bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validity of the Severity of Dependence Scale for detecting dependence behaviours in chronic migraine with medication overuse
Authors: Bottiroli Sara , Galli Federica , Ballante Elena , Pazzi Stefania , Sances Grazia , Guaschino Elena , Allena Marta , Tassorelli Cristina 
Published: September 2021

Aims In this study, we tested the validity of the Severity of Dependence Scale in detecting dependence behaviours in patients with chronic migraine and medication overuse (CM + MO) using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the Leeds Dependence Questionnaire as gold standard measures. Methods Four hundred and fifty-four patients with CM + MO filled in the Severity of Dependence Scale and the Leeds Dependence Questionnaire and underwent a psychological evaluation for the diagnosis of substance dependence according to the DSM-IV criteria. Results Sixty-nine percent of subjects (n = 313) presented substance dependence according to the DSM-IV criteria. These patients scored significantly higher than those without substance dependence in Severity of Dependence Scale total score ( Z = −3.29, p = 0.001), and in items 1 ( Z = −2.44, p = 0.015), 2 ( Z = −2.50, p = 0.012), 4 ( Z = −2.05, p = 0.04), and 5 ( Z = −3.39, p = 0.001). Severity of Dependence Scale total score ( β = 0.13, SE = 0.04, z = 3.49, p < 0.001) was a significant predictor for substance dependence. Receiver Operating Characteristic (ROC) curves showed that Severity of Dependence Scale discriminated patients with or without substance dependence. Conclusion Severity of Dependence Scale could represent an interesting screening tool for dependency-like behaviors in CM + MO patients.
Efficacy and safety of exogenous beta-hydroxybutyrate for preventive treatment in episodic migraine: A single-centred, randomised, placebo-controlled, double-blind crossover trial
Authors: Putananickal Niveditha , Gross Elena C , Orsini Anna-Lena , Schmidt Simone , Hafner Patricia , Gocheva Vanya , Nagy Sara , Henzi Bettina C , Rubino Daniela , Vogt Deborah R , Cichon Sven , Sandor Peter , Fischer Dirk 
Published: September 2021

Background Several studies propose that brain energy deficit might be partially involved in the pathophysiology of migraine. Previously, studies demonstrated that ketogenic diet causes a substantial reduction in migraine frequency. Since the ketogenic diet is restricting and its adherence is difficult, we proposed to supplement ketone bodies exogenously to provide a prophylactic effect in migraineurs. Aim To evaluate the prophylactic effect of exogenous DL-beta-hydroxybutyrate supplementation in episodic migraineurs. Methods A double-blind, placebo-controlled, randomised crossover trial was conducted, involving 41 patients with episodic migraine. Patients were randomised 1:1 into placebo or beta-hydroxybutyrate group before entering the first treatment period. Each treatment period was 12 weeks long, followed by four weeks of washout phase and four weeks of run-in phase before entering into the corresponding second treatment period. The primary endpoint was the number of migraine days in the last four weeks of treatment, adjusted for baseline. Results We observed no clinically significant amelioration of migraine frequency or intensity under DL-beta-hydroxybutyrate treatment as compared to placebo regarding number of migraine days (mean difference [95% CI]: −1.1[−5.07, 2.85]), migraine intensity (0–10 VAS: 1.5[−0.8, 3.7]). Conclusion The selected dose of supplemented exogenous DL-beta-hydroxybutyrate did not demonstrate efficacy in episodic migraineurs. ClinicalTrials.gov Identifier: NCT03132233
Surgical Management of Focal Chondral Defects of the Talus: A Bayesian Network Meta-analysis
Authors: Migliorini Filippo , Maffulli Nicola , Schenker Hanno , Eschweiler Jörg , Driessen Arne , Knobe Matthias , Tingart Markus , Baroncini Alice 
Published: September 2021

Background: No consensus has been reached regarding the optimal surgical treatment for focal chondral defects of the talus. Purpose: A Bayesian network meta-analysis was conducted to compare the clinical scores and complications of mosaicplasty, osteochondral auto- and allograft transplant, microfracture, matrix-assisted autologous chondrocyte transplant, and autologous matrix-induced chondrogenesis (AMIC) for chondral defects of the talus at midterm follow-up. Study Design: Bayesian network meta-analysis; Level of evidence, 4. Methods: This Bayesian network meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Embase, Google Scholar, and Scopus databases were accessed in February 2021. All clinical trials comparing 2 or more surgical interventions for the management of chondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, rate of failure, and rate of revision surgery. The network meta-analysis were performed through the routine for Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measure was used for dichotomous variables, and the standardized mean difference (SMD) was used for continuous variables. Results: Data from 13 articles (521 procedures) were retrieved. The median length of the follow-up was 47.8 months (range, 31.7-66.8 months). Analysis of variance revealed no difference between the treatment groups at baseline in terms of age, sex, body mass index, AOFAS score, VAS score, and mean number of defects. AMIC demonstrated the greatest AOFAS score (SMD, 11.27) and lowest VAS score (SMD, –2.26) as well as the lowest rates of failure (LOR, 0.94) and revision (LOR, 0.94). The test for overall inconsistency was not significant. Conclusion: At approximately 4 years of follow-up, the AMIC procedure for management of focal chondral defects of the talus produced the best outcome.
Medical assistance in dying legislation: Hospice palliative care providers’ perspectives
Authors: Joolaee Soodabeh , Ho Anita , Serota Kristie , Hubert Matthieu , Buchman Daniel Z 
Published: September 2021

Background: After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective: To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance in dying. Design: In this qualitative descriptive study, we conducted an inductive thematic analysis of semi-structured interviews with hospice palliative care providers. Participants and setting: Multi-disciplinary hospice palliative care providers in acute, community, residential, and hospice care in Vancouver and Toronto, Canada, who have engaged in end-of-life care planning with patients who have inquired about and/or requested medical assistance in dying. Ethical considerations: The research proposal was approved by University of British Columbia Research Ethics Board in Vancouver and University Health Network in Toronto. Participants were informed regarding the research goals, signed a written consent, and were assigned pseudonyms. Results: The 48 participants included hospice palliative care physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health providers (n = 4). The average interview length was 50 min. Positive aspects of medical assistance in dying legalization were identified at (1) the individual level: (a) a new end-of-life option, (b) patients’ last chance to express control over their lives, (c) patient and family comfort and relief, and (d) a unique learning experience for hospice palliative care providers; (2) the team level: (a) supportive collegial relationships, (b) broadened discussions about end-of-life and palliative care, and (c) team debriefs provide opportunities for education and support; and (3) the institutional level: (a) improved processes to facilitate the implementation logistics. Conclusion: While being involved in the medical assistance in dying process is complex and challenging, this study sheds light on the positive aspects of medical assistance in dying legalization from the hospice palliative care provider’s perspectives. Medical Assistance in Dying legalization has resulted in improved end-of-life conversations between hospice palliative care providers, patients, and their families. Improved communication leads to a better understanding of patients’ end-of-life care plans and bridges some of the existing gaps between hospice palliative care and medical assistance in dying.
Conversations About Children When an Important Adult Is at End of Life: An Audit
Authors: Hanna Jeffrey R. , Rapa Elizabeth , Miller Mary , Turner Madeleine , Dalton Louise J. 
Published: September 2021

Purpose: Health and social care professionals report it challenging to have conversations with families when an important adult in the life of a child is at end of life, often feeling this aspect of care is the responsibility of other colleagues. This study aimed to understand professionals’ perceived role in family-centered conversations as part of routine care at end of life, and how to promote this element of care in clinical practice. Methods: An audit was completed with 116 professionals who work in palliative care including doctors and nurses that attended a 2-day virtual congress. Results: Professionals (73.2%) felt confident about starting a conversation with adult patients at end of life about important children. However, enquiring about relationships with children was largely dependent on the age of the patient. 64.7% of respondents reported signposting families to websites and services that provide family support. Most professionals (76.7%) wanted training to equip them with the skills and confidence to having family-centered conversations at end of life, with videos demonstrating how to provide these elements of care the most preferred option. Conclusions: Short training resources should be developed to equip professionals with the necessary skills toward having conversations about children with patients and relatives in clinical appointments. There is a need for professionals to ask every patient about important relationships with children.
Prevalence of groin pain after primary dual-mobility total hip arthroplasty
Authors: Lenartowicz Karina A , Wyles Cody C , Carlson Samuel W , Sierra Rafael J , Trousdale Robert T 
Published: September 2021

Background: Instability remains a challenging problem following total hip arthroplasty (THA). Dual-mobility (DM) components are used with increasing frequency to mitigate this potential complication. As has been shown with larger metal-on-metal (MoM) THA, the larger size femoral head may pose an increased risk of groin pain. This study aims to evaluate the prevalence of groin pain following primary DM THA compared to other THA constructs. Methods: We identified 190 primary THAs (183 patients) performed with DM components at a single academic institution from 2008 to 2017. We retrospectively reviewed standardised patient questionnaires and the electronic medical record to determine the prevalence of groin pain. DM patients were compared to historical controls of 39 MoM hip resurfacing, 26 large-head MoM THA, and 217 conventional THA. Mean age was 64 years, 58% were female, mean body mass index was 30 kg/m2, and mean follow-up was 3.5 years (range 2–8 years). Results: The prevalence of groin pain in patients with DM components was 5%, similar to the prevalence reported by patients with conventional THA (7%). There was a decreased prevalence of groin pain in DM patients compared to hip resurfacing (18%) and MoM THA (15%). Among the 9 DM patients with groin pain, 1 was treated with iliopsoas injection, and 1 underwent radiofrequency ablation of the articular nerve. Conclusions: This study documents a relatively low prevalence of groin pain among primary DM THA patients. This is comparable with historical controls of conventional THA and decreased compared to hip resurfacing and large head MoM THA.
Mechanical stretching induces calcification and cartilage matrix metabolism, causing degeneration of the acetabular labrum
Authors: Kawamura Yoshi , Tetsunaga Tomonori , Yamada Kazuki , Sanki Tomoaki , Sato Yoshihiro , Yoshida Aki , Furumatsu Takayuki , Ozaki Toshifumi 
Published: September 2021

Purpose: The acetabular labrum plays an important role in joint lubrication, and damage to this structure leads to osteoarthritis. This study aimed to histologically classify the degree of degeneration of the acetabular labrum and to investigate the changes in gene expression induced by mechanical stretching. Methods: We obtained acetabular labrum cells from patients with hip osteoarthritis during total hip arthroplasty ( n = 25). The labrum was stained with safranin O, and images were histologically evaluated using a new parameter, the red/blue (R/B) value. The samples were divided into the degenerated group (D group: n = 18) and the healthy group (H group: n = 7) in accordance with the Kellgren-Lawrence (KL) grade. The cultured acetabular labral cells were subjected to loaded uniaxial cyclic tensile strain (CTS). After CTS, changes in gene expression were examined in both groups. Results: Spearman’s correlation analysis revealed that the R/B value was significantly correlated with the KL grade and the Krenn score. The expression levels of genes related to cartilage metabolism, osteogenesis and angiogenesis significantly increased after CTS in the H group, while gene expression in the D group showed weaker changes after CTS than that in the H group compared to the nonstretched control group. Conclusions: The degree of labral degeneration could be classified histologically using the R/B value and the KL grade. Mechanical stretching caused changes in gene expression that support the pathological features of labral degeneration.
Transient Impact of Dysglycemia on Sputum Conversion among Smear-Positive Tuberculosis Patients in a Tertiary Care Facility in Ghana
Authors: Yorke Ernest , Boima Vincent , Dey Ida Dzifa , Amissah-Arthur Maame-Boatemaa , Ganu Vincent , Amaning-Kwarteng Ernest , Tetteh John , Charles Mate-Kole C. 
Published: September 2021

BACKGROUND Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients. METHODS We conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6 months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dysglycemia as well as sputum conversion. RESULTS A significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs 67%, P-value < .05) at 2 months but not at 6 months (87% vs 77%, P-value > .05). After controlling for age group and adjusting for other covariates, patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months, respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times increased odds and 89% less likely for sputum conversion, respectively. CONCLUSION A significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.
Effects of lipid-lowering therapy on major adverse limb events in patients with peripheral arterial disease: A meta-analysis of randomized clinical trials
Authors: Masson Walter , Lobo Martín , Barbagelata Leandro , Molinero Graciela , Bluro Ignacio 
Published: September 2021

Objective Patients with peripheral artery disease (PAD) are at increased risk of major adverse limb events (MALE). Furthermore, MALE have several clinical implications and a poor prognosis, so prevention is a fundamental issue. The main objective of the present meta-analysis of randomized clinical trials is to evaluate the effect of different lipid-lowering therapies on MALE incidence in patients with PAD. Methods A meta-analysis of randomized studies that evaluated the use of lipid-lowering therapy in patients with PAD and reported MALE was performed, after searching the PubMed/MEDLINE, Embase, ScieLO, Google Scholar, and Cochrane Controlled Trials databases. A fixed- or random-effects model was used. Results Five randomized clinical trials including 11,603 patients were identified and considered eligible for the analyses (5903 subjects were allocated to receive lipid-lowering therapy, while 5700 subjects were allocated to the respective placebo/control arms). The present meta-analysis revealed that lipid-lowering therapy was associated with a lower incidence of MALE (OR: 0.76, 95% confidence interval: 0.66–0.87; I2: 28%) compared to placebo/control groups. The sensitivity analysis shows that the results are robust. Conclusion This study demonstrated that the use of lipid-lowering therapy compared with the placebo/control arms was associated with a marked reduction in the risk of MALE. Physicians involved in the monitoring and treatment of patients with PAD must work hard to ensure adequate lipid-lowering medication in these patients.
Incidence, prevalence, and economic burden of sarcoidosis in Puerto Rico: Estimates from a government health insurance claims database
Authors: Scharbaai-Vázquez Ramón , Tremblay Raymond L 
Published: September 2021

Objectives To estimate the epidemiology of sarcoidosis in Puerto Rico. Methods Patients with a diagnosis of sarcoidosis between January 2015 and December 2018 were selected from the Puerto Rico Health Insurance Administration Administración de Seguros de Salud de Puerto Rico claims database. The International Classification of Diseases-Tenth Revision coding for sarcoidosis was used for case detection and utilization of health care services. Cases by sex and age were evaluated. Results A total of 488 individuals with sarcoidosis were identified over the 4-year study. The median age at diagnosis was 59 years old. The average annual incidence rate was 9.9/100,000. The baseline prevalence was 14.9 per 100,000. Females represented 68.4% of the cases. Patients with lung and unspecified sarcoidosis predominate with 45.6% and 28.2% of cases, respectively. Overall, the yearly cost of health care utilization and medications per patient was $234 and $13,638, respectively. Conclusions Annual incidence rate and the median age of sarcoidosis in Puerto Ricans are among the highest and oldest reported globally. The demographic profile of sarcoidosis in Puerto Rico presents a patient in the mid-to advanced age, mostly female. While costs for medications were relatively high for a patient with sarcoidosis, the economic burden of the disease to the national health care system is not substantial.
Family caregivers for older persons with dementia offer recommendations to current caregivers: a qualitative investigation
Authors: Hovland Cynthia A , Mallett Christopher A 
Published: September 2021

Background and aims Family members who care for older adults with dementia encounter significant difficulties across many domains. There is limited research in this area; thus, the aim here is to share the actual experiences of 30 family caregivers to other family caregivers and to show how these experiences can provide help and recommendations. Methods This qualitative study of 30 family caregivers of family members aged 65 and older who died with dementia-related diagnoses used in-depth qualitative interviews conducted over a 12-month period for data collection and content analysis to understand the data. The study asked what they learned and what subsequent recommendations these caregivers had for other family caregivers taking care of an older person with dementia. Results Four primary themes emerged from the content data analysis and included the following: (1) “do not do it alone”; (2) patience, love, and kindness; (3) “ first of all, take care of yourself”; and (4) “ get educated.” Conclusions This study is unique in asking directly of family caregivers of older persons who died of dementia what they learned and what they want to share and recommend to ongoing and future family caregivers.
Intensive blood pressure lowering with nicardipine and outcomes after intracerebral hemorrhage: An individual participant data systematic review
Authors: Toyoda Kazunori , Yoshimura Sohei , Fukuda-Doi Mayumi , Qureshi Adnan I , Martin Renee’ Hebert , Palesch Yuko Y , Ihara Masafumi , Suarez Jose I , Okada Yasushi , Hsu Chung Y , Itabashi Ryo , Wang Yongjun , Yamagami Hiroshi , Steiner Thorsten , Sakai Nobuyuki , Yoon Byung-Woo , Inoue Manabu , Minematsu Kazuo , Yamamoto Haruko , Koga Masatoshi ,   the ATACH Trial Investigators and the SAMURAI Investigators
Published: September 2021

Background and aims Nicardipine has strong, rapidly acting antihypertensive activity. The effects of acute systolic blood pressure levels achieved with intravenous nicardipine after onset of intracerebral hemorrhage on clinical outcomes were determined. Methods A systematic review and individual participant data analysis of articles before 1 October 2020 identified on PubMed were performed (PROSPERO: CRD42020213857). Prospective studies involving hyperacute intracerebral hemorrhage adults treated with intravenous nicardipine whose outcome was assessed using the modified Rankin Scale were eligible. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4–6, and hematoma expansion, defined as an increase ≥6 mL from baseline to 24-h computed tomography. Summary of review Three studies met the eligibility criteria. For 1265 patients enrolled (age 62.6 ± 13.0 years, 484 women), death or disability occurred in 38.2% and hematoma expansion occurred in 17.4%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio (aOR) 1.12, 95% confidence interval (CI) 1.00–1.26 per 10 mmHg) and hematoma expansion (1.16, 1.02–1.32). Mean hourly systolic blood pressure from 1 h to any timepoint during the initial 24 h was positively associated with death or disability. Later achievement of systolic blood pressure to ≤140 mmHg increased the risk of death or disability (aOR 1.02, 95% CI 1.00–1.05 per hour). Conclusions Rapid lowering of systolic blood pressure by continuous administration of intravenous nicardipine during the initial 24 h in hyperacute intracerebral hemorrhage was associated with lower risks of hematoma expansion and 90-day death or disability without increasing serious adverse events.