bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scoping Review of Family Interventions That Support the Physical Health of Caregivers
Authors: Poon Abner W. C. , Lappin Julia M. , Cassidy Alyssa , Breckenridge Jan 
Published: November 2020

Purpose: Family interventions have been developed to support carers of people with mental illness, but not much is known about how such interventions can improve carers’ physical health. This review aimed to identify and analyze existing family interventions that addressed the physical health of carers. Methods: A scoping review was conducted to identify peer-reviewed journal articles on family interventions with physical health components. A total of six articles were found and analyzed thematically to identify the family interventions, physical health components of the interventions, and associated physical health outcomes. Results: Synthesis of the findings from relevant articles showed that the development of physical health components in family interventions is emerging and at an early stage. However, most studies had physical health as a minor area focusing mainly on stress and sleep. Conclusions: Family interventions would be more holistic if consideration of physical health issues was addressed as a core module.
A Qualitative Assessment of Bone Mineral Density in Individuals With Hemifacial Microsomia: A Cone-Beam Computed Tomography Study
Authors: ElNaghy Rahma , Bous Rany , Chinoy Afriti , Kumar Anand , Valiathan Manish 
Published: November 2020

Objective: The purpose of this study is to utilize cone-beam computed tomography (CBCT) to compare the bone mineral density (BMD) on the affected versus nonaffected side, among individuals with hemifacial microsomia (HFM). Methods: This retrospective study included 9 patients with HFM. Pretreatment CBCT volumes were imported into Invivo5 software, which was used to measure BMD through Hounsfield units (HU) in 3 regions of the mandible; inferior to the lower lateral incisors, inferior to the first molar and at the ramus inferior to the sigmoid notch. Each region was measured at the buccal cortical bone, lingual cortical bone, and cancellous bone. The densities on the right and left sides were compared by Wilcoxon signed-rank test. Results: Overall, the BMD on the affected side tended to show slightly lower values when compared with the nonaffected side. Differences ranged from 14 HU at the lingual cortical plate of the first molar region to 234 HU at the buccal cortical plate of the ramus region. Differences were only statistically significant at the ramus region for the buccal ( P = .002) and lingual ( P < .001) cortical plates and at the lower incisor region at the buccal cortical plate ( P = .016) and cancellous bone ( P = .044). The differences, however, did not seem to be clinically significant. Conclusions: The current study shows that the quality of bone on the affected side may be slightly reduced but did not seem to be clinically significant. This should be accounted for during surgical and orthodontic planning for patients with HFM.
The Communication Skills and Family Resources in the University Students: The Moderating Effect of Encoding Skills and Commitment to Family
Authors: Kataoka Yusuke , Tsuchiya Koji 
Published: November 2020

Background: Although communication skills can lead to family resources, the association between communication skills in adolescents and family resources remains to be examined multi-dimensionally. Therefore, we examined whether family resources are predicted by six categories of communication skills. Further, we examined the moderating effect of encoding skills and commitment to family in the association between decoding skills and family resources. Method: One hundred forty university students completed several questionnaires assessing communication skills, family resources, and commitment to family. Results: Results indicated that expressivity in communication skills positively predicted cohesion and trust in family strength, and regulation of interpersonal relationships negatively predicted balance between individual family members and the family system. Additionally, analysis showed that commitment to family moderated relationships between “deciphering ability” and trust in family strength in family resources. The hypothesis that trust in family strength is negatively predicted by deciphering ability among those low in commitment to family is supported. Discussion: It can be effective in clinical support to help individuals express feelings and needs to enhance family resources needed to bounce back from a crisis. However, in individuals low in commitment to family, when a practitioner helps individuals with high deciphering ability enhance their commitment to family, it is important to help prevent negative family relationships caused by experiencing mental burdens generated by family dynamics.
Impact of the implementation of a pharmacist-driven immunosuppression drug monitoring protocol for hematopoietic stem cell transplant recipients
Authors: Gawedzki Paula , Collins Jennifer 
Published: November 2020

For patients with serious hematologic malignancies, hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment option. Majority of HSCT recipients receive tacrolimus as part of their immunosuppressive regimen. The purpose of this study is to evaluate the clinical impact of a pharmacist driven immunosuppression drug monitoring protocol for HSCT recipients on tacrolimus. This was a single-center, pre-post interventional study conducted at the University of Chicago Medical Center. Data collected via chart review includes the immunosuppressive agent used, interacting medications, adverse events, dose adjustments, drug concentrations, time to engraftment, and diagnosis of GVHD. Following the incorporation of a therapeutic drug monitoring protocol, the percentage of therapeutic tacrolimus levels was similar to when there was no protocol in place; 68% versus 64%, respectively (p = 0.34). There were 18 total adverse events observed in the pre-protocol group versus 10 in the post-protocol group (p = 0.03). Nephrotoxicity was the most common adverse event occurring in 23% of patients in the pre-protocol group and 15% of patients in the post-protocol group (p = 0.18). In the post-protocol group, there were 20 patients with two or more interacting drugs versus two patients in the pre-protocol group (p < 0.05). Additionally, the post-protocol group had 12 instances of an empiric dose adjustment made whereas the pre-protocol group had three instances (p = 0.006). Although there was no significant difference in percentage of therapeutic tacrolimus levels, pharmacist involvement resulted in improved safety outcomes such as management of drug interactions and incidence of adverse events.
Effects of Individualized Dietary Phosphate Control Program With a Smartphone Application in Hemodialysis Patients in Taiwan
Authors: Chiang Yung-Chen , Chang Ya-Ping , Lin Ssu-Chin , Lin Chin , Hsu Pi-Hsiu , Hsu Yu-Juei , Wu Tsung-Jui 
Published: November 2020

Background: Hyperphosphatemia in end-stage renal disease patients is prevalent and associated with increasing cardiac mortality. Restricting dietary phosphate intake is a key element in controlling hyperphosphatemia, but most patients fail due to lack of knowledge and sustainability. In this study, we aimed to examine whether incorporating a smartphone application (APP) into a multidisciplinary caring system can decrease the prevalence of hyperphosphatemia in hemodialysis patients. Methods: We designed a quasi-experimental study to enroll patients undergoing regular hemodialysis and assigned them to receive APP-assisted caring program (ACP group, n = 30) or standard education caring program (SCP group, n = 30). Both caring programs targeting dietary phosphate control were administered. Patients’ general characteristics, self-care efficacy scales, knowledge test of phosphate control, and results of monthly blood biochemistry were analyzed. Findings: Knowledge of diet phosphate control and self-care efficacy were significantly higher in the ACP group. Notably, the knowledge improvement was higher in patients aged over 60 years. Compared to the SCP group, the percentage of patients with successful hyperphosphatemia control was significantly higher in the ACP group ( p = 0.0398). Conclusion: The APP-assisted caring program benefits patients with regular hemodialysis to achieve better dietary phosphate control without compromising proper protein intake.
Major trauma centre Lead Clinicians: An evaluation of current practice in major trauma centres in England
Authors: Sabin Emma Jane , Cole Elaine 
Published: November 2020

Background NHS England requires there to be a clinical consultant with managerial responsibility for the Major Trauma Centre (MTC) service, who holds the title of MTC Lead Clinician. The objective of this study was to investigate the role of MTC Lead Clinician in England. Firstly, identifying the parent speciality of the current cohort and their background and training. Further aims were to ascertain what attracted clinicians to the position and to explore ideas about how to train the next generation of MTC Lead Clinicians. Methods Survey-based data collection was performed. Included were current MTC Lead Clinicians, or those with equivalent job descriptions, for adult major trauma. Paediatric MTCs and Trauma Units were excluded. Fixed choice questions were analysed using descriptive statistics. Open-ended questions were interpreted using thematic analysis. Results The response rate for the survey was 81.81%. The largest proportion of respondents were Emergency Medicine Physicians (38.9%). Previous senior leadership roles were identified as valuable previous experience. Regular attendance at conferences was deemed to be of more importance than specific training courses. Leadership, management, and financial skills were identified as key areas for further training. There was variance in both the job role and the time allocated for these duties between centres. Conclusion Currently there is variation in the parent specialty, role responsibilities and preparation for MTC Lead Clinicians in England. Our findings suggest that guidance on appropriate training, clarity in responsibilities and fostering leadership and managerial skills are important as the role develops for the future.
Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual Antiplatelet Therapy
Authors: Glotzer Owen S. , Rojas Elianne , Bouchard David Roberge , Hill Susanna S. , Harad F. Todd , Zhang Zugui , Bowser Kathryn E. 
Published: November 2020

Background: Antiplatelet therapy is a cornerstone in the management of carotid artery disease following carotid endarterectomy (CEA). There is a paucity of data regarding the effect of dual antiplatelet therapy (DAPT) on restenosis rates. Methods: A retrospective review of patients who underwent CEA from January 1, 2007 to December 31, 2013 was performed at a single center. Study groups consisted of subjects who received DAPT and those who received single antiplatelet therapy (SAPT) following CEA. Restenosis was evaluated by carotid duplex. Severity and timing of restenosis, postoperative complications, and reinterventions were compared between study groups. Results: Between January 1, 2007 and December 31, 2013, 1453 patients underwent CEA. The SAPT group consisted of 245 patients and the DAPT group consisted of 1208 patients. No difference in restenosis was identified between groups at less than 6 weeks (6.5% vs. 11.7% 50-79% stenosis, 0% vs. 2.2% 80-99% stenosis, 2.2% vs. 0.6% occlusion, p = 0.368), and 6 weeks to 2 years (20.6% vs. 17.9% 50-79% stenosis, 1.1% vs. 1.0% 80-99% stenosis, 1.6% vs. 0.4% occlusion, p = 0.242). A higher rate of restenosis in SAPT was found greater than 2 years from surgery (68.4% vs. 82.4% <50% stenosis, 29.9% vs. 16.1% 50-79% stenosis, 0% vs. 0.6% 80-99% stenosis, 1.7% vs. 0.9% occlusion p = 0.004). This finding persisted on multivariable analysis with 31.6% of the SAPT group showing >50% stenosis vs. 17.6% of the DAPT group (adjusted OR 0.48, 95% CI 0.30-0.76, p = 0.002). In a propensity matched-population, 32.7% of the SAPT group demonstrated restenosis vs. 13.7% of the DAPT group (adjusted OR 0.35, 95% CI 0.16-0.77, p = 0.009). There was no difference in the need for reintervention between study groups (DAPT 3.8% vs SAPT 3.3%, p = 0.684). Conclusion: Following CEA, patients on DAPT exhibited lower rates of late restenosis. Despite this finding, a clinical difference in reintervention was not found during this study period.
Assessing the Supportiveness of Healthcare Environments’ Light and Color: Development and Validation of the Light and Color Questionnaire (LCQ)
Authors: Lindahl Jeanette , Thulesius Hans , Rask Mikael , Wijk Helle , Edvardsson David , Elmqvist Carina 
Published: November 2020

Aim: The aim of this study was to develop and evaluate a self-report instrument measuring patients’, family members’, and staff’s perceived support from light and color in the physical environment of an emergency department (ED)—the Light and Color Questionnaire (LCQ). Background: The physical care environment is an important part of a comprehensive caring approach in all levels of care not only for patients but also for family members and staff. However, no existing self-report questionnaire assessing the extent to which light and color are perceived as being supportive in the physical care environment from the users’ perspective was found. Method: The LCQ was developed as part of a pre–post study in which an ED serving 125,000 people was refurbished and remodeled using evidence-based design. The LCQ consists of six items for light and five items for color and assesses awareness/orientation, safety/security, functional abilities, privacy, personal control, and stimulation. The study was carried out in four steps: constructions of items, assessment of face validity, data collection, and data analysis. Result/Conclusion: Psychometric evaluation of the two versions, LCQ-Patient/Family member and LCQ-Staff, showed satisfactory content and internal validity (>90%) and high internal consistency (Cronbach’s coefficient α = .9) to support the use of the questionnaire for research and development purposes. Explorative factor analysis of a total of 600 questionnaire responses confirmed light and color as distinctive and independent dimensions creating perceptions of more or less supportiveness for respondents. The LCQ instrument may be useful for architects, administrators, and researchers of healthcare environments.
“No thanks, I don’t want to see snakes again”: a qualitative study of pain management versus preservation of cognition in palliative care patients
Authors: Wegier Pete , Varenbut Jaymie , Bernstein Mark , Lawlor Peter G. , Isenberg Sarina R. 
Published: November 2020

Abstract
Background
Towards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them.

Methods
We conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis.

Results
Thirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies.

Conclusions
Decision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.
Methods for improving thermal tolerance in military personnel prior to deployment
Authors: Ashworth Edward Tom , Cotter James David , Kilding Andrew Edward 
Published: November 2020

AbstractAcute exposure to heat, such as that experienced by people arriving into a hotter or more humid environment, can compromise physical and cognitive performance as well as health. In military contexts heat stress is exacerbated by the combination of protective clothing, carried loads, and unique activity profiles, making them susceptible to heat illnesses. As the operational environment is dynamic and unpredictable, strategies to minimize the effects of heat should be planned and conducted prior to deployment. This review explores how heat acclimation (HA) prior to deployment may attenuate the effects of heat by initiating physiological and behavioural adaptations to more efficiently and effectively protect thermal homeostasis, thereby improving performance and reducing heat illness risk. HA usually requires access to heat chamber facilities and takes weeks to conduct, which can often make it impractical and infeasible, especially if there are other training requirements and expectations. Recent research in athletic populations has produced protocols that are more feasible and accessible by reducing the time taken to induce adaptations, as well as exploring new methods such as passive HA. These protocols use shorter HA periods or minimise additional training requirements respectively, while still invoking key physiological adaptations, such as lowered core temperature, reduced heart rate and increased sweat rate at a given intensity. For deployments of special units at short notice (< 1 day) it might be optimal to use heat re-acclimation to maintain an elevated baseline of heat tolerance for long periods in anticipation of such an event. Methods practical for military groups are yet to be fully understood, therefore further investigation into the effectiveness of HA methods is required to establish the most effective and feasible approach to implement them within military groups.
Activation of Preoptic Arginine Vasopressin Neurons Induces Hyperthermia in Male Mice
Authors: Tabarean Iustin V 
Published: November 2020

AbstractArginine vasopressin (AVP) is a neuropeptide acting as a neuromodulator in the brain and plays multiple roles, including a thermoregulatory one. However, the cellular mechanisms of action are not fully understood. Carried out are patch clamp recordings and calcium imaging combined with pharmacological tools and single-cell RT-PCR to dissect the signaling mechanisms activated by AVP. Optogenetics combined with patch-clamp recordings were used to determine the neurochemical nature of these neurons. Also used is telemetry combined with chemogenetics to study the effect of activation of AVP neurons in thermoregulatory mechanisms. This article reports that AVP neurons in the medial preoptic (MPO) area release GABA and display thermosensitive firing activity. Their optogenetic stimulation results in a decrease of the firing rates of MPO pituitary adenylate cyclase-activating polypeptide (PACAP) neurons. Local application of AVP potently modulates the synaptic inputs of PACAP neurons, by activating neuronal AVPr1a receptors and astrocytic AVPr1b receptors. Chemogenetic activation of MPO AVP neurons induces hyperthermia. Chemogenetic activation of all AVP neurons in the brain similarly induces hyperthermia and, in addition, decreases the endotoxin activated fever as well as the stress-induced hyperthermia.
Prospective Evaluation of Incidental Pituitary Imaging Findings in the Sella Turcica
Authors: Kuo Michael , Maya Marcel M , Bonert Vivien , Melmed Shlomo 
Published: November 2020

Abstract

Purpose
Reported rates of incidentally discovered pituitary sellar lesions vary widely, at least in part because of the inadvertent inclusion of patients with a history suspicious for a pituitary disorder. We prospectively evaluated the incidence of truly incidental sellar findings detected on imaging at a large academic medical center.

Methods
Deidentified data were extracted from the electronic medical record of adults who underwent diagnostic computed tomography (CT) or magnetic resonance imaging (MRI) over a 1-year period for any cause unrelated to known or suspected pituitary disorder both in inpatient and outpatient settings. Patients with International Classification of Diseases, Ninth Revision, (ICD-9) and Tenth Revision (ICD-10) codes indicative of a sellar lesion and those with symptoms suggestive of sellar/parasellar mass effects were excluded.

Results
Of 9572 scans performed during the 1-year study period, 3840 met the inclusion criteria to comprise the study cohort; 13 were manually excluded because of findings or symptoms of sellar masses not otherwise captured. The overwhelming majority of evaluable images (n = 3782) showed no sellar lesions. Truly incidental sellar findings were detected in 45 (1.2%), most commonly among inpatients (P &lt; .001). Partially empty sella and empty sella were the most frequent findings, and were twice as likely to be detected on MRI vs CT. All other incidentally discovered lesions, including one microadenoma and one macroadenoma, were detected only by MRI.

Conclusion
Frequency of incidental sellar lesions in patients with no known or suspected history of pituitary disorder is low. Given the small likelihood of aggressive behavior in these lesions, the clinical significance of truly incidentally discovered sellar lesions should not be overestimated.