bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transoral Sialolitectomy as an Alternative to Submaxilectomy in the Treatment of Submaxillary Sialolithiasis
Authors: Saga-Gutierrez Carlos , Chiesa-Estomba Carlos Miguel , Larruscain Ekhiñe , González-García José Ángel , Sistiaga Jon Alexander , Altuna Xabier 
Published: April 2019

Introduction: Sialolithiasis is the most common pathology in the submaxillary gland. The introduction of minimally invasive techniques isolated or associated with sialoendoscopy is replacing glandular resection as a treatment. The conservation of the gland is justified by the recovery of function and a low recurrence rate. The rate of complications is lower in conservative techniques than in submandibular gland resection. Patients and Methods: Thirty-three patients with fixed stones in the hilum of the submaxillary gland were treated by transoral sialolitectomy between July 2015 and July 2018, demographic data of the patients such as the number of stones, size, time of hospital stay, complications, pre- and postoperative lingual nerve function, and lithiasis recurrence were collected. Results: The average volume of the stones was 1.02 cm. Complete removal of the stone was possible in 32 patients. All the patients were operated in the outpatient clinic. Seven (21%) patients reported some degree of alteration of the lingual nerve function, of which the only one presented a persistence of more than 4 weeks due to an inadvertent injury that required a microsurgical anastomosis. Conclusions: Transoral sialolitectomy is a reproducible technique with good results and lower complication rates than submandibular gland resection. Our results in the first 33 cases encourage us to maintain the combined techniques as standard in the treatment of submaxillary sialolithiasis. Current experience guides the definitive substitution of submandibular gland resection by conservative techniques in obstructive pathology.
Intranasal Azelastine and Fluticasone as Combination Therapy for Allergic Rhinitis: Systematic Review and Meta‐analysis
Authors: Debbaneh Peter M. , Bareiss Anna K. , Wise Sarah K. , McCoul Edward D. 
Published: April 2019

ObjectiveCombination therapy with intranasal azelastine and fluticasone propionate is an option for treatment of allergic rhinitis. This systematic review and meta‐analysis examines existing literature to determine efficacy in treating allergic rhinitis compared to monotherapy.Data SourcesThe PubMed, EMBASE, Cochrane, and MEDLINE databases were systematically searched for randomized controlled trials using AzeFlu nasal spray.Review MethodsRandomized, controlled trials that reported symptom relief of allergic rhinitis in males and females of all ages were included. Results were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) standard.ResultsSystematic review identified 8 articles suitable for review. The risk of bias was generally low. All studies exhibited a greater decrease in patient‐reported symptom scores in patients treated with combination therapy compared to monotherapy or placebo. Meta‐analysis revealed superiority of combination therapy in reducing Total Nasal Symptom Score compared to placebo (mean change from baseline: −2.41; 95% confidence interval [CI], −2.82 to −1.99; P <. 001; I
2 = 60%), azelastine (mean change from baseline: −1.40; 95% CI, −1.82 to −0.98; P <. 001; I
2 = 0%), and fluticasone (mean change from baseline: −0.74; 95% CI, −1.17 to −0.31; P <. 001; I
2 = 12%).ConclusionCurrent evidence supports both efficacy and superiority of combination intranasal azelastine and fluticasone in reducing patient‐reported symptom scores in patients with allergic rhinitis. Combination nasal spray should be considered as second‐line therapy in patients with allergic rhinitis that is not controlled with monotherapy.
Multimodal Analgesia Protocol after Head and Neck Surgery: Effect on Opioid Use and Pain Control
Authors: Du Eugenie , Farzal Zainab , Stephenson Elizabeth , Tanner April , Adams Katherine , Farquhar Douglas , Weissler Mark , Patel Samip , Blumberg Jeffrey , Jowza Maryam , Hackman Trevor , Zanation Adam 
Published: April 2019

ObjectiveTo assess the effect that implementation of a multimodal analgesic plan has on opioid requirements and pain control in head and neck (H&N) surgery patients.Study DesignProspective cohort.SettingTertiary academic hospital.Subjects and MethodsAn institutional review board (IRB)–approved quality improvement initiative was undertaken to implement a multimodal analgesic protocol for all admitted H&N surgery patients starting November 2017. Postprotocol data from January to May 2018 were compared to preprotocol data from May to October 2017. Data were obtained from the electronic health records as well as through preoperative and postoperative surveys. Average pain scores and opioid use in morphine milligram equivalents (MMEs) before and after protocol implementation were compared.ResultsIn total, 139 postprotocol patients were compared to 89 preprotocol patients. The adjusted MMEs in the first 24 hours after surgery decreased significantly from 93.7 mg to 58.6 mg (P =. 026) with protocol implementation. When averaged over the length of stay (MME/hospital day), the change was no longer statistically significant (57.9 vs 46.8 mg, P =. 211). The average pain score immediately after surgery and on day of discharge did not change with protocol implementation.ConclusionImplementation of a multimodal analgesia plan reduced opioid use immediately after surgery but not over the course of hospitalization without any change in reported pain scores. This study shows that multimodal opioid‐sparing analgesia after H&N surgery is feasible. Future studies are needed further refine the optimal analgesic strategy for H&N patients and assess the long‐term efficacy, safety, and cost of such regimens.
PART II: Ethics, Environment, and Migration: Immigration and the Ethics of Choice
Authors: Sullivan Teresa A. 
Published: April 2019

This paper begins by developing a language for ethical discourse on immigration and then examining the extent to which choices may be made at the micro-level and at the macro-level. States and individuals are examined as actors who are variously described as making choices or being choiceless. The concepts of cultural distance, reciprocity, the role of the individual and of the state and their interrelationships are evaluated in the perspective of choice. Whether an ethics of immigration can be successfully developed hinges on the degree of choice that individuals and states have or perceive themselves to have. How sad and fraught with trouble is the state of those who yearly emigrate in bodies to America for the means of living…. It is, indeed, piteous that so many unhappy sons of Italy, driven by want to seek another land, should encounter ills greater than those from which they would fly…. When they reach the lands for which they are destined, ignorant as they are of the language and the place, and hired out for daily labor, they fall into the hands of the dishonest, and even into the snares of those powerful men to whom they enslave themselves. (Pope Leo XIII, 1888) You shall not oppress an alien. You well know how it feels to be an alien since you were once aliens yourselves in the land of Egypt. (Ex 23:9)
What Determines the Quality of Life of Terminally Ill Cancer Patients from Their Own Perspective?
Authors: Cohen S. Robin , Leis Anne 
Published: April 2019

Background Although several instruments have been developed to measure the quality of life (QOL) of palliative care patients, a rigorous research study has not specifically asked patients themselves what is important to their QOL. It is, therefore, not clear whether these instruments measure what is most important to these patients’ QOL. Purpose To understand the primary determinants of the QOL of palliative care patients with cancer. Method The study used a qualitative paradigm. Participants were interviewed concerning what was important to their QOL. A systematic content analysis of the transcripts was carried out by all the investigators. Results Five broad domains were found to be important determinants of patient QOL: (1) the patient's own state, including physical and cognitive functioning, psychological state, and physical condition; (2) quality of palliative care; (3) physical environment; (4) relationships; and (5) outlook. Conclusions Existing instruments cover many of these domains, but no single instrument includes all of the relevant content. The McGill Quality of Life Questionnaire, which we developed previously, has been revised based on these data.
No Time for Dying: A Study of the Care of Dying Patients in Two Acute Care Australian Hospitals
Authors: Pincombe Jan , Brown Margaret , Mccutcheon Helen 
Published: April 2019

Objectives Research was conducted in two teaching hospitals in Australia to collect data on the care of patients dying in the acute care setting. Methodology Non-participant observation of the care of dying patients in medical wards was the primary method of data collection and selected staff were interviewed. Observers collected data on the type of care, who gave the care, and the time given to care. Thematic analysis was applied to both the observational and interview data. Participants Patients selected were over the age of 18 years, with a terminal diagnosis and an estimated six days to live. Results Three major factors emerged from the data to form the context in which patients were cared for and died: 1) the organizational factor, 2) the environmental factor, and 3) the human factor. The presence or absence of family members influenced the amount of care given. If family members were not present, dying could be an isolating experience, with minimal care focused on routine hospital activities. Conclusion This research indicated that the principles of palliative care are yet to be incorporated in the acute care hospital setting.
The Pattern of Gabapentin Use in a Tertiary Palliative Care Unit
Authors: Oneschuk Doreen , Al-Shahri M.Z. 
Published: April 2019

Background Little is known about current practice in using the anticonvulsant gabapentin in the management of cancer-related neuropathic pain. Objectives The main objective of this study was to describe the pattern of gabapentin use as an adjuvant analgesic for cancer-related neuropathic pain in patients admitted to a tertiary palliative care unit. Methods A retrospective medical chart review for 150 patients admitted to a tertiary palliative care unit over a period of 10 months. Abstracted data included patient characteristics, primary diagnoses, pain scores, and the type and dose of opioids and other adjuvants used. Results Of the 147 patients with a cancer diagnosis, 45 (31%) had neuropathic pain. Of those, 22 (49%) received gabapentin. The final daily dose of gabapentin ranged from 100 mg-3,000 mg (mean: 941 mg ±665 mg; median: 900 mg). Gabapentin was discontinued in 10 patients (46%). Suggested adverse effects included sedation (n=4), dizziness (n=1), and bitter taste (n=1). The change in pain scores was not significantly different in those who continued on gabapentin compared to those who discontinued it. Conclusions The retrospective nature of the study and the small sample size render solid conclusions difficult to make. However, gabapentin was discontinued in approximately half the patients who received it, and often when only modest doses were used. Similar studies from other centres may improve understanding of current practices and aid in designing future clinical trials on the subject.
Determinants of Congruence between the Preferred and Actual Place of Death for Terminally Ill Cancer Patients
Authors: Tang Siew Tzuh , Mccorkle Ruth 
Published: April 2019

A prospective cohort study was conducted to explore the extent of congruence and to identify the determinants of congruence between the preferred and actual place of death of terminally ill cancer patients. A total of 180 terminally ill cancer patients were enrolled (87% response rate) and 127 died during the one-year study period. Nearly 90% of the subjects preferred to die at home. One-third achieved their preference for place of death. The kappa value of congruence (κ=0.11, 95% confidence interval=0.05–0.17) indicated poor to slight agreement between the preferred and actual place death. Important determinants of congruence between the preferred and actual place of death for terminally ill cancer patients included rehospitalisation and receiving hospice home care during the final days of life, perceived ability for family to help achieve preferred place of death, and residence in New Haven County. Conclusions This study directly confirms that the degree of congruence between the preferred and actual place death is unsatisfactory. Clinical interventions and health policies need to be developed to assist terminally ill cancer patients who may not be able to achieve their preference for place of end-of-life care and death.
Factors Associated with Palliative Care Knowledge among Internal Medicine House Staff
Authors: Clark Jeanne M. , Lurie Jon D. , Claessens Michael T. , Reed Virginia A. , Jernstedt G. Christian , Goodlin Sarah G. 
Published: April 2019

Purpose To assess knowledge and associated factors in palliative care. Methods Self-administered survey of 88 internal medicine house officers in 1996. Results Twenty-one interns and 36 residents completed the survey for a response rate of 65%. Most house officers reported 1–5 hours of prior formal training in palliative care, 1–5 hours in pain management, and 6–20 hours in ethics. The mean knowledge score was 75% correct (SD=8); pain management scores were lowest (70%). Overall, interns had a significantly lower mean score than residents (70% vs. 77%; p=0.001). In multivariate analysis, only the year of residency was significantly associated with knowledge score; prior formal training in palliative care, pain management, or ethics was not. One third of house officers rated themselves as “not at all” or “only slightly” at ease in caring for a dying patient. These self-ratings were not associated with prior training or knowledge, but were higher in residents compared to interns. Conclusions Palliative care knowledge and ease with dying patients were higher in later years of residency but were not associated with prior formal palliative care training. These data highlight the continued need to evaluate and improve training in palliative care and pain management.
Compliance with and Understanding of Advance Directives among Trainee Doctors in the United Kingdom
Authors: Toller Claire A. Stark , Budge Marc M. 
Published: April 2019

Aim To investigate doctors’ response to and understanding of the legal status of advance directives. Methods A vignette-based study administered at palliative medicine, oncology, general practice, and geriatric medicine specialist registrar meetings (United Kingdom). Respondents determined the treatment to provide for a Patient presenting with a myocardial infarction with or without an advance directive requesting maximum therapy. Results Response rate 77% (43/56). Twenty-five percent (10/40) of respondents increased the care that they would provide in response to the advance directive (p=0.004); 77% (33/43) support /strongly support use of advance directives; 51% (22/43) did not know the legal status of advance directives; 44% found that their medical school education was not an important influence on their decision making. Conclusions Advance directives requesting treatment can increase the level of care provided by the physician, however, most trainees chose a level of care different from that in the advance directive. Confusion exists among doctors about the legal status of advance directives, which limits their usefulness. Medical education needs to be improved to train doctors to deal with advance directives.
Physician Practice in the Discontinuation of Statins among Patients with Advanced Lung Cancer
Authors: Tanvetyanon Tawee , Choudhury Abdul M. 
Published: April 2019

Background Statins are effective in reducing events from coronary heart disease and can prolong survival. However, this benefit is controversial when other concurrent serious health problems greatly limit the patient's longevity. Methods We conducted a retrospective chart review of patients with advanced lung cancer who were receiving statins and had lived for at least one month since diagnosis. Findings Forty-seven patients with median age of 71 years were included. Discontinuation of statins occurred in 25 patients (53.2%) before the date of death. Median survival was 370 days. Statins were discontinued at a median of 244 days after cancer diagnosis. Discontinuations were more prevalent in patients who received chemotherapy or had a history of cerebrovascular diseases. Lipid monitoring was observed in 25 patients (53.2%). Interpretation About half of patients with advanced lung cancer who were prescribed statins did not have this drug discontinued until the time of death. Lipid monitoring was suboptimal and, when it occurred, indicated the lipid goal was rarely achieved.
Lived Experiences of Canadian Women with Metastatic Breast Cancer in Preparation for Their Death: A Qualitative Study. Part I-Preparations and Consequences
Authors: Chunlestskul Kanoknuch , Carlson Linda E. , Koopmans Janice P. , Angen Maureen 
Published: April 2019

Objectives This study aimed to detail the tasks of death preparation and the consequences of such preparation for women with metastatic breast cancer. Methods A phenomenological qualitative approach was used. Five women with metastatic breast cancer were interviewed on two occasions. Themes were analyzed, described, and validated, until saturation was met. Outcomes of thematic analysis related to the impetus, process, and consequences of preparing for one's own death. Findings The women prepared for their death by: acknowledging their grief; preparing mentally; seeking information and support; preparing the family; and preparing for the end of life. They also engaged in creating life projects that enhanced their connections with loved ones, and lived full and joyful lives. These activities helped increased their readiness to die in peace. Conclusions Preparing for their own death can help women with incurable cancer live full, satisfying lives, and be prepared to face their own death with peace. Helping women express their feelings around their own death and their preparation for death should be a key interdisciplinary psychosocial nursing intervention.
Rectal, Buccal, and Sublingual Narcotics for the Management of Cancer Pain
Authors: Ripamonti Carla , Bruera Eduardo 
Published: April 2019

We review current knowledge on the rectal, buccal, and sublingual routes of narcotic administration as potential alternatives to oral, intramuscular, intravenous, and subcutaneous administrations of narcotics for the management of cancer pain. Most of the experience reported in the literature is based on the use of rectal, sublingual, and buccal narcotics for the management of acute pain syndromes. Preliminary evidence suggests that both morphine sulfate and chlorhydrate can be administered rectally because there is acceptable absorption with this route even if considerable interpersonal variation exists. There are no controlled trials on the long-term use of rectal morphine for cancer pain. There are very few reports on the clinical effects of sublingual and buccal morphine, and pharmacokinetic data are often debatable. There is evidence to justify further research into all three routes of narcotic administration. At the moment rectal use is justified in clinical trials in cancer patients, but there are not enough data on the pharmacokinetics of different narcotics when administered by the buccal or sublingual routes.
A Phase II Study of Delta-9-Tetrahydrocannabinol for Appetite Stimulation in Cancer-Associated Anorexia
Authors:   A World Health Organizadon Demonstration Project, Nelson Kristine , Walsh Declan , Deeter Paula , Sheehan Finbar 
Published: April 2019

Purpose To evaluate the appetite-stimulating properties of delta-9-tetrahydrocannabinol (THC) in patients with anorexia due to advanced cancer. Patients and Methods Nineteen patients with various malignancies were entered. All had cancer-associated anorexia and a life expectancy greater than four weeks. Patients were started on THC 2.5 mg p.o. t.i.d. one hour after meals for four weeks. Evaluations for side effects, efficacy, acceptability and satisfaction were conducted at two and four weeks. Results 18 patients were evaluable. Ten patients completed the entire 28-day study. Four patients experienced grade I toxicity and three withdrew at their request. Thirteen patients reported an improved appetite. Conclusion THC is an effective appetite stimulant in patients with advanced cancer. It is well tolerated at low doses. Further studies are needed to determine the most appropriate dose and the specific population most likely to respond.
Four-moment CAPM Model: Evidence from the Indian Stock Market
Authors: Misra Dheeraj , Vishnani Sushma , Mehrotra Ankit 
Published: April 2019

This study aims at analysing the impact of co-skewness and co-kurtosis on the returns of the Indian stocks by incorporating co-skewness and co-kurtosis in the traditional capital asset pricing model (CAPM) of Sharpe, in a three-factor model of Fama and French and in a four-factor model of Carhart. The results of the study show that co-skewness and co-kurtosis have significant impact on the returns of the Indian stock. However, the impact of co-skewness is higher than co-kurtosis. JEL Classification: G11, G12
Impact of femoroacetabular impingement and dysplasia of the hip on hip joint sphericity
Authors: Diaz-Lopez Reynol A , Alonso-Rasgado M Teresa , Jimenez-Cruz David , Bailey Colin G , Board Tim N 
Published: April 2019

Background: This paper presents a parametric investigation into the effect of femoroacetabular impingement (FAI) and developmental dysplasia of the hip (DDH) on the sphericity of the femoral supra-equatorial region and acetabulum. Methods: Radiographic parameters from x-rays, sphericity calculations and visualisation and joint contact area and pressure from FE models of 10 DDH, FAI and normal hips were analysed and compared both within and between hip groups. Results: The sphericity of the acetabulum and femoral head of both the DDH and FAI groups was found to be less than that for normal hips but the variation in sphericity was greater (range 2.4% for normal hips, compared to 3.3% and 3.1% for the FAI and DDH groups respectively). For the DDH group, femoral head sphericity was found to correlate strongly with 2 of the radiographic parameters used to diagnose the condition, CE angle and Sharp angle. For FAI and DDH hips peak contact pressure primarily occurred in Ilizaliturri Zone 2 (anterior-superior region) in the acetabulum and femoral head which corresponded with increased aspherity in this region compared to the normal hip group. These findings correlate with loading and damage patterns reported in the literature. Additionally, our analysis identified a protrusion of bone in Ilizaliturri Zones 1 and 6 (anterior-inferior region) of the acetabulum of a subgroup of FAI hips, whose existence was confirmed using a full-scale hip model fabricated using a 3D printer, which we believe could result in cartilage damage. Conclusion: We postulate that such protrusions could potentially explain residual symptoms and unaddressed structural deformity in patients who have undergone FAI surgery.