bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of direct oral anticoagulants in patients with cirrhosis: a systematic review and meta-analysis
Authors: Lapumnuaypol K , DiMaria C , Chiasakul T 
Published: May 2019

Abstract

Introduction
Direct oral anticoagulants (DOACs) are effective treatment for venous thromboembolism. However, safety data in patients with cirrhosis are limited. We conducted a systematic review and meta-analysis to evaluate the safety of DOACs compared with warfarin or low-molecular weight heparin in patients with cirrhosis.

Methods
A systematic literature search was performed using MEDLINE and EMBASE from inception up to June 2018. We included prospective and retrospective studies involving adults ≥18 years with cirrhosis in whom anticoagulants were indicated for any indications. Primary outcome was all-cause bleeding events. Secondary outcome was major bleeding. Pooled risk ratio, pooled odd ratios and 95% confidence intervals (CIs) were calculated using random-effects model.

Results
Five studies with a total of 447 patients were included in the analysis. When compared with controls, the use of DOACs in cirrhotic patients did not show a significant difference in all-cause bleeding (risk ratio 0.72; 95% CI, 0.32–1.63). There was also no significant difference in major bleeding between both groups (odd ratio 0.46; 95% CI, 0.10–2.09).

Conclusions
Our study demonstrates that, compared to those who were treated with traditional anticoagulants, cirrhotic patients who were treated with DOACs had no significant increase risk of all-cause bleeding and major bleeding.
Large variation in branch and branch-tip hydraulic functional traits in Douglas-fir (Pseudotsuga menziesii) approaching lower treeline
Authors: Condo Theresa K , Reinhardt Keith 
Published: May 2019

Abstract
Few studies have quantified intraspecific variation of hydraulic functional traits in conifers across elevation gradients that include range boundaries. In the Intermountain West, USA, the lower elevational limit of forests (lower treeline) is generally assumed to be caused by water limitations to growth and water relations, yet few studies directly show this. To test this assumption, we measured changes in a suite of traits that characterize drought tolerance such as drought-induced hydraulic vulnerability, hydraulic transport capacity and morphological traits in branch tips and branches of Douglas-fir (Pseudotsuga menziesii var. glauca (Mirb.) Franco) along a 400-m elevation gradient in southeastern Idaho that included lower treeline. As elevation decreased, vulnerability to hydraulic dysfunction and maximum conductivity both decreased in branches; some hydraulic safety–efficiency trade-offs were evident. In branch tips, the water potential at the turgor loss point decreased, while maximum conductance increased with decreasing elevation, highlighting that branch-tip-level responses to less moisture availability accompanied by warmer temperatures might not be coordinated with branch responses. As the range boundary was approached, we did not observe non-linear changes in parameters among sites or increased variance within sites, which current ecological hypotheses on range limits suggest. Our results indicate that there is substantial plasticity in hydraulic functional traits in branch tips and branches of Douglas-fir, although the direction of the trends along the elevation gradient sometimes differed between organs. Such plasticity may mitigate the negative impacts of future drought on Douglas-fir productivity, slowing shifts in its range that are expected to occur with climate change.
Seasonal gas exchange and resource-use efficiency in evergreen versus deciduous species from a tropical dry forest
Authors: Ávila-Lovera Eleinis , Urich Rosa , Coronel Ilsa , Tezara Wilmer 
Published: May 2019

Abstract
Tropical dry forests (TDFs) experience a long dry season in which plant species are subject to several months of water deficit. However, TDFs maintain a diverse group of plant life forms, growth forms and leaf phenology, and it is not clear how they vary in their mechanisms for coping with seasonal drought. We studied seasonal changes in leaf water potential (Ψleaf), gas exchange, photochemical activity and functional traits in evergreen and drought-deciduous species from a TDF to determine if leaf phenology mediates plant responses to drought. We found seasonal decreases in Ψleaf, stomatal conductance (gs) and transpiration rate (E), and increases in both intrinsic and instantaneous water-use efficiency. We did not find seasonal differences in photosynthetic rate (Aarea) and carbon isotope composition (δ13C); however, these traits differed between leaf phenology groups, with drought-deciduous plants having higher Aarea and δ13C than evergreen plants. We also found that plants with high leaf nitrogen concentration (Narea) also had low mass-based photosynthetic rate (Amass), photosynthetic-nitrogen-use efficiency and specific leaf area, contrary to the expected relationships given by the leaf economics spectrum. Despite higher Narea, sclerophyllous leaves maintained lower Amass, and this increased structural toughness of leaves may be imposing a stronger limitation for CO2 diffusion and hence photosynthesis. Overall, we found more water-conservative traits in deciduous than in evergreen plants, contrary to what is known about these two leaf phenology groups in other seasonal sites both at tropical and temperate latitudes.
Call Me Maybe: Experimental Evidence on Frequency and Medium Effects in Microenterprise Surveys
Authors: Garlick Robert , Orkin Kate , Quinn Simon 
Published: May 2019

AbstractThis study analyzes the effects of differences in survey frequency and medium on microenterprise survey data. A sample of enterprises were randomly assigned to monthly in-person, weekly in-person, or weekly phone surveys for a 12-week panel. The results show few differences across the groups in measured means, distributions, and deviations of measured data from an objective data-quality standard provided by Benford’s Law. However, phone interviews generated higher within-enterprise variation through time in several variables and may be more sensitive to social desirability bias. Higher-frequency interviews did not lead to persistent changes in reporting or increase permanent attrition from the panel but did increase the share of missed interviews. These findings show that collecting high-frequency survey data by phone does not substantially affect data quality. However, researchers who are particularly interested in within-enterprise dynamics should exercise caution when choosing survey medium.
Placenta Percreta is Associated With More Frequent Severe Maternal Morbidity than Placenta Accreta
Authors: Marcellin L. , Delorme P. , Bonnet M.P. , Grange G. , Kayem G. , Tsatsaris V. , Goffinet F. 
Published: May 2019

(Am J Obstet Gynecol. 2018;219:193.e1–193.e9)
Abnormally invasive placentation is the leading cause of obstetric hysterectomy and can lead to poor maternal outcomes as a result of hemorrhage. Of concern is the rise in the incidence of invasive placentation affecting 0.17% to 0.34% of all deliveries. Prior studies of peripartum management and maternal morbidity have not distinguished between accreta/increta or percreta. The aim of this study was to compare maternal morbidity from placenta percreta and accreta and to compare outcomes when managed conservatively versus planned cesarean hysterectomy.
Pregnancy and Childbirth After Sexual Trauma: Patient Perspectives and Care Preferences
Authors: Sobel L. , OʼRourke-Suchoff D. , Holland E. , Remis K. , Resnick K. , Perkins R. , Bell S. 
Published: May 2019

(Obstet Gynecol. 2018;132:1461–1468)
Although recommendations do exist, there is a lack of evidence-based guidelines for the care of women with a history of sexual trauma. Current literature, which consists predominantly of qualitative studies, supports the use of trauma-informed care, defined as the recognition of the prevalence of trauma, acknowledgment of the role trauma may have played, and integration of that knowledge into treatment. In order to identify effective trauma-informed care practices, the authors of the present study interviewed women with a history of sexual trauma and discussed their preferences regarding pregnancy and the childbirth experience.
Acellular Dermal Matrix Reduces Myofibroblast Presence in the Breast Capsule
Authors: Tevlin Ruth , Borrelli Mimi R. , Irizarry Dre , Nguyen Dung , Wan Derrick C. , Momeni Arash 
Published: May 2019

Background:
Capsular contracture remains a common complication after implant-based breast reconstruction. Previous work has suggested that the use of acellular dermal matrix (ADM) reduces the rate of capsular contracture, though little is understood about the underlying mechanism. As myofibroblasts are believed to be the key cells implicated in contracture formation, we hypothesized that ADM would result in a reduction in periprosthetic myofibroblast concentration.

Methods:
Five patients who underwent immediate prepectoral tissue expander placement with anterior ADM coverage and an inferior cuff were included. At the second stage, tissue samples were obtained of both ADM and capsule from each reconstructed breast. Samples were then prepared for hematoxylin and eosin staining and immunohistochemistry for myofibroblast identification (alpha smooth muscle actin and vimentin positive and desmin negative) and analysis. Experimental values are presented as mean ± SD unless otherwise stated. Statistical significance was determined using unpaired t test.

Results:
Successful incorporation of ADM was noted in all cases. A significant reduction in myofibroblast concentration was noted in the ADM versus the capsule (P = 0.0018). This was paralleled by significantly thicker periprosthetic capsule formation overlying the formerly raw pectoralis major muscle, that is, not covered by ADM (P < 0.0001).

Conclusions:
In the presence of ADM, there are significantly fewer myofibroblasts in breast capsules and thinner capsules on histology. Given the central role of myofibroblasts in the development of clinically significant capsular contracture, this study unmasks a possible mechanism for the protective effect of ADM with respect to capsular contracture development.
Organizational characteristics associated with high performance on quality measures in pediatric primary care: A positive deviance study
Authors: Goff Sarah L. , Mazor Kathleen M. , Priya Aruna , Moran Michael , Pekow Penelope S. , Lindenauer Peter K. 
Published: May 2019

Background
Pediatric health care quality in the United States varies, but the reasons for variation are not fully understood. Differences in pediatric practices’ organizational characteristics, such as organizational structures, strategies employed to improve quality, and other contextual factors, may contribute to the variation observed.

Purpose
To assess the relationship between organizational characteristics and performance on clinical quality (CQ) and patient experience (PE) measures in primary care pediatric practices in Massachusetts.

Methodology
A 60-item questionnaire that assessed the presence of selected organizational characteristics was sent to 172 pediatric practice managers in Massachusetts between December 2017 and February 2018. The associations between select organizational characteristics and publicly available CQ and PE scores were analyzed using analysis of variance; open-ended survey questions were analyzed using qualitative content analysis.

Results
Eighty-six practices (50.0%) responded; 80 (46.5%) were included in the primary analysis. Having a quality champion (p = .03), offering co-located specialty services (e.g., behavioral health; p = .04), being a privately owned practice (p = .04), believing that patients and families feel respected (p = .03), and having a lower percentage of patients (10%–25%) covered by public health insurance (p = .04) were associated with higher CQ scores. Higher PE scores were associated with private practice ownership (p = .0006). Qualitative analysis suggested organizational culture and external factors, such as health care finance, may affect quality.

Conclusions
Both modifiable organizational practices and factors external to a practice may affect quality of care. Addressing differences in practice performance may not be reducible to implementation of changes in single organizational characteristics.

Practice Implications
Pediatric practices seeking to improve quality of care may wish to adopt the strategies that were associated with higher performance on quality measures, but additional studies are needed to better understand the mechanisms behind these associations and how they relate to each other.
A Matter of Trust and Distrust: A Qualitative Investigation of Parents' Perceptions About the Use of Mechanical Restraint on Their Adult Children in a Forensic Psychiatric Setting
Authors: Tingleff Ellen Boldrup , Hounsgaard Lise , Bradley Stephen K. , Wilson Rhonda L. , Gildberg Frederik A. 
Published: May 2019

ABSTRACT

Introduction:
Increased knowledge about forensic psychiatric patients' relatives' perceptions in regard to the use of mechanical restraint (MR) is necessary, if clinical practice is to be improved and to achieve a reduction in the use and frequency of MR. However, a specific knowledge deficit about relatives' perspectives on the use of MR limits the evidence base considerably.

Aim:
The aim of this study was to investigate the perceptions of MR held by relatives of forensic psychiatric patients' including factors impacting its use and duration.

Method:
Qualitative interviews were conducted with 15 parents of patients within a forensic psychiatry setting and thematically analyzed.

Findings:
Two main themes were identified, namely, “care and protection” and “inclusion and involvement,” and one subtheme, “information.” These themes revealed the framework used by parents to construct a sense of “trust or distrust” about the ability of staff to provide adequate and safe care for their adult children in the forensic psychiatric setting.

Conclusion:
Some parents in this study considered that forensic psychiatric staff used MR as a necessary protection. However, most parents held strong negative perceptions regarding the use of MR and the quality and safety of care provision. It is apparent that parents in this study believed they should be included and involved in the care in situations associated with the use of MR, because they considered that this could reduce its use. Further research is required to target interventions to reduce the use and duration of MR episodes and to improve clinical practice in forensic psychiatry.
Exploration of the unmet health care needs of people who inject drugs
Authors: Dion Kimberly , Chiodo Lisa , Whynott Liz , Loftus Brita , Alvarez Pedro , Shanahan Jillian , Quaglia Gabriel , Roman Antonio , Sorbi Elizabeth , Wilkins-Carmody Donna 
Published: May 2019

ABSTRACT

Background and purpose:
Access to adequate health care in the United States is often hindered by an individual's location, socioeconomic status, and lifestyle. Among those underserved are people who inject drugs (PWID), who are affected by stigma and discrimination. The purpose of this study was to describe the utilization of preventative health care services obtained by PWID.

Methods:
A survey querying participants about their utilization of preventative health care services and health education over the past year was administered to PWID at 2 syringe access programs. Descriptive statistics were used to analyze the data.

Conclusion:
Of the 141 participants surveyed, 60.6% saw a provider within the past year and 62.1% indicated that their provider was aware of their drug use. Data analysis revealed that providers counseled PWID on three of nine drug-related harm reduction items. Only 30% of PWID talked with their provider about five or more items. Mean number of items discussed was significantly different between PWID whose provider was aware of their drug use and PWID whose provider was unaware of drug use (t = 10.7, p < 0.001).

Implications for practice:
Results indicated that PWID are not receiving adequate preventative services or harm reduction education from their primary care provider. A need for assessment of substance use, preventative vaccinations, counseling and testing for infectious diseases, and harm reduction education is essential during health care visits. Nurse practitioners and nurses have a role in screening for and educating PWID in a variety of health care settings.
Lactate and other biomarkers as treatment target in cardiogenic shock
Authors: Fuernau Georg 
Published: May 2019

Purpose of review
Cardiogenic shock remains beside sudden cardiac death the most outcome relevant complication of acute myocardial infarction. Over the last two decades as confirmation of the benefit of early revascularization no further relevant improvement in outcome could be achieved. Biomarkers are important for diagnosis, monitoring, and management in cardiogenic shock patients.

Recent findings
A bunch of different biomarkers have been associated with prognosis in patients with cardiogenic shock. In routine use standard parameters such as serum lactate or serum creatinine are still most important in monitoring these patients. These established markers outperformed novel markers in prognostic impact in recent trials.

Summary
Biomarkers serve as important treatment targets and may help physicians in therapeutic decision-making. Furthermore, the complex pathophysiology of cardiogenic shock may be better understood by investigation of different biomarkers.
Bromodomain and Extra-Terminal domain inhibitors for lymphoid malignancies
Authors: Bertoni Francesco , Stathis Anastasios 
Published: May 2019

Purpose of review
Pharmacological inhibition of Bromodomain and Extra-Terminal (BET) domain proteins is a very exciting epigenetic therapeutic modality. Due to the central role of BET proteins in transcription regulation, their inhibition heavily affects lymphoma cells and BET inhibitors show a clear preclinical antitumor activity as single agents and in combination, paired with early reports of clinical activity.

Recent findings
Relevant data have been recently presented on the mechanism of action of the BET inhibitors, on modalities to improve their activity in lymphomas, and their clinical evaluation.

Summary
There are now plenty of preclinical data sustaining BET proteins as therapeutic targets in lymphomas. Newer compounds and combinations with other agents may be pursued in the future aiming also to identify those patients that they most likely benefit from BET inhibition.
Myopia Control: Why Each Diopter Matters
Authors: Bullimore Mark A. , Brennan Noel A. 
Published: May 2019

SIGNIFICANCE
Reducing the incidence or prevalence of any disease by 40% is of huge public health significance. Slowing myopia by 1 diopter may do just that for myopic maculopathy—the most common and serious sight-threatening complication of myopia. There is a growing interest in slowing the progression of myopia due to its increasing prevalence around the world, the sight-threatening consequences of higher levels of myopia, and the growing evidence-based literature supporting a variety of therapies for its control. We apply data from five large population-based studies of the prevalence of myopic maculopathy on 21,000 patients. We show that a 1-diopter increase in myopia is associated with a 67% increase in the prevalence of myopic maculopathy. Restated, slowing myopia by 1 diopter should reduce the likelihood of a patient developing myopic maculopathy by 40%. Furthermore, this treatment benefit accrues regardless of the level of myopia. Thus, while the overall risk of myopic maculopathy is higher in a –6-diopter myope than in a –3-diopter myope, slowing their myopic progression by 1 diopter during childhood should lower the risk by 40% in both.
Vascular Presentation and Outcomes of Patients With Giant Cell Arteritis and Isolated Symptomatic Limb Involvement
Authors: de Boysson Hubert , Espitia Olivier , Liozon Eric , Daumas Aurélie , Vautier Mathieu , Dumont Anael , Granel Brigitte , Saadoun David , Planchard Gaétane , Ly Kim Heang , Aouba Achille 
Published: May 2019

ObjectiveThe aims of this study were to describe and assess the vascular outcomes of patients with giant cell arteritis (GCA) presenting with only symptomatic isolated limb involvement (LI-GCA).MethodsWe recruited patients from 5 tertiary centers who were diagnosed with GCA based on histology or vasculitis demonstration on imaging and who presented with isolated symptomatic limb involvement at diagnosis. For each included patient, we randomly selected 3 control patients who satisfied the 5 criteria from the American College of Rheumatology at diagnosis.ResultsWe included 27 LI-GCA patients and 81 control patients. Compared with the controls, the patients with LI-GCA were younger (p= 0.005), exhibited a more delayed diagnosis (p= 0.006), and had lower C-reactive protein levels (p= 0.001), but they did not show more cardiovascular risk factors. Glucocorticoid use (starting and tapering doses) and relapse rates did not differ in the 2 groups, but the patients with LI-GCA received longer treatment (p= 0.02). Cardiovascular complications occurred in 67% of the patients with LI-GCA versus 21% of the control patients (p< 0.0001), especially ischemic events (p< 0.0001) including stroke (p= 0.03) and myocardial infarction (p= 0.01). Vascular surgery was required in 44% of the patients with LI-GCA versus 2% of the controls (p< 0.0001). Excluding vascular surgery, the cumulative incidence of cardiovascular complications was higher in the patients with LI-GCA (log-rank test:p< 0.0001) than in the controls (hazard ratio, 5.73; 95% confidence interval, 2.94–11.28;p< 0.0001).ConclusionsCompared with the typical cranial form of GCA, LI-GCA has a worse cardiovascular-related prognosis. Further studies are required to determine the best management of these patients.
Educational Interventions to Enhance Situation Awareness
Authors: Walshe Nuala C. , Crowley Clare M. , O'Brien Sinéad , Browne John P. , Hegarty Josephine M. 
Published: May 2019

Summary Statement
We conducted a systematic review to evaluate the comparative effectiveness of educational interventions on health care professionals' situation awareness (SA). We searched MEDLINE, CINAHL, HW Wilson, ERIC, Scopus, EMBASE, PsycINFO, psycARTICLES, Psychology and Behavioural Science Collection and the Cochrane library. Articles that reported a targeted SA intervention or a broader intervention incorporating SA, and an objective outcome measure of SA were included. Thirty-nine articles were eligible for inclusion, of these 4 reported targeted SA interventions. Simulation-based education (SBE) was the most prevalent educational modality (31 articles). Meta-analysis of trial designs (19 articles) yielded a pooled moderate effect size of 0.61 (95% confidence interval = 0.17 to 1.06, P = 0.007, I
2 = 42%) in favor of SBE as compared with other modalities and a nonsignificant moderate effect in favor of additional nontechnical skills training (effect size = 0.54, 95% confidence interval = 0.18 to 1.26, P = 0.14, I
2 = 63%). Though constrained by the number of articles eligible for inclusion, our results suggest that in comparison with other modalities, SBE yields better SA outcomes.