bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping Patterns and Emotional Distress in Patients With Chronic Obstructive Lung Disease Who Are Undergoing Lung Transplant Evaluation
Authors: Soyseth Torunn S. , Dew Mary Amanda , Lund May Brit , Haugstad Gro Killi , Soyseth Vidar , Malt Ulrik Fredrik
Published: June 2020

Objectives:

Living with severe lung disease like chronic obstructive pulmonary disease (COPD) is a very stressful situation. The way patients cope may impact their symptoms of anxiety and depression and physical function as well. We studied how ways of coping are associated with levels of emotional distress and lung function in patients with COPD being evaluated for lung transplantation.

Methods:

Sixty-five (mean age 57 years, 46% females) patients completed the General Health Questionnaire-30 (GHQ-30) assessing emotional distress and the Ways of Coping Questionnaire. Measurements of lung function and 6-minute walk test were included.

Results:

Seventeen (26%) patients had elevated emotional distress. Logistic regression of chronic GHQ score with gender, age, body mass index, lung function, and coping scales as covariates showed that escape avoidance and self-controlling coping and forced vital lung capacity were significantly associated with high emotional distress. Odds ratio of emotional distress increased with 5.2 per tertile ( P = .011) in escape avoidance coping score. Moreover, we revealed that emotionally distressed patients cope with their current situation by refusing to believe the current situation and taking their distress out on other people.

Conclusion:

Among patients with COPD, a high level of emotional distress was uniquely associated with escape-avoidance coping and lung function. Future work should ascertain whether coping style predicts distress or whether distress increases the use of escape-avoidance coping. Nevertheless, our findings indicate that if either element is present, health care professionals should be attentive to the need for interventions to improve patients’ well-being.
Policewomen’s Perceptions of Gender Equity Policies and Initiatives in Australia
Authors: Newton Kathy , Huppatz Kate
Published: June 2020

This paper explores policewomen’s perceptions of Equal Employment Opportunity (EEO) initiatives including breastfeeding rooms, part-time and flexible work arrangements, and gender quotas. Drawing on interviews with 18 Australian policewomen, our analysis reveals that while policewomen recognize that good initiatives and policies exist, when workers attempt to access them, they are often met with resistance and resentment. Policewomen express concerns about quotas, fearing that they might translate to a loss of respect and credibility for women workers. Our research aims to create a more nuanced understanding of how EEO policies are practiced within policing and considers possibilities for future policies.
Design of winding pattern of filament-wound composite pressure vessel with unequal openings based on non-geodesics
Authors: Guo Kaite , Wen Lihua , Xiao Jinyou , Lei Ming , Wang Shiyu , Zhang Chengshuang , Hou Xiao
Published: June 2020

In this article, we proposed a new approach to design the winding patterns of filament-wound composite pressure vessel with unequal polar openings with non-geodesics. To ensure the continuity of winding angles between trajectories along the cylinder and the dome, the non-geodesics for cylindrical part were used. The developed winding patterns of the vessels were simulated using the MATLAB software to verify the feasibility of the acquired trajectories. To demonstrate the performance in designing the winding path for big polar ratios, we analyzed vessels with polar pole ratios of 1:2–1:4, respectively. The developed winding patterns have successfully achieved uniform fiber distributions along the mandrel without severe overlap, except for the polar pole regions. To avoid the severe overlap between filament bands, we further studied the relationship among the winding pattern, bandwidth, and the number of tangent points, and derived a suitable bandwidth based on the winding pattern. These simulated results proved the effectiveness of the developed method in design of winding pattern with unequal polar openings.
Induced Second Trimester Abortion and Associated Factors at Debre Markos Referral Hospital: Cross-Sectional Study
Authors: Tesfaye Bekele , Tewabe Mesenbet , Ferede Aster , Dawson Angela
Published: June 2020

Background:

Although most induced abortions in Ethiopia are performed in the first trimester, many women will still require second trimester abortions. While access to abortion in Ethiopia is limited, few data are being available concerning the demand for and associated outcomes of second trimester abortions. This knowledge is important for planning the health service response to abortion.

Objective:

The main objective of this study was to determine the proportion and associated factors of second trimester abortion among women presenting for abortion care services at Debre Markos Referral Hospital, Debre Markos, Northwest Ethiopia.

Methods:

An institution-based cross-sectional study was conducted at Debre Markos Referral Hospital on a sample of 262 calculated using the single population proportion formula. Women who sought abortion services were interviewed consecutively from 12 February 2017 to 14 March 2017. Data were collected in a face-to-face exit interview and document review and analyzed using SPSS version 24.0 software. Bivariate and multivariable analyses were undertaken to identify factors.

Result:

Of the women who presented for abortion care services in Debre Markos Referral Hospital, 73 (29.6%) had induced second trimester abortion. Unmarried women (adjusted odds ratio = 4.93, 95% confidence interval = 1.41–17.16) and women employed at private business (adjusted odds ratio = 6.17, 95% confidence interval = 1.16–32.76) were associated with induced second trimester abortion.

Conclusion:

This study revealed that almost one-third of women who presented for abortion care services at Debre Markos Referral Hospital had induced second trimester abortions. Raising awareness of the health consequence of second trimester abortion at community levels and counseling to avoid further occurrences are helpful to minimize the problem. Furthermore, early management of induced second trimester abortion is very crucial to prevent further complications.
‘It was like an animal in pain’: Institutional thoughtlessness and experiences of bereavement in prison
Authors: Wilson Marion , Johnston Helen , Walker Liz
Published: June 2020

Using the concept of institutional thoughtlessness, this article examines a range of issues embedded within daily prison life which have a detrimental effect upon the lives of those bereaved during a prison sentence. Drawing on in-depth qualitative research undertaken with bereaved prisoners, staff members and volunteers at a male prison in the North of England, the article explores how individual and institutional goals compete, compounding bereavement experiences and the management of grief. Findings demonstrate the tension between the policies and protocols prisons are tasked to follow, and unintended consequences for the individually bereaved. This article illuminates the need for far greater understanding of bereavement in the prison population and explores how a universal life experience can be particularly debilitating within the prison setting with the potential to exacerbate what is often cumulative loss among prisoners.
Differential Chloride Secretory Capacity in Transepithelial Ion Transport Properties in Chronic Rhinosinusitis
Authors: McCormick Justin , Hoffman Kyle , Thompson Harrison , Skinner Daniel , Zhang Shaoyan , Grayson Jessica , Illek Beate , Cho Do-Yeon , Woodworth Bradford A.
Published: June 2020

Background

Epithelial ion transport regulates hydration of airway mucosal surfaces, and thus promotes effective mucociliary clearance (MCC). Decreased transepithelial Cl− transport may contribute to epithelial dysfunction by abrogating MCC and increasing mucus viscosity in chronic rhinosinusitis (CRS). The objective of the current study is to evaluate Cl− channel transport properties from cultures of human sinonasal epithelia.

Methods

Human sinonasal epithelia (HSNE) from patients undergoing sinus surgery were cultured at an air-liquid interface to confluence and full differentiation. The epithelial monolayers were mounted in Ussing Chambers to investigate pharmacological manipulation of ion transport. Epithelial Na+ channel (via Amiloride), CFTR (via forskolin), and Ca2+-activated Cl− channel (CaCC, via UTP) transport were investigated among three different patient groups: Control, CRS and CRS with polyposis. CFTR mRNA levels were evaluated with quantitative RT-PCR.

Results

HSNE cultures from 18 patients (Control = 9, CRS = 6, CRS with polyposis = 3) were evaluated in 142 experiments. Summary data from the 18 patients demonstrated that stimulated CFTR-mediated anion transport (Δ ISC) was significantly lower with CRS (7.58+/−2.24 µA/cm2) compared to control (25.86+/−3.44 µA/cm2) and CRS with polyposis (20.16+/−4.0 µA/cm2) (p = 0.004). No statistically significant difference was found for CaCC anion transport between groups (p = 0.39). Significantly decreased mRNA (relative expression) was noted in CRS cultures (CRS = 40.83+/−1.76 vs. control = 116.2+/−24.27, p = 0.03).

Conclusions

A substantial decrease in the Cl− secretory capacity of HSNE monolayers was demonstrated in CRS subjects. Data suggest that CFTR may contribute more to abnormal ion transport in CRS than CaCC.
Implicating androgen excess in propagating metabolic disease in polycystic ovary syndrome
Authors: Kempegowda Punith , Melson Eka , Manolopoulos Konstantinos N. , Arlt Wiebke , O’Reilly Michael W.
Published: June 2020

Polycystic ovary syndrome (PCOS) has been traditionally perceived as a reproductive disorder due to its most common presentation with menstrual dysfunction and infertility. However, it is now clear that women with PCOS are at increased risk of metabolic dysfunction, from impaired glucose tolerance and type 2 diabetes mellitus to nonalcoholic fatty liver disease and cardiovascular disease. PCOS is characterised by androgen excess, with cross-sectional data showing that hyperandrogenism is directly complicit in the development of metabolic complications. Recent studies have also shown that C11-oxy C19 androgens are emerging to be clinically and biochemically significant in PCOS, thus emphasising the importance of understanding the impact of both classic and C11-oxy C19 androgens on women’s health. Here we discuss androgen metabolism in the context of PCOS, and dissect the role played by androgens in the development of metabolic disease through their effects on metabolic target tissues in women.
Endoscopic ultrasound‐based multimodal evaluation of the pancreas in patients with suspected early chronic pancreatitis
Authors: Domínguez‐Muñoz J Enrique , Lariño‐Noia Jose , Alvarez‐Castro Ana , Nieto Laura , Lojo Santiago , Leal Saul , de la Iglesia‐Garcia Daniel , Iglesias‐Garcia Julio
Published: June 2020

Background

Diagnosis of early chronic pancreatitis is a clinical challenge and hindered by the lack of a gold standard. Endoscopic ultrasound (EUS) and the endoscopic pancreatic function test (ePFT) are the most sensitive morphological and functional methods in this setting. EUS‐elastography allows for the quantification (strain ratio) of pancreatic fibrosis, and the dynamic evaluation of the main pancreatic duct compliance provides additional information. We developed a multimodal EUS‐based approach for the evaluation of the pancreas by integrating these four methods in a single procedure.

Objective

We aim to describe morphological and functional pancreatic abnormalities in patients with clinical suspicion of chronic pancreatitis and inconclusive EUS findings by using the multimodal EUS‐based approach.

Methods

This was a prospective, cross‐sectional, observational study of patients with clinically suspected chronic pancreatitis and indeterminate EUS criteria of the disease. EUS criteria of chronic pancreatitis, quantitative pancreatic elastography, ePFT and compliance of the main pancreatic duct were evaluated in a single procedure.

Results

In total, 53 patients with 3–4 EUS criteria of chronic pancreatitis were included (mean age 39.7 years, 29 male). Strain ratio was abnormally high in all patients. Peak bicarbonate concentration was decreased in 43 patients (81.1%) and the main pancreatic duct compliance was reduced in 41 patients (77.3%). Some 34 patients (64.1%) had abnormal results at EUS, elastography, ePFT and compliance of the main pancreatic duct.

Conclusions

A multimodal EUS‐based test for the morphological and functional evaluation of the pancreas is presented, which allows detecting mild pancreatic abnormalities in patients with suspected early chronic pancreatitis. The presence of abnormal morphological and functional evaluation of the pancreas could support the clinical suspicion of early chronic pancreatitis in the appropriate clinical setting.
Predicting Clinical Outcome in Expanded Criteria Donor Kidney Transplantation: A Retrospective Cohort Study
Authors: Saha-Chaudhuri Paramita , Rabin Carly , Tchervenkov Jean , Baran Dana , Morein Justin , Sapir-Pichhadze Ruth
Published: June 2020

Background:

The gaps in organ supply and demand necessitate the use of expanded criteria donor (ECD) kidneys.

Objective:

To identify which pre-transplant and post-transplant predictors are most informative regarding short- and long-term ECD transplant outcomes.

Design:

Retrospective cohort study.

Setting:

Single center, Quebec, Canada.

Patients:

The patients were 163 consecutive first-time ECD kidney only transplant recipients who underwent transplantation at McGill University Health Centre (MUHC) between January 1, 2008 and December 31, 2014 and had frozen section wedge procurement biopsies.

Measurements:

Short-term graft outcomes, including delayed graft function and 1-year estimated glomerular filtration rate (eGFR), as well as long-term outcomes including all-cause graft loss (defined as return to dialysis, retransplantation, and death with function).

Methods:

Pre-transplant donor, recipient, and transplant characteristics were assessed as predictors of transplant outcomes. The added value of post-transplant predictors, including longitudinal eGFR, was also assessed using time-varying Cox proportional hazards models.

Results:

In univariate analyses, among the pre-transplant donor characteristics, histopathologic variables did not show evidence of association with delayed graft function, 1-year post-transplant eGFR or all cause graft loss. Recipient age was associated with all-cause graft loss (hazard ratio: 1.038 [95% confidence interval: 1.002-1.075] and the model produced only modest discrimination (C-index: 0.590; standard error [SE]: 0.045). Inclusion of time-dependent post-transplant eGFR improved the model’s prediction accuracy (C-index: 0.711; SE = 0.047). Pre-transplant ECD characteristics were not associated with long-term survival, whereas post-transplant characteristics allowed better model discrimination.

Limitations:

Single-center study, small sample size, and potential incomplete capture of all covariate data.

Conclusions:

Incorporation of dynamic prediction models into electronic health records may enable timely mitigation of ECD graft failure risk and/or facilitate planning for renal replacement therapies. Histopathologic findings on preimplantation biopsies have a limited role in predicting long-term ECD outcomes.

Trial registration:

Not applicable.
Misinformation on Instagram: The Impact of Trusted Endorsements on Message Credibility
Authors: Mena Paul , Barbe Danielle , Chan-Olmsted Sylvia
Published: June 2020

This research explores how social validation, measured through trusted endorsements and bandwagon heuristics, influence the credibility of misinformation on Instagram. Using experimental design, this study found that trusted endorsements (i.e., the liking of content by a trustworthy or reputable source) significantly impacted the credibility of misleading content on Instagram. Perceived message credibility was greater when a fabricated post was endorsed by a trustworthy personality. Findings provide insights into how message credibility is evaluated on a social media platform like Instagram in the context of misinformation.
Differences in Affective Dynamics Among Eating-Disorder Diagnostic Groups
Authors: Williams-Kerver Gail A. , Wonderlich Stephen A. , Crosby Ross D. , Cao Li , Smith Kathryn E. , Engel Scott G. , Crow Scott J. , Peterson Carol B. , Mitchell James E. , Le Grange Daniel
Published: June 2020

Emotion-regulation theories suggest that affect intensity is crucial in the development and maintenance of eating disorders. However, other aspects of emotional experience, such as lability, differentiation, and inertia, are not as well understood. This study is the first to use ecological momentary assessment (EMA) to examine differences in several daily negative affect (NA) indicators among adults diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED). We used EMA data from three large studies to run a series of linear mixed models; the results showed that participants in the AN and BN groups experienced significantly greater NA intensity and better emotion differentiation than participants in the BED group. Alternatively, the BN group demonstrated significantly greater NA lability than the AN group and greater NA inertia than the BED group. These results suggest that several daily affective experiences differ among eating-disorder diagnostic groups and have implications toward distinct conceptualizations and treatments.
Comparison of different carotid stent designs in endovascular therapy of severe carotid artery stenosis
Authors: Gruber Philipp , Berberat Jatta , Kahles Timo , Anon Javier , Diepers Michael , Nedeltchev Krassen , Remonda Luca
Published: June 2020

Background:

One of the major periprocedural risks of carotid artery stenting is embolism caused either by plaque debris or by local thrombus forming. Double-layer micromesh stent design has shown to lower the chance of debris embolism but might have a slightly higher risk of local thrombus forming. Thus, we compared two different stent designs regarding safety and outcome profile in elective patients with high-grade carotid artery stenosis using a self-expanding, double-layer micromesh carotid stent system (DLCS) or a self-expanding hybrid carotid stent system (HCS).

Methods:

A single-center, open-label, retrospective cohort study of 67 consecutive, elective patients with high-grade symptomatic and asymptomatic carotid stenosis was executed at a comprehensive stroke center. Outcome measures were reocclusion rate, periprocedural symptomatic ischemic events, as well as other periprocedural complications, and recurrent stroke and mortality at 30 days’ follow-up.

Results:

Thirty-two patients (24% women, median age 75 years (interquartile range (IQR) 71–80) were treated with DLCS, and 35 patients (29% women, median age 71 years (IQR 63–76) years) with HCS. In both groups, pretreatment carotid stenosis degree was similar (median NASCET of 80%). Successful deployment was achieved in all cases without technical failure, and both groups did not differ in reocclusion rates, recurrent stroke, and mortality within 30 days.

Conclusions:

DCLS and HCS revealed to have similar safety and outcome profile in elective patients with high-grade symptomatic as well as asymptomatic carotid artery stenosis.
COPD and acute myocardial infarction
Authors: Goedemans Laurien , Bax Jeroen J. , Delgado Victoria
Published: June 2020

COPD is strongly associated with cardiovascular disease, in particular acute myocardial infarction (AMI). Besides shared risk factors, COPD-related factors, such as systemic inflammation and hypoxia, underlie the pathophysiological interaction between COPD and AMI. The prevalence of COPD amongst AMI populations ranges from 7% to 30%, which is possibly even an underestimation due to underdiagnoses of COPD in general. Following the acute event, patients with COPD have an increased risk of mortality, heart failure and arrhythmias during follow-up. Adequate risk stratification can be performed using various imaging techniques, evaluating cardiac size and function after AMI. Conventional imaging techniques such as echocardiography and cardiac magnetic resonance imaging have already indicated impaired cardiac function in patients with COPD without known cardiovascular disease. Advanced imaging techniques such as speckle-tracking echocardiography and T1 mapping could provide more insight into cardiac structure and function after AMI and have proven to be of prognostic value. Future research is required to better understand the impact of AMI on patients with COPD in order to provide effective secondary prevention. The present article summarises the current knowledge on the pathophysiologic factors involved in the interaction between COPD and AMI, the prevalence and outcomes of AMI in patients with COPD and the role of imaging in the acute phase and risk stratification after AMI in patients with COPD.
Intra-specific comparison of mitochondrial genomes reveals host gene fragment exchange via intron mobility in Tremella fuciformis
Authors: Deng Youjin , Zhang Xunxiao , Xie Baogui , Lin Longji , Hsiang Tom , Lin Xiangzhi , Lin Yiying , Zhang Xingtan , Ma Yanhong , Miao Wenjing , Ming Ray
Published: June 2020

Background

Mitochondrial genomic sequences are known to be variable. Comparative analyses of mitochondrial genomes can reveal the nature and extent of their variation.

Results

Draft mitochondrial genomes of 16 Tremella fuciformisisolates (TF01-TF16) were assembled from Illumina and PacBio sequencing data. Mitochondrial DNA contigs were extracted and assembled into complete circular molecules, ranging from 35,104 bp to 49,044 bp in size. All mtDNAs contained the same set of 41 conserved genes with identical gene order. Comparative analyses revealed that introns and intergenic regions were variable, whereas genic regions (including coding sequences, tRNA, and rRNA genes) were conserved. Among 24 introns detected, 11 were in protein-coding genes, 3 in tRNA genes, and the other 10 in rRNA genes. In addition, two mobile fragments were found in intergenic regions. Interestingly, six introns containing N-terminal duplication of the host genes were found in five conserved protein-coding gene sequences. Comparison of genes with and without these introns gave rise to the following proposed model: gene fragment exchange with other species can occur via gain or loss of introns with N-terminal duplication of the host genes.

Conclusions

Our findings suggest a novel mechanism of fungal mitochondrial gene evolution: partial foreign gene replacement though intron mobility.
‘Very brief advice’ (VBA) on smoking in family practice: a qualitative evaluation of the tobacco user’s perspective
Authors: Papadakis Sophia , Anastasaki Marilena , Papadakaki Maria , Antonopoulou Μaria , Chliveros Constantine , Daskalaki Chrissi , Varthalis Dionisis , Triantafyllou Sofia , Vasilaki Irene , McEwen Andy , Lionis Christos
Published: June 2020

Background

Very Brief Advice on smoking (VBA) is an evidence-based intervention designed to increase quit attempts among patients who smoke. VBA has been widely disseminated in general practice settings in the United Kingdom, however its transferability to Southern European settings is not well established. This study sought to document the perspectives of Greek general practice patients in terms of the acceptability and satisfaction with receiving VBA from their general practitioner (GP) and its influence on patients’ motivation to make a quit attempt. We also examine patient identified barriers and facilitators to acting on VBA.

Methods

Semi-structured interviews were conducted with 50 patients who reported current tobacco use recruited from five general practices in Crete, Greece. All patients received VBA from their GP and interviews were conducted immediately after the GP appointment. Thematic analysis was used to analyze data.

Results

The majority of patients were satisfied with the VBA intervention. Approximately one quarter of patients reported they were motivated to make an attempt to quit smoking after receiving VBA from their GP. Patients identified a clear preference for VBA to be delivered in a supportive manner, which communicated genuine concern versus fear-based approaches. Patients with an existing smoking-related illness were more likely to report plans to act on their GP’s VBA. Patients not ready to quit smoking indicated they would be likely to seek the support of their GP for future quit attempts as a result of VBA. Many patients reported low self-efficacy with quitting and apprehension about available quit smoking supports.

Conclusions

VBA was positively received by the majority of smokers interviewed. Participating patients confirmed the motivational role of advice when delivered in a supportive and caring manner. Personal health status, beliefs about quit smoking supports, and low self-efficacy appear to influence patient’s motivation to make an aided quit attempt.
Understanding determinants of patients’ decisions to attend their family physician and to take antibiotics for upper respiratory tract infections: a qualitative descriptive study
Authors: Mortazhejri Sameh , Patey Andrea M. , Stacey Dawn , Bhatia R. Sacha , Abdulla Alykhan , Grimshaw Jeremy M.
Published: June 2020

Background

Although antibiotics have little or no benefit for most upper respiratory tract infections (URTIs), they continue to be prescribed frequently in primary care. Physicians perceive that patients’ expectations influence their antibiotic prescribing practice; however, not all patients seek antibiotic treatment despite having similar symptoms. In this study, we explored patients’ views about URTIs, and the ways patients manage them (including attendance in primary care and taking antibiotics).

Methods

Using a qualitative descriptive design, adult English-speaking individuals at a Canadian health center were recruited through convenient sampling. The participants were interviewed using semi-structured interview guide based on the Common Sense-Self-Regulation Model (CS-SRM). The interviews were transcribed verbatim and coded according to CS-SRM dimensions (illness representations, coping strategies). Sampling continued until thematic saturation was achieved. Thematic analysis related to the dimensions of CS-SRM was applied.

Results

Generally, participants had accurate perception about the symptoms of URTIs, as well as how to prevent and manage them. However, some participants revealed misconceptions about the causes of URTIs. Almost all participants mentioned that they only visited their doctor if their symptoms got progressively worse and they could no longer self-manage the symptoms. When visiting a doctor, most participants reported that they did not seek antibiotics. They expected to receive an examination and an explanation for their symptoms.

Conclusion

Our participants reported good understanding regarding the likely lack of benefit from antibiotics for URTIs. Developing interventions that specifically help patients discuss their concerns with their physicians, instead of providing more education to public may help in reducing the use of unnecessary antibiotics.
Exogenous intoxication by non-prescribed use of vitamin D, a case report
Authors: de Paula Ana Laura Teodoro , Gonzaga Wemerson Philipe Ferreira , Oliveira Lucas Martins , Feibelmann Taciana Carla Maia , Markus Juliana
Published: June 2020

Background

This case report, unlike the current literature related to vitamin D intoxication, aims to highlight the risk of self-medication, and how publicity boosts the acquisition of vitamins for different purposes, increasing consumption with no professional indication or supervision. This practice can pose a serious health risk to the population.

Case presentation

Our patient, a brazilian retired 64-year-old female, presented to the emergency service with post-prandial food vomiting of undigested content and stabbing abdominal pain with worsening during palpation. Concomitantly, onset of sporadic frontal headache, fatigue, hyporexia, weight loss of 18 kg in the same period, severe pruritus, musculoskeletal pain in the limbs and nocturia. The physical examination showed hypertension (160/80 mmHg) and itchy macules in the lower limb. Initially, the main diagnostic hypotheses were multiple myeloma, hyperparathyroidism and pancreatitis secondary to hypercalcemia, osteolytic neoplasms and other neoplasms that present with hypercalcemia. However, blood count, parathyroid hormone, chest X-ray, immunoglobulins, myelogram and bone marrow biopsy were not compatible with these diagnoses. Meanwhile, 25 OH vitamin D dosage and diluted vitamin D test confirmed the diagnosis of hypervitaminosis D. Hypercalcemic crisis was managed with vigorous hydration (50 ml/kg in 2 h), furosemide, bisphosphonates and blood pressure control with amlodipine and atenolol. Subsequently, the patient was discharged from the outpatient clinic with complete remission of symptoms, weight gain, serum calcium values of 10.76 mg/dL and ionizable calcium values of 6.52 mg/dL.

Conclusion

Our report summarizes the possible consequences of using a vitamin compound without supervision of a competent professional, as these substances are mistakenly considered non-toxic. To add, little information is available about the supplements’ metabolism and their biological effects. Therefore, It is difficult to diagnose intoxication. This case report shows that even the self-administration of a product designed to bring health benefits can become a risky behavior. These vitamin and mineral supplements are supposed to bring patient empowerment and reduce government spending in health-care, but indeed represent a significant public health concern due to possible overdose and drug interactions.
Vogt–Koyanagi–Harada disease-like uveitis following nivolumab administration treated with steroid pulse therapy: a case report
Authors: Kikuchi Ryo , Kawagoe Tatsukata , Hotta Kazuki
Published: June 2020

Background

Immune checkpoint inhibitors can cause various adverse effects. Recently it has been shown that Vogt–Koyanagi–Harada (VKH) disease-like uveitis can occur in patients treated with nivolumab.

Case presentation

A 69-year-old man developed bilateral panuveitis after nivolumab treatment for recurrent hypopharyngeal cancer. Slit lamp examination revealed bilateral granulomatous keratic precipitates, anterior chamber cells and partial synechiae. Fundus examination revealed bilateral optic disc edema and diffuse serous retinal detachment. His human leukocyte antigen (HLA) typing showed HLA-DRB1*04:05 allele. A lumbar puncture did not demonstrate pleocytosis. Bilateral sub-tenon injections of triamcinolone acetonide were initiated. As his panuveitis did not regress completely, steroid pulse therapy was administered. That therapy led to the resolution of his serous retinal detachment and to rapid improvement in his vision. Following this, we treated him with 50 mg/day of prednisolone for 1 week and then reduced it by 5 mg every week. No bilateral uveitis relapse had occurred by his 3-month follow-up; however, he subsequently died because of his cancer.

Conclusion

To our knowledge, this is the first report of a patient with NVKH who underwent a lumbar puncture. Unlike VKH, our case did not show meningismus or pleocytosis. NVKH may, therefore, have a different etiology from VKH.

In cases of NVKH with posterior uveitis, steroid pulse therapy may be considered as a treatment option, as it is in VKH.
Brief evidence-based interventions for universal child health services: a restricted evidence assessment of the literature
Authors: Newham James J. , McLean Karen , Ginja Samuel , Hurt Lisa , Molloy Carly , Lingam Raghu , Goldfeld Sharon
Published: June 2020

Background

Universal child health services (UCHS) provide an important pragmatic platform for the delivery of universal and targeted interventions to support families and optimize child health outcomes. We aimed to identify brief, evidence-based interventions for common health and developmental problems that could be potentially implemented in UCHS.

Methods

A restricted evidence assessment (REA) of electronic databases and grey literature was undertaken covering January 2006 to August 2019. Studies were eligible if (i) outcomes related to one or more of four areas: child social and emotional wellbeing (SEWB), infant sleep, home learning environment or parent mental health, (ii) a comparison group was used, (iii) universal or targeted intervention were delivered in non-tertiary settings, (iv) interventions did not last more than 4 sessions, and (v) children were aged between 2 weeks postpartum and 5 years at baseline.

Results

Seventeen studies met the eligibility criteria. Of these, three interventions could possibly be implemented at scale within UCHS platforms: (1) a universal child behavioural intervention which did not affect its primary outcome of infant sleep but improved parental mental health, (2) a universal screening programme which improved maternal mental health, and (3) a targeted child behavioural intervention which improved parent-reported infant sleep problems and parental mental health. Key lessons learnt include: (1) Interventions should impart the maximal amount of information within an initial session with future sessions reinforcing key messages, (2) Interventions should see the family as a holistic unit by considering the needs of parents with an emphasis on identification, triage and referral, and (3) Brief interventions may be more acceptable for stigmatized topics, but still entail considerable barriers that deter the most vulnerable.

Conclusions

Delivery and evaluation of brief evidence-based interventions from a UCHS could lead to improved maternal and child health outcomes through a more responsive and equitable service. We recommend three interventions that meet our criteria of “best bet” interventions.
Feasibility and acceptability of using medical and nursing students to provide Implanon NXT at the community level in Kinshasa, Democratic Republic of Congo
Authors: Hernandez Julie H. , Akilimali Pierre , Glover Annie , Bertrand Jane T.
Published: June 2020

Background

The use of implants has steadily increased in Kinshasa since 2013 but clinic-based access to this family planning method is limited due to distance and costs barriers. The objective of this study was to examine the feasibility and acceptability of providing Implanon NXT at the community level using medical and nursing students (M/N) as distributors, as part of a strategy to improve contraceptive uptake in the Democratic Republic of Congo.

Methods

A cohort of 531 women who chose to receive Implanon NXT from a M/N student during community-based campaign days participated in three rounds of a quantitative survey administered at the time of insertion of the method, and at 6 and 12 months later. We conducted descriptive analysis to assess the feasibility and acceptability of providing the method through M/N students in terms of method choice, user profiles, contraceptive history, experience with insertion and side effects, continuation / discontinuation of the method, and overall satisfaction with FP services as well as students’ preparedness and capacity to safely offer the method, and their satisfaction with the experience..

Results

The study demonstrated the feasibility of training students for community-based provision of Implanon NXT and 95% of them were satisfied with their experience. Acceptability of both the method and the service delivery strategy was high among participants, including among young and first-time contraceptive users. Out of the 441 women with a known outcome at 12 months, 92% still had Implanon NXT inserted, despite some of them reporting experiencing side effects. The vast majority (79%) would “strongly recommend” obtaining NXT from a M/N student if a friend wanted to avoid pregnancies.

Conclusions

The provision of Implanon NXT at the community-level is a promising solution to address some of the barriers to accessing this method for women living in Kinshasa. However, strengthening pre-insertion counseling, particularly on expected side-effects and the possibility of early removal, is necessary to increase informed choice for the women and potentially limit method discontinuation.
Use of the KT-MCC strategy to improve the quality of decision making for multidisciplinary cancer conferences: a pilot study
Authors: Fahim Christine , McConnell Meghan M. , Wright Frances C. , Sonnadara Ranil R. , Simunovic Marko
Published: June 2020

Background

Multidisciplinary Cancer Conferences (MCCs) are increasingly used to guide treatment decisions for patients with cancer, though numerous barriers to optimal MCC decision-making quality have been identified. We aimed to improve the quality of MCC decision making through the use of an implementation bundle titled the KT-MCC Strategy. The Strategy included use of discussion tools (standard case intake tool and a synoptic discussion tool), workshops, MCC team and chair training, and audit and feedback. Implementation strategies were selected using a theoretically-rooted and integrated KT approach, meaning members of the target population (MCC participants) assisted with the design and implementation of the intervention and strategies. We evaluated implementation quality of the KT-MCC Strategy and initial signals of impact on decision making quality.

Methods

This was a before-and-after study design among 4 MCC teams. Baseline data (before-phase) were collected for a period of 2 months to assess the quality of MCC decision making. Study teams selected the intervention strategies they wished to engage with. Post-intervention data (after-phase) were collected for 4 months. Implementation quality outcomes included reach, adherence/fidelity and adaptation. We also evaluated feasibility of data management. Decision making quality was evaluated on a per-case and per-round level using the MTB-MODe and MDT-OARS tools, respectively.

Results

There were a total of 149 cases and 23 MCCs observed in the before phase and 260 cases and 35 MCCs observed in the after phase. Teams implemented 3/5 strategies; adherence to selected strategies varied by MCC team. The per-round quality of MCCs improved by 11% (41.0 to 47.3,p = < 0.0001). The quality of per-case decision-making did not improve significantly (32.3 to 32.6,p = 0.781).

Conclusion

While per round MCC decision making quality improved significantly, per-case decision-making quality did not. We posit that the limited improvements on decision making quality may be attributed to implementation quality gaps, including a lack of uptake of and adherence to theoretically-identified implementation strategies. Our findings highlight the importance of evaluating implementation quality and processes, iterative testing, and engagement of key gatekeepers in the implementation process.
Cost-effectiveness analysis of atezolizumab in advanced triple-negative breast cancer
Authors: Phua Lee Cheng , Lee Soo Chin , Ng Kwong , Abdul Aziz Mohamed Ismail
Published: June 2020

Background

The IMpassion130 trial demonstrated that adding atezolizumab to nanoparticle albumin-bound (nab)-paclitaxel improved the survival of patients with untreated, advanced, programmed death ligand 1 (PDL1)-positive triple-negative breast cancer (TNBC). In view of the high cost of immunotherapy, it is important to examine its value with respect to both benefits and costs. In this study, the cost-effectiveness of atezolizumab/nab-paclitaxel combination therapy relative to nab-paclitaxel monotherapy was evaluated for the first-line treatment of advanced, PDL1-positive TNBC, from a healthcare system perspective.

Methods

A three-state partitioned-survival model was developed to compare the clinical and economic outcomes of treatment with atezolizumab/nab-paclitaxel combination therapy with nab-paclitaxel monotherapy in patients with advanced TNBC. Clinical data were obtained from the IMpassion130 trial and extrapolated to 5 years. Health state utilities were retrieved from the literature, while direct costs (in Singapore dollars, S$) were sourced from public healthcare institutions in Singapore. The primary outcomes of the model were life years (LYs), quality-adjusted LYs (QALYs), costs and incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses and scenario analyses were conducted to explore the impact of specific assumptions and uncertainties.

Results

Adding atezolizumab to nab-paclitaxel resulted in an additional 0.361 QALYs (0.636 LYs) at an ICER of S$324,550 per QALY gained. The ICER remained high at S$67,092 per QALY even when atezolizumab was priced zero. One-way sensitivity analysis showed that the ICER was most sensitive to variations in the cost of atezolizumab and the time horizon. Scenario analyses confirmed that the ICERs remained high even under extremely favourable assumptions.

Conclusions

Given the exceedingly high ICER, adding atezolizumab to nab-paclitaxel was unlikely to represent good value for money for the treatment of advanced PDL1-positive TNBC. Our findings will be useful in informing funding policy decisions alongside other considerations such as comparative effectiveness, unmet need and budget impact.
Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: an overview of systematic reviews
Authors: Trentino Kevin M. , Farmer Shannon L. , Leahy Michael F. , Sanfilippo Frank M. , Isbister James P. , Mayberry Rhonda , Hofmann Axel , Shander Aryeh , French Craig , Murray Kevin
Published: June 2020

Background

There are no overviews of systematic reviews investigating haemoglobin thresholds for transfusion. This is important as the literature on transfusion thresholds has grown considerably in recent years. Our aim was to synthesise evidence from systematic reviews and meta-analyses of the effects of restrictive and liberal transfusion strategies on mortality.

Methods

This was a systematic review of systematic reviews (overview). We searched MEDLINE, Embase, Web of Science Core Collection, PubMed, Google Scholar, and the Joanna Briggs Institute EBP Database, from 2008 to 2018. We included systematic reviews and meta-analyses of randomised controlled trials comparing mortality in patients assigned to red cell transfusion strategies based on haemoglobin thresholds. Two independent reviewers extracted data and assessed methodological quality. We assessed the methodological quality of included reviews using AMSTAR 2 and the quality of evidence pooled using an algorithm to assign GRADE levels.

Results

We included 19 systematic reviews reporting 33 meta-analyses of mortality outcomes from 53 unique randomised controlled trials. Of the 33 meta-analyses, one was graded as high quality, 15 were moderate, and 17 were low. Of the meta-analyses presenting high- to moderate-quality evidence, 12 (75.0%) reported no statistically significant difference in mortality between restrictive and liberal transfusion groups and four (25.0%) reported significantly lower mortality for patients assigned to a restrictive transfusion strategy. We found few systematic reviews addressed clinical differences between included studies: variation was observed in haemoglobin threshold concentrations, the absolute between group difference in haemoglobin threshold concentration, time to randomisation (resulting in transfusions administered prior to randomisation), and transfusion dosing regimens.

Conclusions

Meta-analyses graded as high to moderate quality indicate that in most patient populations no difference in mortality exists between patients assigned to a restrictive or liberal transfusion strategy.

Trial registration

PROSPERO CRD42019120503
Identification of long noncoding RNA RP11-89K21.1 and RP11-357H14.17 as prognostic signature of endometrial carcinoma via integrated bioinformatics analysis
Authors: Gao Lingling , Nie Xin , Zhang Wenchao , Gou Rui , Hu Yuexin , Qi Yue , Li Xiao , Liu Qing , Liu Juanjuan , Lin Bei
Published: June 2020

Background

Endometrial carcinoma (EC) is one of the most common malignant tumors in gynecology. The potential functions and mechanisms of long noncoding RNAs (lncRNAs) in the occurrence and progression of EC remains unclear. It’s meaningful to explore lncRNAs signature for providing prognostic value of EC.

Methods

The differentially expressed lncRNAs and their prognostic values in EC were investigated based on The Cancer Genome Atlas (TCGA) database; the transcriptional factors (TFs), the competing endogenous RNA (ceRNA) mechanism, functional regulatory network and immune infiltration of RP11-89K21.1 and RP11-357H14.17 were further explored by various bioinformatics tools and databases.

Results

We firstly identified high expression of RP11-89K21.1 and RP11-357H14.17 were closely associated with shorten overall survival (OS) and poor prognosis in patients with EC. We also elucidated the networks of transcription factor and co-expression genes associated with RP11-89K21.1 and RP11-357H14.17. Furthermore, the ceRNA network mechanism was successfully constructed through 2 lncRNAs (RP11-89K21.1 and RP11-357H14.17), 11 miRNAs and 183 mRNAs. Functional enrichment analysis revealed that the targeting genes of RP11-89K21.1 and RP11-357H14.17 were strongly associated with microRNAs in cancer, vessel development, growth regulation, growth factor and cell differentiation, and involved in pathways including pathways in cancer, microRNAs in cancer and apoptotic signaling pathway.

Conclusions

We demonstrated for the first time that RP11-89K21.1 and RP11-357H14.17 may play crucial roles in the occurrence, development and malignant biological behavior of EC, and can be regarded as potential prognostic biomarkers for EC.