bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Me in We dyadic communication intervention is feasible and acceptable among advanced cancer patients and their family caregivers
Authors: Ketcher Dana , Thompson Casidee , Otto Amy K. , Reblin Maija , Cloyes Kristin G. , Clayton Margaret F. , Baucom Brian R.W. , Ellington Lee 
Published: November 2020

Background: Advanced cancer affects the emotional and physical well-being of both patients and family caregivers in profound ways and is experienced both dyadically and individually. Dyadic interventions address the concerns of both members of the dyad. A critical gap exists in advanced cancer research, which is a failure of goals research and dyadic research to fully account for the reciprocal and synergistic effects of patients’ and caregivers’ individual perspectives, and those they share. Aim: We describe the feasibility and acceptability of the Me in We dyadic intervention, which is aimed at facilitating communication and goals-sharing among caregiver and patient dyads while integrating family context and individual/shared perspectives. Design: Pilot study of a participant-generated goals communication intervention, guided by multiple goals theory, with 13 patient-caregiver dyads over two sessions. Setting/participants: Patients with advanced cancer and their self-identified family caregivers were recruited from an academic cancer center. Dyads did not have to live together, but both had to consent to participate and all participants had to speak and read English and be at least 18 years or age. Results: Of those approached, 54.8% dyads agreed to participate and completed both sessions. Participants generated and openly discussed their personal and shared goals and experienced positive emotions during the sessions. Conclusions: This intervention showed feasibility and acceptability using participant-generated goals as personalized points of communication for advanced cancer dyads. This model shows promise as a communication intervention for dyads in discussing and working towards individual and shared goals when facing life-limiting or end-of-life cancer.
Evaluation of a hospital-wide vancomycin-dosing nomogram in patients with continuous-flow left ventricular assist devices
Authors: Hall Sylvie F , Athans Vasilios , Wanek Matthew R , Wang Lu , Estep Jerry D , Williams Brad 
Published: November 2020

Introduction: Hemodynamic derangements due to heart failure are associated with alterations in pharmacokinetics. Although use of mechanical circulatory support mitigates such derangements, little evidence is available regarding pharmacokinetics in patients with LVADs. A previous pharmacokinetic analysis of vancomycin among patients with LVADs observed a reduced volume of distribution and clearance compared with estimates based on population kinetics. Methods: A total of 28 adult patients with LVADs hospitalized between January 2014 and May 2018 who received vancomycin through a pharmacist dosing consult were included. Internal medicine patients without heart failure receiving vancomycin were enrolled in a 2:1 fashion to make a control group. Exclusion criteria were unstable renal function, ESRD, acute decompensation, cardiac surgery within the preceding 5 days, or weight >110 kg. Results: No difference was observed in the proportion achieving goal trough (64% of LVAD patients vs 71% control patients, p = 0.50). However, mean trough was significantly higher among LVAD patients (23.4 mg/L vs 17.7 mg/L, p = 0.017). Furthermore, there was a significant difference in the distribution of trough levels ( p = 0.025) with LVAD patients being more likely to attain levels >25 mg/L (32% vs 14%) and less likely to have troughs <10 mg/L (4% vs 14%). A numerically greater number of LVAD patients experienced nephrotoxicity but this did not reach statistical significance (32% vs 18%, p = 0.14). Conclusion: The use of vancomycin in LVAD patients may result in higher trough levels when compared to internal medicine patients. Increased monitoring or conservative dosing may be warranted to improve safety and efficacy.
Elimination of fluconazole during continuous renal replacement therapy. An in vitro assessment
Authors: Baud Frédéric J , Jullien Vincent , Abarou Tarik , Pilmis Benoît , Raphalen Jean-Herlé , Houzé Pascal , Carli Pierre , Lamhaut Lionel 
Published: November 2020

Introduction: Continuous renal replacement therapy (CRRT) efficiently eliminates fluconazole. However, the routes of elimination were not clarified. Adsorption of fluconazole by filters is a pending question. We studied the elimination of fluconazole in a model mimicking a session of CRRT in humans using the NeckEpur® model. Two filters were studied. Methods: The AV1000®-polysulfone filter with the Multifiltrate Pro. Fresenius and the ST150®-polyacrylonitrile filter with the Prismaflex. Baxter-Gambro were studied. Continuous filtration used a flowrate of 2.5 L/h in post-dilution only. Session were made in duplicate. Routes of elimination were assessed using the NeckEpur® model. Results: The mean measured initial fluconazole concentration (mean ± SD) for the four sessions in the central compartment (CC) was 14.9 ± 0.2 mg/L. The amount eliminated from the CC at the end of 6 h-session at a 2.5 L/h filtration flowrate for the AV1000®-polysulfone and the ST150®-polyacrylonitrile filters were 90%–93% and 96%–94%, respectively; the clearances from the central compartment (CC) were 2.5–2.6 and 2.4–2.3 L/h, respectively. The means of the instantaneous sieving coefficient were 0.94%–0.91% and 0.99%–0.91%, respectively. The percentages of the amount eliminated from the CC by filtration/adsorption were 100/0%–95/5% and 100/0%–100/0%, respectively. Conclusion: Neither the ST150®-polyacrylonitrile nor the AV1000®-polysulfone filters result in any significant adsorption of fluconazole.
Comparison of Mechanical Axis of the Limb Versus Anatomical Axis of the Tibia for Assessment of Tibiotalar Alignment in End-Stage Ankle Arthritis
Authors: Bernasconi Alessio , Najefi Ali-Asgar , Goldberg Andrew J. 
Published: November 2020

Background: Coronal plane ankle joint alignment is typically assessed using the tibiotalar angle (TTA), which relies on the anatomical axis of the tibia (AAT) and the articular surface of the talus as landmarks. Often, the AAT differs from the mechanical axis of the lower limb (MAL). We set out to test our hypothesis that the TTA using the MAL would differ from the TTA measured using the AAT in patients with ankle osteoarthritis. Methods: Standardized standing long leg radiographs of 61 ankles with end-stage osteoarthritis were analyzed. We measured the MAL and the AAT. A line was drawn along the talar articular surface (TA) and the TTA was calculated using both the MAL (MAL-TA) and the AAT (AAT-TA). The mechanical axis of the tibia (MAT) was also recorded and the MAL-MAT angle calculated. The difference between MAL-TA and AAT-TA and its correlation with the MAL-MAT angle were assessed. Intra- and interobserver agreement were measured for MAL-TA and AAT-TA. Results: The mean MAL-TA was 91.4 degrees (95% CI, 88.5-94.4) and the mean AAT-TA was 91.2 degrees (95% CI, 88.6-93.9). The difference ranged from −8.1 to 7.8 degrees, and was greater than 2 and 3 degrees in 42% and 18% of the patients, respectively. The difference, as an absolute value, also strongly correlated with the MAL-MAT angle ( r = 0.91, P < .001). Intra- and interobserver reliability were excellent for both MAL-TA (intraclass correlation coefficient [ICC], 0.93 and 0.91, respectively) and AAT-TA (ICC, 0.91 and 0.89, respectively). Conclusion: We recommend that surgeons consider using the MAL-TA, which relies on long leg radiographs, especially with proximal deformity, to more accurately measure coronal plane ankle joint alignment. Level of Evidence: Level III, retrospective comparative study.
Association of sleep disturbance with diabetic retinopathy
Authors: Dutta Somsubhra , Ghosh Sambuddha , Ghosh Srijit 
Published: November 2020

Purpose: Diabetes mellitus (DM) patients are more likely to experience sleep disturbances than normal. Sleep disturbances may contribute to the development of diabetic retinopathy (DR) by higher inflammatory markers in circulation. We investigated the association between sleep quality and DR. Methods: Institutional case control study with type 2 DM patients of <10 years duration and HbA1c ⩽8%; 70 cases with DR and 70 controls without DR (NODR) (power 0.8). Sleep quality was assessed by Pittsburg sleep quality index (PSQI) questionnaire and compared. Results: Cronbach’s alpha was 0.777 with high internal homogeneity. Global PSQI score in DR (7.44 ± 3.99; 95%CI 6.88, 9.42) was more than in NODR (4.30 ± 3.26; 95%CI 3.87, 6.45) ( p < 0.001). All sleep disturbance scores were more in DR except sleep duration. Poor sleep (PSQI score>5) was more prevalent in DR ( p = 0.000) and associated with increasing DR severity ( p = 0.026). Normal sleep latency was recorded in 78.57% and 42.85% patients in NODR and DR respectively ( p < 0.001). Severe difficulty in subjective sleep quality ( p = 0.024), sleep latency ( p = 0.002) and daytime dysfunction ( p < 0.001) was seen more in DR. Elevated daytime dysfunction was observed with increasing DR severity ( p = 0.008). The optimal cut-off for global PSQI score and sleep latency for DR was 5.5 (OR: 5.97; 95%CI 2.86, 12.47) and 25 min(OR: 4.89; 95%CI 2.32, 10.26) respectively. Conclusion: Sleep disturbance is positively associated with DR. Our study identifies cut off value for DR of a modifiable parameter like sleep latency. It emphasizes the need of sleep quality assessment for risk assessment of DR.
Diagnostic accuracy of salivary gland ultrasound in Sjögren’s syndrome: A systematic review and meta-analysis
Authors: Ramsubeik Karishma , Motilal Shastri , Sanchez-Ramos Luis , Ramrattan Laurie Ann , Kaeley Gurjit S. , Singh Jasvinder A. 
Published: November 2020

Background: To systematically review the diagnostic accuracy of salivary gland ultrasound in primary Sjögren’s syndrome (pSS). Methods: PubMed, Embase, CINAHL, Cochrane Central and Scopus and ClinicalTrials.gov were searched to identify diagnostic or validation studies in patients with pSS meeting the diagnostic criteria. A diagnostic test meta-analysis was performed using a bivariate model to calculate the pooled sensitivity, specificity, positive/negative likelihood ratios, and the diagnostic odds ratio. Meta-regression analyses were done for several pSS covariates. Results: Sixty-five studies met our criteria for the qualitative review. Fifty-four studies with a total of 6087 patients were included in the meta-analysis. Pooled sensitivity for salivary gland ultrasound was 80% [95% confidence interval (CI): 77–83%; I2 = 78%], and specificity was 90% (95% CI: 87–92%; I2 = 76%). The pooled positive and negative likelihood ratios were 8 (95% CI: 6.4–10) and 0.22 (95% CI: 0.19–0.25), respectively. The corresponding pooled diagnostic odds ratio (DOR) was 37 (95% CI: 28–48). Separate meta-regression models resulted in similar diagnostic estimates: (a) adjusted for mean age: sensitivity 81% (95% CI:77–84%; I2 = 99%) and specificity 90% (95% CI: 87–93%; I2 = 99%); (b) adjusted for mean disease duration, sensitivity 79% (95% CI:72–84%; I2 = 99%), and specificity 90% (89–94%; I2 = 99%). The diagnostic estimates were robust to sensitivity analyses by quality criteria, pSS diagnostic criteria and ultrasound scoring systems. Conclusion: Salivary gland ultrasound is a valuable modality for the diagnosis of Sjögren’s syndrome. It is plausible that salivary gland ultrasound can be used as an important criterion for the diagnosis of pSS.
Assessment of Native Human Articular Cartilage: A Biomechanical Protocol
Authors: Kabir Wassif , Di Bella Claudia , Choong Peter F.M. , O’Connell Cathal D. 
Published: November 2020

Objectives Recapitulating the mechanical properties of articular cartilage (AC) is vital to facilitate the clinical translation of cartilage tissue engineering. Prior to evaluation of tissue-engineered constructs, it is fundamental to investigate the biomechanical properties of native AC under sudden, prolonged, and cyclic loads in a practical manner. However, previous studies have typically reported only the response of native AC to one or other of these loading regimes. We therefore developed a streamlined testing protocol to characterize the elastic and viscoelastic properties of human knee AC, generating values for several important parameters from the same sample. Design Human AC was harvested from macroscopically normal regions of distal femoral condyles of patients ( n = 3) undergoing total knee arthroplasty. Indentation and unconfined compression tests were conducted under physiological conditions (temperature 37 °C and pH 7.4) and testing parameters (strain rates and loading frequency) to assess elastic and viscoelastic parameters. Results The biomechanical properties obtained were as follows: Poisson ratio (0.4 ± 0.1), instantaneous modulus (52.14 ± 9.47 MPa) at a loading rate of 1 mm/s, Young’s modulus (1.03 ± 0.48 MPa), equilibrium modulus (7.48 ± 4.42 MPa), compressive modulus (10.60 ± 3.62 MPa), dynamic modulus (7.71 ± 4.62 MPa) at 1 Hz and loss factor (0.11 ± 0.02). Conclusions The measurements fell within the range of reported values for human knee AC biomechanics. To the authors’ knowledge this study is the first to report such a range of biomechanical properties for human distal femoral AC. This protocol may facilitate the assessment of tissue-engineered composites for their functionality and biomechanical similarity to native AC prior to clinical trials.
Current alcohol consumption and associated factors among school adolescents and youths in Ethiopia: A systematic review and meta-analysis
Authors: Ali Tilahun , Worku Teshager 
Published: November 2020

Background: The use of alcohol is an alarmingly growing public health concern worldwide, and it has an impact on younger generations. There are a few large scale and comprehensive nation-wise surveys conducted on the subject matter and study groups. Hence, the purpose of this study was to render strong evidence for policymakers and researchers on the prevalence of alcohol consumption and its associated factors among school adolescents and youths in Ethiopia. Methods: Systematic searching was conducted using electronic (Medline, EMBASE, PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and Science direct), and grey literature sources. Cross-sectional studies conducted among adolescents and youths (12–24 years old) were included. Joanna Briggs Institute critical appraisal tool was used to assess the quality of studies. Heterogeneity was examined by using forest plot and I2 heterogeneity tests. Publication bias was also assessed by inspecting the funnel plot and Egger’s regression test. Stata/M16.0 for windows was used for the analysis. Results: A total of 26 studies were included in the final analysis with a total of 17,880 participants. The pooled prevalence of current alcohol consumption was 27.0% (95% CI = 22.0–32.0). In the subgroups, the prevalence of current alcohol consumption among high school, college, and university students was 23%, 27%, and 29%, respectively. The pooled data revealed that being a male (odds ratio = 1.93; 95% CI = 1.24–2.99), khat chewing (odds ratio = 6.65; 95% CI = 2.52–17.52), family members alcohol consumption behavior (odds ratio = 3.20; 95% CI = 2.08–5.17), and peer pressure (odds ratio = 3.79; 95% CI = 2.64–5.42) were significantly associated with alcohol consumption. Conclusion: The pooled analysis of 26 studies indicate that over a quarter of school adolescents and youths consume alcohol in Ethiopia. Hence, we recommend designing and implementing community and school-based intervention programs to tackle the growing problems of alcohol consumption and its multifaceted impacts.
Factors associated with incidence of depressiveness among the middle-aged and older Estonian population
Authors: Abuladze Liili , Opikova Galina , Lang Katrin 
Published: November 2020

Objective: Relatively scant research among older Estonian population describes factors associated with the incidence of depressive symptoms. This study identifies factors associated with the incidence of depressiveness among middle-aged and older Estonians over 2- and 4-year periods. Method: In this cross-sectional analysis, logistic regression models are used to identify the factors associated with the incidence of depressiveness over 2- and 4-year periods. The data were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) 2011–2015 which included Estonian population aged 53 years and older in 2013. After excluding those younger than 53 years, not interviewed 2 years later, those with depressive symptoms at baseline in 2013, and missing values for depressiveness or other variables, our analytical sample comprised 2513 people. Results: Among those who were not depressive in 2013, 21.9% became depressive within 2 years; 16.1% of non-depressive individuals since 2011 became depressive by 2015. No age differences in incidence remained in adjusted models. Women have almost 50% higher odds of becoming depressive. A previous history of depressiveness and the presence of everyday activity limitations were important factors increasing the incidence of depression. Discussion: Changes related to the individual’s unique ageing experience are important explanatory factors related to the likelihood of developing depressive symptoms, rather than age itself. To diminish the incidence of depressive symptoms among older Estonian population, public health interventions should attempt to address factors which complicate existing health problems and facilitate continued independence and community involvement, both of which contribute to overall satisfaction with life.
Evaluation of a Conservative Pharmacist-led U-500R Insulin Management Protocol in the Primary Care Setting
Authors: Dumont Cyndi , Fitzgerald Leah , Valdez Connie A. 
Published: November 2020

Objective The objective of this quality assurance study is to evaluate the impact of a conservative, pharmacist-led, U-500R insulin management protocol on diabetes control (A1c) and total daily dosage requirements between August 2016 and August 2018. Methods This was a retrospective chart review of adult patients, aged 18 to 79, with type 2 diabetes and managed with insulin, at 2 federally qualified healthcare clinics in Denver, Colorado. To determine if our conservative pharmacist-led U-500R insulin management protocol impacted efficacy and total daily dosage requirements when converting patients from U-100 to U-500R insulin, we compared the most effective dose of U-500R (defined as the total daily dose (TDD) of U-500R insulin at A1c goal or the lowest tolerated A1c) to the baseline A1c and TDD of U-100 insulin at time of conversion. Results Following conversion of U-100 to U-500R insulin, patients required an average of 21 fewer units of insulin with U-500R than U-100 and achieved an average A1c of 7.2% which reflected a reduction of 3.5 points from baseline. Five patients (62.5%) achieved A1c goal per ADA guidelines, and all patients achieved at least a 1.7 point reduction in A1c, with 1 patient achieving a 6.7 point reduction. Two patients (25%) were still in the process of U-500R titration at the time of data collection, and 1 patient (12.5%) did not achieve goal A1c while under pharmacy management at these clinics. Four of the five patients who achieved A1c goal did so with an overall reduction in total daily insulin dose (average of 57.5 units less than original U-100 dose) resulting in an average A1c decrease of 3.6 points.
Cultural adaptation and validation of the Polish version of the physical activity scale for older people living in a community: a cross-sectional study
Authors: Wiśniowska-Szurlej Agnieszka , Ćwirlej-Sozańska Agnieszka , Wołoszyn Natalia , Sozański Bernard , Wilmowska-Pietruszyńska Anna , Washburn Richard 
Published: November 2020

Abstract
Background
Polish clinicians and researchers face challenges in selecting physical activity tools appropriate and validated for older people. The aim of this study is to provide cultural adaptation and validation of the Polish version of the Physical Activity Scale for Elderly (PASE-P).

Methods
This cross-sectional study was carried out among 115 older adults living in south-eastern Poland. The original version of the scale has been translated into the Polish language following standardized translation procedures. Validation was evaluated by Pearson’s rank correlation coefficients between PASE-P, the normal Timed Up and Go test and that with a cognitive task (TUG and TUG cog, respectively), grip strength, basic and instrumental activities of daily living (ADL and IADL, respectively), Five Times Sit to Stand (5x STS), 10-m Walk Test (10MWT), the Berg Balance Scale (BBS) and the International Physical Activity Questionnaire (IPAQ).

Results
The mean PASE-P was 91.54 (SD 71.15). Sufficient reliability of the test-retest of the PASE-P questionnaire components was found between the trials. The ICC test was strong and ranged from 0.988 to 0.778 for both major domains and the total scale score. A significant correlation was found between the total PASE-P score and the shorter TUG, TUG cog (r = − 0.514, p < 0.001; r = − 0.481, p < 0.001) and 10MWT (r = 0.472, p < 0.001). The total PASE-P score was also positively correlated with ADL and IADL (r = 0.337, p < 0.001; r = 0.415 p < 0.001), BBS (r = 0.537, p < 0.001) and 5xSTS (r = 0.558, p < 0.001).

Conclusions
The results obtained in the study confirm that the Polish version of the PASE scale is a valid and reliable tool for assessing the level of physical activity in older adults living in a community.
Oxygen desaturation during flexible bronchoscopy with propofol sedation is associated with sleep apnea: the PROSA-Study
Authors: Darie Andrei M. , Schumann Desiree M. , Laures Marco , Strobel Werner , Jahn Kathleen , Pflimlin Eric , Tamm Michael , Stolz Daiana 
Published: November 2020

Abstract
Background
Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial obstruction of the upper airways during sleep. Conscious sedation for flexible bronchoscopy (FB) places patients in a sleep-like condition. We hypothesize that oxygen desaturation during flexible bronchoscopy may help to detect undiagnosed sleep apnea.

Methods
Single-centre, investigator-initiated and driven study including consecutive patients undergoing FB for clinical indication. Patients completed the Epworth Sleepiness Scale (ESS), Lausanne NoSAS score, STOP-BANG questionnaire and the Berlin questionnaire and underwent polygraphy within 7 days of FB. FB was performed under conscious sedation with propofol. Oxygen desaturation during bronchoscopy was measured with continuous monitoring of peripheral oxygen saturation with ixTrend (ixellence GmbH, Germany).

Results
145 patients were included in the study, 62% were male, and the average age was 65.8 ± 1.1 years. The vast majority of patients (n = 131, 90%) proved to fulfill OSA criteria based on polygraphy results: 52/131 patients (40%) had mild sleep apnea, 49/131 patients (37%) moderate sleep apnea and 30/131 patients (23%) severe sleep apnea. Patients with no oxygen desaturation had a significantly lower apnea–hypopnea index than patients with oxygen desaturation during bronchoscopy (AHI 11.94/h vs 21.02/h, p = 0.011). This association remained significant when adjusting for the duration of bronchoscopy and propofol dose (p = 0.023; 95% CI 1.382; 18.243) but did not hold when also adjusting for age and BMI.

Conclusion
The severity of sleep apnea was associated to oxygen desaturation during flexible bronchoscopy under conscious sedation. Patients with oxygen desaturation during bronchoscopy might be considered for sleep apnea screening.
Trial registration: The Study was approved by the Ethics Committee northwest/central Switzerland, EKNZ (EK 16/13) and was carried out according to the Declaration of Helsinki and Good Clinical Practice guidelines. Due to its observational character, the study did not require registration at a clinical trial registry.