bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimum hospice at home services for end-of-life care: protocol of a mixed-methods study employing realist evaluation
Authors: Butler Claire , Brigden Charlotte , Gage Heather , Williams Peter , Holdsworth Laura , Greene Kay , Wee Bee , Barclay Stephen , Wilson Patricia 
Published: May 2018

IntroductionHospice at home (HAH) services aim to enable patients to be cared for and die in their place of choice, if that is at home, and to achieve a ‘good death’. There is a considerable range of HAH services operating in England. The published evidence focuses on evaluations of individual services which vary considerably, and there is a lack of consistency in terms of the outcome measures reported. The evidence, therefore, does not provide generalisable information, so the question ‘What are the features of hospice at home service models that work, for whom, and under what circumstances?’ remains unanswered. The study aims to answer this question.Methods and analysisThis is a mixed-methods study in three phases informed by realist evaluation methodology. All HAH services in England will be invited to participate in a telephone survey to enable the development of a typology of services. In the second phase, case study sites representing the different service types will collect patient data and recruit carers, service managers and commissioners to gather quantitative and qualitative data about service provision and outcomes. A third phase will synthesise and refine the results through consensus workshops.Ethics and disseminationThe first survey phase has university ethics approval and the second phase, Integrated Research Application System (IRAS) and Health Research Authority (HRA) approval (IRAS ID:205986, REC:17/LO/0880); the third phase does not require ethics approval. Dissemination will be facilitated by project coapplicants with established connections to national policy-making forums, in addition to publications, conference presentations and reports targeted to service providers and commissioners.
Comparison of severe trauma treatment standards in civilian China with current practice in the Chinese military peacekeeping Level 2 Military Hospital in Gao, Mali
Authors: Li Jian , Tian J , Wang Y B , Zhang H 
Published: May 2018

IntroductionThe People’s Republic of China has been successfully deploying medical teams to support the peacekeeping mission at the Level 2 Military Hospital in Mali since December 2013. The aim of this paper was to compare the current practice in Chinese Peacekeeping Level 2 Military Hospital with the severe trauma treatment standards reported in China.MethodsA retrospective analysis was conducted between 26 April 2014 and 18 May 2016 using records stored in the Chinese Peacekeeping Level 2 Hospital (CHN L2). From 19 May 2016 to 31 March 2017, the data were prospectively collected for all casualties presenting in the hospital. Emergency response time, prehospital transit time, emergency rescue time, consultation call time and mortality were compared with the data from a study that evaluated the effects of standard rescue procedure (SRP) in improving severe trauma treatment in different hospitals across China.ResultsIndexes obtained from the analysis of CHN L2 data were equal or surpassed indexes reported in the study evaluating the implementation of SRP in Chinese hospitals.ConclusionThe deployed CHN L2 delivered a high standard of care in Gao, Mali, and generally surpasses the Chinese standards. This can mostly be attributed to an efficient coordination of work during both prehospital and in-hospital stages of rescue.
How are we currently training and maintaining clinical readiness of US and UK military surgeons responsible for managing head, face and neck wounds on deployment?
Authors: Breeze John , Combes J G , DuBose J , Powers D B 
Published: May 2018

IntroductionThe conflicts in Iraq and Afghanistan provided military surgeons from the USA and the UK with extensive experience into the management of injuries to the head, face and neck (HFN) from high energy bullets and explosive weaponry. The challenge is now to maintain the expertise in managing such injuries for future military deployments.MethodsThe manner in which each country approaches four parameters required for a surgeon to competently treat HFN wounds in deployed military environments was compared. These comprised initial surgical training (residency/registrar training), surgical fellowships, hospital type and appointment as an attending (USA) or consultant (UK) and predeployment training.ResultsNeither country has residents/registrars undertaking surgical training that is military specific. The Major Trauma and Reconstructive Fellowship based in Birmingham UK and the Craniomaxillofacial Trauma fellowship at Duke University USA provide additional training directly applicable to managing HFN trauma on deployment. Placement in level 1 trauma/major trauma centres is encouraged by both countries but is not mandatory. US surgeons attend one of three single-service predeployment courses, of which HFN skills are taught on both cadavers and in a 1-week clinical placement in a level 1 trauma centre. UK surgeons attend the Military Operational Surgical Training programme, a 1-week course that includes 1 day dedicated to teaching HFN injury management on cadavers.ConclusionsMultiple specialties of surgeon seen in the civilian environment are unlikely to be present, necessitating development of extended competencies. Military-tailored fellowships are capable of generating most of these skills early in a career. Regular training courses including simulation are required to maintain such skills and should not be given only immediately prior to deployment. Strong evidence exists that military consultants and attendings should only work at level 1/major trauma centres.
Obesity is associated with impaired long-term success of pulmonary vein isolation: a plea for risk factor management before ablation
Authors: De Maat Gijs E , Mulder Bart , Berretty Wouter L , Al-Jazairi Meelad I H , Tan Yong E S , Wiesfeld Ans C P , Mariani Massimo A , Van Gelder Isabelle C , Rienstra Michiel , Blaauw Yuri 
Published: May 2018

AimsObesity is an increasing health problem and is an important risk factor for the development of atrial fibrillation (AF). We investigated the association of body mass index (BMI) on the safety and long-term efficacy of pulmonary vein isolation (PVI) for drug-refractory AF.Methods414 consecutive patients who underwent transcatheter PVI for AF between 2003 and 2013 were included. Successful PVI was defined as absence of atrial arrhythmia on Holter monitoring or ECG, without and with antiarrhythmic drugs during follow-up. Obesity was defined as BMI≥30 kg/m².ResultsMean age was 56±10 years, 316 (76%) were male, 311 (75%) had paroxysmal AF and 111 (27%) were obese. After a mean follow-up of 46±32 months (1590 patient-years), freedom from atrial arrhythmia and antiarrhythmic drugs was significantly lower in patients with obesity compared with non-obese patients (30% vs 46%, respectively, P=0.005, log-rank 0.016). With antiarrhythmic drugs, freedom from atrial arrhythmia was 56% vs 68% (P=0.036). No differences in minor and major adverse events were observed between patients with obesity and non-obese patients (major 6% vs 3%, P=0.105, and minor 5% vs 5%, P=0.512). Sensitivity analyses demonstrated that BMI (as continuous variable) was associated with PVI outcome (HR 1.08, 95% CI 1.02 to 1.14, P=0.012).ConclusionObesity is associated with reduced efficacy of PVI for drug-refractory AF. No relation between obesity and adverse events was found.
Healthcare use, costs and quality of life in patients with end-stage kidney disease receiving conservative management: results from a multi-centre observational study (PACKS)
Authors: Phair Glenn , Agus Ashley , Normand Charles , Brazil Kevin , Burns Aine , Roderick Paul , Maxwell Alexander P , Thompson Colin , Yaqoob Magdi , Noble Helen 
Published: May 2018

Background: Previous research has explored the cost of providing renal replacement therapies in patients with end-stage kidney disease and their quality of life. This is the first study to examine the healthcare costs of patients receiving conservative care without dialysis for end-stage kidney disease. This alternative to dialysis is an option for patients who prefer a supportive and palliative care approach. Aim: Descriptive cost and quality of life analyses alongside a UK-based multi-centre observational study in patients receiving conservative management for end-stage kidney disease. Design: Health service use was recorded up to 12 months after making the decision to receive conservative management. Mean costs were calculated for each 3-month time period. The annual cost was calculated in two ways: by using only patients with complete cost data and by using all available data weighted by the number of patients at each time point. Setting: In total, 42 patients who opted for conservative management over dialysis were recruited. Results: Mean costs were £1622 (0–3 months), £1008 (3–6 months), £554 (6–9 months) and £2626 (9–12 months). Mean annual cost based on complete data ( n = 8) was £5511, and the weighted mean annual cost was £5620. Conclusion: The importance of this study is twofold. First, it provides substantive new information for health and social care planning of conservative management by demonstrating where demand exists for services, in both the United Kingdom and other countries with a comparable health service structure. Second, methodologically, it indicates that it is feasible to collect service use data directly from this patient population.
‘Death is difficult in any language’: A qualitative study of palliative care professionals’ experiences when providing end-of-life care to patients from culturally and linguistically diverse backgrounds
Authors: Green Anna , Jerzmanowska Natalia , Green Marguerite , Lobb Elizabeth A 
Published: May 2018

Background: Ethnic minority patients have unique challenges in accessing health services. These include language difficulties, unfamiliarity with the health system, lower rates of cancer screening and survival, higher rates of reported side effects from cancer treatment and poorer quality of life. Little is known about this patient group when transitioning to palliative care. Aim: To elicit the experiences of palliative care health professionals when providing care for patients from culturally and linguistically diverse backgrounds which differ from mainstream Australian language and culture. Design: An emergent qualitative design, informed by theoretical and procedural direction from grounded theory research. Setting/participants: Four focus groups held with palliative care staff ( n = 28) in a single specialist palliative care service in Australia. Results: The following themes emerged: (1) determining the rules of engagement around discussion of diagnosis and prognosis, (2) navigating the challenge of language to patient understanding, (3) understanding migration experiences to establish trust, (4) maintaining the balance between patient safety and comfort care, (5) providing a good death experience through accommodation of beliefs, and (6) navigating the important role of family members while privileging patient preferences. Conclusion: Underlying provider perceptions of caring for patients was that death is difficult in any language. Care was conceptualised as considering cultural and linguistic backgrounds within individualistic care. Understanding the migration experience and building trust were key elements of this individualised approach. Acknowledgement of the key role played by families in patient care and safety are strategies to minimise barriers and understand the concerns of this patient group.
Drunk decisions: Alcohol shifts choice from habitual towards goal-directed control in adolescent intermediate-risk drinkers
Authors: Obst Elisabeth , Schad Daniel J , Huys Quentin JM , Sebold Miriam , Nebe Stephan , Sommer Christian , Smolka Michael N , Zimmermann Ulrich S 
Published: May 2018

Background: Studies in humans and animals suggest a shift from goal-directed to habitual decision-making in addiction. We therefore tested whether acute alcohol administration reduces goal-directed and promotes habitual decision-making, and whether these effects are moderated by self-reported drinking problems. Methods: Fifty-three socially drinking males completed the two-step task in a randomised crossover design while receiving an intravenous infusion of ethanol (blood alcohol level=80 mg%), or placebo. To minimise potential bias by long-standing heavy drinking and subsequent neuropsychological impairment, we tested 18- to 19-year-old adolescents. Results: Alcohol administration consistently reduced habitual, model-free decisions, while its effects on goal-directed, model-based behaviour varied as a function of drinking problems measured with the Alcohol Use Disorders Identification Test. While adolescents with low risk for drinking problems (scoring <8) exhibited an alcohol-induced numerical reduction in goal-directed choices, intermediate-risk drinkers showed a shift away from habitual towards goal-directed decision-making, such that alcohol possibly even improved their performance. Conclusions: We assume that alcohol disrupted basic cognitive functions underlying habitual and goal-directed decisions in low-risk drinkers, thereby enhancing hasty choices. Further, we speculate that intermediate-risk drinkers benefited from alcohol as a negative reinforcer that reduced unpleasant emotional states, possibly displaying a novel risk factor for drinking in adolescence.
Impact of NTRK2, DRD2 and ACE polymorphisms on prolactin levels in antipsychotic-treated patients with first-episode psychosis
Authors: Gassó Patricia , Mas Sergi , Bioque Miquel , Cabrera Bibiana , Lobo Antonio , González-Pinto Ana , Díaz-Caneja Covadonga M , Corripio Iluminada , Vieta Eduard , Castro-Fornieles Josefina , Sarró Salvador , Mané Anna , Sanjuan Julio , Llerena Adrián , Lafuente Amalia , Saiz-Ruiz Jerónimo , Bernardo Miguel ,   PEPs Group
Published: May 2018

Background: Hyperprolactinemia is a common side-effect of antipsychotics (APs), which may trigger serious secondary problems and compromise the adherence to treatment which is crucial for prognosis, especially in patients presenting with a first-episode of psychosis (FEP). Aims: We evaluated, in some cases for the first time, the effect of polymorphisms in multiple candidate genes on serum prolactin (PRL) levels in an AP-treated FEP cohort recruited in the multicenter PEPs study (Phenotype − genotype and environmental interaction; Application of a predictive model in first psychotic episodes). Methods: PRL concentration was measured in serum from 222 patients. A total of 167 polymorphisms were selected in 23 genes. Genetic association analysis was performed in the whole sample and also in homogenous subgroups of patients treated with APs with a high (N = 101) or low risk (N = 95) of increasing PRL release, which showed significant differences in their PRL levels. Results: After Bonferroni correction, polymorphisms in NTRK2, DRD2 and ACE genes were associated with PRL concentration. Conclusion: Our results give more support to the impact of DRD2, but also of other genes related to dopamine availability such as ACE. Moreover, this study provides the first evidence for the involvement of NTRK2, which suggests that pathways other than the ones related to dopamine or serotonin may participate in the AP-related PRL levels.
Change in microcalcifications on mammography after neoadjuvant chemotherapy in breast cancer patients: correlation with tumor response grade and comparison with lesion extent
Authors: Yim Hyunee , Ha Taeyang , Kang Doo Kyoung , Park Seong Young , Jung Yongsik , Kim Tae Hee 
Published: May 2018

Background After neoadjuvant chemotherapy (NAC), persistent microcalcifications are often observed in spite of a decrease in the primary tumor size. Purpose To analyze the changes in microcalcifications after NAC and to evaluate the accuracy of residual microcalcifications in predicting the extent of residual cancer. Material and Methods Eighty patients who received NAC and underwent both mammography and magnetic resonance imaging (MRI) before and after the completion of NAC were included. The location of microcalcifications was classified into two types: inside the mass and outside the mass. Results The extent of the residual calcifications was larger than the pathologic residual lesion in 14 (74%) of 19 patients with complete response (CR) on MRI, but the discrepancy was <1 cm in eight (42%) patients. The median value of the discrepancy was significantly higher in patients showing CR with outside calcifications compared to CR with inside calcifications (2.0 cm vs. 0.7 cm, P = 0.008). After NAC, the decrease of calcifications was more frequently observed in cancers showing CR on MRI or Miller-Payne grade 5 and the increase of calcifications more frequently occurred in cancers showing progress disease on MRI or Miller-Payne grade 1 ( P < 0.001 and P = 0.044). Conclusion The change in microcalcifications after NAC was correlated with the tumor response to NAC. The discrepancy was highest in the group showing CR on MRI with outside calcifications. In tumors with inside calcifications, the discrepancy was relatively low within an acceptable range.
Does Anterior Cruciate Ligament Reconstruction Affect the Outcome of Osteochondral Allograft Transplantation? A Matched Cohort Study With a Mean Follow-up of 6 Years
Authors: Tírico Luís E.P. , McCauley Julie C. , Pulido Pamela A. , Bugbee William D. 
Published: May 2018

Background: Few studies have evaluated the influence of anterior cruciate ligament (ACL) reconstruction on the outcome of cartilage repair. Hypothesis/Purpose: The purpose was to investigate the association between ACL reconstruction and functional outcomes after osteochondral allograft (OCA) transplantation. The hypothesis was that patients treated with OCA transplantation who had a history of ACL reconstruction would have inferior clinical outcomes and lower osteochondral graft survivorship when compared with a matched group of patients undergoing OCA transplantation without a history of ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: This study compared 31 knees that underwent OCA transplantation with a history of ACL reconstruction (OCA and ACL group) and 62 knees treated with isolated OCA transplantation (OCA group) that had an intact ACL. Groups were matched by age, diagnosis, year of surgery, and graft size. Minimum follow-up was 2 years. Frequency and type of reoperation were assessed. Clinical failure was defined as revision OCA transplantation or conversion to arthroplasty. Subjective outcome measures included International Knee Documentation Committee scores, Knee injury and Osteoarthritis Outcome Scores, and patient satisfaction. Results: Clinical failure occurred in 3 of 31 knees (9.7%) in the OCA and ACL group and 6 of 62 knees (9.7%) in the OCA group ( P ≤ .999). Five- and 10-year survivorship of the OCA was 94.7% and 82.3% for the OCA and ACL group and 93.4% and 79.6% for OCA group, respectively ( P = .979). Mean follow-up was 6.2 ± 3.3 years among all knees with grafts in situ. Changes from preoperative to latest follow-up visit (difference scores) on all subjective outcome measures were greater in the OCA group; however, none of the difference scores were statistically significant. Satisfaction with the results of OCA transplantation was reported in 78.3% of the OCA and ACL group and 71.7% of the OCA group ( P = .551). Conclusion: Treatment of cartilage lesions with OCA transplantation proved to be reliable and effective regardless of a history of ACL reconstruction as demonstrated by the improvements in outcome scores, long survivorship, and high satisfaction rates. History of ACL reconstruction did not influence outcome of OCA transplantation.
Implementing the Integrated Strategy for the Cultural Adaptation of Evidence-Based Interventions: An Illustration
Authors: Sidani Souraya , Ibrahim Sarah , Lok Jana , Fan Lifeng , Fox Mary 
Published: May 2018

Background Persons’ cultural beliefs about a health problem can affect their perceived acceptability of evidence-based interventions, undermining evidence-based interventions’ adherence, and uptake to manage the problem. Cultural adaptation has the potential to enhance the acceptability, uptake, and adherence to evidence-based interventions. Purpose To illustrate the implementation of the first two phases of the integrated strategy for cultural adaptation by examining Chinese Canadians’ perceptions of chronic insomnia and evidence-based behavioral therapies for insomnia. Methods Chinese Canadians ( n = 14) with chronic insomnia attended a group session during which they completed established instruments measuring beliefs about sleep and insomnia, and their perceptions of factors that contribute to chronic insomnia. Participants rated the acceptability of evidence-based behavioral therapies and discussed their cultural perspectives regarding chronic insomnia and its treatment. Results Participants actively engaged in the activities planned for the first two phases of the integrated strategy and identified the most significant factor contributing to chronic insomnia and the evidence-based intervention most acceptable for their cultural group. Conclusions The protocol for implementing the two phases of the integrated strategy for cultural adaptation of evidence-based interventions was feasible, acceptable, and useful in identifying culturally relevant evidence-based interventions.
The Modified Telephone-Administered Minnesota Cognitive Acuity Screen for Mild Cognitive Impairment
Authors: Pillemer Sarah , Papandonatos George D. , Crook Cara , Ott Brian R. , Tremont Geoffrey 
Published: May 2018

Objective: This study aimed to compare the sensitivity and specificity of a modified version of the Minnesota Cognitive Acuity Screen (MCAS-m), by adding learning and recognition memory components, to the original version MCAS to distinguish amnestic mild cognitive impairment (aMCI) from healthy controls (HCs). Methods/Design: A total of 30 individuals with aMCI and 30 HCs underwent neuropsychological testing, neurologic examination, laboratory, and brain imaging tests. Once diagnosis was confirmed, participants completed the MCAS and MCAS-m in counterbalanced order. Results: The average administration time was 12.6 minutes for the MCAS and 13.5 minutes for the MCAS-m. Receiver operating characteristic curve analyses showed that the MCAS-m demonstrated 97% sensitivity and 97% specificity for distinguishing between aMCI and HC versus 97% and 87%, respectively, for the original MCAS in this sample. Conclusions: Both the MCAS and the MCAS-m were highly sensitive when distinguishing between normal cognition and aMCI; however, the MCAS-m demonstrated a 10% increase in specificity compared to the original version. Improved specificity is particularly relevant to screening in larger community samples with lower base rates of MCI than clinic populations. This modified screening measure presents a brief and cost-effective tool for identifying MCI. Given the risk of progression from aMCI to Alzheimer disease dementia (AD), the MCAS-m represents a modest improvement in telephone-administered methods for the early detection of AD.