bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in bowel habits during menstruation: are IBD patients different?
Authors: Lahat Adi , Falach-Malik Alona , Haj Ola , shatz Zina , Ben- Horin Shomron 
Published: June 2020

Background and aim: Many female inflammatory bowel disease (IBD) patients report symptoms exacerbation before and during menses. Our aim was to characterize their symptoms and specific risk factors in comparison with healthy controls. Methods: Female IBD patients aged 18–50 years were asked to fill out a questionnaire recording their demographic and disease characteristics, menstruation history and symptoms. Disease activity was defined by Harvey–Bradshaw index (HBI) for Crohn’s disease (CD) patients and modified mayo score for ulcerative colitis (UC) patients. Healthcare providers answering an internet survey assessing bowel symptoms during menstruation served as healthy controls. Results: A total of 139 IBD patients, of whom 100 were CD patients, filled the questionnaire. The mean age was 30.4 [±7.7 standard deviation (SD)], mean disease duration was 7.8 (±6 SD), mean HBI was 4.7 (±3.8 SD), and mean Mayo score was 2.1 (±2.5 SD). A change in bowel habits during menstruation was reported by 72% of CD patients compared with 56% of UC patients ( p = 0.07). Out of 258 healthy controls, 93% reported a change in bowel habits during menstruation compared with 68% of IBD patients ( p < 0.001). However, other abdominal and constitutional symptoms were significantly more prevalent among IBD patients compared with healthy controls ( p < 0.01 for most parameters). Smoking status, biologic treatment, and previous abdominal operation were found to significantly aggravate symptoms during menses in IBD patients Conclusion: IBD patients experience various symptoms during menses significantly more commonly than healthy women. Smoking, biologic treatment, and previous abdominal operations are risk factors for higher symptomatic burden. Following future validation and research, these results can help in patients’ risk stratification and possibly in risk reduction.
Long-term effectiveness in patients previously treated with cladribine tablets: a real-world analysis of the Italian multiple sclerosis registry (CLARINET-MS)
Authors: Patti Francesco , Visconti Andrea , Capacchione Antonio , Roy Sanjeev , Trojano Maria ,   on behalf of the CLARINET-MS Study Group
Published: June 2020

Background: The CLARINET-MS study assessed the long-term effectiveness of cladribine tablets by following patients with multiple sclerosis (MS) in Italy, using data from the Italian MS Registry. Methods: Real-world data (RWD) from Italian MS patients who participated in cladribine tablets randomised clinical trials (RCTs; CLARITY, CLARITY Extension, ONWARD or ORACLE-MS) across 17 MS centres were obtained from the Italian MS Registry. RWD were collected during a set observation period, spanning from the last dose of cladribine tablets during the RCT (defined as baseline) to the last visit date in the registry, treatment switch to other disease-modifying drugs, date of last Expanded Disability Status Scale recording or date of the last relapse (whichever occurred last). Time-to-event analysis was completed using the Kaplan–Meier (KM) method. Median duration and associated 95% confidence intervals (CI) were estimated from the model. Results: Time span under observation in the Italian MS Registry was 1–137 (median 80.3) months. In the total Italian patient population ( n = 80), the KM estimates for the probability of being relapse-free at 12, 36 and 60 months after the last dose of cladribine tablets were 84.8%, 66.2% and 57.2%, respectively. The corresponding probability of being progression-free at 60 months after the last dose was 63.7%. The KM estimate for the probability of not initiating another disease-modifying treatment at 60 months after the last dose of cladribine tablets was 28.1%, and the median time-to-treatment change was 32.1 (95% CI 15.5–39.5) months. Conclusion: CLARINET-MS provides an indirect measure of the long-term effectiveness of cladribine tablets. Over half of MS patients analysed did not relapse or experience disability progression during 60 months of follow-up from the last dose, suggesting that cladribine tablets remain effective in years 3 and 4 after short courses at the beginning of years 1 and 2.
Preulcerous Risk Situation in Diabetic Foot Syndrome: Proposal for a Simple Ulcer Prevention Score
Authors: Kress Stephan , Anderten Helmut , Borck Anja , Freckmann Guido , Heinemann Lutz , Holzmüller Ulrike , Kulzer Bernd , Portele Alexandra , Schnell Oliver , Varlemann Helga , Zemmrich Claudia , Lobmann Ralf 
Published: June 2020

Background: Preulcerous risk situations in patients with diabetes are often undiagnosed and care administered too late. Even with regular medical check-ups and status documentation, foot examinations have not been given enough attention. Diagnosing an individual patients’ risk of developing diabetic foot ulcers may increase vigilance for diabetic foot syndrome (DFS), and the appropriate prevention measures matching the risk involved may prevent the emergence of diabetic ulcers. The classical DFS risk factors are well established and have been extensively covered in the literature; however, there is a lack of efficient screening tools that could be used for a rapid assessment of diabetic foot ulcer risk. Methods: A methodical literature search was conducted to assess relevant publications for the preparation of a simple risk score for amputation related to diabetic foot ulcer. We then analyzed the risk factors for predictive value as odds ratios in foot ulcers and/or amputation. We used the available data to deduce a mean value to reflect the authors’ consensus. Results: In view of the current literature on the matter, we have developed a semi-quantitative scoring system using just a few items to allow rapid and visual risk assessment for diabetic foot ulcers alongside recommendations for prevention and a sensible follow-up strategy to match the risk. Conclusion: This relatively simple score enables rapid risk classification for patients that can ease the way for both physicians and patients in gaining an insight into individual risk situations. The score provides more effective preventative measures for high-risk patients against future complications.
Eating Disorders in Male Athletes
Authors: Eichstadt Madison , Luzier Jessica , Cho Daniel , Weisenmuller Chantel 
Published: June 2020

Context: Eating disorders (EDs) in male athletes are potentially debilitating disorders with significant medical, psychological, and athletic performance consequences. Evidence Acquisition: Searches were performed across PubMed, EBSCOhost, and PSYCinfo from 1990 to 2019. Keywords searched were eating disorder, male, athlete, anorexia nervosa, bulimia nervosa, muscularity, muscle dysmorphia, and sports. Search results included articles written in the English language and encompassed reviews, empirical studies, and theoretical articles. Study Design: Clinical review. Level of Evidence: Level 3. Results: EDs among male athletes may lead to serious negative outcomes, including increased susceptibility to injury, inconsistent performance, problematic recovery, muscle deficiencies, impairment of optimal athletic functioning, and medical, social, and emotional problems. Male athletes with EDs may be more difficult to identify and diagnose for a variety of reasons related to differential presentation of symptoms, secretiveness or shame around behaviors, and sex-related stigma. Conclusion: Professionals working closely with athletes are uniquely positioned to identify and screen those who may require further evaluation and treatment.
Dorsal midline incision: A versatile technique for correction of meatal stenosis during hypospadias repair
Authors: Yadav Sher , Bamaniya Manoj , Agarwal Vibhore , Tomar Vinay , Gupta Abhimanyu , Kumawat Ghanshyam 
Published: June 2020

Objectives: To our knowledge, the incidence of congenital meatal abnormalities associated with hypospadias varies from 9.6% to 31%, of which meatal stenosis is the most common, affecting 9.1–16.7% of patients. Traditionally, meatal stenosis has been dealt with by meatal dilatation, although ventral meatotomy until the normal urethra is encountered has also been used. Here, we report the outcome of a technique where, during hypospadias repair, a dorsal midline incision was performed instead of a ventral urethral incision, starting at the narrow meatus and subsequently extending proximally to treat the meatal stenosis. Methods: Patients having distal hypospadias with meatal stenosis were included in this study. In this technique, a dorsal midline incision was extended until normal calibre urethra was encountered. Patients with chordee >15°, proximal hypospadias, redo cases, glans width <14 mm, where separation of the skin from the underlying urethra was not possible and with a follow-up of less than three months were excluded from the study. A total of 73 patients were operated on using this technique. Results were assessed with regards to urethrocutaneous fistula (UCF) and stricture formation. Results: Five (6.85%) patients developed UCF: one (5%) in the subcoronal group, two (8.0%) in the distal penile group and two (14.3%) in the mid-penile hypospadias group. Postoperatively, only one patient had meatal stenosis. Conclusion: We think hypospadiac meatal stenosis is best treated by a dorsal midline incision, as it does not lead to a proximal shift of the meatus, and this defect heals by re-epithelisation without significant scarring, which in turn decreases the possibility of UCF. That is why the fistula rate in our study was 6.85%, which is lower than in various published series.
Internet-based survey of the perceptions of surgical scars of Japanese patients
Authors: Kohta Masushi , Nishigaki Chihiro 
Published: June 2020

Introduction: The adverse aesthetic effects of post-surgical scars frequently impose a psychological burden on patients. We conducted an Internet-based questionnaire survey of Japanese individuals to explore patient satisfaction with respect to surgical scars and to identify the factors that affect their interest and experience of scar care. Method: A cross-sectional study was conducted for the previous year on patients who had undergone the following surgeries: gastrointestinal; orthopaedic; obstetric; gynaecological; and plastic. The questionnaire included: (1) measures of participant characteristics; (2) measures of interest, experience and satisfaction with scar care; (3) measures of current and desired scar condition; and (4) measures of communication with physicians or nurses. Results: A total of 214 participants were enrolled. Of these, only 90 individuals had experienced any treatment or self-care, and only 30 were satisfied with their experience. We found a significant gap between the current and desired thickness and colour of the scar ( P < 0.01). On logistic regression analysis, scars located at a visible site and size of the scar were significant factors that affected the interest and experience of scar care. Only 40% of participants answered that their physician or nurse adequately understands their concerns pertaining to the scar condition. Conclusion: Only a small proportion of individuals were satisfied with their experience of scar care. Additional research in following areas is required: (1) mutual communication between patients and medical providers; and (2) development of a new care programme for the management of scars.
POSSUM and P-POSSUM Scoring in Hip Fracture Mortalities
Authors: Johns William L. , Strong Benjamin , Kates Stephen , Patel Nirav K. 
Published: June 2020

Introduction: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) are general surgical tools used to efficiently assess mortality and morbidity risk. Data suggest that these tools can be used in hip fracture patients to predict morbidity and mortality; however, it is unclear what score indicates a significant risk on a case-by-case basis. We examined the POSSUM and P-POSSUM scores in a group of hip fracture mortalities in order to assess their accuracy in identification of similar high-risk patients. Materials and Methods: Retrospective analysis of all consecutive mortalities in hip fracture patients at a single tertiary care center over 2 years was performed. Patient medical records were examined for baseline demographics, fracture characteristics, surgical interventions, and cause of death. Twelve physiological and 6 operative variables were used to retrospectively calculate POSSUM and P-POSSUM scores at the time of injury. Results: Forty-seven hip fracture mortalities were reviewed. Median patient age was 88 years (range: 56-99). Overall, 68.1% (32) underwent surgical intervention. Mean predicted POSSUM morbidity and mortality rates were 73.9% (28%-99%) and 31.1% (5%-83%), respectively. The mean predicted P-POSSUM mortality rate was 26.4% (1%-91%) and 53.2% (25) had a P-POSSUM predicted mortality of >20%. Subgroup analysis demonstrated poor agreement between predicted mortality and observed mortality rate for POSSUM in operative (χ2 = 127.5, P < .00001) and nonoperative cohorts (χ2 = 14.6, P < .00001), in addition to P-POSSUM operative (χ2 = 101.9, P < .00001) and nonoperative (χ2 = 11.9, P < .00001) scoring. Discussion/Conclusion: Hip fracture patients are at significant risk of both morbidity and mortality. A reliable, replicable, and accurate tool to represent the expected risk of such complications could help facilitate clinical decision-making to determine the optimal level of care. Screening tools such as POSSUM and P-POSSUM have limitations in accurately identifying high-risk hip fracture patients.
Building efficacy beliefs through team task engagement and past task performance in contemporary teams
Authors: Rodríguez-Sánchez Alma Mª , Hakanen Jari , Salanova Marisa 
Published: June 2020

It is important for organizations to identify the drivers for effective collaboration in contemporary teams, such as self-managed ad hoc teams. Therefore, we aimed to investigate (1) the influence of team task engagement and mastery experiences on collective efficacy beliefs and (2) the temporal relationship between team task engagement and task performance over time. We postulate that to build collective efficacy in contemporary teams over time, it is necessary to enhance positive emotional states (i.e., team task engagement) and mastery experiences (teams’ past task performance). The study adopted a three-wave longitudinal design in which 575 individuals nested within 112 self-managed ad hoc teams participated in a decision-making task. Results showed that team task engagement and past task performance positively predicted future collective efficacy. Moreover, team task engagement positively predicted teams’ task performance over time. This study contributes to the understanding of the antecedents of team effectiveness, specifically in contemporary teams. JEL CLASSIFICATION: C92; J24; O15
Politicians in disguise and financial experts on the board: Evidence from Spanish cajas
Authors: de Andres Pablo , Garcia-Rodriguez Inigo , Romero-Merino M. Elena , Santamaria-Mariscal Marcos 
Published: June 2020

This study offers insight into the role of board politicization on the Spanish cajas’ performance from a dual perspective. First, we analyze the effect of a new kind of political directors who occupy board seats as representatives of stakeholders outside the public administrations while maintaining a political affiliation. We call these “hidden” political directors as politicians in disguise. Second, we analyze how political interests can prevent directors with financial expertise from applying their knowledge to improve cajas’ performance. Using a sample of hand-collected data from 45 Spanish cajas, we find that politicians in disguise destroy value in the caja and that politically motivated financial experts on the board do not benefit cajas’ performance. JEL CLASSIFICATION: G34, G21, G28
Attempts to Limit Censoring in Measures of Patient Satisfaction
Authors: Nguyen Cindy , Kortlever Joost T P , Gonzalez Amanda I , Ring David , Brown Laura E , Somogyi Jason R 
Published: June 2020

Background: Measures of patient satisfaction are increasingly used to measure patient experience. Most satisfaction measures have notable ceiling effects, which limits our ability to learn from variation among relatively satisfied patients. This study tested a variety of single-question satisfaction measures for their mean overall score, ceiling and floor effect, and data distribution. In addition, we assessed the correlation between satisfaction and psychological factors and assessed how the various methods for measuring satisfaction affected net promoter scores (NPSs). Methodology: A total of 212 patients visiting orthopedic offices were enrolled in this randomized controlled trial. Patients were randomized to 1 of 5 newly designed, single-question satisfaction scales: (a) a helpfulness 11-point ordinal scale from 0 to 10, (b) a helpfulness ordinal 11-point scale from 0 to 5 (ie, with 1.5, 2.5, etc), (c) a helpfulness 100-point slider, (d) a satisfaction 11-point ordinal scale from 0 to 10, and (e) a willingness to recommend 11-point ordinal scale from 0 to 10. Additionally, patients completed the 2-item Pain Self-Efficacy Questionnaire (PSEQ-2), 5-item Short Health Anxiety Inventory (SHAI-5) Scale, and Patient-Reported Outcomes Measurement Information System (PROMIS) Depression. We assessed mean and median score, ceiling and floor effect, and skewness and kurtosis for each scale. Spearman’s correlation tests were used to test correlations between satisfaction and psychological status. Finally, we assessed the NPS for the various scales. Results: Ceiling effects ranged from 29% to 68%. The 11-point ordinal helpfulness scale from 0 to 10 had the least ceiling effect (29%). All of the scales were asymmetrically distributed, with the 11-point ordinal scale from 0 to 5 having the most Gaussian distribution (skew = 0.64 and kurtosis = 2.3). Satisfaction scores did not correlate with psychological factors: PSEQ-2 ( r = 0.04; P = .57), SHAI-5 ( r = 0.01; P = .93), and PROMIS Depression ( r = −0.04; P = .61). Net promoter scores varied substantially by scale design, with higher scores corresponding with greater ceiling effects. Conclusions: Variations in scale types, text anchors, and lead-in statements do not eliminate the ceiling effect of single-question measures of satisfaction with a visit to an orthopedic specialist. Further studies might test other scale designs and labels. Level of Evidence: Diagnostic; Level II
Spontaneous systolic blood pressure drop early after mechanical thrombectomy predicts dramatic neurological recovery in ischaemic stroke patients
Authors: Carvalho Dias Mariana , Gabriel Denis , Saraiva Marlene , Campos Daniel , Requena Manuel , García-Tornel Álvaro , Muchada Marian , Boned Sandra , Rodriguez-Luna David , Rodriguez-Villatoro Noelia , Pagola Jorge , Juega Jesus , Deck Matías , Ribo Marc , Tomasello Alejandro , Molina Carlos A , Rubiera Marta 
Published: June 2020

Introduction Spontaneous blood pressure drop within the first 24 h has been reported following arterial recanalisation in ischaemic stroke patients. We aimed to assess if spontaneous blood pressure drop within the first hour after mechanical thrombectomy is a marker of early neurological recovery. Patients and methods Retrospective observational single-centre study including ischaemic stroke patients treated with mechanical thrombectomy. Blood pressure parameters from admission, mechanical thrombectomy start, mechanical thrombectomy end and hourly within 24 h after mechanical thrombectomy were reviewed. Primary outcome was early dramatic neurological recovery (8-point-reduction in NIHSS or NIHSS ≤ 2 at 24 h). Secondary outcome was functional independence at 90 days (mRankin 0–2). Results We included 458 patients in our analysis. Two-hundred (43.7%) patients achieved dramatic neurological recovery following mechanical thrombectomy. One hour after mechanical thrombectomy end, median systolic blood pressure was significantly different between outcome groups (129 vs. 138 mmHg, p = 0.005) and a higher drop in median systolic blood pressure was seen in the dramatic neurological recovery group (15 vs. 9 mmHg). Optimal cut-off for predicting dramatic neurological recovery was a systolic blood pressure drop of 10.5 mmHg (sensitivity 0.54, specificity 0.55, AUC 0.55). On multivariate analysis, spontaneous systolic blood pressure drop was associated with higher odds of achieving dramatic neurological recovery (OR for 10 mmHg blood pressure drop 1.14, 95% CI 1.01–1.29, p = 0.04). No significative association between any blood pressure parameter drop and functional independence at 90 days was found. Discussion We hypothesised that spontaneous systolic blood pressure drop is a marker of successful reperfusion and, therefore, a marker of improvement of cerebral autoregulation due to the reduced final ischaemic core. Conclusion Spontaneous systolic blood pressure drop after mechanical thrombectomy is an early predictor of dramatic neurological recovery.
Microbiome-intestine cross talk during acute graft-versus-host disease
Authors: Rafei Hind , Jenq Robert R. 
Published: June 2020

AbstractAllogeneic hematopoietic stem cell transplantation (allo-SCT) offers cure for a variety of conditions, in particular, but not limited to, hematologic malignancies. However, it can be associated with life-threatening complications, including graft-versus-host disease (GVHD) and infections, which are factors limiting its widespread use. Technical advances in the field of microbiome research have allowed for a better understanding of the microbial flora of the human intestine, as well as dissection of their interactions with the host immune system in allo-SCT and posttransplant complications. There is growing evidence that the commensal microbiome is frequently dysregulated following allo-SCT and that this dysbiosis can predispose to adverse clinical outcomes, especially including acute intestinal GVHD and reduced overall survival. In this review, we discuss the interactions between the microbiome and the components of the immune system that play a major role in the pathways leading to the inflammatory state of acute intestinal GVHD. We also discuss the microbiome-centered strategies that have been devised or are actively being investigated to improve the outcomes of allo-SCT patients in regard to acute intestinal GVHD.