bluuebunny/crossref_metadata_2025_split huggingface dataset:
Designing a nurse‐led assessment and care planning intervention to support frail older people in primary care: An e‐Delphi study
Authors: Lyndon Helen , Latour Jos M. , Marsden Jonathan , Kent Bridie 
Published: October 2021

AbstractAimTo identify and establish expert consensus on important and feasible components of a nurse‐led, comprehensive geriatric assessment (CGA)‐based intervention for community‐dwelling older people who live with frailty.DesignA three‐round modified e‐Delphi survey.MethodsAn expert panel of 33 UK specialist older people's, primary and community care nurses participated in the three‐round e‐Delphi survey over a 12‐month period in 2017–2018. Data from round 1 were analysed using content analysis. Descriptive statistics were used in the subsequent two rounds to demonstrate convergence of panel opinion and consensus.ResultsIn round 1, experts proposed 30 CGA components that were combined with six additional components from a literature review and clustered into six domains. In round 2, components were rated for importance and feasibility. Rating scores for importance were high across all domains, with lower scores for feasibility. Round 3 revealed that 36 components achieved consensus on importance and 11 out of 36 components reached consensus on feasibility.ConclusionBased on expert panel opinion, the content of a nurse‐led CGA‐based intervention was established, with the aim of future feasibility testing in a randomized controlled trial.ImpactThis study provides feasible components of a CGA‐based intervention that can be implemented in clinical practice by nurses in partnership with older people who live with frailty. Following further testing and evaluation, the components have the potential to improve clinical outcomes, maximize independence and improve the quality of life for community‐dwelling frail older people.
GPX7 Facilitates BMSCs Osteoblastogenesis via ER Stress and mTOR Pathway
Authors: Hu Xuchen , Li Boer , Wu Fanzi , Liu Xiaoyu , Liu Mengyu , Wang Chenglin , Shi Yu , Ye Ling 
Published: October 2021

AbstractEmerging evidence indicates extensive oxidative stress is a consequence of obesity which impairs bone formation. Glutathione peroxidase 7 (GPX7) is a conserved endoplasmic reticulum (ER) retention protein, lacking of which causes accumulation of reactive oxygen species (ROS) and promotes adipogenesis. Since the imbalance between osteogenic and adipogenic differentiation of bone marrow mesenchymal stem cell (BMSC) leads to severe bone diseases such as osteoporosis, it is critical to investigate the potential protective role of Gpx7 in osteogenesis. Here, we provide evidence that deficiency of Gpx7 reduces osteogenesis, but increases adipogenesis in both human BMSCs (hBMSCs) and mouse mesenchymal stem cell line. Interestingly, further studies indicate this defect can be alleviated by the ER stress antagonist, but not the ROS inhibitor, unveiling an unexpected finding that, unlike adipogenesis, lacking of Gpx7 inhibits osteogenesis mediating by induced ER stress instead of enhanced ROS. Furthermore, the mTOR signalling pathway is found down‐regulation during osteogenic differentiation in Gpx7‐deficient condition, which can be rescued by relief of ER stress. Taken together, for the first time we identify a novel function of Gpx7 in BMSCs’ osteogenic differentiation and indicate that Gpx7 may protect against osteoporotic deficits in humans through ER stress and mTOR pathway interplay.
A pooled analysis of randomized, controlled, phase 3 trials investigating the efficacy and safety of a novel, fixed dose calcipotriene and betamethasone dipropionate cream for the topical treatment of plaque psoriasis
Authors: Pinter A. , Green L.J. , Selmer J. , Praestegaard M. , Gold L.S. , Augustin M. ,   the trial investigator group
Published: October 2021

AbstractBackgroundPlaque psoriasis is a common, chronic and relapsing inflammatory skin disease clinically characterized by erythema and scaling desquamation. As over 90% of psoriasis patients benefit from topical therapies, local treatments continue to play an eminent role in management strategies. One such topical treatment is the fixed dose combination of calcipotriol (CAL) and betamethasone dipropionate (BDP).ObjectivesPooled analysis of two different phase 3 clinical trails to compare superiority regarding efficacy, safety and quality of life (QoL) between CAL/BDP PAD‐cream and CAL/BDP TS.MethodsThe data from two phase 3, multicentre, randomized, investigator‐blind, active and vehicle‐controlled trials enrolling patients with psoriasis were pooled and analysed. Investigational products included a CAL/BDP cream based on PAD™ Technology (PAD‐cream) designed for high skin penetration and increased patient preference, an active control (marketed CAL/BDP topical suspension/gel, in the following abbreviated as CAL/BDP TS) and cream vehicle, which were applied once daily for 8 weeks.ResultsEfficacy and safety of the novel CAL/BDP PAD‐cream formulation for the topical treatment of psoriasis demonstrated superiority for all efficacy end points after 8 weeks of treatment. PGA treatment success for CAL/BDP PAD‐cream (43.2%) was greater than CAL/BDP TS (31.9%; P < 0.0001), the mean per cent reduction in mPASI for CAL/BDP PAD‐cream was 64.6% compared to 56.4% for CAL/BDP TS (P < 0.0001) and DLQI 0/1 was obtained by 43.8% in the CAL/BDP PAD‐cream group versus 34.2% in the CAL/BDP TS group (P = 0.0005). There was no adverse drug reaction reported with a frequency of >1%, associated with the CAL/BDP PAD‐cream.ConclusionsThe novel fixed dose combination CAL/BDP PAD‐cream offers greater efficacy, superior patient QoL and equivalent favourable safety for the topical treatment of psoriasis, in comparison to the currently available topical suspension/gel.
Montgomery's legal and practical impact: A systematic review at 6 years
Authors: Le Gallez Isabelle , Skopek Jeffrey , Liddell Kathleen , Kuhn Isla , Sagar Andrew , Fritz Zoë 
Published: October 2021

AbstractRationale, Aims and ObjectivesSix years ago, the Supreme Court judgement in Montgomery v Lanarkshire changed medical law. It introduced a new patient‐based standard of care for the communication of treatment risks and alternatives, rejecting the doctor‐based standard that had long governed all aspects of medical negligence. This is the first systematic review to analyse the literature on Montgomery. Our aim is to appraise and synthesize the literature on Montgomery's impact on medicine and the law and to identify areas for further academic enquiry and implications for professional guidance and training.MethodsSearches were run in Medline, Embase, PsycINFO, Web of Science, Scopus, Westlaw UK, HeinOnline, and LexisNexis. Two reviewers screened papers. Extracted data was analysed and discussed by an interdisciplinary team. PRISMA guidelines were followed.ResultsOf the 1134 papers identified, 100 met the inclusion criteria. These papers revealed significant disagreement on four core sets of issues, focusing on Montgomery's impact on: (1) legal and professional duties; (2) medical practice; (3) the patient experience; and (4) litigation. The first set addresses whether the case actually changed doctors' legal and professional duties, the relationship between GMC guidance and medical law, and the boundaries of Montgomery. The second explores whether the decision has incentivized defensive medicine, its resource implications, and doctors' knowledge of it. The third concerns whether and how the decision has promoted patient autonomy and involvement in their own care. The fourth focuses on whether the case has caused an increase in litigation.ConclusionsDespite the abundance of legal and medical literature on Montgomery, many issues remain unresolved. Empirical research is required for many of the questions. Doctrinal analysis informed by medical knowledge is also required to assess whether Montgomery may have unrecognized ramifications—for example, whether it will require the disclosure of risks associated with diagnostic uncertainty, where doctors advise patients without performing procedures.
Enamel wear against monolithic zirconia restorations: A meta‐analysis and systematic review of in vitro studies
Authors: Aljomard Yasamin R. M. , Altunok Elif Çiğdem , Kara Haluk Barış 
Published: October 2021

AbstractObjectiveAn assessment was performed to identify and evaluate dental enamel wear caused by monolithic zirconia restoration. Literature searches were conducted in PubMed, Science Direct, Cochrane Evidence, and the Cochrane Library up to May 2020.Material and methodsStudies were selected for systematic review according to the inclusion (articles conducted on the wear of enamel samples opposing monolithic zirconia) and exclusion (case reports, non‐English articles, and monolithic zirconia samples facing other materials rather than human enamel) criteria. Of those, articles on polished and glazed monolithic zirconia subjected to a 50 N vertical load with a range of 240,000–250,000 cycles, equivalent to 1 year of in vivo mastication, were included in the meta‐analysis.ResultsIn total, 3968 articles were pooled. Twenty‐five articles met the inclusion criteria for the systematic review. Three studies were included in the meta‐analysis. The results showed that the enamel wear against monolithic zirconia was within the statistically accepted level. Moreover, the polished monolithic zirconia surface caused less enamel wear than the glazed surface.ConclusionThis review indicates that monolithic zirconia restorations cause acceptable antagonist enamel wear. Moreover, the meta‐analysis results agreed that the final restoration's surface texture plays an essential role in the wear process.Clinical significanceMonolithic zirconia restorations have been widely used in dental practice because they eliminate the chipping problems resulting from using veneered restorations. With recent technology development, monolithic zirconia has obtained more esthetic features and a more natural look. However, due to the high strength and surface roughness of monolithic zirconia, wear on the antagonist's teeth was detected. The results showed that this wear amount was statistically acceptable and lower than other ceramics such as feldspathic porcelain and enamel. Furthermore, surface treatment methods must be applied to minimize tooth wear, as polished or glazed surfaces interfere with enamel loss.
The influence of the renewal or the single application of the peroxide gel on the efficacy and tooth sensitivity outcomes of in‐office bleaching—A systematic review and meta‐analysis
Authors: Kury Matheus , Lins Rodrigo Barros Esteves , Resende Bruna de Almeida , Picolo Mayara Zaghi Dal , André Carolina Bosso , Cavalli Vanessa 
Published: October 2021

AbstractObjectiveTo answer the question: “Does the peroxide gel application regimen (single application vs. renewal) influence the efficacy and the tooth sensitivity outcomes of in‐office tooth bleaching?”MethodsThe search was done in Pubmed, Cochrane, LILACS, Scopus, Web of Science, and EMBASE in February 2021 (updated in July 2021). Randomized clinical trials (RCT) comparing the single application vs. the renewal protocols of HP were included. The meta‐analyses were performed for the objective (ΔEab), subjective (ΔSGU) color changes, and absolute risk of tooth sensitivity (TS). Heterogeneity was evaluated using Q test (I2). Cochrane Collaboration tool assessed the risk of bias (RoB). The GRADE evaluated the certainty of evidence.ResultsFive RCT studies remained. Two studies showed high RoB, and three presented some concerns. No significant differences were observed between the protocols in terms of the ΔEab, ΔSGU, and TS. ΔEab exhibited substantial heterogeneity (I2 = 87%), while ΔSGU (I2 = 60%) and the TS (I2 = 62%) presented a moderate one. The certainty of evidence was considered low or very low, depending on the variable response and the evaluation time.ConclusionThe application regimen (single vs. renewal of HP) did not impact color change or the absolute risk of TS.Clinical significanceThe renewal of bleaching gel during the in‐office appointment may not be necessary. However, there is at least a low certainty of evidence. Because of this, further randomized clinical trials with appropriate methodology on this topic are encouraged.
Association of coffee, green tea, and caffeine with the risk of dementia in older Japanese people
Authors: Matsushita Nana , Nakanishi Yuta , Watanabe Yumi , Kitamura Kaori , Kabasawa Keiko , Takahashi Akemi , Saito Toshiko , Kobayashi Ryosaku , Takachi Ribeka , Oshiki Rieko , Tsugane Shoichiro , Iki Masayuki , Sasaki Ayako , Yamazaki Osamu , Watanabe Kei , Nakamura Kazutoshi 
Published: October 2021

AbstractObjectivesCoffee, green tea, and caffeine are potential preventive factors for dementia, but the underlying evidence is insufficient. This study aimed to examine associations between the consumption of coffee, green tea, and caffeine and dementia risk in middle‐aged and older people.MethodsThis was a cohort study with an 8.0‐year follow‐up. Participants were community‐dwelling individuals (n = 13,757) aged 40–74 years. A self‐administered questionnaire survey was conducted in 2011–2013. Predictors were the consumption of coffee/green tea, from which caffeine consumption was estimated. The outcome was incident dementia obtained from the long‐term care insurance database. Covariates were demographic factors, body mass index, physical activity, energy, smoking, drinking, and disease history. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. HRs were also calculated using a Cox model with delayed entry.ResultsThe number of dementia cases during the study period was 309. Participants with higher coffee consumption had lower HRs (adjusted p for trend = 0.0014), with the fifth quintile (≥326 ml/day) having a significantly lower HR (0.49, 95% confidence interval [CI]: 0.30–0.79) than the first quintile (<26 ml/day, reference). Similarly, participants with higher caffeine consumption had a significantly lower HR (adjusted p for trend = 0.0004) than the reference. The Cox model with delayed entry yielded similar results. These associations were significant in men, but not in women. Moreover, participants who consumed 2–2.9 cups/day and ≥3 cups/day of coffee had lower HRs (0.69, 95% CI: 0.48–0.98 and 0.53, 95% CI: 0.31–0.89, respectively) than those who consumed 0 cup/day. The association between green tea consumption and reduced dementia risk was significant (adjusted p for trend = 0.0146) only in the 60–69 years age subgroup.ConclusionsHigh levels of coffee and caffeine consumption were significantly associated with a reduced dementia risk in a dose‐dependent manner, especially in men. Moreover, coffee consumption of ≥3 cups/day was associated with a 50% reduction in dementia risk.
Predicting 1 year mortality after traumatic injury using the Clinical Frailty Scale
Authors: Braude Philip , Carter Ben , Parry Frances , Ibitoye Sarah , Rickard Frances , Walton Ben , Short Roxanna , Thompson Julian , Shipway David 
Published: October 2021

AbstractBackgroundFrailty is known to affect how people admitted with traumatic injuries recover during their inpatient stay and shortly after discharge. However, few studies have examined the effect of frailty on long‐term mortality when adjusted for significant factors including age. We aimed to determine the effect of frailty on 1‐year morality in older adults admitted with traumatic injuries.MethodsWe undertook an observational study at the Severn Major Trauma Network's major trauma centre based in South West England. Patients ≥65 years old admitted between November 2018 and September 2019 with traumatic injuries were included. Isolated hip fractures and inpatient injuries were excluded. A geriatrician assessed all patients for frailty using the Clinical Frailty Scale. Follow‐up occurred at 1 year. A multivariable Cox proportional baseline hazards model assessed the effect of frailty on time‐to‐mortality. The adjusted model included age, sex, multimorbidity, surgery, most injured site, injury severity, postinjury complications, and geriatrician review.ResultsFive hundred and eighty‐five patients were included. Median age was 81 years old (IQR 74–88), and median injury severity score was 13 (IQR 9–25). At 1 year 147 (25.1%) patients had died. Living with frailty was associated with mortality. The risk of dying increased with frailty severity. Compared to CFS 1–3: CFS 4 aHR = 1.73 (95% CI 0.89–3.36, p = 0.11); CFS 5 aHR = 3.82 (95% CI 2.11–6.93, p < 0.001); CFS 6 aHR = 4·05 (95% CI 2.21–7.45, p < 0.001); CFS 7–8 aHR = 6.57 (95% CI 3.43–12.59, p < 0.001).ConclusionThis study is the first to demonstrate a consistent effect of frailty, at all levels of severity and independent of age, on older peoples' survival 1 year after traumatic injury. These data support performing an admission frailty assessment to aid long‐term management decisions and provide opportunity to modify frailty to improve outcomes.
The ethical implications of paradoxical lucidity in persons with dementia
Authors: Ney David B. , Peterson Andrew , Karlawish Jason 
Published: October 2021

AbstractThis case report describes the ethical implications of paradoxical lucidity in persons with severe stage dementia. Paradoxical lucidity describes an episode of unexpected communication or connectedness in a person who is believed to be noncommunicative due to a progressive and pathological process that causes dementia. A caregiver who witnesses an event of paradoxical lucidity may experience it as ethically and emotionally transformative. We provide an ethical framework for addressing this event in clinical practice. The framework addresses clinician interactions with the patient, caregiver, and family to improve understanding of paradoxical lucidity and to enhance patient care, caregiver well‐being, and decision‐making. Participants for this case study consented to having the case published. Participant names are changed to protect confidentiality.
Local complications of insulin administration sites and effect on diabetes management
Authors: Demir Günay , Er Eren , Atik Altınok Yasemin , Özen Samim , Darcan Şükran , Gökşen Damla 
Published: October 2021

AbstractBackgroundAdministration of insulin may be associated with substantial cutaneous adverse effects, such as lipoatrophy and lipohypertrophy (LH), which can cause glycemic excursions above and below the target levels for blood glucose. Our aim was to evaluate the effect on compliance with the use of insulin administration site, dermatological complications and diabetes management in children with type 1 diabetes (T1D).MethodsPatients aged 021 years who were followed up with the diagnosis of T1D for at least one year were included. A 14‐question survey including demographic characteristics and a subjective opinion of skin‐related complications of insulin administration was given. Data were obtained from the medical records to evaluate the effect of dermatological complications on diabetes management. This study was checked with the STROBE checklist.ResultsTwo hundred and fifty‐four patients were included and 53% of these were female. The mean age was 14.9 ± 4.7 years and the duration of T1D was 7.3 ± 4.1 years. The mean HbA1c level was 8 ± 1.4% and the mean total insulin dose was 0.84 ± 0.25 units/kg/day. More than half of the individuals (57%) were receiving multiple daily injections (MDI) and 43% were on insulin pump therapy (IPT). Of the participants, 11.8% reported LH, 7.5% wound, 21.7% allergy, 55.5% bleeding, 41.3% bruising and 47.2% pain. LH rates varied significantly by regimen, 17.1% in MDI and 4.6% with IPT (p = .001). Those with LH were using higher median doses of insulin (0.97 U/kg/day) than those who did not (0.78 U/kg/day; p = .016). LH was reported more frequently (18.3%) in patients with frequent hypoglycemia (p = .007). Positive correlation between BMI‐SDS and LH in patients aged <18 years was found (p = .043). LH rates by site were: right arm 20.8%, left arm 26.4%, right abdomen 26.4%, left abdomen 22.6% and 1% in the right and left leg.ConclusionsLocal complications of insulin therapy are common in young patients with T1D. The complication with the most impact on metabolic control was LH, present in nearly 12% of patients. Users of IPT have a significantly lower risk of LH. The results emphasise the importance of individualised education for young T1D patients and their families about injection site preference and rotation techniques.Relevance to clinical practiceThe diabetes team should check the insulin administration sites of children with type 1 diabetes at each visit and provide repeated education about the dermatological complications of insulin.
Effect of steroid hormone receptor gene variants PROGINS (Alu insertion) and PGR C/T (rs1042839) as a risk factor for recurrent pregnancy loss in Kashmiri population (North India)
Authors: Khan Nebela , Zargar Mahrukh Hameed , Ahmed Rehana , Godha Meena , Ahmad Abida , Afroze Dil , Masoodi Shariq R. 
Published: October 2021

AbstractAimTo unveil and evaluate the association and analyze the incidence and pattern of PGR gene polymorphisms (PROGINS insertion and PGR exon 5‐C/T polymorphism) in recurrent pregnancy loss (RPL) couples of Kashmir.MethodsIn this study, analyses of PGR gene polymorphisms in RPL couples were genotyped by amplification‐refractory mutation system polymerase chain reaction (PCR) and PCR‐restriction fragment length polymorphism.ResultsMolecular analysis of PGR gene polymorphisms indicated that the genotypic and allelic frequencies of PROGINS insertion and PGR exon 5 C/T polymorphisms of female group in cases and controls to be significantly different and poses risk in predisposition to RPL. Moreover, haplotype analysis in female group revealed that P1P2/CC and P1P2/CT genotype are significantly associated with RPL.ConclusionOur data indicate that the PROGINS insertion and exon 5‐C/T polymorphism can act as useful genetic markers in the female group, but needs to be replicated in further studies including various other single nucleotide polymorphisms of PGR gene relevant to pregnancy loss which may contribute to novel therapeutic targets with improved conclusions.
“WHAT CAN I CALL THAT HURT?”
Authors: Wiinikka‐Lydon Joseph 
Published: October 2021

AbstractMoral injury is a term coined both to reflect the moral dimension of wartime experience and to critique overly clinical approaches to psychological harms originating in wartime. Originally defined not only with the tools of the behavioral sciences but also literature and philosophy, clinical approaches have come to dominate moral injury discourse over the past decade. This article argues for a return to interdisciplinarity by engaging metaphysics and ethics, and in particular Iris Murdoch’s post‐Christian notions of the Good and void, to help better account for the experiences of veterans who claim that they hurt not only physically but also morally as a result of their wartime experience.