bluuebunny/crossref_metadata_2025_split huggingface dataset:
End-of-life decision making by family caregivers of persons with advanced dementia: A literature review of decision aids
Authors: Xie Bo , Berkley Amy S , Kwak Jung , Fleischmann Kenneth R , Champion Jane Dimmitt , Koltai Kolina S 
Published: May 2018

Objectives: To investigate existing knowledge in the literature about end-of-life decision making by family caregivers of persons with dementia, focusing on decision aids for caregivers of persons with advanced dementia, and to identify gaps in the literature that can guide future research. Methods: A literature review through systematic searches in PubMed, CINAHL Plus with Full Text, and PsycINFO was conducted in February 2018; publications with full text in English and published in the past 10 years were selected in multiple steps. Results: The final sample included five decision aids with predominantly Caucasian participants; three of them had control groups, and three used audiovisual technology in presenting the intervention materials. No other technology was used in any intervention. Existing interventions lacked tailoring of information to caregivers’ preferences for different types and amounts of information necessary to make decisions consistent with patients’ values. Conclusion: Research is needed in exploring the use of technology in decision aids that could provide tailored information to facilitate caregivers’ decision making. More diverse samples are needed.
Laparoscopic Harvesting of Omental Flaps for Breast Reconstruction—A Review of the Literature and Outcome Analysis
Authors: Shash Hani , Al-halabi Becher , Aldekhayel Salah , Dionisopoulos Tassos 
Published: May 2018

Background: Evidence on the use of omental flaps for breast reconstruction in patients with breast cancer is lacking, and no published reviews report an outcome-based assessment of such flap. This review explores available data and evidence for change in complication rates following the shift toward laparoscopic harvesting. Methods: We searched the databases Excerpta Medica database, MEDLINE, and PubMed from inception until December 2015 using search terms “omental flaps“ and “breast reconstruction.” Data extracted were patient characteristics, technique used, and outcome measures reported and were then analyzed based on the technique of harvesting. Results: Twenty-two articles reporting 651 patients who underwent mastectomies and breast-conserving surgeries were included in this review. Most flaps, 537 (82.5%), were harvested by laparoscopy, and 626 (96.2%) of the flaps were pedicle flaps. The mean age was 47.7 years (standard deviation: 4.29), and mean follow-up was 38.1 months. There were 88 reported complications among 562 patients in 16 reports. The rate of any complication was calculated to be 15.0%, with a higher rate (29.1%) occurring with the open technique in comparison to laparoscopy (12.6%). The commonest complications were postoperative infection and breast firmness each reported in 2.22%. Most authors reported advantages of malleability and excellent aesthetic outcomes and disadvantages in terms of inability to estimate the volume of the flap and variability in size. Conclusion: Omentum use is safe and has advantages in breast reconstruction where other options are limited including a natural feeling and minimal donor site morbidity if harvested laparoscopically.
Can Weakness in End-Range Plantar Flexion After Achilles Tendon Repair Be Prevented?
Authors: Orishimo Karl F. , Schwartz-Balle Sidse , Tyler Timothy F. , McHugh Malachy P. , Bedford Benjamin B. , Lee Steven J. , Nicholas Stephen J. 
Published: May 2018

Background: Disproportionate end-range plantar flexion weakness, decreased passive stiffness, and inability to perform a heel rise on a decline after Achilles tendon repair are thought to reflect increased tendon compliance or tendon lengthening. Since this was first noted, we have performed stronger repairs and avoided stretching into dorsiflexion for the first 12 weeks after surgery. Hypothesis: Using stronger repairs and avoiding stretching into dorsiflexion would eliminate end-range plantar flexion weakness and normalize passive stiffness. Study Design: Case series; Level of evidence, 4. Methods: Achilles repairs with epitendinous augmentation were performed on 18 patients. Plantar flexion torque, dorsiflexion range of motion (ROM), passive joint stiffness, and standing single-legged heel rise on a decline were assessed at 43 ± 24 months after surgery (range, 9 months to 8 years). Maximum isometric plantar flexion torque was measured at 20° and 10° of dorsiflexion, neutral position, and 10° and 20° of plantar flexion. Passive dorsiflexion ROM was measured with a goniometer. Passive joint stiffness was computed from the increase in passive torque from 10° to 20° of dorsiflexion. Tendon thickness was measured by use of digital calipers. Plantar flexion electromyographic (EMG) data were recorded during strength and functional tests. Analysis of variance and chi-square tests were used to assess weakness and function. Results: Marked weakness was evident on the involved side at 20° of plantar flexion (deficit, 26% ± 18%; P < .001), with no weakness at 20° of dorsiflexion (deficit, 6% ± 17%; P = .390). Dorsiflexion ROM was decreased 5.5° ± 8° ( P = .015), and tendon width was 8 ± 3 mm greater on the involved side ( P < .001). Passive joint stiffness was similar between the involved and noninvolved sides. Only 2 of 18 patients could perform a decline heel rise on the involved side compared with 18 of 18 on the noninvolved side ( P = .01). No difference in EMG amplitude was found between the involved and noninvolved sides during the strength or heel rise tests. Conclusion: The use of stronger repair techniques and attempts to limit tendon elongation by avoiding dorsiflexion stretching did not eliminate weakness in end-range plantar flexion. EMG data confirmed that end-range weakness was not due to neural inhibition. Physiological changes that alter the force transmission capability of the healing tendon may be responsible for this continued impairment. This weakness has implications for high-demand jumping and sprinting after Achilles tendon repair.
A Global Overview of the Geographical Distribution of Dentists: A Scoping Review
Authors: Gabriel M. , Cayetano M.H. , Galante M.L. , Carrer F.C. , Dussault G. , Araujo M.E. 
Published: May 2018

The objective of this study was to identify and analyze the geographic distribution of dentists, in the global context, through available scientific evidence, highlighting the following aspects: 1) the determinants of the geographic distribution of dentists, 2) corrective intervention implemented, and 3) their monitoring and evaluation. A scoping review of the published and gray literature was carried out in scientific databases and in relevant websites. We used an adaptation of a World Health Organization framework to study the distribution of human resources in health to analyze selected publications. After applying the eligibility criteria, 53 publications were included in the review; 10 related to the determinants of geographical distribution, 5 to interventions implemented, and 38 to the monitoring and evaluation process. More studies are needed to identify local determinants of the geographical distribution of dentists and to define adapted intervention strategies to make it more equitable. Knowledge Transfer Statement: The geographic inequality of dentists is a problem for health systems because it has a direct impact on access to services and the oral health conditions of a population. Our study was based on a theoretical conceptual framework formulated in 3 components: 1) determinants of the geographical distribution, 2) strategies implemented to correct the problem, and 3) monitoring and evaluation. It can assist in designing oral health policy and guide decisions by policy makers.
Sleep-Disordered Breathing Is Associated with Reduced Mandibular Cortical Width in Children
Authors: Eimar H. , Al-Saleh M.A.Q. , Cortes A.R.G. , Gozal D. , Graf D. , Flores-Mir C. 
Published: May 2018

Introduction: Evidence from the adult population suggests that sleep-disordered breathing (SDB) (i.e., obstructive sleep apnea [OSA]) is negatively associated with bone mineral density. Whether a similar association exists in children with SDB has not been investigated. Using the mandibular cortical width (MCW) as a proxy for skeletal bone density, we investigated if children at risk of SDB or diagnosed with OSA have a reduced mandibular cortical width compared to children without SDB. Methods: Two retrospective cross-sectional studies were performed. The first study included comparison of MCW between 24 children with polysomnographically (PSG) diagnosed OSA and 72 age- and sex-matched control children. The second study included a cohort of children in which SDB was suggested by the Pediatric Sleep Questionnaire (PSQ) ( n = 101). MCW was measured from panoramic radiographs. Results: Multiple-predictors regression analysis from the first study indicated that in children with a severe form of SDB, as induced by OSA severity, there was a negative association with MCW (β = –0.290, P = 0.049). Moreover, PSG-diagnosed OSA children had thinner MCW (2.9. ± 0.6mm) compared to healthy children (3.5 ± 0.6 mm; P = 0.002). These findings were further supported by the second study illustrating that PSQ total scores were negatively associated with MCW (β = –0.391, P < 0.001). Conclusions: Findings suggest that children at risk for or diagnosed with SDB exhibit reduced mandibular cortical width that purportedly may reflect alterations in bone homeostasis. Knowledge Transfer Statement: We report that sleep-disordered breathing (including its severe form, obstructive sleep apnea) in children is associated with reduced mandibular cortical width. This association might be a direct consequence of reduced bone health to sleep-disordered breathing or a reflection that reduced bone formation underlies the development of sleep-disordered breathing. Our findings suggest that mandibular cortical width can be used as an adjunct diagnostic parameter for the diagnosis of sleep-disordered breathing.
Thyroid Cancer and Iodine Deficiency Status: A 10‐Year Review at a Single Cancer Center in Tanzania
Authors: Sakafu Lulu L. , Mselle Teddy F. , Mwaiselage Julius D. , Maunda Khamza K. , Eddin Bouyoucef S. , Zafereo Mark E. 
Published: May 2018

ObjectiveTo highlight the magnitude and distribution of thyroid cancer at the largest cancer center in Tanzania and to correlate patient region of residence with regions of dietary iodine adequacy and deficiency in the country.Study DesignA retrospective cross‐sectional chart review to characterize patients with thyroid cancer and regions of residence.SettingOcean Road Cancer Institute (ORCI), the largest cancer center in Tanzania.Subjects and MethodsSubjects had histologically confirmed thyroid cancer and no history of cancer treatment. Between January 2006 and April 2016, the cases of 139 consecutive patients with thyroid cancer at ORCI were retrospectively reviewed. Patients were grouped into those from iodine‐adequate and iodine‐deficient regions, based on the Tanzania demographic and health survey.ResultsPatients’ median age was 47 years (range, 17‐73 years), and the male:female ratio was 1:5. The number of people with thyroid cancer seen at ORCI increased steadily during the study period, with no significant difference between papillary (46%) and follicular (45%) diagnoses. Nonpapillary cancers occurred more frequently among males and patients ≥45 years of age, but these did not reach statistical significance. Seventy‐five percent of all thyroid cancers were from areas of iodine deficiency, and this was similar in papillary and follicular cancer subtypes.ConclusionThe incidence of differentiated thyroid cancer is increasing at the largest cancer center in Tanzania, whereby papillary and follicular subtypes were significantly higher in regions with long‐standing dietary iodine deficiency.
Risk-adapted treatment of acute promyelocytic leukemia: results from the International Consortium for Childhood APL
Authors: Testi Anna Maria , Pession Andrea , Diverio Daniela , Grimwade David , Gibson Brenda , de Azevedo Amilcar Cardoso , Moran Lorena , Leverger Guy , Elitzur Sarah , Hasle Henrik , ten Bosch Jutte van der Werff , Smith Owen , De Rosa Marisa , Piciocchi Alfonso , Lo Coco Francesco , Foà Robin , Locatelli Franco , Kaspers Gertjan J. L. 
Published: May 2018

Key Points
Risk-adapted therapy allowed achieving remarkable cure rates in an international trial on childhood APL. Reduction of the anthracycline cumulative dose coupled with ATRA extended use does not compromise the outcome of children with APL.
Inhibition of ATR acutely sensitizes acute myeloid leukemia cells to nucleoside analogs that target ribonucleotide reductase
Authors: Fordham Sarah E. , Blair Helen J. , Elstob Claire J. , Plummer Ruth , Drew Yvette , Curtin Nicola J. , Heidenreich Olaf , Pal Deepali , Jamieson David , Park Catherine , Pollard John , Fields Scott , Milne Paul , Jackson Graham H. , Marr Helen J. , Menne Tobias , Jones Gail L. , Allan James M. 
Published: May 2018

Key PointsLoss of ATR signaling is cytotoxic to AML cells in combination with gemcitabine and hydroxyurea via the induction of replication stress. A small molecule inhibitor of ATR in combination with gemcitabine completely eradicates AML in an orthotopic xenograft mouse model.
Effect of canagliflozin on left ventricular diastolic function in patients with type 2 diabetes
Authors: Matsutani Daisuke , Sakamoto Masaya , Kayama Yosuke , Takeda Norihiko , Horiuchi Ryuzo , Utsunomiya Kazunori 
Published: May 2018

Abstract
Background
Type 2 diabetes mellitus (T2DM) greatly increases the risks of cardiovascular disease and heart failure. In particular, left ventricular diastolic dysfunction that develops from the early stages of T2DM is an important factor in the onset and exacerbation of heart failure. The effect of sodium-glucose cotransporter 2 inhibitors on left ventricular diastolic function has not been elucidated. We have performed the first prospective study on the effects of canagliflozin on left ventricular diastolic function in T2DM.

Methods
This study was performed to evaluate the effects of additional treatment with canagliflozin for 3 months on left ventricular diastolic function in patients with T2DM. A total of 38 patients with T2DM were consecutively recruited for this study. Left ventricular diastolic function was assessed by echocardiography. The primary study outcome was a change in the septal E/e′ as a parameter of left ventricular diastolic function.

Results
A total of 37 patients (25 males and 12 females) were included in the analysis. Mean age of participants was 64.2 ± 8.1 years (mean ± SD), mean duration of diabetes was 13.5 ± 8.1 years, and mean HbA1c was 7.9 ± 0.7%. Of the participants, 86.5% had hypertension, 100% had dyslipidemia, and 32.4% had cardiovascular disease. Canagliflozin significantly improved left ventricular diastolic function (septal E/e′ ratio 13.7 ± 3.5–12.1 ± 2.8, p = 0.001). Furthermore, among the various parameters that changed through the administration of canagliflozin, only changes in hemoglobin significantly correlated with changes in the septal E/e′ ratio (p = 0.002). In multiple regression analysis, changes in hemoglobin were also revealed to be an independent predictive factor for changes in the septal E/e′ ratio.

Conclusions
This study showed for the first time that canagliflozin could improve left ventricular diastolic function within 3 months in patients with T2DM. The benefit was especially apparent in patients with substantially improved hemoglobin values.
Trial registration UMIN Clinical Trials Registry UMIN000028141
An observational cohort study of the use of five-grass-pollen extract sublingual immunotherapy during the 2015 pollen season in France
Authors: Blin Patrick , Demoly Pascal , Drouet Martine , Falissard Bruno , Lignot-Maleyran Séverine , Maizi Hélène , Lorrain Simon , Lassalle Régis , Droz-Perroteau Cécile , Moore Nicholas , Molimard Mathieu 
Published: May 2018

Abstract
Background
Allergic rhinitis affects around one quarter of the Western European population. Prophylactic allergen immunotherapy may be useful to reduce the risk of acute symptomatic attacks (hayfever). A five-grass pollen extract sublingual immunotherapy (5GPE-SLIT) has been developed for the treatment of allergic rhinitis to grass pollen. The objective of this study was to describe real-world treatment patterns with 5GPE-SLIT in France with respect to the prescribing information.

Methods
This prospective cohort study was conducted by 90 community and hospital allergists. Adults and children (> 5 years old) starting a first treatment with 5GPE-SLIT prior to the 2015 pollen season were eligible. Data was collected at the inclusion visit and at the end of the pollen season. The primary outcome variable was compatibility of 5GPE-SLIT prescription with the prescribing information. This was determined with respect to four variables: (1) interval between 5GPE-SLIT initiation and onset of the pollen season ≥ 3 months, (2) age of patient ≥ 5 years, (3) intermittent symptoms or mild symptom severity (4) confirmatory diagnostic test. At study end, symptoms reported during the pollen season and any modifications to treatment or adverse events were documented.

Results
280 adults and 203 children were enrolled. The prescribing information was respected for 82.5% of adults and 86.7% of children. A skin test was performed for all patients. 5GPE-SLIT was started 3–5 months before the pollen season for 85.3%. Treatment was discontinued before the start of the pollen season in 11.0% of patients overall, generally because of an adverse event (78.8% of discontinuations). The mean duration of treatment was 5.2 months in adults and 5.6 months in children. At the end of follow-up, symptoms during the pollen season were intermittent for 75.0% of adults and 85.7% of children, and severity was mild for 61.8 and 66.0% respectively. During 5GPE-SLIT, the following symptoms reported during the previous year were not reported again in > 50% of patients: nasal congestion, rhinorrhoea, repeated sneezing, conjunctivitis and nasal pruritus.

Conclusions
5GPE-SLIT use was generally consistent with prescribing recommendations and was associated with an improvement of AR severity, with resolution of the principal AR symptoms in around half the patients treated.
Trial registration EUPAS9358. Registered 13 May 2015. Not prospectively registered. http://www.encepp.eu/encepp/viewResource.htm?id=16229
Failure to tackle suicide inequalities across Europe
Authors: Das-Munshi Jayati , Thornicroft Graham 
Published: May 2018

SummaryIn this issue, Lorant et al. confirm a social gradient in risk of suicide, across 15 European countries, over a period of marked social change. Understanding contextual and life-course factors, and acknowledging under-funding for mental health and failures to implement national mental health policies, may provide the reasons for these disparities.Declaration of interestNone.
Investigator Disclosure and Advanced Cancer Patient Understanding of Informed Consent and Prognosis in Phase I Clinical Trials
Authors: Hlubocky Fay J. , Kass Nancy E. , Roter Debra , Larson Susan , Wroblewski Kristen E. , Sugarman Jeremy , Daugherty Christopher K. 
Published: May 2018

Purpose: Advanced cancer patients (ACPs) who participate in phase I clinical trials often report a less-than-ideal understanding of the required elements of informed consent (IC) and unrealistic expectations for anticancer benefit and prognosis. We examined phase I clinical trial enrollment discussions and their associations with subsequent ACP understanding. Methods: Clinical encounters about enrollment in phase I trials between 101 ACPs and 29 oncologists (principal investigators [PIs] and fellows) at three US academic medical institutions were recorded. The Roter Interaction Analysis System was used for analysis. ACPs completed follow-up questionnaires to assess IC recall. Results: PIs disclosed the following phase I IC elements to ACPs in encounters: trial purpose in 40%; specific physical risks in 60%; potential specific medical benefits gained by trial participation (eg, disease stabilization) in 48.2%; and alternatives to phase I trial participation in 47.1%, with 1.1% of encounters containing palliative and 2.3% hospice information. PIs provided ACP-specific prognoses in 29.0% of encounters but used precise terms of death in only 4.7% and terminal in 1.2%. A significant association existed between PI disclosure of the trial purpose as dosage/toxicity, and ACPs subsequently correctly recalled trial purpose versus PIs who did not disclose it (85% v 13%; P < .05). Conclusion: Many oncologists provide incomplete disclosures about phase I trials to ACPs. When disclosure of certain elements of IC occurs, it seems to be associated with better recall, especially with regard to the research purpose of phase I trials.
Identifying Barriers to Implementation of the National Partnership for Maternal Safety Obstetric Hemorrhage Bundle at a Tertiary Center: Utilization of the Delphi Method
Authors: De Tina Annemaria , Chau Anthony , Carusi Daniela A. , Robinson Julian N. , Tsen Lawrence C. , Farber Michaela K. 
Published: May 2018

BACKGROUND:
In 2015, the National Partnership for Maternal Safety (NPMS) developed an obstetric hemorrhage consensus bundle to provide birthing facilities in the United States with consistent, validated practice guidelines for postpartum hemorrhage management. The process of implementing each bundle element at a large tertiary labor and delivery unit has not been described; we sought to identify practice deficiencies and perceived barriers to bundle implementation among multidisciplinary providers.

METHODS:
We conducted a prospective, cross-sectional, consensus-building study based on the Delphi method. A multidisciplinary expert panel comprised of anesthesiologists, obstetricians, nurses, and surgical technicians was assembled and participated in 4 sequential questionnaires. The first round identified bundle elements that experts determined as not currently adequate and perceived barriers to implementation. The second round established prioritization of elements within each professional group; and the third round ranked the elements with at least 60% agreement on feasibility of implementation and positive impact on patient care. The last round revealed responses across all 4 professional groups to derive a final consensus. Descriptive statistics were performed.

RESULTS:
A total of 38 experts completed the study (11 anesthesiologists, 11 obstetricians, 10 nurses, and 6 surgical technicians). While all 13 (100%) NPMS obstetric bundle elements were described as deficient in our labor and delivery unit by a provider in at least 1 discipline, consensus among at least 3 of the 4 disciplines was achieved for 6 element deficiencies. Barriers to implementation were determined. The initiatives that achieved consensus as possessing high patient impact and implementation feasibility were protocol-driven management, unit-based simulation drills, blood loss quantification, and team huddles and debriefings.

CONCLUSIONS:
The NPMS obstetric hemorrhage bundle was created to help guide practice and systems improvement for US birthing facilities. The Delphi method enabled identification of deficient elements and perceived barriers to element implementation, as well as group consensus on elements with highest patient impact and feasibility. Multidisciplinary group consensus can identify deficiencies and promote tangible, quality improvements in a large, tertiary-care labor and delivery unit. Institutions may utilize our described technique to guide implementation of future care bundles.