bluuebunny/crossref_metadata_2025_split huggingface dataset:
Basic self-care in older acute medical in-patients: a retrospective cohort study
Authors: Rodrigues Cecília , Mendonça Denisa , Martins Maria Manuela 
Published: October 2018

Abstract

Background:
Older patients hospitalized for acute illness are vulnerable to decline in basic self-care. This functional decline determines future health needs and can lead to negative health outcomes.

Aim:
To compare basic self-care needs in older acute medical in-patients between admission and discharge using the Nursing Patient Classification System data.

Design:
Single-center, observational, and retrospective cohort study.

Methods:
Data were collected between April 2015 and April 2016 and included 384 patients aged 65 or older admitted to a medical ward of a 580-bed teaching hospital in Portugal. Significant differences between groups of patients were assessed by analysis of variance and Kruskal–Wallis for continuous variables and by chi-squared test for categorical variables. Significant changes in the level of dependence were analyzed using McNemar–Bowker test.

Results:
The mean age of the patients was 79.93 years (SD = 7.49) and the majority were women (57.3%). There were no gender differences in length of stay. Oldest-old patients presented higher percentages of dependence on basic self-care, both at admission and at discharge. Younger-old patients improves in hygiene and personal care, toilet use, and movement (P < .01). However, it is also this group of patients who have the highest percentages of deterioration in eating (P = .129), toilet use, and movement (P < .001).

Conclusion:
All patients are vulnerable to decline in basic self-care regardless their age. Use Nursing Patient Classification Systems to track progress in basic self-care between admission and discharge in older acute medical patients is an innovative and valid methodology. Based on the needs of nursing care, we were able to characterize older patients’ needs and achieve health outcomes.
The impact of using newborn bovine serum as fetal calf serum substitute in the in vitro bovine embryos production system
Authors: Abdel-Wahab Ahmed , Abdel Aziz Rabie L. , Helmy Nermeen A. , Ibrahim Shawky S. 
Published: October 2018

Abstract
This study was conducted to assess the effects of addition of 10% newborn bovine serum (NBS) in the maturation and culture media of bovine system on oocytes maturation and developed morula and blastocyst rates. For this purpose, 10% NBS was added to in vitro maturation (IVM) medium alone (Experiment I), in vitro culture (IVC) (Experiment II), and in IVM + IVC (Experiment III). In vitro bovine oocytes maturation and developmental rates of bovine embryos were then compared with control group where the basal maturation or culture media were supplemented with 10% fetal calf serum (FCS). Results revealed that maturation, cleavage, morula, and blastocyst formation rates of in vitro fertilized embryos were not significantly different in NBS and control groups in the 3 experiments. In conclusion, NBS is an efficient macromolecule in bovine system when added either to IVM or to IVC or to both stages. Thus, NBS could provide cheaper and more available treatment to be used as FCS substitute in the IVC system of bovines.
The construction of the health professional in palliative care contexts: a scoping review on caring for the person at the end of life
Authors: Parola Vitor , Coelho Adriana , Romero Álvaro A. , Peiró Roland P. , Blanco-Blanco Joan , Apóstolo João , Gea-Sánchez Montserrat 
Published: October 2018

Abstract

Aim:
The aim of the study was to map of the literature on the elements contributing to the construction of the health care professional in the context of palliative care.

Methods:
Scoping review based on Arksey and O’Malley framework. PubMed, Embase, CINAHL, Scopus databases, and gray literature were the sources searched (2005–2015), completed by reference searching, hand searching, and expert consultations. Primary studies focusing on different professionals working in palliative care units or hospice centers were eligible for inclusion.

Results:
From a total of 3632 articles, 22 met the inclusion criteria. The content of the studies was described and classified in 5 elements: (i) construction and application of the concept of care; (ii) psychosocial effects that the daily care produces; (iii) working conditions that influence the caregiving provided; (iv) knowledge mobilized in the provision of care; and (v) strategies adopted by health care professionals to build relationships. Data about nurses, physicians, and psychologists were found, but no data were found about social workers. Gaps identified in the publications were as follows: relationship competencies and strategies adopted; the real needs from educational programs; and the view of other professionals.

Conclusions:
Key elements identified in the concept of the construction of the health care professional should be addressed in future interventions: prevention of emotional exhaustion, depersonalization, and achievement of a greater personal accomplishment. In addition, none of the articles retrieved offered the different perspectives of all the disciplines in a multidisciplinary team.
Merkel cell carcinoma and the challenge in its approach: a review based on a clinical context of immunosuppression
Authors: Coutinho Filipe , Horta Miguel , Rocha Estrela , Vasconcelos Carlos , Araújo António 
Published: October 2018

Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine cancer with high rate to local relapse and metastasis. Its connection to immunosuppression is well known, with reported association to human immunodeficiency virus (HIV).
The authors present an 87-year-old woman, infected by HIV type 2 at advanced stage of the disease, whom presented a painless papule on left cheek in 2011. After its total excision, the histopathology confirmed MCC “in situ,” with no regional or distant metastases. Simultaneously, she revealed a viral load of 2220 copies/mL and 224 CD4/mm3. Five months later, the patient presented a local and distance relapse with an aggressive behavior and positive regional lymph node. Stage IV disease was confirmed due to presence of liver metastases. Concurrently to the relapse, it was detected low CD4 levels.
In our multidisciplinary team decision meeting, it has been decided conservative treatment due to low Karnofsky status, comorbidities, and stage of disease.
Neuromodulating attention and mind-wandering processes with multi-session real-time electroencephalogram
Authors: Gonçalves Óscar F. , Carvalho Sandra , Mendes Augusto J. , Lema Alberto , Leite Jorge , Boggio Paulo S. 
Published: October 2018

Abstract
Previous studies showed the efficacy of a single session real-time electroencephalogram (rtEEG) protocols in sensorimotor rhythm (SMR) or Theta up-training. However, the impact of this training on sustained or mind-wandering attention was only modest. This could be explained by the lack of specificity in distinct rtEEG training protocols given their limitation in inhibiting or decreasing the amplitude of down-trained bands. Additionally, multiple sessions of rtEEG in up-training/down-training SMR (sensorimotor rhythm) and Theta along with better ways of tracking sustained and mind-wandering attention protocols may be required to achieve consistent effects. Here we describe the effects of a 10-session trial of up-training/down-training SMR or Theta (SMR⇑Theta⇓; Theta⇑SMR⇓), looking at the effects of 2 rtEEG training protocols in 2 n of 1 subject designs. We also tested to impact of this training in sustained and mind-wandering attention during the course of a Sustained Attention Response Task (SART). The present trial confirmed the potentiality of a multi-session protocol in up-training Theta or SMR and, as consequence, increasing sustained attention (Theta up-training) and mind-wandering attention (SMR up-training). However, the simultaneous increase of the Theta amplitude in the SMR⇑Theta⇓ (and the more modest increase of the SMR amplitude in Theta⇑SMR⇓) reduced the specificity of the rtEEG training. Future studies should build on the potentiality of extended rtEEG protocols on this attention paradigm but increasing the specificity of the trained EEG bands choosing less tedious/more motivating feedback instruments (SMR⇑Theta⇓) and conducting the Theta⇑SMR⇓ training eyes closed.
Diarrhea as a form of presentation of medullary thyroid carcinoma
Authors: Pais Mariana Canelas , Maia Tiago , Peixoto Armando , Meira Leonor , Albuquerque Andreia , Lopes Joanne , Capela João 
Published: October 2018

Abstract
A case is presented of a 57-year-old man consulting for chronic diarrhea. Based on subsequent findings (thyroid nodule and metastases), the possibility of metastatic medullary thyroid carcinoma (MTC) was raised. Thyroidectomy allowed diagnosing a multicentric left lobe MTC. MTC is a rare cause of diarrhea, but should be considered, especially in the presence of signs or symptoms of alarm or nonresponse to empirical therapy.
Individualized multimodal treatment strategy for metastatic rectal adenocarcinoma
Authors: Magalhães Helena , Fontes-Sousa Mário , Fernandes Manuel , Machado Manuela 
Published: October 2018

Abstract
Metastatic rectal cancer requires a multidisciplinary and individualized approach.
The authors describe a case report of a 48-year-old man with recurrence of rectal adenocarcinoma that underwent multimodal treatment, which included chemotherapy with biologic agents, cytoreduction surgery with hyperthermic intraperitoneal chemotherapy, and radiotherapy with improvement in progression-free survival and overall survival.
Assessment in pediatrics clerkships: impact of strategies to solve item-sharing problems
Authors: Faria-Costa Gabriel , Severo Milton , Ferreira Maria Amélia , Guimarães Hercília , Henriques-Coelho Tiago 
Published: October 2018

Abstract

Introduction:
Reusing multiple-choice questions in different examinations may lead to item sharing between students. Our aim was to analyze and solve an item-sharing problem during assessment of medical students in pediatrics clerkship.

Methods:
This is a 3 years prospective analysis of 5th year medical students, submitted to an examination at the end of their Pediatrics’ clerkship. In 2012, questions were reused across different clerkships. In 2013, no questions were reused in different clerkships. In 2014, no questions were reused and the review of the test was postponed to the end of the year, after all clerkships ended.

Results:
In 2012, the mean score increased 1.36 points (in a scale of 0–20) per clerkship rotation, with the last clerkship having a difference of 9.5 points regarding the first one (P < .001). Fifty percent of this variation was due to the repetition of questions. In 2013, with a new question bank, the mean score increased 0.8 points per clerkship rotation, with a difference of 5.6 points between the last and the first rotations (P < .024). Finally, in 2014 there was no significant variation between clerkships.
Tests’ scores had a significant moderate correlation with students’ average course grade (r = 0.39, r = 0.30, r = 0.48, for 2012, 2013, and 2014, respectively). The students’ average course grade, however, did not confound the increase in tests’ scores across different clerkships.

Conclusion:
The present work demonstrated an item-sharing problem among students during pediatric clerkships. An effective approach to correct this bias assessment was achieved by restricting the reuse of questions, by changing the time-point of test revision and by progressively adapting equating strategies.
Effects of a nursing care program on functional outcomes in older acute medical in-patients: protocol for a randomized controlled trial
Authors: Rodrigues Cecília , Mendonça Denisa , Martins Maria Manuela 
Published: October 2018

Abstract

Background:
Hospitalization often leads to long periods of bed rest and inactivity which is associated with an increase in length of hospital stay, loss of capacity for basic self-care and discharge into a nursing home.

Objective:
This trial aims to verify if a nursing care program centered on basic self-care and predefined physical activity, improves functional outcomes in older hospitalized patients.

Methods:
This is a 2-group randomized controlled trial with repeated measures: 182 older acute medical patients will be blindly randomly allocated to the control group (n = 91) or intervention group (n = 91). The intervention will consist of nursing care intervention centered on basic self-care that includes a twice daily walking training, plus privileging pre-established trips to the toilet by walking and all daytime meals seated, off the bed. The main outcome was changes in the number of independent activities of daily living from 2 weeks before admission (baseline) to discharge. Trial registration: ClinicalTrials.gov (Identifier NCT03106064).

Results:
This intervention has the potential to change the outcomes of the older patient in the acute setting.

Conclusion:
The loss of independence in self-care is determinant in future health care needs. If our hypothesis is correct and demonstrate that this nursing care program centered on basic self-care for older acute medical patients improves functional outcomes, a change in the paradigmatic organization of hospital care may be justifiable.
Incidence and mortality due to cervical cancer in 4 south European countries
Authors: Teixeira Cristina , Afonso Ana , Rodrigues Luciana , Madureira Muriela , Nogueira António 
Published: October 2018

Abstract

Objective:
To describe variation in incidence and mortality rates of cervical cancer (CC), between 4 Southern European countries that share similar cultural characteristics.

Methods:
Data on CC incidence and mortality reported in Portugal, Spain, Italy, and Greece for the year 2012 were obtained through the International Agency of Research on Cancer. Expected numbers of incident cases and deaths were obtained based on age-specific rates in European region. Standardized incidence rate (SIR) and standardized mortality rate (SMR) and respective 95% confidence interval (95% CI) were computed for each country by age group (15–39, 40–54, 55–64, and ≥65 years old).

Results:
The number of incident cases of and deaths due to CC observed in Greece, Italy, and Spain were significantly lower than expected, whichever the age group. In Portugal such pattern was, however, only found for incident cases among women aged up to 54 years. The number of incident cases observed in Portugal did not differ from that expected among women aged 55 to 64 (SIR = 90.8; 95% CI: 76.8–106.7) and aged 65 or more years (SIR = 110.0; 95% CI: 95.9–125.0). Also, the number of deaths observed in Portugal did not differ from that expected among women aged 15 to 39 (SMR = 70.0; 95% CI: 43.3–100.8), 40 to 54 (SMR = 93.6; 95% CI: 74.9–115.4), and 55 to 64 years (SMR = 93.6; 95% CI: 73.4–117.7) but was significantly higher than that expected among women aged 65 or more years (SMR = 126.7; 95% CI: 110.1–144.4).

Conclusions:
There is variability in CC incidence and mortality between 4 South European countries. To understand the reasons underlying such variability could improve approach to preventive care.
Correlation between apparent diffusion coefficient values in breast magnetic resonance imaging and prognostic factors of breast invasive ductal carcinoma
Authors: Moutinho-Guilherme Ricardo , Oyola Janeth Hercilia , Sanz-Rosa David , Vassallo Israel Thuissard , García Raquel Murillo , Pisco Joana Martins , de Vega Vicente Martínez 
Published: October 2018

Abstract

Background:
We wanted to examine whether the apparent diffusion coefficient values obtained by diffusion-weighted imaging techniques could indicate an early prognostic assessment for patients with Invasive Ductal Carcinoma and, therefore, influence the treatment decision making.

Objective:
The main objective was to evaluate the correlation between the apparent diffusion coefficient values obtained by diffusion-weighted imaging and the key prognostic factors in breast invasive ductal carcinoma. Secondary objectives were to analyze the eventual correlations between magnetic resonance imaging findings and prognostic factors in breast cancer; and to perform a comparison between results in 1.5 and 3.0 T scanners.

Methods:
Breast magnetic resonance imaging with diffusion-weighted imaging sequence was performed on 100 patients, who were proven histopathologically to have breast invasive ductal carcinoma. We compared the apparent diffusion coefficient values, obtained previous to biopsy, with the main prognostic factors in breast cancer: tumor size, histologic grade, hormonal receptors, Ki67 index, human epidermal growth factor receptor type 2, and axillary lymph node status. The Mann-Whitney U test and the Kruskal-Wallis analysis were used to establish these correlations.

Results:
The mean apparent diffusion coefficient value was inferior in the estrogen receptor-positive group than in the estrogen receptor-negative group (1.04 vs 1.17 × 10–3 mm2/s, P = .004). Higher histologic grade related to larger tumor size (P = .002). We found association between spiculated margins and positive axillary lymph node status [odds ratio = 4.35 (1.49–12.71)]. There were no differences in apparent diffusion coefficient measurements between 1.5 and 3.0 T magnetic resonance imaging scanners (P = .513).

Conclusions:
Low apparent diffusion coefficient values are related with positive expression of estrogen receptor. Larger tumors and spiculated margins are associated to worse prognosis. Rim enhancement is more frequently observed in estrogen receptor-negative tumors. There are no differences in apparent diffusion coefficient measurements between different magnetic resonance imaging scanners.
Retrospective evaluation of a clinical decision support tool for effective computed tomography angiography utilization in urgent brain imaging of suspected TIA/minor stroke in the emergency department
Authors: Bibok Maximilian B. , Votova Kristine , Balshaw Robert F. , Penn Melanie , Lesperance Mary L. , Harris Devin R. , Sedgwick Colin , Nealis Madeline , Farrell Brian , Mathieson John R. , Penn Andrew M. 
Published: October 2018

AbstractObjectivesThe Canadian Stroke Best Practice Recommendations suggests that patients suspected of transient ischemic attack (TIA)/minor stroke receive urgent brain imaging, preferably computed tomography angiography (CTA). Yet, high requisition rates for non-cerebrovascular patients overburden limited radiological resources, putting patients at risk. We hypothesize that our clinical decision support tool (CDST) developed for risk stratification of TIA in the emergency department (ED), and which incorporates Canadian guidelines, could improve CTA utilization.MethodsRetrospective study design with clinical information gathered from ED patient referrals to an outpatient TIA unit in Victoria, BC, from 2015-2016. Actual CTA orders by ED and TIA unit staff were compared to hypothetical CTA ordering if our CDST had been used in the ED upon patient arrival.ResultsFor 1,679 referrals, clinicians ordered 954 CTAs. Our CDST would have ordered a total of 977 CTAs for these patients. Overall, this would have increased the number of imaged-TIA patients by 89 (10.1%) while imaging 98 (16.1%) fewer non-cerebrovascular patients over the 2-year period. Our CDST would have ordered CTA for 18 (78.3%) of the recurrent stroke patients in the sample.ConclusionsOur CDST could enhance CTA utilization in the ED for suspected TIA patients, and facilitate guideline-based stroke care. Use of our CDST would increase the number of TIA patients receiving CTA before ED discharge (rather than later at TIA units) and reduce the burden of imaging stroke mimics in radiological departments.
Burden of depressive symptoms and non-alcohol substance abuse; and their association with alcohol use and partner violence: a cross-sectional study in four sub-Saharan Africa countries
Authors: Bajunirwe F. , Maling S. , Adami H.-O. , Ajayi I. O. , Volmink J. , Adebamowo C. , Laurence C. , Reid T. , Nankya-Mutyoba J. , Chiwanga F. S. , Dalal S. , Njelekela M. , Guwatudde D. , Holmes M. D. 
Published: October 2018

In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR = 1.49,p = 0.008), NAS abuse (PR = 2.06,p = 0.02) and IPV (PR = 2.93,p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31,p < 0.001)], female (OR = 0.48,p = 0.036) were protective of NAS but current smokers (OR = 2.98,p < 0.001) and those reporting IPV (OR = 2.16,p = 0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.
Do voters prefer gender stereotypic candidates? evidence from a conjoint survey experiment in Japan
Authors: Ono Yoshikuni , Yamada Masahiro 
Published: October 2018

AbstractThe striking under-representation of women in Japan has been partly attributed to gender stereotypes and prejudice toward female leadership among voters. We examine whether and to what extent candidates get rewarded or punished when they deviate from the behavioral expectations associated with their gender roles and images. Our conjoint experiment results in Japan demonstrate that not only are female candidates disadvantaged compared to their male counterparts, but also that they could lose support when they diverge from gender-based behavioral expectations. Our findings suggest that female candidates face a difficult dilemma in that they must weigh the cost of losing support for failing to conform to gender-based expectations, against the general loss of support they would incur for conforming to these expectations.
Indirect Pathways of Self-Interest and the TPP
Authors: Tuxhorn Kim-Lee 
Published: October 2018

AbstractDo consumer and producer considerations influence support for future trade agreements and, if so, how? Prior research has pitted self-interest-based explanations of trade preferences against perception-based explanations, finding limited empirical support for the self-interest hypothesis. Instead of treating perceptions and self-interest as competing explanations, we construct a theoretical model with perceptions of trade as a mediating factor linking self-interest and support for prospective free trade agreements (FTAs). Using new survey data collected by the Asia Pacific Foundation of Canada, we examine how two distinct forms of self-interest (consumer and producer considerations) can indirectly shape attitudes toward the Trans-Pacific Partnership (TPP). We find that the impact of respondents' income level (proxying producer considerations) and their recognition of the price-lowering effect of international trade (proxying consumer considerations) on support for the TPP are largely mediated by perceptions of trade. Together the findings suggest a middle ground between the two sides of the self-interest debate.