bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of massive cerebral infarction as a complication of post-tonsillectomy and analysis of the risk factors: a case report
Authors: Zhao Jinghao , Lei Yubo , Hu Na , Xia Lang , Zeng Liyang , Zhang Yongheng , Qin Wei 
Published: January 2023

Abstract
Background
The majority of postoperative complications of tonsillectomy are bleeding. However, massive cerebral infarction following haemostasis is a very rare and serious complication and has rarely been reported clinically.

Case presentation
We performed a left tonsillectomy on a patient with chronic tonsillitis. After that, active bleeding was found under the tonsillar fossa, so an exploratory hypopharyngeal haemostasis was performed. However, the bleeding worsened intraoperatively, so the patient was converted to a cervical angiographic embolization. The interventional procedure was completed successfully without an ectopic embolic event. After the procedure, the patient was transferred to the intensive care unit (ICU) and was diagnosed with acute massive cerebral infarction in the left cerebral hemisphere after awakening symptoms combined with cranial computed tomography angiography (CTA) results. Symptomatic treatment such as sedation and analgesia, dehydration to lower intracranial pressure, and maintenance of respiratory and circulatory stability was then administered. After treatment, the patient’s condition stabilized and he was transferred to the rehabilitation physiotherapy unit for rehabilitation.

Conclusion
Post-tonsillectomy haemorrhage can be augmented with a carotid arteriogram to clarify whether the tonsillar fossa is at a safe distance from the posterior internal carotid artery. Furthermore, interventional haemostasis can also be performed as early as possible to reduce the incidence of complications in cases of persistent post-tonsillectomy bleeding.
The trace that is valuable: serum copper and copper to zinc ratio for survival prediction in younger patients with newly diagnosed acute myeloid leukaemia
Authors: Li Taotao , Shi Liming , Wei Wei , Xu Jiancheng , Liu Qiuju 
Published: January 2023

AbstractPurposeNo data on predicting the survival of AML patients based on the level of trace elements in the serum have been presented to date. The aims of this prospective cohort study were as follows: (i) to evaluate the serum Cu and Zn levels in people from Northeast China, (ii) to assess the association between the serum Cu level (SCL) and Cu to Zn ratio (SCZR) and clinical and nutrition data, and (iii) to investigate the predictive values of the SCL and SCZR in newly diagnosed de novo AML patients.MethodsA total of 105 newly diagnosed AML patients and 82 healthy controls were recruited. The serum Cu and Zn levels were determined by inductively coupled plasma spectrometry. The associations of SCL and SCZR with the survival of these AML patients were assessed by Cox proportional hazards models.ResultsBoth SCL and SCZR were positively related to the blast percentage of bone marrow and C-reactive protein, negatively related to albumin level andCEBPAdouble mutation and were significantly associated with worse overall survival and disease-free survival. Meanwhile, patients with higher SCL had worse CTCAE levels, and patients with higher SCZR showed less complete remission during the first course of induction chemotherapy. Moreover, higher SCZR was positively associated with ELN risk stratification, and was negatively associated with haemoglobin level and prognostic nutritional index (PNI).ConclusionThe SCL and SCZR are associated with long-term survival in patients with newly diagnosed AML undergoing intensive induction and may serve as important predictive biomarkers.
Pseudoaneurysm of the brachial artery in an infant due to vaccination: a case report
Authors: Shi Hai-fei , Yuan Shuai , Liang Ke-jiong , Ye Po , Yang Hu 
Published: January 2023

Abstract
Background
Pseudoaneurysm is a known complication of penetrating arterial injuries such as catheterization, gunshot wounds, and open fractures. Vaccination is an effective method for preventing multiple, serious, infectious diseases in children. Common adverse reactions related to vaccination include fever, swelling, redness, and pain. Brachial pseudoaneurysm after vaccination has not been previously reported.

Case presentation
Herein we describe a novel case of brachial pseudoaneurysm after vaccination in a child aged 1 year and 3 months. A pulsatile mass was formed in the medial left arm of the infant 10 days after vaccination at a community hospital and gradually grew larger. Preoperative images depicted an eccentric aneurysm in the brachial artery and a swirling flow pattern in the mass. The pseudoaneurysm was excised, and vein graft interpositioning was successfully performed. There were no short-term or long-term complications during the follow-up period.

Conclusions
Brachial pseudoaneurysm is a rare complication of vaccination via intramuscular injection. Medical staff should avoid puncture wounds to the brachial artery during vaccination, especially in infants.
Effective factors of improved helmet use in motorcyclists: a systematic review
Authors: Mahdavi Sharif Pouya , Najafi Pazooki Sara , Ghodsi Zahra , Nouri Ahmad , Ghoroghchi Hamed Abbasizade , Tabrizi Reza , Shafieian Mehdi , Heydari Seyed Taghi , Atlasi Rasha , Sharif-Alhoseini Mahdi , Ansari-Moghaddam Alireza , O’Reilly Gerard , Rahimi-Movaghar Vafa 
Published: January 2023

Abstract
Background
Road traffic injuries (RTI) are one of the most prominent causes of morbidity and mortality, especially among children and young adults. Motorcycle crashes constitute a significant part of RTIs. Policymakers believe that safety helmets are the single most important protection against motorcycle-related injuries. However, motorcyclists are not wearing helmets at desirable rates. This study systematically investigated factors that are positively associated with helmet usage among two-wheeled motorcycle riders.

Methods
We performed a systematic search on PubMed, Scopus, Web of Science, Embase, and Cochrane library with relevant keywords. No language, date of publication, or methodological restrictions were applied. All the articles that had evaluated the factors associated with helmet-wearing behavior and were published before December 31, 2021, were included in our study and underwent data extraction. We assessed the quality of the included articles using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies.

Results
A total of 50 articles were included. Most evidence suggests that helmet usage is more common among drivers (compared to passengers), women, middle-aged adults, those with higher educations, married individuals, license holders, and helmet owners. Moreover, the helmet usage rate is higher on highways and central city roads and during mornings and weekdays. Travelers of longer distances, more frequent users, and riders of motorcycles with larger engines use safety helmets more commonly. Non-helmet-using drivers seem to have acceptable awareness of mandatory helmet laws and knowledge about their protective role against head injuries. Importantly, complaint about helmet discomfort is somehow common among helmet-using drivers.

Conclusions
To enhance helmet usage, policymakers should emphasize the vulnerability of passengers and children to RTIs, and that fatal crashes occur on low-capacity roads and during cruising at low speeds. Monitoring by police should expand to late hours of the day, weekends, and lower capacity and less-trafficked roads. Aiming to enhance the acceptance of other law-abiding behaviors (e.g., wearing seat belts, riding within the speed limits, etc.), especially among youth and young adults, will enhance the prevalence of helmet-wearing behavior among motorcycle riders. Interventions should put their focus on improving the attitudes of riders regarding safety helmets, as there is acceptable knowledge of their benefits.
Long-term trend of antibiotic use at public health care institutions in northwest China, 2012–20 —— a case study of Gansu Province
Authors: Cao Wenxuan , Feng Hu , Ma Yongheng , Zhao Defang , Hu Xiaobin 
Published: January 2023

Abstract
Background
Over the past 20 years, excessive antibiotic use has led to serious antimicrobial resistance (AMR) worldwide, and the phenomenon is particularly serious in China. To this end, the Chinese health sector took a series of measures to promote rational antibiotic use. In this study, to reveal the impact of policies on antibiotic use, we explored the long-term trend and patterns of antibiotic use at public health care institutions from 2012 to 2020 in northwest China, taking Gansu Province as an example.

Methods
Antibiotic procurement data were obtained from the provincial centralized bidding procurement (CBP) platform between 2012 and 2020. Antibiotic use was quantified using the Anatomical Therapeutic Chemical (ATC)/defined daily doses (DDD) methodology and standardized using the DDD per 1000 inhabitants per day (DID). Twelve relevant quality indicators were calculated for comparison with the European Surveillance of Antimicrobial Consumption (ESAC) project monitoring results.

Results
Total antibiotic use increased from 18.75 DID to 57.07 DID and then decreased to 19.11 DID, a turning point in 2014. The top three antibiotics used were J01C (beta-lactam antibacterials, penicillins), J01F (macrolides, lincosamides and streptogramins), and J01D (other beta-lactam antibacterials, cephalosporins), accounting for 45.15%, 31.40%, and 11.99% respectively. The oral antibiotics used were approximately 2.5 times the parenteral antibiotics, accounting for 71.81% and 28.19%, respectively. Different use preferences were shown in public hospitals and primary health care centres (PHCs), and the latter accounted for more than half of total use. The absolute use of all classes of antibiotics in Gansu is almost higher than any of the 31 European countries included in the ESAC, but the relative use of some focused antibiotics is lower than theirs.

Conclusions
The intervention policies of the health department reduced antibiotic use in Gansu Province, but the proportion of broad-spectrum and parenteral antibiotics was still high. It is necessary to further improve the quality of antibiotic prescriptions and pay more attention to the rationality of antibiotic use in PHCs.
Vulnerability to violence against women or girls during COVID-19 in Uganda
Authors: Bukuluki Paul , Kisaakye Peter , Bulenzi-Gulere Grace , Mulindwa Beatrice , Bazira Dan , Letiyo Evelyn , Namirembe Hellen Nviiri Laetitia , Schmidt Isabella , Kakande Pamela Nabukhonzo , Nissling Simon 
Published: January 2023

AbstractAt the height of the COVID-19 pandemic, gender-based violence (GBV) was reported to have increased worldwide. We build on existing literature to examine the factors that increased vulnerability to GBV during the COVID-19 pandemic in Uganda. We use data from the Rapid Gender Assessment (RGA) survey that was conducted during COVID-19, which was designed to provide information to guide policymaking and offer appropriate interventions that address the needs of people in Uganda during the pandemic. The results show that the following respondents are more likely to experience increased risk and vulnerability to gender-based violence: those with primary level of education (OR = 1.49; 95% CI = 1.10–2.01), those who received information about GBV (OR = 1.30; 95% CI = 1.08–1.57), and those who needed help or medical support as a prevention measure against GBV (OR = 1.29; 95% CI = 1.04–1.61). However, respondents who would need financial support to prevent GBV were less likely to experience increased GBV (OR = 0.83; 95% CI = 0.70–0.98). Our results align with evidence from other studies that risk and vulnerability to GBV in Uganda increased since the onset of COVID-19. The findings provide an understanding of the interrelationship between GBV and COVID-19,which can help with designing GBV preventive measures, particularly during pandemics among those most at-risk.
“Antibiotic prescribing etiquette” an elective course for medical students: could we recruit potential physicians to fight resistance?
Authors: El-sokkary Rehab H. , Badran Shahenda G. , El Seifi Omnia S. , El-Fakharany Yara M. , Tash Rehab M. Elsaid 
Published: January 2023

Abstract
Background
A better understanding of medical students’ competencies about antimicrobial resistance and their use could facilitate a more effective education for them as future prescribers. The aim is to explore the educational impact of an elective course on medical students’ knowledge, perception, and attitude toward antibiotic resistance and use.

Methods
Between December 2021 and January 2022, when a 2-credit hours elective course was designed and implemented, this interventional study was conducted. The primary outcome measure was the change in medical students’ knowledge, perception, and attitude about antibiotic resistance and use. Using a pre-post course questionnaire, this outcome was assessed. The secondary measure included students’ perception of the course; assessed by a post-course online survey.

Results
Among the 50 enrolled students, the total knowledge score had significantly increased after the course with 95% CI After the course, with medium effect size ( Cohen’s d= -0.7 ) the participants’ mean ± SD total perception and attitude scores had significantly increased (52.38 ± 5.53 vs. 56.84 ± 5.86) respectively, (p = 0.000) with large effect size (( Cohen’s d= -0.8) There was a significant positive correlation between the total knowledge, attitude, and perception after the course (r = 0.542, p < 0.01). The mean ± SD of the overall course satisfaction was 4.20 ± 0.94. out of 5.

Conclusion
Medical students’ knowledge, perceptions, and attitudes towards antimicrobial prescription have been improved after the elective antibiotic prescribing etiquette course. Elective courses could offer a great opportunity to enable the students to understand the extent of the problem, stand on the facts, and take responsibility for the antibiotic resistance crisis.

Trial registration
NA
Digital learning designs in occupational therapy education: a scoping review
Authors: Hwang Na-Kyoung , Shim Sun-Hwa , Cheon Hye-Won 
Published: January 2023

Abstract
Background
Digital learning is a rapidly advancing method for teaching and learning in professional health education. Although various digital learning designs have been tried in OT education, studies on digital learning designs are still limited.

Methods
We conducted a scoping study that aimed to identify the digital learning designs used in occupational therapy (OT) education and review the effectiveness, learner perceptions, clinical skills integrated, and technology-based learning strategies used to facilitate learning. Four databases were searched using subheadings and terms relating to digital learning, occupational therapy, and education. The included studies were mapped according to the types of digital learning design, subjects, key clinical skills, and outcomes.

Results
Twenty-two studies were included in this review, most of which were qualitative, observational, or mixed studies of the two designs. The digital learning designs identified in OT education were flipped, blended, hybrid, and distance learning, including e-learning and massive open online courses (MOOC). Among the components of clinical skills, professional reasoning and procedural knowledge were the most integrated into digital learning, and covered various OT subjects. Digital learning designs were reported to be equivalent to or more effective than the traditional face-to-face (F2F) class in learning outcomes of knowledge and skill acquisition, enhancing learning participation, reflection, and collaboration between learners. Various technologies have been used to promote synchronous or asynchronous active learning, providing learning strategies such as thinking, reflection, discussion, peer learning-group activity, and gamifying online learning.

Conclusions
In OT digital learning, appropriate learning subjects, the arrangement of clinical skill components that can be well integrated into digital learning, and the selection of appropriate technologies for effective learning are important. The results should be confirmed within an experimental study design.
Perception from students regarding online synchronous interactive teaching in the clinical year during COVID-19 pandemic
Authors: Cheung Billy H. H. , Foo Dominic C. C. , Chu Kent Man , Co Michael , Lee Lok Sze 
Published: January 2023

Abstract
Aim
The global pandemic of COVID-19 has led to extensive practice of online learning. Our main objective is to compare different online synchronous interactive learning activities to evaluate students’ perceptions. Moreover, we also aim to identify factors influencing their perceptions in these classes.

Methods
A cross-sectional, questionnaire-based study focusing on clinical year medical students’ perceptions and feedback was conducted between February 2021 –June 2021 at the University of Hong Kong. Online learning activities were divided into bedside teaching, practical skill session, problem-based learning (PBL) or tutorial, and lecture. A questionnaire based on the Dundee Ready Education Environment Measure (DREEM) was distributed to 716 clinical year students to document their perceptions.

Results
One hundred responses were received with a response rate of 15.4% (110/716, including 96 from bedside teaching, 67 from practical skill session, 104 from PBL/tutorial, and 101 from lecture).
For the mean score of the DREEM-extracted questionnaire, online PBL/tutorial scored the highest (2.72 ± 0.54), while bedside scored the lowest (2.38 ± 0.68, p = 0.001). Meanwhile, there was no significant difference when we compared different school years (p = 0.39), age (p = 0.37), gender (p = 1.00), year of internet experience (<17 vs ≥17 years p = 0.59), or prior online class experience (p = 0.62).
When asked about students’ preference for online vs face-to-face classes. Students showed higher preferences for online PBL/tutorial (2.06 ± 0.75) and lectures (2.27 ± 0.81). Distraction remains a significant problem across all four learning activities.
A multivariate analysis was performed regarding students’ reported behavior in comparison with their perception through the DREEM-extracted questionnaire. The results showed that good audio and video quality had a significant and positive correlation with their perception of online bedside teaching, practical skill sessions, and PBL/tutorial. It also showed that the use of the video camera correlated with an increase in perception scores for lectures.

Conclusion
The present analysis has demonstrated that students’ perception of different online synchronous interactive learning activities varies. Further investigations are required on minimizing distraction during online classes.
Medical residents’ and teachers’ perceptions of the digital format of nation-wide didactic courses for psychiatry residents in Sweden: a survey-based observational study
Authors: Knez Rajna , El Alaoui Samir , Ivarson Josefin , Risö Bergerlind Lise-Lotte , Stasinakis Sarantos , Ahlgren Anna-Maria , Maripuu Martin , Talaee Mofrad Danielle , Bolander Laksov Klara , Jayaram-Lindström Nitya , Sörman Karolina 
Published: January 2023

Abstract
Background
This study aimed to explore residents’ and teachers’ perceptions of the digital format of Metis (a national education network in Sweden) didactic courses for psychiatry residents in Sweden to guide post-pandemic curriculum development.

Methods
An online attitude survey was developed and sent out to 725 residents in psychiatry and 237 course directors/teachers. Data were examined descriptively and group differences were analysed with independent sample t-tests.

Results
The survey was completed by 112 residents and 72 course directors/teachers. Perceptions of digital formats were quite similar between the two groups with some significant differences i.e., residents agreed more strongly than directors/teachers with the statement that Metis courses in digital format were of the same quality (or better) than the classroom-based format. Residents perceived the positive effects of using interactive tools more than directors/teachers. More than 40% of the responders in both groups preferred a return to classroom-based course meetings. Responders in both groups suggested that different forms of digital elements (e.g., video-based and sound-recorded lectures, digital-group discussions, virtual patients) could be incorporated into different phases in the courses.

Conclusions
The study represents the current largest survey among residents in psychiatry and a teaching faculty in Sweden, to understand the impact of digitalization on the quality of residents’ education during the pandemic. The results point towards applying a mixed format for training and education going forward, incorporating digital aspects into the national curriculum.
Introduction and implementation of an immunization information system in the Indonesian province of Daerah Istimewa Yogyakarta: lessons for scaling-up
Authors: Sulistyawati Sulistyawati , Wibowo Trisno Agung , Rokhmayanti Rokhmayanti , Nugroho Andri Setyo Dwi , Sukesi Tri Wahyuni , Hastuti Siti Kurnia Widi , Mulasari Surahma Asti , Feletto Marta 
Published: January 2023

Abstract
Background
Immunization is critical to saving children from infections. To increase vaccination coverage, valid and real-time data are needed. Accordingly, it is essential to have a good report system that serves as defaulter tracking to prevent children's immunization failure. The Daerah Istimewa Yogyakarta (DIY) Health Office introduced an electronic immunization registry and successfully implemented it for more than five years. It is the only individual-based record system in Indonesia that has been sustainably operated for a long time. Yet, no systematic assessment of this system has been conducted to date. This study examines the Sistem Informasi Imunisasi Terpadu (SIMUNDU) introduction and implementation process with a view to extracting lessons that could inform scalability and sustainability across the country.

Methods
This study used an explanatory sequential mixed-method design, which collected quantitative data from 142 participants and qualitative data from nine participants. The data entry clerk at a health facility was systematically selected to participate in the survey, while in the key informant interview, the informant was selected based on the survey result. A descriptive and thematic approach was adopted to analyze the quantitative and qualitative data. Results from across the two approaches were integrated for comparison and contrast.

Results
Findings are presented according to three core themes that emerged from the data: system strengths, potential threats, weakness and opportunities for scaling-up. Strengths, i.e., factors contributing to the success of SIMUNDU, include management, system performance, people’s behavior, and resources. Potential threats to sustaining the system include individual capacity, technical or system issues, and high workload. Opportunities – i.e., a promising factor that influences the SIMUNDU ability to operate sustainably – such as continuity, expectation, and the possibility of scaling up.

Conclusions
SIMUNDU is a promising innovation for Indonesia, beyond DIY. There is agreement about the potential for scaling up this IIS to other provinces. The experience of implementing this system in DIY over the past five years has shown that the benefits outweigh the challenges, and SIMUNDU has grown into a robust yet user-friendly system.