bluuebunny/crossref_metadata_2025_split huggingface dataset:
Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective
Authors: Fonseca Medeiros Amanda , Margotto Bertollo Caryne , Moreira Reis Adriano Max , Costa Monica Aparecida , Meireles Leite Edna Marilea , da Silva Gonçalves Simony , Nogueira Guimarães de Abreu Mauro Henrique , Pedra de Souza Renan , Parreiras Martins Maria Auxiliadora 
Published: March 2023

Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world’s major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption.Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements.Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of “structure”, “process” and “result” proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021.Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44).Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations.
Real-world efficacy and safety of pyrotinib in patients with HER2-positive metastatic breast cancer: A prospective real-world study
Authors: Zhang Qiongwen , He Ping , Tian Tinglun , Yan Xi , Huang Juan , Zhang Zhang , Zheng Hong , Zhong Xiaorong , Luo Ting 
Published: March 2023

Background: Pyrotinib, a novel irreversible EGFR/HER2 dual tyrosine kinase inhibitor, shows encouraging anticancer activity and acceptable tolerability in multiple phase II and phase III randomized clinical trials, but the real-world data of pyrotinib, especially the outcomes in HER2-positive metastatic breast cancer, have been rarely reported. Here, we evaluated the treatment outcomes of pyrotinib in real-world practice in patients with HER2-positive metastatic breast cancer (MBC).Methods: This was a prospective, real-world, observational cohort study. Through the Breast Cancer Information Management System, HER-2 positive MBC patients treated with pyrotinib between 2017/06 and 2020/09 were included. Provider-reported objective response rate, progression-free survival (PFS), and overall survival (OS) were considered in the assessment of treatment outcomes. Tumor responses to pyrotinib treatment were calculated using RECIST 1.1. Adverse events were evaluated using clinical records.Results: The trial involved 113 individuals who were receiving pyrotinib treatment, with an average age of 51 years. Complete response, partial response and stable disease were observed in 9 (8.0%), 66 (58.4%), and 17 (15.0%) patients, respectively, while progressive disease was recorded in 20 (17.7%) patients. After a median follow-up of 17.2 months, the median PFS was 14.1. The most common adverse events of any grade were diarrhea (87.6%), vomiting (31.9%), and palmar-plantar erythrodysesthesia (26.6%). Among the patients with brain metastases, the median PFS and OS were 15.2 and 19.8 months, respectively. In addition, pyrotinib has similar efficacy in various subtypes of HER2-positive MBC patients, as shown by the lack of a significant difference of PFS and OS among pyrotinib-treated patients with or without brain metastases, or patients using pyrotinib as first-line, second-line, third-line or beyond therapies.Conclusion: Our real-world results demonstrated equivalent clinical efficacy in HER-2 positive MBC patients compared to phase II and phase III clinical trials with pyrotinib, and promising outcomes in patients with brain metastases.
Population pharmacokinetics of nalbuphine in patients undergoing general anesthesia surgery
Authors: Nie Xuyang , Gao Xiaonan , Gao Jinglin , Heng Tianfang , Zhang Yuqi , Sun Yaqi , Feng Zhangying , Jia Li , Wang Mingxia 
Published: March 2023

Purpose: The aim of this study was to build a population pharmacokinetics (PopPK) model of nalbuphine and to estimate the suitability of bodyweight or fixed dosage regimen.Method: Adult patients who were undergoing general anesthetic surgery using nalbuphine for induction of anesthesia were included. Plasma concentrations and covariates information were analyzed by non-linear mixed-effects modeling approach. Goodness-of-fit (GOF), non-parametric bootstrap, visual predictive check (VPC) and external evaluation were applied for the final PopPK model evaluation. Monte Carlo simulation was conducted to assess impact of covariates and dosage regimens on the plasma concentration to nalbuphine.Results: 47 patients aged 21–78 years with a body weight of 48–86 kg were included in the study. Among them, liver resection accounted for 14.8%, cholecystectomy for 12.8%, pancreatic resection for 36.2% and other surgeries for 36.2%. 353 samples from 27 patients were enrolled in model building group; 100 samples from 20 patients were enrolled in external validation group. The results of model evaluation showed that the pharmacokinetics of nalbuphine was adequately described by a two-compartment model. The hourly net fluid volume infused (HNF) was identified as a significant covariate about the intercompartmental clearance (Q) of nalbuphine with objective function value (OFV) decreasing by 9.643 (p &lt; 0.005, df = 1). Simulation results demonstrated no need to adjust dosage based on HNF, and the biases of two dosage methods were less than 6%. The fixed dosage regimen had lower PK variability than the bodyweight regimen.Conclusion: A two-compartment PopPK model adequately described the concentration profile of nalbuphine intravenous injection for anesthesia induction. While HNF can affect the Q of nalbuphine, the magnitude of the effect was limited. Dosage adjustment based on HNF was not recommended. Furthermore, fixed dosage regimen might be better than body weight dosage regimen.
A metamaterial cylindrical shell with multiple graded resonators for broadband longitudinal wave attenuation
Authors: Yao Jingyi , Xu Ke , Yao Dunhui , Yao Lingyun 
Published: March 2023

This paper investigates a metamaterial cylindrical shell with local resonators for broadband longitudinal wave attenuation. A three-component phononic crystal metamaterial cylindrical shell that opens local resonant bandgaps at low frequencies is formed by periodically inserting a lead column coated with soft rubber into an ordinary cylindrical shell. First, the governing equations of elastic wave propagation in cylindrical shell structures are derived through coordinate transformation. Subsequently, numerical models of the metamaterial cylindrical shell are established, and the dispersion relation and vibration transmission characteristics of this structure are calculated using the Finite Element Method (FEM). Finally, in order to further broaden the bandgaps and the strong suppression range of the structure, a multiple-graded-resonator metamaterial cylindrical shell with three different local resonators is also proposed. These local resonators have different start frequencies and locations of their longitudinal wave bandgaps, so they can be combined to produce a wider overall bandgap. Numerical results show that this kind of multiple-graded-resonator metamaterial cylindrical shell has a good vibration suppression effect on longitudinal waves in the range of approximately 180–710 Hz and the vibration suppression effect can reach −40 dB at best. In addition, experimental results on vibration transmission characteristics show good agreement with the numerical results. This work provides a new idea and method for the development of acoustic metamaterials to obtain broadband and low-frequency bandgaps for cylindrical shell structures.
Real-life functioning in women with schizophrenia living in residential facilities: Gender-based comparison
Authors: Rusakovskaya Olga , Kharitonova Natalia , Movina Larisa , Papsuev Oleg 
Published: March 2023

IntroductionDespite many patients with schizophrenia being able to achieve good functional outcomes, the number of patients with poor functional outcome estimates at over 25 percent. One of the wider constructs, reflecting functional outcomes in schizophrenia, is real-life functioning, whose key domains include ability to live relatively autonomously, productive activity and social interaction. Negative symptoms are seen among independent predictors of real-life functioning. As most researchers agree that schizophrenia is a disease with gender differences in terms of both clinical and functional outcomes, the goal of our observational study was to examine real-life functioning of women with schizophrenia, living in residential care facilities, and study the relationship between daily functioning and negative symptoms.MethodsUsing the Standardized Protocol of Clinical Interview and observation for 1 or more weeks, we examined 46 females with schizophrenia, living in psychiatric residential facilities and compared them with 54 males with schizophrenia, living in the same facilities. In a pilot study 21 subjects with schizophrenia (13 females and 8 males), were evaluated by the Russian version of the Brief Negative Symptom Scale (BNSS).ResultsTo the results, more females with schizophrenia, compared to males with schizophrenia, remained active and took initiative in their physical care, vocational activities, involvement in cultural events, and maintained friendly relationships with other inmates. We have identified a group of inmates, in which females prevailed, with less pronounced negative symptoms and a higher level of social functioning, who did not need residential social care in the institutions.DiscussionLimitations of residential social care in the institutions for psychiatric patients are discussed.
The use of IVF/ICSI and risk of postpartum hemorrhage: A retrospective cohort study of 153,765 women in China
Authors: Tang Di , Cheng Yufeng , Feng Xiaosheng , Li Xiaocui , Coyte Peter C. 
Published: March 2023

ObjectivePostpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. Identifying women who are at high risk of PPH is crucial for implementing early preventive and interventive strategies. This study aimed to examine whether there is an association between the use of in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) and increased risk of PPH.MethodThis retrospective cohort study was conducted using medical record data from women who delivered at a tertiary hospital in Shanghai, China, between January 1, 2013 and April 30, 2019. Logistic regression analysis was used to estimate the associations between the use of IVF/ICSI and the risk of PPH.ResultsA total of 153,765 pregnant women were included, of which 6,484 conceived through IVF/ICSI and147,281 conceived naturally. The incidence of PPH was 1.9% in this cohort. The incidence of PPH in women who conceived through IVF/ICSI was significantly higher than those in women who conceived naturally (3.4% vs. 1.7%, p &lt; 0.01). The use of IVF/ICSI was associated with an increase in the amount of postpartum blood loss. Compared to women who conceived naturally, the average amount of postpartum blood loss increased by 42.1 mL (β = 42.1, 95% CI, 38.2–46.0) for women who conceived through IVF/ICSI. In addition, women who conceived through IVF/ICSI were at higher risk of maternal PPH. The adjusted odds ratio (OR) of PPH in women who conceived through ART was 2.7 (OR = 2.7, 95% CI, 2.3–3.1).ConclusionOur findings demonstrated that women who conceived through IVF/ICSI were at higher risk of PPH and suggested to obstetricians and midwives to identify and implement early preventative strategies for PPH among pregnant women who conceived through IVF/ICSI.
Impact of socioeconomic position on the utilization of rehabilitation services among the Chinese older adults disabled by injury
Authors: Wang Yi-Ran , Luo Ya-Nan , Fan Ya-Lin , Fan Yun-Yi , Zheng Xiao-Ying 
Published: March 2023

AimThis study aimed to explore the utilization of rehabilitation services and associated socioeconomic position (SEP) factors among Chinese older adults disabled by injury.MethodsData from the second China National Sample Survey on Disability (CSSD) were used in this study. Chi-square test was used to analyze the significant differences between groups, and binary logistic regression model was used to calculate the odds ratios and 95% confidence intervals for socioeconomic factors associated with utilization of rehabilitation services among Chinese older adults disabled by injury.ResultsAmong the older adults disabled by injury in the CSSD, the gap between demand and utilization of medical treatment, assistive devices and rehabilitation training were around 38, 75, and 64%, respectively. This study revealed two relationship patterns (“high-low-high” and “low-high-low”) among SEP, prevalence of injury-caused disability and odds of utilization of rehabilitation services among the Chinese older adults disabled by injury, that is, the older adult with higher SEP have a lower prevalence of injury-caused disability, but a higher odds of utilization of rehabilitation services; conversely, the older adults with lower SEP have a relatively higher prevalence but a lower odds of utilization of rehabilitation services.ConclusionThere is a large gap between the high demand and low utilization of rehabilitation services among the Chinese older adults disabled by injury, especially for those living in the central or western regions or rural areas, without insurance or disability certificate, having the annual household per capita income lower than the national average or lower educational level. Strategies to improve the disability manage system, to strengthen the chain of “information discovery-information transmission-rehabilitation services supply-continuous health monitoring and management” for the older adults disabled by injury are warranted. In view of the poor and illiterate groups among the disabled older adults, to enhance medical aids and popularize the scientific information to compensate for the lack of affordability and awareness of rehabilitation services utilization is essential. In addition, it is necessary to further expand the coverage and improve the payment system of medical insurance for rehabilitation services.
Association of sleep complaints with all-cause and heart disease mortality among US adults
Authors: Wang Qiao , Hu Shimin , Pan Na Clara , Zhang Tingting , Ren Liankun , Wang Yuping 
Published: March 2023

IntroductionCompared with sleep disorders, no consensus has been reached on whether a subjective complaint of having trouble sleeping is associated with increased all-cause and heart disease mortality risk. Previous studies displayed considerable heterogeneity in population disease characteristics and duration of follow-up. Therefore, the aims of this study were to examine the relationship between sleep complaints and all-cause and heart disease mortality and whether the associations were influenced by follow-up time and population disease characteristics. In addition, we aimed to figure out the influence of the joint effects of sleep duration and sleep complaints on mortality risk.MethodsThe present study utilized data from five cycles of the National Health and Nutrition Examination Survey (NHANES) (2005~2014) linked with the most updated 2019 National Death Index (NDI). Sleep complaints were determined by answers to “Have you ever told a doctor or other health professional that you have trouble sleeping?” and “Have you ever been told by a doctor or other health professional that you have a sleep disorder?”. Those who answered ‘Yes' to either of the aforementioned two questions were considered as having sleep complaints.ResultsA total of 27,952 adult participants were included. During a median follow-up of 9.25 years (interquartile range, 6.75–11.75 years), 3,948 deaths occurred and 984 were attributable to heart disease. A multivariable-adjusted Cox model revealed that sleep complaints were significantly associated with all-cause mortality risk (HR, 1.17; 95% CI, 1.07–1.28). Subgroup analysis revealed that sleep complaints were associated with all-cause (HR, 1.17; 95% CI, 1.05–1.32) and heart disease (HR, 1.24; 95% CI, 1.01–1.53) mortality among the subgroup with cardiovascular disease (CVD) or cancer. In addition, sleep complaints were more strongly associated with short-term mortality than long-term mortality. The joint analysis of sleep duration and sleep complaints showed that sleep complaints mainly increased the mortality risk in those with short (&lt; 6 h/day, sleep complaints HR, 1.40; 95% CI, 1.15–1.69) or recommended (6–8 h/day, sleep complaints HR, 1.15; 95% CI, 1.01–1.31) sleep duration group.DiscussionIn conclusion, sleep complaints were associated with increased mortality risk, indicating a potential public benefit of monitoring and managing sleep complaints in addition to sleep disorders. Of note, persons with a history of CVD or cancer may represent a potentially high-risk group that should be targeted with a more aggressive intervention of sleep problems to prevent premature all-cause and heart disease death.
The impact of users' trust on intention to use the mobile medical platform: Evidence from China
Authors: He Jinjiang 
Published: March 2023

IntroductionThe mobile medical platform effectively complements offline medical services as it can provide patients with broader and more convenient medical services, effectively solving the shortage of medical resources in the public health system. Although the public interest in healthcare service platforms continues to rise, the market data shows that the adoption and acceptance have not reached a high level. How to increase the utilization rate of the mobile medical platform to relieve medical pressure has become an urgent issue to be discussed. Based on the framework of “trust-intention” this research introduces innovation acceptance and technical risk concerns as the two moderating variables to attempt to build a research model of users' intention to use the mobile medical platform. The analysis illustrated that users' trust in the mobile medical platform would positively affect their use intention. The researchers further explored the moderating role of innovation acceptance and technical risk concerns.MethodsUse questionnaire to collect data in China, then use the OLS least square method for the regression test.ResultsThe results showed that users with high personal innovation acceptance would positively promote the relationship between trust and use intention. In contrast, users who are more concerned about the risks of innovative technologies will weaken the relationship between trust and use intention.DiscussionThe findings theoretically extend the academic research of use intention to the specific context of the mobile medical platform and enrich the research framework of “trust-intention”.
The relationships of preventive behaviors and psychological resilience with depression, anxiety, and stress among university students during the COVID-19 pandemic: A two-wave longitudinal study in Shandong Province, China
Authors: Li Hexian , Zhao Jingjing , Chen Rui , Liu Hui , Xu Xixing , Xu Jing , Jiang Xiaoxu , Pang Mingli , Wang Jieru , Li Shixue , Hou Jiaxiang , Kong Fanlei 
Published: March 2023

IntroductionStudies have shown that the psychological impact of the COVID-19 pandemic may lead to long-term health problems; therefore, more attention should be paid to the mental health of university students. This study aimed to explore the longitudinal effects of preventive behaviors and psychological resilience on the mental health of Chinese college students during COVID-19.MethodsWe recruited 2,948 university students from five universities in Shandong Province. We used a generalized estimating equation (GEE) model to estimate the impact of preventive behaviors and psychological resilience on mental health.ResultsIn the follow-up survey, the prevalence of anxiety (44.8% at T1 vs 41.2% at T2) and stress (23.0% at T1 vs 19.6% at T2) decreased over time, whereas the prevalence of depression (35.2% at T1 vs 36.9% at T2) increased significantly (P &lt; 0.001). Senior students were more likely to report depression (OR = 1.710, P &lt; 0.001), anxiety (OR = 0.815, P = 0.019), and stress (OR = 1.385, P = 0.011). Among all majors, medical students were most likely to report depression (OR = 1.373, P = 0.021), anxiety (OR = 1.310, P = 0.040), and stress (OR = 1.775, P &lt; 0.001). Students who wore a mask outside were less likely to report depression (OR = 0.761, P = 0.027) and anxiety (OR = 0.686, P = 0.002) compared to those who did not wear masks. Students who complied with the standard hand-washing technique were less likely to report depression (OR = 0.628, P &lt; 0.001), anxiety (OR = 0.701, P &lt; 0.001), and stress (OR = 0.638, P &lt; 0.001). Students who maintained a distance of one meter in queues were less likely to report depression (OR = 0.668, P &lt; 0.001), anxiety (OR = 0.634, P &lt; 0.001), and stress (OR = 0.638, P &lt; 0.001). Psychological resilience was a protective factor against depression (OR = 0.973, P &lt; 0.001), anxiety (OR = 0.980, P &lt; 0.001), and stress (OR = 0.976, P &lt; 0.001).DiscussionThe prevalence of depression among university students increased at follow-up, while the prevalence of anxiety and stress decreased. Senior students and medical students are vulnerable groups. University students should continue to follow relevant preventive behaviors to protect their mental health. Improving psychological resilience may help maintain and promote university students' mental health.