bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early prolonged ambulatory cardiac monitoring in stroke (EPACS): an open-label randomised controlled trial
Authors: Kaura Amit , Sztriha Laszlo , Chan Fong Kum , Aeron-Thomas John , Gall Nicholas , Piechowski-Jozwiak Bartlomiej , Teo James T. 
Published: July 2019

Abstract
Background
Cardioembolism in paroxysmal atrial fibrillation (PAF) is a preventable cause of transient ischaemic attack (TIA) or ischaemic stroke; however, due to its transient nature, a short-duration Holter monitor may miss a significant proportion of events.

Methods
We conducted an open-label randomised controlled trial of cardiac monitoring after a TIA or ischaemic stroke comparing a 14-day ECG monitoring patch (Zio® Patch, iRhythm Technologies) with short-duration Holter monitoring for the detection of PAF. The primary outcome was the detection of one or more episodes of ECG-documented PAF lasting at least 30 s within 90 days in each of the study arms. A budget impact analysis from the healthcare perspective was performed.

Results
From February 2016 through February 2017, 43 (76.8%) of the 56 patients assigned to the patch-based monitoring group and 47 (78.3%) of the 60 patients assigned to short-duration Holter monitoring group had successful monitor placement with 90 days of follow-up. Of the 26 protocol failures between the two groups, 23 (88.5%) were due to patient refusal for outpatient short-duration ECG monitor placement, whilst only 1 (3.8%) was due unsuccessful ZioPatch placement. The rate of detection of PAF at 90 days was 16.3% in the patch-based monitoring group (seven patients) compared to 2.1% in the short-duration Holter monitoring group (1 patient), with an odds ratio of 8.9 (95% CI 1.1–76.0; P = 0.026). An economic model demonstrated that implementation of the Zio Patch service would result in 10.8 more strokes avoided per year compared to current practice with Holter monitoring with an associated yearly saving in direct medical costs of £113,630, increasing to £162,491 over 5 years.

Conclusions
Early, prolonged, patch-based monitoring after an index stroke or TIA is superior to short-duration Holter monitoring in the detection of PAF and likely cost-effective for preventing recurrent strokes.
Trial registrationhttp://www.isrctn.com. Unique identifier: ISRCTN 50253271. Registered 21 January 2016
Effect of lifestyle, medication and ethnicity on cardiometabolic risk in the year following the first episode of psychosis: prospective cohort study
Authors: Gaughran Fiona , Stahl Daniel , Stringer Dominic , Hopkins David , Atakan Zerrin , Greenwood Kathryn , Patel Anita , Smith Shubulade , Gardner-Sood Poonam , Lally John , Heslin Margaret , Stubbs Brendon , Bonaccorso Stefania , Kolliakou Anna , Howes Oliver , Taylor David , Forti Marta Di , David Anthony S. , Murray Robin M. , Ismail Khalida ,   the IMPACT team
Published: July 2019

BackgroundThe first episode of psychosis is a critical period in the emergence of cardiometabolic risk.AimsWe set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.MethodThis was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.ResultsRates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c(HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c>39 mmol/mol).ConclusionsUnhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.
Molecular Characterization and Clinical Outcomes of Primary Gleason Pattern 5 Prostate Cancer After Radical Prostatectomy
Authors: Isaacsson Velho Pedro , Lim David , Wang Hao , Park Jong Chul , Kaur Harsimar B. , Almutairi Fawaz , Carducci Michael A. , Denmeade Samuel R. , Markowski Mark C. , Isaacs William B. , Antonarakis Emmanuel S. , Pritchard Colin C. , Eisenberger Mario A. , Lotan Tamara L. 
Published: July 2019

Purpose Very high-risk prostate cancer (PC) is associated with poor response to local and systemic treatments; however, few cases have been molecularly profiled. We studied clinical outcomes and molecular profiles of patients with clinically localized primary Gleason pattern 5 PC. Patients and Methods Clinicopathologic features, targeted somatic and germline sequencing, and PTEN, TP53, and ERG status by immunohistochemistry were assessed in patients undergoing surgery from 2005 to 2015; 60 consecutive patients were identified with Gleason score 5 + 4 = 9 or 5 + 5 = 10 PC after radical prostatectomy with available tissue and clinical follow-up. Clinicopathologic and genomic parameters were correlated with biochemical relapse, metastasis-free survival, time to castration resistance, and overall survival using Cox proportional hazards models. Results Of patients with somatic sequencing data and clinical follow-up, 34% had DNA repair gene mutations, including 22% (11 of 49) with homologous recombination and 12% (six of 49) with mismatch repair gene alterations. Homologous recombination mutations were germline in 82% (nine of 11) of patients. In addition, 33% (16 of 49) had TP53 mutation, and 51% (29 of 57) had PTEN loss. Overall, 43% developed metastasis, with a time to castration resistance of 12 months. On multivariable analysis of clinicopathologic variables, only ductal/intraductal histology (hazard ratio, 4.43; 95% CI, 1.76 to 11.15; P = .002) and seminal vesicle invasion (hazard ratio, 5.14; 95% CI, 1.83 to 14.47; P = .002) were associated with metastasis. Among genomic alterations, only TP53 mutation and PTEN loss were associated with metastasis on univariable analysis, and neither remained significant in multivariable analyses. These data are retrospective and hypothesis generating. Conclusion Potentially actionable homologous recombination and mismatch repair alterations are observed in a significant proportion of patients with very high-risk PC at the time of radical prostatectomy. These findings could inform the design of prospective trials in this patient population.
Modelling the MYC-driven normal-to-tumour switch in breast cancer
Authors: Lourenco Corey , Kalkat Manpreet , Houlahan Kathleen E. , De Melo Jason , Longo Joseph , Done Susan J. , Boutros Paul C. , Penn Linda Z. 
Published: July 2019

ABSTRACT
The potent MYC oncoprotein is deregulated in many human cancers, including breast carcinoma, and is associated with aggressive disease. To understand the mechanisms and vulnerabilities of MYC-driven breast cancer, we have generated an in vivo model that mimics human disease in response to MYC deregulation. MCF10A cells ectopically expressing a common breast cancer mutation in the phosphoinositide 3 kinase pathway (PIK3CAH1047R) led to the development of organised acinar structures in mice. Expressing both PIK3CAH1047R and deregulated MYC led to the development of invasive ductal carcinoma. Therefore, the deregulation of MYC expression in this setting creates a MYC-dependent normal-to-tumour switch that can be measured in vivo. These MYC-driven tumours exhibit classic hallmarks of human breast cancer at both the pathological and molecular level. Moreover, tumour growth is dependent upon sustained deregulated MYC expression, further demonstrating addiction to this potent oncogene and regulator of gene transcription. We therefore provide a MYC-dependent model of breast cancer, which can be used to assay in vivo tumour signalling pathways, proliferation and transformation from normal breast acini to invasive breast carcinoma. We anticipate that this novel MYC-driven transformation model will be a useful research tool to better understand the oncogenic function of MYC and for the identification of therapeutic vulnerabilities.
An audit of electron microscopy in the diagnosis of focal segmental glomerulosclerosis: are current pathological techniques missing important abnormalities in the glomerular basement membrane?
Authors: Davis Justin , Tjipto Alwie , Hegerty Katharine , Mallett Andrew 
Published: July 2019

Background:There is an increasing appreciation that variants of the collagen IV genes may be associated with the development of focal segmental glomerulosclerosis (FSGS). On electron microscopy, such variants may produce characteristic changes within the glomerular basement membrane (GBM). These changes may be missed if glomerular lesions histologically diagnosed as FSGS on light microscopy are not subjected to electron microscopy.Methods:We conducted a retrospective cohort analysis of all patients presenting to two hospitals who received a primary histological diagnosis of FSGS to see if these samples underwent subsequent electron microscopy. Each such sample was also scrutinised for the presence of characteristic changes of an underlying collagen IV disorderResults:A total of 43 patients were identified. Of these, only 30 underwent electron microscopy. In two samples there were histological changes detected that might have suggested the underlying presence of a collagen IV disorder. Around one in three biopsy samples that had a histological diagnosis of FSGS were not subjected to electron microscopy.Conclusion:Renal biopsy samples that have a histological diagnosis of primary FSGS not subjected to subsequent electron microscopy may potentially miss ultrastructural changes in the GBM that could signify an underlying collagen IV disorder as the patient’s underlying disease process. This could potentially affect both them and their families’ investigative and management decisions given potential for implications for transplant, heritability and different disease pathogenesis. This represents a gap in care which should be reflected upon and rectified via iterative standard care and unit-level quality assurance initiatives.
Understanding the uptake of a national retinopathy screening programme: An audit of patients with diabetes in two large primary care centres
Authors: Tracey Marsha , Racine Emmy , Riordan Fiona , McHugh Sheena M. , Kearney Patricia M. 
Published: July 2019

Background: Diabetic retinopathy (DR) affects 8.2% of the Irish population with type 2 diabetes over 50 years and is one of the leading causes of blindness among working-age adults. Regular diabetic retinopathy screening (DRS) can reduce the risk of sight loss. In 2013, the new national screening programme (RetinaScreen) was introduced in Ireland. Maximising DRS uptake (consent to participate in the programme and attendance once invited) is a priority, therefore it is important to identify characteristics which determine DRS uptake among those with diabetes in Ireland. We report uptake in an Irish primary care population during the initial phase of implementation of RetinaScreen and investigate factors which predict consenting to participate in the programme. Methods: In two primary care practices, data were extracted from records of people with diabetes (type 1 and type 2) aged ≥18 years who were eligible to participate in RetinaScreen between November 2013 and August 2015. Records were checked for a RetinaScreen letter. RetinaScreen were contacted to establish the status of those without a letter on file. Multivariable Poisson regression was used to examine associations between socio-demographic variables and consenting. Adjusted incident rate ratios (IRR) with 95% CI were generated as a measure of association. Results: Of 722 people with diabetes, one fifth (n=141) were not registered with RetinaScreen. Of 582 who were registered, 63% (n=365) had participated in screening. Most people who consented subsequently attended (n=365/382, 96%). People who had attended another retinopathy screening service were less likely to consent (IRR 0.65 [95%CI 0.5-0.8]; p<0.001). Other predictors were not significantly associated with consent. Conclusions: Over one third of people eligible to participate in RetinaScreen had not consented. Research is needed to understand barriers and enablers of DRS uptake in the Irish context. Implementing strategies to improve DRS uptake (consent and attendance) should be a priority.
Health professionals' lack of knowledge of central venous access devices: the impact on patients
Authors: Kelly Linda J , Snowden Austyn , Paterson Ruth , Campbell Karen 
Published: July 2019

Background: the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope. Aim: the study objective was to uncover the global, cross-disease experience of patients with CVADs. Method: an online survey was sent to an international sample of people living with CVADs. Findings: 74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice. Conclusion: clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.
Psychosocial studies with psychoanalysis
Authors: Frosh Stephen 
Published: July 2019

Psychosocial studies is methodologically and theoretically diverse, drawing on a wide range of intellectual resources. However, psychoanalysis has often taken a privileged position within this diversity, because of its well-developed conceptual vocabulary that can be put to use to theorise the psychosocial subject. Its practices have become a model for some aspects of psychosocial work, especially in relation to its focus on intense study of individuals, its explicit engagement with ethical relations, and its traversing of disciplinary boundaries across the arts, humanities and social sciences.
This article begins with a brief description of some principles of psychosocial thinking, including its transdisciplinarity and criticality and its interest in ethics and in reflexivity. It then explores the place of psychoanalysis in this genealogy, presenting the case for psychoanalysis’ continuing contribution to the development of psychosocial studies. It is argued that this case is a strong one, but that the critique of psychoanalysis from the discursive, postcolonial, feminist and queer perspectives that are also found in psychosocial studies is important. The claim will be made that the engagement between psychoanalysis and its psychosocial critics is fundamentally productive. Even though it generates real tensions, these tensions are necessary and significant, reflecting genuine struggles over how best to understand the socially constructed human subject.
Situação do carcinoma prostático na realidade da saúde do homem em Pernambuco
Authors: Silva Aline Arruda , Mello Luciano Albuquerque , Santos Erlene Ribeiro 
Published: July 2019

No estado de Pernambuco, para o ano de 2012 estimam-se 2.310 novos casos de carcinoma prostático, ultrapassando o número de ocorrências do câncer na mama e colo do útero. A pesquisa objetivou analisar a incidência de internações por CAP nas unidades de saúde no Estado de Pernambuco durante o período de janeiro de 2008 a dezembro de 2011. Foram identificados 164 casos de internações por CAP no estado, representando uma incidência de 0,0081%. A faixa etária de maior incidência foi a de 60 a 69 anos com 36,90%. A I GERES, com sede em Recife, foi responsável por mais da metade das internações ocorridas, 58,6% dos casos. A incidência de óbitos nessa amostra foi de 7,30%. No ano de 2011 verificou-se uma diminuição no tempo de permanência nas internações acompanhada por uma baixa, também nos gastos com CAP neste ano. O aumento no número de internações transparece a elevação da morbidade por CAP pela crescente expectativa de vida da população pernambucana, além de ressaltar a, ainda deficiente, Política de Saúde do Homem com suas dificuldades na implementação dos programas de acolhimento e sensibilização sobre a prevenção do CAP, o que pode levar ao tardio diagnóstico e complicações nos sintomas, resultando em um aumento no tempo de internação e consequentemente uma diminuição na qualidade de vida da população masculina e idosa, além de onerar os custos com a doença.
Acompanhamento e crescimento das crianças maranhenses com ênfase nas ações das equipes de saúde da família
Authors: Almeida Natália Martins de , Vanderlei Maria Iêda Gomes , Cunha Carlos Leonardo Figueiredo , Gama Mônica Elinor Alves , Tonial Sueli Rosina 
Published: July 2019

A população infantil de uma localidade constitui-se um grupo de risco para os agravos de saúde e o estado de saúde da criança é reflexo das condições de vida da comunidade em que vive. Através do acompanhamento do crescimento infantil é possível identificar as crianças em maior risco de morbimortalidade, prevenindo precocemente a desnutrição e contribuindo assim para redução da taxa de mortalidade infantil. Este trabalho tem como objetivo estudar o acompanhamento do crescimento das crianças maranhenses, com destaque para as ações da equipe de Saúde da Família. Trata-se de um estudo descritivo Saúde Materno Infantil no Maranhão. Foram sorteados 30 conglomerados e foi obtida amostra representativa de 1.712 crianças. O cartão/caderneta da criança foi apresentado por 81,8% das mães/cuidadores e o percentual de crianças pesadas no último trimestre chegou a 76,8%, sendo que em 50,5% foi identificado o registro do peso. O principal responsável pela pesagem foi o agente comunitário de saúde, relatado em 53,9% dos casos. Nos 30 dias que antecederam a entrevista, 62,4% das mães/cuidadores relataram ter recebido visita no domicílio de profissionais do PSF – nessa visita referida, 66% das crianças foram pesadas.
Sistematização da Assistência de Enfermagem: o contexto histórico, o processo e obstáculos da implantação.
Authors: Dos Santos Wenysson Noleto , Santos Aline Maiane Silva dos , Lopes Teresa Raquel P. Sousa , Madeira Maria Zélia de Araújo , Rocha Francisca Cecília Viana 
Published: July 2019

Sistematização da Assistência de Enfermagem (SAE) é uma atividade privativa do Enfermeiro. No Brasil foi desenvolvido no ano de 1970 pela Enfermeira Wanda Horta. Esta pesquisa teve como objetivo Conhecer o contexto histórico, processo de implantação e obstáculos da Sistematização da Assistência de Enfermagem. Trata-se de uma pesquisa bibliográfica narrativa realizada no mês de abril de 2012, com um recorte temporal dos anos 2007-2012 pesquisados na base de dados Scielo. Utilizou-se os seguintes descritores:. Enfermagem; Processo de enfermagem, Enfermagem prática. Foram analisados 13 artigos. Emergiram três categorias: o contexto histórico do pensamento á realidade; O Processo de Sistematização Teórico-prático: Da teoria à prática; Obstáculos à Implantação da Sistematização: Utopia ou Realidade? A Sistematização da Assistência de Enfermagem é um mecanismo indispensável a enfermagem, no entanto ainda são inúmeras as dificuldades para sua implantação, pois o enfermeiro precisa ser autêntico e conquistar o seu espaço com mérito, por meio do uso do seu conhecimento científico específico, e esse instrumento de trabalho proporciona autonomia ao profissional para que este possa desenvolver um trabalho consciente, eficiente e com resultados positivos, além de melhorar a qualidade da assistência de enfermagem.
Pneumonia nosocomial: diagnósticos e intervenções de Enfermagem
Authors: Alves Julya Carolline Folle , Grando Kattyelly Cristina , Lima Leo Christyan Alves de , Pinto Jéssica Mayara Alves , Sampaio Maysa Silva , Saracini Kelmi Cristina , Souza Laurindo Pereira de 
Published: July 2019

A pneumonia é uma doença infecciosa, causada por bactérias, vírus, fungos, parasitas e outros microrganismos, sendo a maioria causada por agentes bacterianos. O objetivo da pesquisa foi buscar dados na literatura sobre o estabelecimento da pneumonia nosocomial e propor os principais os diagnósticos e intervenções de enfermagem. Trata-se de um estudo exploratório qualitativo, descritivo realizada por meio de revisão bibliográfica. Os dados foram coletados em [i]revistas e periódicos disponíveis na internet, por meio da busca em base de dados: LILACS(Literatura Latino Americano e do Caribe em Ciências da Saúde), SciELO(Scientific Eletronic Library On-line) e BDENF(Banco de Dados em Enfermagem). O período abordado de revisão e seleção dos artigos foi de 2004 a 2014. As pneumonias nosocomiais, são definidas como uma infecção pulmonar adquirida durante a estadia no hospital que ocorrem 48 horas após a internação hospitalar. O diagnóstico de Enfermagem constitui a base para a seleção das intervenções de enfermagem para o alcance dos resultados dos quais o enfermeiro é responsável. Conclui-se que o enfermeiro tem um papel fundamental, frente a um paciente com pneumonia sistematizando as ações de enfermagem.
Práticas integrativas e complementares e racionalidades médicas no SUS e na atenção primária à saúde: possibilidades estratégicas de expansão
Authors: Tesser Charles Dalcanale 
Published: July 2019

Discutimos a expansão das práticas integrativas e complementares (PIC) no Sistema Único de Saúde (SUS), objetivando contribuir para o desenvolvimento de diretrizes gerais orientadoras dos profissionais e gestores. Após a edição da Política Nacional de PIC (PNPIC), cuja única diretriz concreta de implantação é a ênfase na atenção primária à saúde (APS), a inserção dessas práticas tem sido errática. Os municípios (e às vezes serviços) têm sua experiência própria, sem apoio técnico ou financeiro e sem orientação institucional. Discutimos os principais modos dessa inserção na APS e em outros serviços do SUS. Nossa argumentação discute possibilidades estratégicas de expansão das PIC derivadas dessas experiências. Argumentamos pelo reconhecimento da APS como lócus privilegiado de inserção das PIC. Concluímos que a inserção das PIC no SUS deve privilegiar enfaticamente a APS através de seus profissionais generalistas. Para isso há que desenvolver estratégias de educação permanente e de formação que as tirem da situação de marginalidade. Por outro lado, há que incentivar também sua presença em serviços especializados, sobretudo as racionalidades médicas vitalistas, cuja profundidade e complexidade sugerem o desenvolvimento de centros de expertise nas instituições formadoras e no SUS, atuando com matriciamento de equipes de APS, para que contribuam com cuidado especializado aos usuários e educação permanente dos profissionais da APS.