bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examining nursing processes in primary care settings using the Chronic Care Model: an umbrella review
Authors: Dufour Emilie , Bolduc Jolianne , Leclerc-Loiselle Jérôme , Charette Martin , Dufour Isabelle , Roy Denis , Poirier Andrée-Anne , Duhoux Arnaud 
Published: September 2023

Abstract
Background
While there is clear evidence that nurses can play a significant role in responding to the needs of populations with chronic conditions, there is a lack of consistency between and within primary care settings in the implementation of nursing processes for chronic disease management. Previous reviews have focused either on a specific model of care, populations with a single health condition, or a specific type of nurses. Since primary care nurses are involved in a wide range of services, a comprehensive perspective of effective nursing processes across primary care settings and chronic health conditions could allow for a better understanding of how to support them in a broader way across the primary care continuum. This systematic overview aims to provide a picture of the nursing processes and their characteristics in chronic disease management as reported in empirical studies, using the Chronic Care Model (CCM) conceptual approach.

Methods
We conducted an umbrella review of systematic reviews published between 2005 and 2021 based on the recommendations of the Joanna Briggs Institute. The methodological quality was assessed independently by two reviewers using the AMSTAR 2 tool.

Results
Twenty-six systematic reviews and meta-analyses were included, covering 394 primary studies. The methodological quality of most reviews was moderate. Self-care support processes show the most consistent positive outcomes across different conditions and primary care settings. Case management and nurse-led care show inconsistent outcomes. Most reviews report on the clinical components of the Chronic Care Model, with little mention of the decision support and clinical information systems components.

Conclusions
Placing greater emphasis on decision support and clinical information systems could improve the implementation of nursing processes. While the need for an interdisciplinary approach to primary care is widely promoted, it is important that this approach not be viewed solely from a clinical perspective. The organization of care and resources need to be designed to support contributions from all providers to optimize the full range of services available to patients with chronic conditions.

PROSPERO registration
CRD42021220004.
Structured communication methods for mental health consultations in primary care: a scoping review
Authors: Mosler Franziska , Packer Katy , Jerome Lauren , Bird Victoria 
Published: September 2023

Abstract
Background
Majority of people with mental health problems attend primary care for support. Interventions that structure consultations have been found effective for physical health conditions and secondary mental health care. The aim of the review is to identify what tools or interventions exist to structure communication in primary care for appointments related to mental health problems and examine existing evidence for effectiveness for mental health and quality of life outcomes.

Methods
Quantitative and qualitative studies were eligible for inclusion if staff was based in a primary care setting and the intervention involved bi-directional communication with adult patients. Six databases were searched (MEDLINE, Web of Knowledge, EMBASE, PsycINFO, The Cochrane Library, CINAHL) with no time restriction. Search terms combined four concepts with key words such as “structured” and “interaction” and “mental illness” and “primary care”. Reference lists of eligible studies were searched.

Results
After removing duplicates, 3578 records were found and underwent further screening. A total of 16 records were included, representing eight different interventions from five countries. The majority were delivered by primary care doctors and focused on patients experiencing psychological distress. Similarities across interventions’ service delivery were that most were created for a broad patient population, used self-report assessments at the start and actions or plans as the end point, and employed group settings and didactic methods for training staff in the intervention. Booster and follow-up trainings were not offered in any of the interventions, and supervision was only part of the process for one. The evidence for effectiveness for mental health and quality of life outcomes was mixed with three out of five RCTs finding a positive effect.

Conclusions
Although the idea of structuring communication for mental health consultations has been around since the 1980s, relatively few interventions have attempted to structure the conversations within the consultation, rather than modifying pre-visit events. As the evidence-base showed feasibility and acceptability for a number of interventions, there is scope for those interventions to be developed further and tested more rigorously.
Health care professionals’ experiences and perceptions of health promotion through the health dialogue intervention in the scania region, Sweden: a qualitative interview study
Authors: Alenius Sara , Olsson Kjell , Thomasson Ena , Magnusson Lina 
Published: September 2023

Abstract
Background
Cardiovascular disease and type 2 diabetes are among the largest public health challenges in Sweden. Research indicates that a healthy lifestyle can prevent most cases. The health dialogue is an evidence-based public health programme for primary care with positive results in several regions of Sweden. This study aimed to describe health care professionals’ experiences and perceptions of health promotion through the health dialogue intervention during the pilot phase in the Scania region of Sweden.

Methods
The study consists of 12 individual interviews with health care professionals educated in the health dialogue method, implementing the intervention in Scania. Qualitative content analysis with an inductive approach was used.

Results
The analysis resulted in 10 sub-categories and the four main categories: A more health-promoting mindset would benefit primary care; Empower individuals; Facilitate sustainable lifestyle changes; Challenges, tools and support for the implementation of the health dialogue. One overarching theme emerged: “Health dialogue, a potential start of a paradigm shift in Swedish primary care”.

Conclusions
Conclusions imply that the health dialogue is a well-structured method with tools to make health promotion and primary prevention an integrated part of primary care. A respectful and motivating approach during the health dialogue is recommended. It is important to have an ongoing discussion about the approach among the health care professionals. Incorporating the Health Belief Model in the health care professionals’ education in the method could increase the focus on self-efficacy during counselling, which could favour the participants’ change process.
Supporting primary care through symptom checking artificial intelligence: a study of patient and physician attitudes in Italian general practice
Authors: Mahlknecht Angelika , Engl Adolf , Piccoliori Giuliano , Wiedermann Christian Josef 
Published: September 2023

Abstract
Background
Rapid advancements in artificial intelligence (AI) have led to the adoption of AI-driven symptom checkers in primary care. This study aimed to evaluate both patients' and physicians' attitudes towards these tools in Italian general practice settings, focusing on their perceived utility, user satisfaction, and potential challenges.

Methods
This feasibility study involved ten general practitioners (GPs) and patients visiting GP offices. The patients used a chatbot-based symptom checker before their medical visit and conducted anamnestic screening for COVID-19 and a medical history algorithm concerning the current medical problem. The entered data were forwarded to the GP as medical history aid. After the medical visit, both physicians and patients evaluated their respective symptoms. Additionally, physicians performed a final overall evaluation of the symptom checker after the conclusion of the practice phase.

Results
Most patients did not use symptom checkers. Overall, 49% of patients and 27% of physicians reported being rather or very satisfied with the symptom checker. The most frequent patient-reported reasons for satisfaction were ease of use, precise and comprehensive questions, perceived time-saving potential, and encouragement of self-reflection. Every other patient would consider at-home use of the symptom checker for the first appraisal of health problems to save time, reduce unnecessary visits, and/or as an aid for the physician. Patients’ attitudes towards the symptom checker were not significantly associated with age, sex, or level of education. Most patients (75%) and physicians (84%) indicated that the symptom checker had no effect on the duration of the medical visit. Only a few participants found the use of the symptom checker to be disruptive to the medical visit or its quality.

Conclusions
The findings suggest a positive reception of the symptom checker, albeit with differing focus between patients and physicians. With the potential to be integrated further into primary care, these tools require meticulous clinical guidance to maximize their benefits.

Trial registration
The study was not registered, as it did not include direct medical intervention on human participants.
Prevalence of physical frailty and impact on survival in patients with chronic kidney disease: a systematic review and meta-analysis
Authors: Zhang Fan , Wang Hui , Bai Yan , Zhang Ying , Huang Liuyan , Zhang Huachun 
Published: September 2023

AbstractBackgroundFrailty is common in chronic kidney disease (CKD) patients and becomes more prevalent as kidney disease progresses. This study aimed to investigate the prevalence of physical frailty and quantify the relationship between frailty and mortality risk in patients with CKD.MethodsPubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Clinicaltrial.gov, and major renal academic conferences were systematically searched, and additional references to relevant articles were manually searched. The prevalence of physical frailty and the risk of mortality based on random-effects models were assessed using percentages and hazard ratio (HR) with a 95% confidence interval (CI).ResultsA total of 139 articles, including 1,675,482 participants, met the eligibility criteria for the meta-analysis. The results showed that 34.5% (95% CI 31.0 to 38.1%) of CKD patients showed signs of frailty, and 39.4% (95% CI 35.4 to 43.5%) had prefrail symptoms. Compared to non-frail patients, the risk of mortality was increased by 94.1% (95% CI 1.586 to 2.375) in frail patients and 34.5% (95% CI 1.231 to 1.469) in prefrail patients.ConclusionThe high prevalence of frailty and prefrail in adults with CKD and resulting in premature death emphasize the importance of measuring frailty, which provides important prognostic information and may provide opportunities for interventions to improve the prognosis of patients with CKD.
Relationship between arterial stiffness, left ventricular diastolic function, and renal function in chronic kidney disease
Authors: Sági Balázs , Késői István , Vas Tibor , Csiky Botond , Nagy Judit , Kovács Tibor József 
Published: September 2023

Abstract
Aim
In chronic kidney disease, IgA nephropathy, and left ventricular diastolic dysfunction have prognostic significance as well. However, the relationship between diastolic dysfunction, arterial stiffness, and renal function has not been fully elucidated.

Methods
79 IgA nephropathy patients (aged 46 ± 11 years) and 50 controls were investigated. Tissue Doppler imaging was used to measure early (Ea) and late (Aa) diastolic velocities. Arterial stiffness was measured by a photoplethysmographic (stiffness index (SI)) and an oscillometric method (aortic pulse wave velocity (PWVao)).

Results
We compared the IgAN patients to a similar cardiovascular risk group with a preserved eGFR. A strong correlation was found between Ea/Aa and SI (p < 0.001), also with PWVao (p < 0.001), just in IgAN, and with eGFR (p < 0.001) in both groups. IgAN patients were divided into groups CKD1-2 vs. CKD3-5. In the CKD 3–5 group, the incidence of diastolic dysfunction increased significantly: 39% vs. 72% (p = 0.003). Left ventricle rigidity (LVR) was calculated, which showed a close correlation with SI (p = 0.009) and eGFR (p = 0.038). By linear regression analysis, the independent predictors of SI were age, E/A, and E/Ea; SI was the predictor of LVR; and E/A and hypertension were the predictors of eGFR.

Conclusion
In chronic kidney disease, increased cardiac rigidity and vascular stiffness coexist with decreased renal function, which is directly connected to diastolic dysfunction and vascular stiffness. On the basis of comparing the CKD group to the control group, vascular alterations in very early CKD can be identified.
Family-centered empowerment approach to optimize phosphate management among hemodialysis patients: an experimental study
Authors: Vasli Parvaneh , Hosseini Meimanat , Nasiri Malihe , Bakhtiari Noushin 
Published: September 2023

Abstract
Background
This study aimed to investigate the effect of a family-centered empowerment program on hyperphosphatemia management.

Method
This experimental study was performed on 80 randomly selected eligible patients with hyperphosphatemia undergoing hemodialysis. Patients were assigned randomly to two groups of family-centered empowerment program (FCEPG) and control group (CG) by coin toss (40 people per group). Data collection tools were the researcher-made Phosphate Control Knowledge Scale, the researcher-made Adherence to Dietary Restriction of Phosphorus Intake Scale, the eight-item Morisky Medication Adherence Scale, and serum phosphorus measurements. Data were collected before the intervention, one month, and three months after the intervention. Patients in FCEPG participated in a family-centered empowerment program. The statistical significance level was considered to be 0.05.

Results
Inter-group comparisons showed no significant difference between FCEPG and CG in terms of the mean score of knowledge of phosphate control, adherence to dietary restriction of phosphorus intake, adherence to medication, and the mean serum phosphorus level before the empowerment program, but showed significant differences between them in these respects at one month after the program and three months after the program (p < 0.05). Intra-group comparisons showed a significant difference in FCEPG between the mean and standard deviation of all four variables before the empowerment program and the corresponding values one month and three months after the program (P < 0.05).

Conclusion
The findings of this study can be used in various fields of healthcare in the hospital and community.
Development of an itaconic acid production process with Ustilaginaceae on alternative feedstocks
Authors: Niehoff Paul-Joachim , Müller Waldemar , Pastoors Johannes , Miebach Katharina , Ernst Philipp , Hemmerich Johannes , Noack Stephan , Wierckx Nick , Büchs Jochen 
Published: September 2023

Abstract
Background
Currently, Aspergillus terreus is used for the industrial production of itaconic acid. Although, alternative feedstock use in fermentations is crucial for cost-efficient and sustainable itaconic acid production, their utilisation with A. terreus most often requires expensive pretreatment. Ustilaginacea are robust alternatives for itaconic acid production, evading the challenges, including the pretreatment of crude feedstocks regarding reduction of manganese concentration, that A. terreus poses.

Results
In this study, five different Ustilago strains were screened for their growth and production of itaconic acid on defined media. The most promising strains were then used to find a suitable alternative feedstock, based on the local food industry. U. cynodontis ITA Max pH, a highly engineered production strain, was selected to determine the biologically available nitrogen concentration in thick juice and molasses. Based on these findings, thick juice was chosen as feedstock to ensure the necessary nitrogen limitation for itaconic acid production. U. cynodontis ITA Max pH was further characterised regarding osmotolerance and product inhibition and a successful scale-up to a 2 L stirred tank reactor was accomplished. A titer of 106.4 gitaconic acid/L with a theoretical yield of 0.50 gitaconic acid/gsucrose and a space-time yield of 0.72 gitaconic acid/L/h was reached.

Conclusions
This study demonstrates the utilisation of alternative feedstocks to produce ITA with Ustilaginaceae, without drawbacks in either titer or yield, compared to glucose fermentations.
High expression of HSP60 and survivin predicts poor prognosis for oral squamous cell carcinoma patients
Authors: Zhou Ying , Tang Yaoxiang , Luo Jiadi , Yang Yang , Zang Hongjing , Ma Jian , Fan Songqing , Wen Qiuyuan 
Published: September 2023

Abstract
Background
HSP60 is a heat shock proteins (HSPs) family member and help mitochondrial protein to fold correctly. Survivin is one of the inhibitors of apoptosis protein family member, which plays a significant part in cancer progression. They were capable of forming HSP60-survivin complexes and involved in the development of various tumors.

Methods
The Cancer Genome Atlas (TCGA) database demonstrated that HSP60 and survivin and their correlation on mRNA expression level with OSCC patients. Besides, expression of HSP60 and survivin proteins was studied utilizing immunohistochemistry in tissue microarrays (TMA) in OSCC and in adjacent non-cancerous squamous epithelium (Non-CCSE) tissues.

Results
Significantly increased levels of HSP60 and survivin in most cancers compared to normal tissue by pan-cancer analysis. HSP60 and survivin proved a significantly increased expression in OSCC samples compared to Non-CCSE both on mRNA and protein (both P < 0.05). Additionally, elevated HSP60 displayed a positive correlation with survivin in terms of mRNA and protein expression levels (all P < 0.001). Patients with OSCC who had advanced clinical stage or lymph node metastasis (LNM) showed higher HSP60 expression (P = 0.004, P = 0.006, respectively). Higher levels of the proteins HSP60 and survivin were significantly inversely correlated relationship with OSCC patients’ overall survival rates in multivariate survival analysis (P = 0.018, P = 0.040). From the above results, overexpression of HSP60 and survivin protein may serve as independent biomarkers predicting poor prognosis in OSCC.

Conclusions
Elevated HSP60 and survivin might be served as novel poor prognosis biomarkers for surgically resected OSCC patients.
Effects of virtual reality simulation on medical students’ learning and motivation in human parasitology instruction: a quasi-experimental study
Authors: Gao Fei , Qiu Jingfan , Chen Lin , Li Lan , Ji Minjun , Zhang Rong 
Published: September 2023

Abstract
Background
Despite the proven effectiveness of simulation-based learning activities, its adoption in medical education remains limited, and the influence of simulation on student motivation, particularly subjective task values, is seldom explored. This study aimed to investigate the impact of a simulation-based learning activity on student learning and subjective task values in a medical morphology-related course of Human Parasitology.

Methods
A quasi-experimental study was conducted with 113 Chinese undergraduate medical students who participated in a Human Parasitology course during April to May 2022. Students were divided into two groups: Simulation Group (n = 55), where students used the simulation, and Lecture Group (n = 58), where students attended an online lecture. Students’ learning was measured prior to the intervention, immediately after the intervention, and three weeks later to assess knowledge retention. The subjective task values questionnaire was administered before and after the interventions. Data were analyzed using one-way ANCOVA and MANOVA.

Results
Students in the Simulation Group exhibited significantly higher knowledge gain compared to the Lecture Group [F (1,110) = 23.69, p < 0.01]. Additionally, the Simulation Group retained knowledge significantly better than the Lecture Group [F (1,101) = 10.05, p < 0.005]. Furthermore, students in the Simulation Group experienced a significant increase in subjective task values after the intervention [F (3, 52) = 3.57, p < 0.05, ηp2 = 0.17], while students in the Lecture Group reported a significant decrease in subjective task values [F (3, 55) = 2.96, p < 0.05, ηp2 = 0.14].

Conclusions
Simulation-based learning not only leads to superior learning but also enhances students’ subjective task values. These findings offer valuable insights into designing effective simulation-based learning experiences in medical education and have significant practical implications for educators and medical professionals.
What is simulation-based medical education (SBME) debriefing in prehospital medicine? A qualitative, ethnographic study exploring SBME debriefing in prehospital medical education
Authors: Ahmad Maria , Page Michael , Goodsman Danë 
Published: September 2023

Abstract
Introduction
Simulation-based medical education (SBME) debriefing – a construct distinct from clinical debriefing – is used following simulated scenarios and is central to learning and development in fields ranging from aviation to emergency medicine. However, little research into SBME debriefing in prehospital medicine exists. This qualitative study explored the facilitation and effects of prehospital SBME debriefing, and identified obstacles to debriefing, using the London’s Air Ambulance Pre-Hospital Care Course (PHCC) as a model.

Method
Ethnographic observations of moulages and debriefs were conducted over two consecutive days of the PHCC in October 2019. Detailed contemporaneous field notes were made and analysed thematically. Subsequently, seven one-to-one, semi-structured interviews were conducted with four PHCC debrief facilitators and three course participants to explore their experiences of prehospital SBME debriefing. Interview data were transcribed and analysed thematically.

Results
Four overarching themes were identified: approach to facilitation of debriefs, effects of debriefing, facilitator development, and obstacles to debriefing.
The unpredictable debriefing environment was seen as both hindering and, paradoxically, benefitting SBME debriefing. Despite using varied debriefing structures, facilitators emphasised similar key debriefing components including exploring participants’ reasoning and sharing experiences to improve learning and prevent future errors.
Debriefing was associated with three effects: releasing emotion; learning and improving, particularly compound learning as participants progressed through sequential scenarios; and the application of learning to clinical practice. Facilitator training and feedback were central to facilitator learning and development.
Several obstacles to debriefing were identified, including mismatch of participant and facilitator agendas, pressure and time.

Conclusions
SBME debriefing in prehospital medicine is complex, requiring an understanding of participant agendas and facilitator experience to maximise participant learning. Aspects unique to prehospital SBME debriefing were identified, notably, the unpredictable debriefing environment, and the paradoxical benefit of educational obstacles for learning. Aspects of SBME debriefing not extensively detailed in the literature were also highlighted, such as compound participant learning, facilitator candour, and facilitator learning, which require further exploration.