bluuebunny/crossref_metadata_2025_split huggingface dataset:
Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands
Authors: Renkema Erik , Ahaus Kees , Broekhuis Manda , Tims Maria 
Published: June 2019

ObjectivesThis study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours.DesignCross-sectional survey using exploratory factor analysis was conducted to determine litigation attitude and perceived patient pressure factors. Regression analyses were used to regress these factors on to the ordering of extra tests or procedures (defensive assurance behaviour) or the avoidance of high-risk patients or procedures (defensive avoidance behaviour).SettingData were collected from eight Dutch hospitals.ParticipantsRespondents were 160 physicians and 54 residents (response rate 25%) of the hospital departments of (1) anaesthesiology, (2) colon, stomach and liver diseases, (3) gynaecology, (4) internal medicine, (5) neurology and (6) surgery.Primary outcome measuresRespondents’ application of defensive assurance and avoidance behaviours.Results‘Disapproval of justified litigation’ and ‘Concerns about unjustified litigation’ were positively related to both assurance (β=0.21, p<0.01, and β=0.28, p<0.001, respectively) and avoidance (β=0.16, p<0.05, and β=0.18, p<0.05, respectively) behaviours. ‘Self-blame for justified litigation’ was not significantly related to both defensive behaviours. Perceived patient pressures to refer (β=0.18, p<0.05) and to prescribe medicine (β=0.23, p<0.01) had direct positive relationships with assurance behaviour, whereas perceived patient pressure to prescribe medicine was also positively related to avoidance behaviour (β=0.14, p<0.05). No difference was found between physicians and residents in their defensive medical behaviour.ConclusionsPhysicians adopted more defensive medical behaviours if they had stronger thoughts and emotions towards (un)justified litigation. Further, physicians should be aware that perceived patient pressure for care can lead to them adopting defensive behaviours that negatively affects the quality and safety of patient care.
Screening nursing students to identify those at high risk of poor mental health: a cross-sectional survey
Authors: Hsiung Der-Yun , Tsai Ching-Lun , Chiang Ling-Chun , Ma Wei-Fen 
Published: June 2019

ObjectivesThis study aimed to identify those at high risk of poor mental health among nursing students and to examine the relationships and consistency among five mental health assessments.DesignA cross-sectional design with purposive sampling was used. Four mental health screening tools plus previous mental health history/information were conducted during June 2015 to October 2016.SettingA nursing major university in Taiwan.ParticipantsA total of 2779 participants aged between 19 and 45 years were recruited.Main outcome measuresFive mental health risks were identified: increased risk for ultra-high risk, putative prepsychosis states, high trait anxiety, high state anxiety with genetic risk and depression.ResultsOut of the 3395 collected questionnaire, 2779 (82%) were found valid and included in the study. 612 (22%) of the participants were identified to be at mental health risk. 12 of them appeared positive in four, 79 in three, 148 in two and 373 in one of the adopted mental health screening tools. 69 participants had the experience of seeking medical help due to mental health issues, and 58% of them were identified to be at risk of mental health during the screening. Trait and state anxiety scored the highest in correlation analysis (r(2620)=0.76, p<0.001). Correlations were observed in the scores on the subscales of Chinese Version of Schizotypal Personality Questionnaire-Brief (CSPQ-B) and those of Brief self-report Questionnaire for Screening Putative Prepsychotic States (BQSPS), and the highest correlation coefficients was (r(2740)=0.70, p<0.001). Although both of the screening tools are used to assess mental illness risk at its prodromal phase, but CSPQ-B in general appeared to have more rigorous screening criteria than BQSPS.ConclusionFor expediting early identification high risk of poor mental health, easy-to-use screening questionnaires can be adopted to assess the mental health state of nursing students whose mental well-being and overall health are of vital importance to the entire healthcare industry.
DONORS (Donation Network to Optimise Organ Recovery Study): Study protocol to evaluate the implementation of an evidence-based checklist for brain-dead potential organ donor management in intensive care units, a cluster randomised trial
Authors: Westphal Glauco Adrieno , Robinson Caroline Cabral , Biasi Alexandre , Machado Flávia Ribeiro , Rosa Regis Goulart , Teixeira Cassiano , de Andrade Joel , Franke Cristiano Augusto , Azevedo Luciano Cesar Pontes , Bozza Fernando , Guterres Cátia Moreira , da Silva Daiana Barbosa , Sganzerla Daniel , do Prado Débora Zechmeister , Madalena Itiana Cardoso , Rohden Adriane Isabel , da Silva Sabrina Souza , Giordani Natalia Elis , Andrighetto Luiza Vitelo , Benck Patrícia Spessatto , Roman Fernando Roberto , de Melo Maria de Fátima Rodrigues Buarque , Pereira Thattyane Borba , Grion Cintia Magalhães Carvalho , Diniz Pedro Carvalho , Oliveira João Fernando Picollo , Mecatti Giovana Colozza , Alves Flávio André Cardona , Moraes Rafael Barberena , Nobre Vandack , Hammes Luciano Serpa , Meade Maureen O , Nothen Rosana Reis , Falavigna Maicon 
Published: June 2019

IntroductionThere is an increasing demand for multi-organ donors for organ transplantation programmes. This study protocol describes the Donation Network to Optimise Organ Recovery Study, a planned cluster randomised controlled trial that aims to evaluate the effectiveness of the implementation of an evidence-based, goal-directed checklist for brain-dead potential organ donor management in intensive care units (ICUs) in reducing the loss of potential donors due to cardiac arrest.Methods and analysisThe study will include ICUs of at least 60 Brazilian sites with an average of ≥10 annual notifications of valid potential organ donors. Hospitals will be randomly assigned (with a 1:1 allocation ratio) to the intervention group, which will involve the implementation of an evidence-based, goal-directed checklist for potential organ donor maintenance, or the control group, which will maintain the usual care practices of the ICU. Team members from all participating ICUs will receive training on how to conduct family interviews for organ donation. The primary outcome will be loss of potential donors due to cardiac arrest. Secondary outcomes will include the number of actual organ donors and the number of organs recovered per actual donor.Ethics and disseminationThe institutional review board (IRB) of the coordinating centre and of each participating site individually approved the study. We requested a waiver of informed consent for the IRB of each site. Study results will be disseminated to the general medical community through publications in peer-reviewed medical journals.Trial registration numberNCT03179020; Pre-results.
Investigating the relation between self-assessment and patients’ assessments of physicians-in-training empathy: a multicentric, observational, cross-sectional study in three teaching hospitals in Brazil
Authors: Bernardo Mônica Oliveira , Cecilio-Fernandes Dario , Lima Alba Regina de Abreu , Silva Julian Furtado , Ceccato Hugo Dugolin , Costa Manuel João , de Carvalho-Filho Marco Antonio 
Published: June 2019

ObjectivesThis study investigated the associations between self-assessed empathy levels by physicians in training and empathy levels as perceived by their patients after clinical encounters. The authors also examined whether patient assessments were valid and reliable tools to measure empathy in physicians in training.DesignA multicentric, observational, cross-sectional study.SettingThis study was conducted in three public teaching hospitals in Brazil.ParticipantsFrom the 668 patients invited to participate in this research, 566 (84.7%) agreed. Of these, 238 (42%) were male and 328 (58%) were female. From the invited 112 physicians in training, 86 (76.8%) agreed. Of the 86 physicians in training, 35 (41%) were final-year medical students and 51 (59%) were residents from clinical and surgical specialties. The gender distribution was 39 (45%) males and 47 (51%) females.Primary and secondary outcome measuresPhysicians in training filled the Jefferson Scale of Physician Empathy (JSE) and the Interpersonal Reactivity Index. Patients answered the Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE) and the Consultation and Relational Empathy Scale (CARE).ResultsThis study found non-significant correlations between patient and physicians-in-training self-assessments, except for a weak correlation (0.241, p<0.01) between the JSPPPE score and the JSE compassionate care subscore. CARE and JSPPPE scales proved to be valid and reliable instruments.ConclusionsPhysicians-in-training self-assessments of empathy differ from patient assessments. Knowledge about empathy derived from self-assessment studies probably does not capture the perspective of the patients, who are key stakeholders in patient-centred care. Future research on the development of physician empathy or on outcomes of educational interventions to foster empathy should include patient perspectives.
Features of phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A in malignancy-associated membranous nephropathy
Authors: Zhang Changming , Zhang Mingchao , Chen Dacheng , Ren Qiang , Xu Weiwei , Zeng Caihong , Qin Weisong , Liu Zhihong 
Published: June 2019

AimsPhospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing 7A (THSD7A) were identified as pathogenic antigens in patients with membranous nephropathy (MN). Notably, PLA2R is detected in few patients with malignancy-associated MN, and a high incidence of cancer is reported in patients with THSD7A-associated MN. Therefore, the roles of PLA2R and THSD7A in malignancy-associated MN must be clarified.MethodsSerum anti-PLA2R antibodies and glomerular PLA2R staining were assessed in 36 patients with malignancy-associated MN, followed by examination of serum anti-THSD7A antibodies and glomerular THSD7A. THSD7A staining in cancer tissues was also assessed in 9 of the 36 patients.ResultsTwelve (33%) of 36 patients were positive for both glomerular PLA2R and serum anti-PLA2R antibodies, one of whom had enhanced glomerular THSD7A staining. Two patients were positive for either glomerular PLA2R or serum anti-PLA2R antibody. All these patients had IgG4-dominant deposits in glomeruli. Among the 22 (61%) patients who were double negative for glomerular PLA2R and serum anti-PLA2R antibodies, 17 of 20 (85%) had IgG1-dominant deposits in glomeruli, and 2 (9.1%) were positive for glomerular THSD7A staining. Serum anti-THSD7A antibody was not detected in any of the 36 patients. Among the nine patients with available cancer tissues, positive staining of THSD7A in the cancer tissues was observed in five (56%) patients, and one showed enhanced glomerular staining of THSD7A.ConclusionsScreening of glomerular PLA2R antigen and serum anti-PLA2R antibodies is necessary in patients with malignancy-associated MN, whereas the incidence of glomerular THSD7A antigen or circulating anti-THSD7A antibodies is uncommon.
Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy
Authors: Goyal Nitin , Tsivgoulis Georgios , Chang Jason J , Malhotra Konark , Goyanes Juan , Pandhi Abhi , Krishnan Rashi , Ishfaq Muhammad F , Hoit Daniel , Nickele Christopher , Inoa-Acosta Violiza , Katsanos Aristeidis H , Elijovich Lucas , Alexandrov Andrei , Arthur Adam S 
Published: June 2019

IntroductionOne uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)).ObjectiveTo evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT.MethodsConsecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated.ResultsA total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11–20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005).ConclusionsIVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.
Persistent trigeminal artery aneurysms: case report and systematic review
Authors: Diana Francesco , Mangiafico Salvatore , Valente Vinicio , Wlderk Andrea , Grillea Giovanni , Colonnese Claudio , Bartolo Marcello 
Published: June 2019

BackgroundThe persistent trigeminal artery (PTA) is an adult carotid-basilar anastomosis with debated pathologic aspects, such as its association with brain aneurysms. True trigeminal artery aneurysms are rare vascular anomalies, reported in a few case reports.ObjectiveTo report our experience with a ruptured trigeminal artery aneurysm and to provide a systematic review of the literature in order to analyse potential links between the anatomic configuration of the PTA and PTA aneurysm (PTAA) type, and implications of each PTAA type for the diagnostic and therapeutic approach.MethodsWe reviewed the medical literature on trigeminal artery aneurysms according to the PRISMA guidelines. Population characteristics, aneurysms features, and PTA type and side were assessed.Results40 previously published cases of PTAAs were included in the analysis. The mean age of subjects was 55 years, with a strong female predominance (77%). Four PTAAs were accidentally discovered, while 16 caused compressive symptoms and 20 were ruptured. Successful endovascular treatment was performed in 62% of cases.ConclusionsPTAAs are rare vascular anomalies, underdiagnosed in the presence of a trigemino-cavernous fistula. Parent vessel occlusion seems to be the best therapeutic option for ruptured or symptomatic unruptured PTAAs in Saltzman type II and III PTAs. Patency of the parent vessel is the main target in Saltzman type I PTA.
HIV treatment cascade for older adults in rural South Africa
Authors: Rohr Julia K , Manne-Goehler Jennifer , Gómez-Olivé Francesc Xavier , Wagner Ryan G , Rosenberg Molly , Geldsetzer Pascal , Kabudula Chodziwadziwa , Kahn Kathleen , Tollman Stephen , Bärnighausen Till , Salomon Joshua A 
Published: June 2019

ObjectivesThe HIV treatment cascade is a powerful framework for understanding progress from initial diagnosis to successful treatment. Data sources for cascades vary and often are based on clinical cohorts, population cohorts linked to clinics, or self-reported information. We use both biomarkers and self-reported data from a large population-based cohort of older South Africans to establish the first HIV cascade for this growing segment of the HIV-positive population and compare results using the different data sources.MethodsData came from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) 2015 baseline survey of 5059 adults aged 40+ years. Dried blood spots (DBS) were screened for HIV, antiretroviral drugs and viral load. In-home surveys asked about HIV testing, diagnosis and antiretroviral therapy (ART) use. We calculated proportions and CIs for each stage of the cascade, conditional on attainment of the previous stage, using (1) biomarkers, (2) self-report and (3) both biomarkers and self-report, and compared with UNAIDS 90-90-90 targets.Results4560 participants had DBS results, among whom 1048 (23%) screened HIV-positive and comprised the denominator for each cascade. The biomarker cascade showed 63% (95% CI 60 to 66) on ART and 72% (95% CI 69 to 76) of those on ART with viral suppression. Self-reports underestimated testing, diagnosis and ART, with only 47% (95% CI 44 to 50) of HIV-positive individuals reporting ART use. The combined cascade indicated high HIV testing (89% (95% CI 87 to 91)), but lower knowledge of HIV-positive status (71% (95% CI 68 to 74)).ConclusionsOlder South Africans need repeated HIV testing and sustained ART to reach 90-90-90 targets. HIV cascades relying on self-reports are likely to underestimate true cascade attainment, and biomarkers provide substantial improvements to cascade estimates.
Cyclin-Dependent Kinase-9 Is a Therapeutic Target in MYC-Expressing Diffuse Large B-Cell Lymphoma
Authors: Hashiguchi Taylor , Bruss Nur , Best Scott , Lam Vi , Danilova Olga , Paiva Cody J. , Wolf Joelle , Gilbert Erin W. , Okada Craig Y. , Kaur Prabhjot , Drew Lisa , Cidado Justin , Hurlin Peter , Danilov Alexey V. 
Published: June 2019

Abstract
Deregulation of the MYC transcription factor is a key driver in lymphomagenesis. MYC induces global changes in gene expression that contribute to cell growth, proliferation, and oncogenesis by stimulating the activity of RNA polymerases. A key feature in its ability to stimulate RNA Pol II activity is recruitment of pTEFb, an elongation factor whose catalytic core comprises CDK9/cyclin T complexes. Hence, MYC expression and function may be susceptible to CDK9 inhibition. We conducted a pre-clinical assessment of AZ5576, a selective CDK9 inhibitor, in diffuse large B-cell lymphoma (DLBCL). The in vitro and in vivo effects of AZ5576 on apoptosis, cell cycle, Mcl-1, and MYC expression were assessed by flow cytometry, immunoblotting, qPCR and RNA-Seq. We demonstrate that, in addition to depleting Mcl-1, targeting CDK9 disrupts MYC oncogenic function. Treatment with AZ5576 inhibited growth of DLBCL cell lines in vitro and in vivo, independent of cell-of-origin. CDK9 inhibition downregulated Mcl-1 and MYC mRNA transcript and protein in a dose-dependent manner. MYC-expressing cell lines demonstrated enhanced susceptibility to AZ5576. CDK9 inhibition promoted turnover of MYC protein, and decreased MYC phosphorylation at the stabilizing Ser62 residue and downregulated MYC transcriptional targets in DLBCL cells, a finding confirmed in a functional reporter assay, suggesting that CDK9 may govern MYC protein turnover, thus regulating its expression through multiple mechanisms. Our data suggest that targeting CDK9 is poised to disrupt MYC oncogenic activity in DLBCL and provide rationale for clinical development of selective CDK9 inhibitors.
Direito à saúde no Brasil: reserva do possível e mínimo existencial nas decisões do Superior Tribunal de Justiça (2010-2016)
Authors: Almeida Andrija Oliveira , Freire Marco Valério Viana 
Published: June 2019

O objetivo do trabalho é analisar as características das decisões do Superior Tribunal de Justiça entre 2010 e 2016 concernentes à aplicabilidade, ao direito à saúde no Brasil, das cláusulas da reserva do possível e do mínimo existencial, a partir da interface entre o direito e a política. O estudo insere-se na abordagem empírica da pesquisa em direito, com enfoque qualitativo e do recurso à análise documental. O corpus de dados constituiu-se de 15 decisões coletadas na base eletrônica de julgados do Superior Tribunal de Justiça. A análise dos dados evidencia que o entendimento da Corte sobre a efetivação do direito à saúde caracteriza-se pelo argumento da não “oponibilidade da reserva do possível ao mínimo existencial” em matéria de saúde e pela determinação ao Poder Executivo da obrigação de fazer e da admissibilidade do bloqueio de verbas públicas, mormente quando se trata de garantia de acesso a medicamentos. Ademais, nas decisões judiciais estudadas neste trabalho há destaque para a refutação jurídico-política da ideia de separação de poderes como fator impeditivo à edição de mandamento realizador pelo Poder Judiciário em matéria de direitos sociais, bem como para a demarcação do conteúdo jurídico do mínimo existencial constitutivo do direito fundamental à saúde e, desse modo, do estabelecimento da extensão das prestações positivas do Estado.
Autonomic Parameter and Stress Profile Predict Secondary Ischemic Events After Transient Ischemic Attack or Minor Stroke
Authors: Guan Ling , Wang Yongjun , Claydon Victoria E. , Mazowita Garey , Wang Yilong , Brant Rollin , Collet Jean-Paul 
Published: June 2019

Background and Purpose—
Traditional risk factors for ischemic stroke are body stressors that are related to autonomic autonomic system (ANS) dysfunction. The value of ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) to predict ischemic stroke after transient ischemic attack is compromised by the inclusion of a limited number of stressors. We aimed to assess whether markers of ANS function and stress could predict the occurrence of secondary ischemic events after transient ischemic attack or minor stroke.

Methods—
This is a prospective cohort study in which 201 patients were recruited within 48 hours after initial transient ischemic attack or minor stroke and followed for 90 days to assess the development of secondary ischemic events. ABCD2 score, heart rate variability (HRV) parameters as markers of ANS function, and psychological stress were assessed. Logistic regression and area under the curve (AUC) were used to assess the models’ predictive ability.

Results—

Morning high frequency (HF) HRV power and changes in HF HRV from morning to afternoon (daytime HF changes) were the most useful HRV predictors for both ischemic events (AUC=0.61 and 0.70) and ischemic stroke (AUC=0.62 and 0.72). Compared with ABCD2 score, 2 HRV-based stress models showed higher predictive ability for ischemic events (AUC=0.82 versus 0.63, 0.76 versus 0.63;
P
<0.05) and ischemic stroke (AUC=0.87 versus 0.64, 0.82 versus 0.64;
P
<0.05).

Conclusions—
Assessing the effects of stress on the ANS may be an innovative way to stratify the risk of ischemic events after transient ischemic attack or minor stroke. New risk stratification by assessing the dynamic features of ANS dysfunction and stress may help identify high-risk sub-populations that may benefit from added management.