Miracle-dz/UniFAR-FTUs huggingface dataset:
Clinicians’ Expectations of the Benefits and Harms of Treatments, Screening, and Tests: A Systematic Review

Importance Inaccurate clinician expectations of the benefits and harms of interventions can profoundly influence decision making and may be contributing to increasing intervention overuse. Objective To systematically review all studies that have quantitatively assessed clinicians’ expectations of the benefits and/or harms of any treatment, test, or screening test. Evidence Review A comprehensive search strategy of 4 databases (MEDLINE, EMBASE, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO) from the start years to March 17-20, 2015, with no language or study type restriction, was performed. Searches were also conducted on cited references of the included studies, and experts and study authors were contacted. Two researchers independently evaluated methodologic quality and extracted participants’ estimates of benefit and harms and authors’ contemporaneous estimates. Findings Of the 8166 records screened, 48 articles (13 011 clinicians) were eligible. Twenty studies focused on treatment, 20 on medical imaging, and 8 on screening. Of the 48 studies, 30 (67%) assessed only harm expectations, 9 (20%) evaluated only benefit expectations, and 6 (13%) assessed both benefit and harm expectations. Among the studies comparing benefit expectations with a correct answer (total of 28 outcomes), most participants provided correct estimation for only 3 outcomes (11%). Of the studies comparing expectations of harm with a correct answer (total of 69 outcomes), a majority of participants correctly estimated harm for 9 outcomes (13%). Where overestimation or underestimation data were provided, most participants overestimated benefit for 7 (32%) and underestimated benefit for 2 (9%) of the 22 outcomes, and underestimated harm for 20 (34%) and overestimated harm for 3 (5%) of the 58 outcomes. Conclusions and Relevance Clinicians rarely had accurate expectations of benefits or harms, with inaccuracies in both directions. However, clinicians more often underestimated rather than overestimated harms and overestimated rather than underestimated benefits. Inaccurate perceptions about the benefits and harms of interventions are likely to result in suboptimal clinical management choices.
Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?

OBJECTIVES The efficacy of concomitant ablation techniques in patients with paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery remains under debate. The aim of this prospective, randomized, single-centre study was to compare pulmonary vein isolation (PVI) only versus a left atrial maze (LAM) procedure in patients with paroxysmal AF during mitral valve surgery. METHODS Between February 2009 and June 2011, 52 patients with a mean age of 54.2 (standard deviation 7.2 years) underwent mitral valve surgery and concomitant bipolar radiofrequency ablation for paroxysmal AF. Patients were randomized into the PVI group (n = 27) and the LAM group (n = 25). After surgery, an implantable loop recorder for continuous electrocardiography (ECG) monitoring was implanted. Patients with an AF burden (AF%) of <0.5% were considered AF free (responders). The mean follow-up was 18.6 months (standard deviation 2.1 months), and the patient' data were evaluated every 3 months. RESULTS All patients were alive at discharge. No procedure-related complications occurred for either the ablation or the loop recorder implantation. Mean aortic clamping and ablation times were significantly longer in the LAM group than in the PVI group. The incidence of early AF paroxysm recurrence was significantly higher in the PVI group than in the LAM group (62.9 vs 24.0%, P < 0.001). At 20 months after surgery, 15 (55.6%) of the 27 patients in the PVI group and 22 (88.0%) of the 25 patients in the LAM group had no documented atrial arrhythmias and were considered responders (AF burden <0.5%). The mean AF burden during all follow-up periods was significantly lower in the LAM group (23.6 ± 8.7%) than in the PVI group (6.8 ± 2.2%) (P < 0.001). CONCLUSIONS According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery.
Health and Health Care Use Among Individuals at Risk to Lose Health Insurance With Repeal of the Affordable Care Act

Author Affiliations: Department of Health Care Management and the Division of General Internal Medicine, University of Pennsylvania, Philadelphia (Polsky); Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Polsky, Candon, Rhodes); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Saloner); The Urban Institute, Washington, DC (Wissoker, Kenney); Senior Advisor, Policy, Robert Wood Johnson Foundation, Princeton, New Jersey (Hempstead); Office of Population Health Management, Northwell Health, and the Department of Emergency Medicine, Hofstra Northwell School of Medicine, Manhasset, New York (Rhodes).
Characteristics of equine mesenchymal stem cells derived from amnion and bone marrow: in vitro proliferative and multilineage potential assessment.

REASONS FOR PERFORMING STUDY This is the first study comparing stemness features of equine mesenchymal progenitor cells derived from amniotic membrane and bone marrow. OBJECTIVES To investigate an alternative and noninvasive stromal cell source for equine tissue engineering. STUDY DESIGN In vitro experimental study of the characteristics of equine mesenchymal progenitor cells derived from amnion and bone marrow. METHODS Cells isolated from amniotic membrane and bone marrow were analysed for proliferation (growth curve, doubling time, colony forming unit). Immunocytochemical detection of pluripotency markers and gene expression of stromal cell markers were also performed and these cells were studied for multilineage plasticity. RESULTS Amniotic stromal cells (AMSCs) and bone marrow mesenchymal cells (BM-MSCs) both exhibited mature stromal cell-specific gene expression and immunocytochemical properties, but showed substantial differences in their proliferative and differentiation potential. The mean doubling time for AMSCs was significantly lower (P<0.05) than that observed for BM-MSCs (1.17 ± 0.15 vs. 3.27 ± 0.19 days, respectively). Compared to AMSCs, BM-MSCs also demonstrated a significantly (P<0.05) lower clonogenic capability (one fibroblast-like colony forming unit from a mean of 590.15 cells seeded for BM-MSCs vs. 242.73 cells seeded for AMSCs). BM-MSCs did not differentiate into glial cells, and the osteogenic differentiation process was longer than for AMSCs. CONCLUSIONS AND POTENTIAL RELEVANCE The amniotic membrane could be a valuable source of MSCs to be used both for allogenic and/or autologous therapies. The noninvasive nature and low cost of collection, the rapid proliferation along with a greater differentiation potential and the 'off the shelf' preparation potential could make AMCs useful for cell therapy.
Abnormal plasma neuroactive progestagen derivatives in ill, neonatal foals presented to the neonatal intensive care unit.

REASONS FOR PERFORMING THE STUDY Increased levels of pregnanes have been reported in foals with neonatal maladjustment syndrome (NMS). These steroids may cross the blood-brain barrier and have depressive effects in the central nervous system leading to behavioural abnormalities and altered states of consciousness in affected foals. OBJECTIVES The aim of this study was to determine the pregnane profile of foals with NMS and compare it with that of healthy controls and sick, non-NMS foals. STUDY DESIGN Prospective-clinical study. METHODS Thirty-two foals with a clinical diagnosis of NMS, 12 foals with other neonatal disorders and 10 healthy control foals were selected for the study. Heparinised blood samples were collected from each group of foals and pregnane and androgen concentrations determined using liquid chromatography mass spectrometry at 0, 24 and 48 h of age. RESULTS Healthy foals showed a significant decrease in pregnane concentrations over the first 48 h of life (P<0.01). Foals with NMS and sick, non-NMS foals had significantly increased progesterone, pregnenolone, androstenedione, dehydroepiandrosterone and epitestosterone concentrations compared with healthy foals (P<0.05). Progesterone and pregnenolone concentrations of sick, non-NMS foals decreased significantly over 48 h (P<0.05), whereas concentrations in NMS foals remained increased. CONCLUSIONS AND POTENTIAL RELEVANCE Pregnane concentrations of ill, neonatal foals remain increased following birth, reflecting a delayed, or interrupted, transition from intra- to extra-uterine life. Serial progesterone and pregnenolone measurement may be useful in aiding diagnosis of NMS.
Distal hindlimb kinematics of galloping Thoroughbred racehorses on dirt and synthetic racetrack surfaces.

REASONS FOR PERFORMING STUDY The effect of racetrack surface (dirt or synthetic) on distal hindlimb kinematics of racehorses running at competition speeds is not known. OBJECTIVES To compare distal hindlimb and hoof kinematics during stance of breezing (unrestrained gallop) racehorses between dirt and synthetic surfaces. STUDY DESIGN Two-dimensional kinematic video analysis of 5 Thoroughbred racehorses galloping at high speeds (12-17 m/s) on a dirt racetrack and a synthetic racetrack. METHODS The positions of kinematic markers applied to the left hindlimb were recorded at 500 Hz. Position, velocity and acceleration of joint angles and hoof translation during stance were calculated in the sagittal plane. Peak translational and angular kinematic values were compared between the dirt and synthetic race surfaces using mixed model analyses of covariance. RESULTS Maximum and heel-strike metatarsophalangeal (fetlock) angles were greater (P<0.05) on the dirt surface than on the synthetic surface. Maximum fetlock angle occurred earlier during stance on the dirt surface (P<0.05). Greater horizontal displacement of the heel during slide occurred on the dirt surface (P<0.05). CONCLUSIONS During high-speed gallop, hindlimb fetlock hyperextension and horizontal hoof slide are greater on a dirt surface than on a synthetic surface. Synthetic race surfaces may mitigate risk of injury to hindlimb fetlock structures by reducing fetlock hyperextension and associated strains in fetlock support structures. Differences in hoof slide may contribute to different distal hindlimb kinematics between surfaces.
Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy.

Peanut allergy, the food allergy causing the greatest numbers of anaphylaxis and death, has doubled in prevalence over the past 10 years. U.S. and U.K. clinical practice guidelines currently recommend the exclusion of allergenic foods from the diets of infants considered to be at high risk for food allergies, as well as from the diets of their mothers during pregnancy and lactation. However, studies have shown that this tactic fails to prevent the development of IgE-mediated food allergies.
Use of and attitudes to complementary and alternative medicine in patients with functional bowel disorders

In this article, Sue Woodward, Christine Norton and Louise Barriball report on a service evaluation audit which was conducted to determine the prevalence of CAM use among patients attending a specialist NHS biofeedback service, to identify their perceptions of CAM and to assess their preparedness to use complimentary therapies within the department. Over a six-month period, patients were asked to complete an audit questionnaire while waiting for their appointments. Ninety three questionnaires were completed and returned by individuals during this time. Sixty three respondents (68%) had used CAM previously or were current users, and respondents reported using a total of 21 different complementary and alternative therapies for their bowel and/or other health problems. Herbal medicine was the most commonly used therapy for bowel problems (29%). Both positive and negative drivers for CAM use were identifed. This audit reveals that CAM use is common in patients with functional bowel disorders.
The cranial nuchal bursa: anatomy, ultrasonography, magnetic resonance imaging and endoscopic approach.

REASONS FOR PERFORMING STUDY Although an uncommon condition, cranial nuchal bursitis can affect the performance of the equine athlete. The anatomy is not well described and there are no reports of diagnostic imaging for endoscopic approaches. OBJECTIVES To describe the anatomy, ultrasonographic and magnetic resonance features of and endoscopic approach to the cranial nuchal bursa in horses. STUDY DESIGN Experimental cadaver study. METHODS Four cranial nuchal bursae were dissected, 4 specimens were frozen to prepare anatomical sections and 2 were injected with latex to document surface landmarks and topographical anatomy and to identify the possible sites for endoscopic access. Six cadaveric specimens were used to describe the ultrasonographic and magnetic resonance features of the cranial nuchal bursa before and after intrabursal injection. Sixteen cadaver specimens were evaluated with a rigid arthroscope and gross dissection to determine the endoscopic appearance of the bursa. RESULTS The cranial nuchal bursa could be identified consistently in all cadavers, using ultrasonographic and magnetic resonance on both pre- and post injection specimens. Cranial and caudal endoscopic approaches and instrument portals were developed for the cranial nuchal bursa. Using either approach, the entire extent of the bursa could be evaluated, but separate approaches for left and right compartments of the bursa were needed owing to the lack of manoeuvrability when examining the contralateral compartment. CONCLUSIONS The cranial nuchal bursa can be identified on ultrasonographic and magnetic resonance images. An endoscopic approach to the cranial nuchal bursa is clinically feasible and offered an easy, repeatable entry into the cranial nuchal bursa, which allowed adequate observation of the structures within the bursa. This may be of help for diagnosis and treatment of conditions affecting the cranial nuchal bursa in horses.
Outcome of palmar/plantar digital neurectomy in horses with foot pain evaluated with magnetic resonance imaging: 50 cases (2005-2011).

REASONS FOR PERFORMING STUDY There is limited knowledge of the foot lesions that influence the outcome of palmar/plantar digital neurectomy (PDN). OBJECTIVES 1) To report the short- and long-term outcomes of horses that underwent PDN to alleviate chronic foot pain due to lesions diagnosed by magnetic resonance imaging (MRI) and 2) factors that may influence the outcome of PDN. STUDY DESIGN Multicentre retrospective study. METHODS Medical records of 50 horses subjected to PDN due to chronic foot pain were reviewed. Age, breed, sex, athletic activity, duration of lameness, affected limb(s), response to anaesthesia of the palmar/plantar digital nerves, MRI findings and surgical technique were analysed together with follow-up data to identify factors that influenced the long-term outcomes. RESULTS Forty-six of 50 horses (92%) responded positively to surgery; 40 (80%) were able to return to their previous athletic use for a median time of 20 months (range: 12-72 months). Eighteen (36%) horses developed post operative complications including residual lameness, painful neuromas, or early recurrence of lameness. Horses with pre-existing core or linear lesions of the deep digital flexor tendon (DDFT) had significantly shorter periods of lameness resolution after surgery than horses with dorsal border lesions of the DDFT or other foot lesions. CONCLUSIONS Palmar/plantar digital neurectomy can improve or resolve lameness in horses with foot pain unresponsive to medical therapy without serious post operative complications. However, horses with core or linear lesions of the DDFT should not be subjected to PDN as these horses experience residual lameness or early recurrent lameness after surgery. Magnetic resonance imaging can be used to identify these horses.
The Tobacco Atlas

By 2025, tobacco will be the leading cause of death and disability worldwide, killing more than 10 million people every year. If nothing is done between now and then, tobacco will kill 650 million smokers. The latest edition of this groundbreaking atlas gives shape and meaning to statistics about tobacco use and control. Full-colour maps and graphics illustrate in a clear and accessible format the wide range of tobacco issues, revealing similarities and differences between countries, and exposing the behaviour of the tobacco companies. It also examines solutions and predicts the future course of the epidemic. Topics include: History of tobacco; Prevalence and consumption; Health risks and mortality; Economic costs; The tobacco industry; Legal regulations and limitations; Health education and quitting; The Framework Convention of Tobacco Control; and The future of the epidemic.
Epidemiology of shivering (shivers) in horses.

REASONS FOR PERFOMING STUDY Investigating the epidemiology of shivering in horses. OBJECTIVES The purpose of this study was to characterise the signalment, clinical signs and management factors associated with shivering (also known as shivers), a relatively rare, poorly defined movement disorder in horses. STUDY DESIGN Web-based case series survey and case-control study. METHODS A Web-based survey was used to obtain information from owners, worldwide, who suspected that their horse had shivering. Survey respondents were asked to answer standardised questions and to provide a video of the horse. Authors reviewed the surveys and videos, and horses were diagnosed with shivering if they displayed normal forward walking, with difficulty during manual lifting of the hoof and backward walking due to hyperflexion or hyperextension of the pelvic limbs. Cases confirmed by video were designated 'confirmed shivering', while those with compatible clinical signs but lacking video confirmation were designated 'suspected shivering'. Owners of confirmed shivering horses were asked to provide information on 2 horses without signs of shivering (control group). RESULTS Three hundred and five surveys and 70 videos were received; 27 horses were confirmed shivering (50 controls), 67 were suspected shivering and the rest had a variety of other movement disorders. Suspected shivering horses resembled confirmed shivering cases, except that the suspected shivering group contained fewer draught breeds and fewer horses with exercise intolerance. Confirmed shivering signs often began at <5 years of age and progressed in 74% of cases. Owner-reported additional clinical signs in confirmed cases included muscle twitching (85%), muscle atrophy (44%), reduced strength (33%) and exercise intolerance (33%). Shivering horses were significantly taller (confirmed shivering, mean ∼173 cm; control horses, ∼163 cm) with a higher male:female ratio (confirmed shivering, 3.2:1 vs. control, 1.7:1). No potential triggering factors or effective treatments were reported. CONCLUSIONS Shivering is a chronic, often gradually progressive movement disorder that usually begins before 7 years of age and has a higher prevalence in tall male horses.
Cancer Survivorship Care in Advanced Primary Care Practices: A Qualitative Study of Challenges and Opportunities

Importance Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors. Objective To explain why primary care has not begun to integrate comprehensive cancer survivorship services. Design, Setting, and Participants Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017. Practices were selected from a national registry of 151 workforce innovators compiled for the Robert Wood Johnson Foundation. Practices were recruited to include diversity in policy context and organizational structure. Researchers conducted 10 to 12 days of ethnographic data collection in each practice, including interviews with practice personnel and patient pathways with cancer survivors. Fieldnotes, transcripts, and practice documents were analyzed within and across cases to identify salient themes. Main Outcomes and Measures Description of cancer survivorship care delivery in advanced patient-centered medical homes, including identification of barriers and promotional factors related to that care. Results The 12 practices came from multiple states and policy contexts and had a mix of clinicians trained in family or internal medicine. All but 3 were recognized as National Committee on Quality Assurance level 3 patient-centered medical homes. None of the practices provided any type of comprehensive cancer survivorship services. Three interdependent explanatory factors emerged: the absence of a recognized, distinct clinical category of survivorship in primary care; a lack of actionable information to treat this patient population; and current information systems unable to support survivorship care. Conclusions and Relevance To increase the potential for primary care transformation efforts to integrate survivorship services into routine care, survivorship must become a recognized clinical category with actionable care plans supported by a functional information system infrastructure.
Anatomical variation of the spinous and transverse processes in the caudal cervical vertebrae and the first thoracic vertebra in horses.

REASONS FOR PERFORMING STUDY There are scant data on the incidence of different anatomical variants of the equine caudal cervical spine, despite interest in cervical pathology. OBJECTIVES To identify morphological radiographic variation in the 6th and 7th cervical vertebrae and the first thoracic vertebra in horses of different breeds and to determine whether there are breed- and sex-related differences. STUDY DESIGN Retrospective descriptive study. METHODS Radiographs of the cervical spine of 270 horses were assessed retrospectively. The Chi-square test, or Fisher's exact test when appropriate, was used to test for associations between radiographic findings and sex or breed, and residual analysis was performed to localise differences. Chi-square tests and calculation of phi coefficient (φ) were used to test for associations between different types of radiological variation. RESULTS Three variants were identified in the spinous process of the 7th cervical vertebra, and 2 variants were identified in the spinous process of the first thoracic vertebra. The presence of the spinous process of the 7th cervical vertebra was associated with breed, and transposition of the ventral process of the 6th cervical vertebra onto the ventral aspect of the 7th cervical vertebra was associated with sex. The shape of the spinous process of first thoracic vertebra was associated with the shape of the spinous process of the 7th cervical vertebra and with the presence of transposition of the ventral process of the 6th cervical vertebra onto the ventral aspect of the 7th. CONCLUSIONS A large number of anatomical variants can be detected radiographically in the caudal cervical area; some of these have a higher frequency, depending on sex and breed. Knowledge of the different shapes is very important in avoiding misdiagnosis of periarticular new bone formation. The spinous process of the first thoracic vertebra has 2 morphological variants.