bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding public opinion to the introduction of minimum unit pricing in Scotland: a qualitative study using Twitter
Authors: Astill Wright Laurence , Golder Su , Balkham Adam , McCambridge J 
Published: June 2019

ObjectivesOn 1 May 2018 minimum unit pricing (MUP) of alcohol was introduced in Scotland. This study used Twitter posts to quantify sentiment expressed online during the introduction of MUP, conducted a thematic analysis of these perceptions and analysed which Twitter users were associated with which particular sentiments.Design and settingThis qualitative social media analysis captured all tweets relating to MUP during the 2 weeks after the introduction of the policy. These tweets were assessed using a mixture of human and machine coding for relevance, sentiment and source. A thematic analysis was conducted.Participants74 639 tweets were collected over 14 days. Of these 53 574 were relevant to MUP.ResultsStudy findings demonstrate that opinion on the introduction of MUP in Scotland was somewhat divided, as far as is discernible on Twitter, with a slightly higher proportion of positive posts (35%) than negative posts (28%), with positive sentiment stronger in Scotland itself. Furthermore, 55% of positive tweets/retweets were originally made by health or alcohol policy-related individuals or organisations. Thematic analysis of tweets showed some evidence of misunderstanding around policy issues.ConclusionsIt is possible to appreciate the divided nature of public opinion on the introduction of MUP in Scotland using Twitter, the nature of the sentiment around it and the key actors involved. It will be possible to later study how this changes when the policy becomes more established.
Can a patient-directed video improve inpatient advance care planning? A prospective pre-post cohort study
Authors: Nair Rajesh , Kohen Samuel Abuaf 
Published: June 2019

BackgroundPatients and their families often have an inadequate understanding of the risks and benefits of their advance care planning (ACP) options. Improving patients’ knowledge of therapeutic interventions allows them to better select treatments they believe are most appropriate for their condition.ObjectivesTo determine if a video aimed at educating and engaging hospitalised patients on a standardised ACP order set can improve (1) inpatient understanding of key ACP concepts, (2) ACP documentation within 48 hours of hospital admission, (3) concordance between a patient’s expressed and chart-documented care preferences, (4) patient satisfaction with decision-making, and (5) patient’s decisional confidence.MethodsA prospective, non-randomised, pre-post intervention study of 252 inpatients in a 215-bed community-based hospital in Comox, British Columbia, Canada.ResultsOur video decision support tool was associated with significant improvements in (1) patient understanding of key ACP concepts (70%–100%; p<0.0001), (2) ACP documentation within 48 hours of hospital admission (81%–92%; p=0.01), (3) concordance between patients’ expressed wishes and chart documentation (69%–89%; p<0.0001), (4) patient satisfaction with decision-making (Canadian Health Care Evaluation Project Lite score: 4.3–4.5, p=0.001), and (5) patient’s decisional confidence (patients with no decisional conflict, increased from 72% to 93%; p<0.0001).ConclusionA 13 min video aimed at educating and engaging inpatients on ACP concepts improved patient understanding of key ACP concepts, rates of ACP documentation and patient satisfaction with decision-making.
Evaluation of the effect of cooling strategies on recovery after surgical intervention
Authors: Engelhard Daniel , Hofer Pierre , Annaheim Simon 
Published: June 2019

IntroductionDifferent cooling strategies exist for emergency treatments immediately after sports trauma or after surgery. The aim of this study was to investigate the effects of three cooling regimen during the immediate postoperative phase as well as in the rehabilitation phase.Methods36 patients undergoing anterior cruciate ligament reconstruction received either no cooling (control-group, Con, N=12), were cooled with a menthol-containing cooling bandage (Mtl, N=12) or cooled with an ice containing cold pack (CP, N=12). During a 12-week physiotherapy treatment the cross section of the vastus medialis muscle was examined (day—1; 30; 60; 90) and painkiller consumption was documented.ResultsA significant reduction in the cross section area 30 days after surgery was observed in CP and Con (Mtl: −3.2±1.7%, p=0.14, CP: −8.8±4.3%, p<0.01, Con: −7.2±8.1%, p<0.05). After 90 days of therapy, a significant increase in muscle cross section area was observed in Mtl (Mtl: 4.6%±6.1%, p<0.05, CP: 1.9%± 8.1%, p=0.29, Con: 3.3%±9.4%, p=0.31). The absolute painkiller consumption was lower for Mtl (25.5±3.7 tablets) than for CP (39.5±6.9 tablets) or Con (34.8±4.2 tablets).ConclusionWe observed a beneficial effect of cooling by a menthol-containing bandage during the rehabilitation phase. Reduction of muscle cross section within 30 days after surgery was prevented which highly contributed to rehabilitation success after 90 days of therapy. Painkiller consumption was reduced with Mtl.
Implementing automated external defibrillators into community sports clubs/facilities: a cross-sectional survey of community club member preparedness for medical emergencies
Authors: Fortington Lauren V , West Liam , Morgan Damian , Finch Caroline F 
Published: June 2019

ObjectiveThere is a growing focus on ensuring the availability of automated external defibrillators (AED) in sport settings to assist in preventing sudden cardiac death. For the AED to be most effective, understanding how best to integrate it with wider risk management and emergency action plans (EAP) is needed. The aim of this survey was to identify sports club/facility member knowledge of AED use and club EAPs, 6 months following participation in a government-funded AED provision and cardiopulmonary resuscitation training programme.MethodsCross-sectional survey of community sports clubs and facilities in Victoria, Australia. Included participants were members of sports club/facilities that had been provided with an AED and basic first aid training as part of a government programme to increase access to, and awareness of, AEDs. A descriptive analysis of availability of EAPs and AEDs, together with practical scenarios on AED use and maintenance, is presented.ResultsFrom 191 respondents, more than half (56%) had no previous training in AED use. Knowledge on availability of an EAP at the club/facility was varied: 53% said yes and knew where it was located, while 41% did not have, or did not know if they had, an EAP. Responses to clinical scenarios for use of AED were mostly accurate, with the exception of being unsure how to respond when ‘a participant falls to the ground and is making shaking movements.’ConclusionsWhile there were positive outcomes from this programme, such as half of the respondents being newly trained in emergency first aid response, further improvements are required to assist members with embedding their AED into their club/facility EAP and practices.
Early versus delayed palliative/supportive care in advanced cancer: an observational study
Authors: Bandieri Elena , Banchelli Federico , Artioli Fabrizio , Mucciarini Claudia , Razzini Giorgia , Cruciani Massimiliano , Potenza Leonardo , D'Amico Roberto , Efficace Fabio , Bruera Eduardo , Luppi Mario 
Published: June 2019

ObjectiveThe positive impact of early palliative care interventions in advanced cancer patients has so far been largely evaluated in randomised controlled trials. This study aimed at providing information on the value of early palliative/supportive care, integrated with standard oncologic care, in a real-life setting.MethodsThis was a retrospective observational study of 292 advanced cancer patients consecutively admitted at Carpi Hospital in Modena, Italy, between 2014 and 2017. For the purpose of this analysis, patients were classified into two groups (early and delayed palliative/supportive care patients), and analysed for different clinical indicators. Early and delayed palliative/supportive care were classified according to the time elapsed from advanced cancer diagnosis until palliative/supportive care start.ResultsA total of 200 patients (68%), with at least three visits, were included in the analyses. The frequency of chemotherapy use in the last 60 days of life was 3.4% and 24.6% in the early and delayed groups, respectively (adjusted OR=0.1; 95% CI 0.0 to 0.4; p=0.002). The estimated survival probability at 1 year was 74.5% (95% CI 65.0% to 85.4%) and 45.5% (95% CI 37.6% to 55.0%), in the early and delayed groups, respectively. Performance status, pain and all the Edmonton Symptom Assessment Scale items, assessed at baseline and at 1 to 12 weeks after the intervention, showed significant improvement over time. However, no between-group differences were found with regard to symptom outcomes.ConclusionsAn earlier palliative/supportive care intervention was associated with reduced aggressiveness of therapy, in patients receiving community oncology care. Symptom burden was improved by early palliative/supportive care, independently of the timing of patient referral.
Do surgeon non-technical skills correlate with teamwork-related outcomes during robot-assisted surgery?
Authors: Ahmed Youseff , Lone Zaeem , Hussein Ahmed A , Feng Yingdong , Khan Hijab , Broad Sierra , Kannappan Renuka , Skowronski Alicia , Cole Adam , Wang Derek , Stone Kevin , Hasasneh Adam , Sexton Kevin , Gotsch Amanda , Ali Taimor , Braun Jacob , Khan Saira , Durrani Ayesha , Durrani Mohammad , Guru Khurshid A 
Published: June 2019

IntroductionTo evaluate the impact of non-technical skills (NTS) on team performance, workload and clinical outcomes.MethodsThe operating room (OR) environment of 20 robot-assisted radical prostatectomies performed by three different surgeons was recorded. Trained observers assessed NTS utilising the Non-Technical Skills for Surgeons (NOTSS) questionnaire. Associations between NOTSS scores, teamwork attributes (anticipation and inconveniences), workload (measured by National Aeronautics and Space Administration-Task Load Index (NASA-TLX)) and clinical outcomes (operative time, blood loss and surgical complexity) were determined using logistic regression and Pearson correlation.Results1780 requests were observed, 703 (39%) were non-verbal. Utilisation of non-verbal requests differed significantly among surgeons (26%, 36% and 44%, p<0.001). Anticipation was significantly associated with ‘Situational Awareness’ (OR 2.59, 95% CI 1.52 to 4.38, p<0.001), ‘Decision Making’ (OR 0.42, 95% CI 0.33 to 0.55, p<0.001) and ‘Communication and Teamwork’ (OR 0.43, 95% CI 0.25 to 0.74, p=0.002) domains. Inconveniences were significantly associated with ‘Situational Awareness’ (OR 0.21, 95% CI 0.08 to 0.59, p=0.003), ‘Decision Making’ (OR 2.73, 95% CI 1.53 to 4.86, p<0.001), and ‘Leadership’ (OR 0.62, 95% CI 0.41 to 0.94, p=0.03). There was a significant positive correlation between NOTSS scores and perceived physical and mental workload measures of NASA-TLX, as well as self-perceived performance. There was no significant association between NOTSS scores and any of the investigated clinical outcomes.ConclusionNTS in the OR were associated with team efficiency, fewer surgical flow disruptions and an improved self-perceived performance.
Procedural success with radial access for carotid artery stenting: systematic review and meta-analysis
Authors: Jaroenngarmsamer Tanaporn , Bhatia Kartik Dev , Kortman Hans , Orru Emanuele , Krings Timo 
Published: June 2019

BackgroundFemoral access is the traditional approach for endovascular carotid artery stenting. Radial access is increasingly used as an alternative approach due to its known anatomical advantages in patients with unfavorable aortic arch morphology via the femoral approach and its excellent access site safety profile. Our objective was to analyze procedural success using radial access for carotid artery stenting as reported in the literature.MethodsThree online databases were systematically searched following PRISMA guidelines for studies (n ≥20) using radial artery access for carotid artery stenting (1999–2018). Random-effects meta-analysis was used to pool the procedural success (successful stent placement with no requirement for crossover to femoral access), mortality, and complication rates associated with radial access.ResultsSeven eligible studies reported procedural success outcomes with a pooled meta-analysis rate of 90.8% (657/723; 95% CI 86.7% to 94.2%; I2=53.1%). Asymptomatic radial artery occlusion occurred in 5.9% (95% CI 4.1% to 8.0%; I2=0%) and forearm hematoma in 1.4% (95% CI 0.4% to 2.9%; I2=0%). Risk of minor stroke/transient ischemic attack was 1.9% (95% CI 0.6% to 3.8%; I2=42.3%) and major stroke was 1.0% (95% CI 0.4% to 1.8%; I2=0%). There were three deaths across the seven studies (0.6%; 95% CI 0.2% to 1.3%; I2=0%). The meta-analysis was limited by statistically significant heterogeneity for the primary outcome of procedural success.ConclusionRadial access for carotid artery stenting has a high procedural success rate with low rates of mortality, access site complications, and cerebrovascular complications. The potential benefits of this approach in patients with unfavorable aortic arch access should be explored in a prospective randomized trial.
Providing Higher Resolution Indicators of Rurality in the Surveillance, Epidemiology, and End Results (SEER) Database: Implications for Patient Privacy and Research
Authors: Moss Jennifer L. , Stinchcomb David G. , Yu Mandi 
Published: June 2019

Abstract

Background:
The burden of cancer is higher in rural areas than urban areas. The NCI's Surveillance, Epidemiology, and End Results (SEER) database currently provides county-level information on rurality for cancer patients in its catchment area, but more nuanced measures of rurality would improve etiologic and surveillance studies.

Methods:
We analyzed disclosure risk and conducted a sample utility analysis of census tract–level measures of rurality, using (1) U.S. Department of Agriculture's Rural Urban Commuting Area (RUCA) codes and (2) U.S. Census data on percentage of the population living in nonurban areas. We evaluated the risk of disclosure by calculating the percentage of census tracts and cancer cases that would be uniquely identified by a combination of these two rurality measures with a census tract–level socioeconomic status (SES) variable. The utility analyses examined SES disparities across levels of rurality for lung and breast cancer incidence and relative survival.

Results:
Risk of disclosure was quite low: &lt;0.03% of census tracts and &lt;0.03% of cancer cases were uniquely identified. Utility analyses demonstrated an SES gradient in lung and breast cancer incidence and survival, with relatively similar patterns across rurality variables.

Conclusions:
The RUCA and Census rurality measures have been added to a specialized SEER 18 database. Interested researchers can request access to this database to perform analyses of urban/rural differences in cancer incidence and survival.

Impact:
Such studies can provide important research support for future interventions to improve cancer prevention and control.
Adult Overweight and Survival from Breast and Colorectal Cancer in Swedish Women
Authors: Arnold Melina , Charvat Hadrien , Freisling Heinz , Noh Hwayoung , Adami Hans-Olov , Soerjomataram Isabelle , Weiderpass Elisabete 
Published: June 2019

AbstractBackground:The impact of overweight duration and intensity during adulthood on the prognosis after a cancer diagnosis remains largely unknown. We investigated this association in Swedish women with breast and colorectal cancer.Methods:A cohort of 47,051 women from the Swedish Lifestyle and Health Study was included, of whom 1,241 developed postmenopausal breast (mean age at diagnosis, 57.5 years) and 259 colorectal (mean age at diagnosis, 59.1 years) cancer. Trajectories of body mass index (BMI) between ages 20 and 50 years were estimated for the full cohort using a quadratic growth model and studied in relation to risk of death from any cause using multivariate Cox regression models among cancer survivors.Results:Compared with patients with cancer who were never overweight (BMI &lt; 25) during early adulthood (ages 20–50 years), the risk of early death from breast cancer increased by 3% [hazard ratio (HR) = 1.03; 95% confidence interval (CI), 1.01–1.05] and from colorectal cancer by 4% (HR = 1.04; 95% CI, 1.01–1.06) for every year lived with overweight. A higher intensity of overweight (i.e., a combination of duration and degree of overweight—a concept comparable to pack-years of cigarette smoking) further increased the risk of dying in this population. Although risks were slightly more pronounced for women diagnosed with late-stage breast cancer, no clear association was found for colorectal cancer.Conclusions:Our results suggest that adulthood overweight duration and intensity have a long-lasting influence on breast and colorectal cancer survival.Impact:Our study highlights the need for effective prevention of overweight and obesity starting at an early age.
Glioma Stem Cell–Specific Superenhancer Promotes Polyunsaturated Fatty-Acid Synthesis to Support EGFR Signaling
Authors: Gimple Ryan C. , Kidwell Reilly L. , Kim Leo J.Y. , Sun Tengqian , Gromovsky Anthony D. , Wu Qiulian , Wolf Megan , Lv Deguan , Bhargava Shruti , Jiang Li , Prager Briana C. , Wang Xiuxing , Ye Qing , Zhu Zhe , Zhang Guoxin , Dong Zhen , Zhao Linjie , Lee Derrick , Bi Junfeng , Sloan Andrew E. , Mischel Paul S. , Brown J. Mark , Cang Hu , Huan Tao , Mack Stephen C. , Xie Qi , Rich Jeremy N. 
Published: June 2019

AbstractGlioblastoma ranks among the most aggressive and lethal of all human cancers. Functionally defined glioma stem cells (GSC) contribute to this poor prognosis by driving therapeutic resistance and maintaining cellular heterogeneity. To understand the molecular processes essential for GSC maintenance and tumorigenicity, we interrogated the superenhancer landscapes of primary glioblastoma specimens and in vitro GSCs. GSCs epigenetically upregulated ELOVL2, a key polyunsaturated fatty-acid synthesis enzyme. Targeting ELOVL2 inhibited glioblastoma cell growth and tumor initiation. ELOVL2 depletion altered cellular membrane phospholipid composition, disrupted membrane structural properties, and diminished EGFR signaling through control of fatty-acid elongation. In support of the translational potential of these findings, dual targeting of polyunsaturated fatty-acid synthesis and EGFR signaling had a combinatorial cytotoxic effect on GSCs.Significance:Glioblastoma remains a devastating disease despite extensive characterization. We profiled epigenomic landscapes of glioblastoma to pinpoint cell state–specific dependencies and therapeutic vulnerabilities. GSCs utilize polyunsaturated fatty-acid synthesis to support membrane architecture, inhibition of which impairs EGFR signaling and GSC proliferation. Combinatorial targeting of these networks represents a promising therapeutic strategy.See related commentary by Affronti and Wellen, p. 1161.This article is highlighted in the In This Issue feature, p. 1143
Socio-clinical variables affecting the level of self-care in elderly patients with heart failure
Authors: Prochota Barbara , Szwamel Katarzyna , Uchmanowicz Izabella 
Published: June 2019

Background: Promoting self-care is the cornerstone of heart failure management. The number of hospitalizations and unscheduled visits could be reduced in elderly patients with heart failure by the patients’ active involvement in self-care. Aims: The aim of this study was to measure the level of self-care in elderly patients with heart failure, to examine the influence of socio-clinical variables on the level of self-care, and identify the socio-clinical variables that are predictors of self-care. Methods: The study included 100 heart failure patients (48 female, 52 male) aged between 60 and 88 years, treated at the Oleśno Health Care Center (Poland). The European Heart Failure Self-care Behavior Scale-9 and Mini-Mental State Examination were used. Results: The total classic European Heart Failure Self-care Behavior Scale-9 score was 22.76 points (standard deviation=8.49), and the standardised European Heart Failure Self-care Behavior Scale-9 score was 61.78 (standard deviation=23.59). Patients who were in a relationship, did not take digoxin or diuretics, were in New York Heart Association classes I and II, and had normal scores or cognitive impairment in the Mini-Mental State Examination, had significantly higher levels of self-care. Self-care was also correlated with patient age ( rs=−0.36, p<0.001) and left ventricle ejection fraction ( rs=0.23, p=0.019). Linear regression analysis demonstrated that only the New York Heart Association class has a significant impact on European Heart Failure Self-care Behavior Scale-9 scores. Compared to classes I and II, New York Heart Association class IV decreases the standardised European Heart Failure Self-care Behavior Scale-9 score by a mean of 23.60 points. Conclusions: Intensified self-care education should be provided to patients living alone, taking digoxin and diuretics, suffering from moderate dementia, and classified in New York Heart Association class IV. These patients may require specific educational strategies to gain the knowledge required for effective self-care.
Charcot arthropathy of the diabetic foot in a sub‐Saharan tertiary hospital: a cross‐sectional study
Authors: Wanzou Jean Paul Vwakya , Sekimpi Patrick , Komagum Johnson Owonda , Nakwagala Frederick , Mwaka Erisa Sabakaki 
Published: June 2019

AbstractBackgroundCharcot foot arthropathy is a potentially limb‐threatening condition that leads to progressive destruction of the bones and joints in the neuropathic foot. One of its main causes is diabetes mellitus whose prevalence is steadily increasing. The acute phase is often misdiagnosed thus leading to foot deformity, ulceration and increased risk of amputation. There is a paucity of literature on this condition from sub‐Saharan Africa. This study aimed at determining the extent of Charcot foot arthropathy, the radiological patterns of Charcot foot arthropathy and patient's factors associated with Charcot foot arthropathy among adult patients with longstanding diabetes in an African setting.MethodsThis was a cross‐sectional study that was carried at a national referral and university teaching hospital in Kampala, Uganda. One hundred patients with longstanding diabetes mellitus were consecutively recruited. Patients with a history of having diabetes mellitus for at least seven years since diagnosis were considered to have a longstanding disease. Clinical assessment of both feet was done. Weight‐bearing radiographs of the selected foot were taken and evaluated using the Sanders and Frykberg and modified Eichenholtz classifications. A blood sample was taken for glycosylated haemoglobin (HbA1c). Data were summarized using descriptive statistics and student t‐test.ResultsThe proportion of Charcot foot arthropathy among patients with longstanding diabetes was 12% of which one‐third (4 out of 12) were acute cases. Fifty percent of the lesions were in the forefoot and 50% in the midfoot. Seventeen percent of lesions were at the inflammatory stage of the modified Eichenholtz classification, 50% at the developmental stage, 25% at the healing stage, and 8% at the remodelling stage. An abnormal foot radiograph was significantly associated with Charcot foot arthropathy among patients with longstanding diabetes.ConclusionCharcot foot arthropathy is fairly common in patients with longstanding diabetes mellitus in these settings with one third of patients presenting in the early acute phase. An abnormal weight‐bearing radiograph was an associated factor of Charcot foot arthropathy among this specific group of patients. To reduce on the morbidity and limb threatening sequelae of this condition, clinicians are therefore advised to routinely examine the feet of patients with diabetes and send those with suspicious signs and symptoms for radiographic assessment.