Miracle-dz/UniFAR-FTUs huggingface dataset:
First-year pharmacy students' perceptions of their service-learning experience

To determine the effects of a service-learning experience, first year pharmacy students were surveyed on the following: (i) perceptions regarding cultural diversity, the elderly, the poor, and the disabled; and (ii) perceptions regarding community service and social support; (iii) perceptions regarding their servicelearning assignment were also assessed. One hundred fourteen students were surveyed on objectives 1 and 2 prior to their service-learning experiences. Students were surveyed on all three objectives after completing their service-learning experience. Using a five-point Likert scale (1=strongly disagree to 5=strongly agree), respondents rated their level of agreement with a series of statements. T-tests were used to compare their preand post-test responses. A total of 112 (98 percent) students completed the survey. Comparisons of the pre and post-tests revealed that there was a significant increase in mean perception scores regarding: community service (P=0.02), and patients’ need for social support (P<0.01). No other comparisons were significantly different. Students agreed (mean=3.8) that all pharmacy students should complete a service-learning experience, and they also agreed (mean=4.0) that the service-learning experience would be beneficial to them when practicing pharmacy. Introducing service-learning during the pharmacy curriculum may help students to: (i) better understand the future patients that they will be serving; (ii) recognize the importance of community service; and (iii) become more aware of patients’ need for social support.
Out-of-hours primary care: a population-based study of the diagnostic scope of telephone contacts.

BACKGROUND GPs answer all patient calls to the out-of-hours primary care (OOH-PC) services in Denmark. Knowledge is scarce on how the triage-GPs act on the specific reasons for encounter (RFE). OBJECTIVE This study aims to describe the RFEs, the applied diagnoses and the severity of health problems presented in calls to the OOH-PC. METHODS This was a 1-year cross-sectional study based on IT-integrated pop-up questionnaires addressing patients' health problems. We included only telephone contacts that were categorized according to their triage outcome as telephone consultations, direct admissions to hospital or referrals for face-to-face contact. The GP-assessed severity was calculated for age groups and types of outcome. We identified the 20 most frequent primary RFEs and diagnoses for each type of contact termination. RESULTS We included 7810 telephone calls. Calls considered non-severe made up two-thirds of the calls terminated as telephone consultations, whereas calls considered potentially severe made up the main part of referrals (52.3%). Overall, the 20 most frequent RFEs accounted for 45.2% of all RFEs, fever being the most frequent (10.0%). Some RFEs were terminated mostly as telephone consultations [e.g. insect bite/sting (75.9%)], whereas others were most often referred for a face-to-face contact [i.e. dyspnoea (79.1%)] or directly to hospital [i.e. chest pain (29.4%)]. CONCLUSION The distribution of the RFEs on triage outcomes, dominated by more severe diagnoses in referrals indicates a suitable referral level. However, future research on factors related to the demanding task of telephone triage is highly relevant for postdoctoral training of GPs.
Delirium in Hospitalized Older Adults

KEY CLINICAL POINTS DELIRIUM IN HOSPITALIZED OLDER ADULTSDelirium is an acute confusional state that is extremely common among hospitalized elders and is strongly associated with poor short‐term and long‐term outcomes.The risk of delirium can be assessed according to the presence of predisposing (baseline) and precipitating (acute) factors. The more predisposing factors that are present, the fewer precipitating factors that are required to cause delirium.The first step in delirium management is accurate diagnosis; a brief validated instrument that assesses features in the Confusion Assessment Method algorithm is recommended.After receiving a diagnosis of delirium, patients require a thorough evaluation for reversible causes; all correctable contributing factors should be addressed.Behavioral disturbances should be managed with nonpharmacologic approaches first. If required for patient safety, low doses of high‐potency antipsychotic agents are usually the treatment of choice (off‐label use). Treatment should be targeted to specific behaviors and stopped as soon as possible.Proactive, multifactorial interventions and geriatrics consultation have been shown to reduce the incidence, severity, and duration of delirium.
State Vaccination Requirements for HPV and Other Vaccines for Adolescents, 1990-2015.

State Vaccination Requirements for HPV and Other Vaccines for Adolescents, 1990-2015 Eight years after human papillomavirus (HPV) vaccines were first recommended in the United States, vaccination coverage is substantially below the Healthy People 2020 target of 80%. 1 Data from the US Centers for Disease Control and Prevention (CDC) show that 37.6% of adolescent girls and 13.9% of adolescent boys had completed the 3-dose series in 2013.2 Recent efforts to address these deficits emphasize that HPV vaccines should not be viewed or treated differently than other routinely recommended vaccines.1,2 School requirements are a mainstay of US vaccination policy, widely used by states to promote high vaccination rates. Depending on the vaccine, requirements may exist for attendance at day care, preschool, kindergarten, or higher grade levels.3 Attention to their potential value has been largely absent from recent discussions of strategies to improve HPV vaccination rates. However, requirements were extensively discussed following the approval of the first HPV vaccine in 2006.4 Proponents of vaccination argued at that time that requirements would be premature, explaining that a multi-year implementation period focused on supply, safety, financing, and education is warranted before requiring any new vaccine.5,6 We sought to examine the presence and timing of state requirements for vaccines with particular relevance to adolescent health and to compare those findings to the implementation of HPV vaccines. Methods | Vaccines studied were those used by the CDC to evaluate adolescent vaccination (ie, included in the National Immunization Survey—Teen) that were added to the recommended schedule since 1990 and protected against new disease targets: hepatitis B, varicella, meningococcal conjugate, and HPV. Using legal databases, CDC and other publications, and information from health departments, we identified the earliest date that a requirement, if applicable, took effect for each vaccine in every state and the District of Columbia (DC) for any childhood, adolescent, or college-aged population. Requirements approved through March 2015 were identified, including those with later effective dates. We calculated the time that elapsed between the publication of the corresponding recommendation of the CDC Advisory Committee on Immunization Practices (ACIP) in the Morbidity and Mortality Weekly Report, formalizing a change to the recommended vaccination schedule, and the effective date of each requirement.
The effectiveness of optimised clinical medication reviews for geriatric patients: Opti-Med a cluster randomised controlled trial

Background Inappropriate drug use is a frequent problem in older patients and associated with adverse clinical outcomes and an important determinant of geriatric problems. Clinical medication reviews (CMR) may reduce inappropriate drug use. Objective The aim of this study is to investigate the effectiveness of CMR on quality of life (QoL) and geriatric problems in comparison with usual care in older patients with geriatric problems in the general practice. Methods We performed a cluster randomised controlled trial in 22 Dutch general practices. Patients of ≥65 years were eligible if they newly presented with pre-specified geriatric symptoms in general practice and the chronic use of ≥1 prescribed drug. The intervention consisted of CMRs which were prepared by an independent expert team and discussed with the patient by the general practitioner. Primary outcomes: QoL and the presence of self-reported geriatric problems after a follow-up period of 6 months. Results 518 patients were included. No significant differences between the intervention and control group and over time were found for QoL, geriatric problems, satisfaction with medication and self-reported medication adherence. After 6 months the percentage of solved Drug Related Problems (DRPs) was significantly higher in the intervention group compared to the control group [B 22.6 (95%CI 14.1-31.1), P < 0.001]. Conclusion The study intervention did not influence QoL and geriatric problems. The higher percentage of solved DRPs in the intervention group did not result in effects on the patient's health. CMRs on a large scale seem not meaningful and should be reconsidered.
Noninvasive Prenatal Testing and Incidental Detection of Occult Maternal Malignancies.

IMPORTANCE Understanding the relationship between aneuploidy detection on noninvasive prenatal testing (NIPT) and occult maternal malignancies may explain results that are discordant with the fetal karyotype and improve maternal clinical care. OBJECTIVE To evaluate massively parallel sequencing data for patterns of copy-number variations that might prospectively identify occult maternal malignancies. DESIGN, SETTING, AND PARTICIPANTS Case series identified from 125,426 samples submitted between February 15, 2012, and September 30, 2014, from asymptomatic pregnant women who underwent plasma cell-free DNA sequencing for clinical prenatal aneuploidy screening. Analyses were conducted in a clinical laboratory that performs DNA sequencing. Among the clinical samples, abnormal results were detected in 3757 (3%); these were reported to the ordering physician with recommendations for further evaluation. EXPOSURES NIPT for fetal aneuploidy screening (chromosomes 13, 18, 21, X, and Y). MAIN OUTCOMES AND MEASURES Detailed genome-wide bioinformatics analysis was performed on available sequencing data from 8 of 10 women with known cancers. Genome-wide copy-number changes in the original NIPT samples and in subsequent serial samples from individual patients when available are reported. Copy-number changes detected in NIPT sequencing data in the known cancer cases were compared with the types of aneuploidies detected in the overall cohort. RESULTS From a cohort of 125,426 NIPT results, 3757 (3%) were positive for 1 or more aneuploidies involving chromosomes 13, 18, 21, X, or Y. From this set of 3757 samples, 10 cases of maternal cancer were identified. Detailed clinical and sequencing data were obtained in 8. Maternal cancers most frequently occurred with the rare NIPT finding of more than 1 aneuploidy detected (7 known cancers among 39 cases of multiple aneuploidies by NIPT, 18% [95% CI, 7.5%-33.5%]). All 8 cases that underwent further bioinformatics analysis showed unique patterns of nonspecific copy-number gains and losses across multiple chromosomes. In 1 case, blood was sampled after completion of treatment for colorectal cancer and the abnormal pattern was no longer evident. CONCLUSIONS AND RELEVANCE In this preliminary study, a small number of cases of occult malignancy were subsequently diagnosed among pregnant women whose noninvasive prenatal testing results showed discordance with the fetal karyotype. The clinical importance of these findings will require further research.
Septic Shock: Advances in Diagnosis and Treatment.

IMPORTANCE Septic shock is a clinical emergency that occurs in more than 230,000 US patients each year. OBSERVATIONS AND ADVANCES: In the setting of suspected or documented infection, septic shock is typically defined in a clinical setting by low systolic (≤90 mm Hg) or mean arterial blood pressure (≤65 mm Hg) accompanied by signs of hypoperfusion (eg, oliguria, hyperlactemia, poor peripheral perfusion, or altered mental status). Focused ultrasonography is recommended for the prompt recognition of complicating physiology (eg, hypovolemia or cardiogenic shock), while invasive hemodynamic monitoring is recommended only for select patients. In septic shock, 3 randomized clinical trials demonstrate that protocolized care offers little advantage compared with management without a protocol. Hydroxyethyl starch is no longer recommended, and debate continues about the role of various crystalloid solutions and albumin. CONCLUSIONS AND RELEVANCE The prompt diagnosis of septic shock begins with obtainment of medical history and performance of a physical examination for signs and symptoms of infection and may require focused ultrasonography to recognize more complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of intravenous fluids and vasoactive medications aimed at restoring adequate circulation, and the limitations of protocol-based therapy, as guided by recent evidence.
GASTROENTEROLOGY CLINICS OF NORTH AMERICA Prevention of Colorectal Cancer : Diet , Chemoprevention , and Lifestyle

T his article describes primary prevention of colon cancer (ie, interventions that do not involve the removal of diseased tissue or chemotherapy for known colon cancer). Although screening with ablation of adenomas has a significant impact on colon cancer [1], the logistics of screening are complicated [2–4]. These issues are addressed in accompanying articles. This article focuses on preventing the initiation and promotion of neoplastic growth, particularly with dietary measures. A goal of dietary epidemiology is to identify chemopreventive agents and strategies. The effects of diet are analyzed by observational approaches and experimental dietary, nutritional, or chemopreventive interventions. The adenomatous polyp or adenoma is an important surrogate endpoint for colon cancer [5–7]. The adenoma often remains indolent for years, so prevalence can be analyzed. The adenoma is common among older individuals, especially those more than 50 years old. As many as 30% to 50% of individuals older than 50 years of age harbor one or more adenomatous polyps [8]. The adenoma is usually asymptomatic and is generally discovered only during routine screening. The adenoma is the key premalignant lesion that leads to colon cancer [5,6]. Many, if not most, adenomas never progress to colon cancer, but most colon cancers emerge from adenomas (adenoma-to-carcinoma sequence). As the adenoma is more common than colon cancer and new adenomas develop in individuals who have had previous adenomas that were ablated, studies of interventions designed to prevent colon cancer usually analyze the adenoma as a surrogate marker. This strategy is based on preventing colon cancer by preventing adenomas. The weakness of this strategy is that the formation of adenomas does not guarantee that an individual is at increased colon cancer risk, but this weakness has not deterred investigators from studying the adenoma as a surrogate marker for human colon cancer. The proportion of colon cancer attributable to genetic syndromes—familial adenomatous polyposis and hereditary nonpolyposis colon cancer—seems to be small, so that screening for these two syndromes is unlikely to substantially reduce the incidence of colon cancer. Although these syndromes are powerful
Understanding Family-Centered Care in the Mental Health System: Perspectives From Family Members Caring for Relatives With Mental Health Issues

A recent focus on Family-Centered Care (FCC) in mental health has resulted in a variety of recommendations designed to increase family involvement in caring for relatives with mental health issues. Studies indicate that family members require collaboration, information, and support from the mental health system and its providers, but confidentiality concerns, funding limitations, and discrimination often prevent such needs from being met. A qualitative, exploratory study using in-person interviews has been implemented to consider how family members describe and understand their experiences with the mental health system. A critical, Foucauldian analysis is applied to the data to expose hidden systems of domination and oppression that may be contributing to discriminatory attitudes and practices that interfere with family involvement. Results of this research reiterate those found in the FCC literature; however, family members in this study seem hesitant to identify discrimination as a primary obstacle to FCC. It appears that complex processes may be at work that elicit the participation of family members in the reproduction of discrimination by interfering with their ability to recognize and resist its multiple and subtle forms. Recommendations for resistance include cultivating a critical awareness to disrupt dominant assumptions that inform discriminatory attitudes and practices.
Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia.

IMPORTANCE Dialysis facilities in the United States are required to educate patients with end-stage renal disease about all treatment options, including kidney transplantation. Patients receiving dialysis typically require a referral for kidney transplant evaluation at a transplant center from a dialysis facility to start the transplantation process, but the proportion of patients referred for transplantation is unknown. OBJECTIVE To describe variation in dialysis facility-level referral for kidney transplant evaluation and factors associated with referral among patients initiating dialysis in Georgia, the US state with the lowest kidney transplantation rates. DESIGN, SETTING, AND PARTICIPANTS Examination of United States Renal Data System data from a cohort of 15,279 incident, adult (18-69 years) patients with end-stage renal disease from 308 Georgia dialysis facilities from January 2005 to September 2011, followed up through September 2012, linked to kidney transplant referral data collected from adult transplant centers in Georgia in the same period. MAIN OUTCOMES AND MEASURES Referral for kidney transplant evaluation within 1 year of starting dialysis at any of the 3 Georgia transplant centers was the primary outcome; placement on the deceased donor waiting list was also examined. RESULTS The median within-facility percentage of patients referred within 1 year of starting dialysis was 24.4% (interquartile range, 16.7%-33.3%) and varied from 0% to 75.0%. Facilities in the lowest tertile of referral (<19.2%) were more likely to treat patients living in high-poverty neighborhoods (absolute difference, 21.8% [95% CI, 14.1%-29.4%]), had a higher patient to social worker ratio (difference, 22.5 [95% CI, 9.7-35.2]), and were more likely nonprofit (difference, 17.6% [95% CI, 7.7%-27.4%]) compared with facilities in the highest tertile of referral (>31.3%). In multivariable, multilevel analyses, factors associated with lower referral for transplantation, such as older age, white race, and nonprofit facility status, were not always consistent with the factors associated with lower waitlisting. CONCLUSIONS AND RELEVANCE In Georgia overall, a limited proportion of patients treated with dialysis were referred for kidney transplant evaluation between 2005 and 2011, but there was substantial variability in referral among facilities. Variables associated with referral were not always associated with waitlisting, suggesting that different factors may account for disparities in referral.
Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults: The LIFE Randomized Trial.

IMPORTANCE Epidemiological evidence suggests that physical activity benefits cognition, but results from randomized trials are limited and mixed. OBJECTIVE To determine whether a 24-month physical activity program results in better cognitive function, lower risk of mild cognitive impairment (MCI) or dementia, or both, compared with a health education program. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial, the Lifestyle Interventions and Independence for Elders (LIFE) study, enrolled 1635 community-living participants at 8 US centers from February 2010 until December 2011. Participants were sedentary adults aged 70 to 89 years who were at risk for mobility disability but able to walk 400 m. INTERVENTIONS A structured, moderate-intensity physical activity program (n = 818) that included walking, resistance training, and flexibility exercises or a health education program (n = 817) of educational workshops and upper-extremity stretching. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes of the LIFE study included cognitive function measured by the Digit Symbol Coding (DSC) task subtest of the Wechsler Adult Intelligence Scale (score range: 0-133; higher scores indicate better function) and the revised Hopkins Verbal Learning Test (HVLT-R; 12-item word list recall task) assessed in 1476 participants (90.3%). Tertiary outcomes included global and executive cognitive function and incident MCI or dementia at 24 months. RESULTS At 24 months, DSC task and HVLT-R scores (adjusted for clinic site, sex, and baseline values) were not different between groups. The mean DSC task scores were 46.26 points for the physical activity group vs 46.28 for the health education group (mean difference, -0.01 points [95% CI, -0.80 to 0.77 points], P = .97). The mean HVLT-R delayed recall scores were 7.22 for the physical activity group vs 7.25 for the health education group (mean difference, -0.03 words [95% CI, -0.29 to 0.24 words], P = .84). No differences for any other cognitive or composite measures were observed. Participants in the physical activity group who were 80 years or older (n = 307) and those with poorer baseline physical performance (n = 328) had better changes in executive function composite scores compared with the health education group (P = .01 for interaction for both comparisons). Incident MCI or dementia occurred in 98 participants (13.2%) in the physical activity group and 91 participants (12.1%) in the health education group (odds ratio, 1.08 [95% CI, 0.80 to 1.46]). CONCLUSIONS AND RELEVANCE Among sedentary older adults, a 24-month moderate-intensity physical activity program compared with a health education program did not result in improvements in global or domain-specific cognitive function. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01072500.