bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disponibilidad y barreras para el acceso a opioides en Colombia: experiencia de una institución universitaria
Authors: Flórez Rojas Sandra Patricia , León Delgado Marta Ximena , Rubiano González Lina María , Malagón Sintura Yenny Carolina , Gómez Castellanos Sandra Milena , Castellanos Caro Gina Lizeth , Briker Ángel Andrea , Torres Anaya Ana Marcela 
Published: January 2020

Introducción: El consumo de opioides es uno de los indicadores de la calidad de alivio de dolor de un país. Colombia presenta un bajo consumo de opioides para uso médico, debido a diferentes factores a lo largo de una cadena de distribución, cuyo usuario final es el paciente. Identificar las barreras que los pacientes encuentran para acceder a dichos medicamentos, permitirá sugerir soluciones.Métodos: Mediante una encuesta estructurada se determinaron las barreras para acceder a los opioides de pacientes con dolor crónico que asistieron a una consulta ambulatoria de dolor en una institución hospitalaria en Colombia.Resultados: Se encuestaron 24 pacientes entre 40 y 59 años. El 67% tuvo problemas para obtener el medicamento; 33% reportó problemas de autorización con sus aseguradoras; 33% tuvo inconvenientes con el sitio de entrega del medicamento; 17% tuvo problemas con la información sobre cómo hacer el trámite y, 17%, problemas con la fórmula médica. Conclusiones: La mayoría de los pacientes tuvo dificultades para acceder adecuadamente al opioide. Se sugiere proponer mecanismos para mejorar las condiciones de acceso a los opioides para los pacientes que sufren dolor.
Sarcoma de Kaposi en trasplante renal, respuesta a sirolimus: reporte de caso y revisión de la literatura científica
Authors: García Paola Karina , Córdoba Buritica Juan Pablo , Rodríguez Martha Patricia , Echeverri José Enrique , Lozano Eyner , Benavides Carlos 
Published: January 2020

El cáncer en el paciente que ha recibido un trasplante es una enfermedad reconocida, con factores de riesgo demostrados e incidencia 3,12 mayor que en la población general. El sarcoma de Kaposi ocurre 400 a 500 veces más frecuentemente en el receptor de trasplante renal. Hicimos una revisión de la literatura científica a raíz del primer caso de sarcoma de Kaposi en nuestro grupo de trasplante renal del Hospital Universitario San Ignacio.
Consumo de psicotrópicos sin prescripción médica en farmacodependientes en proceso de rehabilitación
Authors: Medina-Pérez Óscar , Rubio Luz Adriana , Ramírez-Carrillo Sandra Viviana , Rodríguez-Bernal Mileidy 
Published: January 2020

Objetivo. Caracterizar el consumo de psicotrópicos sin prescripción médica en farmacodependientes atendidos por una fundación dedicada a la rehabilitación, en el departamento del Quindío, Colombia, entre los años 2006 y 2009.Métodos. Se utilizó como instrumento para recolectar la información el formulario del Sistema de Vigilancia Epidemiológica para Uso Indebido de Sustancias Psicoactivas –VESPA–, aplicados a los usuarios al momento de ingresar a la institución.Resultados. En total, 175 personas manifestaron haber consumido psicotrópicos sin prescripción médica; de ellas, 92% dijo haber consumido Rivotril y 15% consumieron Rohypnol. Actualmente, 62 consume psicotrópicos y, de ellos, 21% los ingieren, por lo menos, una vez al día. La edad promedio de inicio de consumo de sustancias psicoactivas fue 12,61 años, en su mayoría, tabaco (43%); la de psicotrópicos fue 16,9 años. Conclusiones. Estas cifras sugieren, por un lado, la necesidad de más programas de prevención de consumo de sustancias psicoactivas y, por el otro, de que las autoridades competentes adopten más medidas de control sobre la circulación y el expendio de psicotrópicos.
Importancia y utilidad de las “Guías de simulación clínica” en los procesos de aprendizaje en medicina y ciencias de la salud
Authors: Amaya Afanador Adalberto 
Published: January 2020

El uso de guías es una herramienta didáctica tradicionalmente utilizada, no solo en educación médica y ciencias de la salud sino en múltiples profesiones, principalmente por aquellos que fundamentan su quehacer docente en el constructivismo. Su utilidad se ha centrado para la formación en medicina y otras ciencias de la salud en la estandarización de protocolos de manejo, los cuales muchas veces utilizan, por ejemplo, a la denominada medicina basada en la evidencia, como criterio fundamental de calidad con el fin de lograr dicha estandarización conceptual. La utilidad que tienen las guías de simulación clínica difiere un poco de este concepto y, a pesar de requerir obviamente de una fundamentación científica inequívoca, las guías se convierten en un producto intelectual docente, centrado en un proyecto educativo que refleja en la mayoría de los casos una escuela de formación.A diferencia del concepto descrito de manera tradicional, en el cual el objeto de las guías corresponde a la globalización y estandarización de procesos, las guías en simulación clínica, si bien estandarizan procesos con el fin de obtener mejores desempeños en la evaluación de los mismos, no pretenden ser globalizados sino centrados en una visión de formación docente acorde con el proyecto educativo institucional; por lo tanto, son de carácter institucional y favorecen el desarrollo de la denominada “escuela de formación”.De igual manera, el uso de guías de simulación clínica favorece los conceptos educativos actuales, tales como evaluación formativa, autoevaluación y coevaluación, seguridad psicológica, formación por competencias y seguridad del paciente.
Callosotomía en el tratamiento de epilepsia resistente
Authors: Mantilla Borda David Leonardo , Nariño González Daniel , Acevedo González Juan Carlos , Berreo Calderón Manuel Enrique , Zorro Guío Óscar Fernando 
Published: January 2020

La callosotomía es una técnica aunque antigua aun hoy en día sigue vigente como opción terapéutica quirúrgica en pacientes con epilepsia refractaria, en especial pacientes con epilepsia multifocal, crisis tónicas, atónicas y drops attacks, es una cirugía segura con baja morbilidad y mortalidad siendo la mayoría de las veces complicaciones transitorias.
Linking risk factors and outcomes in autism spectrum disorder: is there evidence for resilience?
Authors: Elsabbagh Mayada 
Published: January 2020

Abstract
Autism spectrum disorder (referred to here as autism) is one of several overlapping neurodevelopmental conditions that have variable impacts on different individuals. This variability results from dynamic interactions between biological and non-biological risk factors, which result in increasing differentiation between individuals over time. Although this differentiation continues well into adulthood, the infancy period is when the brain and behavior develop rapidly, and when the first signs and symptoms of autism emerge. This review discusses advances in our understanding of the causal pathways leading to autism and overlapping neurodevelopmental conditions. Research is also mapping trajectories of brain and behavioral development for some risk groups, namely later born siblings of children with autism and/or infants referred because of developmental concerns. This knowledge has been useful in improving early identification and establishing the feasibility of targeted interventions for infant risk groups before symptoms arise. However, key knowledge gaps remain, such as the discovery of protective factors (biological or environmental) that may mitigate the impact of risk. Also, the dynamic mechanisms that underlie the associations between risk factors and outcomes need further research. These include the processes of resilience, which may explain why some individuals at risk for autism achieve better than expected outcomes. Bridging these knowledge gaps would help to provide tools for early identification and intervention that reflect dynamic developmental pathways from risk to outcomes.
Is telehealthcare for heart failure patients cost-effective? An economic evaluation alongside the Danish TeleCare North heart failure trial
Authors: Vestergaard Anne Sig , Hansen Louise , Sørensen Sabrina Storgaard , Jensen Morten Berg , Ehlers Lars Holger 
Published: January 2020

ObjectiveThis study aimed to assess the cost-effectiveness of telehealthcare in heart failure patients as add-on to usual care.DesignA cost-utility analysis was conducted from a public payer perspective alongside the randomised controlled TeleCare North trial.SettingThe North Denmark Region, Denmark.ParticipantsThe study included 274 heart failure patients with self-reported New York Heart Association class II-IV.InterventionsPatients in the intervention group were provided with a Telekit consisting of a tablet, a digital blood pressure monitor, and a scale and were instructed to perform measurements one to two times a week. The responsibility of the education, instructions and monitoring of the heart failure (HF) patients was placed on municipality nurses trained in HF and telemonitoring. Both groups received usual care.Outcome measuresCost-effectiveness was reported as incremental net monetary benefit (NMB). A micro-costing approach was applied to evaluate the derived savings in the first year in the public health sector. Quality-adjusted life-years (QALY) gained were estimated using the EuroQol 5-Dimensions 5-Levels questionnaire at baseline and at a 1-year follow-up.ResultsData for 274 patients were included in the main analysis. The telehealthcare solution provided a positive incremental NMB of £5164. The 1-year adjusted QALY difference between the telehealthcare solution and the usual care group was 0.0034 (95% CI: −0.0711 to 0.0780). The adjusted difference in costs was -£5096 (95% CI: −8736 to −1456) corresponding to a reduction in total healthcare costs by 35%. All sensitivity analyses showed the main results were robust.ConclusionsThe TeleCare North solution for monitoring HF was highly cost-effective. There were significant cost savings on hospitalisations, primary care contacts and total costs.Trial registration numberClinicalTrials.gov:NCT02860013.
Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study
Authors: McKinley Nicola , McCain R Scott , Convie Liam , Clarke Mike , Dempster Martin , Campbell William Jeffrey , Kirk Stephen James 
Published: January 2020

AimsThis cross-sectional study aimed to assess resilience, professional quality of life and coping mechanisms in UK doctors. It also aimed to assess the impact of demographic variables, such as sex, grade and specialty on these factors.MethodsDuring October and November 2018, medical doctors in the UK were eligible to complete an online survey made up of validated psychological instruments. Royal Colleges and other medical organisations invited their membership to participate via newsletters, email invitations, websites and social media.Results1651 doctors participated from a wide range of specialties and grades across the UK. The mean resilience score was 65.01 (SD 12.3), lower than population norms. Of those who responded, 31.5% had high burnout (BO), 26.2% had high secondary traumatic stress and 30.7% had low compassion satisfaction (CS). Doctors who responded from emergency medicine were more burned out than any other specialty group (F=2.62, p=0.001, df 14). Those who responded from general practice scored lowest for CS (F=6.43, p<0.001, df 14). 120 (8%) doctors met the criteria for all three of high BO, high STS and low CS. The most frequently reported coping mechanism was the maladaptive strategy of self-distraction.ConclusionsOne-third of UK doctors who responded are burned out and suffering from STS. Those who responded from emergency medicine and general practice appear to be suffering the most. Over 100 doctors fell into the at-risk category of high BO, high STS and low CS. Future analysis of the free text responses from doctors may help to identify factors that are playing a role in the high levels of BO and STS being reported by medical staff.
Vulnerability of different nerves to intrafascicular injection by different needle types and at different approach angles: a mathematical model
Authors: Sanromán-Junquera Margarita , Boezaart Andre , Zasimovich Yury , Nin Olga C , Sala-Blanch Xavier , De Andres Jose , Reina Miguel A 
Published: January 2020

Background and objectivesWe assume that intrafascicular spread of a solution can only occur if a large enough portion of the distal needle orifice is placed inside the fascicle. Our aim is to present and evaluate a mathematical model that can calculate the theoretical vulnerability of fascicles, analyzing the degree of occupancy of the needle orifice in fascicular tissue by performing simulations of multiple positions that a needle orifice can take inside a cross-sectional nerve area.MethodsWe superimposed microscopic images of two routinely used nerve block needles (22-gauge, 15° needle and 22-gauge, 30° needle) over the microscopic images of cross-sections of four nerve types photographed at the same magnification. Fascicular tissue that was overlapped between 80% and 100% by a needle orifice was considered at risk to possible intrafascicular injection. The effect of three angular approaches was evaluated.ResultsThere were statistical differences between the vulnerability of fascicular tissue depending on nerve type, the bevel angle of the needle and the angle approach. Fascicular vulnerability was greater in nerve roots of the brachial plexus after using a 22-gauge 30° needle, as was choosing a 45° angle approach to the longitudinal axis of the nerve.ConclusionsOur results suggest that clinicians may want to consider needle insertion angle and bevel type as they perform peripheral nerve blocks. Furthermore, researchers may want to consider this mathematical model when estimating vulnerabilities of various nerves, needle types and angles of approach of needles to nerves.
Time-independent approximations for time-dependent optical potentials
Authors: Fring Andreas , Tenney Rebecca 
Published: January 2020

AbstractWe explore the possibility of modifying the Lewis–Riesenfeld method of invariants developed originally to find exact solutions for time-dependent quantum mechanical systems for the situation in which an exact invariant can be constructed, but the subsequently resulting time-independent eigenvalue system is not solvable exactly. We propose to carry out this step in an approximate fashion, such as employing standard time-independent perturbation theory or the WKB approximation, and subsequently feeding the resulting approximated expressions back into the time-dependent scheme. We illustrate the quality of this approach by contrasting an exactly solvable solution to one obtained with a perturbatively carried out second step for two types of explicitly time-dependent optical potentials.
Phase II Trial of Cabozantinib in Recurrent/Metastatic Endometrial Cancer: A Study of the Princess Margaret, Chicago, and California Consortia (NCI9322/PHL86)
Authors: Dhani Neesha C. , Hirte Hal W. , Wang Lisa , Burnier Julia V. , Jain Angela , Butler Marcus O. , Welch Stephen , Fleming Gini F. , Hurteau Jean , Matsuo Koji , Matei Daniela , Jimenez Waldo , Johnston Carolyn , Cristea Mihaela , Tonkin Katia , Ghatage Prafull , Lheureux Stephanie , Mehta Anjali , Quintos Judy , Tan Qian , Kamel-Reid Suzanne , Ludkovski Olga , Tsao Ming-Sound , Wright John J. , Oza Amit M. 
Published: January 2020

Abstract

Purpose:
The relevance of the MET/hepatocyte growth factor pathway in endometrial cancer tumor biology supports the clinical evaluation of cabozantinib in this disease.

Patients and Methods:
PHL86/NCI#9322 (NCT01935934) is a single arm study that evaluated cabozantinib (60 mg once daily) in women with endometrial cancer with progression after chemotherapy. Coprimary endpoints were response rate and 12-week progression-free-survival (PFS). Patients with uncommon histology endometrial cancer (eg, carcinosarcoma and clear cell) were enrolled in a parallel exploratory cohort.

Results:
A total of 102 patients were accrued. Among 36 endometrioid histology patients, response rate was 14%, 12-week PFS rate was 67%, and median PFS was 4.8 months. In serous cohort of 34 patients, response rate was 12%, 12-week PFS was 56%, and median PFS was 4.0 months. In a separate cohort of 32 patients with uncommon histology endometrial cancer (including carcinosarcoma), response rate was 6% and 12-week PFS was 47%. Six patients were on treatment for &gt;12 months, including two for &gt;30 months. Common cabozantinib-related toxicities (&gt;30% patients) included hypertension, fatigue, diarrhea, nausea, and hand–foot syndrome. Gastrointestinal fistula/perforation occurred in four of 70 (6%) patients with serous/endometrioid cancer and five of 32 (16%) patients in exploratory cohort. We observed increased frequency of responses with somatic CTNNB1 mutation [four partial responses (PRs) in 10 patients, median PFS 7.6 months] and concurrent KRAS and PTEN/PIK3CA mutations (three PRs in 12 patients, median PFS 5.9 months).

Conclusions:
Cabozantinib has activity in serous and endometrioid histology endometrial cancer. These results support further evaluation in genomically characterized patient cohorts.
Investigating Long-Range Seasonal Predictability of East African Short Rains: Influence of the Mascarene High on the Indian Ocean Walker Cell
Authors: Peng Xiao , Steinschneider Scott , Albertson John 
Published: January 2020

AbstractWe investigate the predictability of East African short rains at long (up to 12 month) lead times by relating seasonal rainfall anomalies to climate anomalies associated with the predominant Walker circulation, including sea surface temperatures (SST), geopotential heights, zonal and meridional winds, and vertical velocities. The underlying teleconnections are examined using a regularized regression model that shows two periods of high model skill (0–3-month lead and 7–9-month lead) with similar spatial patterns of predictability. We observe large-scale circulation anomalies consistent with the Walker circulation at short lead times (0–3 months) and dipoles of SST and height anomalies over the Mascarene high region at longer lead times (7–9 months). These two patterns are linked in time by anticyclonic winds in the dipole region associated with a perturbed meridional circulation (4–6-month lead). Overall, these results suggest that there is potential to extend forecast lead times beyond a few months for drought impact mitigation applications.
Weather Literacy in Times of Climate Change
Authors: Fleischhut Nadine , Herzog Stefan M. , Hertwig Ralph 
Published: January 2020

AbstractAs climate change unfolds, extreme weather events are on the rise worldwide. According to experts, extreme weather risks already outrank those of terrorism and migration in likelihood and impact. But how well does the public understand weather risks and forecast uncertainty and thus grasp the amplified weather risks that climate change poses for the future? In a nationally representative survey (N = 1004; Germany), we tested the public’s weather literacy and awareness of climate change using 62 factual questions. Many respondents misjudged important weather risks (e.g., they were unaware that UV radiation can be higher under patchy cloud cover than on a cloudless day) and struggled to connect weather conditions to their impacts (e.g., they overestimated the distance to a thunderstorm). Most misinterpreted a probabilistic forecast deterministically, yet they strongly underestimated the uncertainty of deterministic forecasts. Respondents with higher weather literacy obtained weather information more often and spent more time outside but were not more educated. Those better informed about climate change were only slightly more weather literate. Overall, the public does not seem well equipped to anticipate weather risks in the here and now and may thus also fail to fully grasp what climate change implies for the future. These deficits in weather literacy highlight the need for impact forecasts that translate what the weather may be into what the weather may do and for transparent communication of uncertainty to the public. Boosting weather literacy may help to improve the public’s understanding of weather and climate change risks, thereby fostering informed decisions and mitigation support.
Intraoperative Primary Tumor Identification and Margin Assessment in Head and Neck Unknown Primary Tumors
Authors: Herruer Jasmijn M. , Taylor S. Mark , MacKay Colin A. , Ubayasiri Kishan M. , Lammers Deanna , Kuta Victoria , Bullock Martin J. , Corsten Martin J. , Trites Jonathan R. B. , Rigby Matthew H. 
Published: January 2020

ObjectiveSurgical management of the unknown primary head and neck squamous cell carcinoma (UP HNSCC) remains controversial due to challenging clinical diagnosis. This study compares positron emission tomography–computed tomography (PET‐CT) findings with intraoperative identification of primary tumors and compares intraoperative frozen‐section margins to final histopathology. In addition, adjuvant therapy indications are provided.Study DesignProspective cohort study.SettingAcademic university hospital.Subjects and MethodsSixty‐one patients with UP HNSCC were included. Patients received PET‐CT, followed by oropharyngeal transoral laser microsurgery (TLM). Margins were assessed intraoperatively using frozen sections and afterward by final histopathology. Adjuvant treatment was based on final histopathology.ResultsThe sensitivity of localizing the primary tumor with PET‐CT was 50.9% with a specificity of 82.5%. The primary tumor was found intraoperatively on frozen sections in 82% (n = 50) of patients. Five more tumors were identified on final histopathology, leading to a total of 90% (n = 55). Of the 50 intraoperatively found tumors, 98% (n = 49) had negative margins on frozen sections, and 90% (n = 45) were truly negative on final histopathology. Eighteen patients (29.5%) avoided adjuvant treatment.ConclusionPET‐CT localized the primary tumor in fewer than half the cases. This protocol identified 90% of primary tumors. Intraoperative frozen‐section margin assessment has shown potential with a specificity of 92% compared to final histopathology. As a result, adjuvant therapy was avoided in almost one‐third of our patients.
Down‐Expression of Kinin Receptors in Allergic Nasal Polyps Epithelia: An Immunohistochemistry Study
Authors: Warman Meir , Lahav Yonatan , Huszar Monica , Hadad Liad , Halperin Doron , Cohen Oded 
Published: January 2020

ObjectivesTo investigate the expression of B1 and B2 receptors in patients with nasal polyps (NPs) compared to controls.Study DesignRetrospective case series.SettingsSingle academic center.Subjects and MethodsNasal biopsies of patients with NPs were compared to inferior turbinates of control patients. Comparisons included basic demographics and comorbidities, intensity of inflammation, and immunohistochemical staining of B1 and B2 receptors measured by immunohistochemistry staining scores (ISSs).ResultsA total of 41 patients were enrolled, with 21 patients (51.2%) in the NP group and 20 patients as controls. No differences were found in the prevalence of allergic comorbidities and smoking between the groups. The NP group demonstrated significantly higher prevalence of moderate and severe mononuclear infiltrates compared to the control group (57.1% vs 5.3%, P <. 001). The NP group had significantly lower B1 expression in smooth muscle compared to the control group (mean ISS 0.22 vs 1.56, P <. 001, respectively) and significantly more B2 expression in epithelial cells (mean ISS 1.81 vs 0, P <. 001, respectively).ConclusionPatients with NPs exhibit different expression patterns of B1 and B2 compared to control patients. This implies that bradykinin receptor regulation participates in the pathogenesis of NPs.