bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-reported symptoms and problems at admission to specialized palliative care improved survival prediction in 30,969 cancer patients: A nationwide register-based study
Authors: Hansen Maiken B , Nylandsted Lone Ross , Petersen Morten A , Adsersen Mathilde , Rojas-Concha Leslye , Groenvold Mogens 
Published: March 2020

Background: Large, nationally representative studies of the association between quality of life and survival time in cancer patients in specialized palliative care are missing. Aim: The aim of this study was to investigate whether symptoms/problems at admission to specialized palliative care were associated with survival and if the symptoms/problems may improve prediction of death within 1 week and 1 month, respectively. Setting/participants: All cancer patients who had filled in the EORTC QLQ-C15-PAL at admission to specialized palliative care in Denmark in 2010–2017 were included through the Danish Palliative Care Database. Cox regression was used to identify clinical variables (gender, age, type of contact (inpatient vs outpatient), and cancer site) and symptoms/problems significantly associated with survival. To test whether symptoms/problems improved survival predictions, the overall accuracy (area under the receiver operating characteristic curve) for different prediction models was compared. The validity of the prediction models was tested with data on 5,508 patients admitted to palliative care in 2018. Results: The study included 30,969 patients with an average age of 68.9 years; 50% were women. Gender, age, type of contact, cancer site, and most symptoms/problems were significantly associated with survival time. The predictive value of symptoms/problems was trivial except for physical function, which clearly improved the overall accuracy for 1-week and 1-month predictions of death when added to models including only clinical variables. Conclusion: Most symptoms/problems were significantly associated with survival and mainly physical function improved predictions of death. Interestingly, the predictive value of physical function was the same as all clinical variables combined (in hospice) or even higher (in palliative care teams).
Repeated subcutaneous esketamine administration for depressive symptoms and pain relief in a terminally ill cancer patient: A case report
Authors: Barbosa Matheus Ghossain , Delfino Rodrigo Simonini , Sarin Luciana Maria , Jackowski Andrea Parolin 
Published: March 2020

Background: Depressive disorders are common among cancer patients. Ketamine can quickly relieve depression, and its subcutaneous administration appears to be as effective as and probably safer than its standard intravenous administration. Herein, we report a case verifying the antidepressant effect of a subcutaneous esketamine formulation. Case presentation: A 65-year-old male with metastatic abdominal tumor reported sadness, weight loss, fatigue, hopelessness, insomnia, inattention, and reduced motivation. His scores on the visual analogical scale for pain and Montgomery–Asberg depression rating scale were 8/10 and 30/60, respectively. Possible courses of action: Monoaminergic antidepressants are effective, but their response is slow for end-of-life care. Formulation of a plan: Esketamine was preferred because it possibly contributes to pain relief. It can repeatedly be infused intravenously, but was subcutaneously administered twice a week for safety reasons. Outcome: The patient showed continuous mood improvement, achieving depression remission on day 7. Pain relief was observed but without stability. His vital signs remained stable, and he remained calm, without major complaints. Lessons from the case: Repeated subcutaneous esketamine injections are possibly safe and effective in pain and depression relief in palliative care cancer patients. View on research problems, objectives, or questions generated by the case: Placebo-controlled studies with similar cases are needed to establish efficacy and safety.
Comparison of Baseline, Bone-Subtracted, and Enhanced Chest Radiographs for Detection of Pneumothorax
Authors: Homayounieh Fatemeh , Digumarthy Subba R. , Febbo Jennifer A. , Garrana Sherief , Nitiwarangkul Chayanin , Singh Ramandeep , Khera Ruhani Doda , Gilman Matthew , Kalra Mannudeep K. 
Published: March 2020

Purpose: To assess and compare detectability of pneumothorax on unprocessed baseline, single-energy, bone-subtracted, and enhanced frontal chest radiographs (chest X-ray, CXR). Method and Materials: Our retrospective institutional review board–approved study included 202 patients (mean age 53 ± 24 years; 132 men, 70 women) who underwent frontal CXR and had trace, moderate, large, or tension pneumothorax. All patients (except those with tension pneumothorax) had concurrent chest computed tomography (CT). Two radiologists reviewed the CXR and chest CT for pneumothorax on baseline CXR (ground truth). All baseline CXR were processed to generate bone-subtracted and enhanced images (ClearRead X-ray). Four radiologists (R1-R4) assessed the baseline, bone-subtracted, and enhanced images and recorded the presence of pneumothorax (side, size, and confidence for detection) for each image type. Area under the curve (AUC) was calculated with receiver operating characteristic analyses to determine the accuracy of pneumothorax detection. Results: Bone-subtracted images (AUC: 0.89-0.97) had the lowest accuracy for detection of pneumothorax compared to the baseline (AUC: 0.94-0.97) and enhanced (AUC: 0.96-0.99) radiographs ( P < .01). Most false-positive and false-negative pneumothoraces were detected on the bone-subtracted images and the least numbers on the enhanced radiographs. Highest detection rates and confidence were noted for the enhanced images (empiric AUC for R1-R4 0.96-0.99). Conclusion: Enhanced CXRs are superior to bone-subtracted and unprocessed radiographs for detection of pneumothorax. Clinical Relevance/Application: Enhanced CXRs improve detection of pneumothorax over unprocessed images; bone-subtracted images must be cautiously reviewed to avoid false negatives.
Correlates of Infrequent Plain Water Intake Among US High School Students: National Youth Risk Behavior Survey, 2017
Authors: Park Sohyun , Onufrak Stephen , Cradock Angie , Patel Anisha , Hecht Christina , Merlo Caitlin , Blanck Heidi M. 
Published: March 2020

Purpose: To examine factors associated with frequency of plain water (ie, tap, bottled, and unflavored sparkling water) intake among US high school students. Design: Quantitative, cross-sectional study. Setting: The 2017 national Youth Risk Behavior Survey data. Subjects: US high school students with plain water intake data (N = 10 698). Measures: The outcome was plain water intake. Exposure variables were demographics, academic grades, and behavioral characteristics. Analysis: We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for factors associated with infrequent plain water intake (<3 vs ≥3 times/day). Results: Overall, 48.7% of high school students reported drinking plain water <3 times/day. Factors associated with infrequent plain water intake were younger age (≤15 years; aOR = 1.20, CI = 1.05-1.37); earning mostly D/F grades (aOR = 1.37, CI = 1.07-1.77); consuming regular soda 1 to 6 times/week (aOR = 1.92, CI = 1.67-2.20) or ≥1 time/day (aOR = 3.23, CI = 2.65-3.94), sports drinks 1 to 6 times/week (aOR = 1.30, CI = 1.14-1.49), milk <2 glasses/day (aOR = 1.51, CI = 1.31-1.73), fruits <2 times/day (aOR = 1.92, CI = 1.66-2.22), and vegetables <3 times/day (aOR = 2.42, CI = 2.04-2.89); and being physically active ≥60 minutes/day on <5 days/week (aOR = 1.83, CI = 1.60-2.08). Students with obesity were less likely to have infrequent water intake (aOR = 0.63, CI = 0.53-0.74). Conclusions: Infrequent plain water intake was associated with younger age, poor academic grades, poor dietary behaviors, and physical inactivity. These findings can inform intervention efforts to increase water intake to promote healthy lifestyles among adolescents.
Accuracy of B‐type natriuretic peptide in a multiethnic Asian population with acute dyspnea
Authors: Yeganeh Mojdeh , Jaweed Syed Saleem , Woei Kelvin Siew Shenq , Zakaria Mohd Idzwan bin , Loch Alexander 
Published: March 2020

Background:Optimal cut‐offs for B‐type natriuretic peptide (BNP) for the diagnosis of heart failure differ based on ethnicity. There are no data for Southeast Asian patients. We aimed to define the optimal cut‐off points and the strength of B‐type natriuretic peptide as a predictor of heart failure in Southeast Asian multiethnic population.Methods:Bedside B‐type natriuretic peptide (SOB panel (Biosite®)) was measured for patients (>50 years) presenting with dyspnea. Emergency physicians (blinded to B‐type natriuretic peptide result) assessed the probability of acute heart failure on a scale of 0%–100%. Heart failure diagnosis was adjudicated by two cardiologists.Results:In all, 43% (n = 87) of the 203 dyspneic patients (54.7% males, 453% females) had a final diagnosis of acute heart failure. B‐type natriuretic peptide values ranged from 3.2 to 4960 pg/mL (median, 189 pg/mL). Median B‐type natriuretic peptide values of patients with the final diagnosis of “acute heart failure,” “no acute heart failure but history of heart failure,” and “no heart failure” were 600, 301, and 68 pg/mL, respectively. The optimum cut‐off was 186 pg/mL. The receiver operating characteristic curve of the emergency physician's assessment of the probability of heart failure based on clinical assessment had an area under the curve of 85% (95% confidence interval: 80%–90%). Combining receiver operating characteristic curves of physician assessment and B‐type natriuretic peptide values yielded an area under the curve of 96% (95% confidence interval: 93%–98%). B‐type natriuretic peptide levels less than 100 pg/mL were the strongest predictor of heart failure (odds ratio: 26.36; confidence interval: 6.85–101.41), followed by upper lobe diversion and cardiomegaly.Conclusion:The accuracy of bedside B‐type natriuretic peptide was validated in a multiethnic Asian population. Optimum cut‐off is 186 pg/mL. A B‐type natriuretic peptide >100 pg/mL is the single strongest independent predictor of heart failure.
Isolated intraventricular conduction delay in fulminant myocarditis: A case report
Authors: Lo Yat Hei , Wong Yau Tak 
Published: March 2020

Introduction: Fulminant myocarditis is uncommon. Making the diagnosis in the emergency department is difficult due to the nonspecific clinical presentation and electrocardiogram results. Case presentation: A 58-year-old Chinese woman presented to an emergency department with dizziness and malaise for 2 days. She was hypotensive and afebrile. Initial electrocardiogram showed isolated nonspecific intraventricular conduction delay. Despite resuscitation, she rapidly deteriorated in the emergency department and eventually succumbed. Autopsy and histological examination of heart muscle found acute inflammatory cell infiltration and multifocal necrosis, suggestive of acute fulminant myocarditis. Discussion: There is a wide range of differential diagnosis of nonspecific intraventricular conduction delay. Clinical presentation of mycoarditis is also often non-specific. Rapid and accurate recognition of the condition is essential to save life. Conclusion: Fulminant myocarditis presenting with cardiogenic shock and isolated intraventricular conduction delay on electrocardiogram poses a diagnostic challenge as illustrated in this case report.
Clinical research nursing and factors influencing success: a qualitative study describing the interplay between individual and organisational leadership influences and their impact on the delivery of clinical research in healthcare
Authors: Tinkler Linda , Robinson Lisa 
Published: March 2020

Background Clinical research delivery is a term increasingly used to describe the work undertaken to implement studies which explore and test prevention, diagnosis and treatment in healthcare. Such studies range from multi-site clinical trials to single site observational projects. Whilst widely acknowledged as fundamental to effective healthcare, clinical research is complex to deliver and is met with challenges in the busy clinical environment. The perceptions and experiences of Clinical Research Nurses, whose work is central to this agenda, have emerged as important, yet frequently overlooked insights in relation to the potential success of research delivery. Increased understanding of these insights is essential to address the barriers and maximise facilitators to success in clinical research. Aim To better understand how the perceptions and experiences of Clinical Research Nurses relate to potential for success in research delivery. Methods Seven focus groups and two one-to-one interviews (27 participants) were conducted in a large tertiary North East England National Health Service Foundation Trust between March and June 2017. Results Clinical Research Nurses’ described perceptions and experiences of working to co-ordinate and deliver a range of research as individuals, within their teams, throughout the wider organisation, and beyond. Two key elements situated within an overarching theme of leadership emerged as likely to impact on how successfully they were able to practise: • the individual (self-leadership). • the organisation (leadership culture). Conclusions The framework emerging from this study illustrates a complex interplay between personal attributes and organisational culture, mediated by national strategies and targets associated with the clinical research agenda. When situated within the concept of leadership, it broadens the potential for understanding the underlying issues and increases the range of possible support mechanisms to improve experiences for Clinical Research Nurses. Framing the challenges in this way contributes new knowledge to the dialogue surrounding clinical research delivery.
Multicap to improve adherence after acute coronary syndromes: results of a randomized controlled clinical trial
Authors: Mariani Javier , Rosende Andrés , De Abreu Maximiliano , Gonzalez Villa Monte Gabriel , D’Imperio Heraldo , Antonietti Laura , Lemonnier Gabriela , de Bonis Alejandra , Tajer Carlos 
Published: March 2020

Background: Adherence to treatment after a myocardial infarction (MI) is poor, even in the early postinfarction period. Combining evidence-based drugs into a multicap could improve adherence in this population. No previous randomized trial assessing fixed-dose combination therapy has included patients early after a MI. We aimed to assess if a multicap containing four secondary prevention drugs increases adherence to treatment at 6 months after MI hospitalization. The study was designed as a randomized, parallel, open-label, controlled trial. Methods: Patients were randomized within 7 days of a MI to either multicap or control group. The multicap group received a capsule containing aspirin, atenolol, ramipril, and simvastatin. The control group received each drug in separate pills. The primary outcome was adherence at 6 months. We also measured blood pressure, heart rate, serum cholesterol levels, C-reactive protein, and platelet aggregation. Results: The study was stopped prematurely when 100 patients were included for futility. At 6 months, 92 (95.8%) patients were adherent to medical treatment: 98.0% in the multicap group and 93.5% in the control group [relative risk (RR) 1.05; 95% confidence interval (CI) 0.96–1.14; p = 0.347]. There were no differences between groups in systolic blood pressure ( p = 0.662), diastolic blood pressure ( p = 0.784), heart rate ( p = 0.533), total cholesterol ( p = 0.760), LDL-c ( p = 0.979), C-reactive protein ( p = 0.399), or in the proportion of patients with adequate platelet aggregation inhibition ( p = 0.600). Conclusions: The study did not find any improvement in the adherence at 6 months after a MI with a multicap-based strategy (Multicap for Increase Adherence After Acute Myocardial Infarction; [ ClinicalTrials.gov identifier: NCT02271178]).
Does the Lag Time Between Injury and Treatment Affect Recovery of Infraorbital Nerve Disturbances in Zygomaticomaxillary Complex Fractures?
Authors: Tabrizi Reza , Neamati Majid , Rajabloo Sara , Latifi Fatemeh 
Published: March 2020

Study Design: A cross-sectional study. Objective: Neurosensory disturbances (NSDs) of the infraorbital nerve (ION) are common following orbito-zygomaticomaxillary complex (ZMC) fractures. This study aimed to evaluate the effect of lag time between injury and treatment on recovery of NSDs of the ION following open reduction internal fixation. Methods: Subjects who had ZMC fracture and paresthesia were studied. The lag time between injury and treatment was considered as the predictive factor. The level of NSDs according to the brush test and two-point discrimination (TPD) test and self-reported NSD were the outcomes of this study. Self-reported NSD was quantified using a visual analog scale. Results: Forty patients were studied. The lag time between injury and treatment had a significant correlation with the result of the TPD test and the self-reported level of NSD. In 73.6% of patients who had NSD following ZMC fracture, every 1-day delay in treatment increased the incidence of self-reported paresthesia by 0.44. Conclusions: It seems, a delay in treatment of ZMC fractures increased the risk of NSD.
Management of Isolated Zygomatic Arch Fractures and a Review of External Fixation Techniques
Authors: Cohn Jason E. , Othman Sammy , Bosco Samuel , Shokri Tom , Evarts Marissa , Papajohn Paul , Zwillenberg Seth 
Published: March 2020

Introduction: Fractures of the zygomatic bone can present with complicated aesthetic and neurological pathology. Specifically, management of isolated zygomatic fracture has been sparsely discussed in the literature, and most studies are based upon older techniques. Here, we compare the results of 2 critical operative techniques as well as review the available literature in the setting of isolated zygomatic fractures. Methods: A retrospective chart review was performed at our institution from 2010 to 2018 examining for patients who had sustained an isolated zygomatic fracture confirmed by computed tomography scan. Patients were excluded if they sustained additional maxillofacial fractures. Demographical information, symptoms on presentation, fracture management modality, and postoperative course were all collected and examined. Results: A total of 218 patients were identified for inclusion. The average age of this cohort was 45.5 ± 18 years, with 77.5% being male. Assault (55%) was most the frequent cause of injury with accidents being the least common (17.9%). Most patients (78.8%) underwent nonoperative management. Patients who underwent operation more often presented with zygomatic deformity (97.7% vs 18.4%), paresthesia (29.5% vs 2.9%), and trismus (29.5% vs 6.9%) when compared to their nonoperatively managed counterparts. In all, 44 operatively managed patients underwent open reduction with or without eternal fixation (Gillies Approach vs Keen Approach). There were no significant differences in the presence of zygomatic deformity, paresthesia, and trismus between the 2 operative techniques. Conclusions: Isolated zygomatic arch fractures can present with discerning symptoms. Unfortunately, the literature on appropriate management is not well described. We find external fixation to provide reestablishment of both form and function with minimal required exposure, although the outcomes may be similar without the use of external fixation.
The Long-Lasting Effects of “Placebo Injections” in Knee Osteoarthritis: A Meta-Analysis
Authors: Previtali Davide , Merli Giulia , Di Laura Frattura Giorgio , Candrian Christian , Zaffagnini Stefano , Filardo Giuseppe 
Published: March 2020

Objectives To quantify the placebo effect of intraarticular injections for knee osteoarthritis in terms of pain, function, and objective outcomes. Factors influencing placebo effect were investigated. Design Meta-analysis of randomized controlled trials; Level of evidence, 2. PubMed, Web of Science, Cochrane Library, and grey literature databases were searched on January 8, 2020, using the string: (knee) AND (osteoarthritis OR OA) AND (injections OR intra-articular) AND (saline OR placebo). The following inclusion criteria were used: double-blind, randomized controlled trials on knee osteoarthritis, including a placebo arm on saline injections. The primary outcome was pain variation. Risk of bias was assessed using the RoB 2.0 tool, and quality of evidence was graded following the GRADE (Grading of Recommendations Assessment, Development and Evaluation) guidelines. Results Out of 2,363 records, 50 articles on 4,076 patients were included. The meta-analysis showed significant improvements up to the 6-month follow-up: Visual Analogue Scale (VAS)-pain −13.4 mean difference (MD) (95% confidence interval [CI]: −21.7/−5.1; P < 0.001), Western Ontario and McMaster Osteoarthritis Index (WOMAC)-pain −3.3 MD (95% CI: −3.9/−2.7; P < 0.001). Other significant improvements were WOMAC-stiffness −1.1 MD (95% CI: −1.6/−0.6; P < 0.001), WOMAC-function −10.1 MD (95% CI: −12.2/−8.0; P < 0.001), and Evaluator Global Assessment −21.4 MD (95% CI: −29.2/−13.6; P < 0.001). The responder rate was 52% (95% CI: 40% to 63%). Improvements were greater than the “minimal clinically important difference” for all outcomes (except 6-month VAS-pain). The level of evidence was moderate for almost all outcomes. Conclusions The placebo effect of knee injections is significant, with functional improvements lasting even longer than those reported for pain perception. The high, long-lasting, and heterogeneous effects on the scales commonly used in clinical trials further highlight that the impact of placebo should not be overlooked in the research on and management of knee osteoarthritis.
Instagram as a tool for study engagement and community building among adolescents: A social media pilot study
Authors: Thomas Veronica L , Chavez Marisol , Browne Erica N , Minnis Alexandra M 
Published: March 2020

Objective Social media has been recognized as a promising tool for delivering health interventions and facilitating study recruitment. However, research is needed to understand how social media might be used to enhance the experiences of adolescent participants in ongoing studies. In a prospective cohort study addressing social and structural influences on health trajectories among 599 adolescents in a California agricultural community, we evaluated the effectiveness of and engagement with a human-centered, Instagram-based outreach campaign, with a focus on study retention, enhancement of participants’ experiences, and increasing community awareness of the study. Methods We adopted a youth-centered approach to design a three-month pilot study, which included participatory design sessions, a geo-targeted Instagram campaign, and in-person events at schools. We conducted pre-/post-pilot surveys with study participants, analyzed social media metrics, and collected process measures, such as study visit show rates. Results After three months, the study Instagram account had 209 followers and 806 total engagements. Survey responses showed little change in study participants’ attitudes about the study; most survey respondents agreed that the study is very important for the community (54% pre-pilot and 52% post-pilot). However, the study’s Instagram account appeared to influence study participation, with 43% of post-pilot respondents who use Instagram ( n=65 of 153) indicating that the Instagram account influenced their decision to continue coming to study visits. Conclusion Despite little change in the participants’ attitudes about the study, the findings of this pilot study suggest that Instagram is a promising tool to support engagement of adolescent participants in ongoing research, particularly if the content is designed with adolescents as partners. In addition to assessing the effectiveness of an Instagram outreach campaign to support retention, this paper also presents suggestions and insights for creating similar social media interventions targeting youth.