bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement of psychiatrists’ clinical knowledge of the treatment guidelines for schizophrenia and major depressive disorders using the ‘Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)’ project: A nationwide dissemination, education, and evaluation study
Authors: Takaesu Yoshikazu , Watanabe Koichiro , Numata Shusuke , Iwata Masaaki , Kudo Noriko , Oishi Satoru , Takizawa Takeya , Nemoto Kiyotaka , Yasuda Yuka , Tagata Hiromi , Tsuboi Takashi , Tsujino Naohisa , Hashimoto Naoki , Matsui Yuki , Hori Hikaru , Yamamori Hidenaga , Sugiyama Nobuhiro , Suwa Taro , Kishimoto Taishiro , Hishimoto Akitoyo , Usami Masahide , Furihata Ryuji , Iwamoto Kunihiro , Fujishiro Hiroshige , Nakamura Toshinori , Mizuno Kentaro , Inagaki Takahiko , Katsumoto Eiichi , Tomita Hiroaki , Ohi Kazutaka , Muraoka Hiroyuki , Atake Kiyokazu , Iida Hitoshi , Nagasawa Tatsuya , Fujita Junichi , Yamamura Satoshi , Onitsuka Toshiaki , Murata Atsunobu , Takayanagi Yoichiro , Noda Hokuto , Matsumura Yukiko , Takezawa Kenji , Iga Jun‐ichi , Ichihashi Kayo , Ogasawara Kazuyoshi , Yamada Hisashi , Inada Ken , Hashimoto Ryota
Published: August 2019

Aim

Although treatment guidelines for pharmacological therapy for schizophrenia and major depressive disorder have been issued by the Japanese Societies of Neuropsychopharmacology and Mood Disorders, these guidelines have not been well applied by psychiatrists throughout the nation. To address this issue, we developed the ‘Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE)’ integrated education programs for psychiatrists to disseminate the clinical guidelines. Additionally, we conducted a systematic efficacy evaluation of the programs.

Methods

Four hundred thirteen out of 461 psychiatrists attended two 1‐day educational programs based on the treatment guidelines for schizophrenia and major depressive disorder from October 2016 to March 2018. We measured the participants’ clinical knowledge of the treatment guidelines using self‐completed questionnaires administered before and after the program to assess the effectiveness of the programs for improving knowledge. We also examined the relation between the participants’ demographics and their clinical knowledge scores.

Results

The clinical knowledge scores for both guidelines were significantly improved after the program. There was no correlation between clinical knowledge and participant demographics for the program on schizophrenia; however, a weak positive correlation was found between clinical knowledge and the years of professional experience for the program on major depressive disorder.

Conclusion

Our results provide evidence that educational programs on the clinical practices recommended in guidelines for schizophrenia and major depressive disorder might effectively improve participants’ clinical knowledge of the guidelines. These data are encouraging to facilitate the standardization of clinical practices for psychiatric disorders.
Probability learning and feedback processing in dyslexia: A performance and heart rate analysis
Authors: Fraga González G. , Smit D. J. A. , van der Molen M. J. W. , Tijms J. , de Geus E. J. C. , van der Molen M. W.
Published: August 2019

Recent studies suggest that individuals with dyslexia may be impaired in probability learning and performance monitoring. These observations are consistent with findings indicating atypical neural activations in frontostriatal circuits in the brain, which are important for associative learning. The current study further examined probability learning and performance monitoring in adult individuals with dyslexia (n = 23) and typical readers (n = 31) using two varieties of a typical probabilistic learning task. In addition to performance measures, we measured heart rate, focusing on cardiac slowing with negative feedback as a manifestation of the automatic performance monitoring system. One task required participants to learn associations between artificial script and speech sounds and the other task required them to learn associations between geometric forms and bird sounds. Corrective feedback (informative or random) was provided in both tasks. Performance results indicated that individuals with dyslexia and typical readers learned the associations equally well in contrast to expectations. We found the typical cardiac response associated with feedback processing consisting of a heart rate slowing with the presentation of the feedback and a return to baseline thereafter. Interestingly, the heart rate slowing associated with feedback was less pronounced and the return to baseline was delayed in individuals with dyslexia relative to typical readers. These findings were interpreted in relation to current theorizing of performance monitoring linking the salience network in the brain to autonomic functioning.
Indigenous angels: hybridity and troubled identities in the Iberian network
Authors: Estévez Escardiel González
Published: August 2019

This article examines depictions of Christian angels in Iberian America in the early modern era. It explores a wide range of primary textual and visual sources in order to examine the following issues: the cultural interaction and strategies of accommodation; material and artistic exchange; the reach of the concept of hybridity; and Iberian visual networks. Angels in the Hispanic world have been studied primarily from an iconographic perspective, and their indigenous features have only rarely been analysed. This study discusses the conception and representation of the Indianized angel both verbally and visually in different locations in the Mexican, Andean, Guaraní and Californian missions, and the reconfigurations of identity that emerged in those contexts.
C. S. Lewis, 2 Kings 19:35, and Mice
Authors: Gilmour Michael J.
Published: August 2019

C. S. Lewis’s works are replete with animals of various kinds, offering both vivid and memorable characters and also objects of moral concern and theological value. He thereby anticipates what may be seen as a gradual turn toward the inclusion of animals in theological and ethical contemplation since his death in 1963. Although biographers have noted the important creative and religious influences of George MacDonald on Lewis’s work, this article highlights Lewis’s concern for animals as one of MacDonald’s more significant yet overlooked influences. Mice are arguably Lewis’ especial favourite, their small size and fragility offering pastoral, theological, and ethical lessons. In Lewis’s retelling of the Sennacherib story of 2 Kings 19:35, mice are shown to accomplish the work of angels.
Exact formula for the horizontal-to-vertical displacement ratio of Rayleigh waves in layered orthotropic half-spaces
Authors: Vinh P. C. , Tuan T. T. , Hue L. T. , Anh V. T. N. , Dung T. T. T. , Linh N. T. K. , Malischewsky P.
Published: August 2019

This paper is concerned with the propagation of Rayleigh waves in a compressible orthotropic half-space coated by a compressible orthotropic layer. The main purpose of the paper is to establish an explicit exact formula for the H/V ratio (the horizontal-to-vertical displacement ratio) of the Rayleigh wave. This formula is derived by using the transfer matrix for an orthotropic elastic layer and by the effective boundary condition technique. The formula recovers the H/V formula by Malischewsky and Scherbaum [(2004). Wave Motion 40, 57–67] for the compressible isotropic case and the H/V formula by Love [(1911). Some Problems of Geodynamics (Cambridge University Press, Cambridge)] for the incompressible isotropic case. The effect of anisotropy on the H/V ratio's properties is examined and it is numerically shown that the anisotropy strongly affects the peak and zero frequency of the H/V ratio and its prograde domain as well. As the H/V ratio is a dimensionless quantity and it is easily experimentally measured, the obtained formula will be a useful tool for the nondestructive evaluation of mechanical properties of thin films deposited onto half-spaces. Two numerical examples are performed to show how the obtained formula can be used to extract the material properties of deposited layers from measured values of the H/V ratio.
Multipole borehole acoustic field in a transversely isotropic medium induced by stress
Authors: Liu Jinxia , Zhou Ying , Cui Zhiwen , Kundu Tribikram
Published: August 2019

A borehole multipole acoustic field in a pre-stressed formation is investigated. The pre-stressed formation is modeled as a transversely isotropic medium induced by uniaxial stress. The formation is assumed to be isotropic in absence of any static stress and then becomes anisotropic due to the applied stress parallel to the borehole axis. The approximate equivalent elastic constants of the stress-induced anisotropic medium are derived from the theory of acoustoelasticity. The nonlinear static stress-strain relation is used for both small and large static deformations. This problem can be solved analytically because of uniformity of deformation induced by static stress applied parallel to the borehole axis. The stress effects on the velocity of guided waves and amplitude of waveforms excited by monopole, dipole, and quadrupole sources are investigated. Numerical results show that the velocities of guided waves increase with uniaxial stress. The uniaxial stress affects both amplitude and arrival time of the acoustic waves in the borehole. The integral amplitude of full waveforms varies almost in a parabolic manner with the increasing stress level and thus shows sensitivity to the uniaxial stress. This result may be helpful for remote stress measurements in boreholes.
Structural Insights into Catalytic Relevances of Substrate Poses in ACC-1
Authors: Bae Da-Woon , Jung Ye-Eun , An Young Jun , Na Jung-Hyun , Cha Sun-Shin
Published: August 2019

ACC-1 is a plasmid-encoded class C β-lactamase identified in clinical isolates of
Klebsiella pneumoniae
,
Proteus mirabilis
,
Salmonella enterica
, and
Escherichia coli
. ACC-1-producing bacteria are susceptible to cefoxitin, whereas they are resistant to oxyimino cephalosporins. Here, we depict crystal structures of apo ACC-1, adenylylated ACC-1, and acylated ACC-1 complexed with cefotaxime and cefoxitin.
Interleukin 6 PromotesBrucella abortusClearance by Controlling Bactericidal Activity of Macrophages and CD8+T Cell Differentiation
Authors: Hop Huynh Tan , Huy Tran Xuan Ngoc , Reyes Alisha Wehdnesday Bernardo , Arayan Lauren Togonon , Vu Son Hai , Min WonGi , Lee Hu Jang , Kang Chang Keun , Kim Dong Hee , Tark Dong Seob , Kim Suk
Published: August 2019

To date, the implications of interleukin 6 (IL-6) for immune responses in the context ofBrucellainfection are still unknown. In the present study, we found thatBrucella abortusinfection induced marked production of IL-6 in mice that was important for sufficient differentiation of CD8+T cells, a key factor inBrucellaclearance.
Persistent free-floating pelvic trophoblastic cysts following an interstitial ectopic pregnancy
Authors: Crawford Kaitlin D , Chen Melissa J , Hou Melody Y , Creinin Mitchell D
Published: August 2019

Persistent trophoblast after ectopic pregnancy has been demonstrated at the surgical site or as peritoneal implants. A 37-year-old woman (G5P2) experienced persistently low levels of beta-human chorionic gonadotropin (hCG) after surgical treatment for an interstitial pregnancy. Evaluation for persistent trophoblast, gestational trophoblastic neoplasm and heterophilic antibodies was negative. After 15 months without resolution, she elected for hysterectomy. We found four smooth, freely floating avascular cysts intraoperatively; pathological evaluation identified the cysts as trophoblastic tissue. Serum beta-hCG resolved postoperatively and remained negative at 1 year. Our case demonstrates the novel finding of trophoblastic tissue existing as free-floating cysts in the peritoneal cavity. With appropriate suspicion, these cysts can be identified on radiologic investigation and removed laparoscopically.
Type II polyglandular autoimmune syndrome: a case of Addison’s disease precipitated by use of levothyroxine
Authors: Hoener Katherine , Sharma Tulsi
Published: August 2019

A 46-year-old woman was referred to the endocrinology clinic for evaluation of progressive fatigue, dizziness and treatment-resistant hypothyroidism. Initial laboratory results revealed hypothyroidism, hyponatraemia and hyperkalaemia. Liothyronine sodium (Cytomel) was initiated, which exacerbated her fatigue and dizziness. Suspecting adrenal insufficiency, an 08:00 cortisol level was obtained and found to be low with failure to increase following cosyntropin stimulation test. Diagnosis of primary adrenal insufficiency was confirmed via CT abdomen and pelvis revealing diminutive adrenal glands and elevated 21-hydroxylase antibody. Treatment was initiated with hydrocortisone 10 mg every morning and 5 mg at 16:00/day, with plan for patient follow-up in 3 weeks to assess need for mineralocorticoid replacement. Polyglandular syndromes are rare and have a wide variety of presentation. Thus, we recommend screening patients with a single autoimmune disorder who do not respond to conventional therapy to prevent possible life-threatening adrenal crisis.
Acute fibrinous organising pneumonia presenting as a cavitary lung lesion and treatment response to azithromycin
Authors: Aslam Waqas , Perez-Guerra Francisco , Jebakumar Deborah , Culver Daniel A , Ghamande Shekhar
Published: August 2019

Acute fibrinous organising pneumonia is distinct from the classic diffuse alveolar damage, organising pneumonia and eosinophilic pneumonia. A 52-year-old woman presented with fever, productive cough, night sweats and left-sided pleuritic chest pain for a week. Physical examination was significant only for decreased breath sounds in the left infraclavicular area laterally. Imaging studies revealed a peripheral thick-walled left upper lobe cavitary lesion, left lower lobe consolidation and an enlarged subcarinal lymph node. She was treated with doxycycline for 10 days without improvement. Pertinent laboratory tests, microbiologic workup and fibre-optic bronchoscopy were non-diagnostic and a CT-guided left upper lobe lung biopsy revealed acute fibrinous organising pneumonia. She was treated with azithromycin with complete resolution of symptoms. To our knowledge, this is the first reported case of acute fibrinous organising pneumonia presenting as a cavitary lung lesion and the first with treatment response to azithromycin.
‘Poles apart presentation’: diagnosis and management of iatrogenic posterior urethral false tract in cases of pelvic fracture urethral injury
Authors: Bansal Devanshu , Kumar Sanjay , Jain Siddharth , Dogra Prem Nath
Published: August 2019

Iatrogenic creation of false tract in posterior urethra while managing a case of pelvic fracture urethral injury is a dreadful complication. The spectrum of presentation ranges from complete urinary incontinence to urinary retention. We describe three such cases created due to railroading or attempted repair. Case 1 presented with total urinary incontinence following open perineal urethroplasty for posterior urethral trauma while two cases presented with failure to void after endoscopic or open surgical management for the same. One patient was managed with endoscopic resection of the septum between the false passage and true posterior urethra; two cases required redo urethroplasty. All patients voided well postoperatively and were continent. Surgeon experience and meticulous endoscopic evaluation are the keys to success. Forceful attempt at per urethral catheter placement in the acute setting should be avoided. Blind railroading of the catheter and unnecessarily forceful passage of suprapubic metal bougie during urethroplasty should be condemned.
Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials
Authors: Brown Tracey J , Brainard Julii , Song Fujian , Wang Xia , Abdelhamid Asmaa , Hooper Lee
Published: August 2019

Objective

To assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism.

Design

Systematic review and meta-analyses.

Data sources

Medline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews.

Eligibility criteria

Randomised controlled trials of at least 24 weeks’ duration assessing effects of increasing α-linolenic acid, long chain omega-3, omega-6, or total PUFA, which collected data on diabetes diagnoses, fasting glucose or insulin, glycated haemoglobin (HbA1c), and/or homoeostatic model assessment for insulin resistance (HOMA-IR).

Data synthesis

Statistical analysis included random effects meta-analyses using relative risk and mean difference, and sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline risk of diabetes and use of antidiabetes drugs, trial duration, and dose. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE.

Results

83 randomised controlled trials (mainly assessing effects of supplementary long chain omega-3) were included; 10 were at low summary risk of bias. Long chain omega-3 had little or no effect on likelihood of diagnosis of diabetes (relative risk 1.00, 95% confidence interval 0.85 to 1.17; 58 643 participants, 3.7% developed diabetes) or measures of glucose metabolism (HbA1cmean difference −0.02%, 95% confidence interval −0.07% to 0.04%; plasma glucose 0.04, 0.02 to 0.07, mmol/L; fasting insulin 1.02, −4.34 to 6.37, pmol/L; HOMA-IR 0.06, −0.21 to 0.33). A suggestion of negative outcomes was observed when dose of supplemental long chain omega-3 was above 4.4 g/d. Effects of α-linolenic acid, omega-6, and total PUFA on diagnosis of diabetes were unclear (as the evidence was of very low quality), but little or no effect on measures of glucose metabolism was seen, except that increasing α-linolenic acid may increase fasting insulin (by about 7%). No evidence was found that the omega-3/omega-6 ratio is important for diabetes or glucose metabolism.

Conclusions

This is the most extensive systematic review of trials to date to assess effects of polyunsaturated fats on newly diagnosed diabetes and glucose metabolism, including previously unpublished data following contact with authors. Evidence suggests that increasing omega-3, omega-6, or total PUFA has little or no effect on prevention and treatment of type 2 diabetes mellitus.

Systematic review registration

PROSPERO CRD42017064110.
Challenges in interpreting results from ‘multiple regression’ when there is interaction between covariates
Authors: Shrier Ian , Redelmeier Annabelle , Schnitzer Mireille E , Steele Russell J
Published: August 2019

Properly interpreting research results is the foundation of evidence-based medicine. Most observational studies use multiple regression and report adjusted effects. In randomised trials, adjusted effects are often provided when there are chance baseline imbalances. The estimates for the exposure of interest (eg, treatment) from these adjusted analyses are usually interpreted as population average causal effects (PACEs); for example, what would be the difference in the mean outcome if everyone in the population was treated versus untreated? In this paper, we show this interpretation is incorrect when there is an interaction between treatment and other variables with respect to the outcome. We provide the appropriate methods to calculate the PACE from regression analyses and also introduce alternative methods that have gained popularity over the last 20 years. Finally, we explain why researchers should be cautious when excluding interaction terms based on p values.
Treating gambling disorder with as needed administration of intranasal naloxone: a pilot study to evaluate acceptability, feasibility and outcomes
Authors: Castrén Sari , Mäkelä Niklas , Haikola Janne , Salonen Anne H , Crystal Roger , Scheinin Mika , Alho Hannu
Published: August 2019

Background and aim

There is growing interest in the use of medication-assisted treatments for gambling disorder (GD). Opioid receptor antagonists are hypothesised to blunt the craving associated with gambling. This study was designed to assess the feasibility of using an intranasal naloxone spray to treat GD.

Design

An 8-week, open-label, uncontrolled pilot study.

Setting

A single study site in the capital region of Finland.

Subjects

Twenty problem gamblers (nine men) were randomised into two groups. Group A (n=10) took one dose into one nostril (2 mg naloxone), as needed, with a maximum of 4 doses/day (max. 8 mg/day). Group B (n=10) took one dose into each nostril (4 mg naloxone) as needed, with a maximum of 4 doses/day (max. 16 mg/day).

Intervention

Naloxone hydrochloride nasal spray.

Measures

Acceptability and feasibility of the intervention were assessed. Use of study medication, adverse events, gambling frequency and gambling expenditure were recorded in a mobile diary. Problem gambling: South Oaks Gambling Screen (SOGS), depressive symptoms: Beck Depression Inventory (BDI) and alcohol use: Alcohol Use Disorders Identification Test were recorded.

Results

Study completion rate was 90%. Acceptability and feasibility scores were high. Group B used intranasal naloxone more frequently than group A, and consequently used more naloxone. No serious adverse events were reported. The postintervention SOGS scores were lower (median=4 (IQR=3.75) versus preintervention scores (median=12 (IQR=4.75)). Depressive symptoms were reduced during the trial (preintervention BDI median=9, IQR=9 vs postintervention BDI median=6, IQR=6).

Conclusions

The acceptability and feasibility of using intranasal naloxone were high, and no serious adverse events were reported. Preliminary results suggest mixed results in terms of gambling behaviour (ie, reduced frequency but not expenditure) and decreased depressive symptoms.

Trial registration number

EudraCT2016-001828-56
Shifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment
Authors: Sinnott Carol , Foley Tony , Horgan Linda , McLoughlin Kathleen , Sheehan Cormac , Bradley Colin
Published: August 2019

Objective

General practitioners (GPs) report finding consultations on fitness to drive (FtD) in people with cognitive impairment difficult and potentially damaging to the physician–patient relationship. We aimed to explore GP and patient experiences to understand how the negative impacts associated with FtD consultations may be mitigated.

Methods

Individual qualitative interviews were conducted with GPs (n=12) and patients/carers (n=6) in Ireland. We recruited a maximum variation sample of GPs using criteria of length of time qualified, practice location and practice size. Patients with cognitive impairment were recruited via driving assessment services and participating general practices. Interviews were audio-recorded, transcribed and analysed thematically by the multidisciplinary research team using an approach informed by the framework method.

Results

The issue of FtD arose in consultations in two ways: introduced by GPs to proactively prepare patients for future driving cessation or by patients who urgently needed a medical report for an expiring driving license. The former strategy, implementable by GPs who had strong relational continuity with their patients, helped prevent crisis consultations from arising. The latter scenario became acrimonious if cognition had not been openly discussed with patients previously and was now potentially impacting on their right to drive. Patients called for greater clarity and empathy for the threat of driving cessation from their GPs.

Conclusion

GPs used their longitudinal relationship with cognitively impaired patients to reduce the potential for conflict in consultations on FtD. These efforts could be augmented by explicit discussion of cognitive impairment at an earlier stage for all affected patients. Patients would benefit from greater input into planning driving cessation and acknowledgement from their GPs of the impact this may have on their quality of life.
Sleep duration and multimorbidity in Luxembourg: results from the European Health Examination Survey in Luxembourg, 2013–2015
Authors: Ruiz-Castell Maria , Makovski Tatjana T , Bocquet Valéry , Stranges Saverio
Published: August 2019

Objectives

We estimated the prevalence of short sleep duration and multimorbidity in Luxembourg, and assessed whether sleep duration was associated with multimorbidity after adjusting for sociodemographic and behavioural characteristics.

Design

Cross-sectional study.

Participants

Data from 1508 Luxembourg residents (48% men and 52% women) aged 25 to 64 years came from the European Health Examination Survey 2013–2015.

Outcome measures

Short sleep duration and multimorbidity.

Results

Participants reported sleeping 6.95 hours/night during work days, nearly 1 hour less than during non-work days (7.86 hours/night). Nearly half of participants reported having been diagnosed with ≥2 chronic conditions/diseases. Short sleep duration was associated with the number of chronic conditions (OR 4.65, 95% CI 1.48 to 14.51; OR 7.30, 95% CI 2.35 to 22.58; OR 6.79, 95% CI 2.15 to 21.41 for 1, 2 and ≥3 chronic conditions/diseases, respectively), independently of socioeconomic and behavioural characteristics.

Conclusions

Health promotion programmes should aim at improving and promoting healthy lifestyles among the general population to improve sleep habits as well as decrease multimorbidity in middle-aged adults.
A systematic review of methodological quality of model development studies predicting prognostic outcome for resectable pancreatic cancer
Authors: Bradley Alison , Van Der Meer Robert , McKay Colin J
Published: August 2019

Objectives

To assess the methodological quality of prognostic model development studies pertaining to post resection prognosis of pancreatic ductal adenocarcinoma (PDAC).

Design/setting

A narrative systematic review of international peer reviewed journals

Data source

Searches were conducted of: MEDLINE, Embase, PubMed, Cochrane database and Google Scholar for predictive modelling studies applied to the outcome of prognosis for patients with PDAC post resection. Predictive modelling studies in this context included prediction model development studies with and without external validation and external validation studies with model updating. Data was extracted following the Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) checklist.

Primary and secondary outcome measures

Primary outcomes were all components of the CHARMS checklist. Secondary outcomes included frequency of variables included across predictive models.

Results

263 studies underwent full text review. 15 studies met the inclusion criteria. 3 studies underwent external validation. Multivariable Cox proportional hazard regression was the most commonly employed modelling method (n=13). 10 studies were based on single centre databases. Five used prospective databases, seven used retrospective databases and three used cancer data registry. The mean number of candidate predictors was 19.47 (range 7 to 50). The most commonly included variables were tumour grade (n=9), age (n=8), tumour stage (n=7) and tumour size (n=5). Mean sample size was 1367 (range 50 to 6400). 5 studies reached statistical power. None of the studies reported blinding of outcome measurement for predictor values. The most common form of presentation was nomograms (n=5) and prognostic scores (n=5) followed by prognostic calculators (n=3) and prognostic index (n=2).

Conclusions

Areas for improvement in future predictive model development have been highlighted relating to: general aspects of model development and reporting, applicability of models and sources of bias.

Trial registration number

CRD42018105942
Incidence of cancer-associated thromboembolism in Japanese gastric and colorectal cancer patients receiving chemotherapy: a single-institutional retrospective cohort analysis (Sapporo CAT study)
Authors: Aonuma Ayane Oba , Nakamura Michio , Sakamaki Kentaro , Murai Taichi , Matsuda Chika , Itaya Kazufumi , Sone Takayuki , Yagisawa Masataka , Koike Yuta , Endo Ayana , Tsukuda Yoko , Ono Yuji , Nagasaka Atsushi , Nishikawa Shuji , Yamanaka Takeharu , Sakamoto Naoya
Published: August 2019

Objective

Few data regarding the incidence of cancer-associated thromboembolism (TE) are available for Asian populations. We investigated the incidence of TE (TEi) and its risk factors among gastric and colorectal cancer (GCC) patients received chemotherapy in a daily practice setting.

Design

A retrospective cohort study.

Setting

A single-institutional study that used data from Sapporo City General Hospital, Japan, on patients treated between January 2008 and May 2015.

Participants

Five hundred Japanese GCC patients who started chemotherapy from January 2008 to May 2015.

Primary and secondary outcome measures

TE was diagnosed by reviewing all the reports of contrast-enhanced CT performed during the follow-up period. All types of thrombosis detected by CT or additional imaging tests, such as venous TE, arterial TE and cerebral infarction, were defined as TE. Medical records of all identified patients were reviewed and potential risk factors for TE, including clinicopathological backgrounds, were collected. We defined the following patients as ‘active cancer’; patients with unresectable advanced GCC, cancer recurrence during or after completing adjuvant chemotherapy and/or presence of other malignant tumours.

Results

Of the 500 patients, 70 patients (14.0%) developed TE during the follow-up period. TEi was 9.2% and 17.3% in GCC patients, 18.1% and 3.5% in active and non-active cancer patients, and 24.0% and 12.9% in multiple and single primary, respectively. Multivariate logistic regression analysis showed that colorectal cancer (CRC) (OR 2.371; 95% CI 1.328 to 4.233), active cancer (OR 7.593; 95% CI 2.950 to 19.543) and multiple primary (OR 2.527; 95% CI 1.189 to 5.370) were independently associated with TEi.

Conclusion

TEi was 14.0% among Japanese GCC patients received chemotherapy, and was significantly higher among patients with CRC, active cancer and multiple primary than among those with gastric cancer, non-active cancer and single primary, respectively.

Trial registration number

UMIN000018912.
Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies
Authors: Lai Shicong , Peng Panxin , Diao Tongxiang , Hou Huimin , Wang Xuan , Zhang Wei , Liu Ming , Zhang Yaoguang , Seery Samuel , Wang Jianye
Published: August 2019

Objective

To assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).

Design

Systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.

Data sources

PubMed, EMBASE, the Cochrane Library until October 2018.

Eligibility criteria

Randomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH.

Data extraction and synthesis

Perioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF).

Results

22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p<0.05). No significant difference in IPSS, Qmax, QoL, PVR or IIEF at 3, 24, 36 or 60 months was identified. There was a significant difference in QoL at 6 months (MD=−0.08; 95% CI −0.13 to −0.02; p=0.007), and IPSS (MD = −0.10; 95% CI −0.15 to −0.05; p<0.0001) and Qmax (MD=0.62; 95% CI 0.06 to 1.19; p=0.03) at 12 months, although these differences were not clinically relevant.

Conclusion

PVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.
Anticholinergic burden and fractures: a protocol for a methodological systematic review and meta-analysis
Authors: Reinold Jonas , Schäfer Wiebke , Christianson Lara , Barone-Adesi Francesco , Riedel Oliver , Pisa Federica Edith
Published: August 2019

Introduction

Medications with anticholinergic activity are used in the treatment of many diseases common in old age, including depression, psychosis, Parkinson’s disease, allergies, pain and urinary incontinence. A high anticholinergic burden (ACB) is considered a major risk factor for fractures in older adults but recent studies reported inconsistent results. These inconsistencies may partly be due to differences in methodological aspects. However, no systematic review so far has addressed this association and considered study methods. Thus, we aim to conduct a systematic review and meta-analysis of observational studies addressing the association of ACB with fractures and to provide a methodological appraisal of the included studies.

Methods and analysis

We will search MEDLINE, EMBASE, the Science Citation Index, CENTRAL and grey literature using a strategy that combines the terms anticholinergic and fractures. We will hand search reference lists of articles. Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk of bias of the included studies using the Newcastle-Ottawa Quality Assessment Scale and RTI item bank. Discrepancies will be resolved by consensus or consultation with a third researcher. We will conduct a meta-analysis, either for the overall population or for specific and more homogeneous subgroups, if the number of studies retrieved and their heterogeneity allows it.

Ethics and dissemination

No ethics approval will be sought, as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations.

PROSPERO registration number

CRD42018116737.
Recommendations and practices for holistic chronic obstructive pulmonary disease (COPD) assessment and optimal referral patterns in emergency department presentations: a scoping review protocol
Authors: Moloney Clint , Sneath Emily , Phillips Tania , Issac Hancy , Beccaria Gavin , Mullens Amy
Published: August 2019

Introduction

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that causes persistent respiratory symptoms and decline in lung function over many years. This chronic disease significantly affects health-related quality of life and is known to contribute to frequent emergency department (ED) presentations. Multidimensional management of these patients, including interconnecting health disciplinarians will allow holistic care provision in the ED. The purpose of this scoping review is to synthesise current evidence on holistic management and assessment, and referral practices stemming from acute COPD presentation in the ED. Specifically, to determine: (1) What are the known causal factors associated with COPD ED presentations and (2) Is there an identified connection with appropriate healthcare professional assessment within ED presentations and reported referral pathways?

Methods and analysis

The iterative stages of the Arskey and O’Malley, and Levac advanced scoping review framework informs this review. Using published and unpublished studies in English, a three-tiered search strategy will be applied. After duplicates are removed, screen 1 (title and abstract) and screen 2 (full-text) will be conducted by two independent reviewers to determine eligibility of articles. Disputes will be settled through discussion or by using a third reviewer. A data collection tool developed by the authors will inform the data extraction process. Schematic tabular format of results with a narrative summary will depict how the results link with the scoping review objectives. Categorisation of results will be narrowed down as key conceptual findings and will align with the strategic intent of this review.

Ethics and dissemination

Ethics approval was not required for this study. A multidisciplinary team of authors will participate in dissemination activities (publications, reports, conference presentations, framework development).
Validation of new ICD-10-based patient safety indicators for identification of in-hospital complications in surgical patients: a study of diagnostic accuracy
Authors: McIsaac Daniel I , Hamilton Gavin M , Abdulla Karim , Lavallée Luke T , Moloo Husien , Pysyk Chris , Tufts Jocelyn , Ghali William A , Forster Alan J
Published: August 2019

Objective

Administrative data systems are used to identify hospital-based patient safety events; few studies evaluate their accuracy. We assessed the accuracy of a new set of patient safety indicators (PSIs; designed to identify in hospital complications).

Study design

Prospectively defined analysis of registry data (1 April 2010–29 February 2016) in a Canadian hospital network. Assignment of complications was by two methods independently. The National Surgical Quality Improvement Programme (NSQIP) database was the clinical reference standard (primary outcome=any in-hospital NSQIP complication); PSI clusters were assigned using International Classification of Disease (ICD-10) codes in the discharge abstract. Our primary analysis assessed the accuracy of any PSI condition compared with any complication in the NSQIP; secondary analysis evaluated accuracy of complication-specific PSIs.

Patients

All inpatient surgical cases captured in NSQIP data.

Analysis

We assessed the accuracy of PSIs (with NSQIP as reference standard) using positive and negative predictive values (PPV/NPV), as well as positive and negative likelihood ratios (±LR).

Results

We identified 12 898 linked episodes of care. Complications were identified by PSIs and NSQIP in 2415 (18.7%) and 2885 (22.4%) episodes, respectively. The presence of any PSI code had a PPV of 0.55 (95% CI 0.53 to 0.57) and NPV of 0.93 (95% CI 0.92 to 0.93); +LR 6.41 (95% CI 6.01 to 6.84) and −LR 0.40 (95% CI 0.37 to 0.42). Subgroup analyses (by surgery type and urgency) showed similar performance. Complication-specific PSIs had high NPVs (95% CI 0.92 to 0.99), but low to moderate PPVs (0.13–0.61).

Conclusion

Validation of the ICD-10 PSI system suggests applicability as a first screening step, integrated with data from other sources, to produce an adverse event detection pathway that informs learning healthcare systems. However, accuracy was insufficient to directly identify or rule out individual-level complications.
No rest for the weary: a cross-sectional study comparing patients’ sleep in the emergency department to those on the ward
Authors: Prendiville Richard , Umana Etimbuk , Avalos Gloria , McNicholl Brian
Published: August 2019

Background

Boarding in emergency departments (EDs) is a persistent problem worldwide. We hypothesised that patients sleeping while being boarded in EDs have worse self-rated sleep than those admitted from EDs who sleep on the ward.

Methods

Prospective cross-sectional study conducted at the University College Hospital, Galway between October and November 2016. Self-rated sleep in patients boarded in EDs from 23:00 to 07:00 was compared with those admitted to the ward before 23:00. Patients rated their sleep using the Richards-Campbell Sleep Questionnaire. Patients were excluded if they had cognitive impairment, were unable or incapacitated or had evidence of alcohol or drug use in the previous 24 hours. Continuous data are shown as medians (IQRs 25th–75th percentiles). Linear regression models of log-transformed outcome variables were performed.

Results

Ninety-three patients were included and 22 were excluded. Patients who boarded in the ED were significantly more likely to be medical patients (78% vs 21%, p<0.001), to be older (median age (IQR)=60 (39-71) vs 47 (32-68), p=0.04) and have more urgent presentations (74% vs 48% presenting as Manchester triage category 1 or 2, p=0.01) than patients who sleep on a ward. Patients who slept on the ward had significantly better sleep scores (mean log-transformed sleep scores (SD)=2.92 (1.05) vs 3.72 (0.66), p<0.001)). Those sleeping in the ED reported greater noisiness than those sleeping on the ward (mean log-transformed noisiness scores (SD)=3.18 (1.10) vs 4.15 (0.57), p<0.001). These significant differences in sleep scores and noisiness ratings persisted after adjustment for age, triage category and admitting service.

Conclusion

We found those who sleep boarded in EDs have worse self-rated sleep than those who sleep on the ward.
De novo SCAMP5 mutation causes a neurodevelopmental disorder with autistic features and seizures
Authors: Hubert Laurence , Cannata Serio Magda , Villoing-Gaudé Laure , Boddaert Nathalie , Kaminska Anna , Rio Marlène , Lyonnet Stanislas , Munnich Arnold , Poirier Karine , Simons Matias , Besmond Claude
Published: August 2019

Background

Autistic spectrum disorders (ASDs) with developmental delay and seizures are a genetically heterogeneous group of diseases caused by at least 700 different genes. Still, a number of cases remain genetically undiagnosed.

Objective

The objective of this study was to identify and characterise pathogenic variants in two individuals from unrelated families, both of whom presented a similar clinical phenotype that included an ASD, intellectual disability (ID) and seizures.

Methods

Whole-exome sequencing was used to identify pathogenic variants in the two individuals. Functional studies performed in the Drosophila melanogaster model was used to assess the protein function in vivo.

Results

Probands shared a heterozygous de novo secretory carrier membrane protein (SCAMP5) variant (NM_001178111.1:c.538G>T) resulting in a p.Gly180Trp missense variant. SCAMP5 belongs to a family of tetraspanin membrane proteins found in secretory and endocytic compartments of neuronal synapses. In the fly SCAMP orthologue, the p.Gly302Trp genotype corresponds to human p.Gly180Trp. Western blot analysis of proteins overexpressed in the Drosophila fat body showed strongly reduced levels of the SCAMP p.Gly302Trp protein compared with the wild-type protein, indicating that the mutant either reduced expression or increased turnover of the protein. The expression of the fly homologue of the human SCAMP5 p.Gly180Trp mutation caused similar eye and neuronal phenotypes as the expression of SCAMP RNAi, suggesting a dominant-negative effect.

Conclusion

Our study identifies SCAMP5 deficiency as a cause for ASD and ID and underscores the importance of synaptic vesicular trafficking in neurodevelopmental disorders.
Association of novel measures of sleep disturbances with blood pressure: the Multi-Ethnic Study of Atherosclerosis
Authors: Kim John S. , Azarbarzin Ali , Wang Rui , Djonlagic Ina E. , Punjabi Naresh M. , Zee Phyllis C. , Koo Brian B. , Soliman Elsayed Z. , Younes Magdy , Redline Susan
Published: August 2019

Background

Mechanisms underlying blood pressure (BP) changes in obstructive sleep apnoea (OSA) are incompletely understood. We assessed the associations between BP and selected polysomnography (PSG) traits: sleep depth, airflow limitation measurements and OSA-specific hypoxic burden.

Methods

This cross-sectional analysis included 2055 participants from the Multi-Ethnic Study of Atherosclerosis who underwent PSG and BP measurements in 2010–2013. Sleep depth was assessed using the ‘OR product’, a continuous measure of arousability. Airflow limitation was assessed by duty cycle (Ti/Tt) and % of breaths with flow limitation, and hypoxia by ‘hypoxic burden’. Primary outcomes were medication-adjusted systolic BP (SBP) and diastolic BP (DBP). We used generalised linear models adjusted for age, sex, race/ethnicity, smoking, education, body mass index, alcohol use, periodic limb movements and alternative physiological disturbances.

Results

The sample had a mean age of 68.4 years and apnoea–hypopnoea index of 14.8 events/hour. Sleep depth was not significantly associated with BP. Every 1 SD increment in log-transformed non-rapid eye movement duty cycle was associated with 0.9% decrease in SBP (95% CI: 0.1% to 1.6%), even after adjusting for sleep depth and hypoxic burden. Every 1 SD increment in log-transformed hypoxic burden was associated with a 1.1% increase in SBP (95% CI: 0.1% to 2.1%) and 1.9% increase in DBP (95% CI: 1.0% to 2.8%) among those not using hypertension medications.

Conclusions

Higher duty cycle was associated with lower SBP overall and hypoxic burden with higher SBP and DBP among non-BP medication users. These findings suggest changes in both respiratory effort and oxygenation during sleep influence BP.
Serial measurements of cardiac troponin I in heart failure secondary to canine mitral valve disease
Authors: Chan I‐Ping , Wu San‐Yu , Chang Chao‐Chin , Chen Wen‐Ying
Published: August 2019

Serial measurements of cardiac troponin I (cTnI) levels are considered to be better predictors of cardiac death than single‐time‐point analyses in human medicine. We hypothesised that cTnI levels could reflect the severity of myxomatous mitral valve disease (MMVD), and that serial changes in the cTnI level had a prognostic value in dogs with congestive heart failure (CHF) secondary to MMVD. Seventy‐six dogs were initially enrolled and classified by the American College of Veterinary Internal Medicine (ACVIM) staging system. The single‐timepoint cTnI concentration in these dogs significantly increased with the ACVIM stage. Twenty‐seven dogs with CHF subsequently underwent serial measurement of cTnI levels, and the results showed that those who demonstrated a decrease in cTnI levels from the first to the third visit exhibited a higher risk of cardiac death than did those without such changes (P=0.012). We suspect that the downward trend in cTnI levels may be affected by medical treatment for CHF. In conclusion, although cTnI levels could reflect the severity of MMVD to a certain extent, the serial changes may be affected by medical treatment. Therefore, caution should be exercised when cTnI is used for assessment of the prognosis of CHF secondary to MMVD in dogs.
Farmer and veterinarian attitudes towards the risk of zoonotic Mycobacterium bovis infection in Northern Ireland
Authors: Robinson Philip A
Published: August 2019

Based on a qualitative social science research methodology using semi‐structured interviews, this paper examines the attitudes of farmers and veterinarians in Northern Ireland around the risk of acquiring tuberculosis caused by Mycobacterium bovis from infected cattle and drinking raw milk. This region has traditionally had one of the highest rates of bovine tuberculosis in the United Kingdom and among the highest in Europe. The research finds that the risk is often downplayed and considered so rare that it is no longer a significant public health risk due to the pasteurisation of milk and intensive surveillance on farms through systematic testing and removal of positive animals, as evidenced by the low recorded human incidence. Although the incidence of tuberculosis in humans caused by M bovis is only around 1% of all annual human tuberculosis cases, this paper argues that M bovis may be underestimated as a human pathogen and makes the case for a renewed perspective. Discourses surrounding the disease may need to be re‐orientated to remind relevant stakeholders that human infection with M bovis is a hazard that needs to be treated with more caution on the front line of control.