bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insurance Status Effect on Laryngeal Cancer Survival: A Population Based Study
Authors: Abt Nicholas B. , Miller Lauren E. , Parikh Anuraag , Bhattacharyya Neil 
Published: September 2021

Objective: To analyze insurance status effect on overall survival (OS) and disease-specific survival (DSS) in laryngeal cancer. Study Design: Cross-sectional population analysis. Setting: Surveillance, Epidemiology, and End Results (SEER) database. Participants: Laryngeal cancer patients from 2007 to 2016. Main Outcome Measures: Kaplan-Meier method with log-rank statistic analyzed OS and DSS by insurance status. Multivariable cox proportional hazard modeling generated survival prognostic factors. Results: Of 19 667 laryngeal cancer cases, initial disease presentation was stage I: 7770 patients (39.5%), stage II: 3337 patients (17.0%), stage III: 3289 patients (16.7%), and stage IV: 5226 patients (26.6%). Patients had non-Medicaid insurance (15 523, 78.9%), had Medicaid (3306, 16.8%), or were uninsured (891, 4.5%). Mean and median OS for insured, Medicaid, and uninsured patients were 60.5, 49.6, and 56.6 and 74.0, 40.0, and 65.0 months, respectively. Following multivariable analysis, OS for insured, Medicaid, and uninsured patients was stage I: 87.9, 82.8, and 88.4 ( P < .001), stage II: 79.1, 75.1, and 78.3 ( P = .12), stage III: 68.7, 66.1, and 72.1 ( P = .11), and stage IV: 57.1, 51.7, and 50.3 ( P < .001) months. DSS mean survival times were 77.0, 65.8, and 67.7 months ( P < .001) for insured, Medicaid, and uninsured patients. Age (HR: 1.02/year, P < .001) and black (HR: 1.15, P = .001) compared to white race predicted worse survival. Compared to insured status, Medicaid insurance carried a death hazard ratio of 1.40 ( P < .001) and uninsured status had a death hazard ratio of 1.40 ( P < .001). Conclusion: Insured laryngeal cancer patients had prolonged OS and DSS compared to Medicaid and uninsured patients. Medicaid patients had equivalent survival outcomes to uninsured patients. Level of Evidence: 2c.
Comparison of ultra-performance liquid chromatography and ARK immunoassay for therapeutic drug monitoring of voriconazole
Authors: Peña-Lorenzo Diego , Rebollo Noemi , Sánchez-Hernández José German , Zarzuelo-Castañeda Aranzazu 
Published: September 2021

Background Therapeutic drug monitoring (TDM) of voriconazole is recommended for personalizing doses. The objective of this study was to compare the enzyme immunoassay developed by ARKTM Diagnostics Inc. for the quantification of voriconazole adapted to the Architect C4000 autoanalyzer (Abbott®) with ultra-performance liquid chromatography using ultraviolet detector (UPLC-UV) method. Materials and Methods Linearity, precision and accuracy of both methods were validated according to the Food and Drug Administration (FDA) and European Medicines Agency guidelines. The limit of quantification (LOQ) of the UPLC-UV method was determined experimentally. Both methods were applied to the analysis of 62 samples from patients. Correlation was evaluated by Passing-Bablok analysis and the concordance by the Bland–Altman method. Dosage recommendations were generated; the discordances according to the technique were evaluated. Results All validation parameters determined for UPLC-UV met the criteria set out and LOQ of 0.1 μg/mL was established. However, when the enzyme immunoassay was used to determine concentrations ≤1 μg/ml, CVs were >20%. A linear correlation between both methods was found. However, an overestimation of immunoassay (systematic error of 0.39 μg/mL) was detected. In 11.3% of the samples, the differences in concentrations when they were determined by different techniques would imply a different therapeutic regime. These samples had concentrations close to 1 μg/mL. Conclusion Although both techniques can be used for TDM of voriconazole, when a value close to the lower limit of the therapeutic range is determined by the ARKTM immunoassay, it would be better to verify the result by a non-automated technique to avoid possible underdosing.
Using the Patient Health Questionnaire to estimate prevalence and gender differences of somatic symptoms and psychological co-morbidity in a secondary inpatient population with abdominal pain
Authors: Stieler Melissa , Pockney Peter , Campbell Cassidy , Thirugnanasundralingam Vaisnavi , Gan Lachlan , Spittal Matthew , Carter Gregory 
Published: September 2021

Background: Somatic disorders and somatic symptoms are common in primary care populations; however, little is known about the prevalence in surgical populations. Identification of inpatients with high somatic symptom burden and psychological co-morbidity could improve access to effective psychological therapies. Methods: Cross-sectional analysis ( n = 465) from a prospective longitudinal cohort study of consecutive adult admissions with non-traumatic abdominal pain, at a tertiary hospital in New South Wales, Australia. We estimated somatic symptom prevalence with the Patient Health Questionnaire-15 at three cut-points: moderate (⩾10), severe (⩾15) and ‘bothered a lot’ on ⩾3 symptoms; and psychological co-morbidity with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 at standard (⩾10) cut-points. We also examined gender differences for somatic symptoms and psychological co-morbidity. Results: Prevalence was moderate (52%), female predominance (odds ratio = 1.71; 95% confidence interval = [1.18, 2.48]), severe (20%), no gender difference (1.32; [0.83, 2.10]) and ‘bothered a lot’ on ⩾3 symptoms (53%), female predominance (2.07; [1.42, 3.03]). Co-morbidity of depressive, anxiety and somatic symptoms ranged from 8.2% to 15.9% with no gender differences. Conclusion: Somatic symptoms were common and psychological triple co-morbidity occurred in one-sixth of a clinical population admitted for abdominal pain. Co-ordinated surgical and psychological clinical intervention and changes in clinical service organisation may be warranted to provide optimal care.
Intra-aortic balloon pump versus percutaneous Impella© in emergency revascularisation for myocardial infarction and cardiogenic shock: systematic review
Authors: Frain Kristina , Rees Paul 
Published: September 2021

Objectives: Mortality rates in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) remain persistently high despite advances over the past decade in percutaneous mechanical circulatory support. This systematic review aims to analyse the existing literature to compare mortality outcomes in patients mechanically supported by intra-aortic balloon pump or percutaneous Impella 2.5/CP© for AMI-CS undergoing emergency revascularisation. Methods: The following MeSH terms were applied to the databases Ovid Medline, Ovid Embase, Cochrane and Web of Science: ‘Intra-aortic balloon pump’, ‘Impella’, ‘Cardiogenic shock’, ‘Myocardial Infarction’ and ‘Mortality’. This yielded 2643 studies. Using predefined inclusion and exclusion criteria, the studies were initially screened by title and abstract before full text analysis. Results: Fourteen studies met eligibility criteria: two randomised controlled trials (RCTs) and 12 observational studies. Data from a total of 21,006 patients were included across the studies. Notably, one study claimed reduced mortality with IABP versus control, and one study concluded that Impella© improved survival rates over the IABP. The average 30-day all-cause mortality in patients supported by IABP was 38.1%, 54.3% in Impella© groups and 39.4% in control groups. Conclusion: AMI-CS presents an important cohort of patients in whom conducting RCTs is difficult. As a result, the literature is limited. Analysis of the available literature suggests that there is insufficient evidence to support superior survival in those supported by IABP or Impella© when compared to control despite suggestions that the Impella© offers superior haemodynamic support. Limitations of the studies have been discussed to outline suggestions for future research.
Venoarterial extracorporeal membrane oxygenation with intra-aortic balloon pump for postcardiotomy cardiogenic shock: A systematic review and meta-analysis
Authors: Huang Daochao , Xu Anyi , Guan QiongChan , Qin Jie , Zhang Chuang 
Published: September 2021

Objective: Intra-aortic balloon pump (IABP) is currently recommended as a strategy to address the increased afterload in patients who received venoarterial extracorporeal membrane oxygenation (VA-ECMO). The benefit of VA-ECMO with IABP in postcardiotomy cardiogenic shock is inconclusive. A systematic review and meta-analysis was conducted to assess the influence of VA-ECMO with IABP for postcardiotomy cardiogenic shock (PCS). Methods: The Cochrane Library, PubMed, and Embase were searched for all articles published from 1 January, 1964 to July 11, 2020. Retrospective cohort studies targeting the comparison of VA-ECMO with IABP and isolated VA-ECMO were included in this study. Results: We included 2251 patients in the present study (917 patients in the VA-ECMO with IABP group and 1334 patients in the isolated VA-ECMO group). Deaths occurred in 589 of 917 patients (64.2%) in the VA-ECMO with IABP group and occurred in 885 of 1334 patients (66.3%) in isolated VA-ECMO group. Pooling the results of all studies showed that VA-ECMO with IABP was not related to a reduced in-hospital mortality in patients who received VA-ECMO for PCS (RR, 0.95; 95% CI, 0.86–1.04; p = 0.231). In addition, VA-ECMO with IABP was not related to an increased rate of VA-ECMO weaning in patients who received VA-ECMO for PCS (RR, 1.28; 95% CI, 0.99–1.66; p = 0.058). Conclusions: This study indicates that VA-ECMO with IABP did not improve either in-hospital survival or weaning for VA-ECMO in postcardiotomy cardiogenic shock patients.
End of life care for people with severe mental illness: Mixed methods systematic review and thematic synthesis (the MENLOC study)
Authors: Edwards Deborah , Anstey Sally , Coffey Michael , Gill Paul , Mann Mala , Meudell Alan , Hannigan Ben 
Published: September 2021

Background: Parity of esteem means that end-of-life care for people with severe mental illness should be of equal quality to that experienced by all. Aim: To synthesise international, English language, research and UK policy and guidance relating to the organisation, provision, and receipt of end-of-life care for people with severe mental illness. Design: A mixed methods systematic review was conducted following the Evidence for Policy and Practice Information and Co-ordinating Centre approach and informed by a stakeholder group. We employed thematic synthesis to bring together data from both qualitative and quantitative studies, and from non-research material. We assessed the strength of synthesised findings using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approaches. Data sources: Ten electronic databases were searched from inception to December 2019, along with 62 organisational websites. Quality appraisal was conducted using Critical Appraisal Skills Programme checklists or other study design-specific alternatives as necessary. Results: Of the 11,904 citations retrieved, 34 research publications were included plus 28 non-research items. The majority of research was of high or acceptable quality. An overarching synthesis including 52 summary statements, with assessments of confidence in the underpinning evidence, was produced using four themes: Structure of the system; Professional issues; Contexts of care; and Living with severe mental illness. Conclusions: Implications for services and practice reflect evidence in which there is a high degree of confidence. Partnership should be developed across the mental health and end-of-life systems, and ways found to support people to die where they choose. Staff caring for people with severe mental illness at the end-of-life need education, support and supervision. End-of-life care for people with severe mental illness requires a team approach, including advocacy. Proactive physical health care for people with severe mental illness is needed to tackle problems of delayed diagnosis.
Nurse perspectives on the psychosocial care of patients with urinary incontinence in home hospice: A qualitative study
Authors: Russell David , Stoddard Michelina D , Morgan Natalie , McDonald Margaret V , Dignam Ritchell , Bowles Kathryn H , Prigerson Holly G , Chughtai Bilal 
Published: September 2021

Background: Urinary incontinence is prevalent among patients receiving home hospice and presents multiple care management challenges for nurses and family caregivers. Aim: This study sought to understand how urinary incontinence influences the psychosocial care of patients receiving home hospice and the strategies that nurses employ to maximize patient and family comfort. Design: Qualitative descriptive study using semi-structured interviews. Setting/participants: Nurses employed at a large not-for-profit hospice agency in New York City. Results: Analyses of 32 interviews revealed three primary themes. First, nurses considered urinary incontinence to be associated with multiple psychosocial issues including embarrassment for patients and caregiver burden. Second, nurses described urinary incontinence as a threat to patient dignity and took steps to preserve their continence function. Third, nurses assisted patients and their families to cope with urinary incontinence through normalization, reframing incontinence as part of the disease process, mobilizing caregiving assistance, and encouraging use of continence supplies such as diapers and liners. Conclusion: Urinary incontinence influences the psychosocial care of patients receiving home hospice and nurses employ strategies to maximize patient and family comfort. Additional research is needed to examine the psychosocial benefits of facilitated discussions with patients and family members about incontinence, provision of caregiving support, and distribution of comprehensive incontinence supplies to patients with fewer resources.
In Vivo Evaluation of Micronucleus Frequencies in Buccal Mucosal Cells of Orthodontic Patients with and Without Fluoride Use
Authors: Chitra Prasad , Prashantha GS , Rao Arun , Jois Harshvardhan S 
Published: September 2021

Introduction: Fluoride agents to prevent white spot lesions are used often during orthodontic treatment. The beneficial effects of fluoride, when consumed within permissible limits on dental structures, are well known. Their implications on underlying biological tissues, however, are unknown. Mouthwashes and dentifrices with fluorides are associated with metal ion release into the mouth with possible cell genotoxicity. Since these cariostatic agents are frequently used during orthodontic therapy, a deeper understanding of the effects of fluoride on oral tissues was considered necessary. Methodology: Three groups of patients (30 each)—group 1 (untreated controls), group 2 (non-fluoridated), and group 3 (Fluoridated) were analyzed. Patients in groups 2 and 3 were bonded with the same bracket prescription and treated with similar archwire sequences. Buccal mucosal cells at 4 specific time periods (before treatment, 1 week, 30 days, and 6 months) were collected, using a wooden tongue depressor, and assessed for any nuclear abnormalities. Comparisons of changes were made with an untreated control group and also between the non-fluoridated and fluoridated groups. Relevant conclusions were drawn after analysis of the results. Results: Greater number of nuclei were observed at the 30-day time interval in the fluoridated group, which was statistically significant at P < .001. Conclusion: Use of fluoridated oral hygiene products in patients undergoing fixed orthodontic treatment with NiTi archwires could increase the risk of micronuclei formation in buccal mucosal cells.
Survival analysis in the incident dialysis patients by different modalities
Authors: Lv Wenlv , Chen Xiaohong , Wang Yaqiong , Yu Jiawei , Cao Xuesen , Ding Xiaoqiang , Zou Jianzhou , Shen Bo , Nie Yuxin 
Published: September 2021

Background: To analysis survival in onset uremic patients who initiating HD or PD dialysis in our dialysis center. Methods: Between Jan. 2015 and June. 2018, patients with onset uremia and initiating planned-start dialysis were retrospectively enrolled in this study and followed up to January, 2019. The relationships between the types of dialysis modality and patient prognosis were assessed. Results: A total of 460 patients were included in the final analysis. Of which, 213 patient (46.30%) undergoing PD and 247 patients (53.70%) undergoing HD with arteriovenous fistula. The average follow-up time was 27.9 months. Eighty-seven (18.91%) patients died during the study period. The all-cause mortality was 127 per 1000 person-year. It was 102 per 1000 person-year in the HD group and 171 per 1000 person-year in the PD group ( p < 0.01). However, dialysis modality was not an independent predictor for survival. During the first year after dialysis initiation, patient survival was comparable between the PD and HD groups (log-rank p = 0.14). As the dialysis age increased over 1 year, HD patients seemed to have a better survival as compared to that of PD patient (log-rank p < 0.05), especially those older than 65 years and without DN. Conclusions: Though dialysis modality was not an independent factor for overall survival, HD therapy seemed to be more suitable for patients without DN.
Delivering clinical evidence-based child–parent interventions for emotional development through a digital platform: A feasibility trial
Authors: Selby Emma , Allabyrne Clare , Keenan Joseph R 
Published: September 2021

As the prevalence of mental health conditions in childhood increases, there are growing concerns around the accessibility and scale of evidence-based support. However, barriers to referral, time commitment and engagement rates means recommended traditional group-based parenting programmes are unable to provide population level support at scale. The aim of this feasibility study was to establish whether a suite of purposively constructed animated films and digital resources could positively impact on parent and child outcomes in the early years. Families from a range of backgrounds ( n = 129) participated in a mixed method evaluation of the digital programme. After completing online surveys and interviews, the test group was given access to the Embers the Dragon platform for 8 weeks whilst the control group continued as usual. 98% of test group parents showed an improvement in parental response in relation to effective parenting styles. During qualitative interviews, child participants verbally recalled an increased range of emotions and coping strategies highlighted in the programme. Digital interventions can be used to support children’s emotional development independent of clinicians and may provide a solution to sustainable family psychoeducation, thereby fulfilling a preventative agenda and potentially lessening the future impact on Child and Adolescent Mental Health Services.
Higher risk of mortality in HIV-HBV co-infected patients from sub-Saharan Africa is observed at lower CD4+ cell counts
Authors: Kouamé Gérard M , Gabillard Delphine , Moh Raoul , Badje Anani , Ntakpé Jean B , Emième Arlette , Maylin Sarah , Toni Thomas d’Aquin , Ménan Hervé , Zoulim Fabien , Danel Christine , Anglaret Xavier , Eholié Serge , Lacombe Karine , Boyd Anders 
Published: September 2021

Background Hepatitis B virus (HBV) co-infection in human immunodeficiency virus (HIV)-positive individuals increases the risk of overall mortality, especially when HBV DNA levels are high. The role of CD4+ cell counts in this association is poorly defined. We aimed to determine whether HIV–HBV co-infection influences changes in CD4+ cell count before and during antiretroviral therapy and whether it affects mortality risk at levels of CD4+. Methods 2052 HIV-positive participants from Côte d’Ivoire in a randomized-control trial assessing early or deferred ART were included. HBV-status was determined by hepatitis B surface antigen (HBsAg). Changes in CD4+ cell levels were estimated using a mixed-effect linear model. The incidence rates of all-cause mortality were estimated at CD4+ counts ≤350, 351–500, >500/mm3 and were compared between HBV-status groups as incidence rate ratios (IRR). Results At baseline, 190 (9%) were HBsAg-positive [135 (71%) with HBV DNA <2000 IU/mL, 55 (29%) ≥2000 IU/mL]. Follow-up was a median 58 months (IQR = 40–69). Between co-infection groups, there were no differences in CD4+ decline before ART initiation and no differences in CD4+ increase after ART initiation. After adjusting for sex, age, baseline HIV RNA level, and early/deferred ART arm, mortality rates were not significantly different between HBsAg-positive versus HBsAg-negative participants across strata of CD4+ levels. However, HBsAg-positive individuals with HBV-DNA ≥2000 IU/mL versus HBsAg-negative individuals had increased mortality rates at ≤350/mm3 (adjusted-IRR = 3.82, 95% CI = 1.11–9.70) and 351–500/mm3 (adjusted-IRR = 4.37, 95% CI = 0.98–13.02), but not >500/mm3 (adjusted-IRR = 1.07, 95% CI = 0.01–4.91). Conclusion Despite no effect of HBV-infection on CD4+ levels, HIV-HBV co-infected individuals with high HBV replication are at higher risk of mortality when CD4+ is <500/mm3.
A qualitative exploration of autistic mothers’ experiences II: Childbirth and postnatal experiences
Authors: Hampton Sarah , Man Joyce , Allison Carrie , Aydin Ezra , Baron-Cohen Simon , Holt Rosemary 
Published: September 2021

Navigating childbirth and the postnatal period may pose additional challenges for autistic people, who can face communication and sensory barriers to accessing healthcare. However, research exploring autistic experiences of parenthood is scarce. Semi-structured interviews were conducted with 21 autistic and 25 non-autistic women 2–3 months after giving birth. Interviews concerned experiences of childbirth, postnatal healthcare and parenting. Thematic analysis revealed that sensory aspects of childbirth could be challenging for autistic participants; participants highlighted the need for sensory adjustments. Autistic participants stressed the importance of clear, direct communication from professionals during the birth. During childbirth and the postnatal period, autistic participants sometimes felt that professionals lacked knowledge of autism and this could hinder receiving appropriate adjustments. Both groups reported several parenting strengths and challenges. The findings indicate ways in which childbirth and postnatal healthcare can be improved for autistic people, including sensory and communication adjustments. They also indicate a need for greater autism-related training for professionals involved in childbirth and postnatal care. Lay abstract Very little research has looked at how autistic people experience childbirth and the first few months of parenthood. We interviewed 21 autistic and 25 non-autistic women 2–3 months after their baby was born, to find out how they experienced giving birth and being a parent. Some autistic participants found sensory aspects of giving birth difficult, such as noise and being touched. They also wanted healthcare professionals to give them clear information while giving birth. Participants sometimes thought that healthcare professionals did not know enough about autism. Autistic and non-autistic participants both found parenthood difficult at times and autistic parents sometimes had extra difficulties, such as with planning and organising. Autistic participants also felt good at understanding their baby’s needs. This research suggests that autistic people would benefit from changes to childbirth and postnatal healthcare such as being communicated with more clearly. It also indicates that healthcare professionals should receive more training about autism.