bluuebunny/crossref_metadata_2025_split huggingface dataset:
The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment: a systematic review and meta-analysis
Authors: Ren Xiaolin , Zhang Yuhan , Xiang Yong , Hu Tao , Cheng Ran , Cai He 
Published: April 2023

AbstractBackgroundMouthwashes were convenient adjuncts to mechanical cleaning procedures. This review aimed to evaluate the efficacy of mouthwashes on oral microorganisms and gingivitis in orthodontic patients.MethodsBy April 16, 2022, multiple databases and grey literature were searched based on the PICOS strategy. Randomized controlled trials in orthodontic patients evaluating the efficacy of mouthwashes with at least one microbial parameter and/or plaque- and/or gingival inflammation-related index were included. Relevant data were extracted, and the risk of bias was evaluated using Cochrane's tool. Individual mean and standard deviation of the outcomes in mouthwashes and placebos/blank controls were pooled to estimate the weighted mean differences (WMDs) and 95% confidence intervals (95%CIs). Sensitivity analysis, and certainty of evidence were evaluated.ResultsOf 1684 articles, 32 studies satisfied the eligibility criteria, and nine were included for meta-analysis. Missing outcome data was the primary source of bias. Compared to blank controls, the short-term application of fluoride mouthwashes significantly reduced the colony counts ofMutans streptococci (MS), while the long-term application may not be effective. Compared to placebos or blank controls, Chlorhexidine mouthwashes significantly reduced the colony counts of multiple microorganisms in the short-term. Compared to placebos or blank controls, herbal mouthwashes showed the inhibitory effect ofMSin the short-term, with some results lacking statistical significance. After meta-analysis, significant lower plaque- and gingival inflammation-related indexes were observed in the Chlorhexidine mouthwashes groups [Gingival Index: WMD = -0.45, 95%CI = -0.70 to -0.20 (placebos as control); WMD = -0.54, 95%CI = -0.96 to -0.13 (blank controls); Plaque Index: WMD = -0.70, 95%CI = -1.12 to -0.27 (blank controls)]. Significant lower gingival inflammation-related indexes were observed in the herbal mouthwashes groups [Gingival Index: WMD = -0.20, 95%CI = -0.32 to -0.09 (blank controls)].ConclusionsThe short-term application of fluoride mouthwashes may reduce the colony counts of cariogenic bacteria, but the long-term effect is not evident. Chlorhexidine may reduce the colony counts of multiple microorganisms in the short-term. Short-term application Chlorhexidine and herbal mouthwashes may effectively reduce plaque- and gingival inflammation-related indexes. However, the risk of bias, inconsistency, and imprecision in the included studies may reduce the certainty of the evidence.
Impact of information and communication software on multiprofessional team collaboration in outpatient palliative care – a qualitative study on providers’ perspectives
Authors: Suslow Anastasia , Giehl Chantal , Hergesell Jannis , Vollmar Horst Christian , Otte Ina 
Published: April 2023

Abstract
Background
The communication processes between different stakeholders in outpatient palliative care face challenges when multiprofessional teams want to keep each other updated on patient information. Meanwhile, the software market offers different tools to connect these teams in real-time to improve communication. In the research project ADAPTIVE (Impact of Digital Technologies in Palliative Care), we investigated how information and communication technology affects collaboration and work in multiprofessional teams and what advantages and disadvantages the use of said software might entail.

Methods
We conducted 26 semi-structured interviews between August and November 2020 with general practitioners (n = 8), palliative care nurses (n = 17), and a pharmacist (n = 1). They were conducted in a hybrid format, meaning that both face-to-face interviews and telephone interviews were carried out. Subsequently, we analyzed the interviews following the qualitative content analysis according to Kuckartz.

Results
Information and communication software has the potential to enable faster communication and delegation of tasks and to simplify communication and task management between providers. Furthermore, it creates the opportunity to decrease unnecessary supervision of duties and responsibilities for physicians in multiprofessional teams. Therefore, it allows facilitating the collaboration between multiprofessional teams that work independently of each other but care for the same patients. All providers have the same knowledge about their patients without time-consuming coordination such as phone calls or search processes in paper documentation. On the other hand, mishandling, poor Internet connection, and unfamiliarity with various features can diminish these benefits.

Conclusion
Even though the use of such software offers many advantages, these advantages only reveal themselves if the software is used as it was intended by the developers. Misuse and unawareness of the individual functions can lead to the full potential not being realized. The software developers frequently offer specialized training, and the multiprofessional teams should utilize that to improve team communication, facilitate tasks, and allow physicians to delegate tasks.

Trial registration
The study is registered in the German Clinical Trials Register (DRKS): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021603 (Registration number: DRKS00021603; date of first registration: 02/07/2020).
The impact of the COVID-19 pandemic on processes, resource use and cost in palliative care
Authors: Hodiamont Farina , Schatz Caroline , Schildmann Eva , Syunyaeva Zulfiya , Hriskova Katerina , Rémi Constanze , Leidl Reiner , Tänzler Susanne , Bausewein Claudia 
Published: April 2023

Abstract
Background
The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit and PC advisory team) in a university hospital before and during the first pandemic year.

Methods
Retrospective, cross-sectional study using routine data of all patients cared for in a PC unit and a PC advisory team during 10–12/2019 and 10–12/2020. Data included patient characteristics (age, sex, cancer/non-cancer, symptom/problem burden using Integrated Palliative Care Outcome Scale (IPOS)), information on care episode, and labour time calculated in care minutes. Cost calculation with combined top-down bottom-up approach with hospital’s cost data from 2019. Descriptive statistics and comparisons between groups using parametric and non-parametric tests.

Results
Inclusion of 55/76 patient episodes in 2019/2020 from the PC unit and 135/120 episodes from the PC advisory team, respectively.
IPOS scores were lower in 2020 (PCU: 2.0 points; PC advisory team: 3.0 points). The number of completed assessments differed considerably between years (PCU: episode beginning 30.9%/54.0% in 2019/2020; PC advisory team: 47.4%/40.0%). Care episodes were by one day shorter in 2020 in the PC advisory team. Only slight non-significant differences were observed regarding total minutes/day and patient (PCU: 150.0/141.1 min., PC advisory team: 54.2/66.9 min.). Staff minutes showed a significant decrease in minutes spent in direct contact with relatives (PCU: 13.9/7.3 min/day in 2019/2020, PC advisory team: 5.0/3.5 min/day).
Costs per patient/day decreased significantly in 2020 compared to 2019 on the PCU (1075 Euro/944 Euro for 2019/2020) and increased significantly for the PC advisory team (161 Euro/200 Euro for 2019/2020). Overhead costs accounted for more than two thirds of total costs. Direct patient cost differed only slightly (PCU: 134.7 Euro/131.1 Euro in 2019/2020, PC advisory team: 54.4 Euro/57.3 Euro).

Conclusions
The pandemic partially impacted on daily work routines, especially on time spent with relatives and palliative care problem assessments. Care processes and quality of care might vary and have different outcomes during a crisis such as the COVID-19 pandemic. Direct costs per patient/day were comparable, regardless of the pandemic.
Chronic conditions in women: the development of a National Institutes of health framework
Authors: Temkin Sarah M. , Barr Elizabeth , Moore Holly , Caviston Juliane P. , Regensteiner Judith G. , Clayton Janine A. 
Published: April 2023

AbstractRising rates of chronic conditions were cited as one of the key public health concerns in the Fiscal Year (FY) 2021 U.S. Senate and House of Representatives appropriations bills, where a review of current National Institutes of Health (NIH) portfolios relevant to research on women’s health was requested. Chronic conditions were last defined by the US Department of Health and Human Services (HHS) in 2010. However, existing definitions of chronic conditions do not incorporate sex or gender considerations. Sex and gender influence health, yet significant knowledge gaps exist in the evidence-base for prevention, diagnosis, and treatment of chronic diseases amongst women. The presentation, prevalence, and long-term effects of chronic conditions and multimorbidity differs in women from men. A clinical framework was developed to adequately assess the NIH investment in research related to chronic conditions in women. The public health needs and NIH investment related to conditions included in the framework were measured. By available measures, research within the NIH has not mapped to the burden of chronic conditions among women. Clinical research questions and endpoints centered around women can be developed and implemented; clinical trials networks with expanded or extended eligibility criteria can be created; and data science could be used to extrapolate the effects of overlapping or multiple morbidities on the health of women. Aligning NIH research priorities to address the specific needs of women with chronic diseases is critical to addressing women’s health needs from a life course perspective.
Protocatechuic aldehyde acts synergistically with dacarbazine to augment DNA double-strand breaks and promote apoptosis in cutaneous melanoma cells
Authors: Pei Junxia , Su Zhou , Zeng Xin , Zhong Ya , Zhang Yamei , Yang Yixi , Lu Qiuxia , Li Jian , Deng Yu 
Published: April 2023

Abstract
Background
Despite rapid developments in immunotherapy and targeted therapy, dacarbazine (DTIC)-based chemotherapy still has been placed at the first-line for advanced melanoma patients who are after failure of immunotherapy or targeted therapy. However, the limited response rate and survival benefit challenge the DTIC-based chemotherapy for advanced melanoma patients.

Methods
Two melanoma cell lines, A375 and SK-MEL-28 were cultured with PA and DTIC over a range of concentrations for 72 h and the cell viabilities were detected by CCK8 assay. The Bliss model and ZIP model were used for calculating the synergistic effect of PA and DTIC. DNA double-strand breaks in the two cell lines were examined by the Comet assay, and cell apoptosis was analyzed by flow cytometry. The short hairpin RNA (shRNA)-mediated knockdown, Real-time polymerase chain reaction (RT-PCR) and Western blot were performed for molecular analysis.

Results
In the present study, we report that Protocatechuic aldehyde (PA) synergistically enhances the cytotoxicity of DTIC to two melanoma cell lines, A375 and SK-MEL-28. The combination of PA and DTIC augments DNA double-strand breaks and increases cell apoptosis. Further mechanism study reveals that PA destabilizes MGMT protein (O-6-Methylguanine-DNA Methyltransferase) through the ubiquitin-proteasome process and directly repairs DTIC-induced genetic lesions. Knockdown of MGMT compromises the synergistic effect between PA and DTIC.

Conclusion
Our study demonstrates that the bioactive compound, Protocatechuic aldehyde, synergistically promotes the cytotoxicity of DTIC to melanoma cells through destabilization of MGMT protein. It could be a potential candidate for melanoma chemotherapy.
Future physicians’ behavioral intentions towards collaborative practice - a qualitative study on polish final-year medical students guided by the theory of planned behavior
Authors: Przymuszała Piotr , Szmelter Jagoda , Zielińska-Tomczak Łucja , Cerbin-Koczorowska Magdalena , Marciniak Ryszard 
Published: April 2023

Abstract
Background
Interprofessional collaboration constitutes a vital part of modern patient care, and many of its benefits for patients, medical staff, and the healthcare system have been described. However, little is known about factors influencing medical students’ intentions to work in a collaborative practice after graduation. Therefore, with the theory of planned behavior by Ajzen as a framework, this study aimed to evaluate their intentions and identify factors that influence their attitudes, subjective norms, and perceived behavioral control.

Methods
For this purpose, eighteen semi-structured interviews were conducted with medical students following a thematic guide developed according to the theory. They were thematically analyzed by two independent researchers.

Results
The results showed that their attitudes contained positive (better patient care, comfort and safety of work, learning and development opportunities) and negative examples like the fear of conflicts, losing authority and mistreatment. Sources of social pressure regarding the behavior (subjective norms) involved their peers, other physicians, representatives of other medical professions, patients, and managing bodies. Finally, perceived behavioral control included limited occasions for contacts and interprofessional learning during the studies, existing stereotypes and prejudices, legal regulations and systemic solutions, organizational aspects, and existing relations at the ward.

Conclusions
Analysis showed that Polish medical students generally seem to hold positive views on interprofessional collaboration and feel positive social pressure to get involved in interprofessional teams. However, factors listed in perceived behavioral control may act as barriers in the process.
Decision curve analysis confirms higher clinical utility of multi-domain versus single-domain prediction models in patients with open abdomen treatment for peritonitis
Authors: Huber Markus , Schober Patrick , Petersen Sven , Luedi Markus M. 
Published: April 2023

AbstractBackgroundPrediction modelling increasingly becomes an important risk assessment tool in perioperative systems approaches, e.g. in complex patients with open abdomen treatment for peritonitis. In this population, combining predictors from multiple medical domains (i.e. demographical, physiological and surgical variables) outperforms the prediction capabilities of single-domain prediction models. However, the benefit of these prediction models for clinical decision-making remains to be investigated. We therefore examined the clinical utility of mortality prediction models in patients suffering from peritonitis with a decision curve analysis.MethodsIn this secondary analysis of a large dataset, a traditional logistic regression approach, three machine learning methods and a stacked ensemble were employed to examine the predictive capability of demographic, physiological and surgical variables in predicting mortality under open abdomen treatment for peritonitis. Calibration was examined with calibration belts and predictive performance was assessed with the area both under the receiver operating characteristic curve (AUROC) and under the precision recall curve (AUPRC) and with the Brier Score. Clinical utility of the prediction models was examined by means of a decision curve analysis (DCA) within a treatment threshold range of interest of 0–30%, where threshold probabilities are traditionally defined as the minimum probability of disease at which further intervention would be warranted.ResultsMachine learning methods supported available evidence of a higher prediction performance of a multi- versus single-domain prediction models. Interestingly, their prediction performance was similar to a logistic regression model. The DCA demonstrated that the overall net benefit is largest for a multi-domain prediction model and that this benefit is larger compared to the default “treat all” strategy only for treatment threshold probabilities above about 10%. Importantly, the net benefit for low threshold probabilities is dominated by physiological predictors: surgical and demographics predictors provide only secondary decision-analytic benefit.ConclusionsDCA provides a valuable tool to compare single-domain and multi-domain prediction models and demonstrates overall higher decision-analytic value of the latter. Importantly, DCA provides a means to clinically differentiate the risks associated with each of these domains in more depth than with traditional performance metrics and highlighted the importance of physiological predictors for conservative intervention strategies for low treatment thresholds. Further, machine learning methods did not add significant benefit either in prediction performance or decision-analytic utility compared to logistic regression in these data.
Patterns of work-related stress and their predictors among emergency department nurses and emergency medical services staff in a time of crisis: a latent profile analysis
Authors: Charzyńska Edyta , Habibi Soola Aghil , Mozaffari Naser , Mirzaei Alireza 
Published: April 2023

AbstractBackgroundPrevious studies have shown that a disease outbreak may cause high stress among healthcare workers. However, the vast majority of those studies applied a variable-centered approach, in which relationships between the variables are believed to be identical across the studied population. The main purpose of this study was to identify latent profiles of healthcare workers with similar combinations of levels of various work-related stressors during the coronavirus disease 2019 (COVID-19) pandemic and to examine their predictors.MethodsA cross-sectional paper-and-pencil study was conducted among a convenience sample of 297 emergency department (ED) nurses and 219 emergency medical services (EMS) staff members working in 10 hospital EDs and 52 EMS centers in Ardabil province, Iran. Data were collected using the Health and Safety Executive Management Standards Indicator Tool (HSE-MS IT).ResultsUsing the latent profile analysis (LPA), five work-related stress profiles were identified: “high stress with a good understanding of one’s job role” (11.1%), “moderate stress” (41.9%), “relatively high stress with average demands and a very low understanding of one’s job role” (23.8%), “low stress” (18.0%), and “generally low stress but with very high job demands and relational conflicts” (5.2%). Age, marital status, service location, workplace, and the number of overtime hours significantly predicted profile membership.ConclusionThe results of the study suggest the importance of incorporating various sources of stress and using the person-centered approach when investigating the work-related stress of healthcare workers during disease outbreaks. Identifying sociodemographic and work-related predictors of profile membership may be useful for preparing interventions that will be better suited to healthcare workers’ needs.
Beyond heroism: a qualitative study on the lived experiences of nurses caring for patients with COVID-19 in Pakistan
Authors: Afzal Mahreen , Hassan Rashid Muhammad Abo ul , Fischer Florian 
Published: April 2023

AbstractBackgroundHealthcare professionals around the globe suffered severely during the COVID-19 pandemic. The present study aims to explore the lived experiences of nurses caring for COVID-19 patients in Pakistan.MethodsThe study is a qualitative exploration of the lived experiences caring for patients with COVID-19 in Pakistan. This research was conducted in two government hospitals there. Face-to-face in-depth interviews were conducted amongst 30 nurses who had been selected using purposive sampling technique. Thematic analysis was applied to extract the themes from respondents’ answers.ResultsBy using thematic analysis, social response, impacts on physical and mental health, and experience of handling COVID-19 patients were extracted as major themes.ConclusionsThe findings of this research are of immense importance in showing the impact of COVID-19 on mental and physical health, along with the social and personal consequences for nurses providing care to COVID-19 patients.
The effectiveness of clinical guideline implementation strategies in oncology—a systematic review
Authors: Bora Ana-Mihaela , Piechotta Vanessa , Kreuzberger Nina , Monsef Ina , Wender Andreas , Follmann Markus , Nothacker Monika , Skoetz Nicole 
Published: April 2023

AbstractImportanceGuideline recommendations do not necessarily translate into changes in clinical practice behaviour or better patient outcomes.ObjectiveThis systematic review aims to identify recent clinical guideline implementation strategies in oncology and to determine their effect primarily on patient-relevant outcomes and secondarily on healthcare professionals' adherence.MethodsA systematic search of five electronic databases (PubMed, Web of Science, GIN, CENTRAL, CINAHL) was conducted on 16 december 2022. Randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) assessing the effectiveness of guideline implementation strategies on patient-relevant outcomes (overall survival, quality of life, adverse events) and healthcare professionals' adherence outcomes (screening, referral, prescribing, attitudes, knowledge) in the oncological setting were targeted. The Cochrane risk-of-bias tool and the ROBINS-I tool were used for assessing the risk of bias. Certainty in the evidence was evaluated according to GRADE recommendations. This review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the identification number CRD42021268593.FindingsOf 1326 records identified, nine studies, five cluster RCTs and four controlled before-and after studies, were included in the narrative synthesis. All nine studies assess the effect of multi-component interventions in 3577 cancer patients and more than 450 oncologists, nurses and medical staff.Patient-levelEducational meetings combined with materials, opinion leaders, audit and feedback, a tailored intervention or academic detailing may have little to no effect on overall survival, quality of life and adverse events of cancer patients compared to no intervention, however, the evidence is either uncertain or very uncertain.Provider-levelMulti-component interventions may increase or slightly increase guideline adherence regarding screening, referral and prescribing behaviour of healthcare professionals according to guidelines, but the certainty in evidence is low. The interventions may have little to no effect on attitudes and knowledge of healthcare professionals, still, the evidence is very uncertain.Conclusions and relevanceKnowledge and skill accumulation through team-oriented or online educational training and dissemination of materials embedded in multi-component interventions seem to be the most frequently researched guideline implementation strategies in oncology recently. This systematic review provides an overview of recent guideline implementation strategies in oncology, encourages future implementation research in this area and informs policymakers and professional organisations on the development and adoption of implementation strategies.