bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experiences of cancer rehabilitation: A cross‐sectional study
Authors: Garmy Pernilla , Jakobsson Liselotte 
Published: March 2018

Aims and objectivesTo investigate the cancer rehabilitation experiences of working‐age cancer survivors.BackgroundCancer survivors have extremely complex needs, spanning physical, vocational and sexual domains. Although cancer rehabilitation services have been found to eliminate or reduce these strains, these services are often underutilised.DesignA cross‐sectional study design was employed.MethodsA survey of persons over the age of 18 with a cancer diagnosis, enrolled in the Social Insurance Agency in a municipality in southern Sweden (n = 168, 68% women), was conducted.ResultsPatients who used the cancer rehabilitation service (57%) were generally satisfied with it. Of participants, 26% reported not having received an offer of rehabilitation. Of those who reported that they received information about cancer rehabilitation services, most also reported that they received this information from a healthcare service professional (69%); for example, from the oncology nurse or the oncologist, whereas 20% claimed they received the information from the administrator of the Swedish Social Insurance Agency. A minority of children and family members of patients received support from the healthcare system.ConclusionsMore efforts should be taken to reach patients in need of cancer rehabilitation. Additionally, more attention should be directed towards family members and young children.Relevance to clinical practiceMore than one in four patients claimed to not have received an offer of cancer rehabilitation, and an even greater number of patients claimed that their spouses and children had never received an offer for this service either. Hence, there is a communication barrier that needs to be overcome. Health providers should be aware that information needs to be repeated several times, and presented both orally and in writing.
Mothers’ experiences of managing their child's pain before and during attendance at the emergency department
Authors: Edmonds Jenny , Twycross Alison 
Published: March 2018

Aims and objectivesTo explore mothers’ experiences of managing their child's pain before and during attendance at the emergency department.BackgroundPain accounts for 50%–80% of all visits to the emergency department. Historically paediatric pain has been poorly managed in the emergency department and there remains variability in practice. It is mothers who usually bring their child to the emergency department and as such it is important to explore their perspectives of how pain is managed.DesignExploratory qualitative study.MethodologySemi‐structured interviews were carried out with mothers (n = 10) of children who have attended the emergency department in one hospital in the East of England during April 2015.ResultsMost mothers felt able to assess their child's pain and reported attending the emergency department when their normal pain‐relieving strategies failed following an injury. Several mothers sought advice from elsewhere before bringing their child to the emergency department. The advice received was usually to take their child to the emergency department. Mothers welcomed the professional approach to pain management in the emergency department and valued being kept informed about their child's care. Mothers rated the care provided in the emergency department as good or very good.ConclusionsMothers attended the emergency department when their normal pain‐relieving strategies failed. This suggests there is a need to provide additional resources to support parents in this context. Mothers often brought their child to the emergency department rather than their General Practitioner or other primary healthcare providers. The reasons for this need exploring further.Relevance to clinical practiceThe results suggest that mothers need additional resources to enable them to manage their child's pain at home following an injury. The reasons mothers attend the emergency department rather than other healthcare providers need exploring in more depth.
The older patient's experience of the healthcare chain and information when undergoing colorectal cancer surgery according to the enhanced recovery after surgery concept
Authors: Samuelsson Katja Schubert , Egenvall Monika , Klarin Inga , Lökk Johan , Gunnarsson Ulf , Iwarzon Marie 
Published: March 2018

Aims and objectivesTo describe how older patients experience the healthcare chain and information given before, during and after colorectal cancer surgery.BackgroundMost persons with colorectal cancer are older than 70 years and undergo surgery with subsequent enhanced recovery programmes aiming to quickly restore preoperative function. However, adaptation of such programmes to suit the older patient has not been made.DesignQualitative descriptive study.MethodSemi‐structured interviews were conducted on 16 patients undergoing colorectal cancer surgery at a Swedish University Hospital. The inductive content analysis was employed.ResultsDuring the period of primary investigation and diagnosis, a paucity of information regarding the disease and management, and lack of help in coping with the diagnosis of cancer and its impact on future life, leads to a feeling of vulnerability. During their stay in hospital, the patient's negative perception of the hospital environment, their need for support, and uncertainty and anxiety about the future are evident. After discharge, rehabilitation is perceived as lacking in structure and individual adaptation, leading to disappointment. Persistent difficulty with nutrition delays recovery, and confusion regarding division of responsibility between primary and specialist care leads to increased anxiety and feelings of vulnerability. Information on self‐care is perceived as inadequate. Furthermore, provided information is not always understood and therefore not useful.ConclusionInformation before and after surgery must be tailored to meet the needs of older persons, considering the patient's knowledge and ability to understand. Furthermore, individual nutritional requirements and preoperative physical activity and status must be taken into account when planning rehabilitation.Relevance to clinical practicePatient information must be personalised and made understandable. This can improve self‐preparation and participation in the own recovery. Special needs must be addressed early and followed up.
An updated systematic review and meta‐analysis of early outcomes after left atrial appendage occlusion
Authors: Yerasi Charan , Lazkani Mohamad , Kolluru Prathik , Miryala Varun , Kim Jae , Moole Harsha , Sawant Abhishek C. , Morris Michael , Pershad Ashish 
Published: March 2018

BackgroundLeft atrial appendage occlusion (LAAO) is a promising intervention for stroke prevention in patients with non‐valvular atrial fibrillation (NVAF). Early outcomes following LAAO have been published in many studies with variable results.ObjectiveThis updated meta‐analysis aims to provide a summary of the early outcomes of LAAO.MethodsMedline/Pubmed, Ovid Journals, Clinical trials, Abstract meetings, Cochrane databases were searched from January 1st, 1999 to November 30th, 2016.ResultsThis meta‐analysis included 49 studies involving 12 415 patients. The median age was 73.5 years (IQR 72‐75 years) and 43% were males. Hypertension and diabetes were present in 36% and 15% of the population, respectively. There was a prior history of stroke and congestive heart failure in 14% and 18% of the population, respectively. The median CHADS2 score was 2.9 (IQR 2.6‐3.3) and the median HASBLED score was 3.3 (IQR 3‐4). LAAO implantation was successful in 96.3% of patients (95.40‐97.08, I2 = 76.1%). The pooled proportion of all‐cause mortality was 0.28% (0.19‐0.38, I2 = 0%). The pooled proportion of all‐cause stroke was 0.31% (0.22‐0.42, I2 = 9.4%), major bleeding requiring transfusion was 1.71% (1.13‐2.41, I2 = 73.2%), and pericardial effusion was 3.25% (2.46‐4.14, I2 = 79%). Sub analysis of randomized clinical trials comparing LAAO devices to warfarin showed lower mortality (P = 0.03) with similar bleeding risk (P = 0.20) with LAAO.ConclusionsThis meta‐analysis concludes that LAAO occlusion is a safe and effective stroke prevention strategy in patients with NVAF.
The Association Between Family–Teacher Partnership Satisfaction and Outcomes of Academic Progress and Quality of Life for Children/Youth With Autism
Authors: Goldrich Eskow Karen , Ann Summers Jean , Chasson Gregory S. , Mitchell Renae 
Published: March 2018

AbstractAs the prevalence of Autism Spectrum Disorders (ASD) increases, teachers and special education service providers are experiencing increased contact with not only children with ASD, but also with their parents and families. Partnerships between families and teachers have become more commonplace in the last 20 years in response to mandates related to parent involvement by federal law. The present study examined the relationship between parent–teacher partnership satisfaction and child progress and family quality of life among children (n = 313) receiving autism waiver services (Waiver—Home and Community‐Based Services Waivers (42 U.S.C. SS 1915(b) (c)) and those whose families expressed an interest in receiving waiver services (registry). Results indicated family–teacher partnership satisfaction was associated with parent‐reported improvement in academic progress and family quality of life. These findings were not dependent on group status (waiver vs. registry) and highlight the importance of the quality of service delivery through family–teacher partnerships for children with ASD.
Cardiovascular autonomic dysfunction in insomnia patients with objective short sleep duration
Authors: Jarrin Denise C. , Ivers Hans , Lamy Manon , Chen Ivy Y. , Harvey Allison G. , Morin Charles M. 
Published: March 2018

SummaryTwo phenotypes have been proposed: insomnia with objective near‐normal sleep duration, related to increased psychological symptoms, and insomnia with objective short sleep duration, associated with cardiometabolic morbidity. Reduced heart rate variability has also been implicated in the pathophysiology of cardiometabolic disease; however, there are little data on whether cardiovascular function differs between patients with objective short sleep duration and near‐normal sleep duration. Participants (Mage = 49.9 ± 11.3 years; 62.8% female) were 180 adults with chronic insomnia (Mduration = 15.7 ± 13.6). Objective sleep duration was based on total sleep time averaged across two consecutive nights of polysomnography and subjective sleep duration was based on 2‐week sleep diaries. The sample was divided into two groups, with sleep duration shorter (polysomnography‐total sleep time: n = 46; sleep diary: n = 95) or equal/longer (polysomnography‐total sleep time: n = 134; sleep diary: n = 85) than 6 hr. Electrocardiogram data derived from polysomnography were used to obtain heart rate and heart rate variability during stage 2 (N2) and rapid eye movement sleep. Heart rate variability measures included absolute and normalized high‐frequency component, an index of parasympathetic activation, and the ratio of low‐ to high‐frequency (LF/HF ratio), an index of sympathovagal balance. After controlling for covariates (e.g., co‐morbidity), patients with objective short sleep duration had reduced high‐frequency (p < .05) and elevated low‐frequency/high‐frequency ratio (p = .036) and heart rate (p = .051) compared with patients with near‐normal sleep duration. No differences were observed between phenotypes when subjective sleep duration was used. Insomnia patients with objective short sleep duration showed significantly dampened parasympathetic activation and increased sympathovagal imbalance relative to their counterparts with near‐normal sleep duration. These findings highlight the importance of treating insomnia, as treatment may reduce the risk of cardiovascular disease.
Investigation of sleep spindle activity and morphology as predictors of neurocognitive functioning in medicated patients with schizophrenia
Authors: Baandrup Lone , Christensen Julie A. E. , Fagerlund Birgitte , Jennum Poul 
Published: March 2018

SummaryNeurocognitive impairment is a trait marker of schizophrenia, but no effective treatment has yet been identified. Sleep spindle deficits have been associated with diminished sleep‐dependent memory learning. We examined whether this link could be extended into various cognitive domains by investigating the association of a neurocognitive test battery (the Brief Assessment of Cognition in Schizophrenia) with sleep spindle activity and morphology. We examined 37 outpatients diagnosed with schizophrenia and medicated with both antipsychotics and benzodiazepines. Participants underwent 1 night polysomnography and test of neurocognitive functioning. We identified and analysed sleep spindles in all non‐rapid eye movement sleep and in non‐rapid eye movement sleep stage 2 in a central electroencephalography channel using an automatic sleep spindle detector previously validated. Slow sleep spindle density was computed from a frontal electroencephalography channel as well. We found no association between cognitive functioning and sleep spindle density or sleep spindle morphology for spindles in non‐rapid eye movement sleep when controlling for gender, age, symptom severity, and daily dose of antipsychotics and benzodiazepines. For spindles in non‐rapid eye movement sleep stage 2, we found that motor speed was associated with frontal slow sleep spindle density. We conclude that frontal slow spindle density might predict motor speed in medicated patients with schizophrenia, but that no other sleep spindle activity or sleep spindle morphology measures were predictors of neurocognitive functioning.
An overview of sleep and circadian dysfunction in Parkinson's disease
Authors: Mantovani Susanna , Smith Simon S. , Gordon Richard , O'Sullivan John D. 
Published: March 2018

SummarySleep and circadian alterations are amongst the very first symptoms experienced in Parkinson's disease, and sleep alterations are present in the majority of patients with overt clinical manifestation of Parkinson's disease. However, the magnitude of sleep and circadian dysfunction in Parkinson's disease, and its influence on the pathophysiology of Parkinson's disease remains often unclear and a matter of debate. In particular, the confounding influences of dopaminergic therapy on sleep and circadian dysfunction are a major challenge, and need to be more carefully addressed in clinical studies. The scope of this narrative review is to summarise the current knowledge around both sleep and circadian alterations in Parkinson's disease. We provide an overview on the frequency of excessive daytime sleepiness, insomnia, restless legs, obstructive apnea and nocturia in Parkinson's disease, as well as addressing sleep structure, rapid eye movement sleep behaviour disorder and circadian features in Parkinson's disease. Sleep and circadian disorders have been linked to pathological conditions that are often co‐morbid in Parkinson's disease, including cognitive decline, memory impairment and neurodegeneration. Therefore, targeting sleep and circadian alterations could be one of the earliest and most promising opportunities to slow disease progression. We hope that this review will contribute to advance the discussion and inform new research efforts to progress our knowledge in this field.
Harrod's long‐range capital outlay as a stabilizer of Harrodian instability
Authors: Franke Reiner 
Published: March 2018

AbstractDrawing on Harrod, Kalecki and Kaldor, this paper seeks to revive the view that ceteris paribus firms reduce investment if they have already built up high capacities relative to their assessment of the normal potential of their markets. This reaction introduces a fundamental stabilizing mechanism into the economy. The paper adapts the idea to a growth context and applies it to the neo‐Kaleckian baseline model with its Harrodian instability. It demonstrates that, in principle, a sufficiently strong feedback could stabilize the steady state.
Evaluation of a chronic kidney disease risk assessment service in community pharmacies
Authors: Gheewala Pankti A , Peterson Gregory M , Zaidi Syed Tabish R , Jose Matthew D , Castelino Ronald L 
Published: March 2018

ABSTRACTAimTargeted ‘opportunistic’ screening might be a sustainable approach for the early detection of people with undiagnosed chronic kidney disease (CKD). The aim of this study was to implement and evaluate a CKD risk assessment service in the community pharmacy setting.MethodsTwenty‐four pharmacies in Tasmania, Australia participated in this study. Targeted people were aged between 50 and 74 years, with at least one CKD risk factor. The QKidney risk calculator was used to estimate the participants’ 5‐year percentage risk of developing moderate–severe CKD. Participants identified with ≥3% risk were referred to their general practitioner (GP) and followed‐up after 9 months. Laboratory data was collected from a pathology provider. The main outcome measures were rates of GP referral uptake and of participants who underwent estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (ACR) measurement.ResultsWe analyzed data for 389 screened participants, of whom 203 (52.1%) had ≥3% 5‐year risk of developing moderate–severe CKD and were referred to their GP. Follow‐up was successful for 126 participants and showed low (27%) GP referral uptake. Analysis of the pathology data revealed suboptimal kidney testing in participants with ≥3% risk, with eGFR and ACR tests performed for only 52.7% and 25.1% of these participants, respectively.ConclusionsThere is significant scope for improving early detection of CKD via implementation of a community pharmacy‐based CKD risk assessment service. However, a healthcare system that encourages inter‐professional collaboration between community pharmacists and GPs, and provides a robust referral pathway is needed to optimize the effectiveness of this service.
Income Inequality and Saving
Authors: Alvarez‐Cuadrado Francisco , El‐Attar Vilalta Mayssun 
Published: March 2018

AbstractOver the last three decades, the average income for the bottom half of the US distribution increased by 8% while their average saving rate decreased by 8 percentage points. Over the same period, the US experienced a substantial increase in inequality and a continuous decrease in the aggregate saving rate. We propose an explanation based on interpersonal comparisons consistent with these trends. When households care about their consumption relative to others, individual saving rates decrease with reference income while aggregate saving decreases with income inequality. We provide evidence from the PSID and a panel of OECD countries consistent with these predictions.
Glaucoma referral refinement in Ireland: managing the sensitivity‐specificity paradox in optometric practice
Authors: Barrett Catriona , O'Brien Colm , Loughman James 
Published: March 2018

AbstractPurposeGlaucoma referral refinement (GRR) has proven a successful demand management strategy for glaucoma suspect cases in the United Kingdom (UK). A GRR clinic was established in Dublin, Ireland to investigate the clinical viability of this pathway outside the UK's National Health Service (NHS) structures, and away from the influence of National Institute for Clinical Excellence (NICE) guidance.MethodsGlaucoma suspect patients were recruited into the scheme following referral from community optometrists in the greater Dublin area. The GRR exam protocol was designed in consultation with the participating ophthalmology department. The refinement scheme optometrist, trained through apprenticeship style experience at a hospital outpatient clinic, made a tentative management decision after carrying out the GRR exam. The final management decision was made in a ‘virtual clinic’ by a glaucoma specialist consultant ophthalmologist.ResultsTwo hundred and twenty‐five glaucoma suspect patients were seen in the scheme. After their first GRR visit, 28% were discharged back to their own optometrist, 42% were monitored in the GRR clinic, and 30% were referred to ophthalmology. After this monitoring cohort were further assessed, a total of 38% of the patients seen within the scheme required referral to ophthalmology. Sixteen percent of the total participant group (n = 225) were lost to follow up. Cohen's κ was used to determine the level of agreement between the scheme optometrist and ophthalmologist. There was substantial agreement, with κ = 0.63 for the first visit management decisions (n = 225). Agreement increased for subsequent monitoring visits with κ = 0.85 for second visits (n = 65), and κ = 0.69 for all management decisions within the scheme (n = 301). We received management outcomes for 44 of the 86 patients referred to ophthalmology. Of these 44, 57% received medical treatment for glaucoma, 34% were monitored without treatment, 2% were discharged, and 7% had comorbidities that were assessed and managed.ConclusionOf the patients seen within the scheme, 62% did not require referral onward to ophthalmology, thus releasing the significant majority of hospital clinic slots that would previously have been required to examine such patients. The high level of inter‐professional decision agreement likely reflects the benefits of pre‐scheme apprenticeship style training and ongoing hospital clinic participation by the scheme optometrist. The rate of loss to follow up compares favourably with ophthalmology led, hospital based, glaucoma clinics. Nevertheless, the losses indicate that patient education remains a key priority for future planning.
Use of topical therapies for pediatric psoriasis: A systematic review
Authors: Kravvas Georgios , Gholam Karolina 
Published: March 2018

AbstractPsoriasis is one of the most common chronic skin diseases, affecting 1%‐3% of the general population. It can have a significant negative impact on a patient's quality of life, and in approximately 30% of patients first symptoms can be traced back to childhood. We have performed a comprehensive literature search using the MEDLINE database in order to ascertain the efficacy and adverse reactions of topical treatments in pediatric psoriasis. A total of 13 relevant articles were identified on the following topical agents: corticosteroids, calcineurin inhibitors, vitamin D analogs, and dithranol. Corticosteroids achieved clearance in 72.7% of patients. Calcitriol lead to a 57.2%‐100% mean improvement in severity, and calcipotriol to 52%‐64%. Combination of calcipotriol and corticosteroids achieved an improvement in mean severity ranging between 32.1% and 80%. Treatment with tacrolimus lead to an >50% improvement. Finally, short contact dithranol lead to a variable response in clearance between different studies, ranging between 3.7% and 81%. No serious adverse reactions were documented, the most common local reaction being irritation. Pediatric psoriasis is a common and challenging condition with no easy and definitive solution. Topical agents are safe, easy to use, readily available and cheap. However, they need to be applied repeatedly, may cause skin irritation, and can be messy. Based on the results presented above, we recommend utilizing all the available topical options before escalating to systemic treatments.