bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy
Authors: Wang Chao-Yang , Yang Jin , Zi Hao , Zheng Zhong-Li , Li Bing-Hui , Wang Yang , Ge Zheng , Jian Guang-Xu , Lyu Jun , Li Xiao-Dong , Ren Xue-Qun 
Published: December 2019

Abstract
Background: Surgery is the only way to cure gastric adenocarcinoma (GAC), and chemotherapy is the basic adjuvant management for GAC. A prognostic model for predicting the individual disease-specific survival (DSS) rates of GAC patients who receive surgery and chemotherapy has not been established. Objective: We aimed to establish a survival nomogram for GAC patients who receive surgery and chemotherapy. Methods: We identified 5764 GAC patients who had received surgery and chemotherapy from the SEER (Surveillance, Epidemiology, and End Results) database. Approximately 80% (n=4034) of the included patients were randomly assigned to the training set, and the remaining patients (n=1729) were assigned to the external validation set. Nomogram was established by the training set and validated by the validation set. Results: Based on the results of a multivariate analysis, a nomogram was developed that encompassed age at diagnosis, number of regional lymph nodes examined, number of positive regional lymph nodes, sex, race, grade, derived AJCC stage, summary stage, and radiotherapy status. The C-index (Harrell’s concordance index) of the model was higher than that of the traditional seventh AJCC staging system (0.707 vs 0.661). Calibration plots of the nomogram showed that the probability of DSS optimally corresponded to the survival rate. Integrated discrimination improvement (IDI) and categorical net reclassification improvement (NRI) showed visible improvement. IDI for 3-, 5- and 10- year DSS were 0.058, 0.059 and 0.058, respectively (P>0.05), and NRI for 3-, 5- and 10- year DSS were 0.380 (95% CI=0.316–0.470), 0.407 (95% CI=0.350–0.505), and 0.413 (95% CI=0.336–0.519), respectively. Decision curve analysis supported that the constructed nomogram was superior to the AJCC staging system. Conclusion: The proposed nomogram provides more-reliable DSS predictions for GAC patients who receive surgery and chemotherapy in the general population. According to validation, the new nomogram will be beneficial in facilitating individualized survival predictions and useful when performing clinical decision-making for GAC patients who receive surgery and chemotherapy.
AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study
Authors: KOFFI Kouassi Gustave , Silué DA , Laurent C , Boidy K , Koui S , Compaci G , Adeba ZH , Kamara I , Botty RP , Bognini A.S , Sanogo I , Despas F , Laurent G 
Published: December 2019

Abstract
Background Previous studies have indicated that accompanying socially undeserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improve adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. Methods This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. Hundred African patients were randomly assigned to either AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. Results We found that AMA was feasible and has significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CRR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. Conclusion Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.
The burden of unrecognised chronic kidney disease in patients with type 2 diabetes at a county hospital clinic in Kenya: implications to care and need for screening.
Authors: Otieno Frederick C. F. , Ogola Elijah N , Kimando Mercy W , Mutai Ken K 
Published: December 2019

Abstract
Background: Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and is a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that would optimize outcomes including forestalling progression to end-stage kidney disease.
This study was conducted in a regional referral public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area.
Methods: A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over five months. Informed consent was obtained and clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative.
Main outcomes measure: Estimated Glomerular filtration rate and albuminuria as markers of chronic kidney disease.
Results: A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0 % (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age >50years, long duration with diabetes >5years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status.
Conclusion: Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over thirty percent of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.
Radiosurgery and fractionated stereotactic body radiotherapy for patients with lung oligometastases
Authors: Kalinauskaite Goda , Tinhofer Ingeborg , Kufeld Marcus , Kluge Anne Kathrin , Grün Arne , Budach Volker , Senger Carolin , Stromberger Carmen 
Published: December 2019

Abstract
Background: Patients with oligometastatic disease can potentially be cured by using an ablative therapy for all active lesions. Stereotactic body radiotherapy (SBRT) is a non-invasive treatment option that lately proved to be as effective and safe as surgery in treating lung metastases (LM). However, it is not clear which patients benefit most and what are the most suitable fractionation regimes. The aim of this study was to analyze treatment outcomes after single fraction radiosurgery (SFRS) and fractionated SBRT (fSBRT) in patients with lung oligometastases and identify prognostic clinical features for better survival outcomes.
Methods: Fifty-two patients with 94 LM treated with SFRS or fSBRT between 2010 and 2016 were analyzed. The characteristics of primary tumor, LM, treatment, toxicity profiles and outcomes were assessed. Kaplan-Meier and Cox regression analyses were used for estimation of local control (LC), overall survival (OS), progression free survival and distant metastases free survival (DMFS).
Results: Ninety-four LM in 52 patients were treated using SFRS/fSBRT with a median of 2 lesions per patient (range: 1–5). The median planning target volume (PTV)-encompassing dose for SFRS was 24 Gy (range: 17-26) compared to 45 Gy (range: 20-60) in 2-12 fractions in fSBRT. The median follow-up time was 21 months (range: 3-68). LC rates at 1 and 2 years for SFSR vs. fSBRT were 89% and 83% vs. 75% and 59%, respectively (p=0.026). LM treated with SFSR were significantly smaller (p=0.001). The 1 and 2-year OS rates for all patients were 84% and 71%, respectively. In univariate analysis treatment with SFRS, an interval of ≥ 12 months between diagnosis of LM and treatment, non-colorectal cancer histology and BED <100 Gy were significantly associated with better LC. However, none of these parameters remained significant in the multivariate Cox regression model. OS was significantly better in patients with negative lymph nodes (N0), Karnofsky performance status (KPS) >70% and time to first metastasis ≥12 months. There was no grade 3 acute or late toxicity.
Conclusions: We observed good LC and low toxicity rates after SFRS for small lung metastases. Longer time to first metastasis, good KPS and N0 predicted better OS.
Perceptions of pregnant women on reasons for late initiation of antenatal care: A qualitative interview study
Authors: Warri Denis , George Asha 
Published: December 2019

Abstract
Background: Antenatal care serves as a key entry point for a pregnant woman to receive a broad range of services and should be initiated at the onset of pregnancy. The aim of the study was to understand the reasons for late initiation of antenatal by pregnant women in Nkwen Baptist Health Center, Cameroon. Methods: The study applied purposive sampling to recruit eighteen pregnant women and three key informants for data collection through individual interviews. Pregnant women who initiated antenatal care after the first trimester were recruited during antenatal care clinics and interviewed in a room at the antenatal care unit. Key informants were midwives working at the antenatal care unit. Participation in the study was voluntary. Participants were explained the purpose of the study and signed a consent form if they were willing to participate in the research. Data was collected using an audio tape and analyzed using Thematic Coding Analysis. Results: Pregnant women place low value on early antenatal care due to the fact that they perceive pregnancy as a normal health condition or not a serious issue that requires seeking health care. Furthermore previous pregnancy outcomes that were positive regardless of accessing care made them less motivated to initiate antenatal care early. The booking system is perceived as user-unfriendly with overcrowded conditions, long waiting times and rudeness of some service providers. Cost of services and distance to health facilities with uncomfortable transport and poor road network were identified as perceived barriers. The absence of effective community health programmes, perceived lack of support from parents and spouses, fear of bewitchment and stigma due to cultural beliefs about early initiation of antenatal care were also identified as variables influencing late initiation. Conclusion: Pregnant women lack information on the purpose of early antenatal care. Health facility barriers as well as socio cultural beliefs also have significant influence on timing of antenatal care initiation. The government of Cameroon should strengthen the health system and implement activities that engage communities to improve timing of care seeking for antenatal care and thereby improve the maternal health status of women.
The association between symptoms of depression during pregnancy and low birth weight:a prospective study
Authors: Li Xiu xiu , Gao Rui , Dai Xiaowei , Liu Hong , Zhang Jinxin , Liu Xuemei , Si Dongmei , Deng Te , Xia Wei 
Published: December 2019

Abstract
Objectives Most studies have showed that maternal depression is associated with pregnancy complications. However, there were limited evidences in Chinese population. We examined the associations of the antenatal depression symptoms with pregnancy outcomes, especially for low birth weight. Methods A total of 1377 singleton pregnant women were recruited from Nanshan Maternity & Child Healthcare Hospital of Shenzhen in this prospective cohort study. Depression symptoms were assessed by the Edinburgh postnatal depression scale (EPDS) questionnaire in the second trimester of gestation; cut-points for the indication of antenatal depression were ≥12 scores in this study. Sociodemographic data, life-style and pregnancy outcomes were collected through Shenzhen Maternity & Child Healthcare database. The risks of adverse outcomes in patients with depression were determined by multivariate logistic regression and represented as odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 1377 subjects, the prevalence of antenatal depression was 19.1%. The EPDS scores were 13.8±2.0 and 6.5±2.9 ( P <0.001) in subjects with and without antenatal depression, respectively. After adjustment for maternal age, education, parity, pre-pregnancy body mass index (BMI), residential area, fetal gender, an EPDS score≥12 (versus. <12) was associated with an increased risk for low birth weight (odds ratio: 2.05, 95% CI: 1.12-4.64), but not for preterm birth, large for gestational age, small for gestational age and macrosomia. Conclusion Pregnant women presenting antenatal depressive symptoms are at elevated risk of low birth weight. Mental health problems of pregnancy should be addressed for the prevention of low birth weight.
EFFECTIVENESS OF STEROIDS VS PLACEBO IN PREVENTING UPPER AIRWAY OBSTRUCTION AFTER EXTUBATION IN CRITICALLY-ILL CHILDREN: RATIONALE AND DESIGN OF A MULTICENTRIC, DOUBLE-BLIND, RANDOMIZED STUDY
Authors: Manrique Gema , Laiseca Laura Butragueño , González Rafael , Rey Corsino , Martínez Zuriñe , Gil Javier , Rodriguez Antonio , Martínez Cecilia , Manrique Silvia , López-Herce Jesús 
Published: December 2019

Abstract
Background: Post-extubation upper airway obstruction (UAO) is a frequent complication causing stridor and respiratory distress, which occasionally may require reintubation, thereby increasing morbidity and mortality rates. Contradictory results have been obtained in studies assessing the effectiveness of steroids in preventing post-extubation UAO, and the available evidence is limited. We designed a multicentric randomized, placebo-controlled study to explore the effectiveness of dexamethasone in preventing post-extubation UAO in children. Methods: A multicentric, prospective, double-blind, randomized, placebo-controlled, phase IV clinical trial has been designed. The sample will include pediatric patients between 1 month and 16 years of age who have been intubated for more than 48 hours. Patients with airway disorders or who have received steroids within the last seven days will be excluded. Patients will be randomized to receive either placebo or a therapy with dexamethasone 0.25 mg/kg every 6 hours to be started 6-to-12 hours prior to extubation, to a total of four doses. Randomization will be performed at a 1:1 ratio. Follow-up of patients will be carried out for 48 h after extubation. The main objective of this study is to assess the reduction of moderate-severe UAO symptoms following extubation, as measured using the Taussig scale. Secondary objectives include assessing the decrease in the incidence of reintubation, evaluating the use of additional therapies for upper airway obstruction, and monitoring dexamethasone potential side effects.Discussion: The results of this study will contribute to the existing evidence on prophylaxis for post-extubation airway obstruction.
Palliative home parenteral nutrition in patients with ovarian cancer and malignant bowel obstruction: experiences of women and family caregivers.
Authors: Sowerbutts Anne Marie , Lal Simon , Sremanak Jana , Clamp Andrew , Jayson Gordon C. , Teubner Antje , Hardy Lisa , Todd Chris , Raftery Anne-Marie , Sutton Eileen , Morgan Robert D. , Vickers Alexander J. , Burden Sorrel 
Published: December 2019

Abstract
Background Malnutrition is a problem is advanced cancer, particularly ovarian cancer where malignant bowel obstruction (MBO) is a frequent complication. Parenteral nutrition is the only way these patients can received adequate nutrition and is a principal indication for palliative home parenteral nutrition (HPN). Giving HPN is contentious as it may increase the burden on patients. This study investigates patients’ and family caregivers’ experiences of HPN, alongside nutritional status and survival in patients with ovarian cancer and MBO. Methods This mixed methods study collected data on participant characteristics, clinical details and body composition using computed tomography (CT) combined with longitudinal in-depth interviews underpinned by phenomenological principles. The cohort comprised 38 women with ovarian cancer and inoperable MBO admitted (10/2016 to 12/ 2017) to a tertiary referral hospital. Longitudinal interviews (n=57) were carried out with 20 women considered for HPN and 15 of their family caregivers. Results Of the 38 women, 32 received parenteral nutrition (PN) in hospital and 17 were discharged on HPN. Nutritional status was poor with 31 of 33 women who had a CT scan having low muscle mass, although 10 were obese. Median overall survival from admission with MBO for all 38 women was 70 days (range 8 - 506) and for those 17 on HPN was 156 days (range 46 – 506). Women experienced HPN as one facet of their illness, but viewed it as a “lifeline” that allowed them to live outside hospital Nevertheless, HPN treatment came with losses including erosion of normality through an impact on activities of daily living and dealing with the bureaucracy surrounding the process. Family caregivers coped but were often left in an emotionally vulnerable state. Conclusions: Women and family caregivers reported that the inconvenience and disruption caused by HPN was worth the extended time they had at home.
Users’ Acceptance of Electronic Patient Portals in Lebanon
Authors: Honein-AbouHaidar Gladys , Antoun Jumana , Badr Karim , Hlais Sani , Nazaretian Houry 
Published: December 2019

Abstract
Background Acceptance of Electronic patient portal (EPP) is instrumental for its success. Studies on users’ acceptance in the Middle East region are scarce. This study aims to use the Technology Acceptance Model (TAM) as a framework to quantitatively describe potential users' intention to use and factors influencing the intention to use EPP. We concurrently test the internal construct validity and the reliability of the TAM. Methods A cross-sectional survey design and the vignette approach were used. For validation, we needed a minimum of 180 patients; all 35 attending physicians and 11 registered nurses were targeted. We used descriptive statistics to calculate the intention to use EPP and its determinants based on the TAM constructs. Exploratory factor analysis (EFA) and structural equation modeling (SEM) were employed to estimate significant path coefficients for patients only as the sample size of providers was too small. Results We had 199 patients, half intended to use EPP; 73% of providers (N=17) intended to use EPP. Perceived ease of use and privacy concerns were significantly higher among providers than patients (Mean (M) = 0.77 vs M= 0.42 (CI: -0.623 ; -0.081)) and (M=3.67 vs M=2.13, CI: -2.16; -0.91) respectively; other constructs were not significantly different. Reliability of TAM revealed a Cronbach Alpha of α=.91. EFA showed that three components explained 73.48% of the variance: Behavioral Intention of Use (14.9%), Perceived Ease of Use (50.74%), Perceived Usefulness (7.84%). SEM found that perceived ease of use increased perceived usefulness (standardized regression weight=0.49); perceived usefulness (0.51) had more predictive value than perceived ease of use (0.27) to explain the behavioral intention of use of the EPP. Conclusions We found that providers valued the usefulness of EPP and were mostly intending to use it. This finding has yet to be tested in future studies testing actual use as intention and actual use may not be concordant. The intention to use among patients was lower than those reported in developed countries. We identified two factors that we need to address to increase use, namely perceived ease and usefulness, and proposed practical implications to address them; future research directions were also discussed.
Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth Intervention in Brazil: A cross-sectional study
Authors: Fernandes Luísa M M , Lansky Sônia , Oliveira Bernardo J , Friche Amélia A L , Bozlak Christine T. , Shaw Benjamin A. 
Published: December 2019

Abstract
Background: Senses of Birth (SoB) is a health education intervention in Brazil that addresses reproductive rights, the benefits and risks of normal birth and cesarean, and use of evidence-based practices (EBP) during labor and childbirth, aiming to reduce unnecessary cesareans in the country. This study evaluates the impact of the SoB intervention on pregnant women’s perceived knowledge about normal birth, cesarean, and use of EBP in childbirth. Method: 1,287 pregnant women answered a structured questionnaire, immediately after their visit to the exhibition, between March 2015 and March 2016, in four cities. To identify the impact of the intervention on women’s perceived knowledge and possible association with socioeconomic and demographic characteristics, statistical analyses were performed including paired T-tests, ANOVA, and logistic and linear regressions. Results: The mean score (MS) of perceived knowledge after the intervention was higher than the mean score before experiencing the SoB for all three knowledge domains: Normal Birth (MS Before= 3.71 x MS After= 4.49), Cesarean (MS Before= 3.54 x MS After= 4.26) and EBPs (MS Before= 3.14 x MS After= 4.14). The results suggest that SoB intervention was more effective for low income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49- 4.09 for normal birth), women with private prenatal care (OR 2.42, 95% CI: 1.59- 3.66 for normal birth), women experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for normal birth; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and women in their first or second trimester at the time of the intervention (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for normal birth; OR 1.85, 95% CI: 1.40-2.41 for cesarean). Conclusion: The study showed opportunities to increase knowledge among Brazilian pregnant women for the three knowledge domains, and a need to focus the discussion on how to achieve a positive experience of birth using EBP. The intervention gains relevance considering the lack of evidence of the efficacy of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries targeting women.