Miracle-dz/UniFAR-FTUs huggingface dataset:
How does perceived informational and managerial continuity affect quality of care? Patients’ opinions on the Catalan public health services

Introduction: Continuity of care – the patient’s experience of connected and coherent care consistent with his or her health needs and personal circumstances [1] – is essential for achieving high-quality care and should further improve health outcomes. 14th International Conference on Integrated Care, Brussels, April 2-4 2014 International Journal of Integrated Care – Volume 14, 01 October – URN:NBN:NL:UI:10-1-116219 – http://www.ijic. org/ Objective: To explore the patient’s perception of consequences of informational and managerial continuity in three different healthcare areas (regarding the number of health providers, type of ownership and location) of the National Health Service in Catalonia, Spain. Methods: A descriptive, qualitative study on continuity of care across the primary and secondary care level with a phenomenological approach was conducted, employing semi-structured interviews with a purposeful sample of patients (49) who had been seen by their primary and secondary care physician three months prior the data collection for the same health problem. A thematic content analysis was carried out, segmented by study area and triangulated by three researchers. Results: Preliminary data analysis suggest that informants generally consider that clinical information is shared and used across care levels (informational continuity); compensating for experienced inconsistency of personnel. Main perceived consequences of existent informational continuity are twofold: receiving adequate care along the continuum (from accurate diagnosis to appropriate referrals to the right care level, immediate onset of an adequate treatment adapted to other physicians’ instructions and regular follow-up care), and facilitating the patient role (no need to repeat antecedents, explain the reason for the referral or storing paper-based medical reports). Perceived deficiencies in receiving coherent care in the right care level and adapted to the patient’s health needs in all care levels (managerial continuity) are linked to a waste of time and resources for the individual patient and the health system as a whole, to a delayed or no resolution of their health problem and the patient seeking private care. Conclusion: Patients identified a series of consequences of informational and managerial continuity in all study areas that might affect, positively or negatively, clinical and service quality of care as well as health outcomes. Financing: Health Investigation Fund (ISCIII; PI10/00348) co-financed by the European Regional Development Fund
The burden of respiratory syncytial virus infection in young children.

BACKGROUND The primary role of respiratory syncytial virus (RSV) in causing infant hospitalizations is well recognized, but the total burden of RSV infection among young children remains poorly defined. METHODS We conducted prospective, population-based surveillance of acute respiratory infections among children under 5 years of age in three U.S. counties. We enrolled hospitalized children from 2000 through 2004 and children presenting as outpatients in emergency departments and pediatric offices from 2002 through 2004. RSV was detected by culture and reverse-transcriptase polymerase chain reaction. Clinical information was obtained from parents and medical records. We calculated population-based rates of hospitalization associated with RSV infection and estimated the rates of RSV-associated outpatient visits. RESULTS Among 5067 children enrolled in the study, 919 (18%) had RSV infections. Overall, RSV was associated with 20% of hospitalizations, 18% of emergency department visits, and 15% of office visits for acute respiratory infections from November through April. Average annual hospitalization rates were 17 per 1000 children under 6 months of age and 3 per 1000 children under 5 years of age. Most of the children had no coexisting illnesses. Only prematurity and a young age were independent risk factors for hospitalization. Estimated rates of RSV-associated office visits among children under 5 years of age were three times those in emergency departments. Outpatients had moderately severe RSV-associated illness, but few of the illnesses (3%) were diagnosed as being caused by RSV. CONCLUSIONS RSV infection is associated with substantial morbidity in U.S. children in both inpatient and outpatient settings. Most children with RSV infection were previously healthy, suggesting that control strategies targeting only high-risk children will have a limited effect on the total disease burden of RSV infection.
Team Creativity in Web Site Design: An Empirical Test of a Systemic Model

A cross sectional study of 60 student teams examined the impact of team diversity, team interaction processes (planning/organizing) and intrateam conflict on team creativity in a Web site design task. An input–process–output model was used as a theoretical background and it was predicted that team diversity has an indirect impact on team creativity, mediated by planning/organizing and intrateam conflict, as well as a direct impact, with team variety being beneficial for team creativity, and team disparity being detrimental for team creativity. The results support the overall path model and show that the impact of team diversity on team creativity in Web site design is mediated by the team processes and intrateam conflict.
A review of the prevalence and pattern of presentation of gynaecological cancers in a tertiary hospital in Nnewi, South-East Nigeria

Background: Although the battle against infections and communicable diseases is still ongoing, malignancies are increasingly becoming a health burden especially in gynaecological practice due to the late presentation of cancer patients. When these patients present with advanced forms of disease, medical personnel are often handicapped as they can only offer palliative treatment. Aim / Objective: To conduct a preliminary review (pilot study) of gynaecological cancers in our centre preparatory to the establishment of a Gynaecological Oncology unit. Method: This is a retrospective review of gynaecological cancers in our centre over a three-year period using information from patients’ folders, and theatre and admission registers. Results: Out of a total of 1849 new gynaecological patients, 57(3.1%) were malignancies, representing 10.8% of all gynaecological admissions. Cervical cancer (61.4%) remains the most common cancer, while cancers of the fallopian tube and vulva (1.8%) are the least common. About 80% of the patients either had only primary or no formal education. The mean onset-to-presentation interval for symptoms ranged from 130days for cervical cancer to 336days for endometrial cancer. Conclusion: Cervical cancer, though largely preventable, remains the most common gynaecological cancer in our environment with a strong linkage to illiteracy. Keywords: Cancers, gynaecological, Nnewi, pattern
Bruit routier et statut socio-économique : étude des inégalités environnementales à un niveau géographique fin au sein de la commune de Marseille

les inegalites environnementales liees au bruit – cumul de faibles statuts socio-economiques (SSE) et de probabilites d’exposition elevees – ont ete relativement peu etudiees contrairement aux inegalites liees a la pollution de l’air et aux risques industriels. L’objectif de cette etude est d’analyser le lien entre le SSE et l’exposition potentielle au bruit routier a l’echelle des Ilots regroupes pour l’information statistique (Iris) de Marseille. cinq indicateurs de SSE ont ete construits a partir des donnees du recensement de 2006, soit un indice synthetique de precarite, trois indices thematiques (economique, social, origine geographique) et un indice de mobilite de la population. Deux indicateurs d’exposition au bruit ont ete calcules selon la directive europeenne 2002/49/CE respectivement pour l’exposition au bruit durant 24 heures (Lden) et pour le bruit nocturne (Ln). Les liens entre les indicateurs de SSE et d’exposition au bruit ont ete decrits a l’aide de diagrammes de Loess et analyses a l’aide de regressions spatiales. aucune des relations observees entre les indicateurs d’exposition au bruit et ceux de SSE n’est lineaire, sauf la relation avec l’indice de mobilite. Apres prise en compte des autocorrelations spatiales, le Lden et le Ln sont significativement plus eleves pour les classes intermediaires de l’indice synthetique de precarite, mais non pour la classe la plus precaire. Des resultats similaires sont observes pour l’indice de precarite economique alors qu’aucun lien n’est observe avec l’indice de precarite sociale. La relation entre l’exposition au bruit et l’indice d’origine geographique etait significative pour les parts faibles de personnes d’origine etrangere mais plus pour les parts plus elevees. Le Lden et le Ln augmentent avec l’indice de mobilite de la population. cette etude apporte des elements originaux sur la thematique encore peu etudiee des inegalites sociales d’exposition au bruit routier. Les resultats sont discutes en fonction de la litterature et des hypotheses portant sur les mecanismes des inegalites environnementales ainsi que de la connaissance du territoire marseillais.
Rapid Swelling of Infarcted Myocardium Soon after Primary Percutaneous Coronary Intervention: A Sign of Critical Reperfusion Hemorrhage

A 64-year-old man with a history of diabetes mellitus presented with acute myocardial infarction. He received successful primary percutaneous coronary intervention (PPCI) of the circumflex coronary artery, with good reflow at 8 hours after the onset of chest pain (Fig. 1A–C, movie clip S1). Intravascular ultrasound images at the site of occlusion denied the existence of coronary dissection. He had received oral prasugrel and aspirin along with intravenous heparin prior to the PPCI. Six hours after the PPCI, echocardiography revealed a massively thickened, infarcted myocardium from the lateral to the posterior wall, with granular echoes (Fig. 2B), as compared to the images before PPCI (Fig. 2A). On day 2, he developed cardiac tamponade (Fig. 3) and was treated with open pericardiocentesis. We postulated that the cause of cardiac tamponade might be bleeding from the infarcted myocardium, because the pericardial effusion was bloody. Cardiac magnetic resonance imaging (CMR) was performed on day 6, and T2* imaging clearly confirmed the presence of a massive intramyocardial hemorrhage (IMH) with transmural hypointensity in the infarcted myocardium (Fig. 4, arrowheads). Thereafter, the patient’s course was uneventful. Rapid swelling of infarcted myocardium after PPCI is a rare phenomenon on echocardiography. The mechanism might be a massive transmural IMH as
IDH1 and IDH2 mutations in gliomas.

BACKGROUND A recent genomewide mutational analysis of glioblastomas (World Health Organization [WHO] grade IV glioma) revealed somatic mutations of the isocitrate dehydrogenase 1 gene (IDH1) in a fraction of such tumors, most frequently in tumors that were known to have evolved from lower-grade gliomas (secondary glioblastomas). METHODS We determined the sequence of the IDH1 gene and the related IDH2 gene in 445 central nervous system (CNS) tumors and 494 non-CNS tumors. The enzymatic activity of the proteins that were produced from normal and mutant IDH1 and IDH2 genes was determined in cultured glioma cells that were transfected with these genes. RESULTS We identified mutations that affected amino acid 132 of IDH1 in more than 70% of WHO grade II and III astrocytomas and oligodendrogliomas and in glioblastomas that developed from these lower-grade lesions. Tumors without mutations in IDH1 often had mutations affecting the analogous amino acid (R172) of the IDH2 gene. Tumors with IDH1 or IDH2 mutations had distinctive genetic and clinical characteristics, and patients with such tumors had a better outcome than those with wild-type IDH genes. Each of four tested IDH1 and IDH2 mutations reduced the enzymatic activity of the encoded protein. CONCLUSIONS Mutations of NADP(+)-dependent isocitrate dehydrogenases encoded by IDH1 and IDH2 occur in a majority of several types of malignant gliomas.
Mepolizumab and exacerbations of refractory eosinophilic asthma.

BACKGROUND Exacerbations of asthma are associated with substantial morbidity and mortality and with considerable use of health care resources. Preventing exacerbations remains an important goal of therapy. There is evidence that eosinophilic inflammation of the airway is associated with the risk of exacerbations. METHODS We conducted a randomized, double-blind, placebo-controlled, parallel-group study of 61 subjects who had refractory eosinophilic asthma and a history of recurrent severe exacerbations. Subjects received infusions of either mepolizumab, an anti-interleukin-5 monoclonal antibody (29 subjects), or placebo (32) at monthly intervals for 1 year. The primary outcome measure was the number of severe exacerbations per subject during the 50-week treatment phase. Secondary outcomes included a change in asthma symptoms, scores on the Asthma Quality of Life Questionnaire (AQLQ, in which scores range from 1 to 7, with lower values indicating more severe impairment and a change of 0.5 unit considered to be clinically important), forced expiratory volume in 1 second (FEV(1)) after use of a bronchodilator, airway hyperresponsiveness, and eosinophil counts in the blood and sputum. RESULTS Mepolizumab was associated with significantly fewer severe exacerbations than placebo over the course of 50 weeks (2.0 vs. 3.4 mean exacerbations per subject; relative risk, 0.57; 95% confidence interval [CI], 0.32 to 0.92; P=0.02) and with a significant improvement in the score on the AQLQ (mean increase from baseline, 0.55 vs. 0.19; mean difference between groups, 0.35; 95% CI, 0.08 to 0.62; P=0.02). Mepolizumab significantly lowered eosinophil counts in the blood (P<0.001) and sputum (P=0.002). There were no significant differences between the groups with respect to symptoms, FEV(1) after bronchodilator use, or airway hyperresponsiveness. The only serious adverse events reported were hospitalizations for acute severe asthma. CONCLUSIONS Mepolizumab therapy reduces exacerbations and improves AQLQ scores in patients with refractory eosinophilic asthma. The results of our study suggest that eosinophils have a role as important effector cells in the pathogenesis of severe exacerbations of asthma in this patient population. (Current Controlled Trials number, ISRCTN75169762.)
Caregiver Perspectives About Using Antipsychotics and Other Medications for Symptoms of Dementia

Background and Objectives To avoid "chemical restraints," policies and guidelines have been implemented to curb the use of medications for behavioral and psychological symptoms of dementia (BPSD). Antipsychotics have been particularly targeted because of their rare severe side effects. Consequently, caregiver directed non-pharmacologic therapies have increased while medication use for BPSD has diminished. Despite such initiatives, however, antipsychotics continue to be prescribed "off-label" for roughly 20% of nursing home patients. How caregivers impact management approaches and prescribing decisions for BPSD, including antipsychotic use, is poorly understood. Aim: assesses experiences and perceptions of family and nursing caregivers regarding factors influencing medication decisions for BPSD. Research Design and Methods Semi-structured interviews, analyzed via template, immersion and crystallization, and thematic development. Thirty-two participants from Northwestern Virginia representing five groups of caregivers for dementia patients were interviewed: families of community-dwelling, assisted living, and nursing home patients, and nurses from the same assisted living/nursing home facilities. Results Caregivers described three major themes regarding medications: (a) Systemic barriers exist for non-pharmacologic BPSD therapies. (b) Medications have few barriers, and seem generally effective and safe. (c) When non-pharmacologic measures fail, medications, including antipsychotics, may be necessary and appropriate for palliation of patient distress. Discussion and Implications To further reduce medications for BPSD, obstacles to services and alternative therapies must be mitigated. Caregiver perceptions that medications are generally safe and effective contribute to their continued use. Guidelines and policies for BPSD management should incorporate the caregiver position that medications, including antipsychotics, are sometimes justified and required to alleviate patient suffering.
M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy.

BACKGROUND Idiopathic membranous nephropathy, a common form of the nephrotic syndrome, is an antibody-mediated autoimmune glomerular disease. Serologic diagnosis has been elusive because the target antigen is unknown. METHODS We performed Western blotting of protein extracts from normal human glomeruli with serum samples from patients with idiopathic or secondary membranous nephropathy or other proteinuric or autoimmune diseases and from normal controls. We used mass spectrometry to analyze the reactive protein bands and confirmed the identity and location of the target antigen with a monospecific antibody. RESULTS Serum samples from 26 of 37 patients (70%) with idiopathic but not secondary membranous nephropathy specifically identified a 185-kD glycoprotein in nonreduced glomerular extract. Mass spectrometry of the reactive protein band detected the M-type phospholipase A(2) receptor (PLA(2)R). Reactive serum specimens recognized recombinant PLA(2)R and bound the same 185-kD glomerular protein as did the monospecific anti-PLA(2)R antibody. Anti-PLA(2)R autoantibodies in serum samples from patients with membranous nephropathy were mainly IgG4, the predominant immunoglobulin subclass in glomerular deposits. PLA(2)R was expressed in podocytes in normal human glomeruli and colocalized with IgG4 in immune deposits in glomeruli of patients with membranous nephropathy. IgG eluted from such deposits in patients with idiopathic membranous nephropathy, but not in those with lupus membranous or IgA nephropathy, recognized PLA(2)R. CONCLUSIONS A majority of patients with idiopathic membranous nephropathy have antibodies against a conformation-dependent epitope in PLA(2)R. PLA(2)R is present in normal podocytes and in immune deposits in patients with idiopathic membranous nephropathy, indicating that PLA(2)R is a major antigen in this disease.
Apixaban or enoxaparin for thromboprophylaxis after knee replacement.

BACKGROUND The optimal strategy for thromboprophylaxis after major joint replacement has not been established. Low-molecular-weight heparins such as enoxaparin predominantly target factor Xa but to some extent also inhibit thrombin. Apixaban, a specific factor Xa inhibitor, may provide effective thromboprophylaxis with a low risk of bleeding and improved ease of use. METHODS In a double-blind, double-dummy study, we randomly assigned patients undergoing total knee replacement to receive 2.5 mg of apixaban orally twice daily or 30 mg of enoxaparin subcutaneously every 12 hours. Both medications were started 12 to 24 hours after surgery and continued for 10 to 14 days. Bilateral venography was then performed. The primary efficacy outcome was a composite of asymptomatic and symptomatic deep-vein thrombosis, nonfatal pulmonary embolism, and death from any cause during treatment. Patients were followed for 60 days after anticoagulation therapy was stopped. RESULTS A total of 3195 patients underwent randomization, with 1599 assigned to the apixaban group and 1596 to the enoxaparin group; 908 subjects were not eligible for the efficacy analysis. The overall rate of primary events was much lower than anticipated. The rate of the primary efficacy outcome was 9.0% with apixaban as compared with 8.8% with enoxaparin (relative risk, 1.02; 95% confidence interval, 0.78 to 1.32). The composite incidence of major bleeding and clinically relevant nonmajor bleeding was 2.9% with apixaban and 4.3% with enoxaparin (P=0.03). CONCLUSIONS As compared with enoxaparin for efficacy of thromboprophylaxis after knee replacement, apixaban did not meet the prespecified statistical criteria for noninferiority, but its use was associated with lower rates of clinically relevant bleeding and it had a similar adverse-event profile. (ClinicalTrials.gov number, NCT00371683.)
Pharmacogenomics of Antihypertensive Treatment a Clinical Pharmacological Studies of Digoxin Treatment

OBJECTIVE: Hypertension is associated with a number of adverse morphologic and functional changes in the cardiovascular system, including left ventricular (LV) hypertrophy. Studies have demonstrated that bradykinin, through the B2 bradykinin receptor (B2BKR), mediates important cardiovascular effects that may protect against LV hypertrophy. Recently, a +9/-9 exon 1 polymorphism of the B2BKR was shown to be strongly associated with LV growth response among normotensive males undergoing physical training. We aimed to clarify whether the processes found in exercise-induced LV growth in normotensive people also occur in pathological LV hypertrophy. DESIGN AND METHODS: We determined the B2BKR genotype of 90 patients with essential hypertension and echocardiographically diagnosed LV hypertrophy, included in a double-blind study to receive treatment for 48 weeks with either the angiotensin II type 1 (AT1) receptor antagonist irbesartan or the beta1-adrenoceptor antagonist atenolol. RESULTS: B2BKR +9/+9 genotypes responded poorly in LV mass regression, independent of blood pressure reduction or treatment, as compared to the other genotypes (adjusted mean change in LV mass index = -10.0 +/- 4.6 versus -21.6 +/- 2.2 g/m2, P = 0.03). CONCLUSIONS: Our results suggest an impact of the B2BKR polymorphism on LV mass regression during antihypertensive treatment.
Mutation of FOXL2 in granulosa-cell tumors of the ovary.

BACKGROUND Granulosa-cell tumors (GCTs) are the most common type of malignant ovarian sex cord-stromal tumor (SCST). The pathogenesis of these tumors is unknown. Moreover, their histopathological diagnosis can be challenging, and there is no curative treatment beyond surgery. METHODS We analyzed four adult-type GCTs using whole-transcriptome paired-end RNA sequencing. We identified putative GCT-specific mutations that were present in at least three of these samples but were absent from the transcriptomes of 11 epithelial ovarian tumors, published human genomes, and databases of single-nucleotide polymorphisms. We confirmed these variants by direct sequencing of complementary DNA and genomic DNA. We then analyzed additional tumors and matched normal genomic DNA, using a combination of direct sequencing, analyses of restriction-fragment-length polymorphisms, and TaqMan assays. RESULTS All four index GCTs had a missense point mutation, 402C-->G (C134W), in FOXL2, a gene encoding a transcription factor known to be critical for granulosa-cell development. The FOXL2 mutation was present in 86 of 89 additional adult-type GCTs (97%), in 3 of 14 thecomas (21%), and in 1 of 10 juvenile-type GCTs (10%). The mutation was absent in 49 SCSTs of other types and in 329 unrelated ovarian or breast tumors. CONCLUSIONS Whole-transcriptome sequencing of four GCTs identified a single, recurrent somatic mutation (402C-->G) in FOXL2 that was present in almost all morphologically identified adult-type GCTs. Mutant FOXL2 is a potential driver in the pathogenesis of adult-type GCTs.