bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multi-Site Study of Provider Self-Efficacy and Beliefs in Explaining Judgments About Need and Responsibility for Advance Care Planning
Authors: Baughman Kristin R. , Ludwick Ruth , Jarjoura David , Yeager Mia , Kropp Denise 
Published: December 2020

Background and Objectives: We examined the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgments about resident need and provider responsibility for initiating ACP conversations. Research Design and Methods: This observational multi-site study of 348 registered nurses, licensed practical nurses, and social workers within 29 SNFs used an anonymous survey in which providers judged vignettes with assigned situational features of a typical SNF resident. Mixed modeling was used to analyze the vignette responses. Results: Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring ACP took place. Self-efficacy did not have a significant impact on judgments of need, but did significantly increase judgments of responsibility for ensuring ACP conversations. Providers with the highest levels of ACP self-efficacy were most likely to feel responsible for ensuring ACP conversations. In an exploratory analysis, these relationships remained the same whether responding to high or low risk residents (i.e., based on risk of hospitalization, type of diagnosis, functional status, and rate of declining health). Discussion and Implications: Both negative beliefs about ACP and self-efficacy in one’s ability to conduct ACP discussions were associated with professional judgments regarding ACP. The findings illustrate the importance of addressing negative beliefs about ACP and increasing provider ACP self-efficacy through education and policies that empower nurses and social workers.
Changing Disparity of Gastric Cancer Incidence by Histological Types in US Race-Specific Populations
Authors: Zhu Xuan , Pigazzi Alessio , Zell Jason , Lu Yunxia 
Published: December 2020

Background: The incidence pattern of gastric cancer by histological types across major race/ethnic groups is unknown. Methods: Age-standardized rates from 1992-2016 by race/ethnicity were calculated using data from Surveillance, Epidemiology, and End Results Program (SEER). Annual percent changes (APCs) in rates and corresponding 95% confidence intervals (CIs) were calculated and pairwise comparison of rates between race/ethnic groups was performed using the Joinpoint Regression Program. Calendar periods of incidence rates of gastric cardia and non-cardia cancer by histological types across race/ethnicity groups were shown by figures. Results: The White population has the highest incidence of gastric cardia adenocarcinoma and the incidence is keeping constant from 1992 through 2016 except the decreasing in the Asian population (AAPC = −1.4, 95%CI (−2.1, −0.8)). Although the incidence of non-cardia adenocarcinoma is decreasing in each group, the descending trend in the Asian population is the quickest (AAPC = −3.8, 95%CI (−4.0, −3.5)). Gastric carcinoids were observed to have statistically significant increasing trends in all race/ethnicity groups, especially in Hispanic women from 0.4 per 100,000 to 1.6 per 100,000 persons. The incidence of gastrointestinal stromal tumors (GISTs) is rising, with Non-Hispanic blacks having the highest incidence. Conclusion: This study demonstrated disparities in the incidence of gastric cancer by histological types among different race/ethnic groups. Further investigations are warranted to understand the changing incidence patterns by race/ethnicity.
Changes in Coagulation and Fibrinolysis in Post-Cesarean Section Parturients Treated With Low Molecular Weight Heparin
Authors: Liu Ziwei , Liu Chixiang , Zhong Mei , Yang Fang , Chen Hongtian , Kong Wenbing , Lv Piao , Chen Wanjun , Yao Yuan , Cao Qiong , Zhou Huayou 
Published: December 2020

Background: Cesarean section is an independent risk factor for Venous thromboembolism (VTE). Low molecular weight heparin (LMWH) is extensively used for VTE prophylaxis after cesarean section. In this study, the effects of LMWH on coagulation and fibrinolysis after cesarean section and its clinical value were explored by studying the changes in laboratory indicators. Methods: Antepartum and postpartum peripheral blood of 44 pregnant women who underwent vaginal delivery and 44 pregnant women who underwent cesarean section treated per routine with LMWH thromboprophylaxis on the first day post-operatively were collected for the following tests: D-dimer; thrombotic markers such as thrombomodulin (TM), thrombin-antithrombin complex (TAT), α2-plasmin inhibitor-plasmin complex (PIC), and tissue plasminogen activator inhibitor complex (t-PAIC); thromboelastography. Results: Compared to the antepartum levels, PIC increased, TM, TAT, and t-PAIC decreased significantly in the parturients after a spontaneous vaginal delivery. Compared to the antepartum levels, parturients routinely treated with LMWH after cesarean section had higher PIC levels and lower D-dimer, TAT, and t-PAIC levels. Compared with parturients after vaginal delivery, parturients treated with LMWH after cesarean section had higher levels of TM, R, and MA, while there was no significant differences in the levels of D-dimer, TAT, PIC, t-PAIC, K, angle, LY30, and CI. Conclusion: The coagulation and fibrinolytic systems in gravidas and parturients are in a high level of dynamic equilibrium. The levels of coagulation and fibrinolytic system activation were similar in parturients who were routinely treated with LMWH after cesarean section compared with parturients after a spontaneous vaginal delivery.
Evaluation of a pharmacist-driven rapid infusion rituximab conversion protocol at a multisite cancer center
Authors: Moore Donald C , Gebru Tsion , Plesca Dragos 
Published: December 2020

Introduction Infusion-related reactions (IRR) are a common adverse event associated with rituximab, an anti-CD20 monoclonal antibody indicated for the treatment of B-cell lymphomas. IRR risk is highest with the first infusion, which is given by a slow titration over an average of 3.5 hours. Subsequent administrations can be given over an accelerated, rapid 90-minute infusion if patients meet specific criteria. To improve rapid infusion rituximab utilization, we developed and implemented a pharmacist-driven protocol which allows pharmacists to change the administration instructions to rapid infusion. Methods A retrospective chart review was conducted to evaluate patients age ≥18 years with B-cell lymphomas who were eligible to receive rapid infusion rituximab following protocol implementation. The primary outcome was the prevalence of the use of rapid infusion rituximab for eligible patients. Secondary outcomes included the frequency of pharmacist-initiated conversions to rapid infusion rituximab and incidence of IRR with rapid infusions. Results A total of 180 patients were included in this study; 89 patients in the pre-protocol group and 91 patients in the post-protocol group. Fifteen patients and 66 patients in the pre-protocol and post-protocol groups, respectively, received rapid infusion rituximab (17% vs. 73%, p < 0.00001). The pharmacist-driven protocol was used to convert 49 patients (54%) to rapid infusion. No IRR occurred in patients receiving rapid infusion rituximab. Conclusion The implementation of a pharmacist-driven protocol led to a significant improvement in the use of rapid infusion rituximab and optimized chair time utilization at our institution.
Incision site fat thickness and 90-day complications for direct anterior and posterior approach total hip arthroplasty
Authors: Sprowls Gregory R. , Allen Bryce C , Lundquist Kathleen F , Sager Lauren N , Barnett Clint D 
Published: December 2020

Background: Defining the distribution of subcutaneous fat around the hip in relation to different approaches for total hip arthroplasty (THA) may lead to a better understanding of the relationship between obesity and complications. The purpose of this study was to: (1) describe the intraoperative thickness of subcutaneous fat at the incision site for direct anterior (DAA) and posterior approaches (PA) for THA; and (2) examine the relationship between fat thickness and 90-day postoperative complications. Methods: Intraoperative fat measurements were obtained at the anterior incision site (AT-IS) of the DAA ( n = 60) and the lateral incision site (LT-IS) of the PA ( n = 64). Lateral hip fat thickness was measured from preoperative anteroposterior pelvis radiographs (LT-XR). Body mass index (BMI), sex, age, and 90-day complications were collected retrospectively. Results: Patients within the same demographic groupings had significantly more fat laterally than anteriorly, between 9.6 mm and 17.96 mm. Return to the OR was significantly associated with BMI, AT-IS, and LT-IS. Wound complications were significantly associated with AT-IS. Periprosthetic joint infection (PJI) was significantly associated with BMI and LT-IS. No outcome variables were associated with LT-XR, approach, sex, or age. LT-XR was strongly correlated with AT-IS and LT-IS. Conclusions: Regardless of BMI, sex, or age more soft tissue was encountered with a PA compared to a DAA. General adiposity was associated with return to the OR. Excess incisional fat was associated with wound complications following a DAA and PJI after a PA. LT-XR and clinical examination near the proposed incision, may provide helpful data in making preoperative risk assessments.
The influence of anterior and posterior knot placement on hip function after total hip arthroplasty using a modified Dall’s approach: a prospective non-randomised comparative study
Authors: Hara Hiroaki , Fujita Hiroshi , Okutani Yuki , Kataoka Masanao , Harada Hideto , Murotani Yoshiki 
Published: December 2020

Background: The direct lateral modified Dall’s approach for total hip arthroplasty (THA) provides an excellent vision of the hip joint by osteotomising the greater trochanter (GT). A robust method for the reattachment of osteotomised fragments is essential to prevent complications around the GT. Ultra-high molecular weight polyethylene cables are reported to be useful for reattachment; but the optimal suture method of these cables is unknown. The purpose of this study was to investigate the influence of the knot position on hip function after primary THA. Methods: In a prospective non-randomised study 216 primary THA were included, being scheduled for an operation with a modified Dall’s approach. They were divided into 2 groups, anterior (A) and posterior (P) according to the knot position for the GT. Hip function was assessed using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), pain visual analogue scale (VAS), satisfaction VAS and Merle d’Aubigne-Postel hip score at 3 and 6 months postoperatively. A logistic regression analysis was used to investigate factors influenced by the knot position. Results: Patient demographics were comparable between the 2 groups. Differences of the knot position did not affect the radiological failure rate of GT reattachment. Regression analysis showed a significantly positive impact on pain VAS and flexion range at 6 months postoperatively for posterior knot position. Conclusions: For the reattachment of osteotomised fragments, the posterior knot may be superior to the anterior knot.
Evaluating the efficacy of topical vancomycin powder in the treatment of open lower extremity fractures
Authors: Vaida Justin , Conti Alexander DB , Ray Justin J , Bravin Daniel A , Bramer Michelle A 
Published: December 2020

Introduction Optimal management of lower extremity fractures includes early antibiotics administration, thorough irrigation and debridement, consideration of soft tissue injury, and definitive skeletal management. The purpose of this study was to evaluate the efficacy of topical vancomycin powder in the treatment of open lower extremity fractures. Methods This was a retrospective case control study in which open lower extremity fractures at our institution were reviewed for development of infection (including species and sensitivity if present) and the development of unanticipated wound complications requiring intervention. Patients from 2010-2015 were treated with standard of care consistent with evidence-based literature (IV antibiotics with external fixator, intramedullary nail, etc.). Patients from 2016–18 were additionally treated with vancomycin powder applied directly to the wound before closure. All patients were monitored per the treating surgeon’s standard follow-up protocol and had follow-up of at least two months. Results This retrospective case control study comprised 434 patients. The historical control group (n = 388 patients) and treatment group (n = 46 patients) were similar for age, sex, BMI (body mass index), diabetes, smoking status, and Injury Severity Score (ISS). There were 36 infections (9.28%) in the control group compared to four infections (8.70%) in the vancomycin powder group (p = 0.901). No significant difference was seen after adjusting for age, sex, BMI, diabetes, smoking status, and ISS. The vancomycin powder group experienced significantly more wound complications (15.2%) compared to the control group (6.4%; p = 0.039), which remained significant when adjusting for multiple covariates. Conclusions Topical vancomycin powder did not reduce the infection rate when applied in the surgical site of open lower extremity fractures. Instead, the addition of topical vancomycin powder resulted in significantly more wound complications in patients with open lower extremity fractures.
Risk factors for kidney disorders in patients with type 2 diabetes at high cardiovascular risk: An exploratory analysis (DEVOTE 12)
Authors: Amod Aslam , Buse John B , McGuire Darren K , Pieber Thomas R , Pop-Busui Rodica , Pratley Richard E , Zinman Bernard , Hansen Marco Bo , Jia Ting , Mark Thomas , Poulter Neil R ,   on behalf of the DEVOTE Study Group
Published: December 2020

Aim: To investigate risk factors associated with kidney disorders in patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk. Methods: In DEVOTE, a cardiovascular outcomes trial, 7637 patients were randomised to insulin degludec (degludec) or insulin glargine 100 units/mL (glargine U100), with standard of care. In these exploratory post hoc analyses, serious adverse event reports were searched using Standardised MedDRA® Queries related to chronic kidney disease (CKD) or acute kidney injury (AKI). Baseline predictors of CKD, AKI and change in estimated glomerular filtration rate (eGFR) were identified using stepwise selection and Cox or linear regression. Results: Over 2 years, eGFR (mL/min/1.73 m2) decline was small and similar between treatments (degludec: 2.70; glargine U100: 2.92). Overall, 97 and 208 patients experienced CKD and AKI events, respectively. A history of heart failure was a risk factor for CKD (hazard ratio [HR] 1.97 [95% confidence interval [CI] 1.41; 2.75]) and AKI (HR 2.28 [95% CI 1.64; 3.17]). A history of hepatic impairment was a significant predictor of CKD (HR 3.28 [95% CI 2.12; 5.07]) and change in eGFR (estimate: −8.59 [95% CI −10.20; −7.00]). Conclusion: Our findings indicate that traditional, non-modifiable risk factors for kidney disorders apply to insulin-treated patients with T2D at high CV risk. Trial registration: NCT01959529 (ClinicalTrials.gov).
Attributions of Blame in Stranger and Acquaintance Rape: A Multilevel Meta-Analysis and Systematic Review
Authors: Persson Sofia , Dhingra Katie 
Published: December 2020

Background: Victim blame, particularly in cases of acquaintance rape, presents an obstacle to criminal justice. Past research indicates that acquaintance rape results in more blame than stranger rape. However, there are inconsistencies in these findings (e.g., whether there is a linear relationship between victim blame and relationship closeness), partly due to methodological variation. Objectives: To examine the effect of victim–perpetrator relationship on victim blame, how this effect is impacted by rape myth acceptance (RMA) and ambivalent sexism (AS), and to establish what the methodological quality is of studies. Synthesis method: Studies were synthesized through a multilevel meta-analysis using the Metafor package in R (version 2.4-0), synthesizing findings from 47 individual studies. Studies compared victim blame between stranger and acquaintance rape, in isolation or in conjunction with RMA and AS, and were identified through a database search. Results: The review found higher levels of blame in acquaintance as compared to stranger rape, with a medium effect size. This effect was not moderated by RMA. AS was not included as a moderator in the meta-analysis, but the review indicated that benevolent sexism may be a particularly relevant variable. Implications: Future research should examine the relationship between AS and victim blame. The current review contributes to the evidence base on victim blame in rape cases by suggesting that methodological limitations can account for some of the past mixed findings in this area, particularly in a lack of consistency in vignette details. It is recommended that future sexual assault research uses rigorous methodology and increases transparency of research processes.
The Potential Role of Intensity-Modulated Proton Therapy in Hepatic Carcinoma in Mitigating the Risk of Dose De-Escalation
Authors: Cozzi Luca , Comito Tiziana , Loi Mauro , Fogliata Antonella , Franzese Ciro , Franceschini Davide , Clerici Elena , Reggiori Giacomo , Tomatis Stefano , Scorsetti Marta 
Published: December 2020

Purpose: To investigate the role of intensity-modulated proton therapy (IMPT) for hepatocellular carcinoma (HCC) patients to be treated with stereotactic body radiation therapy (SBRT) in a risk-adapted dose prescription regimen. Methods: A cohort of 30 patients was retrospectively selected as “at-risk” of dose de-escalation due to the proximity of the target volumes to dose-limiting healthy structures. IMPT plans were compared to volumetric modulated arc therapy (VMAT) RapidArc (RA) plans. The maximum dose prescription foreseen was 75 Gy in 3 fractions. The dosimetric analysis was performed on several quantitative metrics on the target volumes and organs at risk to identify the relative improvement of IMPT over VMAT and to determine if IMPT could mitigate the need of dose reduction and quantify the consequent potential patient accrual rate for protons. Results: IMPT and VMAT plans resulted in equivalent target dose distributions: both could ensure the required coverage for CTV and PTV. Systematic and significant improvements were observed with IMPT for all organs at risk and metrics. An average gain of 9.0 ± 11.6, 8.5 ± 7.7, 5.9 ± 7.1, 4.2 ± 6.4, 8.9 ± 7.1, 6.7 ± 7.5 Gy was found in the near-to-maximum doses for the ribs, chest wall, heart, duodenum, stomach and bowel bag respectively. Twenty patients violated one or more binding constraints with RA, while only 2 with IMPT. For all these patients, some dose de-intensification would have been required to respect the constraints. For photons, the maximum allowed dose ranged from 15.0 to 20.63 Gy per fraction while for the 2 proton cases it would have been 18.75 or 20.63 Gy. Conclusion: The results of this in-silico planning study suggests that IMPT might result in advantages compared to photon-based VMAT for HCC patients to be treated with ablative SBRT. In particular, the dosimetric characteristics of protons may avoid the need for dose de-escalation in a risk-adapted prescription regimen for those patients with lesions located in proximity of dose-limiting healthy structures. Depending on the selection thresholds, the number of patients eligible for treatment at the full dose can be significantly increased with protons.
Acupuncture for Cancer Related Pain: Protocol for a Pragmatic Randomised Wait-List Controlled Trial
Authors: Zhao Qi , Zheng Suyang , Delaney Geoff P. , Moylan Eugene , Agar Meera R. , Koh Eng-Siew , Lai Hezheng , Birling Yoann , Zhang George Shengxi , Wang Kang , Ma Yong , Zhu Xiaoshu 
Published: December 2020

Background: Acupuncture has been proved effective for cancer related pain (CRP) in China, America and some other countries. However, there is relative lack of evidence to support the use of acupuncture for CRP in Australia. Objectives: To assess the effectiveness and safety of acupuncture for management of CRP in a real-world setting and to understand cancer patients’ experience of undergoing acupuncture for CRP. Methods: A pragmatic randomised controlled trial will be conducted in South Western Sydney Local Health District (SWSLHD) in NSW, Australia. Adults with cancer related pain (n = 106) will be randomised in a 1:1 ratio to receive the acupuncture intervention up front versus after a wait list period of 4 weeks. Pain level (by Numerical Rating Scale), analgesic use, auricular acupressure frequency and adverse events will be assessed at baseline, mid-treatment and post-treatment. Expectancy on trial outcome (by Credibility and Expectancy questionnaire) will be assessed at baseline. The perspective of the participants (by an interview) will be recorded after the last intervention. Expected outcomes: We hypothesise that acupuncture will relieve cancer related pain at mid-treatment and post-treatment. We also hypothesise that few adverse events will be provoked by acupuncture. Trial registration: Australia New-Zealand Clinical Trial Registry (ACTRN12620000325909).
Challenging Power Dynamics and Eliciting Marginalized Adolescent Voices Through Qualitative Methods
Authors: Pincock Kate , Jones Nicola 
Published: December 2020

Eliciting adolescents’ voices through qualitative research necessitates research methods which challenge the power dynamics that marginalize young people and thus inhibit them from sharing their perspectives. In lower- and middle-income countries where younger adolescents in particular are often discouraged from expressing their voices, this is especially important. Methodological tools which are adaptable, interesting and create space within the research process for participation and freedom of expression are critical when eliciting the “voices” of young people aged 10–14 years, who are often less visible or accessible and thus marginalized both socially and within research processes. For example, adolescents with disabilities or those out of school may require methodological adaptations to ensure meaningful participation. This article focuses on the ethical, practical and data quality issues that emerge when engaging with young adolescents that are marginalized both in research and within their own communities, and the need to ensure complementarity between the process of the research and its broader objective of expanding adolescent capabilities. Bearing in mind these challenges, this paper reflects on the methodological toolkit developed by the Gender and Adolescence: Global Evidence (GAGE) research project as a means for eliciting a diversity of adolescent voices and ensuring that socially excluded adolescents are not “left behind,” nor included on a merely tokenistic basis. We suggest that the strengths of the GAGE methodological toolkit lie in its grounding within broader research objectives vis-à-vis expanding adolescent capabilities and challenging structures and norms which marginalize young people. The flexibility, reflexivity and importantly the enjoyability of these methods led to adolescents both feeling at ease, able and willing to contribute their voices to the research—as well as empowered to use their voices in other areas of their lives.