bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prescribing and medical non-adherence after myocardial infarction: qualitative interviews with general practitioners in Germany
Authors: Freier Christian , Heintze Christoph , Herrmann Wolfram J. 
Published: May 2020

Abstract
Background
An increasing prevalence of having survived a myocardial infarction increases the importance of medical secondary prevention. Although preventive medication reduces mortality, prescribing and adherence are known to be frequently insufficient. General practitioners are the most important prescriber. However, their perspective on prescribing and medical non-adherence following myocardial infarction has not yet been explored. Thus, the aim of this study was to explore the general practitioners’ perspective on long-term care after myocardial infarction focussing on medical prevention.

Methods
In this qualitative interview study we conducted episodic interviews with sixteen general practitioners from rural and urban surgeries in Germany. Framework analysis with focus on general practitioners’ prescribing and patients’ non-adherence was performed.

Results
Almost all general practitioners reported following guidelines for myocardial infarction aftercare and prescribing the medication that was initiated in the hospital; however, they described deviating from guidelines because of drugs’ side effects or patients’ intolerances. Some questioned the benefits of medical secondary prevention for the oldest of patients.
General practitioners perceived good adherence among their patients who had had an MI while they regarded their methods for assessing medical non-adherence as limited. They perceived diverse reasons for non-adherence, particularly side effects, patients’ freedom from symptoms and patients’ indifference to health. They attributed mainly negative characteristics, like lack of knowledge and understanding, to non-adherent patients. These characteristics contribute to the difficulty of convincing these patients to take medications as prescribed.
General practitioners improved adherence by preventing side effects, explaining the medication’s necessity, facilitating intake and involving patients in decision-making. However, about half of the general practitioners reported threatening their patients with negative consequences of non-adherence.

Conclusions
General practitioners should be aware that discharge medication can be insufficient and thus, should always check hospital recommendations for accordance with guideline recommendations. Improving physicians’ communication skills and informing and motivating patients in an adequate manner, for example in simple language, should be an important goal in the hospital and the general practitioner setting. General practitioners should assess patients’ motivations through motivational interviewing, which no general practitioner mentioned during the interviews, and talk with them about adherence and long-term treatment goals regularly.
Association between lifestyle factors and decreased kidney function in older adults: a community-based cross-sectional analysis of the Taipei City elderly health examination database
Authors: Chang Horng-Jinh , Lin Kuan-Reng , Lin Meng-Te , Chang Junn-Liang 
Published: May 2020

Abstract
Background
Impaired kidney function is the hallmark of chronic kidney disease (CKD), and is associated with increased risk of all-cause mortality in the elderly. In the present cross-sectional population-based study, we aimed to evaluate the associations between lifestyle factors (exercise habit, alcohol consumption, smoking history, and betel nut chewing) and decreased kidney function.

Methods
The data from the Taipei City Elderly Health Examination Database (2006 to 2012) were extracted. Associations between risk factors and reduced estimated Glomerular filtration rate (eGFR) were evaluated by regression and stratification analyses.

Results
A total of 297,603 participants were included in the final analysis, and 29.7% of them had reduced eGFR. Smoking was significantly associated with an elevated risk of reduced eGFR. While, physical exercise conferred to a significantly decreased adjusted odds ratio (aOR) in reduced eGFR (regular exercise, aOR = 0.79; occasional exercise, aOR = 0.87). Furthermore, the protective effect of exercise habit against reduced eGFR was not affected by comorbid conditions, such as hypertension, diabetes, obesity, and cardiovascular disease.

Conclusions
Engaging in physical exercise was beneficially associated with reduced eGFR in older individuals. Longitudinal or prospective studies are warranted for confirmation and extrapolation of the current findings.
Cigarette smoke exposure impairs lipid metabolism by decreasing low-density lipoprotein receptor expression in hepatocytes
Authors: Ma Baitao , Chen Yunfei , Wang Xuebin , Zhang Rui , Niu Shuai , Ni Leng , Di Xiao , Han Qin , Liu Changwei 
Published: May 2020

Abstract
Background
Cigarette smoke (CS) exposure impairs serum lipid profiles and the function of vascular endothelial cells, which accelerates the atherosclerosis. However, the precise mechanism and effect on the expression of low-density lipoprotein receptor (LDLR) in the liver by CS exposure is still unclear.

Methods
In this study, adult male C57BL/6 J mice were divided into three groups, with one group being exposed to CS for 6 weeks. HepG2 cells were treated with CS extract at concentrations of 1, 2.5, 5, and 10%.

Results
The serum levels of total cholesterol (TC), triglycerides (TGs), and low-density lipoprotein cholesterol (LDL-C) for the CS-exposure group were significantly higher than those in the control group (P < 0.05). Moreover, CS exposure decreased the LDLR expression in the hepatocytes and promoted inflammation in the blood vessel walls. Melatonin was intraperitoneally injected at 10 mg/kg/d for 6 weeks alongside CS exposure, and this significantly decreased the levels of TC, TGs, and LDL-C and decreased the expression of intercellular adhesion molecule-1 and the infiltration of cluster determinant 68-cells. In vitro, CS extract prepared by bubbling CS through phosphate-buffered saline decreased the LDLR expression in HepG2 cells in a time- and concentration-dependent manner, and this effect was prevented by pretreatment with 100 μM melatonin.

Conclusions
In conclusion, CS exposure impaired lipid metabolism and decreased LDLR expression in hepatocytes, and these effects could be prevented by melatonin supplementation. These findings implied that melatonin has the potential therapeutic applicability in the prevention of lipid metabolic disorder in smokers.
Factors associated with health related quality of life of patients with stroke in Sri Lankan context
Authors: Kariyawasam Pramudika Nirmani , Pathirana Kithsiri Dedduwa , Hewage Don Chandana 
Published: May 2020

AbstractBackgroundStroke is a major global health concern which affects the health related quality of life (HRQOL). As the prevalence of stroke is increasing especially in lower-middle income countries, it is vital to identify the factors associated with the HRQOL of affected individuals.Available literature for post stroke HRQOL and the associated factors are mainly from high income countries. Therefore, we conducted this study to identify the factors associated with HRQOL of stroke survivors using a stroke specific measure.MethodsA longitudinal study was conducted with the participation of 257 stroke survivors. Participants were followed up after 3 months at the neurology and medical clinics in the Teaching Hospital, Karapitiya, Sri Lanka.Health related quality of life was assessed using the validated version of Stroke Aphasia Quality of Life (SAQOL)-39 generic scale. Pearson correlation, independent sample t-test, one-way ANOVA and regression analysis were used to identify the factors associated with quality of life.ResultsMean age of the participants with stroke was 66.1 (SD 11.7) years. The mean overall HRQOL was 3.15 (SD 0.96) as measured by the SAQOL-39 g. The socio-demographic factors which had significant associations with HRQOL were; gender, level of education, marital status, occupation and monthly income (p < 0.05). The clinical factors which had significant associations with HRQOL were; level of dependence and disability, type of stroke, side of the lesion, type of aphasia, level of language impairment, receiving physiotherapy and speech therapy and follow up care (p < 0.05). The results of regression indicated six independent predictors [F (6,234) = 42.6,p < 0.05], with an R2of 0.52. The HRQOL was significantly predicted by the level of dependence (β = .43,p < .01), level of language impairment (β = .20,p < .01), age (β = −.23,p < .01), type of stroke (β = −.19,p < .01), side of the lesion (β = .17,p < .01) and the level of education (β = .12,p < .05).ConclusionSevere degree of dependence, severe level of language impairment, older age, hemorrhagic stroke, and lesions in the left side were associated with lower HRQOL. Higher education level was associated with higher HRQOL scores.
Hemoperitoneum due to bleeding from a vein overlying a subserous uterine myoma: a case report
Authors: Rokhgireh Samaneh , Kashi Abolfazl Mehdizadeh , Kermansaravi Mohammad , Tajbakhsh Banafsheh , Allahqoli Leila , Alkatout Ibrahim , Khodaverdi Sepideh 
Published: May 2020

AbstractBackgroundFibroids are the most common pelvic tumors in women; serious complications are rare but can be life-threatening.Case presentationWe present a case report of a 38-year-old Persian woman with acute abdominal pain and a history of uterine fibroids. The patient refused to undergo a laparoscopic myomectomy. Her ultrasound examination revealed free fluid in the abdominal cavity, and her vital signs were indicative of vasogenic shock. A diagnostic laparoscopy was performed to identify and control the source of bleeding: 400 ml of blood and blood clots were removed. Active bleeding was seen from a vein overlying a subserosal myoma. A laparotomic myomectomy was performed, and the patient was discharged 3 days after surgery with no complications.ConclusionSurgeons should consider the possibility of this complication in women with acute abdominal pain and a history of uterine leiomyoma.
Physiologic perfusion monitoring methods during endovascular revascularization for atherosclerotic peripheral arterial disease: protocol for a systematic review
Authors: Rockley Mark , Jetty Prasad , Wells George 
Published: May 2020

Abstract
Background
Endovascular therapy is a fundamental treatment for peripheral arterial disease. However, the success rate of endovascular therapy remains poor, as a third of patients with critical limb ischemia ultimately require a major amputation for gangrene despite endovascular treatment. This failure rate has prompted investigation into methods of determining physiologic procedural success before and after treatment, before clinically apparent outcomes occur such as gangrene. The aim of this systematic review is to evaluate if in patients undergoing endovascular surgery for lower extremity atherosclerotic peripheral arterial disease, do changes in physiologic measures of perfusion during surgery correlate with clinical outcomes.

Methods
We registered and designed a study protocol for a systematic review. Literature searches will be conducted in MEDLINE, EMBASE, and CENTRAL (from January 1977 onwards). Grey literature will be identified through OpenGrey and clinical trial registries, and supplemented by citation searches. We will include randomized controlled trials, quasi-experimental trials, and observational (cohort, case-control) studies conducted in human adults (age 18 or older) who received elective arterial angioplasty for atherosclerotic peripheral vascular disease. The primary outcome of interest will be major adverse limb events. Two investigators will independently screen all citation, full-text articles, and abstract data. The study quality (risk of bias) will be appraised appropriate tools. Data analysis and synthesis will be qualitative; no meta-analysis is planned, as the anticipated homogeneity of measurement and outcome reporting standardization is low.

Discussion
The treatment of peripheral arterial disease is unique in that the tissue of the ischemic leg is easily accessible for direct monitoring during procedures. This is contrasted with cardiac and neurologic monitoring during cardiac and cerebral procedures, where indirect or invasive measures are required to monitor organ perfusion. Currently synthesized evidence describing limb perfusion focuses on static states of ischemia, and does not evaluate the value of change in perfusion measurement as an indicator of endovascular treatment success. These methods could potentially be applied to optimize procedural outcomes by guiding perfusion-based decision-making during surgery.

Systematic review registration
PROSPERO CRD42019138192
Logbooks alone are not enough: initial experience with implementing a logbook for medical students in a clinical internship in gynecology and obstetrics
Authors: Jud Sebastian M. , Cupisti Susanne , Frobenius Wolfgang , Benn Sigrid , Winkler Andrea , Antoniadis Sophia , Beckmann Matthias W. , Heindl Felix 
Published: May 2020

Abstract
Background
Logbooks are being increasingly widely used as a means of improving medical education and further training. They will in all probability continue to be mandatory in the Practical Year (PJ) in Germany even after the upcoming amendment of the Medical Licensing Regulations (ÄAppO). However, there are different approaches to their design and use, and these are also currently undergoing considerable change. This study for the first time examines and discusses the influence of logbooks on students’ evaluation of a gynecology internship.

Methods
The study was based on a well-established two-part 1-week internship course, with initially unstructured morning classes on wards and duty areas, along with precisely planned afternoon classes with skills training by peer teachers and seminars supervised by duty-exempted physicians. The postgraduate lecturers were prepared for the introduction of the logbook in a special course, and the aim was to optimize morning classes by introducing learning objectives adapted to the respective locations. The effects over 38 weeks of practical training were examined in evaluations by 235 prospectively group-randomized students with and without logbooks (n = 166 and n = 66, respectively; three datasets were not evaluable).

Results
In the cohort comparison, the logbook group responded significantly more positively toward the internship at the start of the course (P = 0.046). In the final evaluation, however, medical supervision during the entire internship was rated significantly more poorly (P = 0.007). The logbook cohort also considered that guidance based on learning objectives was significantly worse, as was the extent to which wards and duty areas were prepared for the students (P = 0.001 and P = 0.029).

Conclusions
Introducing a logbook to optimize clinical teaching in internships may raise expectations that cannot always be met. In addition to adapting the learning objectives to a general framework that is less favorable in comparison with the Practical Year, the least that is required appears to be simultaneous and continuous mentoring of the lecturers, as well as an increase in staffing resources.
A nonintrusive reduced order model for nonlinear transient thermal problems with nonparametrized variability
Authors: Casenave Fabien , Gariah Asven , Rey Christian , Feyel Frederic 
Published: May 2020

AbstractIn this work, we consider a transient thermal problem, with a nonlinear term coming from the radiation boundary condition and a nonparametrized variability in the form complex scenarios for the initial condition and the convection coefficients and external temperatures. We use a posteriori reduced order modeling by snapshot Proper Orthogonal Decomposition. To treat the nonlinearity, hyperreduction is required in our case, since precomputing the polynomial nonlinearities becomes too expensive for the radiation term. We applied the Empirical Cubature Method, originally proposed for nonlinear structural mechanics, to our particular problem. We apply the method to the design of high-pressure compressors for civilian aircraft engines, where a fast evaluation of the solution temperature is required when testing new configurations. We also illustrate that when using in the reduced solver the same model as the one from the high-fidelity code, the approximation is very accurate. However, when using a commercial code to generate the high-fidelity data, where the implementation of the model and solver is unknown, the reduced model is less accurate but still within engineering tolerances in our tests. Hence, the regularizing property of reduced order models, together with a nonintrusive approach, enables the use of commercial software to generate the data, even under some degree of uncertainty in the proprietary model or solver of the commercial software.
Analyzing the disaster response competency of the local government official and the elected representative in Nepal
Authors: Malla Shrijan Bahadur , Dahal Ranjan Kumar , Hasegawa Shuichi 
Published: May 2020

AbstractLocal authorities i.e. government officials working at the district level and below and elected representatives of municipalities are the steering body of local-level disaster response mechanism in Nepal. The effectiveness of response operation moreover depends on their competency. This paper investigates their disaster response knowledge, preparedness, and perception, and to identify gaps and suggest recommendations.The prevailing competency of Nepalese local authorities doesn’t warrant an effective response during the time of disaster. They lack awareness and preparedness. Amidst their positive perception towards the need of disaster response capacity building, in the void of an effective mechanism, the government has failed to enhance their competency.The national investment for disaster response competency building is meager in Nepal. The country heavily relies on foreign aid. The present capacity-building mechanism should be redressed from the newer dynamic.
Predictors of mental health and academic outcomes in first-year university students: Identifying prevention and early-intervention targets
Authors: Duffy A. , Keown-Stoneman C. , Goodday S. , Horrocks J. , Lowe M. , King N. , Pickett W. , McNevin S. H. , Cunningham S. , Rivera D. , Bisdounis L. , Bowie C. R. , Harkness K. , Saunders K. E. A. 
Published: May 2020

Background
Although there is growing interest in mental health problems in university students there is limited understanding of the scope of need and determinants to inform intervention efforts.

Aims
To longitudinally examine the extent and persistence of mental health symptoms and the importance of psychosocial and lifestyle factors for student mental health and academic outcomes.

Method
Undergraduates at a Canadian university were invited to complete electronic surveys at entry and completion of their first year. The baseline survey measured important distal and proximal risk factors and the follow-up assessed mental health and well-being. Surveys were linked to academic grades. Multivariable models of risk factors and mental health and academic outcomes were fit and adjusted for confounders.

Results
In 1530 students surveyed at entry to university 28% and 33% screened positive for clinically significant depressive and anxiety symptoms respectively, which increased to 36% and 39% at the completion of first year. Over the academic year, 14% of students reported suicidal thoughts and 1.6% suicide attempts. Moreover, there was persistence and overlap in these mental health outcomes. Modifiable psychosocial and lifestyle factors at entry were associated with positive screens for mental health outcomes at completion of first year, while anxiety and depressive symptoms were associated with lower grades and university well-being.

Conclusions
Clinically significant mental health symptoms are common and persistent among first-year university students and have a negative impact on academic performance and well-being. A comprehensive mental health strategy that includes a whole university approach to prevention and targeted early-intervention measures and associated research is justified.
A New Oral Testosterone Undecanoate Formulation Restores Testosterone to Normal Concentrations in Hypogonadal Men
Authors: Swerdloff Ronald S , Wang Christina , White William B , Kaminetsky Jed , Gittelman Marc C , Longstreth James A , Dudley Robert E , Danoff Theodore M 
Published: May 2020

Abstract

Context
A novel formulation of oral testosterone (T) undecanoate (TU) was evaluated in a phase 3 clinical trial.

Objective
Determine efficacy, short-term safety, and alignment of new oral TU formulation with current US approval standards for T replacement therapy.

Design
Randomized, active-controlled, open-label study.

Setting and Patients
Academic and private clinical practice sites; enrolled patients were clinically hypogonadal men 18 to 65 years old.

Methods
Patients were randomized 3:1 to oral TU, as prescribed (JATENZO®; n = 166) or a topical T product once daily (Axiron®; n = 56) for 3 to 4 months. Dose titration was based on average T levels (Cavg) calculated from serial pharmacokinetic (PK) samples. T was assayed by liquid chromatography–mass spectrometry/mass spectrometry. Patients had 2 dose adjustment opportunities prior to final PK visit. Safety was assessed by standard clinical measures, including ambulatory blood pressure (BP).

Results
87% of patients in both groups achieved mean T Cavg in the eugonadal range. Sodium fluoride-ethylenediamine tetra-acetate plasma T Cavg (mean ± standard deviation) for the oral TU group was 403 ± 128 ng/dL (~14 ± 4 nmol/L); serum T equivalent, ~489 ± 155 ng/dL (17 ± 5 nmol/L); and topical T, 391 ± 140 ng/dL (~14 ± 5 nmol/L). Modeling/simulation of T PK data demonstrated that dose titration based on a single blood sample 4 to 6 h after oral TU dose yielded efficacy (93%) equivalent to Cavg-based titration (87%). Safety profiles were similar in both groups, but oral TU was associated with a mean increase in systolic BP of 3 to 5 mm Hg.

Conclusion
A new oral TU formulation effectively restored T to mid-eugonadal levels in hypogonadal patients.