bluuebunny/crossref_metadata_2025 huggingface dataset:
Tamoxifen use in recurrent ovarian cancer in a Chinese population: A 15 ‐year clinical experience in a tertiary referral center
Authors: Chan Karen Kar Loen , Ngu Siew Fei , Chu Mandy Man Yee , Tse Ka Yu , Ngan Hextan Yuen Sheung
Published: October 2020

Aim

To review the clinical use and the effectiveness of tamoxifen in patients with advanced or recurrent ovarian cancer.

Methods

A retrospective review of clinical records was conducted in patients who received tamoxifen for the treatment of ovarian cancer between 2002 and 2016. We reviewed the clinical setting that it was given, duration of use, patients' tolerability, clinical benefit and progression‐free survival. We also attempted to identify predictive markers for response.

Results

A total of 92 patients received tamoxifen during this 15‐year period. The patients received a median of 2.5 lines of chemotherapy before switching to tamoxifen, and they remained on tamoxifen for a median of 5.6 months (range 0–85 months), with 24 patients receiving it for more than 12 months. Seventy‐six patients continued on tamoxifen for more than 2 months. In this group, 75 patients had an evaluable response, either by CA 125 or clinically and clinical benefit rate (defined as complete, partial response and static disease) was seen in 42 patients (56%), with majority of patients having static disease. The median progression‐free survival was 5.3 months (95% confidence interval, 2.6–8.1). Tamoxifen was well tolerated. Hormone receptor status was not demonstrated to predict response.

Conclusion

Patients with advanced ovarian cancer who have failed previous lines of chemotherapy may achieve static disease with tamoxifen with minimal side effects. Tamoxifen may still have a role in the era of molecular target therapy.
Measurement, outcomes and interventions of cognitive function after breast cancer treatment: A narrative review
Authors: Jia Miaomiao , Zhang Xiaojun , Wei Liyuan , Gao Jinnan
Published: October 2020

Cancer‐related cognitive impairment (CRCI) is a common complaint in breast cancer patients, especially related to chemotherapy. It is characterized as cognitive disorders in areas of memory, attention and executive function, which can negatively affect patients' quality of life and their ability to work. While various assessment methods of CRCI cause highly diverse results in CRCI‐related studies. Currently, it is not clear how cerebral structure and function change in breast cancer patients and underlying mechanisms of developing CRCI are still undefined. Intervention research is limited. This article reviews the results of CRCI‐related studies and research progress and discusses the advantages and limits of various methods. Besides, the mechanisms and intervention strategies are reviewed.
Cardiovascular disease in childhood and adolescence: Lessons from children with chronic kidney disease
Authors: Querfeld Uwe
Published: October 2020

Children suffering from chronic kidney disease (CKD) have the apparent highest risk for the development of cardiovascular disease (CVD) at a young age. While symptoms of CVD are characteristically absent in childhood and adolescence, remodelling of the myocardium, medium and large‐sized arteries and of the microcirculation is clinically significant and can be assessed with non‐invasive technology. Kidney disease and its progression are the driver of CVD, mediated by an unparalleled accumulation of risk factors converging on several comorbid conditions including hypertension, anaemia, dyslipidaemia, disturbed mineral metabolism and chronic persistent inflammation. Large prospective paediatric cohorts studies have provided valuable insights into the pathogenesis and the progression of CKD‐induced cardiovascular comorbidity and have characterised the cardiovascular phenotype in young patients. They have also provided the rationale for close monitoring of risk factors and have defined therapeutic targets. Recently discovered new biomarkers could help identify the individual risk for CVD. Prevention of CVD by aggressive therapy of modifiable risk factors is essential to enable long‐term survival of young patients with CKD.
Developing and testing a set of quality indicators for pharmacist home visit services: A mixed methods study in Japan
Authors: Fujita Kenji , Kushida Kazuki , Okada Hiroshi , Moles Rebekah J. , Chen Timothy F.
Published: October 2020

Objective

Quality indicators (QIs) are an important mechanism by which health services can be evaluated. We aimed to develop a set of QIs for pharmacist home visit services and assess their measurement properties.

Methods

A three‐step procedure was applied: (1) Selection of existing content‐validated QIs from the international literature and the development of QIs based on national guidelines and home healthcare professionals' opinions; (2) Expert panel consensus of a preliminary set of QIs using the RAND/UCLA Appropriateness Method; (3) Field testing to evaluate their measurement properties (feasibility, applicability, improvement potential, discriminatory capacity, sensitivity to change, acceptability and implementation issues) followed by exploratory semistructured interviews in Japan.

Results

Fifty‐two preliminary QIs were prepared and 45 were judged as “appropriate”by the expert panel. Sixty‐one community pharmacies were recruited to this study with 41 contributing QI data monthly over the 6‐month period. Field testing showed that 20 QIs met six measurement properties (ie, feasibility, applicability, improvement potential, discriminatory capacity, acceptability and implementation issues). Nine of these QIs also had high sensitivity to change. Additionally, interviews identified that the main positive impact on practice of using QIs was the early detection of causes of drug‐related problems but a negative impact was decrease of pharmacists' motivation. Auto extraction of QIs was seen as a major facilitator, given the time taken to manually extract QI data.

Conclusions

A set of QIs for pharmacist home visit services was rigorously developed and tested. This QI set may be useful in evaluating the quality of such services.
Warfarin dosing algorithms: A systematic review
Authors: Asiimwe Innocent G. , Zhang Eunice J. , Osanlou Rostam , Jorgensen Andrea L. , Pirmohamed Munir
Published: October 2020

Aims

Numerous algorithms have been developed to guide warfarin dosing and improve clinical outcomes. We reviewed the algorithms available for various populations and the covariates, performances and risk of bias of these algorithms.

Methods

We systematically searched MEDLINE up to 20 May 2020 and selected studies describing the development, external validation or clinical utility of a multivariable warfarin dosing algorithm. Two investigators conducted data extraction and quality assessment.

Results

Of 10 035 screened records, 266 articles were included in the review, describing the development of 433 dosing algorithms, 481 external validations and 52 clinical utility assessments. Most developed algorithms were for dose initiation (86%), developed by multiple linear regression (65%) and mostly applicable to Asians (49%) or Whites (43%). The most common demographic/clinical/environmental covariates were age (included in 401 algorithms), concomitant medications (270 algorithms) and weight (229 algorithms) while CYP2C9 (329 algorithms), VKORC1 (319 algorithms) and CYP4F2 (92 algorithms) variants were the most common genetic covariates. Only 26% and 7% algorithms were externally validated and evaluated for clinical utility, respectively, with <2% of algorithm developments and external validations being rated as having a low risk of bias.

Conclusion

Most warfarin dosing algorithms have been developed in Asians and Whites and may not be applicable to under‐served populations. Few algorithms have been externally validated, assessed for clinical utility, and/or have a low risk of bias which makes them unreliable for clinical use. Algorithm development and assessment should follow current methodological recommendations to improve reliability and applicability, and under‐represented populations should be prioritized.
The value of communities and their consent: A communitarian justification of community consent in medical research
Authors: Al Pepijn
Published: October 2020

Community engagement is increasingly defended as an ethical requirement for biomedical research. Some forms of community engagement involve asking the consent of community leaders prior to seeking informed consent from community members. Although community consent does not replace individual consent, it could problematically restrict the autonomy of community members by precluding them from research when community leaders withhold their permission. Community consent is therefore at odds with one of the central principles of bioethics: respecting autonomy. This raises the question as to how community consent can be justified or even required. This paper aims to provide an answer to this question by arguing, based on the work of Taylor and Kymlicka, that community practices are important for the identity and autonomy of community members. When these practices are incompatible with a solitary focus on individual informed consent, they need to be protected by making these decision‐making practices (including asking permission to community authorities) part of the consent process. Since these decision‐making practices are important for the autonomy of community members, community consent with the goal of protecting these practices is not necessarily in conflict with autonomy.
Investigating which behaviour change techniques work for whom in which contexts delivered by what means: Proposal for an international collaboratory of Centres for Understanding Behaviour Change (CUBiC)
Authors: Armitage Christopher J. , Conner Mark , Prestwich Andrew , de Bruin Marijn , Johnston Marie , Sniehotta Falko , Epton Tracy
Published: October 2020

Purpose

Behaviour change techniques are fundamental to the development of any behaviour change intervention, but surprisingly little is known about their properties. Key questions include when, why, how, in which contexts, for which behaviours, in what combinations, compared with what, and for whom behaviour change techniques are typically effective. The aims of the present paper are to: (1) articulate the scope of the challenge in understanding the properties of behaviour change techniques, (2) propose means by which to tackle this problem, and (3) call scientists to action.

Methods

Iterative consensus (O’Connor et al., 2020, Br. J. Psychol., e12468) was used to elicit and distil the judgements of experts on how best to tackle the problem of understanding the nature and operation of behaviour change techniques.

Results

We propose a worldwide network of ‘Centres for Understanding Behaviour Change’ (CUBiC) simultaneously undertaking research to establish what are the single and combined properties of behaviour change techniques across multiple behaviours and populations. We additionally provide a first attempt to systematize an approach that CUBiC could use to understand behaviour change techniques and to begin to harness the efforts of researchers worldwide.

Conclusion

Better understanding of behaviour change techniques is vital for improving behaviour change interventions to tackle global problems such as obesity and recovery from COVID‐19. The CUBiC proposal is just one of many possible solutions to the problems that the world faces and is a call to action for scientists to work collaboratively to gain deeper understanding of the underpinnings of behaviour change interventions.
Glycogen synthase kinase‐3 inhibition rescues sex‐dependent contextual fear memory deficit in human immunodeficiency virus‐1 transgenic mice
Authors: Moidunny Shamsudheen , Benneyworth Michael A. , Titus David J. , Beurel Eleonore , Kolli Udhghatri , Meints Joyce , Jalodia Richa , Ramakrishnan Sundaram , Atkins Coleen M. , Roy Sabita
Published: October 2020

Background and Purpose

A significant number of HIV‐1 patients on antiretroviral therapy develop HIV‐associated neurocognitive disorders (HAND). Evidence indicate that biological sex may regulate HAND pathogenesis, but the mechanisms remain unknown. We investigated synaptic mechanisms associated with sex differences in HAND, using the HIV‐1‐transgenic 26 (Tg26) mouse model.

Experimental Approach

Contextual‐ and cue‐dependent memories of male and female Tg26 mice and littermate wild type mice were assessed in a fear conditioning paradigm. Hippocampal electrophysiology, immunohistochemistry, western blot, qRT‐PCR and ELISA techniques were used to investigate cellular, synaptic and molecular impairments.

Key Results

Cue‐dependent memory was unaltered in male and female Tg26 mice, when compared to wild type mice. Male, but not female, Tg26 mice showed deficits in contextual fear memory. Consistently, only male Tg26 mice showed depressed hippocampal basal synaptic transmission and impaired LTP induction in area CA1. These deficits in male Tg26 mice were independent of hippocampal neuronal loss and microglial activation but were associated with increased HIV‐1 long terminal repeat mRNA expression, reduced hippocampal synapsin‐1 protein, reduced BDNF mRNA and protein, reduced AMPA glutamate receptor (GluA1) phosphorylation levels and increased glycogen synthase kinase 3 (GSK3) activity. Importantly, selective GSK3 inhibition using 4‐benzyl‐2‐methyl‐1,2,4‐thiadiazolidine‐3,5‐dione increased levels of synapsin‐1, BDNF and phosphorylated‐GluA1 proteins, restored hippocampal basal synaptic transmission and LTP, and improved contextual fear memory in male Tg26 mice.

Conclusion and Implications

Sex‐dependent impairments in contextual fear memory and synaptic plasticity in Tg26 mice are associated with increased GSK3 activity. This implicates GSK3 inhibition as a potential therapeutic strategy to improve cognition in HIV‐1 patients.
Spider diversity across an elevation gradient in Área de Conservación Guanacaste (ACG), Costa Rica
Authors: Dolson Sarah J. , McPhee Megan , Viquez Carlos F. , Hallwachs Winnie , Janzen Daniel H. , Smith M. Alex
Published: October 2020

Throughout the Neotropics, temperature and precipitation change with elevation and these changes affect the assemblage of species at any particular elevation. We documented the diversity of litter‐inhabiting spiders, (Arachnida: Araneae) along a Costa Rican elevational gradient as it relates to covarying abiotic factors such as temperature and precipitation. The spiders we collected were principally unidentifiable juveniles, and so we used Barcode Index Numbers (BINs) derived from DNA barcodes as proxies for species‐level interim names. We contrasted these taxon‐based estimates with phylogenetic measures of alpha‐ and beta‐diversity derived from both the mitochondrial DNA barcode region and a multi‐gene phylogeny of spiders and found that neither the abundance nor the species richness of spiders was significantly correlated with elevation, temperature, or precipitation. However, we did find that spider assemblages in the upper elevation cloud forests were phylogenetically clustered, (and this pattern was unrelated to whether the phylogenetic patterns were derived mitochondrially or from a multi‐gene analysis). One standard explanation for such a pattern is that harsh abiotic conditions in higher elevation forests have selected for particular spider lineages; however, this remains to be tested fully. The diversity of leaf‐litter spider species we uncovered was high and further sampling of spider abundance and diversity across the ACG is likely to yield many new species.
Hypotheses for Possible Iatrogenic Impacts of School Bullying Prevention Programs
Authors: Healy Karyn L.
Published: October 2020

Commensurate with the serious risks bullying poses to students’ mental health, substantial attention has been devoted to evaluating school bullying prevention programs. Research on the effectiveness of these interventions shows mixed outcomes. Recent evidence suggests that even programs that reduce overall bullying may have negative outcomes for victims. Most bullying prevention programs incorporate a range of strategies, but we know little about which strategies actively reduce bullying and whether some may have iatrogenic effects. Questions have been raised about programs that involve working with peer bystanders and whether some strategies stigmatize victims. In this article, I propose three theoretically derived hypotheses that describe mechanisms through which encouraging peers to actively defend victims may produce adverse outcomes for victims. More research is needed to test these hypotheses. A deeper understanding of the differential impact of bullying prevention strategies will lead to improvements in programs and more targeted use of effective strategies.
A Luta Continua1: Next Steps for Racism Research Among Black American Youth
Authors: Seaton Eleanor K.
Published: October 2020

Research examining the impact of racism among Black American children and adolescents has exploded in recent years. Given what we have learned about racism among Black American youth, in this article, I provide recommendations for developmental scientists. First, we need to examine other types of racism‐related stressors, namely internalized racism, vicarious racism, environmental racism, Internet assessments of racism, and racial macro stressors. A recent racial macro stressor that should be studied is Covid‐19, which has had devastating effects on the Black American community. Second, we need to examine middle childhood and adolescence as early periods of accelerated aging due to experiencing racism early in life. Adolescence may be a sensitive period given research illustrating that experiences of racial discrimination in adolescence affect adult health. Measurement is critical because these recommendations cannot be realized without developing new measures and incorporating diverse methods.
A theoretical model of contraceptive decision‐making and behaviour in diabetes: A qualitative application of the Health Belief Model
Authors: Johnson Emily , DeJonckheere Melissa , Oliverio Andrea L. , Brown Kathryn S. , Van Sparrentak Murphy , Wu Justine P.
Published: October 2020

Aim

People with diabetes have contraceptive needs that have been inadequately addressed. The aim of this qualitative study was to develop a theoretical model that reflects contraceptive decision‐making and behaviour in the setting of diabetes mellitus.

Methods

We conducted semi‐structured, qualitative interviews of 17 women with type 1 or type 2 diabetes from Michigan, USA. Participants were recruited from a diabetes registry and local clinics. We adapted domains from the Health Belief Model (HBM) and applied reproductive justice principles to inform the qualitative data collection and analysis. Using an iterative coding template, we advanced from descriptive to theoretical codes, compared codes across characteristics of interest (e.g. diabetes type), and synthesized the theoretical codes and their relationships in an explanatory model.

Results

The final model included the following constructs and themes: perceived barriers and benefits to contraceptive use (effects on blood sugar, risk of diabetes‐related complications, improved quality of life); perceived seriousness of pregnancy (harm to self, harm to foetus or baby); perceived susceptibility to pregnancy risks (diabetes is a ‘high risk’ state); external cues to action (one‐size‐fits‐all/anxiety‐provoking counselling vs. personalized/trust‐based counselling); internal cues to action (self‐perceived ‘sickness’); self‐efficacy (reproductive self‐efficacy, contraceptive self‐efficacy); and modifying factors (perceptions of biased counselling based upon one’s age, race or severity of disease).

Conclusions

This novel adaptation of the HBM highlights the need for condition‐specific and person‐centred contraceptive counselling for those with diabetes.
Clinical profile and prognosis in patients on oral anticoagulation before admission for COVID‐19
Authors: Rivera‐Caravaca José Miguel , Núñez‐Gil Iván J. , Vivas David , Viana‐Llamas María C. , Uribarri Aitor , Becerra‐Muñoz Víctor Manuel , Trabattoni Daniela , Fernández Rozas Inmaculada , Feltes Gisela , López‐Pais Javier , El‐Battrawy Ibrahim , Macaya Carlos , Fernandez‐Ortiz Antonio , Estrada Vicente , Marín Francisco ,   HOPE COVID‐19 Investigators
Published: October 2020

Background

The coronavirus disease 2019 (COVID‐19) shows high morbidity and mortality, particularly in patients with concomitant cardiovascular diseases. Some of these patients are under oral anticoagulation (OAC) at admission, but to date, there are no data on the clinical profile, prognosis and risk factors of such patients during hospitalization for COVID‐19.

Design

Subanalysis of the international ‘real‐world’ HOPE COVID‐19 registry. All patients with prior OAC at hospital admission for COVID‐19 were suitable for the study. All‐cause mortality was the primary endpoint.

Results

From 1002 patients included, 110 (60.9% male, median age of 81.5 [IQR 75‐87] years, median Short‐Form Charlson Comorbidity Index [CCI] of 1 [IQR 1‐3]) were on OAC at admission, mainly for atrial fibrillation and venous thromboembolism. After propensity score matching, 67.9% of these patients died during hospitalization, which translated into a significantly higher mortality risk compared to patients without prior OAC (HR 1.53, 95% CI 1.08‐2.16). After multivariate Cox regression analysis, respiratory insufficiency during hospitalization (HR 6.02, 95% CI 2.18‐16.62), systemic inflammatory response syndrome (SIRS) during hospitalization (HR 2.29, 95% CI 1.34‐3.91) and the Short‐Form CCI (HR 1.24, 95% CI 1.03‐1.49) were the main risk factors for mortality in patients on prior OAC.

Conclusions

Compared to patients without prior OAC, COVID‐19 patients on OAC therapy at hospital admission showed lower survival and higher mortality risk. In these patients on OAC therapy, the prevalence of several comorbidities is high. Respiratory insufficiency and SIRS during hospitalization, as well as higher comorbidity, pointed out those anticoagulated patients with increased mortality risk.
Altered neural processing of emotional words in adults with a history of institutionalization: Evidence from the emotional Stroop task
Authors: Zhukova Marina A. , Ovchinnikova Irina V. , An Iuliia , Grigorenko Elena L.
Published: October 2020

We investigated neural correlates of traumatic experience related to the lack of family care in adults with a history of institutionalization (IC) using the Emotional Stroop paradigm. The goals of our study were twofold: we investigated whether adults with IC history (n = 24; Mage = 22.17, SD = 6.7) demonstrate atypical processing of emotionally salient words in general, and whether they exhibit selective processing bias toward family related words compared to adults raised in biological families (BFC; n = 28; Mage = 22.25, SD = 4.9). Results demonstrated significant differences in accuracy but not response times between groups on the behavioral level, indicating that the IC group was overall less accurate in identifying the color of the font. Contrary to our prediction, there were no significant differences between neural response to family related versus unrelated words in the IC and BFC groups. The absence of group differences can be explained by the selection of stimuli, which were associated with family rather than institutional history. The IC group showed a larger N280‐380 component in response to negative words compared to the BFC group, and larger negativity in the right parietal area in response to positive words in the same time window. Results demonstrate that institutional history is marked by altered emotional processing in the subpopulation of institutional care‐leavers, but the footprint is not specific to traumatic experience and extends from general sensitivity to emotional words.
Selecting plant traits for soil erosion control in grassed waterways under a changing climate: A growth room study
Authors: Lees Corina , de Baets Sarah , Rickson Jane , Simmons Robert W.
Published: October 2020

Grassed waterways are used to mitigate the offsite transport of sediment generated by soil erosion. This study used a novel trait‐based ranking approach as a method to screen potential candidate grass monocultures and mixes based on their theoretical performance in reducing (a) detachment via rainsplash, (b) detachment via scouring due to concentrated flow and (c) sediment transport and deposition processes. Selected grass species were grown under simulated UK summer and autumn establishment conditions under three different replicated rainfall scenarios: drought, normal rainfall and excess rainfall. The grass species used were the novel hybrid species Festulolium cv Prior (Fest_1) and Festulolium Bx511 (Fest_2) and a conventional mixture of Lolium perenne and Festuca rubra (Conv). Monocultures and mixtures of these species were studied. Plant traits pertinent to control of soil erosion by water were measured. Aboveground traits included plant height, percentage ground cover, aboveground biomass, stem diameter, stem area density and number of tillers. Belowground traits included total root length, root total surface area, belowground biomass, root diameter and % fine roots ≤0.25 mm. For summer conditions, the species treatments that had the highest overall soil erosion mitigation potential were Conv, Fest_1 + 2 + Conv and Fest_2. For autumn conditions, the best treatments were Fest_1 + 2, Fest_1 + 2 + Conv and Conv. The Fest 1 + 2 + Conv had more desirable traits for erosion control than mono Festulolium treatments for the autumn conditions. The conventional mixture had more desirable traits for erosion control than mono Festulolium treatments in both climate scenarios. The results indicate that the trait‐based ranking approach utilized in this study can be used to inform rapid screening of candidate grass species for soil erosion control.

Highlights

How to select the most suitable grass species for soil erosion control under changing climate conditions?

A novel scoring system based on plant traits associated with soil erosion mitigation was developed.

Fest_1 + 2 and Conv treatments expressed traits strongly associated with maximum soil erosion mitigation.

Species selection for grassed waterways should consider the establishment growing season and expected rainfall.
The Family Engagement Practice Framework: A Comprehensive Framework Developed From the Voices of School‐Based Practitioners
Authors: Ball Annahita , Skrzypek Candra , Lynch Michael
Published: October 2020

Objective

This study developed a practice framework to identify and explain family engagement practice for school‐based service delivery.

Background

School–family–community partnerships expand the possibilities for family engagement by providing comprehensive services to families and children. No research to date has explored practitioners' perspectives of family engagement practice, and few practice frameworks exist to guide family engagement efforts.

Method

In this grounded theory study, we used qualitative interview data from 18 family engagement professionals (FEP) within one district‐wide, school‐based agency to identify the practices FEPs used to engage families in services.

Results

Analyses revealed that FEPs used a specific set of engagement practice strategies that included providing immediate and ongoing support, establishing rapport, establishing trust, and empowering families. These strategies were situated within a broader paradigmatic context and rooted in a set of core personal dispositions that were reflected in the framework.

Implications

This framework may be used to guide professional development activities, refine existing practice, and inform programmatic policies shaping school‐based family engagement initiatives.
Effect of a nurse‐led hypertension management program on quality of life, medication adherence and hypertension management in older adults: A randomized controlled trial
Authors: Kolcu Merve , Ergun Ayse
Published: October 2020

Aim

This study evaluated the effects of a nurse‐led hypertension management program on quality of life, medication adherence and hypertension management in older adults.

Methods

A total of 74 hypertensive older adults residing in two different nursing homes were randomized to the intervention group (n = 37) or control group (n = 37). The intervention group participated in a training program consisting of 20 weeks of health education and motivational meetings. Data were collected using a hypertension management knowledge and behavior questionnaire, quality of life scale, Morisky Medication Adherence Scale, and measurements of blood pressure and anthropometric and biochemical parameters. Data were analyzed using the χ2‐test, Wilcoxon signed‐rank test and Mann–Whitney U‐test.

Results

Post‐test systolic (118.64 ± 10.04 mmHg) and diastolic (77.83 ± 5.34 mmHg) blood pressures, and total cholesterol levels (178.43 ± 25.59 mg/dL) were significantly lower in the intervention group compared with the control group (130.54 ± 15.08 mmHg, 82.70 ± 7.69 mmHg, 200.7 ± 34.57 mg/dL, respectively). Post‐test hypertension knowledge score (20.75 ± 1.01), medication adherence rate (100.0%), and quality of life scale physical component (58.42 ± 13.93) and mental component (64.24 ± 12.85) scores were significantly higher in the intervention group than in the control group (12.21 ± 2.48; 64.9%; 44.36 ± 16.73; 53.93 ± 15.71, respectively). In addition, mean post‐test body mass index (27.19 ± 4.62 kg/m2), weight (74.81 ± 15.33 kg), waist circumference (93.29 ± 15.20 cm), hip circumference (107.67 ± 14.05 cm) and total cholesterol (178.43 ± 25.59 mg/dL) values were lower than pretest (28.13 ± 4.96 kg/m2; 77.37 ± 16.56 kg; 97.83 ± 16.23 cm; 112.89 ± 14.37 cm; 194.78 ± 38.64 mg/dL, respectively) in the intervention group.

Conclusions

The nurse‐led hypertension management program implemented in this study provides an example of an effective program to guide nurses who work with older adults. Geriatr Gerontol Int 2020; 20: 1182–1189.
The ursodeoxycholic acid response score predicts pathological features in primary biliary cholangitis
Authors: Kawata Kazuhito , Joshita Satoru , Shimoda Shinji , Yamashita Yuki , Yamashita Maho , Kitsugi Kensuke , Takatori Shingo , Ohta Kazuyoshi , Ito Jun , Shimoyama Shin , Noritake Hidenao , Suda Takafumi , Harada Kenichi
Published: October 2020

Aim

The ursodeoxycholic acid response score (URS) can predict the biochemical response to 12 months of ursodeoxycholic acid (UDCA) treatment in patients with primary biliary cholangitis (PBC). We investigated the relationship between the URS and the histopathological features before and after UDCA treatment.

Methods

Patients with PBC (n = 126) were examined for the association between the probability of response (POR) to UDCA based on the URS formulas and clinicopathological features. Furthermore, 30 patients were examined for the association between the POR and pathological changes.

Results

The POR area under the receiver operating characteristic curve (AUROC) for predicting the biochemical response to UDCA was 0.861. The PORs of stage 1 in the Nakanuma system and grade 0 in the CK7 grading in hepatocytes were significantly higher than those of stage 3 and grade 3, respectively. The AUROCs for the prediction of stage ≥2, stage ≥3 and stage 4 in the Nakanuma system at pretreatment were 0.592, 0.710 and 0.817, respectively. The AUROCs for the prediction of grade ≥1, grade ≥2 and grade 3 in the CK7 hepatocyte grading were 0.741, 0.824 and 0.970, respectively. Furthermore, the AUROC for predicting the histological stage progression after UDCA treatment in the Scheuer classification and the Nakanuma system were 0.712 and 0.799, respectively.

Conclusions

The URS not only predicts the biochemical response, but also reflects the Nakanuma system and the CK7 hepatocyte grading at pretreatment. This scoring system can identify an inadequate histological response to UDCA treatment in the Scheuer classification and the Nakanuma system.
Military moral injury: A concept analysis
Authors: Jamieson Nikki , Maple Myfanwy , Ratnarajah Dorothy , Usher Kim
Published: October 2020

Moral injury is the current term describing the breaching or violation of one’s moral code and has gained international research attention due to suicide linkages in military populations (Jamieson et al., Invisible wounds and suicide: Moral injury and veteran mental health. International Journal of Mental Health Nursing, 29, 105–109, 2020). Moral injury’s core features are spiritual/existential conflict, shame, guilt and self‐condemnation. To date, research focuses on the core features of moral injury and or the nature of events that exposed individuals to moral injury. Walker and Avant (Strategies for Theory Construction in Nursing, Prentice Hall New York, 2011) concept analysis model was used to examine the literature. The aim of this study is to enhance understanding of the defining attributes, antecedents, consequences and empirical referents of moral injury and systematically analyse the concept of moral injury in the context of military members. A literature search was undertaken using specific websites and journals, electronic databases, library catalogues and hand‐searches. Concept analysis was used to explicate moral injury, focusing exclusively on use of the concept in the included literature, comparing the terms used over time and across disciplines, and measurement tools for the concept. This concept analysis provides a renewed definition of moral injury in relation to the experience of veterans – ‘moral trauma’ and defined as: ‘the existential, psychological, emotional and or spiritual trauma arising from a conflict, violation or betrayal, either by omission or commission, of or within one’s moral beliefs or code(s)’. The analysis will facilitate understanding and operationalization of the concept applied to teaching, learning, practice and research.
Integration of family caregivers in delirium prevention care for hospitalized older adults: A case study analysis
Authors: Cohen Christine , Pereira Filipa , Kampel Thomas , Bélanger Louise
Published: October 2020

Aim

To understand how family caregivers of older adults hospitalized for orthopaedic surgery are integrated by nurses in delirium prevention care.

Design

Multiple case study.

Methods

The sample consisted of eight cases. Each case comprised an older adult, a family caregiver, and a nurse. Data were collected from September 2017 ‐ April 2018 through various instruments, including semi‐structured interviews and family caregiver logs. Within‐ and across‐case analyses were conducted, based on the model of The Care Partner Engagement developed by Hill, Yevchak, Gilmore‐Bykovskyi, & Kolanowski (Geriatric Nursing, 35, 2014, 272).

Results

Two themes emerged: (a) family caregivers were engaged in caring for the older adults during their hospital stay, though they had differences in terms of views and needs; and (b) family caregivers communicated with nurses but nurses did not recognize their role and did not integrate them much in care.

Conclusion

The presence and availability of family caregivers, their sense of responsibility towards the hospitalized older adults, and their positive effects on them suggest that family caregivers could be integrated more systematically in a care partnership with nurses. Poor integration of family caregivers in delirium prevention care shows that nurse delirium prevention competencies and their relational skills for communicating effectively with family caregivers need to be developed further.

Impact

Integrating family caregivers in delirium prevention care for older adults is a challenge for nurses. Family caregivers are engaged during the hospitalization of older adults, though differences and problems exist between the two groups. While there is communication between patients, family caregivers, and nurses, nurses do not recognize the role of family caregivers and hardly integrated them in the delirium prevention care of hospitalized older adults. Nurses must adopt a patient‐ and family‐centred approach. Care and training facilities must make resources available to implement this approach in nursing practice.
Atrial fibrillation ablation success defined by duration of recurrence on cardiac implantable electronic devices
Authors: Lohrmann Graham , Kaplan Rachel , Ziegler Paul D. , Monteiro João , Passman Rod
Published: October 2020

Introduction

Ablation for atrial fibrillation (AF) has emerged as an effective method of rhythm control. This exploratory analysis aimed to determine how various measures of recurrence would influence the definition of treatment success.

Methods

Using an electronic health record data set from January 2007 to June 2019 linked with Medtronic cardiac implantable electronic device (CIED) data, patients who underwent a first AF ablation procedure following CIED implantation were identified. Data were analyzed for recurrence of AF stratified by varying definitions of successful ablation. The performance of various simulated external AF monitoring strategies was assessed.

Results

A total of 665 patients were analyzed including 248 with paroxysmal AF (mean age: 66.2 ± 9.3 years, 73.0% male) and 417 patients with persistent AF (mean age: 67.3 ± 9.0 years, 73.6% male). Among patients with paroxysmal AF, survival free from recurrence at 1 year ranged from 28.2% to 72.1% (>6 min and >23 h thresholds, respectively) with an overall median percentage of time in AF reduction of 99.6%. Among patients with persistent AF, survival free from recurrence at 1 year ranged from 24.9% to 60.0% (>6 min and 7 consecutive days > 23 h thresholds, respectively) with an overall median percentage of time in AF reduction of 99.3%. A single 7‐day monitoring strategy had a sensitivity of less than 50% for detecting AF greater than 6 min in patients with paroxysmal and persistent AF.

Conclusion

In this real‐world data set of AF patients with CIEDs undergoing catheter ablation, treatment success varied substantially with different definitions of minimally required AF duration and is significantly impacted by the method of recurrence detection.
Newly designed Protein Transduction Domain (PTD)‐mediated BMP‐7 is a potential therapeutic for peritoneal fibrosis
Authors: Kim Seonghun , Shin Dong Ho , Nam Bo Young , Kang Hye‐Young , Park Jimin , Wu Meiyan , Kim Nam Hee , Kim Hyun Sil , Park Jung Tak , Han Seung Hyeok , Kang Shin‐Wook , Yook Jong In , Yoo Tae‐Hyun
Published: October 2020

While the bone morphogenetic protein‐7 (BMP‐7) is a well‐known therapeutic growth factor reverting many fibrotic diseases, including peritoneal fibrosis by peritoneal dialysis (PD), soluble growth factors are largely limited in clinical applications owing to their short half‐life in clinical settings. Recently, we developed a novel drug delivery model using protein transduction domains (PTD) overcoming limitation of soluble recombinant proteins, including bone morphogenetic protein‐7 (BMP‐7). This study aims at evaluating the therapeutic effects of PTD‐BMP‐7 consisted of PTD and full‐length BMP‐7 on epithelial‐mesenchymal transition (EMT)‐related fibrosis. Human peritoneal mesothelial cells (HPMCs) were then treated with TGF‐β1 or TGF‐β1 + PTD‐BMP‐7. Peritoneal dialysis (PD) catheters were inserted into Sprague‐Dawley rats, and these rats were infused intra‐peritoneally with saline, peritoneal dialysis fluid (PDF) or PDF + PTD‐BMP‐7. In vitro, TGF‐β1 treatment significantly increased fibronectin, type I collagen, α‐SMA and Snail expression, while reducing E‐cadherin expression in HPMCs (P < .001). PTD‐BMP‐7 treatment ameliorated TGF‐β1‐induced fibronectin, type I collagen, α‐SMA and Snail expression, and restored E‐cadherin expression in HPMCs (P < .001). In vivo, the expressions of EMT‐related molecules and the thickness of the sub‐mesothelial layer were significantly increased in the peritoneum of rats treated with PDF, and these changes were significantly abrogated by the intra‐peritoneal administration of PTD‐BMP‐7. PTD‐BMP‐7 treatment significantly inhibited the progression of established PD fibrosis. These findings suggest that PTD‐BMP‐7, as a prodrug of BMP‐7, can be an effective therapeutic agent for peritoneal fibrosis in PD patients.
Clinical practice guidelines for the treatment of extragenital endometriosis in Japan, 2018
Authors: Hirata Tetsuya , Koga Kaori , Kai Kentaro , Katabuchi Hidetaka , Kitade Mari , Kitawaki Jo , Kurihara Masatoshi , Takazawa Naoko , Tanaka Toshiaki , Taniguchi Fuminori , Nakajima Jun , Narahara Hisashi , Harada Tasuku , Horie Shigeo , Honda Ritsuo , Murono Koji , Yoshimura Kotaro , Osuga Yutaka
Published: October 2020

The aim of this publication is to disseminate the clinical practice guidelines for the treatment of intestinal, bladder/ureteral, thoracic and umbilical endometriosis, already published in Japanese, to non‐Japanese speakers. For developing the original Japanese guidelines, the clinical practice guideline committee was formed by the research team for extragenital endometriosis, which is part of the research program of intractable disease of the Japanese Ministry of Health, Labor and Welfare. The clinical practice guideline committee formulated eight clinical questions for the treatment of extragenital endometriosis, which were intestinal, bladder/ureteral, thoracic and umbilical endometriosis. The committee performed a systematic review of the literature to provide responses to clinical questions and developed clinical guidelines for extragenital endometriosis, according to the process proposed by the Medical Information Network Distribution Service. The recommendation level was determined using modified Delphi methods. The clinical practice guidelines were officially approved by the Japan Society of Obstetrics and Gynecology and the Japan Society of Endometriosis. This English version was translated from the Japanese version.
Efficacy of oral myofunctional therapy in middle‐aged to elderly patients with obstructive sleep apnoea treated with continuous positive airway pressure
Authors: Suzuki Mayumi , Okamoto Toshihiro , Akagi Yuichi , Matsui Kentaro , Sekiguchi Haruki , Satoya Natsumi , Inoue Yuji , Tatsuta Akihisa , Hagiwara Nobuhisa
Published: October 2020

Background

Oral myofunctional therapy (MFT) is an effective treatment for mild‐to‐moderate obstructive sleep apnoea (OSA) in middle‐aged patients. However, few reports have described its use in elderly patients with moderate and severe OSA. Moreover, no studies have examined the relationship between changes in tongue pressure with MFT and the severity of OSA.

Objective

We conducted an interventional study using MFT to evaluate the effect of MFT on middle‐to‐senior‐aged patients with moderate or severe OSA and compared changes in apnoea‐hypopnea index (AHI) and tongue pressure.

Methods

Thirty‐two OSA patients (≥45 years) treated with continuous positive airway pressure (CPAP) were included. MFT was performed in parallel with CPAP. Three days after CPAP discontinuation, polysomnographies were performed and tongue pressures were measured before and after MFT.

Results

Patients were 69.3 ± 1.5 years old. After 6 months of MFT, AHI decreased significantly from 34.7 to 29.0/h (P = .03), while tongue pressure significantly increased from 35.9 to 45.6 kPa (P < .01). Seven patients (22%), including 6 of the 12 patients with moderate OSA (50%), experienced successful CPAP discontinuation.

Conclusions

MFT can be a useful intervention even among middle‐aged to elderly patients with OSA. Increased tongue pressure may have contributed to the AHI improvement.

Clinical trials: Trial registration at www.umin.ac.jp UMIN000027547.
The effect of daily aerobic cycling exercise on sleep quality during inpatient cannabis withdrawal: A randomised controlled trial
Authors: McCartney Danielle , Isik Ashling D. , Rooney Kieron , Arnold Jonathon C. , Bartlett Delwyn J. , Murnion Bridin , Richards Elisha , Arkell Thomas R. , Lintzeris Nicholas , McGregor Iain S.
Published: October 2020

Sleep disturbance is a common symptom encountered by cannabis‐dependent individuals abstaining from cannabis use. In the present study, we investigated the effect of daily aerobic cycling exercise versus control stretching on sleep quality during inpatient cannabis withdrawal in treatment‐seeking dependent cannabis users. The protocol incorporated three consecutive phases: a 4‐Day (4‐Night) (at‐home) ‘Baseline’ phase, a 6‐Day (5‐Night) ‘Treatment’ phase (within a 7‐Day inpatient hospital stay) and a 3‐Day (4‐Night) (at‐home) ‘Post‐Treatment’ phase. Participants performed 35 min of monitored activity per day during the Treatment phase. The intervention group (n = 19) cycled at ~60% aerobic capacity (VO2max), while the control group (n = 12) performed a stretching routine. Objective sleep quality was measured nightly throughout the study using wrist actigraphy ratings of subjective sleep quality were also recorded during the Treatment phase. There were no group differences in sleep measures during the Baseline phase (all p > .05). Objective sleep onset latency increased from the Baseline to the Treatment phase in the control (stretching) group (p = .042). In contrast, the Cycling group exhibited improvements in sleep duration (p = .008) and sleep efficiency (p = .023) during the Treatment phase compared to the Baseline phase. Cycling also increased sleep duration (p = .005), decreased average wake bout (p = .040) and tended to increase sleep efficiency (p = .051) compared to stretching during the Treatment phase. Subjective sleep quality ratings did not differ between groups (p > .10). These preliminary findings suggest that moderate‐intensity aerobic exercise may attenuate the sleep disturbances associated with cannabis withdrawal.
What a veterinary graduate should know about basic and clinical pharmacology: A Delphi study to finalize day‐1 competencies
Authors: Werners Arno , Fajt Virginia
Published: October 2020

The recent changes in curricula in veterinary medicine have changed the delivery and focus on veterinary pharmacology and therapeutics, resulting in a perceived lack of knowledge of pharmacology and therapeutic decision making in recent graduates. To aid veterinary pharmacologists and clinicians teaching clinical pharmacology, core competencies were drafted by a working group. Following this process, a Delphi study was performed to come to a consensus on day‐1 competencies in veterinary pharmacology and therapeutics. The described competencies could be useful to a variety of stakeholders in veterinary pharmacology, including those teaching veterinary pharmacology worldwide. Secondly, they could form the basis of vertical alignment of the subject within schools and across the world, as well as serving to frame the integration of veterinary pharmacology and therapeutics into competency‐based veterinary education.
Do Politicians Ethnically Discriminate Against Hispanics? Evidence from a Field Experiment with State Legislative Offices
Authors: Landgrave Michelangelo
Published: October 2020

Legislatures are meant to represent the populace but are also racialized institutions capable of perpetuating structural disadvantages against vulnerable populations. It is necessary to periodically test if vulnerable populations are provided with equal access to legislative services. In this manuscript I test for potential ethnic discrimination against Hispanics in US state legislatures. A problem with prior studies is that Hispanicity signals both an ethnic outgroup and non‐citizen stat. I overcome this challenge by comparing migrant Hispanics with migrant whites. I find that Hispanics and whites receive similar constituency service, as measured by reply rate and reply content, but I find that legislators are less likely to acquire information about Hispanic constituents. I advance the existing Hispanic literature by providing a clean comparison between Hispanics and whites with similar nativity backgrounds. I advance the study of discrimination by showcasing best practices for future studies of discrimination.