bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive value of preoperative MRI features for the Ki-67 index in well-differentiated G1/G2 pancreatic neuroendocrine tumors
Authors: Sun Haitao , Zhang Shilong , Liu Kai , Zhou Jianjun , Wang Xingxing , Shen Tingting , Wang Xiaolin 
Published: March 2019

Background The accurate estimation of the Ki-67 index of well-differentiated pancreatic neuroendocrine tumors (PanNET) not only guides curative management but also avoids unnecessary treatment. Purpose To investigate whether magnetic resonance imaging (MRI) features could preoperatively discriminate the Ki-67 index of well-differentiated G1/G2 PanNETs and to construct an individualized predictive model through developing a MRI-based nomogram. Material and Methods Ninety-nine patients with G1/G2 PanNETs were divided into Ki-67 index <5% (n = 58) and Ki-67 index ≥5% groups (n = 41). Multiparametric MRI features of two groups were assessed via uni- and multivariate logistic regression models. The MRI-based nomogram was then developed based on multivariable logistic analysis; the effectivity of the nomogram was validated according to the C-index, calibrations, and a decision curve analysis. Results MRI features, including tumor size (odds risk [OR] = 7.791; P = 0.003) and the ADC values (OR = 0.245, P = 0.018) were significant independent risk factors for the high Ki-67 index (≥5%) of G1/2 PanNETs at multivariable analysis. The performance of the MRI-based nomogram (with a C-index of 0.825) was improved compared with that based on tumor size and ADC alone (with C-index values of 0.709 and 0.716, respectively). The calibration curve of the nomogram exhibited good consistency between evaluated and observed outcomes. The decision curve showed that the nomogram incorporating two MRI features had better clinical utilization than single features. Conclusion The preliminary MRI-based nomogram could be used to discriminate the Ki-67 index in well-differentiated G1/2 PanNETs.
Enamel defects in permanent teeth of patients with cleft lip and palate: a cross-sectional study
Authors: Shen Chia-An , Guo Runzhi , Li Weiran 
Published: March 2019

Objective This study investigated the prevalence, type, and location of enamel defects in the permanent teeth of patients with complete unilateral or bilateral cleft lip and palate (CLP), and compared the prevalence and characteristics of defects between CLP patients and non-CLP individuals. Methods We examined completely erupted permanent dentition, except for third molars, of CLP patients and non-CLP individuals of both sexes, 9–36 years of age, and analyzed corresponding panoramic radiographs. Two independent examiners performed clinical examinations in accordance with the Modified Developmental Defects of Enamel index. Results A total of 210 (87.9%) CLP patients and 194 (41.4%) non-CLP individuals had at least one enamel defect; these were more prevalent in the CLP group than in the non-CLP group. Upper teeth were primarily affected by enamel defects associated with the cleft; defects were most prevalent on the cleft side in CLP patients, followed by the non-cleft side in CLP patients, and then by non-CLP individuals. Conclusion Enamel defects were more common in CLP patients than in non-CLP individuals. Among CLP patients, enamel defects were more prevalent in the cleft side of the maxilla; the central incisor was the most commonly affected tooth in this quadrant.
Feasibility of Early Application of an Advance Directive at the Time of First-Line Palliative Chemotherapy in Patients With Incurable Cancer: A Prospective Study
Authors: ParK Eun-Ju , Lim Yeon Jae , Kim Jae-Joon , Oh Sang-Bo , Oh So Yeon , Park Kwonoh 
Published: March 2019

Context: This study aimed to evaluate the feasibility of an advance directive (AD) at the time of starting first-line palliative chemotherapy. We investigated changes in emotional distress, quality of life (QoL), and attitudes toward anticancer treatments between before and after AD. Methods: Patients with advanced cancer who had just started palliative chemotherapy were prospectively enrolled. We assessed attitudes toward chemotherapy, Hospital Anxiety and Depression Scale (HADS), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ) before conducting the AD and subsequently performed the AD after the first cycle of chemotherapy. Follow-up evaluations using same parameters were performed in the next cycle visit. Results: During the study period, 104 patients started palliative chemotherapy. Among them, 41 patients (11 with cognitive impairment at baseline, 14 with clinical deteriorations after the first cycle of chemotherapy, 6 with follow-up loss, 7 without proxy, 3 with protocol violations) were excluded, and the AD were recommended in the remaining 64 patients (proportion of AD recommendation: 62%). Among the 64 patients, 44 agreed to conduct the AD (proportion of AD consent: 69%). There were no significant changes before and after AD in terms of HADS and EORTC-QLQ. Attitudes regarding chemotherapy were also unchanged ( P = .773). A total of 36 (82%) patients followed physician’s recommendations, with the exception of 8 patients who terminated chemotherapy due to refusal or loss to follow-up. Conclusions: Considering our results showing no significant changes in depression and anxiety scores, QoL, and attitudes toward anticancer treatments after the AD, early integration of the AD at initiation of first-line palliative chemotherapy might be feasible.
Mind the Gap: Disparities in Cigarette Smoking in Canada
Authors: Chaiton Michael , Callard Cynthia 
Published: March 2019

Objectives: The Government of Canada has proposed an ‘endgame’ target for cigarette smoking that aims to reduce prevalence below 5% by 2035. To meet this difficult goal, it will be necessary to identify populations where interventions will (1) have the greatest impact in reducing the number of smokers and (2) have the greatest impact in addressing smoking disparities. Method(s): Using data from the Canadian Community Health Survey, smoking prevalence was estimated for populations that differed with respect to demographic, substance use, and mental health factors. Risk difference, relative risk, and attributable disparity number, which describes the magnitude of the potential impact if the disparity were addressed, were calculated for each group. Results: The strongest disparities (relative risk ⩾ 2) were associated with immigration status (for women), substance use, marital status, and lifetime experience of mental health or substance use disorders. The smallest disparities (relative risk ⩽ 1.5) were associated with sexual orientation, household income, immigration status (men), and province of residence. The groups with the largest attributable disparity number were among those who used cannabis, and those who were not immigrants, not married, and white. Conclusions: Disparities which were both strong and had a large potential impact on prevalence overall were found for populations facing mental health and substance use concerns. Differences in rankings were found depending on the scale of the measure. Addressing disparities in smoking rates is an important component of developing tobacco endgame strategies.
A Survey of Health Care Professionals’ Knowledge and Experience of Foetal Alcohol Spectrum Disorder and Alcohol Use in Pregnancy
Authors: Howlett Helen , Mackenzie Shonag , Strehle Eugen-Matthias , Rankin Judith , Gray William K 
Published: March 2019

Background: Foetal alcohol spectrum disorders (FASDs) are one of the most common preventable forms of developmental disability and congenital abnormalities globally, particularly in countries where alcohol is considered socially acceptable. Screening for alcohol use early in pregnancy can facilitate the detection of alcohol-exposed pregnancies and identify women who require further assessment. However, only a small percentage of children with FASD are identified in the United Kingdom. This may be partly attributed to a lack of awareness of the condition by National Health Service (NHS) health professionals. Methods: We developed an online survey to determine health care professionals’ (midwives, health visitors, obstetricians, paediatricians, and general practitioners) perceived knowledge, attitudes, and clinical practices relating to alcohol in pregnancy and FASD. Results: There were a total of 250 responses to the surveys (78 midwives, 60 health visitors, 55 obstetricians, 31 paediatricians, and 26 general practitioners). About 58.1% of paediatricians had diagnosed a patient with foetal alcohol syndrome (FAS) or FASD and 36.7% worried about stigmatisation with diagnosis. Paediatricians reported the highest levels of FASD training (54.8%), with much lower levels in midwives (21.3%). This was reflected in perceived knowledge levels; overall, only 19.8% of respondents knew the estimated UK prevalence of FASD for example. Conclusions: We identified a need for training in alcohol screening in pregnancy and FASD to improve awareness and recognition by UK professionals. This could improve patient care from the antenatal period and throughout childhood.
Family experiences as a caregiver for patients with Parkinson's disease: a qualitative study
Authors: Dekawaty Ayu , Malini Hema , Fernandes Feri 
Published: March 2019

Background Parkinson's disease is a chronic progressive neurodegenerative disorder with unpredictable symptoms, which leads to stress for individuals caring for their family members. Most patients with Parkinson's disease in Indonesia are cared for by family members. Their treatment requires continuous supervision and a great deal of attention. Aims Accordingly, this research explores caregivers' experiences in caring for family members with Parkinson's disease. Methods This study is qualitative with a phenomenological design. Participants, selected via a purposive sampling technique, were individuals caring for and living with family members suffering from Parkinson's disease. The data were analysed using the Colaizzi approach. Results This research identified four themes: the ways in which members of the family adapt; the impact of the patient's condition on the caregiver; support received in providing care; and the cultural and spiritual meanings the caregiver obtained when providing care. Conclusion This study uncovered several aspects that contribute to the understanding of the life of family members as caregivers for Parkinson's disease patients. This research also found there is still limited psychosocial support from health workers, so it is necessary for them to be more proactive in providing support for family members who care for patients with Parkinson's disease.
Real-life outcomes of teriflunomide treatment in patients with relapsing multiple sclerosis: TAURUS-MS observational study
Authors: Kallmann Boris A. , Tiel-Wilck Klaus , Kullmann Jennifer S. , Engelmann Ulrich , Chan Andrew 
Published: March 2019

Background: Teriflunomide is a once-daily oral immunomodulatory agent approved for the treatment of relapsing–remitting multiple sclerosis (MS). We aimed to obtain data on the effectiveness, tolerability, and subject satisfaction with teriflunomide (Aubagio®) under clinical practice conditions in unselected MS patients. Methods: This work was a non-interventional, prospective, longitudinal, observational study in 307 sites in Germany. Results: A total of 1128 patients were eligible for the efficacy analysis [67.5% female; mean age (± standard deviation) 44.9 ± 9.7 years, range 20–73 years]. Time since first MS symptoms was 10.6 ± 8.2 years, and time since MS diagnosis was 8.9 ± 7.6 years. Expanded Disability Status Scale (EDSS) score at inclusion was 2.3 ± 1.5 (70.4% with score < 3.5). The mean observation period was 16.3 ± 9.1 months. A total of 75.2% had received previous disease-modifying therapies (DMTs) at any time. Of these patients, 504 (44.7%) received no DMT within 6 months of study entry, 593 patients (52.6%) had DMT discontinued prior to study entry [glatiramer acetate in 10.6%, subcutaneous interferon-beta 1a (IFNβ-1a) in 9.3%, intramuscular IFNβ-1a or IFNβ-1b in 6.6% each, azathioprine oral in 0.4%, other in 7.3%, last medication not known in 12.0%]. The mean annualized relapse rate decreased from 0.87 in the 24 months prior to study entry to 0.35 in the 24 months after study entry ( n = 468; p ⩽ 0.001). EDSS and Fatigue Severity Scale remained stable. In patients who received previous MS treatments, Treatment Satisfaction Questionnaire (TSQM-9) values (maximum = 100), for the observation at 24 months improved by 8.1 points for effectiveness, 17.0 points for convenience, and 15.3 points for global satisfaction ( p ⩽ 0.001 each, compared with study entry). In the safety cohort ( n = 1139), the proportion of patients with adverse events (AEs) of any severity was 35.8%, and with serious events 13.0%. The most frequently reported AEs were diarrhea ( n = 55), followed by MS relapse ( n = 48), hair thinning ( n = 38), and viral upper respiratory tract infection ( n = 31). Conclusions: Relapse rate was halved during the observation period in comparison with the same time period before study entry. Patient satisfaction with teriflunomide was high in this real-world observation of patients, the majority of whom switched from other DMTs. The safety and tolerability profile of teriflunomide was similar to that reported in previous clinical trials.
Outcome, efficacy and safety of endovascular thrombectomy in ischaemic stroke according to time to reperfusion: data from a multicentre registry
Authors: Meinel Thomas Raphael , Kaesmacher Johannes , Mordasini Pasquale , Mosimann Pascal J. , Jung Simon , Arnold Marcel , Heldner Mirjam Rachel , Michel Patrik , Hajdu Steven D. , Ribo Marc , Requena Manuel , Maegerlein Christian , Friedrich Benjamin , Costalat Vincent , Benali Amel , Pierot Laurent , Gawlitza Matthias , Schaafsma Joanna , Pereira Vitor Mendes , Gralla Jan , Fischer Urs 
Published: March 2019

Background and purpose: In acute ischaemic stroke (AIS) of the anterior circulation (AC) treated with mechanical thrombectomy (MT), data point to a decline of treatment effect with increasing time from symptom onset to treatment. However, the magnitude of the decline will depend on the clinical setting and imaging selection used. The aims of this study were (1) to evaluate the clinical effect of time to reperfusion (TTR); and (2) to assess the safety and technical efficacy of MT according to strata of TTR. Methods: Using the retrospective multicentre BEYOND-SWIFT registry data (ClinicalTrials.gov identifier: NCT03496064), we compared safety and efficacy of MT in 1461 patients between TTR strata of 0–180 min ( n = 192), 180–360 min ( n = 876) and >360 min ( n = 393). Clinical effect of TTR was evaluated using multivariable logistic regression analyses adjusting for pre-specified confounders [adjusted odds ratios (aOR) and 95% confidence intervals (95% CI)]. Primary outcome was good functional outcome (modified Rankin Scale: mRS 0–2) at day 90. Results: Every hour delay in TTR was a significant factor related to mRS 0–2 (aOR 0.933, 95% CI 0.887–0.981) with an estimated 1.5% decreased probability of good functional outcome per hour delay of reperfusion, and mRS 0–1 (aOR 0.929, 95% CI 0.877–0.985). Patients with late TTR had lower rates of successful and excellent reperfusion, higher complication rates and number of passes. Conclusions: TTR is an independent factor related to long-term functional outcome. With increasing TTR, interventional procedures become technically less effective. Efforts should be made to shorten TTR through optimized prehospital and in-hospital pathways.
Is ureteral stent an effective way to deliver drugs such as bacillus Calmette-Guérin to the upper urinary tract? An experimental study
Authors: Korkes Fernando , Baccaglini Willy , Silveira Marcel Aranha 
Published: March 2019

Background: We aim to evaluate the distribution in the upper urinary tract of intravesical-delivered fluids, after inducing vesicoureteral reflux (VUR) with a double J stent. Methods: In group 1 ( n = 35) patients were maintained in a 20° Trendelenburg position and were evaluated after immediate insertion of ureteral stent, while in group 2 ( n = 16) patients were evaluated after several days with ureteral stent placement. Patients in both groups were submitted to a cystogram with progressive volumes of iodine contrast and were evaluated according to VUR of contrast medium to the renal pelvis. Additionally, in group 2 visual confirmation was performed by endoscopic inspection of upper tract mucosal impregnation with methylene blue. Results: In group 1, after immediate insertion of ureteral stent reflux occurred in 51.4% ( n = 18/35), and after several days with ureteral stent placement reflux was observed in 87.5% ( n = 14/16) of patients. Reflux was progressively more frequent according to increasing bladder volume ( p < 0.001). At 60 ml bladder volume no reflux was observed, while at 120 ml, 180 ml, 240 ml, 300 ml and 360 ml bladder volume reflux was observed in 14%, 25%, 41%, 55% and 63% of patients, respectively. Conclusion: Retrograde delivery of fluids such as bacillus Calmette-Guérin to the upper urinary tract through double J stents can be effective; however, it is mainly effective after several days with ureteral stent and relatively large volumes might be instilled into the bladder.
Influence of Environmental Design on Team Interactions Across Three Family Medicine Clinics: Perceptions of Communication, Efficiency, and Privacy
Authors: Karp Zaher , Kamnetz Sandra , Wietfeldt Natalie , Sinsky Christine , Molfenter Todd , Pandhi Nancy 
Published: March 2019

Objective: In this study, we explored how two different primary care clinic physical layouts (onstage/offstage and pod-based [PB] designs) influenced pre- and postvisit team experiences and perceptions. Background: Protocols encourage healthcare team communication before and after primary care visits to support better patient care. Physical clinic environments may influence these behaviors, but limited research has been performed. Method: We conducted observations, three interviews with clinic managers, and six focus groups with 21 providers and staff at three family medicine teaching clinics. Observational data were captured through field notes and spaghetti diagrams. Interviews and focus groups were recorded, transcribed, and analyzed using a grounded theory-based approach to understand how aspects of the clinic environment affected communication, efficiency, and privacy. Results: Variations in communication styles and trade-offs between patient contact and privacy emerged as differences. In the onstage/offstage design, colocated teams had increased verbal communication but perceived being isolated from other clinic teams. In contrast, teams in PB clinics communicated with other clinic teams but had more informal patient contact within care-team stations that imposed privacy risk. Conclusions: Primary care clinic design appears to alter provider–team and patient–provider communication and flow. Organizations should consider aligning environmental design with desired interaction patterns when building new primary care clinics.
Sport Participation and Specialization Characteristics Among Pediatric Soccer Athletes
Authors: McLeod Tamara Valovich , Israel Michael , Christino Melissa A. , Chung Jane S. , McKay Scott D. , Lang Pamela J. , Bell David R. ,   the PRiSM Sports Specialization Research Interest Group, Chan Charles M. , Crepeau Allison , Davis Elizabeth , Fletcher Amanda L. , Laniak Jessica , McCaffrey Kelsie , Pacicca Donna , Riederer Mark , Rizzone Katherine , Rush Jeremy K. , Zaslow Tracy 
Published: March 2019

Background: Soccer is an increasingly popular sport for children and adolescents in the United States. Little is known about participation patterns related to sport specialization. Purpose: To investigate soccer participation levels and sport specialization characteristics among youth soccer athletes. Study Design: Cross-sectional study. Methods: Adolescent athletes aged between 12 and 18 years completed an online survey addressing participant demographics, sports and soccer participation history, and level of specialization. Descriptive analyses characterized participation, while chi-square and Kruskal-Wallis tests assessed the influence of specialization, sex, and grade on survey variables. Results: Overall, 83.7% of 746 respondents participated in an organized soccer league outside of school, and 37% played in multiple leagues concurrently. Nearly three-quarters of respondents trained in soccer more than 8 months of the year, with those who participated in club soccer being more likely to train more than 8 months of the year. More respondents were classified as high specialization (37.5%), followed by moderate (35.6%) and low (28.6%) specialization. No differences between sexes were noted for level of specialization or quitting other sports to specialize in soccer, but male athletes were more likely to train more than 8 months per year compared with female athletes. Respondents in older grades (9th-10th and 11th-12th grades) were more likely to be highly specialized and quit other sports to focus on soccer. No differences between grade levels were found among respondents training more than 8 months per year. Conclusion: The study findings suggest that many youth soccer athletes participated in multiple teams or leagues at the same time and trained more than 8 months of the year. Characteristics including participation on a club team, level of specialization, and male sex were associated with a greater likelihood of exceeding the 8-month training recommendation.
Dismantling airway disease with the use of new pulmonary function indices
Authors: Zimmermann Sabine C. , Tonga Katrina O. , Thamrin Cindy 
Published: March 2019

We are currently limited in our abilities to diagnose, monitor disease status and manage chronic airway disease like asthma and chronic obstructive pulmonary disease (COPD). Conventional lung function measures often poorly reflect patient symptoms or are insensitive to changes, particularly in the small airways where disease may originate or manifest. Novel pulmonary function tests are becoming available which help us better characterise and understand chronic airway disease, and their translation and adoption from the research arena would potentially enable individualised patient care.In this article, we aim to describe two emerging lung function tests yielding novel pulmonary function indices, the forced oscillation technique (FOT) and multiple breath nitrogen washout (MBNW). With a particular focus on asthma and COPD, this article demonstrates how chronic airway disease mechanisms have been dismantled with the use of the FOT and MBNW. We describe their ability to assess detailed pulmonary mechanics for diagnostic and management purposes including response to bronchodilation and other treatments, relationship with symptoms, evaluation of acute exacerbations and recovery, and telemonitoring. The current limitations of both tests, as well as open questions/directions for further research, are also discussed.