bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neighbourhood Material and Social Deprivation and Exposure to Antidepressant Drug Treatment: A Cohort Study Using Administrative Data
Authors: Lauzier Sophie , Kadachi Hichem , Moisan Jocelyne , Vanasse Alain , Lesage Alain , Fleury Marie-Josée , Grégoire Jean-Pierre 
Published: March 2018

Objective: To assess whether neighbourhood deprivation is associated with exposure to an antidepressant drug treatment (ADT) and its quality among individuals diagnosed with unipolar depression and insured by the Quebec public drug plan. Method: We conducted an administrative database cohort study of adults covered by the Quebec public drug plan who were diagnosed with a new episode of unipolar depression. We assessed material and social deprivation using an area-based index. We considered exposure to an ADT as having ≥1 claim for an ADT within the 365 days following depression diagnosis. Among those exposed to ADT, ADT quality was assessed with 3 indicators: first-line recommended ADT, persistence with the ADT, and compliance with the ADT. Generalized linear models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI). Results: Of 100,432 individuals with unipolar depression, 65,436 (65%) were exposed to an ADT in the year following the diagnosis. Individuals living in the most materially deprived areas were slightly more likely to be exposed to an ADT than those living in the least deprived areas (aPR, 1.04; 95% CI, 1.03 to 1.06). The likelihoods of being exposed to a first-line ADT, persisting for the minimum recommended duration and complying with the ADT were independent of the deprivation levels. Conclusions: Neighbourhood deprivation was not associated with ADT quality among individuals insured by the Quebec public drug plan. It might be partly attributable to the public drug plan whose goal is to provide equitable access to prescription drugs regardless of income.
The Doctor–Patient Relationship and Information-Seeking Behavior
Authors: Adamson Matthew , Choi Kelsey , Notaro Stephen , Cotoc Crina 
Published: March 2018

Background: In cancer communication, patients and physicians often understand a patient’s experience and situation differently. This can negatively impact health outcomes and the physician–patient relationship. Aim: To explore how cancer patients’ interpretations of the physician’s role as information giver affect the communication relationship with the physician and their information-seeking behavior regarding different aspects of their cancer care. Design: Participants completed a semistructured qualitative interview addressing their treatment experience and communication with their physician. Interviews were coded and analyzed using inductive thematic analysis. Setting/Participants: Ten patients with cancer treated at a regional cancer center in central Illinois participated in the study. Cancer stages I to IV and 4 cancer types were represented. Results: Participants’ orientations to the relationship with their physician (and their information-seeking behavior) were classified into 4 general categories: (1) “questioners” have a general mistrust toward their physicians and the information doctors are giving; (2) “the undecided” focuses on physician “fit,” often requiring time to step away in order to make decisions and process information; (3) “cross-checkers” are concerned with content of their treatment protocol, often double-checking the treatment plan; and (4) “the experience-oriented” feel a gap between their experience and their physician’s experience (and perspective), often seeking information from other survivors. All categories described a perceived lack of adequate exchange of information and the need to seek information outside of the physician–patient relationship to compensate. Conclusion: Participants exhibited different information-seeking behaviors based on how they interpreted the role of their physician as information giver. This affected what kind of information they sought and how they understood the information received, which in turn affected understanding of their broader experience and care.
Assessing Acid–Base Status in Circulatory Failure: Relationship Between Arterial and Peripheral Venous Blood Gas Measurements in Hypovolemic Shock
Authors: Rudkin Scott E. , Anderson Craig L. , Grogan Tristan R. , Elashoff David A. , Treger Richard M. 
Published: March 2018

Background and Objectives: In severe circulatory failure agreement between arterial and mixed venous or central venous values is poor; venous values are more reflective of tissue acid–base imbalance. No prior study has examined the relationship between peripheral venous blood gas (VBG) values and arterial blood gas (ABG) values in hemodynamic compromise. The objective of this study was to examine the correlation between hemodynamic parameters, specifically systolic blood pressure (SBP) and the arterial–peripheral venous (A-PV) difference for all commonly used acid–base parameters (pH, Pco 2, and bicarbonate). Design, Setting, Participants, and Measurements: Data were obtained prospectively from adult patients with trauma. When an ABG was obtained for clinical purposes, a VBG was drawn as soon as possible. Patients were excluded if the ABG and VBG were drawn >10 minutes apart. Results: The correlations between A-PV pH, A-PV Pco 2, and A-PV bicarbonate and SBP were not statistically significant ( P = .55, .17, and .09, respectively). Although patients with hypotension had a lower mean arterial and peripheral venous pH and bicarbonate compared to hemodynamically stable patients, mean A-PV differences for pH and Pco 2 were not statistically different ( P = .24 and .16, respectively) between hypotensive and normotensive groups. Conclusions: In hypovolemic shock, the peripheral VBG does not demonstrate a higher CO2 concentration and lower pH compared to arterial blood. Therefore, the peripheral VBG is not a surrogate for the tissue acid–base status in hypovolemic shock, likely due to peripheral vasoconstriction and central shunting of blood to essential organs. This contrasts with the selective venous respiratory acidosis previously demonstrated in central venous and mixed venous measurements in circulatory failure, which is more reflective of acid–base imbalance at the tissue level than arterial blood. Further work needs to be done to better define the relationship between ABG and both central and peripheral VBG values in various types of shock.
A qualitative description of service providers’ experiences of ethical issues in HIV care
Authors: Sabone Motshedisi B , Mogobe Keitshokile Dintle , Matshediso Ellah , Shaibu Sheila , Ntsayagae Esther I , Corless Inge B , Cuca Yvette P , Holzemer William L , Dawson-Rose Carol , Soliz Baez Solymar S , Rivero-Mendz Marta , Webel Allison R , Eller Lucille Sanzero , Reid Paula , Johnson Mallory O , Kemppainen Jeanne , Reyes Darcel , Nokes Kathleen , Wantland Dean , Nicholas Patrice K , Lingren Teri , Portillo Carmen J , Sefcik Elizabeth , Long-Middleton Ellen 
Published: March 2018

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care.
Effects of an ethical empowerment program on critical care nurses’ ethical decision-making
Authors: Jamshidian Fatemeh , Shahriari Mohsen , Aderyani Mohsen Rezaei 
Published: March 2018

Background: Nurses require empowerment if they are to make ethical decisions. Ethical empowerment has always been one of the main concerns in nurse training programs. Research aim: The present study was conducted to determine the effect of an ethical empowerment program on critical care nurses’ ethical decision-making. Research design: This is a clinical trial study with two groups and pre and post design. Participants and research context: In this study, 60 nurses working in Intensive Care Unit were selected through random sampling and then divided into a control and an experimental group after filling out the Moral Sensitivity Questionnaire. Both groups completed the questionnaire again immediately and 2 months after the ethical empowerment workshop had been held for the experimental group. The collected data were analyzed in SPSS-16 using descriptive and inferential statistics. Ethical considerations: The goals of the study were explained to the participants and then a written informed consent was received from them. Findings: The results showed no significant differences between the two groups in terms of their ethical sensitivity scores at the beginning of the study; however, immediately and 2 months after the intervention, the mean score increased significantly in the experimental group. Moreover, the scores obtained 2 months after the workshop increased compared to the pre-intervention scores but showed a drop compared to the scores reported immediately after the workshop. Discussion: The ethical empowerment program, given to the critical care nurses in this study, improved their ethical sensitivity in making decisions significantly over time. Despite the extensive methods, available for teaching nursing ethics, the ethical empowerment program, adopted in this study, had long-lasting effects in terms of ameliorating the process of ethical decision-making in clinical situations. Conclusion: The ethical empowerment of nurses requires the adoption and application of proper methods and patterns of complying with nursing ethics.
A Pilot Study of a Mindfulness-Based Art Therapy Intervention in Outpatients With Cancer
Authors: Meghani Salimah H. , Peterson Caroline , Kaiser Donna H. , Rhodes Joseph , Rao Hengyi , Chittams Jesse , Chatterjee Anjan 
Published: March 2018

Background: Patients with cancer frequently experience physical and psychological distress that can worsen their quality of life. Objectives: We assessed the outcomes of an 8-week mindfulness-based art therapy (MBAT) intervention, Walkabout: Looking In, Looking Out, on symptoms, sleep quality, health-related quality of life, sense of coherence (SOC), and spirituality in outpatients with cancer. Methods: A 1-group, pre–post intervention design with repeated measures at baseline, week 4, and week 8. Results: Despite a small pilot sample (n = 18), we found large effect sizes and statistically significant improvements from week 1 to week 8 in depression, the comprehensibility subscale of the SOC, and each subscale of spirituality, that is, peace, meaning, and faith. There were no significant changes in physical functioning, pain, sleep, tiredness, drowsiness, nausea, and appetite. Conclusions: The MBAT intervention, Walkabout, seems to meet key palliative care goals including improvement in emotional well-being, comprehensibility, and meaning making among outpatients with cancer.
Work Motivation in the Rhetoric of Component Content Management
Authors: Batova Tatiana 
Published: March 2018

This article describes a 12-month qualitative study that analyzes how a company’s transition to component content management (CCM)—a set of methodologies, processes, and technologies that allows working with texts as small components rather than complete, static documents—influences the work motivation of its technical communicators. The analysis is based on actor-network theory and the theories of work motivation from economics. When technical communicators felt that CCM’s only focus was efficiency and savings and that they were not recognized and connected to the fruits of their labor, their motivation decreased. But their motivation increased when they were engaged in job crafting—reshaping their understanding of the fruits of their labor and gaining recognition through prosocial behavior.
Dentoalveolar Cleft Treatment Outcome Using Modified Huddart-Bodenham Index and Regression Analysis of Associated Factors
Authors: Arshad Anas Imran , Alam Mohammad Khursheed , Khamis Mohammad Fadhli 
Published: March 2018

Objectives: The aim of this study is to assess the treatment outcome of complete unilateral cleft lip and palate (CUCLP) patients using modified Huddart/Bodenham scoring system (MHB). To determine whether there is an association of congenital and postnatal factors with the treatment outcome. Design: Retrospective observational study. Setting: Two regional cleft-referral centers. Main Outcome Measures: In the current study, 101 pairs of dental models of non-syndromic CUCLP patients were retrieved from hospital archives. Each occlusal relationship from central incisor till the first permanent molars were scored except the lateral incisor. Sum of 10 occlusal relationships in each study sample gave a total occlusion score. The primary outcome was the mean total occlusion score. Results: According to MHB, a mean (standard deviation) total occlusion score of –8.92 (6.89) was determined. Based on treatment outcome, 66 cases were favorable (grades 1, 2, and 3) and 35 cases were unfavorable (grades 4 and 5). Chi-square tests indicated, difference of cheiloplasty ( P = .001) and palatoplasty ( P < .001) statistically significant. Five variables—gender, family history of cleft, cleft side, cheiloplasty, and palatoplasty—were analyzed with a logistic regression model. Conclusions: Final model indicated that cases treated with modified Millard technique (cheiloplasty) and Veau-Wardill-Kilner method (palatoplasty) had higher odds of unfavorable treatment outcome.
The integration of transabdominal ultrasound simulators into an ultrasound curriculum
Authors: Orr KE , Hamilton SC , Clarke R , Adi MY , Gutteridge C , Suresh P , Freeman SJ 
Published: March 2018

Introduction Simulation is increasingly used throughout medicine. Within ultrasound, simulators are more established for learning transvaginal and interventional procedures. The use of modern high-fidelity transabdominal simulators is increasing, particularly in centres with large trainee numbers. There is no current literature on the value of these simulators in gaining competence in abdominal ultrasound. The aim was to investigate the impact of a new ultrasound curriculum, incorporating transabdominal simulators into the first year of training in a UK radiology academy. Methods The simulator group included 13 trainees. The preceding cohort of 15 trainees was the control group. After 10 months, a clinical assessment was performed to assess whether the new curriculum resulted in improved ultrasound skills. Questionnaires were designed to explore the acceptability of simulation training and whether it had any impact on confidence levels. Results Trainees who had received simulator-enriched training scored higher in an objective clinical ultrasound assessment, which was statistically significant ( p = 0.0463). End confidence scores for obtaining diagnostic images and demonstrating pathology were also higher in the simulation group. All trainees stated that transabdominal simulator training was useful in early training. Conclusions This initial study shows that embedded into a curriculum, transabdominal ultrasound simulators are an acceptable training method that can result in improved ultrasound skills and higher confidence levels. Using simulators early in training could allow trainees to master the basics, improve their confidence, enabling them to get more educational value from clinical ultrasound experience while reducing the impact of training on service provision.
An inquiry into what organised difficult advance care planning conversations in a Scottish residential care home using institutional ethnography
Authors: Reid Lorna , Kydd Angela , Slade Bonnie 
Published: March 2018

Aim This paper provides an institutional ethnographic analysis of how advance care planning discussions, which included advance decisions about serious illness, hospital admission and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms, were systematically placed into the hands of senior social care workers (SSCWs) in a residential care home (RCH). RCHs are care settings where there are no on-site nurses, and access to hospital and/or community doctors and nurses is limited. Methods The paper traces the organising features of day-to-day work gathered from interviews with SSCWs ( n = 4) and others ( n = 6) whose (well-intentioned) work shaped what happened in the RCH. Results It shows how the experience of SSCWs was socially organised to happen as it did as they (and others) complied with powerful organising texts such as national and local policy documents, care plans and audit forms. The paper concludes that although SSCWs decision-making conversations were out of alignment with the national DNACPR policy, they cannot simply be described as poor practice. This is because they were socially organised by a complex web of institutional practices related to the occupancy rate in the RCH, the inspection process of the care home scrutiny body, the quality assurance process of the RCH company, the funding of palliative care education, and powerful political and fiscal drives to reduce spending on over-75s. These practices had little to do with the actual care needs of RCH residents or the actual support needs of RCH staff. Conclusions The paper points towards necessary policy changes. It also highlights how ‘competent’ work driven by ideological institutional practices can result in ethically troubling situations in day-to-day working life. This emphasises the importance of carefully examining the social organisation of situations typically described as poor practice if we are to understand how they are (re)produced. It also offers a different account of care home deaths than is typically presented in the professional literature.
Successful pregnancy in a recipient of an ABO-incompatible renal allograft
Authors: Rao Nitesh N , Wilkinson Chris , Morton Mark , Bennett Greg D , Russ Graeme R , Coates Patrick T , Jesudason Shilpa 
Published: March 2018

Kidney transplantation restores fertility in patients with end-stage renal disease, with many successful pregnancies after kidney transplantation being reported. However, there are little data regarding pregnancy in women transplanted under modern-era desensitisation protocols that utilise rituximab, plasma exchange and intravenous immunoglobulin, including ABO-incompatible transplants. Pregnancies in ABO-incompatible recipients can pose new challenges from an immunological perspective. Here, we report a case of successful pregnancy using in vitro fertilisation, in a renal transplant recipient who underwent desensitisation two years prior, that included use of rituximab and plasma exchange to receive an ABO-incompatible transplant from her husband and subsequent father of the baby. We believe this was the first case of successful pregnancy after ABO-incompatible kidney transplantation in Australia and New Zealand. This case also highlights the difficulties faced in conception following transplantation and demonstrates that in vitro fertilisation utilising ovulation induction can be successfully utilised for conception in this cohort. This recipient also had gestational diabetes, worsening renal function and preterm delivery which are important complications often seen in pregnancies of solid organ transplant recipients.
Lifestyle factors and risk for colorectal polyps and cancer at index colonoscopy in a FIT‐positive screening population
Authors: Colussi Dora , Fabbri Margherita , Zagari Rocco Maurizio , Montale Amedeo , Bazzoli Franco , Ricciardiello Luigi 
Published: March 2018

BackgroundMany countries have adopted the fecal immunochemical test (FIT) as the primary colorectal cancer (CRC) screening tool; however, its accuracy is limited. Epidemiological studies have shown that obesity and type 2 diabetes increase risk for the disease.ObjectiveThe objective of this article is to evaluate the association of colorectal polyps and cancer with comorbidities and lifestyle factors in a population that is part of a FIT‐based CRC screening program.MethodsBetween 2005 and 2013, we analyzed 3894 FIT + patients who underwent total colonoscopy. The impact of lifestyle factors on polyps and cancer was assessed using individuals with a negative colonoscopy as the control group. A multivariate logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsWe collected data from 3894 FIT + patients. Obesity (OR 1.29; 95% CI 1.05–1.60) and smoking (OR 1.45; 95% CI 1.24–1.71) were significantly associated with high‐risk adenomas. Smoking and heavy alcohol drinking were both independently associated with high risk of CRC (OR 1.50; 95% CI 1.10–2.04 and OR 2.29; 95% CI 1.15–4.58) and colon cancer alone (OR 1.43; 95% CI 1.01–2.02 and OR 3.09; 95% CI 1.53–6.23). Positivity to first round of FIT was associated with high‐risk adenomas (OR 1.47; CI 95% 1.26–1.71) and CRC (OR 1.74; 95% CI 1.29–2.36). No associations were found for diabetes.ConclusionIn our FIT + population, lifestyle factors are significantly associated with the risk of carrying high‐risk adenomas and CRC. In the future, studies could be aimed at finding better screening strategies through the development of clinical algorithms based on lifestyle changes/comorbidities.