bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of metformin on vertebral marrow fat in postmenopausal women with newly diagnosed type 2 diabetes mellitus
Authors: Lin Fang , Pan Yuning , Zhang Yinwei , Zhou Qiang 
Published: December 2019

Abstract

Objective:
To determine the effect of metformin on marrow adiposity in postmenopausal women with newly diagnosed type 2 diabetes mellitus (T2DM).

Methods:
We enrolled 25 postmenopausal T2DM women who satisfied the requirement of having been on 1 year of metformin therapy and 26 age-matched healthy women receiving a placebo. All participants were analyzed for marrow fat fraction (FF) by magnetic resonance spectroscopy, vertebral volumetric bone mineral density (vBMD) by quantitative computed tomography, blood glucose, lipid profiles, and bone biomarkers to compare values before and after the interventions. Differences between groups were assessed using a Student's t test and chi-square test or an analysis of covariance adjusted for covariates. Twelve-month change in within-group difference was assessed using paired t tests. Correlations were determined by Pearson's correlation.

Results:
Vertebral vBMD was lower in T2DM than in nondiabetic controls (105.6 ± 13.8 vs 112.8 ± 15.2 mg/cm3; P = 0.029). T2DM women had a higher marrow FF than those without diabetes (66.3 ± 7.2% vs 58.9 ± 7.5%; P < 0.001), even after adjusting for covariates. From baseline to month 12 in the T2DM group, metformin was associated with a reduction in marrow FF (−12.0%; P < 0.001) and an increase in vBMD (3.7%; P = 0.020). For metformin-treated T2DM women, the 12-month change in marrow FF was inversely associated with change in vBMD (r = −0.771, P < 0.001), but not with changes in bone biomarkers, whereas change in vBMD or FF was not significant in the control group.

Conclusion:
Postmenopausal women with newly diagnosed T2DM have a higher marrow fat content compared with nondiabetic women. Metformin treatment reduced marrow adiposity in T2DM.
Online Family Problem-Solving Therapy (F-PST) for Executive and Behavioral Dysfunction After Traumatic Brain Injury in Adolescents: A Randomized, Multicenter, Comparative Effectiveness Clinical Trial
Authors: Kurowski Brad G. , Taylor H. Gerry , McNally Kelly A. , Kirkwood Michael W. , Cassedy Amy , Horn Paul S. , Stancin Terry , Wade Shari L. 
Published: December 2019

Objective:
To examine the comparative effectiveness of 3 modes of family problem-solving therapy (F-PST): therapist-guided online, self-guided online, and face-to-face.

Setting:
Four children's hospitals and a general hospital with pediatric commitment.

Participants:
A total of 150 adolescents aged 14 to 18 years, previously hospitalized with traumatic brain injury (TBI), and evidence of behavior problems at enrollment.

Design:
Multicenter, randomized clinical trial.

Main Measures:
Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC), Behavior Regulation Index, and Metacognition Index, and Strengths and Difficulties Questionnaire (SDQ) Total at baseline and 6 and 9 months later.

Results:
Mixed-model intention-to-treat analyses of comparative effectiveness failed to reveal statistically significant differences among treatment groups. At 6 months, parent BRIEF-GEC improved for the therapist-guided and self-guided, online groups. Effects remained significant and increased in magnitude at 9 months for the self-guided online group. Scores for the Self-guided online group significantly improved from baseline to 9 months on the SDQ Total.

Conclusions:
This comparative effectiveness study supports the utility of both self- and therapist-guided online F-PST in improving executive function behaviors in adolescents following TBI. Further work regarding clinical implementation and how best to integrate telehealth with ongoing rehabilitation care is warranted.
Impact of Secondary ADHD on Long-Term Outcomes After Early Childhood Traumatic Brain Injury
Authors: Narad Megan E. , Riemersma Jacqlyn , Wade Shari L. , Smith-Paine Julia , Morrison Paige , Taylor H. Gerry , Yeates Keith Owen , Kurowski Brad G. 
Published: December 2019

Objective:
To examine the impact of secondary attention-deficit/hyperactivity disorder (SADHD) on long-term global and executive functioning in adolescents after traumatic brain injury (TBI).

Setting:
Three tertiary cared children's hospitals and 1 general hospital.

Participants:
One hundred twenty children (TBI: n = 54; orthopedic injury: n = 66) without preinjury ADHD evaluated approximately 6.8 years postinjury.

Design:
Cross-sectional data analysis from a prospective, longitudinal study.

Main Measures:
Outcomes included functional impairment (Child and Adolescent Functional Assessment Scale) and executive functioning (Behavior Rating Inventory of Executive Function [BRIEF]).

Results:
SADHD moderated the association of injury type with the BRIEF-Behavioral Regulation Index (F
1,113 = 4.42, P = .04) and the Child and Adolescent Functional Assessment Scale (F
1,112 = 8.95, P = .003). TBI was only associated with poorer outcomes in the context of SADHD. SADHD was also associated with poorer outcomes on the BRIEF-Global Executive Composite (F
1,113 = 52.92, P < .0001) and BRIEF-Metacognitive Index scores (F
1,113 = 48.64, P < .0001) across groups. Adolescents with TBI had greater BRIEF-Global Executive Composite scores than those with orthopedic injury (F
1,113 = 5.00, P = .03).

Conclusions:
Although SADHD was associated with poorer functioning across groups, its adverse effects on behavioral regulation and overall functioning were amplified following TBI. TBI + SADHD may confer an elevated risk for significant impairments in early adolescence.
The Effect of Second-Generation Antidepressant Treatment on the Memory of Patients With Major Depressive Disorder
Authors: Gudayol-Ferré Esteve , Duarte-Rosas Patricia , Peró-Cebollero Maribel , Guàrdia-Olmos Joan 
Published: December 2019

Abstract

Background
Major depressive disorder (MDD) has been linked to episodic memory deficits that may be improved after pharmacological treatment, but it is unclear whether there is a class of antidepressants that is more effective than others to ameliorate these deficits in MDD. In addition, the possible effects of clinical and sociodemographic variables on the improvement of MDD memory deficits after pharmacological treatment are currently unknown. Our aims are to study the possible neuropsychological effects of second-generation antidepressant classes on the episodic memory of MDD patients and to study the potential effects of clinical and demographic variables as moderators of the effects of antidepressants on the memory of depressed patients through a meta-analysis approach.

Procedures
Nine articles were included in our study. A structural equation model meta-analysis was performed.

Results
Our results suggest that selective serotonin reuptake inhibitors and serotonine-noradrenaline reuptake inhibitors would bring about a substantial improvement in the memory of depressed patients, whereas other antidepressant classes would cause rather modest effects. Our results also suggest that clinical and demographic variables play a very important role as mediators of memory improvement after MDD treatment. Thus, a relatively low level of symptom severity, a high degree of clinical improvement, a younger age, and more years of education were positively related to memory improvement after MDD treatment.

Conclusions
Although antidepressant class is an important variable linked to memory improvement in MDD, overall, the degree of memory amelioration in depression is very closely related to clinical and demographic variables of patients with depression.
Biperiden Selectively Impairs Verbal Episodic Memory in a Dose- and Time-Dependent Manner in Healthy Subjects
Authors: Borghans Laura , Sambeth Anke , Blokland Arjan 
Published: December 2019

Abstract

Purpose/Background
Biperiden is a muscarinic antagonist that produces memory impairments without impairing attention or motor functions in healthy subjects. It has been suggested that a biperiden-induced memory deficit could model age- and dementia-related memory impairments. The goal of the current study was to determine the dose- and time-dependent effects of biperiden on cognition in healthy volunteers.

Methods/Procedures
Twenty-one healthy volunteers participated in a placebo-controlled, 3-way, crossover study. After a baseline test, cognitive performance was tested at 3 time points after a single dose of biperiden 2 or 4 mg, or placebo. Episodic memory was measured using a 15-word verbal learning task (VLT). Furthermore, n-back tasks, a sustained attention to response task and a reaction time task were used, as well as subjective alertness and a side effects questionnaire. In addition, blood serum values and physiological measures were taken.

Findings/Results
Biperiden decreased the number of words recalled in immediate and delayed recall of the VLT 90 minutes after drug intake. A dose-dependent impairment was found for the delayed recall, whereas the immediate recall was equally impaired by the 2 doses. Biperiden did not affect the performance on the VLT 4 hours after administration. Performance in the n-back task and the sustained attention to response task were not affected by biperiden at any time point. Both doses were well tolerated as reported side effects were mild at T
max and were minimal at the other time points.

Implications/Conclusions
Biperiden exerts effects on episodic memory without negatively affecting other cognitive performance and behavioral measures that were assessed in this study. The data provide further evidence that biperiden has selective effects on cognition, even after a high dose.
Lower Prolactin Levels in Patients Treated With Aripiprazole Regardless of Antipsychotic Monopharmacy or Polypharmacy
Authors: Sugai Takuro , Suzuki Yutaro , Yamazaki Manabu , Sugawara Norio , Yasui-Furukori Norio , Shimoda Kazutaka , Mori Takao , Ozeki Yuji , Matsuda Hiroshi , Okamoto Kurefu , Sagae Toyoaki , Someya Toshiyuki 
Published: December 2019

Abstract

Background
Hyperprolactinemia is a troublesome adverse effect of antipsychotics. Aripiprazole (ARP), which is one of second-generation antipsychotics, has been reported to lower serum prolactin (PRL) levels. However, few studies have compared the effect of ARP on plasma PRL levels between monopharmacy and polypharmacy with antipsychotics.

Methods
We conducted a large-scale investigation of the physical risk for inpatients with schizophrenia using a questionnaire covering demographic data, the number, dose and type of antipsychotics, and serum PRL levels.

Results
Sufficient data to conduct an assessment of the effect on PRL levels between antipsychotic monopharmacy and polypharmacy were obtained from 316 of the inpatients. Serum PRL levels in ARP combination group were lower than non-ARP combination group, regardless of antipsychotic monopharmacy or polypharmacy.

Conclusions
The present study suggests that ARP lowers serum PRL levels regardless of monopharamacy or polypharmacy with antipsychotics.
Clinical Risk Factors for Therapeutic Lithium-Associated Electrocardiographic Changes in Patients With Bipolar Disorder
Authors: Chen Pao-Huan , Kao Yu-Hsun , Chang Chi-Kang , Lin Yen-Kuang , Lin Yuan-Feng , Chen Yi-Jen 
Published: December 2019

Abstract

Purpose/Background
Lithium, a common medication used in bipolar disorder treatment, can exert an inhibitory effect on sodium and potassium channels and potentially cause cardiac electrical conduction disturbance and corrected QT (QTc) prolongation. This study aimed to examine whether lithium at therapeutic levels can change electrocardiographic parameters in different groups of patients with bipolar disorder and to identify the potential clinical risk factors.

Methods/Procedures
Standard 12-lead electrocardiogram data before and after lithium treatment in bipolar disorder patients after at least 2-week dropout of psychotropic medications were analyzed.

Findings/Results
A total of 39 patients with bipolar disorder receiving lithium treatment were enrolled. Nineteen patients (48.7%) exhibited increased from P wave beginning to QRS complex beginning intervals after lithium treatment (mean serum level, 0.653 ± 0.247 mmol/L). Twenty-four patients (61.5%) exhibited increased a combination of Q, R, and S waves complex durations and increased QTc intervals. Twenty-three patients (59.0%) exhibited increased corrected JT (JTc) intervals. The patient group with increased QTc or JTc intervals exhibited a higher mean systolic blood pressure than did the patient group without increased QTc (134.7 ± 19.2 mm Hg vs 115.7 ± 11.8 mm Hg, P = 0.020) or JTc intervals (134.4 ± 19.6 mm Hg vs 117.6 ± 13.3 mm Hg, P = 0.054), respectively. Biochemical and hemodynamic parameters were comparable between patients with and without increased a combination of Q, R, and S waves complex durations or from P wave beginning to QRS complex beginning intervals.

Implications/Conclusions
Elevated systolic blood pressure may be the risk factor for the ventricular conduction delay in bipolar disorder patients receiving lithium at therapeutic levels.
Sarcopenia is associated with longer hospital stay and multiorgan dysfunction in alcoholic hepatitis
Authors: Al-Azzawi Yasir , Albo Betty , Fasullo Matthew , Coukos Jennifer , Watts George J. , Tai Ryan , Radcliffe David , Kroll-Desrosiers Aimee , Devuni Deepika , Szabo Gyongyi 
Published: December 2019

Introduction:
Excessive alcohol consumption has steadily risen to become the third leading cause of preventable death in the USA. One consequence of heavy alcohol use recently under considerable investigation is alcoholic hepatitis. Although many risk factors for developing alcoholic hepatitis have been documented, our aim in this study was to examine the potential association between sarcopenia and severity, mortality, 30 days readmission rate, complication, infections and length of hospital stay in alcoholic hepatitis patients.

Methods:
A retrospective analysis was performed at a large, academic hospital in 194 alcoholic hepatitis patients aged 18–60 who had cross-sectional computed tomography imaging and met our clinical definition of alcoholic hepatitis. The fifth percentile of the psoas muscle index was used as a cutoff for sarcopenia.

Results:
One hundred ninety-four patients met the criteria for alcoholic hepatitis and had cross-sectional imaging. Higher Model for End-Stage Liver disease score was found in the sarcopenia group when compared to the non-sarcopenia group (mean Model for End-Stage Liver disease 21.5 and 24.2, respectively, P = 0.03). Sarcopenia also correlated with significantly longer hospital stay; the average length of stay in the sarcopenia group was 17.2 days while the non-sarcopenia patients had an average of 12.4 days. We found higher risk of developing pneumonia, sepsis and hepatic encephalopathy in sarcopenic patients.

Conclusion:
Alcoholic hepatitis patients with sarcopenia have significantly worse outcomes when compared with the patients without sarcopenia, including a severe form of alcoholic hepatitis, longer hospital stays, higher risk of developing pneumonia, sepsis and hepatic encephalopathy.
Bioanalytical Assessment of Plasma Concentrations of Angiotensin-Converting Enzyme II Inhibitors and Angiotensin Receptor Blockers: A Pilot Study Among Patients Hospitalized With Acute Heart Failure
Authors: McNaughton Candace D. , Collins Sean P. , Lindenfeld JoAnn , Morrison Ryan , Daniels John Scott , Wang Thomas J. 
Published: December 2019

Background:
Although angiotensin-converting enzyme II inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) improve chronic heart failure (HF) outcomes, their potential harms and benefits in acute HF (AHF) is less clear.

Study Question:
We explored the relationship between ACEI or ARB plasma concentrations among patients with AHF with in-hospital change in estimated glomerular filtration rate (eGFR).

Data Sources and Study Design:
From August 2016–June 2017, patients with AHF prescribed an outpatient ACEI or ARB were enrolled before AHF treatment. All patients were given twice their home dose of diuretic intravenously and received clinical care at the discretion of the medical team. Of 61 patients in the parent study, saved plasma from 34 who were prescribed an outpatient ACEI or ARB was included in this substudy.

Measures and Outcomes:
Liquid chromatography–tandem mass spectrometry was performed to assess ACEI or ARB plasma concentrations before AHF treatment. Change in eGFR was computed using the Chronic Kidney Disease Epidemiology Collaboration equation, which adjusts for age, sex, and race; diuretic dose and enrollment eGFR were used to adjust for HF severity. Multiple linear regression adjusting for enrollment eGFR and diuretic dose was performed to examine the relationship between drug concentration (undetectable/low vs. in/above-range) and in-hospital change in eGFR.

Results:
Of 34 patients with AHF, median age was 63 years (interquartile range, 58–78 years), 19 (55.9%) were women, median eGFR at enrollment was 55.6 mL/min (interquartile range, 35.2–75.3 mL/min), and for 11 (32.4%), no ACEI or ARB was detectable in plasma. Medication concentrations in- or above-reference range were associated with in-hospital decrease in eGFR of 8.3 mL/min (95% confidence interval, 15.3–1.3 mL/min decrease), after adjusting for enrollment eGFR and diuretic treatment.

Conclusions:
Bioanalytical assessment of medication levels may be useful to guide in-hospital ACEI and ARB therapy for patients with AHF.
Effects of Evidence-Based Continuing Care Bundle on Health Outcomes in Rectal Cancer Patients With Temporary Stomas
Authors: Su Xi , Zhong Mei-hua , Ye Xin-mei , Zhen Li , Yin Xue-xia , Qin Fang , Zhu Mu-lan , Kuang Yin-yi , Wang Hui-zhen 
Published: December 2019

Background
The patients with temporary stomas after anterior resection for rectal cancer may experience significant impact on their health outcomes, and hence continuing care is necessary and important for these patients. However, the effects of some single continuing care interventions remain unclear. Continuing care bundle may be an effective approach to address this uncertainty.

Objective
The aim of this study was to investigate the effects of an evidence-based continuing care bundle on selected health outcomes in patients with temporary stomas after anterior resection for rectal cancer.

Methods
This was a multicenter randomized controlled trial. A total of 124 patients with temporary stomas after anterior resection for rectal cancer were recruited from 4 general tertiary hospitals in Guangzhou, China, and were randomly assigned to a control group or an intervention group. Both groups received usual care, whereas the intervention group additionally received evidence-based continuing care bundle. Self-efficacy, quality of life, and stoma-related complications were collected at baseline and 4 and 12 weeks after surgery. Satisfaction and outcomes of stoma reversal were collected at the end of the observation.

Results
The intervention group had significantly improved the self-efficacy (F = 11.88, P = .001), quality of life (F = 17.99, P < .001) over time, satisfaction (t = 4.08, P < .001), and outcomes of stoma reversal (χ
2 = 5.93, P = .015) and reduced the incidence of complications (P < .05).

Conclusions
Evidence-based continuing care bundle can be an effective method to improve the health outcomes among these patients

Implication for Practice
By using the evidence-based continuing care bundle, nurses can help these patients improve their health outcomes in stoma-specific nursing.
Losing Her: Children's Reported Concerns in the First 6 Months of Their Mother's Breast Cancer Diagnosis
Authors: Almulla Hebah Ahmed , Lewis Frances Marcus 
Published: December 2019

Background
Maternal breast cancer has a significant impact on the well-being of school-aged children, but we know very little about the concerns these children attribute to their mother's illness.

Objective
The aim of this study was to describe child-reported illness-related concerns experienced in the initial 6 months of their mother's diagnosis and to identify any differences by age and gender of the child.

Methods
Data were obtained from 140 school-aged children (7–12 years) within 6 months of their mother diagnosis with stage 0 to III breast cancer. Children's written responses to an open-ended question were analyzed: “Think about a situation that has bothered you during the last month that had to do with your mom's breast cancer.” Inductive content analysis was used to analyze the data using methods adapted from grounded theory. Trustworthiness of results was protected by coding to consensus, formal peer debriefing, and maintaining an audit trail.

Results
“Losing Her”, the core construct, was identified and organized the children's concerns in 4 domains: (1) her being away from me, (2) worrying about her, (3) seeing my mother be different, and (4) changing how things work.

Conclusion
All children reported illness-related concerns about which they were bothered. Even seemingly short-term treatment-related absences from the child were interpreted as difficult.

Implication for Practice
Findings from the current study add to nurses' awareness and knowledge about the concerns of school-aged children during their mother's initial treatment of breast cancer. Nurses are in a key position to provide services directly to the child or through the mother.
Managing Patients With Severe and Enduring Anorexia Nervosa
Authors: Yager Joel 
Published: December 2019

ObjectiveApproximately 20% of patients with anorexia nervosa develop severe and enduring anorexia nervosa (SE-AN), manifest by decades-long illnesses. At certain points, demoralized and/or based on judicious appraisals of the seeming futility of further professional treatment to radically alter their course, some SE-AN patients decide that “enough is enough” and opt out of intensive treatment. This article considers courses and treatment options available at these stages for patients, families, and clinicians.MethodsThe author uses clinical illustrations, Socratic questioning, and available literature to explore questions of treatment strategies with patients struggling with SE-AN.ResultsSE-AN patients have frequently received care in varieties of medical, psychiatric, and specialized eating disorders inpatient, residential, partial hospital, and outpatient treatment settings. Patients may reject further high-intensity treatment for judicious or capricious reasons, but may still accept lower intensity treatments. Some may reject any and all offers of treatment. Clinicians' treatment recommendations, not always coinciding with patients' wishes, are influenced by numbers of clinical, social, and professional pressures, including those from families, treatment settings, regulatory bodies, and payors.ConclusionsWhen managing patients with decades-long disease and multiple comorbidities, clinicians must be realistic about the low odds of effecting cure and adjust treatment expectations accordingly. For patients with SE-AN, a variety of low-intensity treatment approaches, at times extending to palliative and hospice care, may be useful. Clinicians should always strive to provide humane comfort and support, as closely aligned to patients' judicious wishes as realistically possible.