bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Illness Perceptions to Cluster Chronic Pain Patients
Authors: Frostholm Lisbeth , Hornemann Christina , Ørnbøl Eva , Fink Per , Mehlsen Mimi 
Published: May 2018

Objectives:
The aims of our study were (1) to identify possible subgroups of individuals with chronic pain based on their illness perceptions (IPs); (2) to examine whether these subgroups differed in health status and health expenditure; and (3) to examine whether the subgroups differed in their response to participation in a lay-led Chronic Pain Self-Management Program (CPSMP).

Materials and Methods:
Four hundred twenty-four participants in a randomized controlled trial on the CPSMP completed a questionnaire on their perceptions of their chronic pain condition at baseline. In addition, they completed a range of health status measures at baseline and 3 months after end of participation in the CPSMP. Health care expenditure was obtained from Danish health registers. We performed cluster analyses to identify possible subgroups based on the participants’ perceptions of their chronic pain condition.

Results:
Cluster analysis of IPs resulted in 3 meaningful clusters, classified as “distressed, certain cause,” “distressed, uncertain cause,” and “nondistressed, certain cause,” respectively. The 2 distressed groups had significantly higher scores on pain catastrophizing, illness worry, and emotional distress than did the nondistressed. Moderator analyses showed, that the “distressed, certain cause” had significant positive effect of participating in the CPSMP on pain catastrophizing and emotional distress, whereas the “distressed, uncertain cause” had a decrease and the “nondistressed, certain cause” an increase in primary health expenditure.

Discussion:
Clusters based on IPs meaningfully distinguished individuals with chronic pain on health measures and outcome of participating in the CPSMP, and may prove useful in future studies to understand responses to treatment.
Fathers' Stress in a Neonatal Intensive Care Unit
Authors: Noergaard Betty , Ammentorp Jette , Garne Ester , Fenger-Gron Jesper , Kofoed Poul-Erik 
Published: May 2018

Background:
Healthcare professionals in neonatal intensive care units (NICUs) tend to focus attention on the mothers and the newborn infants. Thus, fathers may find it difficult to establish an optimal father–child relationship and their stress may increase and persist during hospitalization.

Purpose:
To investigate the impact of a more father-friendly NICU on paternal stress and their participation in childcare.

Methods:
A quasiexperimental design was conducted on Danish-speaking fathers of newborn infants 28 or more weeks' gestational age. The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) was used to measure paternal perceptions of stressors. Paternal participation in childcare was measured using 7 additional items. The questionnaires were distributed on admission to the NICU, at the 14th day of hospitalization, and at the time of discharge. The primary outcome was the difference in the PSS:NICU overall stress score on admission to the NICU and at the time of discharge in the control group compared with the intervention group.

Results:
A total of 109 fathers were included. The overall PSS:NICU stress score increased after the intervention. Paternal involvement, staff expectations, and the social expectation to fulfill the traditional role of a breadwinner and additionally of a caregiver may have caused increased stress.

Implications for Practice:
Healthcare professionals must be aware of the father's need to be an equal coparent. Nurses, as key persons, should motivate and expect fathers to be involved, and support them to establish a father–child relationship, although they might become more stressed.

Implications for Research:
More adequate outcome measures are needed to determine the effect of interventions on paternal stress.
Evidence Regarding the Use of Bubble Continuous Positive Airway Pressure in the Extremely Low Birth-Weight Infant
Authors: Alessi Samantha 
Published: May 2018

Background:
Gentle ventilation with optimal oxygenation is integral to prevention of chronic lung disease in the extremely low birth-weight (ELBW) infant. Various types of noninvasive ventilation are used in neonatal intensive care units worldwide. Bubble continuous positive airway pressure (BCPAP) has been in use in newborn intensive care since 1975.

Purpose:
To synthesize the current evidence on the use of BCPAP in the ELBW infant and its relationship to outcomes, particularly morbidity and mortality.

Methods/Search Strategies:
A literature review was completed using PubMed, EMBASE, CINAHL, and Cochrane with a focus on BCPAP use in the ELBW population.

Findings/Results:
No study found was exclusive to the ELBW population. All studies ranged from ELBW to full-term neonates. Studies supported the use of BCPAP in the ELBW, demonstrating decreased incidence of chronic lung disease and barotrauma through the use of oscillation and permissive hypercapnia.

Implications for Practice:
Literature supports the use of nasal bubble CPAP in the ELBW population. Barriers such as septal erosion, pneumothorax, inconsistent pressures, and air in the abdomen were identified and management recommendations were provided.

Implications for Research:
Studies are needed comparing outcomes of nasal bubble CPAP use with other forms of CPAP in the ELBW infant, comparison of prongs to mask for nasal bubble CPAP, and comparing interventions to recommend optimal care bundles to prevent nasal septum injuries.
Effects of the Affordable Care Act on Young Women With Gynecologic Cancers
Authors: Smith Anna Jo Bodurtha , Fader Amanda N. 
Published: May 2018

OBJECTIVE:
To evaluate the effects of the dependent coverage mandate of the 2010 Affordable Care Act (ACA) on insurance status, stage at diagnosis, and receipt of fertility-sparing treatment among young women with gynecologic cancer.

METHODS:
We used a difference-in-differences design to assess insurance status, stage at diagnosis (stage I–II vs III–IV), and receipt of fertility-spearing treatment before and after the 2010 ACA among young women aged 21–26 years vs women aged 27–35 years. We used the National Cancer Database with the 2004–2009 surveys as the pre-ACA years and the 2011–2014 surveys as the post-ACA years. Women with uterine, cervical, ovarian, vulvar, or vaginal cancer were included. We analyzed outcomes for women overall and by cancer and insurance type, adjusting for race, nonrural area, and area-level household income and education level.

RESULTS:
A total of 1,912 gynecologic cancer cases pre-ACA and 2,059 post-ACA were identified for women aged 21–26 years vs 9,782 cases pre-ACA and 10,456 post-ACA for women aged 27–35 years. The ACA was associated with increased insurance (difference in differences 2.2%, 95% CI −4.0 to 0.1, P=.04) for young women aged 21–26 years vs women aged 27–35 years and with a significant improvement in early stage at cancer diagnosis (difference in differences 3.6%, 95% CI 0.4–6.9, P=.03) for women aged 21–26 years. Receipt of fertility-sparing treatment increased for women in both age groups post-ACA (P for trend=.004 for women aged 21–26 years and .001 for women aged 27–35 years); there was no significant difference in differences between age groups. Privately insured women were more likely to be diagnosed at an early stage and receive fertility-sparing treatment than publicly insured or uninsured women throughout the study period (P<.001).

CONCLUSIONS:
Under the ACA's dependent coverage mandate, young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.
Trends in Place of Death Among Patients With Gynecologic Cancer in the United States
Authors: Hicks-Courant Katherine , Melamed Alexander , Worley Michael J. , Kim Young Bae , Schorge John O. , Rauh-Hain J. Alejandro 
Published: May 2018

OBJECTIVE:
To describe the change over time in place of death (hospital, home, hospice) among all women in the United States who died of gynecologic malignancies and compare them with other leading causes of female cancer deaths.

METHODS:
This is a retrospective cross-sectional study using national death certificate data from the Mortality Multiple Cause-of-Death Public Use Record Data. All women who died from gynecologic, breast, lung, and colorectal cancers were identified according to International Classification of Diseases, 10th Revision, cause of death from 2003 to 2015. Regression analyses with ordinary least-squares linear probability modeling were used to test for differences in location of death over time, and differences in trends by cancer type, while controlling for age, race, ethnicity, marital status, and education status.

RESULTS:
From 2003 to 2015, 2,133,056 women died from gynecologic, lung, breast, and colorectal malignancies in the United States. A total of 359,340 died from gynecologic malignancies, including ovarian cancer (n=188,366 [52.4%]), uterine cancer (n=106,454 [29.6%]), cervical cancer (n=52,320 [14.6%]), and vulvar cancer (n=12,200 [3.4%]). Overall, 49.2% (n=176,657) of gynecologic cancer deaths occurred at home or in hospice. The relative increase from 2003 to 2015 in the rate of deaths at home or in hospice was 47.2% for gynecologic cancer deaths (40.5% in 2003 to 59.5% in 2015). In adjusted analyses, the trend in the percentage of deaths at home or in hospice increased at a rate of 1.6 percentage points per year for gynecologic cancer deaths (95% CI 1.5–1.6) vs 1.5 (95% CI 1.4–1.5, P<.001), 1.4 (95% CI 1.4–1.5, P<.001), and 1.5 (95% CI 1.4–1.5, P=.09) percentage points per year for lung, breast, and colorectal cancer deaths, respectively.

CONCLUSION:
Between 2003 and 2015, there was a 47.2% increase (40.5–59.5%) in the rates of gynecologic cancer deaths occurring at home or in hospice. This trend may represent an increase in advance care planning and value-based treatment decisions.
Niacin and Selenium Attenuate Brain Injury After Cardiac Arrest in Rats by Up-Regulating DJ-1-Akt Signaling
Authors: Kwon Woon Yong , Suh Gil Joon , Kim Kyung Su , Jung Yoon Sun , Kim Sung Hee , Lee A Rum , You Kyoung Min , Park Min Ji 
Published: May 2018

Objectives:To determine neuroprotective effects and mechanism of the combination therapy of niacin and selenium in cardiac arrest rats.Design:Prospective laboratory study.Setting:University laboratory.Subjects:Rat cortex neurons and male Sprague-Dawley rats (n= 68).Interventions:In rat cortex neurons underwent 90 minutes of oxygen-glucose deprivation and 22.5 hours of reoxygenation, effects of the combination therapy of niacin (0.9 mM) and selenium (1.5 μM) were investigated. The role of DJ-1 was determined using DJ-1 knockdown cells. In cardiac arrest rats, posttreatment effects of the combination therapy of niacin (360 mg/kg) and selenium (60 μg/kg) were evaluated.Measurements and Main Results:In oxygen-glucose deprivation and 22.5 hours of reoxygenation cells, combination therapy synergistically activated the glutathione redox cycle by a niacin-induced increase in glutathione reductase and a selenium-induced increase in glutathione peroxidase activities and reduced hydrogen peroxide level. It increased phosphorylated Akt and intranuclear Nuclear factor erythroid 2–related factor 2 expression and attenuated neuronal injury. However, these benefits were negated by DJ-1 knockdown. In cardiac arrest rats, combination therapy increased DJ-1, phosphorylated Akt, and intranuclear nuclear factor erythroid 2–related factor 2 expression, suppressed caspase 3 cleavage, and attenuated histologic injury in the brain tissues. It also improved the 7-day Neurologic Deficit Scales from 71.5 (66.0–74.0) to 77.0 (74.–80.0) (p= 0.02).Conclusions:The combination therapy of clinically relevant doses of niacin and selenium attenuated brain injury and improved neurologic outcome in cardiac arrest rats. Its benefits were associated with reactive oxygen species reduction and subsequent DJ-1-Akt signaling up-regulation.
Adjunct Ketamine Use in the Management of Severe Ethanol Withdrawal
Authors: Pizon Anthony F. , Lynch Michael J. , Benedict Neal J. , Yanta Joseph H. , Frisch Adam , Menke Nathan B. , Swartzentruber Greg S. , King Andrew M. , Abesamis Michael G. , Kane-Gill Sandra L. 
Published: May 2018

Objectives:
Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal.

Design:
Retrospective observational cohort study.

Setting:
Academic tertiary care hospital.

Patients:
Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria.

Interventions:
Pre and post guideline, all patients were treated in a symptom-triggered fashion with benzodiazepines and/or phenobarbital. Postguideline, standard symptom-triggered dosing continued as preguideline, plus, the patient was initiated on an IV ketamine infusion at 0.15–0.3 mg/kg/hr continuously until delirium resolved. Based upon withdrawal severity and degree of agitation, a ketamine bolus (0.3 mg/kg) was provided prior to continuous infusion in some patients.

Measurements and Main Results:
A total of 63 patients were included (29 preguideline; 34 postguideline). Patients treated with ketamine were less likely to be intubated (odds ratio, 0.14; p < 0.01; 95% CI, 0.04–0.49) and had a decreased ICU stay by 2.83 days (95% CI, –5.58 to –0.089; p = 0.043). For ICU days outcome, correlation coefficients were significant for alcohol level and total benzodiazepine dosing. For hospital days outcome, correlation coefficients were significant for patient age, aspartate aminotransferase, and alanine aminotransferase level. Regression revealed the use of ketamine was associated with a nonsignificant decrease in hospital stay by 3.66 days (95% CI, –8.40 to 1.08; p = 0.13).

Conclusions:
Mechanistically, adjunctive therapy with ketamine may attenuate the demonstrated neuroexcitatory contribution of N-methyl-d-aspartate receptor stimulation in severe ethanol withdrawal, reduce the need for excessive gamma-aminobutyric acid agonist mediated–sedation, and limit associated morbidity. A ketamine infusion in patients with delirium tremens was associated with reduced gamma-aminobutyric acid agonist requirements, shorter ICU length of stay, lower likelihood of intubation, and a trend toward a shorter hospitalization.
Value of Collaboration With Standardized Patients and Patient Facilitators in Enhancing Reflection During the Process of Building a Simulation
Authors: Stanley Claire , Lindsay Sally , Parker Kathryn , Kawamura Anne , Samad Zubairi Mohammad 
Published: May 2018

Introduction:
We previously reported that experienced clinicians find the process of collectively building and participating in simulations provide (1) a unique reflective opportunity; (2) a venue to identify different perspectives through discussion and action in a group; and (3) a safe environment for learning. No studies have assessed the value of collaborating with standardized patients (SPs) and patient facilitators (PFs) in the process. In this work, we describe this collaboration in building a simulation and the key elements that facilitate reflection.

Methods:
Three simulation scenarios surrounding communication were built by teams of clinicians, a PF, and SPs. Six build sessions were audio recorded, transcribed, and thematically analyzed through an iterative process to (1) describe the steps of building a simulation scenario and (2) identify the key elements involved in the collaboration.

Results:
The five main steps to build a simulation scenario were (1) storytelling and reflection; (2) defining objectives and brainstorming ideas; (3) building a stem and creating a template; (4) refining the scenario with feedback from SPs; and (5) mock run-throughs with follow-up discussion. During these steps, the PF shared personal insights, challenging participants to reflect deeper to better understand and consider the patient's perspective. The SPs provided unique outside perspective to the group. In addition, the interaction between the SPs and the PF helped refine character roles.

Discussion:
A collaborative approach incorporating feedback from PFs and SPs to create a simulation scenario is a valuable method to enhance reflective practice for clinicians.
Quality of Life Perception, Cognitive Function, and Psychological Status in a Real-world Population of Glioblastoma Patients Treated With Radiotherapy and Temozolomide
Authors: Lombardi Giuseppe , Bergo Eleonora , Del Bianco Paola , Bellu Luisa , Pambuku Ardi , Caccese Mario , Trentin Leonardo , Zagonel Vittorina 
Published: May 2018

Background:
Health-related quality of life (HRQoL), cognitive function, and psychological status represent an important focus during the treatment of glioblastoma patients. Nevertheless, few randomized, prospective clinical trials have analyzed these factors, and very little is known in the real-clinical world. We evaluated these characteristics in glioblastoma patients treated with standard first-line therapy outside clinical trials.

Patients and Methods:
In total, 111 newly, histologically diagnosed glioblastoma patients treated at our oncology center with radiotherapy and temozolomide were prospectively enrolled. No patient was enrolled in an experimental clinical trial. We assessed HRQoL, cognitive function, and psychological status before starting treatment, at the end of radiotherapy, and every 3 months until 9 months after the end of radiotherapy using EORTC QLQ-C30, BN20, MMSE, and HADS questionnaires.

Results:
Global health status, physical, cognitive, and social functioning remained unchanged throughout the study period. A statistically significant change was found in emotional functioning as well as a clinically meaningful amelioration in role functioning between the baseline assessment and 9 months after radiotherapy. Patients older than 65 years reported greater impairment on the bladder control scale than younger patients. When considering tumor location, global health status, communication deficit, and drowsiness, scores were significantly different between the right and left hemispheres. Female patients had a clinically relevant lower score for physical functioning at baseline and 3 months after radiation therapy. Female patients also had a clinically relevant lower depression score at 9 months after radiation therapy.

Conclusions:
In routine neurooncology practice, HRQoL, cognitive function, and psychological status did not worsen during first-line treatment in glioblastoma patients receiving standard radiotherapy and temozolomide treatment. However, some patient subgroups, such as elderly and female patients, may have different experiences with treatment, and further investigation is required.
Primary Subcutaneous Synovial Sarcoma: First Reported Subcutaneous Case Showing TLE1 Immunoreactivity
Authors: Alegría-Landa Victoria , Nájera Laura , Massa Dolores Suárez , Roustan Gastón , Río María del , Kutzner Heinz , Requena Luis 
Published: May 2018

Abstract:
Synovial sarcoma (SS) accounts for 5%–10% of all soft tissue sarcomas. It is a well-defined soft tissue neoplasm with biphasic and monophasic histologic subtypes and unknown histogenesis. It usually occurs in the extremities, especially the thigh-knee region of young adults. Recurrences are frequent and distant metastasis developed in approximately half of the patients. SSs are characterized by a recurrent nonrandom chromosomal translocation, t(X; 18) (p11; q11), which is considered the primary genetic event in more than 90% of cases. Only 4 cases of cutaneous and subcutaneous SSs have been published in the literature so far. We report a case of primary subcutaneous SS in the forearm of a young woman and discuss the histopathologic differential diagnosis with other similar neoplasms. This is the first reported case of primary cutaneous SS showing immunoreactivity for TLE1 in the nuclei of neoplastic cells, supporting the use of this marker for diagnosis of this rare cutaneous neoplasm.
Mass Spectrometry for Research and Application in Therapeutic Drug Monitoring or Clinical and Forensic Toxicology
Authors: Maurer Hans H. 
Published: May 2018

Abstract:This article reviews current applications of various hyphenated low- and high-resolution mass spectrometry techniques in the field of therapeutic drug monitoring and clinical/forensic toxicology in both research and practice. They cover gas chromatography, liquid chromatography, matrix-assisted laser desorption ionization, or paper spray ionization coupled to quadrupole, ion trap, time-of-flight, or Orbitrap mass analyzers.
Large-Scale Variability of Inpatient Tacrolimus Therapeutic Drug Monitoring at an Academic Transplant Center: A Retrospective Study
Authors: Strohbehn Garth W. , Pan Warren W. , Petrilli Christopher M. , Heidemann Lauren , Larson Sophia , Aaronson Keith D. , Johnson Matt , Ellies Tammy , Heung Michael 
Published: May 2018

Background:
Inpatient tacrolimus therapeutic drug monitoring (TDM) lacks standardized guidelines. In this study, the authors analyzed variability in the preanalytical phase of the inpatient tacrolimus TDM process at their institution.

Methods:
Patients receiving tacrolimus (twice-daily formulation) and tacrolimus laboratory analysis were included in the study. Times of tacrolimus administration and laboratory study collection were extracted, and time distribution plots for each step in the inpatient TDM process were generated.

Results:
Trough levels were drawn appropriately in 25.9% of the cases. Timing between doses was consistent, with 91.9% of the following dose administrations occurring 12 ± 2 hours after the previous dose. Only 38.1% of the drug administrations occurred within 1 hour of laboratory study collection. Tacrolimus-related patient safety events were reported at a rate of 1.9 events per month while incorrect timing of TDM sample collection occurred approximately 200 times per month. Root cause analysis identified a TDM process marked by a lack of communication and coordination of drug administration and TDM sample collection. Extrapolating findings nationwide, we estimate $22 million in laboratory costs wasted annually.

Conclusions:
Based on this large single-center study, the authors concluded that the inpatient TDM process is prone to timing errors, thus is financially wasteful, and at its worst harmful to patients due to clinical decisions being made on the basis of unreliable data. Further work is needed on systems solutions to better align the laboratory study collection and drug administration processes.
CRISPR GENOME SURGERY IN THE RETINA IN LIGHT OF OFF-TARGETING
Authors: Cho Galaxy Y. , Schaefer Kellie A. , Bassuk Alexander G. , Tsang Stephen H. , Mahajan Vinit B. 
Published: May 2018

Purpose:
Recent concerns regarding the clinical utilization of clustered regularly interspaced short palindromic repeats (CRISPR) involve uncertainties about the potential detrimental effects that many arise due to unintended genetic changes, as in off-target mutagenesis, during CRISPR genome surgery. This review gives an overview of off-targeting detection methods and CRISPR's place in the clinical setting, specifically in the field of ophthalmology.

Results:
As CRISPR utilization in the laboratory setting has increased, knowledge regarding CRISPR mechanisms including its off-target effects has also increased. Although a perfect method for achieving 100% specificity is yet to be determined, the past few years have seen many developments in off-targeting detection and in increasing efficacy of CRISPR tools.

Conclusion:
The CRISPR system has high potential to be an invaluable therapeutic tool as it has the ability to modify and repair pathogenic retinal lesions. Although it is not yet a perfect system, with further efforts to improve its specificity and efficacy along with careful screening of off-target mutations, CRISPR-mediated genome surgery potential can become maximized and applied to patients.