bluuebunny/crossref_metadata_2025_split huggingface dataset:
ICU shift related effects on sleep, fatigue and alertness levels
Authors: Bihari S , Venkatapathy A , Prakash S , Everest E , McEvoy R D , Bersten A 
Published: January 2020

Abstract

Background
Shift work may lead to suboptimal sleep resulting in impaired alertness, and lowered performance levels, all of which can lead to medical errors.

Aims
To examine fatigue, sleepiness and behavioural alertness prospectively in a tertiary level Australian intensive care unit (ICU).

Methods
All full-time doctors providing 24-h resident cover on a 12-h day and 12-h night shift roster were invited to participate in this study. Data collected included Epworth Sleepiness Scale (ESS), sleep and awake history, Samn-Perelli Fatigue (SPF) Scale, Karolinska Sleepiness Scale (KSS) and iOS-based Psychomotor Vigilance Test (behavioural alertness). Data about medical emergency team (MET) shifts were collected separately as they were perceived to be busier shifts.

Results
Twenty-nine ICU doctors participated in this study for a consecutive 6-week period. At baseline the median (interquartile range (IQR)) ESS was 5 (3–9). Day shift leads to an increase in fatigue and sleepiness (both P &lt; 0.01). Night shift leads to worsening in fatigue, sleepiness and psychomotor vigilance (all P &lt; 0.01). MET shifts had a lower psychomotor vigilance than non-MET shifts. The difference in the psychomotor vigilance was mostly due to the difference in recorded lapses and response time.

Conclusions
Shift work ICU doctors experience high levels of fatigue and sleepiness. Night shifts also lead to decreased vigilance. This is even more evident in doctors working MET shifts. These factors may lead to errors. Optimal rostering may reduce these effects and improve patient safety.
Postoperative Antifungal Treatment of Pulmonary Cryptococcosis in Non-HIV-Infected and Non-Transplant-Recipient Patients: A Report of 110 Cases and Literature Review
Authors: Wei Shuo , Su Xin , Pan Yun-hu , Zheng Yuan-yuan , Dong Xiao-wen , Hu Xiao-hua , Wu Fan , Shi Yi 
Published: January 2020

Abstract

Background
To explore the efficacy of postoperative antifungal treatment for preventing the recurrence of pulmonary cryptococcosis (PC) and occurrence of cryptococcal meningitis (CM), a retrospective study was conducted in 112 hospitalized PC patients with or without antifungal treatment following surgery.

Methods
The treatment failure rate, PC recurrence rate, and CM incidence were compared. Additionally, the effectiveness of postoperative antifungal therapy was assessed by gathering and analyzing the published literature.

Results
The failure rate (P = .054) and recurrence rate (P = .178) were similar in the 2 groups, but the incidence of CM was lower in the group that received postoperative antifungal treatment (P = .039).

Conclusions
This study did not show any difference in the PC recurrence rate or failure rate in the different treatment duration groups. Thus, a shorter antifungal treatment course of 2 months may be an optional treatment. In addition, upon review of the literature, no case of CM occurrence was reported among the 169 cases given postoperative antifungal treatment.
Adult haemophagocytic lymphohistiocytosis: a review
Authors: Yildiz H , Van Den Neste E , P. Defour J , Danse E , Yombi J.C 
Published: January 2020

Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder characterized by hyperimmune response. The mortality is high despite progress being made in the diagnosis and treatment of the disease. This review aimed to update knowledge on adult HLH pathophysiology, identify the numerous causes and help clinicians make early diagnosis and initiate treatment. Using Embase, we searched relevant articles published from 1 January 2010 to 31 October 2019, with the MESH term ‘haemophagocytic lymphohistiocytosis; macrophagic activation syndrome, adult’. The mean age at presentation is about 50 years, with a male predominance. The most frequent disease associations are haematological diseases, viral or bacterial infections and autoimmune diseases. The pathophysiologic mechanism is probably the combination of inherited genetic mutations and extrinsic triggers. The mortality rate is 26.5–74.8%. HScore is more efficient than HLH-2004 criteria to identify HLH, with diagnostic sensitivity and specificity 90% and 79%, respectively. 18-fluorodeoxyglucose positron emission tomography–computed tomography is potentially useful for detecting underlying disease and the extent of secondary HLH. Disease-specific treatment should be given as soon as possible. Treatment with corticosteroids combined or not with etoposide is the mainstay of treatment. Monoclonal antibodies and JAK pathway inhibitors show promise of being effective. In adult HLH, infectious diseases, autoimmune disease and malignancy should be suspected so that disease-specific treatment can be given promptly. Treatment with corticosteroids combined or not with etoposide is the mainstay of treatment, but new therapies show promise of being effective.
Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS
Authors: Macfarlane Gary J , Pathan Ejaz , Jones Gareth T , Dean Linda E 
Published: January 2020

Abstract

Objectives
While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit.

Methods
The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the ‘biologic’ sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state.

Results
335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12–17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%).

Conclusion
Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.
Associations between amygdala reactivity to social threat, perceived stress and C-reactive protein in breast cancer survivors
Authors: Leschak Carrianne J , Dutcher Janine M , Haltom Kate E Byrne , Breen Elizabeth C , Bower Julienne E , Eisenberger Naomi I 
Published: January 2020

Abstract
Chronic inflammation in women diagnosed with breast cancer is critically linked with tumor progression, metastasis and survival. C-reactive protein (CRP)—a circulating marker of inflammation—is an important prognostic marker for cancer-related outcomes in breast cancer survivors (e.g. recurrence, fatigue). Psychological stress, which increases circulating markers of inflammation following sympathetic nervous system (SNS) activation, may modulate tumor-relevant inflammatory processes. However, little is known about neural mechanisms that might link stress and downstream SNS-initiated proinflammatory processes, such as elevated CRP. Past work suggests that threat-related neural regions, such as the amygdala, may be key in translating psychological stress into SNS activity and subsequent peripheral inflammation. Thus, we examined amygdala reactivity to socially threatening stimuli in association with perceived stress and plasma CRP levels to further elucidate neuro-immune pathways of social threat processing within breast cancer survivors (N = 37). Significant positive correlations were found between left amygdala reactivity in response to socially threatening stimuli (e.g. angry/fearful faces vs happy faces) and perceived stress in the previous month (r = 0.32, P = 0.025) and between left amygdala reactivity and CRP (r = 0.33, P = 0.025). This work builds on prior research implicating the amygdala as a key structure in crosstalk between threat-related neural circuitries and peripheral inflammation, particularly within cancer survivors.
Is Work and Aging Research a Science of Questionnaires? Moving the Field Forward by Considering Perceived Versus Actual Behaviors
Authors: Gerpott Fabiola H , Lehmann-Willenbrock Nale , Scheibe Susanne 
Published: January 2020

AbstractResearch on work and aging predominantly relies on self-report data to create new insights relevant to individuals, organizations, and society. Whereas surveys and interviews based on self-reports offer a valuable inward-directed perspective on individuals and their understanding of others, they can only provide limited knowledge on the behaviors of employees at different ages and in age-diverse settings. This is because what employees actually do is often considerably different from their survey-based reports of what they or others do. In this commentary, we challenge the field to move beyond a science of questionnaires by complementing survey research with behavioral data. First, this would allow scholars to identify when and how behaviors accurately translate into surveyed perceptions of behaviors. Second, such an approach can advance our understanding of the micro-dynamics occurring in age-diverse workforces that ultimately manifest in emerging phenomena (e.g., age-inclusive climate, psychological safety perceptions, or group affective tone). Lastly, studying concrete and specific behaviors also allows scholars to develop better interventions and provide meaningful recommendations for practice that differentiate actual from perceived behaviors.
Women With Clinically Significant Fatigue After Breast Cancer Treatment Report Increased Falls and Perform Poorly on Objective Measures of Physical Fitness and Function
Authors: Wood Lisa J. , Winters-Stone Kerri M. , Kneiss Janet A. , Fox Annie B. , Walker Rachel K. 
Published: January 2020

Purpose:
To determine whether there were significant differences in self-report and objective measures of physical fitness and function between women post–breast cancer (BC) treatment with and without clinically significant fatigue.

Methods:
We performed a secondary analysis of baseline data collected from 281 postmenopausal women post–BC treatment (62 ± 10 years; time since diagnosis = 5.6 ± 3.9 years) who participated in prior exercise trials. Scores on the SF-36 (36-Item Short Form Health Survey) vitality subscale (0-100) were used to identify women with clinically significant fatigue, where a score of 45 or less represents fatigue and a score of 70 or more represents no fatigue. Objectively measured function included maximal leg press strength (kg), physical function battery, timed chair stand, Unipedal Stance Test, and gait characteristics. Self-reported outcomes included physical function, pain, mental health, sensory symptoms of chemotherapy-induced peripheral neuropathy (CIPN), habitual physical activity level, and fall history.

Results:
Twenty percent of women (n = 57) reported clinically significant fatigue 6 years postdiagnosis, whereas 34% (n = 100) reported no fatigue. Except for leg strength, unipedal stance, step length, and base of support while walking, fatigued women had significantly worse objectively measured function than women without fatigue. Fatigued women also reported poorer physical function, greater bodily pain, and poorer mental health and were twice as likely as nonfatigued women to report symptoms of CIPN and having fallen.

Conclusions:
Women with a history of BC, and in particular those with CIPN, should be routinely screened for clinically significant fatigue in the survivorship period. Clinical and survivorship care plans aimed at limiting functional decline and reducing falls in survivors of BC should include fatigue-reduction strategies.
A Quality Improvement Initiative to Increase the Frequency of Vaginal Delivery in Brazilian Hospitals
Authors: Borem Paulo , de Cássia Sanchez Rita , Torres Jacqueline , Delgado Pedro , Petenate Ademir Jose , Peres Daniel , Parry Gareth , Pilar Betrán Ana , Barker Pierre 
Published: January 2020

OBJECTIVE:
To evaluate a quality improvement (QI) initiative designed to increase the frequency of vaginal delivery in Brazilian hospitals.

METHODS:
Twenty-eight hospitals enrolled in a 20-month (May 2015–December 2016) Breakthrough Series Collaborative that used QI methods to increase implementation of obstetric approaches with potential to increase the frequency of vaginal delivery. All hospitals contributed qualitative data for iterative redesign. Thirteen intervention hospitals with complete data contributed to an analysis of changes in vaginal delivery in a targeted population over time. Hospitals from the São Paulo region (five intervention and eight nonintervention) contributed to a comparator analysis of changes in vaginal delivery for all deliveries over time.

INTERVENTION:
Most hospitals targeted low-risk pregnancies in primiparous women, delivered by hospital-employed obstetricians or admitted through emergency departments, and some included all pregnant women. The collaborative tested four interventions to increase vaginal delivery: 1) coalition building of stakeholders with the common purpose of ensuring “appropriate delivery,” 2) empowering pregnant women to choose their preferred mode of delivery, 3) implementation of new care models favoring physiologic birth, and 4) improved information systems for continuous learning by health care providers.

RESULTS:
For 119,378 targeted deliveries (36% of all deliveries) in 13 intervention hospitals, vaginal delivery increased from 21.5% in 2014 to 34.8% in 2016, a relative increase of 1.62 (95% CI 1.27–2.07, P<.001). In the comparator analysis, vaginal delivery for all deliveries in the five São Paulo intervention hospitals increased from 16.1% to 23% (RI 1.43, P<.001) and from 11.0% to 13.0% (relative rate ratio 1.18, P<.001) in the eight nonintervention São Paulo hospitals. The relative increase in vaginal delivery between the São Paulo intervention and nonintervention groups was 1.21 (95% CI 1.05–1.41, P=.01). The rate of maternal adverse events and neonatal intensive care unit admissions for newborns who weighed at least 2,500 g did not differ significantly during the observation period.

CONCLUSIONS:
Key interventions implemented with QI methods were associated with increased vaginal delivery. This approach may help address the global cesarean delivery epidemic.
Association of the Affordable Care Act With Ovarian Cancer Care
Authors: Smith Anna Jo Bodurtha , Fader Amanda Nickles 
Published: January 2020

OBJECTIVE:
To estimate how implementation of the 2010 Affordable Care Act (ACA) might be associated with stage at diagnosis and time to treatment for women with ovarian cancer.

METHODS:
We conducted a retrospective cohort study using difference-in-differences analysis comparing stage at diagnosis and time to treatment before and after implementation of the ACA among women with ovarian cancer aged 21–64 years (exposure group) compared with women aged 65 years or older (control group). Using 2004–2015 data from the National Cancer Database, outcomes were analyzed overall and by insurance type and race, adjusting for urban-rural, income and education level, comorbidities, distance traveled for care, region, and care at an academic center.

RESULTS:
A total of 39,999 ovarian cancer cases prereform and 36,564 postreform were identified for women aged 21–64 years compared with 31,290 cases prereform and 29,807 postreform for women aged 65 years or older. The ACA was associated with increased early-stage diagnosis detection for women aged 21–64 years compared with women 65 and older (difference-in-differences 1.4%, 95% CI 0.4–2.4). The ACA was associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (2.3%, 95% CI 1.7–3.0). Among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis and receipt of treatment within 30 days of diagnosis (difference-in-differences 2.7%, 95% CI 1.0–4.5, difference-in-differences 2.5%, 95% CI 1.2–3.8). Improvements in time to treatment were seen across race and income groups.

CONCLUSION:
Implementation of the ACA was associated with earlier ovarian cancer stage at detection and treatment within 30 days of diagnosis.
Effect of Surgery for Stress Incontinence on Female Sexual Function
Authors: Glass Clark Stephanie M. , Huang Qi , Sima Adam P. , Siff Lauren N. 
Published: January 2020

OBJECTIVE:
To evaluate the effects of four different surgical interventions for stress urinary incontinence (SUI) on 2-year postoperative sexual function.

METHODS:
This is a combined secondary analysis of SISTEr (Stress Incontinence Surgical Treatment Efficacy Trial) and TOMUS (Trial of Mid-Urethral Slings). Women in the original trials were randomized to receive surgical treatment for SUI with an autologous fascial sling or Burch colposuspension (SISTEr), or a retropubic or transobturator midurethral sling (TOMUS). Sexual function (assessed by the short version of the PISQ-12 [Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire]) was compared between groups at baseline, 12 and 24 months. Secondarily, the effects of subjective and objective surgical cure rates and the effect of concomitant surgical procedures on 24-month sexual function was explored.

RESULTS:
Nine hundred twenty-four women were included in this study: 249 (26.9%) had an autologous fascial sling, 239 (25.9%) underwent Burch colposuspension, 216 (23.3%) had a retropubic midurethral sling placed, and 220 (23.8%) had transobturator midurethral sling placed. Baseline characteristics (including PISQ-12 scores) were similar between the four treatment arms, with notable exceptions including race–ethnicity, prolapse stage, concomitant surgery, and number of vaginal deliveries. After adjustment for differences between the groups, there was a clinically important improvement in PISQ-12 scores over the 24-month postoperative period for all treatment groups, with no significant differences attributed to the type of anti-incontinence procedure (baseline PISQ-12: 32.6, 33.1, 31.9, 31.4; 24-month PISQ-12: 37.7, 37.8, 36.9, 37.1, P<.01). There was no significant difference in mean PISQ-12 scores between 12 months and 24 months (12-month PISQ-12: 37.7, 37.8, 36.9, 37.1; 24 months as above, P=.97). Multivariable analysis showed independent associations between objective and subjective cure rates as well as concomitant procedures with a 24-month PISQ-12 score.

CONCLUSION:
Women undergoing anti-incontinence surgery show overall improvement in sexual function from baseline to 24 months postoperatively, without significant differences based on surgical procedure performed. The majority of this improvement occurs in the first 12 months and is maintained over 24 months.
Association of Acculturation With Adverse Pregnancy Outcomes
Authors: Premkumar Ashish , Debbink Michelle P. , Silver Robert M. , Haas David M. , Simhan Hyagriv N. , Wing Deborah A. , Parry Samuel , Mercer Brian M. , Iams Jay , Reddy Uma M. , Saade George , Grobman William A. 
Published: January 2020

OBJECTIVE
To evaluate the relationship between acculturation and adverse pregnancy outcomes, and whether these relationships differ across racial or ethnic groups.

METHODS
This is a planned secondary analysis of the nuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study of 10,038 pregnant women at eight academic health care centers in the United States. Nulliparous pregnant women with singleton gestations were recruited between 6 0/7 and 13 6/7 weeks of gestation from October 2010–September 2013. Acculturation was defined by birthplace (United States vs non–United States), language used during study visits (English or Spanish), and self-rated English proficiency. The adverse pregnancy outcomes of interest were preterm birth (less than 37 weeks of gestation, both iatrogenic and spontaneous), preeclampsia or eclampsia, gestational hypertension, gestational diabetes, stillbirth, small for gestational age, and large for gestational age. Multivariable regression modeling was performed, as was an interaction analysis focusing on the relationship between acculturation and adverse pregnancy outcomes by maternal race or ethnicity.

RESULTS
Of the 10,006 women eligible for this analysis, 8,100 (80.9%) were classified as more acculturated (eg, born in the United States with high English proficiency), and 1,906 (19.1%) were classified as having less acculturation (eg, born or not born in the United States with low proficiency in English or use of Spanish as the preferred language during study visits). In multivariable logistic regression modeling, more acculturation was significantly associated with higher frequency of preterm birth (odds ratio [OR] 1.46, adjusted odds ratio [aOR] 1.50, 95% CI 1.16–1.95); spontaneous preterm birth (OR 1.54, aOR 1.62, 95% CI 1.14–2.24); preeclampsia or eclampsia (OR 1.39, aOR 1.31, 95% CI 1.03–1.67); preeclampsia without severe features (OR 1.44, aOR 1.43, 95% CI 1.03–2.01); and gestational hypertension (OR 1.68, aOR 1.48, 95% CI 1.22–1.79). These associations did not differ by self-described race or ethnicity.

CONCLUSION
In a large cohort of nulliparous women, more acculturation, regardless of self-described race or ethnicity, was associated with increased odds of several adverse pregnancy outcomes.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT01322529.