than 1.5, content validity ratio was between 0.6 and 1, content validity index was between 0.8 and 1, and SCVI-Average was 0.91. Based on exploratory factor analysis, three sub-scales were extracted that explained 55.49% of the changes in the questions. Cronbach’s alpha and intraclass correlation coefficient were 0.880 and 0.949, respectively.ConclusionThe Persian version of IIS had acceptable validity and reliability. Therefore, it can be used to assess the level of individual innovation among nursing students and planning interventions in this field. In addition, nursing education researchers can also use this tool for descriptive and interventional studies in the field of individual innovation in nursing students.
The efficacy of an anatomy and ultrasonography workshop on improving residents’ confidence and knowledge in regional anesthesia
Authors: Harmon Derek J. , Boscardin Christy K. , Cohen Neal H. , Braehler Matthias R. 
Published: September 2023

Abstract
Background
Ultrasound Guided Regional Anesthesia (UGRA) has become the standard for regional anesthesia practice, but there is not a standardized educational approach for training residents. The objective of this study was to evaluate the efficacy of an UGRA workshop utilizing the theoretical framework of embodied cognition for anesthesiology residents.

Methods
A workshop was developed consisting of didactics, scanning training on standardized patients (SPs) and anatomy reviews on prosected cadavers that focused on the most common UGRA procedures for the upper and lower extremity. At the beginning of the workshop and at the end of the workshop residents completed pre-test and pre-confidence surveys, as well as post-test and post-confidence surveys, respectively to assess the impact of the workshop.

Results
39 residents (100% of the possible residents) participated in the workshop in 2019. Residents’ confidence in identifying relevant anatomy for the most common UGRA procedures significantly increased in 13 of the 14 measurements. Residents’ knowledge gain was also statistically significant from the pre-test to post-test (20.13 ± 3.61 and 26.13 ± 2.34; p < .0001). The residents found the course overall to be very useful (4.90 ± 0.38) and in particular the cadaveric component was highly rated (4.74 ± 0.55).

Conclusions
In this study, we developed a workshop guided by the embodied cognition framework to aid in shortening the overall learning curve of UGRA for anesthesiology residents. Based on our results this workshop should be replicated by institutions that are hoping to decrease the learning curve associated with UGRA and increase residents’ confidence in identifying the relevant anatomy in UGRA nerve blocks.
Using patient comments from a standardised experience survey to investigate their perceptions and prioritise improvement actions: a thematic and syntactic analysis
Authors: Crubezy Marion , Douay Céline , Michel Philippe , Haesebaert Julie 
Published: September 2023

Abstract
Background
Although patient experience surveys flourish in many countries with the aim to improve quality of care, questions remain concerning their ability to become effective drivers of change within institutions. The patient comments from the French national patient experience hospital survey were analysed using an innovative structured approach to characterise patient experience and identify field actions for the institutions.

Methods
The comments were taken from the two open-ended questions comprised in the patient experience survey of the Hospices Civils de Lyon between 2018 and 2019. The comments analysis methodology consisted in three steps: thematic analysis; syntactic analysis; generation of statistics for the creation of a patient journey and prioritisation of sub-themes. The STROBE statement checklist was followed.

Results
Over a year, 79.7% of the 7 362 respondents left at least one comment at the end of the survey and were included in the study, for a total of 5 868 surveys and 10 061 comments. These led to the identification of 28 general themes and 184 specific sub-themes. From the patient journey created, 23 sub-themes were prioritised and gathered into four key categories: relationship between patient and staff; environment; surgery and pain management; information and care coordination. For each of them, the actions and expectations formulated by the respondents were described.

Conclusions
The analysis of patient comments obtained from a standardised survey allowed to characterise the patient journey using data that describes patient experience, enabling a prioritisation of actions aiming to improve practice and quality of care at the institution, department, and staff level.
Challenges in predicting future high-cost patients for care management interventions
Authors: Crowley Chris , Perloff Jennifer , Stuck Amy , Mechanic Robert 
Published: September 2023

Abstract
Background
To test the accuracy of a segmentation approach using claims data to predict Medicare beneficiaries most likely to be hospitalized in a subsequent year.

Methods
This article uses a 100-percent sample of Medicare beneficiaries from 2017 to 2018. This analysis is designed to illustrate the actuarial limitations of person-centered risk segmentation by looking at the number and rate of hospitalizations for progressively narrower segments of heart failure patients and a national fee-for-service comparison group. Cohorts are defined using 2017 data and then 2018 hospitalization rates are shown graphically.

Results
As the segments get narrower, the 2018 hospitalization rates increased, but the percentage of total Medicare FFS hospitalizations accounted for went down. In all three segments and the total Medicare FFS population, more than half of all patients did not have a hospitalization in 2018.

Conclusions
With the difficulty of identifying future high utilizing beneficiaries, health systems should consider the addition of clinician input and ‘light touch’ monitoring activities to improve the prediction of high-need, high-cost cohorts. It may also be beneficial to develop systemic strategies to manage utilization and steer beneficiaries to efficient providers rather than targeting individual patients.
Development of an evidence-based model for predicting patient, provider, and appointment factors that influence no-shows in a rural healthcare system
Authors: Shour Abdul R. , Jones Garrett L. , Anguzu Ronald , Doi Suhail A. , Onitilo Adedayo A 
Published: September 2023

Abstract
Background
No-show appointments pose a significant challenge for healthcare providers, particularly in rural areas. In this study, we developed an evidence-based predictive model for patient no-shows at the Marshfield Clinic Health System (MCHS) rural provider network in Wisconsin, with the aim of improving overbooking approaches in outpatient settings and reducing the negative impact of no-shows in our underserved rural patient populations.

Methods
Retrospective data (2021) were obtained from the MCHS scheduling system, which included 1,260,083 total appointments from 263,464 patients, as well as their demographic, appointment, and insurance information. We used descriptive statistics to associate variables with show or no-show status, logistic regression, and random forests utilized, and eXtreme Gradient Boosting (XGBoost) was chosen to develop the final model, determine cut-offs, and evaluate performance. We also used the model to predict future no-shows for appointments from 2022 and onwards.

Results
The no-show rate was 6.0% in both the train and test datasets. The train and test datasets both yielded 5.98. Appointments scheduled further in advance (> 60 days of lead time) had a higher (7.7%) no-show rate. Appointments for patients aged 21–30 had the highest no-show rate (11.8%), and those for patients over 60 years of age had the lowest (2.9%). The model predictions yielded an Area Under Curve (AUC) of 0.84 for the train set and 0.83 for the test set. With the cut-off set to 0.4, the sensitivity was 0.71 and the positive predictive value was 0.18. Model results were used to recommend 1 overbook for every 6 at-risk appointments per provider per day.

Conclusions
Our findings demonstrate the feasibility of developing a predictive model based on administrative data from a predominantly rural healthcare system. Our new model distinguished between show and no-show appointments with high performance, and 1 overbook was advised for every 6 at-risk appointments. This data-driven approach to mitigating the impact of no-shows increases treatment availability in rural areas by overbooking appointment slots on days with an elevated risk of no-shows.
Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study
Authors: Bolongaita Sarah , Lee Yeeun , Johansson Kjell Arne , Haaland Øystein A. , Tolla Mieraf Taddesse , Lee Jongwook , Verguet Stéphane 
Published: September 2023

Abstract
Background
Financial risk protection (FRP) is a key component of universal health coverage (UHC): all individuals must be able to obtain the health services they need without experiencing financial hardship. In many low-income and lower-middle-income countries, however, the health system fails to provide sufficient protection against high out-of-pocket (OOP) spending on health services. In 2018, OOP health spending comprised approximately 40% of current health expenditures in low-income and lower-middle-income countries.

Methods
We model the household risk of catastrophic health expenditures (CHE), conditional on having a given disease or condition—defined as OOP health spending that exceeds a threshold percentage (10, 25, or 40%) of annual income—for 29 health services across 13 disease categories (e.g., diarrheal diseases, cardiovascular diseases) in 34 low-income and lower-middle-income countries. Health services were included in the analysis if delivered at the primary care level and part of the Disease Control Priorities, 3rd edition “highest priority package.” Data were compiled from several publicly available sources, including national health accounts, household surveys, and the published literature. A risk of CHE, conditional on having disease, was modeled as depending on usage, captured through utilization indicators; affordability, captured via the level of public financing and OOP health service unit costs; and income.

Results
Across all countries, diseases, and health services, the risk of CHE (conditional on having a disease) would be concentrated among poorer quintiles (6.8% risk in quintile 1 vs. 1.3% in quintile 5 using a 10% CHE threshold). The risk of CHE would be higher for a few disease areas, including cardiovascular disease and mental/behavioral disorders (7.8% and 9.8% using a 10% CHE threshold), while lower risks of CHE were observed for lower cost services.

Conclusions
Insufficient FRP stands as a major barrier to achieving UHC, and risk of CHE is a major problem for health systems in low-income and lower-middle-income countries. Beyond its threat to the financial stability of households, CHE may also lead to worse health outcomes, especially among the poorest for whom both ill health and financial risk are most severe. Modeling the risk of CHE associated with specific disease areas and services can help policymakers set progressive health sector priorities. Decision-makers could explicitly include FRP as a criterion for consideration when assessing the health interventions for inclusion in national essential benefit packages.
Body mass index and inflammation in depression and treatment-resistant depression: a Mendelian randomisation study
Authors: Karageorgiou Vasilios , Casanova Francesco , O’Loughlin Jessica , Green Harry , McKinley Trevelyan J. , Bowden Jack , Tyrrell Jessica 
Published: September 2023

AbstractBackgroundMajor depressive disorder (MDD) has a significant impact on global burden of disease. Complications in clinical management can occur when response to pharmacological modalities is considered inadequate and symptoms persist (treatment-resistant depression (TRD)). We aim to investigate inflammation, proxied by C-reactive protein (CRP) levels, and body mass index (BMI) as putative causal risk factors for depression and subsequent treatment resistance, leveraging genetic information to avoid confounding via Mendelian randomisation (MR).MethodsWe used the European UK Biobank subcohort ($$n=451,025$$n=451,025), the mental health questionnaire (MHQ) and clinical records. For treatment resistance, a previously curated phenotype based on general practitioner (GP) records and prescription data was employed.We applied univariable and multivariable MR models to genetically predict the exposures and assess their causal contribution to a range of depression outcomes. We used a range of univariable, multivariable and mediation MR models techniques to address our research question with maximum rigour. In addition, we developed a novel statistical procedure to apply pleiotropy-robust multivariable MR to one sample data and employed a Bayesian bootstrap procedure to accurately quantify estimate uncertainty in mediation analysis which outperforms standard approaches in sparse binary outcomes. Given the flexibility of the one-sample design, we evaluated age and sex as moderators of the effects.ResultsIn univariable MR models, genetically predicted BMI was positively associated with depression outcomes, including MDD ($$\beta$$β($$95\%$$95%CI): 0.133(0.072, 0.205)) and TRD (0.347(0.002, 0.682)), with a larger magnitude in females and with age acting as a moderator of the effect of BMI on severity of depression (0.22(0.050, 0.389)). Multivariable MR analyses suggested an independent causal effect of BMI on TRD not through CRP (0.395(0.004, 0.732)). Our mediation analyses suggested that the effect of CRP on severity of depression was partly mediated by BMI. Individuals with TRD ($$n=2199$$n=2199) observationally had higher CRP and BMI compared with individuals with MDD alone and healthy controls.DiscussionOur work supports the assertion that BMI exerts a causal effect on a range of clinical and questionnaire-based depression phenotypes, with the effect being stronger in females and in younger individuals. We show that this effect is independent of inflammation proxied by CRP levels as the effects of CRP do not persist when jointly estimated with BMI. This is consistent with previous evidence suggesting that overweight contributed to depression even in the absence of any metabolic consequences. It appears that BMI exerts an effect on TRD that persists when we account for BMI influencing MDD.