bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapeutic Interventions for Adjustment Disorder: A Systematic Review
Authors: Constantin Dan , Dinu Eleonora A. , Rogozea Liliana , Burtea Victoria , Leasu Florin-Gabriel 
Published: June 2020

Background:
Adjustment disorder requires therapeutic intervention because of its complications, which include a significant risk of suicide, but evidence-based therapeutic guidelines are not available.

Areas of Uncertainty:
The main problem is related to answer to the following question: What is the optimal therapeutic approach to adjustment disorder? In this respect we review all randomized controlled trials that aimed to investigate therapeutic interventions for adjustment disorder in adult populations.

Data Sources:
Comprehensive search of the electronic database PubMed (January 1980–June 2019). The review included clinical trials that aimed to investigate a psychological or pharmacological treatment for adjustment disorder in adult population and reported outcome data for therapeutic interventions.

Results:
The search identified 23 studies that fulfilled the inclusion criteria for this review. Pharmacotherapy interventions were the focus of 11 studies that used various medications and dosages including viloxazine, lormetazepam, S-adenosylmethionine, pivagabine, trazodone, clorazepate, etifoxine, lorazepam, diazepam, afobazole, and plant extracts (Kava–kava, Euphytose, and Ginkgo biloba) on a total number of 1020 patients. Psychotherapy interventions were identified in 12 studies that used mirror therapy, short-term dynamic psychotherapy, yoga meditation, body-mind-spirit technique, mindfulness, bibliotherapy (self-help manual), humor training, and cognitive behavioral therapy.

Conclusions:
Psychotherapy seems indicated for mildly symptomatic adjustment disorder. Given the fact that adjustment disorder with severe symptoms is associated with a high risk of suicidal ideation and suicide attempts, clinicians must consider the potential benefit of using psychotropic agents such as benzodiazepines, antidepressants, or etifoxine.
Cost-effectiveness of Investment in End-of-Life Home Care to Enable Death in Community Settings
Authors: Isenberg Sarina R. , Tanuseputro Peter , Spruin Sarah , Seow Hsien , Goldman Russell , Thavorn Kednapa , Hsu Amy T. 
Published: June 2020

Background:
Many people with terminal illness prefer to die in home-like settings—including care homes, hospices, or palliative care units—rather than an acute care hospital. Home-based palliative care services can increase the likelihood of death in a community setting, but the provision of these services may increase costs relative to usual care.

Objective:
The aim of this study was to estimate the incremental cost per community death for persons enrolled in end-of-life home care in Ontario, Canada, who died between 2011 and 2015.

Methods:
Using a population-based cohort of 50,068 older adults, we determined the total cost of care in the last 90 days of life, as well as the incremental cost to achieve an additional community death for persons enrolled in end-of-life home care, in comparison with propensity score–matched individuals under usual care (ie, did not receive home care services in the last 90 days of life).

Results:
Recipients of end-of-life home care were nearly 3 times more likely to experience a community death than individuals not receiving home care services, and the incremental cost to achieve an additional community death through the provision of end-of-life home care was CAN$995 (95% confidence interval: −$547 to $2392).

Conclusion:
Results suggest that a modest investment in end-of-life home care has the potential to improve the dying experience of community-dwelling older adults by enabling fewer deaths in acute care hospitals.
Polyethylene Glycol Dosing for Constipation in Children Younger Than 24 Months
Authors: Rachel Helisa , Griffith Andrew F. , Teague Warwick J. , Hutson John M. , Gibb Susan , Goldfeld Sharon , Trajanovska Misel , King Sebastian K. 
Published: June 2020

ABSTRACTObjectives:Evaluate safety and effectiveness of Polyethylene glycol (PEG) for chronic constipation in children aged younger than 24 months. Identify the optimum dose of PEG to manage chronic constipation in children aged younger than 24 months.Methods:In this systematic review, Embase, Medline Ovid, Pubmed, and the Cochrane Library were searched between January 1, 2000 and February 1, 2019. Studies investigating functional constipation, in which patients younger than 24 months of age were treated with PEG, were considered as potentially eligible for review. Two authors screened the studies against inclusion/exclusion criteria. Study quality was assessed with the PEDro quality assessment, Cochrane risk of bias tool, and/or the Newcastle‐Ottawa Scale.Results:Five studies (2 randomized controlled trials, 3 retrospective chart reviews) satisfied selection criteria (n = 459). All studies employed different dosage categories: mean effective maintenance dose, mean initial dose, mean short‐term and long‐term dose, and mean daily dose. Dosage regimens were variable, with 0.45 to 1.1 g · kg−1 · day−1 for PEG3350 and 0.48 to 0.65 g · kg−1 · day−1 for PEG4000. Adverse effects were transient across all studies for all types of PEG; these included diarrhea and abdominal pain.Conclusions:This systematic review provided evidence for a lack of reported side effects from PEG for children aged younger than 24 months. Evidence to establish appropriate dosage regimens does not exist.An infographic accompanying this article can be found at http://links.lww.com/MPG/B839.
Protocol for Symptom Experience, Management, Outcomes, and Adherence in Women Receiving Breast Cancer Chemotherapy
Authors: Nugent Bethany D. , McCall Maura K. , Connolly Mary , Mazanec Susan R. , Sereika Susan M. , Bender Catherine M. , Rosenzweig Margaret Q. 
Published: June 2020

Background
The 5-year survival for Black women with breast cancer in the United States is lower than White women for stage-matched disease. Our past and ongoing work and that of others suggest that symptom incidence, cancer-related distress, and ineffective communication contribute to racial disparity in dose reduction and early therapy termination. Although race is perhaps the most studied social determinant of health, it is clear that race alone does not account for all disparities.

Objectives
The aim of the study was to present a study protocol of Black and White women prescribed breast cancer chemotherapy. The aims are to (1) examine and compare chemotherapy received/prescribed over time and in total; (2a) examine and compare symptom incidence, distress, and management and clinical encounter, including patient-centeredness of care and management experience over time and (2b) correlate symptom incidence, distress, and management experience to Aim 1; and (3) explore the effects of social determinants of health, including age, income, education, zip code, and lifetime stress exposure, on Aims 1, 2a, and 2b.

Methods
A longitudinal, repeated-measures (up to 18 time points), comparative, mixed-methods design is employed with 179 White and 179 Black women from 10 sites in Western Pennsylvania and Northeast Ohio over the course of chemotherapy and for 2 years following completion of therapy.

Results
The study began in January 2018, with estimated complete data collection by late 2023.

Discussion
This study is among the first to explore the mechanistic process for racial disparity in dosage and delay across the breast cancer chemotherapy course. It will be an important contribution to the explanatory model for breast cancer treatment disparity and may advance potential mitigation strategies for racial survival disparity.
Characterization of the Vaginal Microbiome in Women of Reproductive Age From 5 Regions in Brazil
Authors: Marconi Camila , El-Zein Mariam , Ravel Jacques , Ma Bing , Lima Moises D. , Carvalho Newton Sergio , Alves Rosane R F. , Parada Cristina M G L. , Leite Sandra H M. , Giraldo Paulo C. , Gonçalves Ana K. , Franco Eduardo L. , Silva Marcia G. 
Published: June 2020

Background
Composition of the vaginal microbiome is strongly related to a woman's reproductive health and risk of sexually transmitted infections. Ethnoracial, behavioral, and environmental factors can influence microbiome. The Brazilian population is unique in terms of miscegenation of ethnic groups and behavioral characteristics across different regions. We aimed to characterize the vaginal microbiome of women from 5 geographical regions of Brazil.

Methods
We sequenced V3–V4 regions of 16S rRNA gene in vaginal samples of 609 reproductive-aged women. We performed logistic regression analyses to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between sociodemographic and behavioral factors with Lactobacillus-depleted microbiome (community state type [CST] IV).

Results
Vaginal samples were grouped into 5 CST: CST I (L. crispatus predominant, 30.5%), CST II (L. gasseri predominant, 4.4%), CST III (Lactobacillus iners predominant, 36.5%), CST IV (Lactobacillus-depleted, 27.4%), and CST V (L. jensenii predominant, 1.2%). Several factors were independently associated with CST IV, such as smoking (OR, 1.80; 95% CI, 1.02–3.18), number of partners (OR, 2.11; 95% CI, 1.20–3.70), and vaginal douching (OR, 2.24; 95% CI, 1.34–3.74). A protective effect was observed for milk/dairy intake (OR, 0.47; 95% CI, 0.27–0.82) and sitz bathing (OR, 0.43; 95% CI, 0.19–0.98).

Conclusions
Nearly two thirds of Brazilian women may be at an increased risk for adverse outcomes associated with a vaginal microbiota characterized by the depletion of Lactobacillus or dominance by L. iners, whose protective role has been widely questioned. Several factors related to sexual behavior and intimate hygiene were associated with CST IV.
Cephalosporin-Resistant Neisseria gonorrhoeae Isolated in Portugal, 2019
Authors: Pinto Miguel , Matias Rui , Rodrigues João Carlos , Duarte Sílvia , Vieira Luís , Gonçalves Inês , Gonçalves Maria João , Ramos Maria Helena , Gomes João Paulo , Borrego Maria José 
Published: June 2020

Abstract
We report a multidrug-resistant Neisseria gonorrhoeae exhibiting resistance to ceftriaxone and cefixime, isolated in Portugal in 2019. Whole-genome sequencing was performed for typing and identification of genetic determinants of antimicrobial resistance. Because of its antimicrobial susceptibility profile, awareness should be raised for the circulation of this strain.
Implementation of a Pilot Leadership Curriculum for Physical Medicine and Rehabilitation Residents
Authors: McIntyre McKyla , Alavinia Seyed Mohammad , Matlow Anne 
Published: June 2020

Abstract
Medical trainees are expected to achieve leadership competencies by the end of their training. However, there is a lack of standardized postgraduate leadership education. The aims of this study were to evaluate a pilot program consistent with leadership aims of the medical education body and to assess learners’ perceived responses to the curriculum. A pilot workshop was developed using Kern’s six-step approach to curriculum development for medical education. Topics included leading teams, managing conflict, feedback, goal setting, and time management, as these gaps were identified during a targeted needs assessment. Learning was assessed by preworkshop and postworkshop self-assessments, and the curriculum was evaluated with a postworkshop survey. The workshop was attended by 14 physical medicine and rehabilitation residents and 1 medical student. There was a statistically significant increase in participants’ Likert scale confidence scores for the summative areas of leading teams, managing conflict, feedback, goal setting, and time management (P < 0.001). All participants rated the session as 4 or 5/5 on all evaluation domains. In conclusion, a single session targeting stated needs of trainees was successful in increasing perceived competence in areas relevant to clinical leadership. Expansion to include a longitudinal component, with assessment for behavior change for ongoing improvement would be beneficial.
Integrating Suicide Risk Screening into Pediatric Ambulatory Subspecialty Care
Authors: Lois Becky H. , Urban Tamaki H. , Wong Christina , Collins Erin , Brodzinsky Lara , Harris Mary Ann , Adkisson Hayley , Armstrong Monique , Pontieri Jeanmarie , Delgado Diana , Levine Jeremiah , Liaw K. Ron-Li 
Published: June 2020

Background:
Suicide risk screening is recommended in pediatric care. To date, no previous studies illustrate the implementation of suicide risk screening in pediatric subspecialty care, even though chronic medical conditions are associated with a higher risk of suicide.

Methods:
A large multidivision pediatric ambulatory clinic implemented annual suicide risk screening. Patients ages 9–21 years participated in suicide risk screening using the Ask Suicide-Screening Questions during the project. A multidisciplinary team employed quality improvement methods and survey-research design methods to evaluate the feasibility and acceptability of the screening process for patients, families, and medical providers.

Results:
During the quality improvement project period, 1,934 patients were offered screening; 1,301 (67.3%) patients completed screening; 82 patients (6.3% of 1,301 patients) screened positive. The monthly compliance rate held steady at 86% following several Plan-Do-Study-Act cycles of improvement. The survey results demonstrate that providers rated the suicide risk screening process positively; however, a subset of providers indicated that the screening process was out of their scope of practice or impeded their workflow.

Conclusions:
Suicide risk screening is feasible in pediatric specialty care and can identify at-risk patients. Continued efforts are needed to standardize suicide risk screening practices. Future directions include identifying factors associated with suicide risk in patients in pediatric subspecialty care settings.
A Multimetric Health Literacy Analysis of Online Information for Gluteal Augmentation With Fat Grafting
Authors: Oleck Nicholas C. , Johnson Anna Rose , Tran Bao Ngoc N. , Ayyala Haripriya S. , Lee Edward S. , Lee Bernard T. 
Published: June 2020

Background and Objectives
According to the American Society of Plastic Surgeons the number of gluteal augmentations with fat grafting, colloquially known as the “Brazilian buttock lift” (BBL), doubled from 2014 to 2018. Recent studies have demonstrated that gluteal augmentation with fat grafting has a higher mortality rate when compared with other esthetic surgeries. We hypothesize that online patient-directed information for gluteal augmentation are overly complex, written at an elevated reading grade level, with incomplete or no information regarding associated surgical risks.

Objective
To perform an objective appraisal of the most popular online patient education materials for gluteal augmentation surgery and explore potential interventions for improving material quality.

Methods
An online Google search using the term “Brazilian butt lift” was performed and the top 10 websites providing relevant information were identified. Readability for each website was determined using Readability Studio. Understandability, actionability and cultural sensitivity was assessed with validated tools by 2 independent raters.

Results
The top 10 websites were written at a mean reading grade level of 13.0, appropriate for a high school graduate. No website was written at the American Medical Association and the National Institutes of Health recommended 6th to 8th grade reading level. Mean understandability and actionability scores of 51% and 18.9%, respectively, suggest significant room for improvement. The average cultural sensitivity assessment tool score was 2.30, below the recommended threshold for acceptability of 2.5. Ninety percent of all websites did not meet the threshold for cultural acceptability.

Conclusions
Online patient education materials for gluteal augmentation with fat grafting were written at an inappropriately elevated reading grade level and were overly complex, did not promote reader action, and were not sensitive to the needs of the target demographic.
Outcomes of Elective Major Cancer Surgery During COVID 19 at Tata Memorial Centre
Authors: Shrikhande Shailesh V. , Pai Prathmesh S. , Bhandare Manish S. , Bakshi Ganesh , Chaukar Devendra A. , Chaturvedi Pankaj , Goel Mahesh , Gulia Ashish , Qureshi Sajid S. , Maheshwari Amita , Moiyadi Aliasgar , Nair Sudhir , Nair Nita S. , Karimundackal George , Saklani Avanish P. , Shankhadhar Vinay K. , Parmar Vani , Divatia Jigeeshu V. , CS Pramesh , Puri Ajay , Badwe Rajendra A. 
Published: June 2020

Background:
Overburdened systems and concerns of adverse outcomes have resulted in deferred cancer surgeries with devastating consequences. In this COVID pandemic, the decision to continue elective cancer surgeries, and their subsequent outcomes, are sparsely reported from hotspots.

Methods:
A prospective database of the Department of Surgical Oncology was analysed from March 23rd to April 30th, 2020.

Findings:
Four hundred ninety-four elective surgeries were performed (377 untested and 117 tested for Covid 19 before surgery). Median age was 48 years with 13% (n = 64) above the age of 60 years. Sixty-eight percent patients were American Society of Anaesthesiology (ASA) grade I. As per surgical complexity grading, 71 (14·4%) cases were lower grade (I-III) and 423 (85.6%) were higher grade complex surgeries (IV – VI).
Clavien-Dindo ≥ grade III complications were 5.6% (n = 28) and there were no postoperative deaths. Patients >60 years documented 9.3% major complications compared to 5.2% in <60 years (P = 0.169). The median hospital stay was 1 to 9 days across specialties.
Postoperatively, 26 patients were tested for COVID 19 and 6 tested positive. They all had higher grade surgeries but none required escalated or intensive care treatment related to COVID infection.

Interpretation:
A combination of scientific and administrative rationale contributed to favorable outcomes after major elective cancer surgeries. These results support the continuation of elective major cancer surgery in regions with Covid 19 trends similar to India.
Liquid plasma: A solution to optimizing early and balanced plasma resuscitation in massive transfusion
Authors: Beattie Genna , Cohan Caitlin M. , Ng Valerie L. , Victorino Gregory P. 
Published: June 2020

BACKGROUND
Early and balanced resuscitation for traumatic hemorrhagic shock is associated with decreased mortality, making timely plasma administration imperative. However, fresh frozen plasma (FFP) thaw time can delay administration, and the shelf life of thawed FFP limits supply and may incur wastage. Liquid plasma (LP) offers an attractive alternative given immediate transfusion potential and extended shelf life. As such, we hypothesized that the use of LP in the massive transfusion protocol (MTP) would improve optimal plasma/red blood cell (RBC) ratios, initial plasma transfusion times, and clinical outcomes in the severely injured patient.

METHODS
Using Trauma Quality Improvement Program data from our level 1 trauma center, we evaluated MTP activations from 2016 to 2018. Type A LP use was instated April 2017. Before this, thawed FFP was solely used. Plasma/RBC ratios and initial plasma transfusion times were compared in MTP patients before and after LP implementation. Patient and injury characteristics were accounted for using linear regression analysis. Secondary outcomes of mortality, 28-day recovery, and complications were evaluated using Cox proportional hazards regression.

RESULTS
A total of 95 patients were included (pre-LP, 39; post-LP, 56). Time to initial plasma transfusion and plasma/RBC ratios at 4 and 24 hours were improved post-LP implementation with a coinciding reduction in RBC units transfused (p < 0.05). In a 28-day Cox proportional hazards regression LP implementation was associated with favorable recovery (hazard ratio, 3.16; 95% confidence interval, 1.60–6.24; p < 0.001) and reduction in acute kidney injury (hazard ratio, 0.092; 95% confidence interval, 0.011–0.77; p = 0.027). No post-LP patients with blood group type B or AB (n = 9) demonstrated evidence of hemolysis within 24 hours of type A LP transfusion.

CONCLUSION
Initial resuscitation with LP optimizes early plasma administration and improves adherence to transfusion ratio guidelines. Furthermore, LP offers a solution to inherent delays with FFP and is associated with improved clinical outcomes, particularly 28-day recovery and odds of acute kidney injury. Liquid plasma should be considered as an alternative to FFP in MTPs.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
Recent genetic advances in early-onset dystonia
Authors: Steel Dora , Kurian Manju A. 
Published: June 2020

Purpose of review
The discovery of new disease-causing genes and availability of next-generation sequencing platforms have both progressed rapidly over the last few years. For the practicing neurologist, this presents an increasingly bewildering array both of potential diagnoses and of means to investigate them. We review the latest newly described genetic conditions associated with dystonia, and also address how the changing landscape of gene discovery and genetic testing can best be approached, from both a research and a clinical perspective.

Recent findings
Several new genetic causes for disorders in which dystonia is a feature have been described in the last 2 years, including ZNF142, GSX2, IRF2BPL, DEGS1, PI4K2A, CAMK4, VPS13D and VAMP2. Dystonia has also been a newly described feature or alternative phenotype of several other genetic conditions, notably for genes classically associated with several forms of epilepsy. The DYT system for classifying genetic dystonias, however, last recognized a new gene discovery (KMT2B) in 2016.

Summary
Gene discovery for dystonic disorders proceeds rapidly, but a high proportion of cases remain undiagnosed. The proliferation of rare disorders means that it is no longer realistic for clinicians to aim for diagnosis to the level of predicting genotype from phenotype in all cases, but rational and adaptive use of available genetic tests can certainly expedite diagnosis.
Wilson disease
Authors: Aggarwal Annu , Bhatt Mohit 
Published: June 2020

Purpose of review
The aim of this article is to review recent developments in the areas of the disease features and treatment of Wilson disease, and survey disorders that share its pathophysiology or clinical symptoms.

Recent findings
Knowledge of the clinical spectrum of Wilson disease has expanded with recognition of patients who present in atypical age groups – patients with very early onset (<5 years) and those in whom symptoms present in mid-to-late adulthood. A disease phenotype with dominant psychiatric features and increased risk of cardiac problems and various sleep disorders have been identified.
In addition to a better understanding of the phenotype of Wilson disease itself, features of some related disorders (‘Wilson disease-mimics’) have been described leading to a better understanding of copper homeostasis in humans. These disorders include diseases of copper disposition, such as mental retardation, enteropathy, deafness, neuropathy, ichthyosis, keratoderma syndrome, Niemann–Pick type C, and certain congenital disorders of glycosylation, as well as analogous disorders of iron and manganese metabolism.
Outcomes for existing treatments, including in certain patient subpopulations of interest, are better known. Novel treatment strategies being studied include testing of bis-choline tetrathiomolybdate in phase 2 clinical trial as well as various preclinical explorations of new copper chelators and ways to restore ATP7B function or repair the causative gene.

Summary
Recent studies have expanded the phenotype of Wilson disease, identified rare inherited metal-related disorders that resemble Wilson disease, and studied long-term outcomes of existing treatments. These developments can be expected to have an immediate as well as a long-term impact on the clinical management of the disease, and point to promising avenues for future research.