bluuebunny/crossref_metadata_2025_split huggingface dataset:
A qualitative approach in determining the patient-centered information and supportive care needs of cancer patients in Singapore
Authors: Chua Gek Phin , Tan Hiang Khoon 
Published: February 2020

ObjectivesTo qualitatively interpret the information and supportive care needs perceived by cancer patients undergoing treatment in order to get a deeper appreciation of patients’ needs and concerns. The intended outcome is to provide baseline knowledge for improving patient-centred strategies to better meet the information and supportive needs of patients.DesignA qualitative research approach, based on conventional content analysis, was used throughout the research process. The three open-ended questions obtained from a previous quantitative study guided the researchers to explore the information and supportive care needs of patients. Data from patients’ responses were analysed and coded in themes.Participants and settingPatients attending the Ambulatory Treatment Unit of the National Cancer Centre Singapore were invited to participate in the study. We determined from these subjects the type of information that cancer patients need, and to measure the extent to which these information needs are met by measuring patients’ level of satisfaction. Included in the quantitative study were three open-ended questions designed to gain a deeper understanding of their needs and concerns. All subjects were aged 21 years and above and able to understand and communicate in English/Mandarin. They were also aware of their diagnosis, they were not cognitively impaired and were not at the end-of-life situation.ResultsA variety of information and supportive care needs were identified, and three specific areas of concerns were identified: (1) psychosocial and supportive care needs, (2) information needs and (3) information delivery by professionals.ConclusionThe information and supportive care needs expressed were consistent with issues of cancer patients undergoing treatment. The strategies to improve patients’ coping abilities through patient-centred care are discussed. Further studies assessing the barriers of information provision by healthcare professionals should provide more detailed knowledge about unmet information needs.
How defensive medicine is defined and understood in European medical literature: protocol for a systematic review
Authors: Baungaard Nathalie , Skovvang Pia , Assing Hvidt Elisabeth , Gerbild Helle , Kirstine Andersen Merethe , Lykkegaard Jesper 
Published: February 2020

IntroductionThe term defensive medicine, referring to actions motivated primarily by litigious concerns, originates from the USA and has been used in medical research literature since the late 1960s. Differences in medical legal systems between the US and most European countries with no tort legislation raise the question whether the US definition of defensive medicine holds true in Europe.AimTo present the protocol of a systematic review investigating variations in definitions and understandings of the term ‘defensive medicine’ in European research articles.Methods and analysisIn concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of all medical research literature that investigate defensive medicine will be performed by two independent reviewers. The databases PubMed, Embase and Cochrane will be systematically searched on the basis of predetermined criteria. Data from all included European studies will systematically be extracted including the studies’ definitions and understandings of defensive medicine, especially the motives for doing medical actions that the study regards as ‘defensive’.Ethics and disseminationNo ethics clearance is required as no primary data will be collected. The results of the systematic review will be published in a peer-reviewed, international journal.PROSPERO registration numberThis review has been submitted to International Prospective Register of Systematic Reviews (PROSPERO) and is awaiting registration.
Study protocol of a randomised controlled trial of prostate radiotherapy in high-risk and node-positive disease comparing moderate and extreme hypofractionation (PRIME TRIAL)
Authors: Murthy Vedang , Mallick Indranil , Gavarraju Abhilash , Sinha Shwetabh , Krishnatry Rahul , Telkhade Tejshri , Moses Arunsingh , Kannan Sadhna , Prakash Gagan , Pal Mahendra , Menon Santosh , Popat Palak , Rangarajan Venkatesh , Agarwal Archi , Kulkarni Sheetal , Bakshi Ganesh 
Published: February 2020

IntroductionThere has been an interest in studying the efficacy of extreme hypofractionation in low and intermediate risk prostate cancer utilising the low alpha/beta ratio of prostate. Its role in high-risk and node-positive prostate cancer, however, is unknown. We hypothesise that a five-fraction schedule of extreme hypofractionation will be non-inferior to a moderately hypofractionated regimen over 5 weeks in efficacy and will have acceptable toxicity and quality of life while reducing the cost implications during treatment.Methods and analysisThis is an ongoing, non-inferiority, multicentre, randomised trial (NCT03561961) of two schedules for National Cancer Control Network high-risk and/or node-positive non-metastatic carcinoma of the prostate. The standard arm will be a schedule of 68 Gy/25# over 5 weeks while the test arm will be extremely hypofractionated radiotherapy with stereotactic body radiation therapy to 36.25 Gy/5# (7 to 10 days). The block randomisation will be stratified by nodal status (N0/N+), hormonal therapy (luteinizing hormone-releasing hormone therapy/orchiectomy) and centre. All patients will receive daily image-guided radiotherapy.The primary end point is 4-year biochemical failure free survival (BFFS). The power calculations assume 4-year BFFS of 80% in the moderate hypofractionation arm. With a 5% one-sided significance and 80% power, a total of 434 patients will be randomised to both arms equally (217 in each arm). The secondary end points include overall survival, prostate cancer specific survival, acute and late toxicities, quality of life and out-of-pocket expenditure.DiscussionThe trial aims to establish a therapeutically efficacious and cost-efficient modality for high-risk and node-positive prostate cancer with an acceptable toxicity profile. Presently, this is the only trial evaluating and answering such a question in this cohort.Ethics and disseminationThe trial has been approved by IEC-III of Tata Memorial Centre, Mumbai.Trial registration numberRegistered with CTRI/2018/05/014054 (http://ctri.nic.in) on 24 May 2018
Prevalence and determinants of current cigarette smoking and secondhand smoking among Greek adolescents: the Global Youth Tobacco Survey (GYTS) 2013 study
Authors: Rachiotis George , Barbouni Anastasia , Basagiannis Athanasios , Katsioulis Antonis , Kostikas Konstantinos , Mouchtouri Varvara , Merakou Kyriakoula , Kremastinou Jenny , Hadjichristodoulou Christos S 
Published: February 2020

ObjectivesSmoking prevalence in Greece is considered high within the European Union and the collection of evidence on tobacco use among adolescents is of vital importance in order to develop effective smoking prevention and cessation programmes.DesignCross-sectional.SettingGreece.Primary and secondary outcome measuresGlobal Youth Tobacco Survey (GYTS) is a national representative, paper-and-pencil, cross-sectional, school-based study of students at ages 13–15 years. The survey employed a multistage cluster sample design with schools selected proportional to enrolment size. Finally, 4618/5127 students aged 13–15 years participated in the survey. The school response rate was 98.1%, the student response rate was 90.1% and the overall response rate was 88.4%.ResultsThe prevalence of current cigarette smoking was estimated at 10.1% (10.4% in GYTS 2005) and of exposure to secondhand smoking in public places at 67.4% (94.1% in GYTS 2005). The vast majority of the adolescents (82.1%) supported the banning of smoking inside enclosed public places. Most of the current smokers (90.8%) were not prevented/refused purchase because of their age according to existing law. Multivariate analysis showed that peer influence (OR=48.32; 95% CI 36.2 to 64.48), pocket money (OR=2.63; 95% CI 1.28 to 3.41), increasing age (OR=2.35; 95% CI 1.63 to 3.39) and low educational level of father (OR=2.82; 95% CI 1.7 to 4.68) were risk factors independently associated with current cigarette smoking.ConclusionsDespite the existence of strict laws related to tobacco control, exposure to secondhand smoking among Greek students remained high even when compared with GYTS in 2005. This is likely a result of weak enforcement, what is really missing is the enforcement of the related legislation.
Medroxyprogesterone acetate plus metformin for fertility-sparing treatment of atypical endometrial hyperplasia and endometrial carcinoma: trial protocol for a prospective, randomised, open, blinded-endpoint design, dose-response trial (FELICIA trial)
Authors: Mitsuhashi Akira , Kawasaki Yohei , Hori Makoto , Fujiwara Tadami , Hanaoka Hideki , Shozu Makio 
Published: February 2020

IntroductionProgestin therapy is the only fertility-sparing treatment option for patients with atypical endometrial hyperplasia (AEH) and endometrial cancer (EC). However, the results of three meta-analyses revealed a high remission rate, as well as an association with a high rate of relapse. We previously conducted a phase II of medroxyprogesterone acetate (MPA) plus metformin as a fertility-sparing treatment for AEH and EC patients, and reported that metformin inhibited disease relapse after remission.Methods and analysisA randomised, open, blinded-endpoint design phase IIb dose response trial was planned to commence in July 2019. The trial aims to identify the appropriate dose of metformin to be combined with MPA therapy for fertility-sparing treatment of patients with AEH and EC. The primary endpoint of the trial is the 3-year relapse-free survival (RFS) rate. The secondary endpoints are RFS rate, the overall rate of response to MPA therapy, the conception rate after treatment, the outcome of pregnancy, toxicity evaluation and changes in insulin resistance and body mass index. A total of 120 patients will be enrolled from 15 Japanese institutions within a 2.5-year period and followed up for at least 3 years.Ethics and disseminationThe protocol was approved by the institutional review board at Chiba University Hospital and boards at 14 other institutions. The trial will be conducted according to the principles of the World Medical Association’s Declaration of Helsinki and in accordance with Good Clinical Practice (GCP) standards. The trial findings will be published in a peer-reviewed journal.Trial registration numberJapan Registry of Clinical Trials (jRCT2031190065).
i-Move, a personalised exercise intervention for patients with advanced melanoma receiving immunotherapy: a randomised feasibility trial protocol
Authors: Hyatt Amelia , Gough Karla , Murnane Andrew , Au-Yeung George , Dawson Tamara , Pearson Elizabeth , Dhillon Haryana , Sandhu Shahneen , Williams Narelle , Paton Elizabeth , Billett Alex , Traill Anya , Andersen Hayley , Beedle Victoria , Milne Donna 
Published: February 2020

IntroductionThere is increasing evidence demonstrating the benefits of exercise in counteracting cancer treatment-related fatigue. Immunotherapy is an established treatment for advanced melanoma, and is associated with fatigue in a third of patients. The safety and efficacy of exercise in counteracting treatment-related fatigue in patients with advanced melanoma receiving immunotherapy are yet to be determined. This study aims to assess the safety, adherence to and acceptability of a mixed-methods parallel-group, pilot randomised controlled trial of a personalised, 12-week semi-supervised exercise programme prescribed by an exercise physiologist (iMove) in 30 patients with stage IV melanoma scheduled to commence immunotherapy: single agent ipilimumab, nivolumab or pembrolizumab, or combination ipilimumab and nivolumab. The trial will be used to provide preliminary evidence of the potential efficacy of exercise for managing fatigue.Methods and analysisThirty participants will be recruited from a specialist cancer centre between May and September, 2019. Participants will be randomised 1:1 to receive iMove, or usual care (an information booklet about exercise for people with cancer). Feasibility data comprise: eligibility; recruitment and retention rates; adherence to and acceptability of exercise consultations, personalised exercise programme and study measures; and exercise-related adverse events. Patient-reported outcome measures assess potential impact of the exercise intervention on: fatigue, role functioning, symptoms and quality of life. Follow-up will comprise five time points over 24 weeks. Physical assessments measure physical fitness and functioning.Ethics and disseminationThis study was reviewed and approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (HREC/48927/PMCC-2019). The findings from this trial will be disseminated via conference presentations and publications in peer-reviewed journals, and by engagement with clinicians, media, government and consumers. In particular, we will promote the outcomes of this work among the oncology community should this pilot indicate benefit for patients.Trial registration numberACTRN12619000952145; Pre-results.
Serious bacterial infections and antibiotic prescribing in primary care: cohort study using electronic health records in the UK
Authors: Gulliford Martin C , Sun Xiaohui , Charlton Judith , Winter Joanne R , Bunce Catey , Boiko Olga , Fox Robin , Little Paul , Moore Michael , Hay Alastair D , Ashworth Mark 
Published: February 2020

ObjectiveThis study evaluated whether serious bacterial infections are more frequent at family practices with lower antibiotic prescribing rates.DesignCohort study.Setting706 UK family practices in the Clinical Practice Research Datalink from 2002 to 2017.Participants10.1 million registered patients with 69.3 million patient-years’ follow-up.ExposuresAll antibiotic prescriptions, subgroups of acute and repeat antibiotic prescriptions, and proportion of antibiotic prescriptions associated with specific-coded indications.Main outcome measuresFirst episodes of serious bacterial infections. Poisson models were fitted adjusting for age group, gender, comorbidity, deprivation, region and calendar year, with random intercepts representing family practice-specific estimates.ResultsThe age-standardised antibiotic prescribing rate per 1000 patient-years increased from 2002 (male 423; female 621) to 2012 (male 530; female 842) before declining to 2017 (male 449; female 753). The median family practice had an antibiotic prescribing rate of 648 per 1000 patient-years with 95% range for different practices of 430–1038 antibiotic prescriptions per 1000 patient-years. Specific coded indications were recorded for 58% of antibiotic prescriptions at the median family practice, the 95% range at different family practices was from 10% to 75%. There were 139 759 first episodes of serious bacterial infection. After adjusting for covariates and the proportion of coded consultations, there was no evidence that serious bacterial infections were lower at family practices with higher total antibiotic prescribing. The adjusted rate ratio for 20% higher total antibiotic prescribing was 1.03, (95% CI 1.00 to 1.06, p=0.074).ConclusionsWe did not find population-level evidence that family practices with lower total antibiotic prescribing might have more frequent occurrence of serious bacterial infections overall. Improving the recording of infection episodes has potential to inform better antimicrobial stewardship in primary care.
Effect of short moderate intensity exercise bouts on cardiovascular function and maximal oxygen consumption in sedentary older adults
Authors: Magutah Karani , Thairu Kihumbu , Patel Nilesh 
Published: February 2020

AimTo investigate effect of <10 min moderate intensity exercise on cardiovascular function and maximal oxygen consumption (V˙O2max) among sedentary adults.MethodsWe studied 53 sedentary urbanites aged ≥50 years, randomised into: (1) male (MS) and (2) female (FS) undertaking three short-duration exercise (5–10 min) daily, and (3) male (ML) and (4) female (FL) exercising 30–60 min 3–5 days weekly. Resting systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate andV˙O2max were measured at baseline and 8 weekly for 24 weeks.ResultsAt baseline, 50% MS, 61.5% ML, 53.8% FSand 53.8% FLhad SBP ≥120 mm Hg, and 14.3% MS, 53.8% ML, 23.1% FSand 38.5% FLhad DBP ≥80 mm Hg. At 24 weeks, where SBP remained ≥120 mm Hg, values decreased from 147±19.2 to 132.3±9.6 mm Hg (50% of MS), from 144±12.3 to 128±7.0 mm Hg (23.1% of ML), from 143.1±9.6 to 128.0±7.0 mm Hg (53.8% of FS) and from 152.3±23.7 to 129±3.7 mm Hg (30.8% of FL). For DBP ≥80 mm Hg, MSand FSpercentages maintained, but values decreased from 101±15.6 to 84.5±0.7 mm Hg (MS) and 99.0±3.6 to 87.7±4.9 mm Hg (FS). In MLand FL, percentage with DBP ≥80 mm Hg dropped to 15.4% (86.1±6.5 to 82.5±3.5 mm Hg) and (91.4±5.3 to 83.5±0.71 mm Hg).V˙O2max increased from 26.1±4.4 to 32.0±6.2 for MS, from 25.8±5.1 to 28.8±5.4 for ML(group differences p=0.02), from 20.2±1.8 to 22.7±2.0 for FSand from 21.2±1.9 to 24.2±2.7 for FL(groups differences p=0.38).ConclusionAccumulated moderate intensity exercise bouts of <10 min confer similar-to-better cardiovascular andV˙O2max improvements compared with current recommendations among sedentary adults.
Perceptions of the osteopathic profession in New York City’s Chinese Communities
Authors: Chin Justin , Li Sarah , Yim Gregory , Zhou YaQun Arlene , Wan Peter Justin , Dube Emily R , Volokitin Mikhail , Sahni Sonu , Terrell Mark A , Lomiguen Christine M 
Published: February 2020

ObjectiveThe purpose of this study was to assess knowledge of and barriers to osteopathic medicine in Chinese immigrant communities in New York City (NYC).DesignA cross-sectional study was designed in which a culturally appropriate survey in Chinese and English versions was administered anonymously to measure immigrant perceptions and knowledge of osteopathic medicine.SettingData collection occurred in the municipal delineations for the Chinatown neighbourhood within the New York, New York borough of Manhattan.ParticipantsCommunity members were selected using convenience sampling from high-density areas to participate. Information gathered from the survey included demographics, education level, healthcare habits and knowledge of the osteopathic profession.Results120 surveys were conducted with 68 males and 52 females, with an average age=40. Respondents in the age range of 18–29 years, those with fluent English-language proficiency, and participants with graduate-level education status demonstrated a higher proportion of knowledge of osteopathic manipulative medicine and osteopathic physicians (doctors of osteopathic medicine) among the study variables.ConclusionCompared with research on the general US population, a general lack of knowledge of osteopathic medicine exists within NYC’s Chinese immigrant community. Although this difference may be ascribed to linguistics and ethnosociological factors, greater outreach and education is needed in urban minority communities to make immigrants aware of all healthcare resources available during the current shortage of US primary care physicians.
Efficient acute and chronic infection of stem cell-derived hepatocytes by hepatitis C virus
Authors: Carpentier Arnaud , Sheldon Julie , Vondran Florian W R , Brown Richard JP , Pietschmann Thomas 
Published: February 2020

Objective and designHuman stem cell-derived hepatocyte-like cells (HLCs) have shown high potential as authentic model for dissection of the HCV life cycle and virus-induced pathogenesis. However, modest HCV replication, possibly due to robust innate immune responses, limits their broader use. To overcome these limitations and to dissect the mechanisms responsible for control of HCV, we analysed expression of key components of the interferon (IFN) system in HLCs, assessed permissiveness for different HCV strains and blocked innate immune signalling by pharmacological intervention.ResultsTranscriptional profiling revealed that HLCs constitutively express messenger RNA of RLRs, and members of the IFN pathway. Moreover, HLCs upregulated IFNs and canonical interferon-regulated genes (IRGs) upon transfection with the double-stranded RNA mimic poly(I:C). Infection of HLCs with Jc1-HCVcc produced only limited viral progeny. In contrast, infection with p100, a Jc1-derived virus population with enhanced replication fitness and partial resistance to IFN, resulted in robust yet transient viraemia. Viral titres declined concomitant with a peak of IRG induction. Addition of ruxolitinib, a JAK/STAT inhibitor, permitted chronic infection and raised p100 infectious virus titres to 1×105FFU/mL. IRGs expression profiling in infected HLCs revealed a landscape of HCV-dependent transcriptional changes similar to HCV-infected primary human hepatocytes, but distinct from Huh-7.5 cells. Withdrawal of ruxolitinib restored innate immune responses and resulted in HCV clearance.ConclusionThis authentic human cell model is well suited to examine acute and chronic host-HCV interactions, particularly IFN-triggered antiviral effector functions and mechanisms of innate immune control of HCV infection.
Interstitial lung disease is a risk factor for ischaemic heart disease and myocardial infarction
Authors: Clarson Lorna Elise , Bajpai Ram , Whittle Rebecca , Belcher John , Abdul Sultan Alyshah , Kwok Chun Shing , Welsh Victoria , Mamas Mamas , Mallen Christian D 
Published: February 2020

ObjectivesDespite many shared risk factors and pathophysiological pathways, the risk of ischaemic heart disease (IHD) and myocardial infarction (MI) in interstitial lung disease (ILD) remains poorly understood. This lack of data could be preventing patients who may benefit from screening for these cardiovascular diseases from receiving it.MethodsA population-based cohort study used electronic patient records from the Clinical Practice Research Datalink and linked Hospital Episode Statistics to identify 68 572 patients (11 688 ILD exposed (mean follow-up: 3.8 years); 56 884 unexposed controls (mean follow-up: 4.0 years), with 349 067 person-years of follow-up. ILD-exposed patients (pulmonary sarcoidosis (PS) or idiopathic pulmonary fibrosis (PF)) were matched (by age, sex, registered general practice and available follow-up time) to patients without ILD or IHD/MI. Rates of incident MI and IHD were estimated. HRs were modelled using multivariable Cox proportional hazards regression accounting for potential confounders.ResultsILD was independently associated with IHD (HR 1.85, 95% CI 1.56 to 2.18) and MI (HR 1.74, 95% CI 1.44 to 2.11). In all disease categories, risk of both IHD and MI peaked between ages 60 and 69 years, except for the risk of MI in PS which was greatest <50 years. Men with PF were at greatest risk of IHD, while women with PF were at greatest risk of MI.ConclusionsILD, particularly PF, is independently associated with MI and IHD after adjustment for established cardiovascular risk factors. Our results suggest clinicians should prioritise targeted assessment of cardiovascular risk in patients with ILD, particularly those aged 60–69 years. Further research is needed to understand the impact of such an approach to risk management.