bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors associated with the persistence of oral 5-aminosalicylic acid monotherapy in ulcerative colitis: a nationwide Norwegian cohort study
Authors: Fossmark Reidar , Olaisen Maya , Martinsen Tom Christian , Melberg Hans Olav 
Published: June 2021

Background: Oral 5-aminosalicylic acid (5-ASA) is the mainstay treatment of ulcerative colitis (UC) and therapy with oral 5-ASA is associated with beneficial outcomes. We have examined factors associated with the persistence of oral 5-ASA treatment in a national cohort of UC patients. Methods: Patients with newly diagnosed UC from 2010 to 2014 using oral 5-ASA monotherapy were identified by combining data from the Norwegian Patient Registry and the Norwegian Prescription Database. The median follow-up time was 1029 days. Drug persistence was defined as duration of oral 5-ASA preparation as monotherapy. Non-persistence of a oral 5-ASA preparation as monotherapy was defined as stopping oral 5-ASA, initiation of any further anti-inflammatory treatment including a course of glucocorticoids and a change to another oral 5-ASA preparation. Drug persistence was analyzed using the Kaplan–Meier method and influence of covariates on drug persistence was analyzed with the Cox proportional hazard model. Results: A total of 3421 patients were identified. The overall median 5-ASA drug persistence was 179 days. In univariate analyses, persistence was associated with preparation type and high-dose treatment, while oral glucocorticoid use or hospitalization around the start of oral 5-ASA were associated with shorter 5-ASA persistence. In multivariate analyses, oral glucocorticoids [HR 1.67 (1.54–1.80), p < 0.005] and hospitalization around start of 5-ASA [HR 1.23 (1.14–1.34), p < 0.005] were associated with non-persistence, whereas high dose (⩾3 g/day) 5-ASA was associated with longer persistence [HR 0.68 (0.65–0.71), p < 0.005]. Conclusion: High-dose treatment with oral 5-ASA was associated with longer persistence of oral 5-ASA monotherapy, whereas the presence of factors indicating more severe disease around initiation of 5-ASA monotherapy was associated with a shorter persistence.
Largely varying patterns and trends of primary cancer-directed resection for gastric carcinoma with synchronous distant metastasis in Europe and the US: a population-based study calling for further standardization of care
Authors: Huang Lei , Jansen Lina , Verhoeven Rob H.A. , Ruurda Jelle P. , Van Eycken Liesbet , De Schutter Harlinde , Johansson Jan , Lindblad Mats , Johannesen Tom B. , Zadnik Vesna , Žagar Tina , Mägi Margit , Lagarde Sjoerd M. , Bastiaannet Esther , van de Velde Cornelis J.H. , Schrotz-King Petra , Brenner Hermann 
Published: June 2021

Aims: The role of resection remains debated in cases of metastatic gastric carcinoma (mGC). Some mGCs are technically resectable. At the population level, the real-world application of resection for mGC remains largely unclear in most Western countries. This large, population-based international investigation aimed to reveal the resection patterns and trends for mGC and the treatment-associated factors in Europe and the US. Methods: Data on cases with microscopically-confirmed primary invasive stomach carcinoma with distant metastasis were obtained from the nationwide cancer registries of the Netherlands, Belgium, Norway, Sweden, Estonia, and Slovenia and the US Surveillance, Epidemiology, and End Results-18 database. We calculated age-standardized rates of primary cancer-directed resection and assessed resection trends using linear regression. We investigated associations of treatment with patient and cancer factors using multivariable-adjusted log-binomial regression. Results: Among 133,321 patients with gastric cancer, overall, 40,215 cases with mGC diagnosed between 2003–2017 were investigated. Age-standardized resection rates significantly declined over time in the US, Belgium, Sweden, and Norway (by 5–14%). Resection rates greatly differed from 5% to 16% in 2013–2014. Cases with older ages, cardia tumors, or tumors involving adjacent structures were significantly less often operated across most countries. Sex was not significantly associated with resection. Across countries the association patterns and strengths differed largely. With multivariable adjustment, resection rates decreased significantly in all countries except Slovenia and Estonia (prevalence ratio per year = 0.90–0.98), and the decreasing trends were consistently observed in various stratifications by age and location. Conclusion: In Europe and the US, resection patterns and trends largely varied across countries for mGCs, which were mostly less often resected in the early 21st century. Various resection-associated factors were shown, with greatly varying association patterns and strengths. Our report could aid to identify discrepancies in clinical practice and highlight the great need for further clarifying the role of resection in mGCs to enhance standardization of care.
Mental health effect of COVID-19 pandemic among women who are pregnant and/or lactating: A systematic review and meta-analysis
Authors: Demissie Dereje Bayissa , Bitew Zebenay Workneh 
Published: June 2021

Objectives: The purpose of this study is to examine the effects of coronavirus disease 2019 pandemic on the prevalence of anxiety, depression, stress, insomnia, and social dysfunction among pregnant and/or lactating women and to measure the global pooled prevalence of mental health effects among these populations in the era of coronavirus disease 2019 pandemic. Methods: Comprehensive literature searching was conducted and studies published from 1 January 2020 to 30 September 2020 reporting the prevalence of anxiety, depression; stress, insomnia, and social dysfunctions were included. The pooled prevalence of anxiety, depression, stress, insomnia, and social dysfunctions was estimated using a random-effect model. In this study, all statistical analyses were performed using STATA (version 15) software. Results: There were a total of 19 studies included in the meta-analysis, of which 16, 14, 4, 2, and 2 studies were included in computing the pooled prevalence of anxiety, depression, stress, insomnia, and social dysfunction, respectively. The pooled prevalence of anxiety was 33% (95% confidence interval: 50%−61%), with significant heterogeneity between studies (I2 = 99.68%, p = 0.001). The pooled prevalence of depression was 27% (95% confidence interval: 9%−45%), with remarkable heterogeneity between studies (I2 = 99.29%, p = 0.001). Likewise, the pooled prevalence of stress was 56% (95% confidence interval: 30.07%−82.22%), with significant heterogeneity between studies (I2 = 98.8%, p = 0.0001). The pooled prevalence of social dysfunction was 24.3% (95% confidence interval: 13.41%−62.03%), with significant heterogeneity between studies (I2 = 97.5%, p = 0.0001) and finally, the pooled prevalence of insomnia was 33.53% (95% confidence interval: 3.05%−64.0%), with significant heterogeneity between studies (I2 = 99.6%, p = 0.0001). Conclusions: In this study, the mental health effects of the COVID-19 pandemic among pregnant and lactating women were found to be significant. Stress was the most common mental health problem in these population groups. Therefore, policymakers and health planners should give great emphasis to addressing maternal mental well-being during and after this global health crisis. Maternal mental health must be one of the international and national public health priority agendas to enhance the well-being of pregnant and lactating women. Besides, giving psychological support to pregnant and lactating women may reduce the long-term negative effects of this pandemic.
Psychological distress in patients undergoing urological surgery: A cross-sectional study
Authors: Murray Nuala , O’Connor Charles , Dempsey Rhona , Liew Sean , Richards Helen , Brady Ciaran , Sweeney Paul , Hennessey Derek 
Published: June 2021

Purpose: The purpose of this study was to evaluate the psychological distress of urological and uro-oncological patients undergoing surgery. Methods: Patients who presented to Mercy University Hospital from October 2019–May 2020 were consecutively recruited. Demographic and clinical characteristics including age, gender, marital status, type of surgery (uro-oncology or general urology), endoscopy or open surgery were gathered. Mood was evaluated using the Hospital Anxiety and Depression Scale prior to admission, prior to discharge and 6 weeks post-surgery. Results: A total of 118 participants (79.7% male) completed the Hospital Anxiety and Depression Scale prior to admission, prior to discharge and at 6 weeks post-surgery. Forty patients (33.9%) underwent uro-oncology-related surgery. At pre-admission 39 patients (33%) fell into a possible-probable clinical category for anxiety and 15 (12.7%) for depression. Older patients had significantly lower anxiety levels than younger patients ( p⩽0.01). There were no differences between patients undergoing uro-oncology or more general urology surgery and levels of anxiety or depression. Repeated measures analysis of variance with age as a covariate indicated no significant differences in Hospital Anxiety and Depression Scale anxiety scores over time. There was a statistically significant reduction in Hospital Anxiety and Depression Scale depression scores over the three assessment time points ( p=0.004). Conclusion: Over one-third of patients were experiencing moderate to severe levels of psychological distress pre-surgery – higher than levels previously reported in uro-oncological patients. Surprisingly, there was no difference in anxiety and depression scores in uro-oncology and urology patients. Psychological distress in both uro-oncology and more general urology patients should be considered in the surgical setting. Level of evidence Moderate
Incidental discovery of azoospermia on work-up of testicular tumour: a practice changing discovery
Authors: Abou Heidar Nassib 
Published: June 2021

Testicular tumours are increasing in incidence, especially in developed countries. This incidence increases specifically in the subpopulation of infertile men. This case highlights a young man incidentally diagnosed with a subcentimetric testicular lesion, who was discovered to have concomitant azoospermia. The authors review management strategies in this challenging case, as treatment options for men with infertility and concomitant testicular tumours vary from men who are fertile. Level of evidence: Not applicable for this multicentre audit.
Ischemic priapism due to coagulopathy of severe COVID-19 infection
Authors: Grimberg Dominic C , Tejwani Rohit , Allkanjari Armand , Forrester Michael T , Kraft Bryan D , Kaye Deborah R 
Published: June 2021

Initially thought to be a primarily respiratory disease process, the hypercoagulable state associated with COVID-19 has been associated with myriad clinical sequelae. We report a case of stuttering ischemic priapism associated with COVID-19, and describe a management approach to achieve detumescence in patients undergoing ventilatory proning limiting penile access. Level of evidence: Not applicable for this single center case report.
An Environmental Scan and Evaluation of Quality Indicators Across Canadian Kidney Transplant Centers
Authors: Glavinovic Tamara , Vinson Amanda J. , Silver Samuel A. , Yohanna Seychelle 
Published: June 2021

Background: Kidney transplantation is the optimal treatment for an individual requiring kidney replacement therapy, resulting in improved survival and quality of life while costing the health care system less than maintenance dialysis. Achieving and maintaining a kidney transplant requires extensive coordination of several different health care services. To improve the quality of kidney transplant care, quality metrics or indicators that encompass all aspects of the individual’s journey to transplant should be measured in a standardized fashion. Objective: To identify, categorize, and evaluate strengths and weaknesses of kidney transplant quality indicators currently being used across Canada. Design: An environmental scan of quality indicators being used by kidney organizations and programs. Setting: A 16-member volunteer pan-Canadian panel with expertise in nephrology, transplant, and quality improvement. Sample: Transplant programs, as well as provincial transplant and kidney agencies across Canada. Methods: Indicators were first categorized based on the period of transplant care and then using the Institute of Medicine and Donabedian frameworks. A 4-member subcommittee rated each indicator using a modified version of the Delphi consensus technique based on the American College of Physician/Agency for Healthcare Research and Quality criteria. Consensus ratings were subsequently shared with the entire 16-member panel for additional comments. Results: We identified 46 measures related to transplant care across 7 Canadian provinces (9 referral and evaluation, 9 waitlist activity and outcomes, 6 hospitalization for transplant surgery, 12 posttransplant care, 6 organ utilization, 4 living donor). We rated 24 indicators (52%) as necessary to distinguish high-quality from low-quality care, most of which measured effective (n = 10) or efficient (n = 6) care. Only 7 (15%) of 46 indicators evaluated person-centered or equitable care. Fourteen common indicators were measured by 5 of 7 provinces, 10 of which were deemed “necessary,” measuring safe (n = 2), effective (n = 5), efficient (n = 2), and equitable (n = 1) care. Limitations: The panel lacked patient and allied health representation. Conclusions: There are a large number of kidney transplant quality indicators currently being used in Canada, some of which are common across provinces and focus primarily on measuring effective care. Person-centered and equitable care indicators were lacking, and only half of these indicators were deemed “necessary” for quality improvement. Our results should complement ongoing work to achieve national consensus on the standardization of quality indicators in kidney transplantation.
Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes?
Authors: Pulatkan Anil , Kapicioglu Mehmet , Ucan Vahdet , Masai Mustafa Ngeiywo , Ozdemir Bulent , Akpinar Sercan , Bilsel Kerem 
Published: June 2021

Background: Different techniques are used for the remplissage procedure, including the double-pulley and mattress suture techniques. Both techniques have shown good results; however, it is unclear if one technique is superior. Hypothesis: The remplissage procedure using the double-pulley technique with 2 anchors would have superior functional and radiological outcomes compared with the mattress suture technique with a single anchor. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients with anterior shoulder instability who were treated using arthroscopic Bankart repair combined with remplissage between 2012 and 2017. A structured questionnaire was used to gather information on the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya index, presence of a Hill-Sachs defect, number of dislocations before surgery, sports participation, radiological measurement of the Hill-Sachs lesion, postoperative range of motion in both shoulders, Rowe score, Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling Index Score of Remplissage grade according to magnetic resonance imaging scans at the last follow-up. Results: There were 41 patients included with a mean age of 30 ± 7 years who underwent the Hill-Sachs remplissage procedure using the double-pulley technique with 2 anchors (n = 21; group DA) or the mattress suture technique with a single anchor (n = 20; group SA). At the final follow-up, there were no significant differences between the groups regarding the Instability Severity Index Score ( P = .134), the Sugaya index ( P = .538), sports participation ( P = .41), the radiological measurement of the Hill-Sachs lesion ( P = .803), or the Rowe score ( P = .182). However, there were significant differences between the groups in the Walch-Duplay score ( P = .012), American Shoulder and Elbow Surgeons score ( P = .005), and Filling Index Score of Remplissage grade ( P = .015), favoring group DA, as well as differences in external rotation in a neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3° [group DA]; P = .003) and at 90° of abduction (external rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P = .006), favoring group SA. Conclusion: In the remplissage procedure, the double-pulley technique provided better filling of the lesion and improvement in functional scores, but external rotation was limited compared with the mattress suture technique.
Academic Ethical Awareness and Moral Sensitivity of Undergraduate Nursing Students: Assessment and Influencing Factors
Authors: Alnajjar, PhD Hend Abdu , Abou Hashish, PhD Ebtsam Aly 
Published: June 2021

Introduction Nursing students are exposed to ethically challenging conditions in their future workplaces; hence, they must be ethically knowledgeable and morally sensitive to provide patients with holistic care based on sound ethical decision-making skills. Objectives: This study aimed to assess nursing students’ perception of their academic ethical awareness and moral sensitivity and determine the relationship between these variables. Methods: We conducted a descriptive correlational research study with a convenient sample of nursing students (N = 246) in a Saudi University nursing college. Data were collected using the Academic Ethical Awareness Questionnaire and Moral Sensitivity Questionnaire. We used descriptive statistics, ANOVA, and regression analyses. Results: Nursing students exhibited moderate academic ethical awareness and moral sensitivity. The regression analysis showed that academic ethical awareness can substantially predict 28.8% of the explained moral sensitivity variance ( p < 0.001). Nursing students were aware that the violation of patients’ respect or confidentiality and cheating in examinations were unethical behaviors. However, they showed low ethical awareness toward plagiarism behaviors. Furthermore, they reported higher moral sensitivity for patient-oriented care and professional responsibility and did not experience conflict. Academic level and integrated classroom and clinical learning experiences seemed to positively impact students’ academic ethical awareness. Conclusion: The findings provide a basis for monitoring nursing students’ professional misconduct so that they maintain integrity and adhere to academic ethics guidelines. Constant exertions for fostering nursing ethics courses with inspiring learning content and innovative instructional material are vital in improving nursing students’ academic integrity and ethical care.
Exploring the development and maintenance of therapeutic relationships through e-Health support: A narrative analysis of therapist experiences
Authors: Wood Matthew J , Wilson Hannah MN , Parry Sarah L 
Published: June 2021

Objective: Amid COVID-19 disruptions, e-therapy has become even more essential and has rapidly expanded across statutory, private and third sectors to meet growing demands for digital mental health support. A challenge in digital therapeutic care is how to develop and maintain a supportive, collaborative therapeutic relationship, built upon mutual trust and respect; intrinsic values of relationships that are often implied through complex non-verbal cues. Online practitioners are eager to learn how to adapt to online delivery, although platform-specific training is limited. The aim of the current study was to focus upon the therapist experience of online therapeutic relationships with young people, exploring a range of factors through their perspectives, including the impact of anonymity. Methods: Eight e-therapy practitioners were recruited from Kooth, an online mental health service. Narrative interviews undertaken via Skype facilitated reflective conversational one-to-one discussions, based upon the practitioners’ individual experiences, led by the interviewee. Following transcription and anonymisation, a narrative analysis was undertaken to explore participants’ experiences, perspectives and reflections. Results: Four analytic layers arose from the narratives, which explored the challenging learning experience of translating existing therapeutic skills to online working, rapidly building therapeutic relationships, managing risk in the online therapeutic relationship, and techniques for maintaining a digital therapeutic relationship. Conclusion: The study provides novel insights into the flexibility and adjustments therapists can make to improve online interventions and delivery through the development and maintenance of positive therapeutic relationships. Recommendations are also made in relation to platform-specific training, communicative adaptations, risk management and practitioner support.
Choroidal thickness alterations in idiopathic acute retinal vasculitis
Authors: Kumar Ashok , Ambiya Vikas , Mishra Sanjay Kumar , Jhanwar Mayank 
Published: June 2021

Background: To evaluate changes in sub-foveal choroidal thickness in patients with acute idiopathic retinal vasculitis compared with age-matched healthy subjects and unaffected fellow eyes. Methods: This prospective observational study included 36 eyes of 23 acute idiopathic retinal vasculitis patients (group V) which included a sub-group of 10 eyes of 10 patients with unilateral vasculitis (group UV), and 50 eyes of 25 healthy subjects (group N). The assessment involved demographics, systemic examination, comprehensive ocular examination, fundus photography with/without fundus fluorescein angiography, and spectral domain–optical coherence tomography with enhanced depth imaging. Results: There was significant difference between the mean sub-foveal choroidal thickness in groups V and N (V: 338.86 ± 28.72 um; N: 296.72 ± 19.45 μm; p < 0.001). The eyes of patients with unilateral vasculitis compared with unaffected fellow eyes had no significant difference in best corrected visual acuity (group UV: median = 0.2; range = (0.0–0.3) and group N: median = 0.2; range = (0.0–0.3); p = 0.35) but the sub-foveal choroidal thickness was significantly increased in the involved eye (group UV: 333.5 ± 16.68 um; group N: 284.4 ± 15.68 um; p ⩽ 0.001). The BCVA was significantly lower in the eyes with anterior chamber inflammation (median = 0.2; range = (0.0–0.3) and; median = 0.1; range (0.0–0.3); p = 0.002), but there was no statistically significant difference in sub-foveal choroidal thickness measurement between the two groups of vasculitis patients with and without anterior chamber inflammation (334.3 ± 18.85 um and 336 ± 31.56 um; p = 0.22). Conclusion: The sub-foveal choroidal thickness increases during active inflammation in eyes with idiopathic retinal vasculitis compared with unaffected fellow eyes and healthy control eyes. Thus, measurement of the sub-foveal choroidal thickness on optical coherence tomography with enhanced depth imaging can serve as a non-invasive modality in the diagnosis and monitoring of acute idiopathic retinal vasculitis.