bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior atlantoaxial internal fixation using Harms technique assisted by 3D-based navigation robot for treatment of atlantoaxial instability
Authors: Lang Zhao , Han Xiaoguang , Fan Mingxing , Liu Yajun , He Da , Tian Wei 
Published: November 2022

Abstract
Background
To evaluate the accuracy of screw placement using the TiRobot surgical robot in the Harms procedure and to assess the clinical outcomes of this technique.

Methods
This retrospective study included 21 patients with atlantoaxial instability treated by posterior atlantoaxial internal fixation (Harms procedure) using the TiRobot surgical robot between March 2016 and June 2021. The precision of screw placement, perioperative parameters and clinical outcomes were recorded. Screw placement was assessed based on intraoperative guiding pin accuracy measurements on intraoperative C-arm cone-beam computed tomography (CT) images using overlay technology and the incidence of screw encroachment identified on CT images.

Results
Among the 21 patients, the mean age was 44.8 years, and the causes of atlantoaxial instability were os odontoideum (n = 11), rheumatoid arthritis (n = 2), unknown pathogenesis (n = 3), and type II odontoid fracture (n = 5). A total of 82 screws were inserted with robotic assistance. From intraoperative guiding pin accuracy measurements, the average translational and angular deviations were 1.52 ± 0.35 mm (range 1.14–2.25 mm) and 2.25° ± 0.45° (range 1.73°–3.20º), respectively. Screw placement was graded as A for 80.5% of screws, B for 15.9%, and C for 3.7%. No complications related to screw misplacement were observed. After the 1-year follow-up, all patients with a neurological deficit experienced neurological improvement based on Nurick Myelopathy Scale scores, and all patients with preoperative neck pain reported improvement based on Visual Analog Scale scores.

Conclusions
Posterior atlantoaxial internal fixation using the Harms technique assisted by a 3D-based navigation robot is safe, accurate, and effective for treating atlantoaxial instability.
Exploring risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: construction of a novel population-based predictive model
Authors: Huang Yanling , Mao Yaqian , Xu Lizhen , Wen Junping , Chen Gang 
Published: November 2022

Abstract
Background
Machine learning was a highly effective tool in model construction. We aim to establish a machine learning-based predictive model for predicting the cervical lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC).

Methods
We obtained data on PTMC from the SEER database, including 10 demographic and clinicopathological characteristics. Univariate and multivariate logistic regression (LR) analyses were applied to screen the risk factors for cervical LNM in PTMC. Risk factors with P < 0.05 in multivariate LR analysis were used as modeling variables. Five different machine learning (ML) algorithms including extreme gradient boosting (XGBoost), random forest (RF), adaptive boosting (AdaBoost), gaussian naive bayes (GNB) and multi-layer perceptron (MLP) and traditional regression analysis were used to construct the prediction model. Finally, the area under the receiver operating characteristic (AUROC) curve was used to compare the model performance.

Results
Through univariate and multivariate LR analysis, we screened out 9 independent risk factors most closely associated with cervical LNM in PTMC, including age, sex, race, marital status, region, histology, tumor size, and extrathyroidal extension (ETE) and multifocality. We used these risk factors to build an ML prediction model, in which the AUROC value of the XGBoost algorithm was higher than the other 4 ML algorithms and was the best ML model. We optimized the XGBoost algorithm through 10-fold cross-validation, and its best performance on the training set (AUROC: 0.809, 95%CI 0.800–0.818) was better than traditional LR analysis (AUROC: 0.780, 95%CI 0.772–0.787).

Conclusions
ML algorithms have good predictive performance, especially the XGBoost algorithm. With the continuous development of artificial intelligence, ML algorithms have broad prospects in clinical prognosis prediction.
Pathways to ovarian cancer diagnosis: a qualitative study
Authors: Lawson-Michod Katherine A. , Watt Melissa H. , Grieshober Laurie , Green Sarah E. , Karabegovic Lea , Derzon Samantha , Owens Makelle , McCarty Rachel D. , Doherty Jennifer A. , Barnard Mollie E. 
Published: November 2022

Abstract
Background
Ovarian cancer is often diagnosed at a late stage, when survival is poor. Qualitative narratives of patients’ pathways to ovarian cancer diagnoses may identify opportunities for earlier cancer detection and, consequently, earlier stage at diagnosis.

Methods
We conducted semi-structured interviews of ovarian cancer patients and survivors (n = 14) and healthcare providers (n = 11) between 10/2019 and 10/2021. Interviews focused on the time leading up to an ovarian cancer diagnosis. Thematic analysis was conducted by two independent reviewers using a two-phase deductive and inductive coding approach. Deductive coding used a priori time intervals from the validated Model of Pathways to Treatment (MPT), including self-appraisal and management of symptoms, medical help-seeking, diagnosis, and pre-treatment. Inductive coding identified common themes within each stage of the MPT across patient and provider interviews.

Results
The median age at ovarian cancer diagnosis was 61.5 years (range, 29–78 years), and the majority of participants (11/14) were diagnosed with advanced-stage disease. The median time from first symptom to initiation of treatment was 2.8 months (range, 19 days to 4.7 years). The appraisal and help-seeking intervals contributed the greatest delays in time-to-diagnosis for ovarian cancer. Nonspecific symptoms, perceptions of health and aging, avoidant coping strategies, symptom embarrassment, and concerns about potential judgment from providers prolonged the appraisal and help-seeking intervals. Patients and providers also emphasized access to care, including financial access, as critical to a timely diagnosis.

Conclusion
Interventions are urgently needed to reduce ovarian cancer morbidity and mortality. Population-level screening remains unlikely to improve ovarian cancer survival, but findings from our study suggest that developing interventions to improve self-appraisal of symptoms and reduce barriers to help-seeking could reduce time-to-diagnosis for ovarian cancer. Affordability of care and insurance may be particularly important for ovarian cancer patients diagnosed in the United States.
Effect of vitamin D supplementation on the severity of stress urinary incontinence in premenopausal women with vitamin D insufficiency: a randomized controlled clinical trial
Authors: Shahraki Sedigheh Khodabandeh , Emadi Seyedeh Fatemeh , Salarfard Mahla , Chenari Zahra , Tadayyonfar Faezeh , Alikamali Maryam 
Published: November 2022

Abstract
Background
Urinary incontinence, especially stress urinary incontinence (SUI), is one of the problems experienced by premenopausal women. Given the role of vitamin D in enhancing muscle strength and function, this study explored the effect of vitamin D3 supplementation on SUI in premenopausal women.

Methods
A randomized controlled trial was performed with 60 premenopausal women referring to Kerman gynecological clinic in 2020 and 2021. Eligible women received a 5000-unit vitamin D supplement or placebo weekly for 3 months. The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) was utilized to assess SUI severity before and after the intervention. The t-test, Chi-square test, and repeated measures ANOVA were carried out in SPSS software (version 22) to analyze the data. P-values smaller than 0.05 were considered significant.

Results
Before the intervention, there was no significant difference between the intervention and control groups in SUI severity (P = 0.652) and the impact of SUI severity on premenopausal women’s lives (P = 0.804). In contrast, after 8-12 weeks of vitamin D supplementation, these scores decreased significantly in the intervention group relative to the control group (P <  0.001). In addition, after vitamin D supplementation, the number of SUI and urinary leakage symptoms decreased in the intervention group (P <  0.001).

Conclusion
Vitamin D supplementation improves SUI in premenopausal women.

Trial registration
This trial was registered with the Iranian Registry of Clinical Trials; https://fa.irct.ir/trial/53474 (IRCT20190724044318N2) on 11/02/2021.
Preparing students to deal with the consequences of the workforce shortage among health professionals: a qualitative approach
Authors: Golz Christoph , Oulevey Bachmann Annie , Defilippis Tiziana Sala , Kobleder Andrea , Peter Karin Anne , Schaffert René , Schwarzenbach Xenia , Kampel Thomas , Hahn Sabine 
Published: November 2022

AbstractBackgroundHealthcare is facing a shortage of qualified healthcare professionals. The pandemic has brought to light the fragile balance that affects all healthcare systems. Governments have realized that these systems and the professionals working in them need support at different levels to strengthen the retention of the workforce. Health professionals’ education can play an important role in ensuring that new generations of workers have sound personal and professional competencies to successfully face the challenges of professional practice. These challenges are described in the literature, but the extent to which they are considered in health professionals’ education is less clear.MethodsThis qualitative study compares the professional challenges and educational needs described in the literature with the current curricula for health professionals offered in Switzerland. Data were collected nationally through focus group interviews with 65% of Switzerland’s directors of bachelor’s and master’s programs of health professions (nursing, physiotherapy, occupational therapy, midwifery, nutrition and dietetics, osteopathy, radiologic medical imaging technology, health promotion and prevention, and health sciences). The data attained were analyzed using knowledge mapping.ResultsThe results reveal a gap among education programs with regard to occupational health promotion and cultural diversity. Both topics are taught with a sole focus on patients, and students are expected to adopt similar strategies for their health promotion and stress management. Physicians are insufficiently involved in interprofessional education. The programs fail to enhance health professionals’ political, economic and digital competencies.ConclusionThe results of this study offer clear guidance about what topics need to be integrated into curricula to improve health professionals’ well-being at work and their preparedness to face daily professional challenges.
The reimbursement for expensive medicines: stakeholder perspectives on the SMA medicine nusinersen and the Dutch Coverage Lock policy
Authors: Scheijmans Féline E. V. , Zomers Margot L. , Fadaei Sina , Onrust Marthe R. , van der Graaf Rieke , Delden Johannes J. M. van , van der Pol W. Ludo , van Thiel Ghislaine J. M. W. 
Published: November 2022

Abstract
Background
The reimbursement for expensive medicines poses a growing challenge to healthcare worldwide. In order to increase its control over the costs of medicines, the Dutch government introduced the Coverage Lock (CL) policy in 2015. The CL postpones decisions regarding reimbursement of expensive medicines until detailed advice on i.e., cost-effectiveness has been given. The CL has been in place for six years, has raised many questions and concerns, but currently, no evaluation is known to the authors. A better understanding of the effects of the CL on all stakeholders involved may contribute to reflections on the CL process and help find ways to improve it. An evaluation of Dutch policy will also be relevant for other countries that aim to optimize reimbursement procedures for expensive treatments. To perform this evaluation, we focused on the CL procedure for the medicine nusinersen. Nusinersen is the first treatment for spinal muscular atrophy (SMA). Following EMA approval in May 2017, it was placed in the CL. The analysis of cost-effectiveness and added therapeutic value resulted in an advice for reimbursement limited to children younger than 9.5 years at the start of treatment; this was implemented from August 2018 onwards.

Methods
Qualitative stakeholder perspective analysis of the CL procedure focusing on nusinersen with 15 stakeholders.

Results
Stakeholders raised key issues of the CL based on their experience with nusinersen: emotional impact of the CL, duration of the CL procedure, appropriateness of the CL procedure for different types of medicines, transparency of the CL, a wish for patient-centred decision-making and the lack of uniformity of access to expensive treatments.

Discussion
Stakeholders supported measures to control healthcare expenses and to ensure reasonable pricing. They considered the delay in access to therapies and lack of procedural transparency to be the main challenges to the CL. Stakeholders also agreed that the interests of patients deserve more attention in the practical implementation of the reimbursement decision. Stakeholders suggested a number of adjustments to improve the CL, such as a faster start with conditional reimbursement programs to ensure access and intensify European collaboration to speed up the assessment of the medicine.
Systematic evaluation of the pre-eclampsia drugs, dietary supplements and biologicals pipeline using target product profiles
Authors: McDougall Annie R. A. , Hastie Roxanne , Goldstein Maya , Tuttle Andrew , Tong Stephen , Ammerdorffer Anne , Gülmezoglu A. Metin , Vogel Joshua P. 
Published: November 2022

Abstract
Background
The Accelerating Innovation for Mothers (AIM) project established a database of candidate medicines in research and development (R&D) between 2000 and 2021 for five pregnancy-related conditions, including pre-eclampsia. In parallel, we published target product profiles (TPPs) that describe optimal characteristics of medicines for use in preventing/treating pre-eclampsia. The study objective was to use systematic double screening and extraction to identify all candidate medicines being investigated for pre-eclampsia prevention/treatment and rank their potential based on the TPPs.

Methods
Adis Insight, Pharmaprojects, WHO international clinical trials registry platform (ICTRP), PubMed and grant databases were searched (Jan–May 2021). The AIM database was screened for all candidates being investigated for pre-eclampsia. Candidates in clinical development were evaluated against nine prespecified criteria from TPPs identified as key for wide-scale implementation, and classified as high, medium or low potential based on matching to the TPPs. Preclinical candidates were categorised by product type, archetype and medicine subclass.

Results
The AIM database identified 153 candidates for pre-eclampsia. Of the 87 candidates in clinical development, seven were classified as high potential (prevention: esomeprazole, l-arginine, chloroquine, vitamin D and metformin; treatment: sulfasalazine and metformin) and eight as medium potential (prevention: probiotic lactobacilli, dalteparin, selenium and omega-3 fatty acid; treatment: sulforaphane, pravastatin, rosuvastatin and vitamin B3). Sixty-six candidates were in preclinical development, the most common being amino acid/peptides, siRNA-based medicines and polyphenols.

Conclusions
This is a novel, evidence-informed approach to identifying promising candidates for pre-eclampsia prevention and treatment — a vital step in stimulating R&D of new medicines for pre-eclampsia suitable for real-world implementation.
Study protocol of the GLOW study: maximising treatment options for recurrent glioblastoma patients by whole genome sequencing-based diagnostics—a prospective multicenter cohort study
Authors: van Opijnen Mark P. , Broekman Marike L. D. , de Vos Filip Y. F. , Cuppen Edwin , van der Hoeven Jacobus J. M. , van Linde Myra E. , Compter Annette , Beerepoot Laurens V. , van den Bent Martin J. , Vos Maaike J. , Fiebrich Helle-Brit , Koekkoek Johan A. F. , Hoeben Ann , Kho Kuan H. , Driessen Chantal M. L. , Jeltema Hanne-Rinck , Robe Pierre A. J. T. , Maas Sybren L. N. 
Published: November 2022

Abstract
Background
Glioblastoma (GBM), the most common glial primary brain tumour, is without exception lethal. Every year approximately 600 patients are diagnosed with this heterogeneous disease in The Netherlands. Despite neurosurgery, chemo -and radiation therapy, these tumours inevitably recur. Currently, there is no gold standard at time of recurrence and treatment options are limited. Unfortunately, the results of dedicated trials with new drugs have been very disappointing. The goal of the project is to obtain the evidence for changing standard of care (SOC) procedures to include whole genome sequencing (WGS) and consequently adapt care guidelines for this specific patient group with very poor prognosis by offering optimal and timely benefit from novel therapies, even in the absence of traditional registration trials for this small volume cancer indication.

Methods
The GLOW study is a prospective diagnostic cohort study executed through collaboration of the Hartwig Medical Foundation (Hartwig, a non-profit organisation) and twelve Dutch centers that perform neurosurgery and/or treat GBM patients. A total of 200 patients with a first recurrence of a glioblastoma will be included. Dual primary endpoint is the percentage of patients who receive targeted therapy based on the WGS report and overall survival. Secondary endpoints include WGS report success rate and number of targeted treatments available based on WGS reports and number of patients starting a treatment in presence of an actionable variant. At recurrence, study participants will undergo SOC neurosurgical resection. Tumour material will then, together with a blood sample, be sent to Hartwig where it will be analysed by WGS. A diagnostic report with therapy guidance, including potential matching off-label drugs and available clinical trials will then be sent back to the treating physician for discussing of the results in molecular tumour boards and targeted treatment decision making.

Discussion
The GLOW study aims to provide the scientific evidence for changing the SOC diagnostics for patients with a recurrent glioblastoma by investigating complete genome diagnostics to maximize treatment options for this patient group.
Trial registration: ClinicalTrials.gov Identifier: NCT05186064.
Prevalence of malaria and its risk factors in Lake Tana and surrounding areas, northwest Ethiopia
Authors: Adugna Fasil , Wale Melaku , Nibret Endalkachew 
Published: November 2022

Abstract
Background
In Ethiopia, malaria is a major concern to the health, and socio-economic development of the country because of its occurrence at the peak agricultural activities. Factors such as environmental, human host, parasite, and vector determine malaria transmission. Therefore, the present study was conducted to determine the prevalence and associated factors of malaria among febrile patients who visited selected health centres.

Methods
Institutional-based cross-sectional study was conducted between October 2020 to July 2021 in eight selected health centres located in Lake Tana and its surrounding areas. A simple random sampling technique was used to select febrile patients. Thick and thin blood films were prepared and processed according to the WHO guidelines. Socio-demographic and malaria risk factors were collected from study participants who could read and write using a self-administered questionnaire, whereas face-to-face interview was used to collect information from those participants who could not write and read. The strength of association between risk factors and malaria was assessed using univariate and multivariate logistic regression models.

Results
Of the total (531) febrile patients, 75.3% were malaria negative and 24.7% (overall prevalence) were malaria confirmed cases. Most of the infections were caused by Plasmodium falciparum (72.5%) followed by Plasmodium vivax (23.7%) and mixed-species (3.8%). The highest prevalence was recorded in Kidist Hana (51.5%) followed by Robit (34.8%), Gorgora (30.3%), and Wusha Tiris (25%) health centres. In terms of months, the highest prevalence (37.5%) was detected in October whereas the lowest (14%) was in March. Logistic regression analysis revealed that gender (p = 0.023), educational level (p = 0.025), study month (p = 0.036), presence of eave in the house (p = 0.002) and wall openings (p = 0.041), not using bed nets (p = 0.001), sleeping in the same house with cattle (p = 0.031) and the distance between mosquito-breeding site and living house (p = 0.020) were explanatory risk factors significantly associated with malaria among studied participants.

Conclusions
In this study, we confirmed that the occurrence of malaria prevalence was high and continued against the Ethiopian malaria elimination plan of 2021–2025. Therefore, to meet the goals of this plan, the current prevention and control efforts should be stepped up even better in the coming years.
How can health technology assessment support our response to public health emergencies?
Authors: Ananthakrishnan Aparna , Luz Alia Cynthia Gonzales , KC Sarin , Ong Leslie , Oh Cecilia , Isaranuwatchai Wanrudee , Dabak Saudamini Vishwanath , Teerawattananon Yot , Turner Hugo C. 
Published: November 2022

AbstractPublic health emergencies (PHEs), such as the COVID-19 crisis, are threats to global health and public order. We recommend that countries bolster their PHE responses by investing in health technology assessment (HTA), defined as a systematic process of gathering pertinent information on and evaluating health technologies from a medical, economic, social and ethical standpoint. We present examples of how HTA organizations in low- and middle-income countries have adapted to supporting PHE-related decisions during COVID-19 and describe the ways HTA can help the response to a PHE. In turn, we advocate for HTA capacity to be further developed globally and for increased institutional acceptance of these methods as a building block for preparedness and response to future PHEs. Finally, the long-term potential of HTA in strengthening health systems and embedding confidence and transparency into scientific policy should be recognized.
Covert Contraceptive Use amongst the urban poor in Accra, Ghana: experiences of health providers
Authors: Kushitor Mawuli , Henry Elizabeth G. , Obeng-Dwamena Akua Danquah , Agyekum Martin Wiredu , Agula Caesar , Toprah Theophilus , Shah Iqbal , Bawah Ayaga A. 
Published: November 2022

Abstract
Background
An estimated one-third of women in Ghana use contraceptives without the knowledge of their partners, a phenomenon known as Covert Contraceptive Use (CCU). Most research on CCU to date has focused on individual women to the neglect of the role of health system. This study explores CCU in urban poor communities of Accra, Ghana, from the experiences and perspectives of health providers.

Methods
Qualitative in-depth interviews were conducted with health care providers in both the public and private sectors at multiple levels, from the community clinic to the tertiary hospital, to gain insights into the strategies women use and the ways in which the health system supports the practice of CCU.

Results
Five major thematic areas emerged: use of easily concealed-methods, discrete-access-and-information-keeping, time-of-day, non-verbal-communication and use of relationships. The study further revealed that fear, mistrust, shyness, myths, and misperceptions regarding contraceptives explain CCU among women in the communities that the providers serve.

Conclusion
Importantly, disclosure of methods used by providers without women’s consent could potentially lead to violent outcomes for both women and the providers. Our results highlight the pivotal role that providers play in confidentially supporting women’s choices regarding the use of contraceptives.