bluuebunny/crossref_metadata_2025_split huggingface dataset:
Facilitators and Barriers of Reflective Learning in Postgraduate Medical Education: A Narrative Review
Authors: Gathu C 
Published: May 2022

Background Reflection in postgraduate medical education has been found to aid in the development of professional skills, improve clinical expertise, and problem solving with the aim of advancing lifelong learning skills and self-awareness, leading to good medical practice among postgraduate residents. Despite the evidenced benefits, reflection remains underused as a tool for teaching and learning, and few trainee physicians regularly engage in the process. Factors that affect the uptake of reflective learning in residency training have not yet been adequately explored. Objective The purpose of this review is to demonstrate the factors that influence the adoption of reflective learning for postgraduate students and their centrality to good clinical practice. Methods A review of the literature was performed using defined databases and the following search terms: ‘reflection’, ‘reflective learning’, ‘postgraduate medical education’, ‘barriers’ and ‘facilitators’. The search was limited to peer-reviewed published material in English between 2011 and 2020 and included research papers, reviews, and expert opinion pieces. Results Eleven relevant articles were included, which identified three main categories as facilitators and barriers to the adoption of reflective learning in postgraduate medical education. These included structure, assessment and relational factors. The structure of reflective practice is important, but it should not be too rigid. Assessments are paramount, but they should be multidimensional to accommodate the multicomponent nature of reflections. Relational factors such as motivation, coaching, and role modeling facilitate sustainable reflective practice. Conclusions This review suggests that the same factors that facilitate reflection can be a barrier if not used within the right epistemic. Educators should consider these factors to increase the acceptance and integration of reflective learning in curriculums by both teachers and learners.
Accuracy of a score predicting the presence of an atypical pathogen in hospitalized patients with moderately severe community-acquired pneumonia
Authors: Chauffard Aline , Bridevaux Pierre-Olivier , Carballo Sebastian , Prendki Virginie , Reny Jean-Luc , Stirnemann Jérôme , Garin Nicolas 
Published: May 2022

Abstract
Background
Atypical pathogens (AP), present in some patients with community-acquired pneumonia (CAP), are intrinsically resistant to betalactam drugs, the mainstay of empirical antibiotic treatment. Adding antibiotic coverage for AP increases the risk of adverse effects and antimicrobial selection pressure, while withholding such coverage may worsen the prognosis if an AP is causative. A clinical model predicting the presence of AP would allow targeting atypical coverage for patients most likely to benefit.

Methods
This is a secondary analysis of a multicentric randomized controlled trial that included 580 adults patients hospitalized for CAP. A predictive score was built using independent predictive factors for AP identified through multivariate analysis. Accuracy of the score was assessed using area under the receiver operating curve (AUROC), sensitivity, and specificity.

Results
Prevalence of AP was 5.3%. Age < 75 years (OR 2.7, 95% CI 1.2–6.2), heart failure (OR 2.6, 95% CI 1.1–6.1), absence of chest pain (OR 3.0, 95% CI 1.1–8.2), natremia < 135 mmol/L (OR 3.0, 95% CI 1.4–6.6) and contracting the disease in autumn (OR 2.7, 95% CI 1.3–5.9) were independently associated with AP. A predictive score using these factors had an AUROC of 0.78 (95% CI 0.71–0.85). A score of 0 or 1 (present in 33% of patients) had 100% sensitivity and 35% specificity.

Conclusion
Use of a score built on easily obtained clinical and laboratory data would allow safe withholding of atypical antibiotic coverage in a significant number of patients, with an expected positive impact on bacterial resistance and drug adverse effects.
Trial registration: NCT00818610.
DNA methylation of miR-138 regulates cell proliferation and EMT in cervical cancer by targeting EZH2
Authors: Chen Rui , Gan Qiyu , Zhao Shuting , Zhang Dongrui , Wang Shunli , Yao Lili , Yuan Min , Cheng Jingxin 
Published: May 2022

Abstract
Background
Emerging evidence has identified miR-138 as a tumor suppressor that can suppress the proliferation of various cancers. Meanwhile, the cause of abnormal miR-138 expression in cervical cancer remains uncertain. This study clarified the mechanism by which miR-138 regulates proliferation, invasion, metastasis, and EMT in cervical cancer cells.

Results
miR-138 expression in human cervical cancer and adjacent normal tissue was measured using qPCR. SiHa and C33A cells were used to determine the function of miR-138 via miR-138 mimic or inhibitor transfection, followed by wound healing, Cell Counting Kit-8, flow cytometry, and Transwell assays. Epithelial and mesenchymal marker expression was analyzed using Western blotting. DNA methylation in the miR-138 promoter was examined using bisulfite sequencing PCR. The downstream target genes of miR-138 were identified via bioinformatics analysis and luciferase reporter assays. A tumor xenograft model was employed to validate DNA methylation-induced miR-138 downregulation and tumor growth inhibition in cervical cancer in vivo. miR-138 levels were significantly lower in cervical cancer tissues than in adjacent control tissues. Furthermore, lower miR-138 expression and higher CpG methylation in the miR-138 promoter were identified in lymph node-positive metastatic cervical cancer tumors versus that in non-metastatic tumor tissues. Upon miR-138 overexpression, cell proliferation, metastasis, invasion, and EMT were suppressed. miR-138 agomir transfection and demethylating drug treatment significantly inhibited cervical tumor growth and EMT in tumor xenograft models. DNA methylation inhibited miR-138 transcription, and enhancer of zeste homolog 2 (EZH2) downregulation mediated the tumor suppressor function of miR-138 in cervical cancer.

Conclusion
We demonstrated that miR-138 suppresses tumor progression by targeting EZH2 in cervical cancer and uncovered the role of DNA methylation in the miR-138 promoter in its downregulation. These findings demonstrated the potential of miR-138 to predict disease metastasis and/or function as a therapeutic target in cervical cancer.
Social alignment matters: Following pandemic guidelines is associated with better wellbeing
Authors: Tunçgenç Bahar , Newson Martha , Sulik Justin , Zhao Yi , Dezecache Guillaume , Deroy Ophelia , Zein Marwa El 
Published: May 2022

AbstractBackgroundIn response to the Covid-19 pandemic, most countries implemented physical distancing measures. Many mental health experts warned that through increasing social isolation and anxiety, these measures could negatively affect psychosocial wellbeing. However, socially aligning with others by adhering to these measures may also be beneficial for wellbeing.MethodsWe examined these two contrasting hypotheses using cross-national survey data (N = 6675) collected fortnightly from participants in 115 countries over 3 months at the beginning of the pandemic. Participants reported their wellbeing, perceptions of how vulnerable they were to Covid-19 (i.e., high risk of infection) and how much they, and others in their social circle and country, were adhering to the distancing measures.ResultsLinear mixed-effects models showed that being a woman, having lower educational attainment, living alone and perceived high vulnerability to Covid-19 were risk factors for poorer wellbeing. Being young (18–25) was associated with lower wellbeing, but longitudinal analyses showed that young people’s wellbeing improved over 3 months. In contrast to widespread views that physical distancing measures negatively affect wellbeing, results showed that following the guidelines was positively associated with wellbeing even for people in high-risk groups.ConclusionsThese findings provide an important counterpart to the idea that pandemic containment measures such as physical distancing negatively impacted wellbeing unequivocally. Despite the overall burden of the pandemic on psychosocial wellbeing, social alignment with others can still contribute to positive wellbeing. The pandemic has manifested our propensity to adapt to challenges, particularly highlighting how social alignment can forge resilience.
“Psychometric properties of the Norwegian foot function index revised short form”
Authors: Mørk Marianne , Hoksrud Aasne Fenne , Soberg Helene Lundgaard , Zucknick Manuela , Heide Marte , Groven Karen Synne , Røe Cecilie 
Published: May 2022

Abstract
Background
Foot disorders affect up to one quarter of the adult population. Plantar fasciopathy is a common cause of foot pain associated with decreased activity level and quality of life. Patient-reported outcome measures are important in assessing the burden of a condition as well as in research on the effects of interventions. The Foot Function Index revised short form (FFI-RS) is a region specific questionnaire frequently used in research. This study aimed to cross-culturally adapt the FFI-RS into Norwegian and to test its psychometric properties.

Methods
The FFI-RS was translated into Norwegian (FFI-RSN) following international guidelines. 139 patients with foot disorders (88% with plantar fasciopathy) were included at baseline to measure internal consistency, explorative factor analysis, construct validity and floor and ceiling effects. 54 patients were included after 1 week for test-retest reliability and smallest detectable change analyses. 100 patients were included for responsiveness and minimal important change at 3 months.

Results
Cronbach’s alpha for internal consistency was 0.97 and factor analysis supported the use of the total score of the FFI-RSN. Two out of three predefined hypotheses were confirmed by assessing the construct validity with Spearman’s correlation coefficient. Quadratic weighted Kappa for test-retest reliability showed 0.91 (95% CI 0.86–0.96) and the smallest detectable change was 6.5%. The minimal important change was 8.4% and the area under the receiver operating characteristic curve for responsiveness was 0.78 (95% CI 0.69–0.87). We found no floor or ceiling effects on the total score of the FFI-RSN.

Conclusions
The present study showed excellent reliability of the FFI-RSN and supports the use of the total score of the questionnaire. Furthermore, we found the FFI-RSN to have acceptable responsiveness in relation to change in general health. Smallest detectable change, minimal important change and responsiveness were presented as novel results of the total score of the FFI-RS. FFI-RSN can be used to evaluate global foot health in clinical or research settings with Norwegian patients suffering from plantar fasciopathy.

Trial registration
Clinical Trials.gov NCT04207164. Initial release 01.11.19.
Psychometric evaluation of the Ethical Caring Competency Scale in nursing
Authors: Katayama Harumi , Muramatsu Taeko , Aoki Yoshimi , Nagashima Eri 
Published: May 2022

Abstract
Background
An ethical competence list for nurses could guide educators and managers in the field of health care to both support the development of ethical conduct and improve the assessment of ethical competence in health care.

Aim
This study aimed to verify the reliability and validity of the Ethical Caring Competency Scale (ECCS) and to obtain suggestions for its use as an evaluation form in rubric format among a sample of Japanese nurses.

Research design
This research employed a descriptive and cross-sectional design.

Participants and research context
A self-administered questionnaire was distributed to 1157 nurses working in two hospitals in Japan. The contents of the survey were demographic data, a draft of the ECCS consisting of 22 competencies from four core competencies, questions regarding experience in learning about medical/nursing ethics, and the Work Motivation Measurement Scale for Nurses. Three levels of difficulty for the 22 items were established using relative comparisons of the mean scores within the four core competencies. Three groups, namely, an expert group, a middle group, and a beginner group, were categorized according to the quartiles of the total ECCS score.

Ethical considerations
This study was approved by the Clinical Research Ethics Committee of Hamamatsu University School of Medicine (Decision no. 18-267). The ethical principles of voluntary participation, anonymity, and confidentiality were considered.

Findings
A total of 962 valid responses were analyzed. The ECCS scores for the three levels of difficulty were significantly different from each other. Stability was confirmed by the test-retest of the total ECCS scores (r = .900, p < .0001). The total ECCS scores for the three groups showed significant differences in all pairs. The Cronbach’s α coefficient ranged from .72 to .89 for each core competency, and internal consistency was confirmed.

Conclusion
The reliability and validity of the ECCS as a scale were statistically verified, and we were able to obtain suggestions for its application as a form of evaluation in rubric format.
What are the health consequences associated with differences in medical malpractice liability laws? An instrumental variable analysis of surgery effects on health outcomes for proximal humeral facture across states with different liability rules
Authors: Chen Brian , Floyd Sarah , Jindal Dakshu , Chapman Cole , Brooks John 
Published: May 2022

AbstractBackgroundStates enacted tort reforms to lower medical malpractice liability, which are associated with higher surgery rates among Medicare patients with shoulder conditions. Surgery in this group often entails tradeoffs between improved health and increased risk of morbidity and mortality. We assessed whether differences in surgery rates across states with different liability rules are associated with surgical outcomes among Medicare patients with proximal humeral fracture.MethodsWe obtained data for 67,966 Medicare beneficiaries with a diagnosis of proximal humeral fracture in 2011. Outcome measures included adverse events, mortality, and treatment success rates, defined as surviving the treatment period with < $300 in shoulder-related expenditures. We used existing state-level tort reform rules as instruments for surgical treatment and separately as predictors to answer our research question, both for the full cohort and for stratified subgroups based on age and general health status measured by Charlson Comorbidity Index and Function-Related Indicators.ResultsWe found a 0.32 percentage-point increase (p < 0.05) in treatment success and a 0.21 percentage-point increase (p < 0.01) in mortality for every 1 percentage-point increase in surgery rates among patients in states with lower liability risk. In subgroup analyses, mortality increased among more vulnerable patients, by 0.29 percentage-point (p < 0.01) for patients with Charlson Comorbidity Index >  = 2 and by 0.45 percentage-point (p < 0.01) among those patients with Function-Related Indicator scores >  = 2. On the other hand, treatment success increased in patients with lower Function-Related Index scores (< 2) by 0.54 percentage-point (p < 0.001). However, younger Medicare patients (< 80 years) experienced an increase in both mortality (0.28 percentage-point,p < 0.01) and treatment success (0.89 percentage-point,p < 0.01). The reduced-form estimates are consistent with our instrumental variable results.ConclusionsA tradeoff exists between increased mortality risk and increased treatment success across states with different malpractice risk levels. These results varied across patient subgroups, with more vulnerable patients generally bearing the brunt of the increased mortality and less vulnerable patients enjoying increased success rates. These findings highlight the important risk-reward scenario associated with different liability environments, especially among patients with different health status.
Home care for patients with dirty homes: a qualitative study of the problems experienced by nurses and possible solutions
Authors: De Veer Anke J. E. , De Groot Kim , Verkaik Renate 
Published: May 2022

Abstract
Background
Home-care nurses are often the first care professionals to enter a dirty home. The perceived problems and support needs of home-care nurses in these situations are largely unknown.

Objective
To examine the problems home-care nurses encounter in caring for patients living in dirty homes, and possible solutions for these problems.

Design
Qualitative descriptive research.

Setting
Communities across the Netherlands.

Participants
Twenty-three participants to investigate the problems or needs experienced, and 20 participants to investigate solutions. Participants included patients, home-care nurses and other professionals working in the community.

Methods
Semi-structured interviews were conducted with 23 participants and analysed according to the principles of deductive thematic analysis. Subsequently, in interviews with 4 (representatives of) patients and four focus-group sessions with 16 professionals, the problems found were validated and solutions to the problems discussed.

Results
Ten subthemes emerged that were clustered into three main themes: ‘dilemmas arise in choosing the right nursing care’; ‘cooperation and an integrated approach are often necessary, but lacking’; ‘home-care nurses have insufficient competencies’. Seven possible solutions were found: (1) strengthening collaboration between organizations in the community; (2) involving others sooner; (3) case management; (4) person-centred care; (5) taking more time; (6) providing home-care nurses with tools and support services; and (7) strengthening the competencies of nurses.

Conclusions
Care for patients with a dirty home is complex. An integrated person-centred care approach is often necessary and home-care nurses need extra support to provide such care. Interventions should not only focus on patients, but address the nurses, the organization, and the collaboration between organizations in the community.
Time trends (2001–2019) and sex differences in incidence and in-hospital mortality after lower extremity amputations among patients with type 1 diabetes in Spain
Authors: Lopez-de-Andres Ana , Jimenez-Garcia Rodrigo , Hernández-Barrera Valentín , de-Miguel-Diez Javier , de-Miguel-Yanes José M. , Omaña-Palanco Ricardo , Carabantes-Alarcon David 
Published: May 2022

Abstract
Background
We examined trends in incidence (2001–2019), clinical characteristics, and in-hospital outcomes following major and minor lower extremity amputations (LEAs) among type 1 diabetes mellitus (T1DM) patients in Spain and attempted to identify sex differences.

Methods
Retrospective cohort study using data from the Spanish National Hospital Discharge Database. We estimated the incidence of the LEA procedure stratified by type of LEA. Joinpoint regression was used to estimate incidence trends, and logistic regression was used to estimate factors associated with in-hospital mortality (IHM).

Results
LEA was coded in 6011 patients with T1DM (66.4% minor and 33.6% major). The incidence of minor LEA decreased by 9.55% per year from 2001 to 2009 and then increased by 1.50% per year, although not significantly, through 2019. The incidence of major LEA decreased by 13.39% per year from 2001 to 2010 and then remained stable through 2019. However, incidence increased in men (26.53% per year), although not significantly, from 2017 to 2019. The adjusted incidence of minor and major LEA was higher in men than in women (IRR 3.01 [95% CI 2.64–3.36] and IRR 1.85 [95% CI 1.31–2.38], respectively). Over the entire period, for those who underwent a minor LEA, the IHM was 1.58% (2.28% for females and 1.36% for males; p = 0.045) and for a major LEA the IHM was 8.57% (10.52% for females and 7.59% for males; p = 0.025).
IHM after minor and major LEA increased with age and the presence of comorbid conditions such as peripheral arterial disease, ischemic heart disease or chronic kidney disease. Female sex was associated with a higher IHM after major LEA (OR 1.37 [95% CI 1.01–1.84]).

Conclusions
Our data show a decrease in incidence rates for minor and major LEA in men and women with T1DM and a slight, albeit insignificant, increase in major LEA in men with T1DM in the last two years of the study. The incidence of minor and major LEA was higher in men than in women. Female sex is a predictor of IHM in patients with T1DM following major LEA.
Why Plasmodium vivax and Plasmodium falciparum are so different? A tale of two clades and their species diversities
Authors: Escalante Ananias A. , Cepeda Axl S. , Pacheco M. Andreína 
Published: May 2022

AbstractThe global malaria burden sometimes obscures that the genus Plasmodium comprises diverse clades with lineages that independently gave origin to the extant human parasites. Indeed, the differences between the human malaria parasites were highlighted in the classical taxonomy by dividing them into two subgenera, the subgenus Plasmodium, which included all the human parasites but Plasmodium falciparum that was placed in its separate subgenus, Laverania. Here, the evolution of Plasmodium in primates will be discussed in terms of their species diversity and some of their distinct phenotypes, putative molecular adaptations, and host–parasite biocenosis. Thus, in addition to a current phylogeny using genome-level data, some specific molecular features will be discussed as examples of how these parasites have diverged. The two subgenera of malaria parasites found in primates, Plasmodium and Laverania, reflect extant monophyletic groups that originated in Africa. However, the subgenus Plasmodium involves species in Southeast Asia that were likely the result of adaptive radiation. Such events led to the Plasmodium vivax lineage. Although the Laverania species, including P. falciparum, has been considered to share “avian characteristics,” molecular traits that were likely in the common ancestor of primate and avian parasites are sometimes kept in the Plasmodium subgenus while being lost in Laverania. Assessing how molecular traits in the primate malaria clades originated is a fundamental science problem that will likely provide new targets for interventions. However, given that the genus Plasmodium is paraphyletic (some descendant groups are in other genera), understanding the evolution of malaria parasites will benefit from studying “non-Plasmodium” Haemosporida.
Evolutionary history of Plasmodium vivax and Plasmodium simium in the Americas
Authors: Rougeron Virginie , Daron Josquin , Fontaine Michael C. , Prugnolle Franck 
Published: May 2022

AbstractMalaria is a vector-borne disease caused by protozoan parasites of the genus Plasmodium. Plasmodium vivax is the most prevalent human-infecting species in the Americas. However, the origins of this parasite in this continent are still debated. Similarly, it is now accepted that the existence of Plasmodium simium is explained by a P. vivax transfer from humans to monkey in America. However, many uncertainties still exist concerning the origin of the transfer and whether several transfers occurred. In this review, the most recent studies that addressed these questions using genetic and genomic approaches are presented.