bluuebunny/crossref_metadata_2025_split huggingface dataset:
Towards an understanding of the burdens of medication management affecting older people: the MEMORABLE realist synthesis
Authors: Maidment Ian , Lawson Sally , Wong Geoff , Booth Andrew , Watson Anne , Zaman Hadar , Mullan Judy , McKeown Jane , Bailey Sylvia 
Published: June 2020

Abstract
Background
More older people are living in the community with multiple diagnoses and medications. Managing multiple medications produces issues of unrivalled complexity for those involved. Despite increasing literature on the subject, gaps remain in understanding how, why and for whom complex medication management works, and therefore how best to improve practice and outcomes. MEMORABLE, MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation, aimed to address these gaps.

Methods
MEMORABLE used realism to understand causal paths within medication management. Informed by RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines, MEMORABLE involved three overlapping work packages: 1) Realist Review of the literature (24 articles on medication management exploring causality); 2) Realist Evaluation (50 realist-informed interviews with older people, family carers and health and care practitioners, explaining their experiences); and 3) data synthesis and theorising from 1) and 2).

Results
Medication management was viewed from the perspective of ‘implementation’ and structured into five stages: identifying a problem (Stage 1), getting a diagnosis and/or medications (Stage 2), starting, changing or stopping medications (Stage 3), continuing to take medications (Stage 4), and reviewing/reconciling medications (Stage 5).
Three individual stages (1, 3 and 4) are conducted by the older person sometimes with family carer support when they balance routines, coping and risk. Stages 2 and 5 are interpersonal where the older person works with a practitioner-prescriber-reviewer, perhaps with carer involvement.
Applying Normalisation Process Theory, four steps were identified within each stage: 1) sense making: information, clarification; 2) action: shared-decision-making; 3) reflection/monitoring; and 4) enduring relationships, based on collaboration and mutual trust.
In a detailed analysis of Stage 5: Reviewing/reconciling medications, adopting the lens of ‘burden’, MEMORABLE identified five burdens amenable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Two initial improvement propositions were identified for further research: a risk screening tool and individualised information.

Conclusions
Older people and family carers often find medication management challenging and burdensome particularly for complex regimens. Practitioners need to be aware of this potential challenge, and work with older people and their carers to minimise the burden associated with medication management.

Trial registration
PROSPERO 2016:CRD42016043506.
Early diagnosis of miliary tuberculosis in a hemodialysis patient by combining two interferon-γ-release assays: a case report
Authors: Bonkain Florence , De Clerck Dieter , Dirix Violette , Singh Mahavir , Locht Camille , Mascart Françoise , Corbière Véronique 
Published: June 2020

Abstract
Background
Patients with end-stage renal disease undergoing chronic hemodialysis (HD) are at high risk to develop tuberculosis (TB) associated with a high mortality rate. TB diagnosis is often delayed due to non-specific symptoms, frequent extra-pulmonary manifestations, and rare microbiological confirmation. This case report illustrates the clear added value of combined interferon-γ -release assays (IGRA) in response to different mycobacterial antigens for an early diagnosis of TB in HD patients.

Case presentation
We report the case of an Egyptian patient under chronic HD treatment, who presented with recurrent episodes of fever and myalgia of unknown origin, associated with an important inflammatory syndrome. These episodes resolved partially or completely within less than 1 month without any treatment but recurred 10 times within 3 years. Chest Computed Tomography and 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18FDG PET-CT) demonstrated several active mediastinal lymphadenopathies. TB was the first suspected diagnosis but cultures and polymerase chain reaction (PCR) remained negative on a mediastinal lymph node aspiration. In contrast, the results from two different IGRA performed on blood were highly suggestive of TB disease. Several granulomas, some of them with central non-caseating necrosis, were demonstrated on a pulmonary nodule obtained by thoracoscopic resection, but PCR and culture remained negative for M. tuberculosis. Three years after the initial symptoms, a new PET-CT revealed a retro-clavicular lymphadenopathy in addition to the mediastinal lymphadenopathies, and the M. tuberculosis culture performed on the resected lymphadenopathy was positive. Antibiotic treatment for TB was started and resulted in a clear improvement of the patient’s clinical condition, allowing him to successfully receive a renal graft.

Conclusions
In view of the high frequency of TB in patients undergoing chronic HD and of the limitations of the classical diagnosis procedures, nephrologists have to diagnose TB mostly on clinical suspicion. We demonstrate here that the use of a combined IGRA to two different mycobacterial antigens may significantly raise the index of suspicion and help clinicians to decide starting anti-TB treatment in HD patients.
Posterior cerebral artery stroke by reverse flow embolism in thoracic outlet syndrome - a case report
Authors: Celier Adam , Chabay Simon , Maurizot Aurélien , Cochennec Frédéric , Stanciu Daniela , Pico Fernando 
Published: June 2020

Abstract
Background
Arterial thoracic outlet syndrome is a rare condition characterized by a subclavian artery pathology associated with a bone abnormality. It is rarely associated with thromboembolic stroke. The mechanism of cerebral embolism associated with thoracic outlet syndrome have rarely been demonstrated. We present here a fully studied case with a high probability of reverse flow embolism.

Case presentation
A 24-year-old man with a known arterial thoracic outlet syndrome presented with a right cerebral posterior artery brain infarction. An ultrasound examination depicted the compression of the right subclavian artery in the scalene defile with a post stenotic aneurysm and the presence of a floating thrombus in this aneurysm. There was a reverse flow during diastole in this aneurysm. Anticoagulation was carried out with the disappearance of the floating thrombus with no new clinical or brain MRI event. Corrective surgery of this thoracic outlet syndrome was performed one month after stroke.

Conclusion
Very few cases of stroke in arterial thoracic outlet syndrome have been described with thorough dynamic vascular imaging. To our knowledge, this is the fourth reported case that advocates for a reverse flow embolism mechanism in stroke associated with thoracic outlet syndrome, and the first to realize an extensive ultrasound and doppler workup.
Experiences and training needs of healthcare providers involved in the care of Ghanaian adolescents living with HIV: an interventional study
Authors: Hayfron-Benjamin Anna , Obiri-Yeboah Dorcas , Bockarie Yemah Mariama , Asiedua Ernestina , Baidoo Ibrahim , Akorsu Angela D. , Ayisi-Addo Stephen 
Published: June 2020

Abstract
Background
Caring for adolescents living with HIV/AIDS (ALHIV) can be overwhelming due to their unique needs. Ghana is currently among nine countries in West and Central Africa contributing to 90% of new paediatric infections in the sub-region with a growing population of ALHIV. Regardless, gaps in paediatric related care including healthcare providers (HCPs) capacity issues have been identified. This study sought to assess the competencies of adolescent-oriented healthcare providers before, and after interventionist training to inform recommendation that would guide the psychosocial care they give to ALHIV.

Methods
The study adopted a mixed methods approach with a non-randomized interventional study involving three-phase multi-methods. The sample consisted of 28 adolescent-oriented and multi-disciplinary healthcare providers at the Cape Coast Teaching Hospital (CCTH) in Ghana. Data were obtained in three phases, namely, a baseline survey, interventionist training, and post-training in-depth interviews. Quantitative data were analyzed using Stata version 13 for descriptive analysis while the qualitative data were analyzed thematically using NVivo version 11.

Results
Although the majority of the HCPs claim to be knowledgeable about adolescent health issues (n = 21, 75.0%), only about a third (n = 10, 35.7%) could correctly define who an adolescent is. The majority (n = 18, 64.3%) had not received any training on how to work with the adolescent client. The main areas identified for improvement in the ALHIV care in phase 1 included issues with psychosocial assessment, communication and treatment adherence strategies, creating an adolescent-friendly work environment, and availability of job aids/protocols. During the post-training interviews, participants reported an improved understanding of the characteristics of an adolescent-friendly site and basic principles for ALHIV care. They were also able to correctly describe the widely used adolescent health assessment tool; the HEEADSSS. Post intervention interviews also revealed HCPs perception on increased practice related confidence levels and readiness to implement new knowledge and skills gained.

Conclusion
This study has shown that targeted training on routine ALHIV care is effective in increasing HCPs knowledge, skills and confidence. Addressing the healthcare system/facility related gaps serves as an impetus for improved ALHIV care among HCPs.
Combination of gamma-glutamyl transferase and liver stiffness measurement for biliary atresia screening at different ages: a retrospective analysis of 282 infants
Authors: Shen Qiulong , Tan Sarah Siyin , Wang Zengmeng , Cai Siyu , Pang Wenbo , Peng Chunhui , Chen Yajun 
Published: June 2020

Abstract
Background
This study aims to explore the diagnostic accuracy of the combination of gamma-glutamyl transferase (GGT) and liver stiffness measurement (LSM) for biliary atresia (BA) screening at different ages.

Methods
Our retrospective study involved 282 infants under the age of 120 days with jaundice who were admitted into Beijing Children’s Hospital between January 2016 to December 2018. The GGT and LSM levels of infants were obtained. A parallel test was used, and ROC curve was created to obtain cutoff values of GGT and LSM for BA infants at different ages.

Results
Of the 282 infants, 135 were diagnosed with BA and 147 were non-BA infants. In all age groups (A: ≤60 days; B: 61–90 days; C: 91–120 days), the LSM and GGT levels of the BA group were significantly higher than that of the non-BA group, P < 0.05. The cutoff value of GGT and LSM to diagnosis BA was 191.2 U/L, 213.2 U/L, 281.5 U/L and 7.5 kPa, 10.0 kPa, 11.0 kPa in groups A, B and C, respectively. The parallel test was used to determine a sensitivity of 97.3, 98.1 and 100% in group A, B and C when either GGT or LSM levels were met in BA infants. The sensitivities of parallel testing for group A and B were higher than LSM or GGT used alone.

Conclusions
Cutoff values of GGT and LSM to screen BA increased with age. Parallel testing of GGT and LSM in infants who are younger than 90 days old can decrease the rate of BA misdiagnosis.
Food habits in overweight and obese adolescent girls with Polycystic ovary syndrome (PCOS): a qualitative study in Iran
Authors: Hajivandi Leila , Noroozi Mahnaz , Mostafavi Firoozeh , Ekramzadeh Maryam 
Published: June 2020

Abstract
Background
Polycystic ovary syndrome (PCOS) is a hormonal disorder in women of reproductive age. It seems that over the recent years, PCOS has augmented in adolescent girls due to unhealthy food habits and obesity. So, the present study was conducted to explore the food habits in overweight and obese adolescent girls with PCOS.

Methods
In the present qualitative study, 33 participants were selected using a purposive sampling method. Data were collected through individual in-depth interviews, focus group discussions (FGDs), and field notes. These data were analyzed through the use of conventional qualitative content analysis.

Results
Three main categories were extracted: First, the high consumption of unhealthy food had three sub-categories: “high consumption of fatty and salty foods”, “high consumption of unhealthy snacks”, and “high consumption of sugar-rich foods”. Second, low consumption of healthy food had three sub-categories: “low consumption of dairy products”, “low consumption of fiber-rich foods”, and “low consumption of meat, beans, fish and seafood” Third, inappropriate behavioral habits had three sub-categories: “lack of concentration and consumption of large meals”, “inappropriate dietary and physical activity patterns”, and “skipping the meals and going on arbitrary diets”.

Conclusion
This research through presenting an image of food habits in overweight and obese adolescent girls with PCOS is able to help for designing the necessary interventions to change the food habits, control the symptoms and complications of PCOS, and finally, improve the reproductive health of these girls.
Patient and service-related barriers and facitators to the acceptance and use of interventions to promote communication in health and social care: a realist review
Authors: Leavey Gerard , Curran Emma , Fullerton Deirdre , Todd Steven , McIlfatrick Sonja , Coates Vivien , Watson Max , Abbott Aine , Corry Dagmar 
Published: June 2020

Abstract
Background
More people living into old age with dementia. The complexity of treatment and care, particularly those with multiple health problems, can be experienced as disjointed. As part of an evaluation of a ‘healthcare passport’ for people living with dementia we undertook a realist review of communication tools within health and social care for people living with dementia.

Aims
To explore how a ‘healthcare passport’ might work in the ‘real world’ of people living with dementia through a better understanding of the theoretical issues related to, and the contextual issues that facilitate, successful communication.

Methods
A realist review was considered the most appropriate methodology to inform the further development and evaluation of the healthcare passport. We undertook a purposive literature search related to communication tools to identify (a) underlying programme theories; (b) published reports and papers on their use in various healthcare settings; (c) evidence on barriers and facliitators of their use.

Results
Communication tools were noted as a way of improving communication and outcomes through: (1) improvement of service user autonomy; (2) strengthening the therapeutic alliance; and (3) building integrated care. However, while intuitively perceived to of benefit, evidence on their use is limited and key barriers to their acceptance and use include: (1) difficulties in clearly defining purpose, content, ownership and usage; (2) understanding the role of family caregivers; and (3) preparation among healthcare professionsals.

Conclusion
Patient-held communication tools may be helpful to some people living with dementia but will require considerable preparation and engagement with key stakeholders.
U-shaped association between plasma sphingosine-1-phosphate levels and mortality in patients with chronic systolic heart failure: a prospective cohort study
Authors: Xue Yanbo , Jiang Wei , Ma Qiong , Wang Xiqiang , Jia Pu , Li Qiang , Chen Shuping , Song Bingxue , Wang Ya , Zhang Jingwen , Liu Jing , Yang Guodong , Lin Yuyao , Liu Jing , Wei Linyan , Dong Caijuan , Li Haiquan , Xie Zhonglei , Bai Ling , Ma Aiqun 
Published: June 2020

Abstract
Background
The endogenous lipid molecule sphingosine-1-phosphate (S1P) has received attention in the cardiovascular field due to its significant cardioprotective effects, as revealed in animal studies. The purpose of our study was to identify the distribution characteristics of S1P in systolic heart failure patients and the prognostic value of S1P for long-term prognosis.

Methods
We recruited 210 chronic systolic heart failure patients from June 2014 to December 2015. Meanwhile 54 healthy people in the same area were selected as controls. Plasma S1P was measured by liquid chromatography-tandem mass spectrometry. Patients were grouped according to the baseline S1P level quartiles, and restricted cubic spline plots described the association between S1P and all-cause death. Cox proportional hazard analysis was used to determine the relationship between category of S1P and all-cause death.

Results
Compared with the control group, the plasma S1P in chronic heart failure patients demonstrated a higher mean level (1.269 μmol/L vs 1.122 μmol/L, P = 0.006) and a larger standard deviation (0.441 vs 0.316, P = 0.022). Based on multivariable Cox regression with restricted cubic spline analysis, a non-linear and U-shaped association between S1P levels and the risk of all-cause death was observed. After a follow-up period of 31.7 ± 10.3 months, the second quartile (0.967–1.192 μml/L) with largely normal S1P levels had the lowest all-cause mortality and either an increase (adjusted HR = 2.368, 95%CI 1.006–5.572, P = 0.048) or a decrease (adjusted HR = 0.041, 95%CI 0.002–0.808, P = 0.036) predicted a worse prognosis. The survival curves showed that patients in the lowest quartile and highest quartile were at a higher risk of death.

Conclusions
Plasma S1P levels in systolic heart failure patients are related to the long-term all-cause mortality with a U-shaped correlation.

Trial registration
CHiCTR, ChiCTR-ONC-14004463. Registered 20 March 2014.
Analysis of particles from hamster lungs following pulmonary talc exposures: implications for pathogenicity
Authors: Sato Erika , McDonald Sandra A. , Fan Yuwei , Peterson Shaina , Brain Joseph D. , Godleski John J. 
Published: June 2020

AbstractBackgroundTalc, a hydrous magnesium silicate, often used for genital hygiene purposes, is associated with ovarian carcinoma in case-control studies. Its potential to cause inflammation, injury, and functional changes in cells has been described. A complication of such studies is that talc preparations may be contaminated with other materials. A previous study by (Beck et al. Toxicol Appl Pharmacol 87:222-34, 1987) used a hamster model to study talc and granite dust exposure effects on various biochemical and cellular inflammatory markers. Our current study accessed key materials used in that 1987 study; we re-analyzed the original talc dust with contemporary scanning electron microscopy and energy dispersive x-ray analysis (SEM/EDX) for contaminants. We also examined the original bronchoalveolar lavage (BAL) cells with polarized light microscopy to quantify cell-associated birefringent particles to gain insight into the talc used.ResultsSEM/EDX analyses showed that asbestos fibers, quartz, and toxic metal particulates were below the limits of detection in the original talc powder. However, fibers with aspect ratios ≥3:1 accounted for 22% of instilled material, mostly as fibrous talc. Talc (based on Mg/Si atomic weight % ratio) was the most abundant chemical signature, and magnesium silicates with various other elements made up the remainder. BAL cell counts confirmed the presence of acute inflammation, which followed intratracheal instillation. Measurements of cell associated birefringent particles phagocytosis revealed significant differences among talc, granite, and control exposures with high initial uptake of talc compared to granite, but over the 14-day experiment, talc phagocytosis by lavaged cells was significantly less than that of granite. Phagocytosis of talc fibers by macrophages was observed, and birefringent particles were found in macrophages, neutrophils, and multinucleate giant cells in lavaged cells from talc-exposed animals.ConclusionOur data support the contention that talc, even without asbestos and other known toxic contaminants, may elicit inflammation and contribute to lung disease. Our findings support the conclusions of (Beck et al. Toxicol Appl Pharmacol 87:222-34, 1987) study. By analyzing particulate exposures with polarized light microscopy and SEM/EDX, fibrous talc was identified and a distinctive pattern of impaired particulate ingestion was demonstrated.
A chromosome 1q22 microdeletion including ASH1L is associated with intellectual disability in a Chinese family
Authors: Xi Hui , Peng Ying , Xie Wanqin , Pang Jialun , Ma Na , Yang Shuting , Peng Jinping , Wang Hua 
Published: June 2020

Abstract
Background
Copy number variants (CNVs) associated with developmental delay and intellectual disability (DD/ID) continue to be identified in patients. This article reports identification of a chromosome 1q22 microdeletion as the genetic cause in a Chinese family affected by ID.

Case presentation
The proband was a 19-year-old pregnant woman referred for genetic counseling and prenatal diagnosis at 18 weeks of gestation. She had severe ID with basically normal stature (height 154 cm [0 SD], weight 61 kg [− 0.2 SD], and head circumference 54 cm [− 1.12 SD]). Her distinctive facial features included a prominent forehead; flat face; flat nasal bridge and a short upturned nose; thin lips; and small ears. The proband’s father was reported to have low intelligence, whereas her mother was of normal intelligence but with scoliosis. Chromosome microarray analysis (CMA) reveals that the proband, her father and the fetus all carry a 1q22 microdeletion of 936.3 Kb (arr[GRCh37] 1q22 (155016052_155952375)×1), which was not observed in her mother and paternal grandparents and uncles, suggesting a de novo mutation in the proband’s father. The microdeletion involves 24 OMIM genes including ASH1L (also known as KMT2H and encoding a histone lysine methyltransferase). Of note, haploinsufficiency of ASH1L has been shown to be associated with neurodevelopmental disorders. Based on the inheritance of the detected CNV in the pedigree and similar CNVs associated with ID in public databases (Decipher, DGV and ClinVar) and literature, the detected CNV is considered as pathogenic. The family chose to terminate the pregnancy.

Conclusions
The identified 1q22 microdeletion including ASH1L is pathogenic and associated with ID. This case broadens the spectrum of ID-related CNVs and may be useful as a reference for clinicians.
Cluster randomised trials of prescribing policy: an ethical approach to generating drug safety evidence? A discussion of the ethical application of a new research method
Authors: Rogers Amy , Craig Gillian , Flynn Angela , Mackenzie Isla , MacDonald Thomas , Doney Alexander 
Published: June 2020

AbstractFor most chronic medical conditions, multiple medications are available and prescribers often have limited evidence about which therapy is likely to be the most effective and safe for an individual patient. As many patients are exposed every day to medicines that may be less effective than available alternatives, this is of public health importance. Cluster randomised trials of prescribing policy offer an opportunity to rapidly obtain evidence of comparative effectiveness and safety. These trials can pose a low risk to patients and cause minimal disruption to usual care. Despite the potential scientific value of this approach, there remain valid concerns about consent, medication switching and the use of routinely collected data in research. We discuss these concerns with reference to an ongoing pilot study (Evaluating Diuretics in Normal Care (EVIDENCE) - a cluster randomised evaluation of hypertension prescribing policy, ISRCTN 46635087, registered 11 August 2017).