bluuebunny/crossref_metadata_2025_split huggingface dataset:
General practitioners’ experiences in consultations with foreign language patients after the introduction of a user’s fee for professional interpretation: a qualitative interview study
Authors: Davidsen Annette Sofie , Lindell Johanna Falby , Hansen Cæcilie , Michaëlis Camilla , Lutterodt Melissa Catherine , Krasnik Allan , Norredam Marie Louise , Reventlow Susanne 
Published: May 2022

Abstract
Background
In 2018, an amendment to the Danish Health Care Act was passed making it a requirement for patients not proficient in Danish to pay for interpretation services in health care settings. Thereafter there has been a drastic decline in the use of professional interpreters, especially in general practice. We aimed to investigate the experiences of general practitioners (GPs) in establishing an understanding with these patients in consultations, without the presence of a professional interpreter.

Methods
The study was qualitative, based on semi-structured interviews with nine purposively selected GPs. Analysis was by interpretative phenomenological analysis.

Results
The GPs said that after the amendment was passed, the patients chose to almost exclusively use family members or friends as ad hoc interpreters, or they attended consultations with no interpreter present at all. The GPs experienced that the use of family interpreters caused specific problems, due to both their relationship with the patient and their lack of professional interpretation skills. If no mediator was present the GPs perceived the establishment of understanding as extremely challenging. This was particularly the case if patients had chronic conditions, mental or psychosocial problems or if cultural barriers were present. According to the GPs, the challenges were not exclusively restricted to a lack of language translation, but could also involve intertwined cultural barriers or social problems. The impairment in mutual understanding had different consequences, and led to poorer treatment at many levels in health care. The lack of access to a professional interpreter also presented the GP with ethical and legal dilemmas.

Conclusions
The GPs experienced that the changes in interpretation provision for patients in health care had led to professional interpretation being almost absent from general practice settings for patients subject to the fee. This led to several communication challenges, insufficient understanding in consultations, and poorer treatment of these, often very vulnerable, patients. The situation could, however, also involve the risk of epistemic injustice. The GPs experienced the situation as very unsatisfactory; it both comprised their ability to exercise their professionalism and their ethical obligations and restricted their legal rights.
Exclusive enteral nutrition remodels the intestinal flora in patients with active Crohn's disease
Authors: Jiang Jingjing , Chen Lu , Chen Yanfang , Chen Hong 
Published: May 2022

Abstract
Background
Although there are many hypotheses, the pathogenesis of Crohn's disease (CD) is not completely clear so far. Exclusive enteral nutrition (EEN) is a routine measure in the treatment of active CD. We aimed at investigating the impact of EEN on patients with active CD from microbial metabolomics.

Methods
16S-rDNA sequencing technology and gas chromatography–mass spectrometer analysis were employed to investigate the modification of the intestinal flora and fecal short-chain fatty acid (SCFA) during the EEN.

Results
Seven patients with CD, who conducted EEN, were followed up successfully in the present study. The 8-week EEN resulted in a remission of the condition of subjects with active CD, as revealed by a significant decrease in erythrocyte sedimentation rate (ESR) (P = 0.018), C-reactive protein (CRP) (P = 0.028), and Crohn’s disease activity index (CDAI) (P = 0.018). The nutrition of the subjects was improved after an 8-week treatment course with EEN, which was associated with an increase in body mess index (BMI) (P = 0.018) and serum albumin (ALB) (P = 0.018) levels. Furthermore, our investigations revealed a significantly increased abundance of Firmicutes paralleled by decreased levels of Proteobacteria. With respect to the genus, five species of bacteria including Ruminococcus (P = 0.01), Lachnospiraceae (P = 0.02), Anaerotruncus (P = 0.04), Flavonifractor (P = 0.04), and Novosphingobium (P = 0.05) showed significantly increased abundance. This was accompanied by relative changes in fecal short-chain fatty acids levels. Moreover, we successfully constructed a stable model by combining these five significantly different genera to predict the therapeutic effect of EEN on patients with CD (AUC = 0.9598).

Conclusions
The findings indicated that EEN can alleviate the condition and the nutrition of patients with active CD by regulating the intestinal flora and influencing the expression level of fecal short-chain fatty acids.
Sarcopenia is associated with prognosis in patients with esophageal squamous cell cancer after radiotherapy or chemoradiotherapy
Authors: Qian Junchao , Si Youjiao , Zhou Ke , Tian Yu , Guo Qisen , Zhao Kaikai , Yu Jinming 
Published: May 2022

Abstract
Background
This study aimed to determine the prognostic value of the sarcopenia on the progression free survival (PFS) and overall survival (OS) of esophageal squamous cell cancer (ESCC) patients who received radiotherapy (RT) or chemoradiotherapy (CRT).

Methods
Data on clinicopathological characteristics and nutritional parameters were analyzed and correlated with PFS and OS, retrospectively. Skeletal muscle, subcutaneous, visceral and total fat tissue cross-sectional areas were evaluated on CT images at the midpoint of the 3rd lumbar vertebrae. A total of 213 patients were enrolled in this study.

Results
Sarcopenia was significantly associated with subcutaneous fat content. The univariate analysis demonstrated that OS was superior in patients with non-sarcopenia, non-alcohol, NRI ≥ 100, albumin ≥ 40 g/L, TATI > 83.0, SATI > 27.8, VATI > 49, non-anemia, cervical and upper-thoracic ESCC, T stage 1–2, N stage 0–1 and TNM stage I–II. In the multivariate analysis, sarcopenia, albumin, N stage and TNM stage were identified as independent prognostic factors of survival. This study demonstrated that sarcopenia was related to worse PFS and OS in patients with ESCC who received RT or CRT.

Conclusions
Sarcopenia is considered to be a useful predictor in patients with ESCC who received RT or CRT. This study also provided a conceptual basis for further prospective research on the application of the sarcopenia for patients receiving RT or CRT for intermediate- and advanced-stage ESCC.
Comparing emergency department use among individuals with varying levels of cognitive impairment
Authors: Green Rebecca K. , Shah Manish N. , Clark Lindsay R. , Batt Robert J. , Chin Nathaniel A. , Patterson Brian W. 
Published: May 2022

Abstract
Introduction
As the population ages, Alzheimer’s disease and related dementias (ADRD) are becoming increasingly common in patients presenting to the emergency department (ED). This study compares the frequency of ED use among a cohort of individuals with well-defined cognitive performance (cognitively intact, mild cognitive impairment (MCI), and ADRD).

Methods
We performed a retrospective cohort study of English-speaking, community-dwelling individuals evaluated at four health system-based multidisciplinary memory clinics from 2014–2016. We obtained demographic and clinical data, including neuropsychological testing results, through chart review and linkage to electronic health record data. We characterized the frequency and quantity of ED use within one year (6 months before and after) of cognitive evaluation and compared ED use between the three groups using bivariate and multivariate approaches.

Results
Of the 779 eligible patients, 89 were diagnosed as cognitively intact, 372 as MCI, and 318 as ADRD. The proportion of subjects with any annual ED use did not increase significantly with greater cognitive impairment: cognitively intact (16.9%), MCI (26.1%), and ADRD (28.9%) (p = 0.072). Average number of ED visits increased similarly: cognitively intact (0.27, SD 0.72), MCI (0.41, SD 0.91), and ADRD (0.55, SD 1.25) (p = 0.059). Multivariate logistic regression results showed that patients with MCI (odds ratio (OR) 1.62; CI = 0.87–3.00) and ADRD (OR 1.84; CI = 0.98–3.46) did not significantly differ from cognitively intact adults in any ED use. Multivariate negative binomial regression found patients with MCI (incidence rate ratio (IRR) 1.38; CI = 0.79–2.41) and ADRD (IRR 1.76, CI = 1.00–3.10) had elevated but non-significant risk of an ED visit compared to cognitively intact individuals.

Conclusion
Though there was no significant difference in ED use in this small sample from one health system, our estimates are comparable to other published work. Results suggested a trend towards higher utilization among adults with MCI or ADRD compared to those who were cognitively intact. We must confirm our findings in other settings to better understand how to optimize systems of acute illness care for individuals with MCI and ADRD.
Associations between albumin, globulin, albumin to globulin ratio and muscle mass in adults: results from the national health and nutrition examination survey 2011–2014
Authors: Chen Zhi , Song Chenyang , Yao Zhipeng , Sun Jun , Liu Wenge 
Published: May 2022

Abstract
Introduction
Chronic inflammation and malnutrition play important roles in muscle loss. Although albumin, globulin and albumin to globulin ratio (AGR) are considered to be useful inflammatory-nutritional biomarkers, their relationship with muscle mass remain unclear. This study aimed to investigate the relationship between them in adults.

Methods
We utilized data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014 for analysis. Data on albumin, globulin, appendicular skeletal muscle mass, body mass index (BMI) and potential confounders (sociodemographic characteristics, medical conditions, laboratory parameters) were extracted and analyzed. We conducted multivariate linear regression models and smooth curve fittings to investigate the association between albumin, globulin, AGR and muscle mass. Subgroup analysis based on gender and muscle mass were performed.

Results
A total of 4110 participants were included, there were 294 participants with low muscle mass (LMM) and 3816 participants with normal muscle mass (NMM). LMM individuals were older, had greater prevalence of diabetes, higher BMI, globulin and triglycerides, lower albumin and AGR. Albumin was positively correlated to muscle mass in men, but negatively correlated with muscle mass in women. There were negative association between globulin and muscle mass, and positive association between AGR and muscle mass among men, but no significant associations were detected among women. Moreover, a linear relationship between albumin, globulin and muscle mass, as well as a non-linear relationship between AGR and muscle mass in men were identified.

Conclusions
The relationships between albumin, globulin, AGR and muscle mass were sex-specific. We speculate these indicators may be useful in assessing muscle mass in men.
Impact of antimicrobial stewardship programs on antibiotic consumption and antimicrobial resistance in four Colombian healthcare institutions
Authors: Pallares Christian , Hernández-Gómez Cristhian , Appel Tobías Manuel , Escandón Kevin , Reyes Sergio , Salcedo Soraya , Matta Lorena , Martínez Ernesto , Cobo Sara , Mora Laura , Marín Adriana , Correa Adriana , De La Cadena Elsa , Rodríguez-Baño Jesús , Villegas María Virginia 
Published: May 2022

Abstract
Background
Antimicrobial stewardship programs (ASPs) have become a fundamental pillar in optimizing antimicrobial usage, improving patient care, and reducing antimicrobial resistance (AMR). Herein we evaluated the impact of an ASP on antimicrobial consumption and AMR in Colombia.

Methods
We designed a retrospective observational study and measured trends in antibiotic consumption and AMR before and after the implementation of an ASP using interrupted time series analysis over a 4-year period (24 months before and 24 months after ASP implementation).

Results
ASPs were implemented according to the available resources in each of the institutions. Before ASP implementation, there was a trend toward an increase in the antibiotic consumption of all measured antimicrobials selected. Afterward, an overall decrease in antibiotic consumption was observed. The use of ertapenem and meropenem decreased in hospital wards, while a decrease in the use of ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, and vancomycin was observed in intensive care units. After ASP implementation, the trend toward an increase of oxacillin-resistant Staphylococcus aureus, ceftriaxone-resistant Escherichia coli, and meropenem-resistant Pseudomonas aeruginosa was reversed.

Conclusions
In our study, we showed that ASPs are a key strategy in tackling the emerging threat of AMR and have a positive impact on antibiotic consumption and resistance.
Contrast-enhanced ultrasound improves the potency of fine-needle aspiration in thyroid nodules with high inadequate risk
Authors: Yin Tinghui , Zheng Bowen , Lian Yufan , Li Haifeng , Tan Lei , Xu Shicheng , Liu Yong , Wu Tao , Ren Jie 
Published: May 2022

AbstractBackgroundThis study aims to determine the clinical value of contrast enhanced ultrasound (CEUS) for fine-needle aspiration (FNA) of high inadequate risky thyroid nodules.MethodsDuring April 2018 and April 2021, consecutive 3748 thyroid nodules underwent FNA were retrospectively analyzed. CEUS guided FNA (CEUS-FNA) was applied in 115 nodules with high inadequate risk in Lingnan Campus. Ten nodules underwent CEUS-FNA presented non-enhancing, and would be further analyzed independently. Other 105 partial or total enhancing nodules were included as CEUS-FNA group, and 210 nodules with high inadequate risk in Tianhe Campus were match as the US-FNA control group. FNA specimens were collected for liquid-based preparation. Cytological results were classified following the Bethesda System for Reporting Thyroid Cytopathology.ResultsThe overall FNA specimen inadequate rate in our center was 6.6%. All of the ten non-enhancing nodules under CEUS have an inadequate result in cytopathological analyzes. The subsequent postoperative pathology and follow-up ultrasonography showed the non-enhancing nodules were benign or stable without further malignant features. Total specimen inadequate rate of high inadequate risk thyroid nodules in CEUS-FNA group was significantly lower than US-FNA group (6.7% vs. 16.7%,P = 0.014). Further stratified analyzed shown that FNA under US guidance, the inadequate rates in cystic, predominantly cystic, predominantly solid and solid sub-groups were 28.1%, 17.1%, 10.0% and 9.2% (P = 0.019). In contrast, the inadequate rates in cystic, predominantly cystic, predominantly solid and solid sub-groups were 7.4%, 6.7%, 5.6% and 6.7% (P = 0.996) in CEUS-FNA group.ConclusionsCEUS can improve the specimen adequacy of FNA in high inadequate risk thyroid nodules by avoiding unnecessary FNAs of the non-enhancing nodules, and accurately locating the viable tissue and precise guidance in real-time. CEUS is a recommend modality for FNA guidance of high inadequate risk thyroid nodules.
The burden of renal admissions in a tertiary Hospital in Sierra Leone
Authors: Coker Joshua , Abiri Onome , Nwosu Obinna Jude , Gbla Alhaji , Taylor Adetunji Wilson , Lisk Durodami 
Published: May 2022

Abstract
Background
The burden of both acute kidney injury and chronic kidney disease is on the rise globally. In sierra Leone, there has been no data on renal patients or admissions. This study intends to close this gap in knowledge and give preliminary data on the burden of renal disease in this country.

Methods
The study was a retrospective review of the case notes of patients admitted at Connaught Hospital, Freetown over a 2 year period. Data extraction was done using a well- structured proforma.

Results
A 2.7% renal admission burden was obtained; mean duration of hospital stay was 15.1 ± 14.7; mean age of patients was 47.2 ± 17.5 with a female preponderance. The common risk factors for chronic kidney disease were systemic hypertension (43%) and diabetes mellitus (24%). The common risk factors for acute kidney injury were sepsis (77%) and hypovolemia (15%). The in- hospital mortality rate was 47% and 73% were non-compliant with haemodialysis probably due to financial reasons.

Conclusion
There is a significant burden of kidney disease in our environment, affecting mainly our young and middle-aged population. A rational approach is to embark on kidney disease prevention programs.
Syphilis Trigram: a domain-specific visualisation to combat syphilis epidemic and improve the quality of maternal and child health in Brazil
Authors: de Morais Cleber Matos , Teixeira Igor Vitor , Sadok Sara , Endo Patricia Takako , Kelner Judith 
Published: May 2022

Abstract
Background
The Brazilian healthcare system is a large and complex system, specially considering its mixed public and private funding. The incidence of syphilis has increased in the last four years, in spite of the presence of an effective and available treatment. Furthermore, syphilis takes part in a group of disorders of compulsory notification to the public health surveillance. The epidemiological implications are especially important during pregnancy since it can lead to complications, related to prematurity stillbirth and miscarriage, in addition to congenital syphilis, characterized by multisystem involved in the newborn.

Methods
The Action Research methodology was applied to address the complexity of the syphilis surveillance scenario in Pernambuco, Brazil. Iterative learning cycles were used, resulting in six cycles, followed by a formal validation of an operational version of the syphilis Trigram visualisation at the end of the process. The original data source was analyzed and prepared to be used without any new data or change in the ordinary procedure of the current system.

Results
The main result of this work is the production of a Syphilis Trigram: a domain-specific infographic for presenting gestational data and birth data. The second contribution of this work is the Average Trigram, an organized pie chart which synthesizes the Syphilis Trigram relationship in an aggregated way. The visualization of both graphics is presented in an Infographic User Interface, a tool that gathers an infographic broad visualization aspect to data visualization. These interfaces also gather selections and filters tools to assist and refine the presented information. The user can experience a specific case-by-case view, in addition to an aggregated perspective according to the cities monitored by the system.

Conclusions
The proposed domain-specific visualization amplifies the understanding of each syphilis case and the overall characteristics of cases of a chosen city. This new information produced by the Trigram can help clarify the reinfection/relapse cases, optimize resource allocation and enhance the syphilis healthcare policies without the need of new data. Thus, this enables the health surveillance professionals to see the broad tendency, understand the key patterns through visualization, and take action in a feasible time.
Adverse obstetric and perinatal outcomes in 2333 singleton pregnancies conceived after different endometrial preparation protocols: a retrospective study in China
Authors: Yang Zexin , Bai Xuelian , Han Ying , Zou Zhangxiang , Fan Yazhen , Wang Xinyan , Luo Haining , Zhang Yunshan 
Published: May 2022

Abstract
Backgroup
Frozen-thawed embryo transfer is rising worldwide. One adverse effect of programmed frozen embryo transfer (FET) reported in some studies is an increased risk of adverse obstetric and perinatal outcomes. Meanwhile, body mass index (BMI) also has adverse effect on obstetric and perinatal outcomes. In this study, we investigated that the influence of different endometrial preparation protocols on obstetric and perinatal outcomes and the role of BMI in it.

Method
This retrospective cohort study included 2333 singleton deliveries after frozen-thaw embryo transfer at our centre between 2014 and 2021, including 550 cycles with programmed FET, 1783 cycles with true natural cycle FET (tNC-FET). In further analysis according to BMI grouped by Asian criterion, group A (18.5 kg/m2 ≤ BMI < 24.00 kg/m2) included 1257 subjects, group B (24 kg/m2 ≤ BMI < 28.00 kg/m2) included 503 subjects and group C (BMI ≥ 28 kg/m2) included 573 subjects. Baseline characteristics of the two groups were compared and analyzed. Binary logistic regression analyses were performed to explore the association between obstetric and perinatal outcomes and endometrial preparation protocols.

Results
There were no significant differences in the placenta previa, gestational diabetes mellitus(GDM), preterm premature rupture of membranes (PPROM), cesarean section (CS) and macrosomia between the tNC-FET and programmed FET groups (P > 0.05). The programmed FET cycles were associated to a higher risk of pregnancy-induced hypertension (PIH) compared with the tNC-FET cycles (7.3% vs 4.4%, crude OR 1.71[1.16–2.54]; adjusted OR 1.845[1.03–3.30]). After dividing the patients into three groups according to the BMI, The programmed FET cycles were associated to a higher risk of PIH in group C (14.4% vs 6.2%, crude OR 2.55 [1.42–4.55]; adjusted OR 4.71 [1.77–12.55]) compared with the tNC-FET cycles. But there was no statistically significant difference in group A and group B. Programmed FET group compared with the tNC-FET group, the risk of PIH increase as the body mass index increase.

Conclusion
This study showed a tendency toward increasing risk of PIH in programmed FET cycle compared with the tNC-FET cycle, and the risk of PIH increases as BMI increases. Increased risk of preterm birth and low birth weight is linked to increased risk of PIH.
Promoting the practice of exclusive breastfeeding: a philosophic scoping review
Authors: Amoo Tumilara Busayo , Popoola Tosin , Lucas Ruth 
Published: May 2022

Abstract
Background
The World Health Organization recommends exclusive breastfeeding for the first 6 months of an infant’s life and continued breastfeeding for 2 years. The global rate of exclusive breastfeeding is low at 33%. Thus, it is important to identify philosophical and theory-based strategies that can promote exclusive breastfeeding. The aim of the study was to identify philosophical schools of thought and theories used in research on promoting the practice of exclusive breastfeeding.

Methods
A scoping review using Arksey and O'Malley's framework explored the phenomenon of exclusive breastfeeding practice promotion. Searches were conducted using CINAHL Plus full-text, PubMed, APA PsycInfo, and Academic Search Premier. Search terms included theory, philosophy, framework, model, exclusive breastfeeding, promotion, support, English, and publication between 2001—2022.

Results
The online search yielded 1,682 articles, however, only 44 met the inclusion criteria for the scoping review. The articles promoting exclusive breastfeeding used pragmatism (n = 1) or phenomenology (n = 2) philosophies and theories of self-efficacy (n = 10), theory of planned behaviour (n = 13), social cognitive theories (n = 18) and represented 16 countries. Theories of self-efficacy and planned behaviour were the most used theories.

Conclusions
This review suggests that theories and models are increasingly being used to promote exclusive breastfeeding. Orienting exclusive breastfeeding programmes within theoretical frameworks is a step in the right direction because theories can sensitize researchers and practitioners to contextually relevant factors and processes appropriate for effective exclusive breastfeeding strategies. Future research should examine the efficacy and effectiveness of theory-informed exclusive breastfeeding programmes over time. Such information is important for designing cost-effective EBF programmes.