bluuebunny/crossref_metadata_2025_split huggingface dataset:
How Physicians Manage Medical Uncertainty: A Qualitative Study and Conceptual Taxonomy
Authors: Han Paul K. J. , Strout Tania D. , Gutheil Caitlin , Germann Carl , King Brian , Ofstad Eirik , Gulbrandsen Pål , Trowbridge Robert 
Published: February 2021

Background Medical uncertainty is a pervasive and important problem, but the strategies physicians use to manage it have not been systematically described. Objectives To explore the uncertainty management strategies employed by physicians practicing in acute-care hospital settings and to organize these strategies within a conceptual taxonomy that can guide further efforts to understand and improve physicians’ tolerance of medical uncertainty. Design Qualitative study using individual in-depth interviews. Participants Convenience sample of 22 physicians and trainees (11 attending physicians, 7 residents [postgraduate years 1–3), 4 fourth-year medical students), working within 3 medical specialties (emergency medicine, internal medicine, internal medicine–pediatrics), at a single large US teaching hospital. Measurements Semistructured interviews explored participants’ strategies for managing medical uncertainty and temporal changes in their uncertainty tolerance. Inductive qualitative analysis of audio-recorded interview transcripts was conducted to identify and categorize key themes and to develop a coherent conceptual taxonomy of uncertainty management strategies. Results Participants identified various uncertainty management strategies that differed in their primary focus: 1) ignorance-focused, 2) uncertainty-focused, 3) response-focused, and 4) relationship-focused. Ignorance- and uncertainty-focused strategies were primarily curative (aimed at reducing uncertainty), while response- and relationship-focused strategies were primarily palliative (aimed at ameliorating aversive effects of uncertainty). Several participants described a temporal evolution in their tolerance of uncertainty, which coincided with the development of greater epistemic maturity, humility, flexibility, and openness. Conclusions Physicians and physician-trainees employ a variety of uncertainty management strategies focused on different goals, and their tolerance of uncertainty evolves with the development of several key capacities. More work is needed to understand and improve the management of medical uncertainty by physicians, and a conceptual taxonomy can provide a useful organizing framework for this work.
The burden of migraine on acute and emergency services in a London teaching hospital
Authors: Southwell Jessica , Afridi Shazia K 
Published: February 2021

Objective There is a lack of data on the burden of primary headache disorders such as migraine on emergency services. Existing data relies on a coding of “headache”, which encompasses both primary and secondary headache of all causes; for example, subarachnoid haemorrhage. Guy’s and St Thomas’ NHS Trust in London is one of the UK’s busiest emergency departments with 150,000 attendances per year. Our aim was to assess the healthcare resource utilisation of primary headaches, in particular migraine, in acute medical services. Methods We conducted an audit of all adult presentations to the emergency department of Guy’s and St Thomas’ Hospitals which were coded as “headache” over the first 6 months of 2018. We reviewed the initial diagnosis at presentation and also at discharge, investigations and outcome. Results Of 78,273 attendances to the emergency department, there were 976 presentations to the emergency department with “headache” as their primary complaint. “Migraine” was the most frequent of all diagnoses, accounting for 30% of all headache presentations and 25% of headache admissions. We calculated the cost of admitting and investigating migraine as £131,250 over the 6-month period. Conclusion Emergency admissions for migraine represent an avoidable cost and burden for both the hospital and the migraineur. This data informs us about the need to develop better care pathways for migraine in the community and to improve headache education for physicians and patients.
An Integrative Review of Behavioral Disturbances in Veterans With Dementia and PTSD
Authors: Kramer Abigail , Kovach Shannon , Wilkins Stacy 
Published: February 2021

Objective: Both posttraumatic stress disorder (PTSD) and dementia have been associated with a variety of behavioral changes; however, little is known about the behavioral consequences of comorbid PTSD and dementia. An integrative review was conducted to identify and examine studies reporting on behavioral disturbances in Veterans with PTSD and dementia. Methods: PubMed and PsychINFO databases were searched for articles on behavioral disturbances in Veterans with comorbid PTSD and dementia. Results: Seven studies met inclusion for this review, sampling a total of 822 Veterans. Preliminary findings suggest that though Veterans with dementia and comorbid PTSD may present with more difficult behavioral symptoms, they do not typically display increased levels of aggression. Conclusion: Given the limited study inventory, the key finding from this review highlights the lack of methodologically rigorous empirical studies on this topic. A research agenda is proposed to encourage future studies to address gaps in the literature.
Acceptability and feasibility of testing for sexually transmitted infections among pregnant women in Muscat, Sultanate of Oman
Authors: Lau Richard , Eskander Rula , Al-Yaqoobi Mubarak , Al-Habsi Zeyana , Elgalib Ali , Shah Samir , Al-Fouri Maha , Al-Rawahi Bader , Al-Abri Seif 
Published: February 2021

There are currently no reliable epidemiological data for estimating the burden of sexually transmitted infections (STIs) in Oman. STIs such as gonorrhoea and chlamydia are often asymptomatic and associated with sexual and reproductive morbidity. An exploratory study was conducted in an antenatal clinic in Muscat, Oman, to assess the acceptability and feasibility of testing for gonorrhoea and chlamydia. Two hundred and twenty-one women were recruited over 14 weeks between July and October 2020. There were three cases of chlamydia (3/221, 1.36%); no cases of gonorrhoea were identified. Acceptability and feasibility for testing in this cohort of pregnant women were good despite anticipated cultural sensitivities surrounding sexually transmitted infections.
Oseltamivir-Associated Bradycardia in Critically Ill Patients
Authors: MacLaren Robert , Francisco Janelle , Fetters Megan , Brady Jessica , Kim Crystal , Welker Cameron 
Published: February 2021

Background: Oseltamivir is frequently administered to critically ill patients with presumed influenza. It may modulate Na+, K+, and Ca2+ channels to produce bradycardia. Objective: To evaluate the association between oseltamivir and bradycardia in critically ill patients and assess parameters associated with bradycardia. Methods: This was a retrospective audit of 203 critically ill adults with presumed influenza receiving at least 2 doses of oseltamivir. The primary outcome was the occurrence of bradycardia, defined as a heart rate (HR) ≤59 beats per minute (BPM) while receiving oseltamivir or a decrease of ≥20 BPM compared with the lowest HR before initiating oseltamivir. Results: A total of 88 (43.4%) patients manifested bradycardia, 59 with HR ≤59 BPM, 19 with HR decrease of ≥20 BPM, and 10 with both. The time from first dose to bradycardia was 51.4 ± 43 hours. In all, 48 (54.6%) patients received therapies for bradycardia, including increased inotropic/vasopressor dose, electrolyte replacement, electrocardiogram, discontinuation of other medications, cardiology consult, discontinuation of oseltamivir, and pacer placement. There were no significant differences between groups with bradycardia versus without in terms of demographics, laboratory values, hospital characteristics, or oseltamivir dosing. Multivariate logistic regression showed that bradycardia was associated with baseline HR, age, past medical history of neurological issues, and positive influenza status. Between hours 6 through 126, significant differences existed between groups in actual and lowest HR. Conclusion and Relevance: Oseltamivir was associated with clinically relevant bradycardia in critically ill patients. Clinicians should closely monitor HR in critically ill patients receiving oseltamivir.
Evaluation of Dipeptidyl Peptidase-IV Inhibitor Use in Hospitalized Patients With Diabetes
Authors: Petite Sarah E. , Hill Maja C. 
Published: February 2021

Background: Glycemic control within goal blood glucose (BG) ranges is essential to minimize hospital complications for patients with type 2 diabetes mellitus (T2DM). Optimal treatment in the non–intensive care unit (ICU) setting includes a basal insulin containing regimen. Dipeptidyl peptidase-IV (DPP-IV) inhibitors have minimal hypoglycemia incidence and may be an appropriate bolus insulin replacement in the inpatient setting. Objective: To determine the effect of basal insulin plus DPP-IV inhibitor compared with basal plus bolus insulin in hospitalized patients with T2DM. Methods: This multicenter cohort study included adult patients with T2DM admitted to the non-ICU setting and prescribed either basal insulin plus DPP-IV inhibitor or basal plus bolus insulin. Propensity-score matching was performed for age, sex, Charlson Comorbidity Index, first BG reading during hospitalization, and hemoglobin A1C (A1C). The primary outcome was the difference in mean daily BG during hospitalization. Secondary outcomes included hospital length of stay (LOS), total daily dose (TDD) of insulin, hypoglycemic events, and mean daily BG in patients with an A1C >8%. Results: A total of 105 patients were included in each group. Mean daily BG during hospitalization was lower in the basal insulin plus DPP-IV inhibitor group (199.3 ± 52.5 vs 213.6 ± 45.8 mg/dL; P = 0.04). There was a significant difference in hospital LOS (5 [interquartile range = 3-8] vs 6 [4-11] days; P = 0.02) and short-acting insulin TDD (11.6 ± 9.1 vs 20.5 ± 21.2 units; P < 0.001). No differences were observed in basal insulin TDD and hypoglycemia. There was no difference in mean daily BG in the subgroup analysis of patients with a A1C >8%. Conclusions and Relevance: A significant difference in mean daily BG and hospital LOS was found with a basal insulin plus DPP-IV inhibitor regimen. Use of a DPP-IV inhibitor to replace bolus insulin in hospitalized patients with T2DM should be considered.
Impact of Intravenous Methadone Administered Intraoperatively on Postoperative Opioid Utilization
Authors: Petrosan Adina , Zassman Stefanie , Cohn Sara , Guerra Michael , Soares Karina , Kennedy James , Abdelghany Osama , Gutman Elena 
Published: February 2021

Background: Studies have shown that intravenous methadone intraoperatively can reduce opioid usage postoperatively. Objective: This study’s purpose was to evaluate the effect of intravenous methadone on postoperative opioid use. Methods: A prospective, single-center observational study was conducted to evaluate patients who received intravenous methadone intraoperatively. A control group was identified by matching procedure, gender, and age in a 1:3 ratio of methadone to control. Exclusion criteria included patients less than 18 years old or on methadone maintenance therapy. The primary outcome was morphine milligram equivalents (MME) administered 24h postoperatively. Secondary outcomes included MME administered 48h and 72h postoperatively, discharge prescription MME, daily mean postoperative pain scores, and length of hospital stay. A subgroup analysis was performed comparing opioid-naïve patients. Results: A total of 240 patients were included in the analysis. At 24h, postoperative MME was increased in the methadone group (142.6 vs 84.5; P = 0.0026). Postoperative MME was also increased in the methadone group at 48h and 72h. Daily pain scores were similar between both groups at all time intervals. Discharge prescription MME was reduced in the methadone group compared with controls, but not statistically significant. A subgroup analysis of opioid-naïve patients showed a significant reduction in MME at 48h ( P = 0.0240) and daily pain scores at 24h ( P = 0.0366) in the methadone group. Conclusion and Relevance: Intravenous methadone intraoperatively did not show a significant reduction in postoperative opioid use and discharge prescription MMEs when comparing all patients; however, benefit was seen when examining opioid-naïve patients.
Adults with autism spectrum disorder show atypical patterns of thoughts and feelings during rest
Authors: Simpraga Sonja , Weiland Ricarda F , Mansvelder Huibert D , Polderman Tinca JC , Begeer Sander , Smit Dirk JA , Linkenkaer-Hansen Klaus 
Published: February 2021

Mind wandering constitutes a major part of everyday experience and is inherently related to how we feel and identify ourselves. Thus, probing the character and content of thoughts and feelings experienced during mind-wandering episodes could lead to a better understanding of the human mind in health and disease. How mind wandering and spontaneous thought processes are affected in disorders such as autism is poorly understood. Here, we used the eyes-closed rest condition to stimulate mind wandering and quantified the subjective experiences using the Amsterdam Resting-State Questionnaire—which quantifies subjective psychological states of resting-state cognition across 10 domains—in 88 adults with autism spectrum disorder and 90 controls. We observed an atypical pattern of both thoughts and feelings in the autism spectrum disorder cohort, specifically in the domains of Theory of Mind, Comfort, and Discontinuity of Mind. We propose that the use of the Amsterdam Resting-State Questionnaire as a standardized cognitive instrument could advance our understanding of thoughts and feelings in autism spectrum disorder as well as in a wide variety of other brain disorders and how these may change due to therapeutic interventions. Lay abstract Everyone knows the feeling of letting one’s mind wander freely in a quiet moment. The thoughts and feelings experienced in those moments have been shown to influence our well-being—and vice versa. In this study, we looked at which thoughts and feelings are being experienced by adults with autism spectrum disorder and compared them to adults without autism spectrum disorder. In total, 88 adults with autism spectrum disorder and 90 adults without autism spectrum disorder were asked to rest for 5 min with their eyes closed and let their mind wander. Directly after, they filled in the Amsterdam Resting-State Questionnaire, which probes what participants were feeling and thinking during the period of rest. We found that adults with autism spectrum disorder tend to think less about others, felt less comfortable, and had more disrupted thoughts during the rest compared to adults without autism spectrum disorder. Interestingly, autism spectrum disorder participants reporting lower levels of comfort during the rest also reported more autism spectrum disorder symptoms, specifically in social behaviors and skills, attention switching, and imagination. We propose to use the eyes-closed rest condition in combination with the Amsterdam Resting-State Questionnaire more widely to shed light on aberrant thoughts and feelings in brain disorders and to study the effect of therapeutic interventions.
Diabetes, gender and deterioration in estimated glomerular filtration rate in patients with chronic heart failure: Ten-year prospective cohort study
Authors: Kearney Jessica , Drozd Michael , Walker Andrew MN , Slater Thomas A , Straw Sam , Gierula John , Paton Maria , Lowry Judith , Cole Charlotte , Witte Klaus K , Cubbon Richard M , Kearney Mark T 
Published: February 2021

Introduction: We aimed to evaluate the relationship between temporal changes in renal function and long-term mortality in patients with heart failure with reduced ejection fraction (HFrEF) and identify correlates of deteriorating renal function. Methods: A total of 381 patients with HFrEF enrolled in a prospective cohort study between 2006–2014 had eGFR measured at initial visit and at 1 year. Baseline characteristics were used in a multivariate analysis to establish variables that predict deterioration in eGFR. Follow-up data were used to assess whether declining eGFR was related to outcomes. Results: Patients were grouped into tertiles based on percentage change in eGFR. In a multivariate logistic regression analysis, male sex was associated with a 1.77-fold ([95% CI 1.01–2.89]; p = 0.045) and diabetes a 1.66-fold ([95% CI 1.02–2.70]; p = 0.041) greater risk of a decline in eGFR compared to those with stable/improving eGFR. Declining eGFR was associated with a 1.4-fold greater risk of death over 10 years ([95% CI 1.08–1.86]; p = 0.01) and a 3.12-fold ([1.44–6.75]; p = 0.004) greater risk of death at 1 year from second eGFR measurement. Conclusions: In patients with HFrEF diabetes and male sex are independent predictors of a decline in eGFR at 1 year. A decline eGFR over 1 year is associated with higher long-term all-cause mortality.
Dexterity of the Less Affected Hand in Children With Hemiplegic Cerebral Palsy
Authors: Burn Matthew B. , Gogola Gloria R. 
Published: February 2021

Background: To determine if the “unaffected” hand in children with hemiplegic cerebral palsy (CP) is truly unaffected. Methods: We performed a retrospective review of manual dexterity as measured by the Functional Dexterity Test (FDT) in 66 children (39 boys, 27 girls, mean age: 11 years 4 months) with hemiplegic CP. Data were stratified by Manual Ability Classification System (MACS) level, birth weight, and gestational age at birth, and compared with previously published normative values. Results: The FDT speed of the less affected hand is significantly lower than typically developing (TD) children ( P < .001). The development of dexterity is significantly lower than TD children (0.009 vs. 0.036 pegs/s/year, P < .001), with a deficit that increases with age. MACS score, birth weight, and age at gestation are not predictors of dexterity. The dexterity of the less affected hand is poorly correlated with that of the more affected hand. Conclusions: Both dexterity and rate of fine motor skill acquisition in the less affected hand of children with hemiplegic CP is significantly less than that of TD children. The less affected hand should be evaluated and included in comprehensive treatment plans for these children.
Can surgeons optimize range of motion and reduce scapulohumeral impingements in reverse shoulder arthroplasty? A computational study
Authors: Gauci Marc-Olivier , Chaoui Jean , Berhouet Julien , Jacquot Adrien , Walch Gilles , Boileau Pascal 
Published: February 2021

Background Early glenohumeral impingement leads to poor range of motion and notching in reverse shoulder arthroplasty. The aim was to find from planning software which implant configuration provides the best motions in reverse shoulder arthroplasty. Patients and Methods Reverse shoulder arthroplasty planning (Glenosys) was made in 31 patients (12 men, 19 women, 76 ± 6 yo) and impingements were analyzed. Inlay (155°-inclined) and Onlay (145°-inclined) humeral designs were tested. Four configurations were tested for each shoulder: “INLAY”: non-lateralized glenoid-inlay humerus, “BIO-INLAY”: lateralized glenoid (BIO-RSA)-inlay humerus, “ONLAY”: non-lateralized glenoid-onlay humerus, and “BIO-ONLAY”: lateralized (BIO-RSA) glenoid-onlay humerus. Results BIO-ONLAY and BIO-INLAY groups presented a significantly better result in all tested motion ( p < 0.001 for all tests). BIO-ONLAY allowed a significantly better external rotation, extension and adduction than BIO-INLAY with decreased impingements with the pilar. BIO-INLAY presented a significantly better abduction. In abduction, an abutment of the greater tuberosity against the acromion was associated with a lower range of motion ( p < 0.0001) and did not depend on the lateralization. Conclusion Glenoid lateralization delays the glenohumeral impingement in reverse shoulder arthroplasty and gives the best rotations, adduction and extension when associated with neutral inclination and humeral 145° inclination. Greater tuberosity abutment has to be avoided in abduction and the Inlay design provides the best abduction.
Real-world analysis of the effect of gefitinib as a first-line therapy in patients with advanced non-small cell lung cancer with EGFR mutations
Authors: Van Luan Pham , Tien Nguyen Dinh , Hai Nguyen Minh , Tien Nguyen Dao , Duyen Thi Thi 
Published: February 2021

Background: There have been few studies on the efficacy of tyrosine kinase inhibitors in lung carcinomas. The purpose of this study was to evaluate the effect of gefitinib as a first-line therapy in patients with advanced non-small cell lung cancer (NSCLC) who were positive for epidermal growth factor receptor ( EGFR) mutations. Methods: This prospective analysis included 120 patients with advanced NSCLC with EGFR mutations who were administered gefitinib as the first-line therapy. Patient follow-up and evaluation were performed every 3 months or when there were symptoms of progressive disease. The main criteria for the analysis of response were progression-free survival (PFS) and overall response rate (ORR). The secondary criteria were overall survival (OS) and disease control rate (DCR). In addition, the relationship of OS with sex, smoking history, and performance status (PS), as well as gefitinib toxicity were analyzed. Results: The ORR and DCR were 59.2% and 95.8%, respectively. The median PFS was 14.5 months and the median OS was 33 months. The longer OS was statistically significant in women and non-smokers, and the patients had a good PS. Adverse events occurred in 59.2% patients, but most of them were grade 1 and 2 events. Conclusion: This study conducted in Vietnam suggests the effectiveness of gefitinib as a first-line treatment option in patients with advanced NSCLC and positive EGFR mutations regardless of whether the patients have a good PS or not. In particular, targeted therapy with gefitinib improved the OS in women and non-smokers.