bluuebunny/crossref_metadata_2025_split huggingface dataset:
Scoping Review of the Role of Shared Decision Making in Dental Implant Consultations
Authors: Alzahrani A.A.H. , Gibson B.J. 
Published: March 2018

To what extent does dental research on implant consultations focus on the use of shared decision making? There has been an explosion in the use of implant therapies in dentistry, but very little is known about the decision-making processes involved in the provision of dental implants. The use of shared decision making (SDM) has been found to reduce undesirable outcomes and increase patient and clinician satisfaction in other health care fields. This scoping review reports on the current status of SDM in research on implant therapies. A scoping review methodology was used. Web of Knowledge, MEDLINE via OvidSP, MEDLINE via PubMed, Embase, Scopus, Cochrane, DARE, and CINAHL databases were reviewed between 1900 and December 1, 2017. The search strategy resulted in 2,289 eligible articles; 1,892 duplicated articles were deleted, resulting in a hand search of 397 titles and abstracts. These were subsequently evaluated while applying the inclusion and exclusion criteria, resulting in 48 articles for full-text evaluation. After full-text evaluation of these 48 studies, a further 27 were eliminated as not being relevant, leading to the inclusion of 21 studies for the review. No studies to date have examined how patients and dentists engage in decisions to place dental implants. Aspects that were discussed in the literature related to the decision-making process included a discussion about patients’ values and discussing possible treatment options. How patients and dentists interacted during implant consultations was poorly explored. Shared decision making has been shown to improve health care quality and increase clinician and patient satisfaction. Further research concerning dental implant decisions is warranted with emphasis on evaluating patients’ contributions to treatment, which is currently poorly understood. Exploring existed methods for examining the SDM process in implant consultations should facilitate improve care and consent. Knowledge Transfer Statement: The findings of this scoping review can be used by all dentists when deciding which decision-making model they wish to use when planning implant therapy. The article places special emphasis on the role of shared decision making in improving health care quality and increasing patients’ and clinicians’ satisfaction.
Impact of diabetes mellitus on ischemic cardiomyopathy. Five-year follow-up. REVISION-DM trial
Authors: Hueb Thiago , Rocha Mauricio S. , Siqueira Sergio F. , Nishioka Silvana Angelina D´Orio , Peixoto Giselle L. , Saccab Marcos M. , Lima Eduardo Gomes , Garcia Rosa Maria Rahmi , Ramires José Antonio F. , Kalil Filho Roberto , Martinelli Filho Martino 
Published: March 2018

Abstract
Background
Patients with ischemic cardiomyopathy and severe left ventricular dysfunction have a worse survival prognosis than patients with preserved ventricular function. The role of diabetes in the long-term prognosis of this patient group is unknown. This study investigated whether the presence of diabetes has a long-term impact on left ventricular function.

Methods
Patients with coronary artery disease who underwent coronary artery bypass graft surgery, percutaneous coronary intervention, or medical therapy alone were included. All patients had multivessel disease and left ventricular ejection fraction measurements. Overall mortality, nonfatal myocardial infarction, stroke, and additional interventions were investigated.

Results
From January 2009 to January 2010, 918 consecutive patients were selected and followed until May 2015. They were separated into 4 groups: G1, 266 patients with diabetes and ventricular dysfunction; G2, 213 patients with diabetes without ventricular dysfunction; G3, 213 patients without diabetes and ventricular dysfunction; and G4, 226 patients without diabetes but with ventricular dysfunction. Groups 1, 2, 3, and 4, respectively, had a mortality rate of 21.6, 6.1, 4.2, and 10.6% (P < .001); nonfatal myocardial infarction of 5.3, .5, 7.0, and 2.6% (P < .001); stroke of .40, .45, .90, and .90% (P = NS); and additional intervention of 3.8, 11.7, 10.3, and 2.6% (P < .001).

Conclusion
In this sample, regardless of the treatment previously received patients with or without diabetes and preserved ventricular function experienced similar outcomes. However, patients with ventricular dysfunction had a worse prognosis compared with those with normal ventricular function; patients with diabetes had greater mortality than patients without diabetes.
Trial registrationhttp://www.controlled-trials.com. Registration Number: ISRCTN66068876
Incidence of unipolar and bipolar depression, and mania in adults with intellectual disabilities: prospective cohort study
Authors: Cooper Sally-Ann , Smiley Elita , Allan Linda , Morrison Jillian 
Published: March 2018

BackgroundIncidence and determinants of affective disorders among adults with intellectual disabilities are unknown.AimsTo investigate affective disorder incidence, and determinants of unipolar depression, compared with general population reports.MethodProspective cohort study measuring mental ill health of adults with mild to profound intellectual disabilities living within a defined community, over 2 years.ResultsThere was 70% cohort retention (n= 651). Despite high mood stabiliser use (22.4%), 2-year incident mania at 1.1% is higher than the general population; 0.3% for first episode (standardised incident ratio (SIR) = 41.5, or 52.7 excluding Down syndrome). For any bipolar episode the SIR was 2.0 (or 2.5 excluding Down syndrome). Depression incidence at 7.2% is similar to the general population (SIR = 1.2), suggesting more enduring/undertreatment given the higher prevalence. Problem behaviours (odds ratio (OR) = 2.3) and life events (OR = 1.3) predict incident unipolar depression.ConclusionsDepression needs improved treatment. Mania has received remarkably little attention in this population, despite high prevalence and incidence (similar to schizophrenia), and given the importance of clinician awareness for accurate differential diagnosis from attention-deficit hyperactivity disorder and problem behaviours.Declaration of interestNone.
Generalized Competing Event Models Can Reduce Cost and Duration of Cancer Clinical Trials
Authors: Zakeri Kaveh , Panjwani Neil , Carmona Ruben , Shen Hanjie , Vitzthum Lucas K. , Zhang Qiang E. , Murphy James D. , Mell Loren K. 
Published: March 2018

PurposeGeneralized competing event (GCE) models improve stratification of patients according to their risk of cancer events relative to competing causes of mortality. The potential impact of such methods on clinical trial power and cost, however, is uncertain. We sought to test the hypothesis that GCE models can reduce estimated clinical trial cost in elderly patients with cancer.MethodsPatients with nonmetastatic head and neck (n = 9,677), breast (n = 22,929), or prostate cancer (n = 51,713) were sampled from the SEER-Medicare database. Using multivariable Cox proportional hazards models, we compared risk scores for all-cause mortality (ACM) and cancer-specific mortality (CSM) with GCE-based risk scores for each disease. We applied a cost function to estimate the cost and duration of clinical trials with a primary end point of overall survival in each population and in high-risk subpopulations. We conducted sensitivity analyses to examine model uncertainty.ResultsFor the purpose of enriching subpopulations, GCE models reduced estimated clinical trial cost compared with Cox models of ACM and CSM in all disease sites. The relative cost reductions with GCE models compared with ACM and CSM models, respectively, were −68.4% and −14.4% in prostate cancer, −38.8% and −18.3% in breast cancer, and −17.1% and −4.1% in head and neck cancer. Cost savings in breast and prostate cancers were on the order of millions of dollars. The GCE model also reduced relative clinical trial duration compared with CSM and ACM models for all disease sites. The optimal risk score cutoff for clinical trial enrollment occurred near the top tertile for all disease sites.ConclusionGCE models have significant potential to improve clinical trial efficiency and reduce cost, with a potentially large impact in prostate and breast cancers.
Survival Analysis After Neoadjuvant Chemotherapy With Trastuzumab or Lapatinib in Patients With Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer in the GeparQuinto (G5) Study (GBG 44)
Authors: Untch Michael , von Minckwitz Gunter , Gerber Bernd , Schem Christian , Rezai Mahdi , Fasching Peter A. , Tesch Hans , Eggemann Holm , Hanusch Claus , Huober Jens , Solbach Christine , Jackisch Christian , Kunz Georg , Blohmer Jens-Uwe , Hauschild Maik , Fehm Tanja , Nekljudova Valentina , Loibl Sibylle ,   for the GBG and the AGO-B Study Group
Published: March 2018

PurposeThe GeparQuinto phase III trial demonstrated a lower pathologic complete response (pCR; pT0 ypN0) rate when lapatinib was added to standard anthracycline–taxane chemotherapy compared with trastuzumab in patients with human epidermal growth factor receptor 2 (HER2) –positive breast cancer. Here, we report the long-term outcomes.MethodsPatients with HER2-positive tumors (n = 615) received neoadjuvant treatment with epirubicin (E) plus cyclophosphamide (C), followed by docetaxel (T) in combination with either lapatinib (L) or trastuzumab (H; ECH-TH arm: n = 307; ECL-TL arm: n = 308). All patients received adjuvant trastuzumab for a total of 12 months and 18 months in the ECH-TH and ECL-TL arms, respectively. Median follow-up was 55 months.ResultsThree-year disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) were not significantly different between the two treatment arms. Long-term outcomes correlated with pCR (DFS: hazard ratio [HR], 0.63; P = .042; DDFS: HR, 0.55; P = .021; and OS: HR, 0.31; P = .004). A benefit only for OS was observed in patients who were treated with trastuzumab and achieved pCR versus no pCR (HR, 0.15; P = .010), whereas no difference was found in patients with pCR versus without pCR in the lapatinib arm. DFS and DDFS remained unchanged in both treatment arms according to hormone receptor status, whereas OS was significantly better in hormone receptor–positive patients who were treated with neoadjuvant lapatinib (HR, 0.32; P = .019), followed by adjuvant trastuzumab. No difference was observed in hormone receptor–negative patients; however, the small number of events limits this interpretation. Within the hormone receptor–negative cohort, pCR was significantly associated with DFS, DDFS, and OS ( P = .002, .005, and .002, respectively).ConclusionpCR correlated with long-term outcome. In patients with hormone receptor–positive tumors, prolonged anti-HER2 treatment—neoadjuvant lapatinib for 6 months, followed by adjuvant trastuzumab for 12 months—significantly improved survival compared with anti-HER2 treatment with trastuzumab alone.
Pilot Study on the Application of Telemedicine as a Tool for a Population-Based Cancer Registry in Hlegu Township, Yangon Region, Myanmar
Authors: Aye Khin Saw , Wai KhinThet , Swe Yan Naing , Mon Ssu Wynn , Mon Nan Cho Nwe , Naing Win Pa Pa , Aung Soe , Thant Kyaw Zin 
Published: March 2018

Abstract 57 Purpose The cancer burden is rising and threatens the social and economic development of low- and middle-income countries, including Myanmar, in the ASEAN region. A quality cancer registry plays a unique role in planning, the evaluation of cancer control program, treatment, and palliative care. To date, there is a paucity of studies in Myanmar that have focused on the implementation of a population-based cancer registry. In addition, the concept of telemedicine with the use of information technology applications as appropriate during implementation needs to be introduced. Such an approach may be beneficial to those working at the grassroots level for the overall improvement of the processes of community reporting, confirmation of diagnoses, effective referral for palliative care, and the establishment of cancer registries. Methods A pilot study was therefore carried out to formulate the strategic approach for establishing a population-based cancer registry in Hlegu Township in Northern Yangon District, Myanmar. First, the cancer data entry software was created and installed on mobile phones as an information technology tool to initialize telemedicine. Next, 15 health assistants in Hlegu Township were trained in the collection of data and the entry of basic information on patients with cancer, including name, age, gender, national ID, education, occupation, primary diagnosis, and the site of metastasis of confirmed cancer cases through mobile phone applications and reported to the cancer database unit at the Department of Medical Research. Results A total of 126 patients with cancer were registered in Hlegu Township from June 2016 to May 2017. The estimated prevalence of disease is 4.6 per 10,000 people. The most common age at cancer diagnosis was 46 to 65 years (73.58%). Female sex was 2.5 times predominant than male sex (72% v 27%). Among 91 registered female patients with cancer, the three most common cancers were breast (32.35%), cervix (16.17%) and uterine (15.17%). Eighty-five patients with cancer (67.46%) received their diagnosis in public hospitals. Overall, 59% of patients received combination treatment, 19% received surgery only, 16% were treated with traditional medicine, 3% were treated with radiotherapy only, and 3% were treated with chemotherapy only. Conclusion This study is a first step in applying the concept of telemedicine to the creation of a population-based cancer registry in a resource-limited setting. More concerted efforts are needed to move toward a well-established population-based cancer registry in Myanmar. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Breastfeeding Duration and the Risk of All-Cause and Breast Cancer Mortality Among Parous Women From the Mexican Teachers’ Cohort
Authors: Munguía Mishel Unar , Esparza Susana Lozano , Stern Dalia , Posadas Mónica Mazariegos , Ridaura Ruy López , Lajous Martin 
Published: March 2018

Abstract 79 Purpose Women who have breastfed have a lower risk of breast and ovarian cancer and other chronic diseases. Currently, breast cancer has become the leading cause of death from cancer in Mexican women. In Mexico, exclusive breastfeeding rates have declined one third in the last decade, and only 35% of women breastfed at least 1 year, which provides a unique scenario in which to analyze breastfeeding and mortality. The aim of the current study was to estimate the impact of lifetime breastfeeding duration on the risk of all-cause and breast cancer mortality in Mexican women. Methods We analyzed parous women who were enrolled in a Mexican Teachers’ Cohort since 2006 and observed over 10 years. Months of breastfeeding per pregnancy were self-reported at baseline. We categorized participants according to the accumulated duration of any mode of breastfeeding (never, < 6 months, 6 to 11 months, 12 to 23 months, and ≥ 24 months). Deaths were identified using the employer’s database and next of kin reports, and the date and cause of death were obtained from national mortality databases. We used Cox proportional hazards regression models adjusted for baseline age, parity (one, two, three, and four or more children), age at first birth (< 20, 20 to 24, 25 to 29, and ≥ 30 years), BMI at age 18 years (≤ 25 or > 25), socioeconomic level (tertiles), and smoking (current, past, and never) to estimate hazard ratios (HRs). Results Mean age at baseline was 43 ± 7 years. Over 767,600 person-years of follow-up, 952 all-cause deaths and 92 breast cancer deaths occurred among 92,794 parous women. Mean age at death was 57 ± 7 years. The incidence rate per 1,000 person-years of all-cause mortality was 1.8 for women who did not breastfeed, 1.18 (< 6 months), 1.21 (6 to 11 months), 1.01 (12 to 23 months), and 1.26 (≥ 24 months). HRs for all-cause mortality among parous women with lifetime breastfeeding of < 6 months was 0.79 (95% CI, 0.63 to 0.97), 0.85 (95% CI, 0.70 to 1.05) for 6 to 11 months, 0.78 (95% CI, 0.64 to 0.94) for 12-23 months, and 0.88 (95% CI, 0.69 to 1.10) for > 24 months compared with parous women who never breastfed. No dose-response relationship was found when comparing HRs of the different categories of breastfeeding. HR for breast cancer mortality for women who ever breastfed compared with parous women who never breastfed was 0.75 (95% CI, 0.45 to 1.33). Conclusion Breastfeeding among parous Mexican women was associated with lower all-cause mortality. Breastfeeding could potentially reduce premature deaths in women. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Factors Associated With Early-Onset Esophageal Cancer in Tanzania: A Case-Control Study
Authors: Buckle Geoffrey , Mmbaga Elia J. , Paciorek Alan , Akoko Larry , Deardorff Katrina , Mgisha William , Mushi Beatrice , Mwaiselage Julius , Van Loon Katherine , Zhang Li 
Published: March 2018

Abstract 89 Purpose Previous studies have characterized geographic clusters of esophageal cancer (EC) in East Africa. Many of the epidemiologic features of EC in this context are shared globally with other clusters, including high rates, male predominance, and squamous cell histology. A unique feature in East Africa is the high proportion of young patients, with a recent case series reporting up to 24% of patients age < 45 years. The aim of the current study was to assess factors that are associated with early-onset EC in Tanzania (TZ). Methods We performed a secondary analysis of a previous case-control study. Patients with newly diagnosed EC were recruited at Muhimbili National Hospital and Ocean Road Cancer Institute in 2014 to 2016. Hospital controls were identified from patients with nonmalignant conditions and matched 1:1 for gender and age ± 10 years. Risk factors were assessed through interviews. Logistic regression was used to estimate age-specific odds ratios (ORs) of EC for exposures across age groups (30 to 44 years, 45 to 59 years, and ≥ 60 years) and for interactions with age. Results A total of 473 cases and 473 controls were enrolled. Median ages were 59 years (range, 30 to 91 years) for cases and 55 years (range, 31 to 88 years) for controls. Among cases, 102 patients (22%) were age 30 to 44 years, 144 patients (30%) were age 45 to 59 years, and 227 patients (48%) were age ≥ 60 years. High household income was protective for those age 30 to 44 years (OR, 0.08; 95% CI, 0.01 to 0.69) and 45 to 59 years (OR, 0.13; 95% CI, 0.04 to 0.45), but not for those age ≥ 60 years (effect modification P = .047). Family history of EC was associated with a higher risk of EC among those age 45 to 59 years (OR, 3.8; 95% CI, 1.02 to 14.47) and age ≥ 60 years (OR, 6.63; 95% CI, 1.50 to 29.37), with no effect among those age 30 to 44 years (effect modification P = .019). Second-hand smoke and infrequent teeth cleaning were also associated with early-onset EC, but did not differ significantly across age groups. Additional factors associated with EC risk across all ages were firewood use (cooking), kerosene use (lighting), work on a maize farm, and in-home grain and nut storage. Protective factors were the regular use of medication, surrogates of high socioeconomic status (TV, radio, refrigerator, indoor toilet, and electricity), and charcoal or gas cooking. Conclusion Multiple exposures were identified as risk factors for early-onset EC in TZ. In age-stratified analyses, household income, second-hand smoke, and poor dental hygiene emerged as possible risk factors, whereas family history of EC had strong associations among the older but not the young age group. Our results suggest that environmental factors may underlie the high incidence of young patients with EC in TZ. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Implementation of Anatomic Pathology Services in Mirebalais, Haiti
Authors: Anglade Fabienne , Mompremier Myrlene , Bhangdia Kayleigh , Greenberg Lauren , Orozco Juan Daniel , Brock Jane , Pepoon James , Milner Dan 
Published: March 2018

Abstract 97 Purpose Despite great barriers, implementing pathology services in resource-limited rural settings is achievable. Challenges include the lack of infrastructure, trained personnel, supply chain, and decentralized services, and have hindered the appropriate provision of cancer care to those who live in resource-limited settings. In Haiti, we began treating cancer at University Hospital Mirebalais (HUM) before pathology services existed, sending samples to the United States for diagnoses. This model allowed patients to receive treatment, but turnaround time was often delayed. Our goal is to implement pathology services at HUM that can provide high-quality diagnostics to patients who are enrolled in the cancer program. We demonstrate that, by rolling out a phased implementation of local pathology services with appropriate commitment from local and international partners, accurate pathologic diagnoses can exist in low- and middle-income countries. Methods Phase I—infrastructure and personnel—occurred fall 2016 with the construction of the laboratory and the hiring of a pathologist and laboratory technicians, which allowed samples to be grossed into paraffin blocks before being sent to Boston. Phase II—technology transfer and training—occurred fall 2017 with the procurement of additional equipment and hands-on histology training, which allowed samples to be cut, stained, and diagnosed on-site. In this phase, only complex samples that needed additional immunohistochemistry or a second opinion were sent to Boston. Phase III—testing capacity expansion—will occur summer 2018 and involves procuring immunohistochemistry and training, which will further limit the need to send cases to the United States. Phase IV—routine testing and quality assurance—will occur in tandem with phase III and involves implementing a telepathology system on-site in the HUM laboratory. Results Outcomes of this phased implementation will result in decentralized pathology services in the public sector and ultimately decreased turnaround times, producing better clinical outcomes. Our model demonstrates that it is possible to build local pathology capacity in rural areas. Since the opening of our laboratory, more than 1,000 cases have been processed into paraffin blocks before being sent to Boston. In September 2017, the first cases were diagnosed in country, and more than 100 cases have been processed and reported in Haiti. Conclusion Building on the foundational phases, the next phases of implementation involve long-term diagnostic support that will correlate directly with a substantial decrease in turnaround time. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.