bluuebunny/crossref_metadata_2025_split huggingface dataset:
Turning Feed-forward and Feedback Processes on Patient-reported Data into Intelligent Action and Informed Decision-making
Authors: Oliver Brant J. , Nelson Eugene C. , Kerrigan Carolyn L. 
Published: April 2019

Introduction:
The collection of patient-reported outcomes (PROs) in routine clinical practice provides opportunities to “feed-forward” the patient’s perspective to his/her clinical team to inform planning and management. This data can also be aggregated to “feedback” population-level analytics that can inform treatment decision-making, predictive modeling, population-based care, and system-level quality improvement efforts.

Methods Aiding Interpretation and Acting on Results:
Three case studies demonstrate a number of system-level features which aid effective PRO interpretation: (1) feed-forward and feedback information flows; (2) score interpretation aids; (3) cascading measurement; (4) registry-enabled learning health care systems; and (5) the maturational development of information systems.

Discussion:
The case studies describe the developmental span of feed-forward PRO programs—from simple to mature applications. The Concord Hospital (CH) Multiple Sclerosis Neurobehavioral Clinic exemplifies a simple application in which PRO data are used before and during clinic visits by patients and clinicians to inform care. The Dartmouth-Hitchcock (D-H) Spine Center exemplifies a mature program which utilizes population-level analytics to provide decision support by predicting outcomes for different treatment options. The Swedish Rheumatology Quality (SRQ) Registry epitomizes an exceptional application which has spread to multiple systems across an entire country.

Key Points:
Feed-forward and feedback PRO information systems can better inform, involve, and support clinicians, patients and families, and allow health systems to monitor and improve system performance and population health outcomes. Ideal systems have the capability for multilevel analyses at patient, system, and population levels, and an information technology infrastructure that is linked to associated workflows and a supportive practice culture. As systems mature, they progress beyond the ability to describe and inform towards higher level capabilities including prediction and decision support. Finally, there is additional promise for the integration of patient-reported information that is adjusted (or weighted) by preferences and values to guide shared decision-making and inform individualized precision health care in the future.
Interpreting and Acting on the PRO Scores From the Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) eHealth System
Authors: Girgis Afaf , Durcinoska Ivana , Arnold Anthony , Delaney Geoff P. 
Published: April 2019

Introduction:
Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) is the first eHealth system in Australia that is fully electronically integrated into hospital oncology information systems, enabling real-time, routine collection of patient-reported outcomes (PROs) to support and enable cancer patients to achieve and maintain improved health, well-being, and cancer outcomes. Five previously published papers detail the impetus for developing this eHealth system, its development, and testing of its acceptability and feasibility, the development of algorithms to standardize the cancer care pathways which underpin patient care, and the protocol for evaluating the efficacy of PROMPT-Care.

Methods:
This manuscript provides “how-to” guidance to inform future system development, focusing on selecting relevant PROs and measuring them in cancer patients, score interpretation, and determining recommended care in response to scores which are above the predetermined threshold.

Discussion:
Electronic PRO systems are increasingly used in cancer clinical care settings, with the potential to support timely patient-centered care when implemented appropriately.

Key Points:
PRO selection should consider patient response burden, and prioritizing PROs that are amenable to clinical intervention. Having clear, evidence-based, care pathways, and actionable recommendations in response to above-threshold PRO scores facilitate PRO integration into the clinical workflow. Centers should determine thresholds for clinical action for each PRO which provide an acceptable balance between false positives and false negatives; and develop care pathway recommendations which consider the availability of local services and resources, are feasible in the clinical setting, clear, concise, manageable, based on evidence-based guidelines, and adaptable to local environments.
Using Stakeholder Engagement to Overcome Barriers to Implementing Patient-reported Outcomes (PROs) in Cancer Care Delivery
Authors: Stover Angela M. , Tompkins Stricker Carrie , Hammelef Karen , Henson Sydney , Carr Philip , Jansen Jennifer , Deal Allison M. , Bennett Antonia V. , Basch Ethan M. 
Published: April 2019

Introduction:
Patient-reported outcome (PRO) measures used during cancer care delivery improve communication about symptoms between patients and clinicians and reduce service utilization for uncontrolled symptoms. However, uptake of PROs in routine cancer care has been slow. In this paper, we describe stakeholder engagement activities used to overcome barriers to implementing PROs. Implementation occurred in 2 study settings: PROs completed in the waiting room and reviewed during clinical visits to guide symptom management for multiple myeloma (visit-based PROs); and weekly PROs completed by cancer patients between chemotherapy visits to monitor symptoms at home (remote PROs).

Methods:
PRO implementation steps across studies included: (1) clinician and patient input on key symptoms, PRO measures, and identifying which PRO responses are clinically concerning to better target nursing actions; (2) developing PRO-based clinical decision support (CDS) for responding to concerning PROs; (3) training clinicians and clinical research assistants to interpret PROs and use software; and (4) describing implementation impact (frequency of concerning PRO responses and nursing actions).

Discussion:
Clinician and patient input was critical for identifying key symptoms, PRO measures, and clinically concerning response options. For the visit-based PRO observational study, all symptom scores appeared on a clinician dashboard, and those rated ≥1 by patients (on a 0–4 or 0–10 scale) had PRO-based CDS available for access. For the 2 remote PROs trials, stakeholders recommended that the 2 “worst” response options (eg, PRO responses of “often”/“always” or “severe”/“very severe”) would trigger an automated email alert to a nurse along with PRO-based CDS. In each study, PRO-based CDS was tailored based on clinician input. Across studies, the most common nursing response to concerning PROs was counseling patients on (or providing care plans for) self-management of symptoms. In the trials, the percentage of weekly remote PROs generating an alert to a nurse ranged from 13% at an academic center to 36% in community oncology practices.

Key Points:
Across 3 prospective studies, PROs implemented into cancer care enabled tailored care based on issues identified on PROs. Stakeholder engagement was critical for successful implementation. This paper assists in addressing important PRO implementation challenges by describing a stakeholder-driven approach.
Can Methods Developed for Interpreting Group-level Patient-reported Outcome Data be Applied to Individual Patient Management?
Authors: King Madeleine T. , Dueck Amylou C. , Revicki Dennis A. 
Published: April 2019

Background:
Patient-reported outcome (PRO) data may be used at 2 levels: to evaluate impacts of disease and treatment aggregated across individuals (group-level) and to screen/monitor individual patients to inform their management (individual-level). For PRO data to be useful at either level, we need to understand their clinical relevance.

Purpose:
To provide clarity on whether and how methods historically developed to interpret group-based PRO research results might be applied in clinical settings to enable PRO data from individual patients to inform their clinical management and decision-making.

Methods:
We first differentiate PRO-based decision-making required at group versus individual levels. We then summarize established group-based approaches to interpretation (anchor-based and distribution based), and more recent methods that draw on item calibrations and qualitative research methods. We then assess the applicability of these methods to individual patient data and individual-level decision-making.

Findings:
Group-based methods provide a range of thresholds that are useful in clinical care: some provide screening thresholds for patients who need additional clinical assessment and/or intervention, some provide thresholds for classifying an individual’s level of severity of symptoms or problems with function, and others provide thresholds for meaningful change when monitoring symptoms and functioning over time during or after interventions. Availability of established cut-points for screening and symptom severity, and normative/reference values, may play into choice of PRO measures for use in clinical care. Translatability of thresholds for meaningful change is more problematic because of the greater reliability needed at the individual-level versus group-level, but group-based methods may provide lower bound estimates. Caution is needed to set thresholds above bounds of measurement error to avoid “false-positive changes” triggering unwarranted alerts and action in clinic.

Conclusions:
While there are some challenges in applying available methods for interpreting group-based PRO results to individual patient data and clinical care—including myriad contextual factors that may influence an individual patient’s management and decision-making—they provide a useful starting point, and should be used pragmatically.
Applying PRO Reference Values to Communicate Clinically Relevant Information at the Point-of-care
Authors: Jensen Roxanne E. , Bjorner Jakob B. 
Published: April 2019

Introduction:
The inclusion of reference values for common patient-reported outcomes (PROs) measures in clinical care settings provides a clinically relevant context for an individual patient’s PRO scores. PRO reference values are currently not reported in clinical care settings. This is a missed opportunity, as clinicians are familiar with the presence and interpretation of reference values, commonly provided alongside laboratory test results. Incorporating PRO reference values into clinical PRO reporting requires: an understanding of the clinical purpose, the availability of an appropriate reference value, and graphical representation.

Methods for PRO Score Interpretation:
We present reference value terminology adapted for PROs and discuss important differences between using reference values in the PRO score interpretation compared to other types of clinical measures from clinical chemistry. We outline the basic methodological approaches in obtaining a PRO reference sample and calculating reference intervals. Lastly, we provide recommendations on how to present and use PRO reference values in clinical care settings.

Discussion:
There is a strong, long-standing discipline behind reference value development and application in psychology and medicine, allowing for both providers and patients to understand comparisons and identify what is “out of range.” PRO reference values can be communicated in a wide range of ways within clinical care settings and are adaptable as required to different patient populations or clinical care situations. However, a notable adoption barrier is the expense and methodological expertise needed to establish and apply PRO reference values effectively in clinical encounters.
Regulation of lipid rafts, angiogenesis and inflammation by AIBP
Authors: Fang Longhou , Miller Yury I. 
Published: April 2019

Purpose of review
Recent studies demonstrate an important role of the secreted apolipoprotein A-I binding protein (AIBP) in regulation of cholesterol efflux and lipid rafts. The article discusses these findings in the context of angiogenesis and inflammation.

Recent findings
Lipid rafts are cholesterol-rich and sphingomyelin-rich membrane domains in which many receptor complexes assemble upon activation. AIBP mediates selective cholesterol efflux, in part via binding to toll-like receptor-4 (TLR4) in activated macrophages and microglia, and thus reverses lipid raft increases in activated cells. Recent articles report AIBP regulation of vascular endothelial growth factor receptor-2, Notch1 and TLR4 function. In zebrafish and mouse animal models, AIBP deficiency results in accelerated angiogenesis, increased inflammation and exacerbated atherosclerosis. Spinal delivery of recombinant AIBP reduces neuraxial inflammation and reverses persistent pain state in a mouse model of chemotherapy-induced polyneuropathy. Inhalation of recombinant AIBP reduces lipopolysaccharide-induced acute lung injury in mice. These findings are discussed in the perspective of AIBP's proposed other function, as an NAD(P)H hydrate epimerase, evolving into a regulator of cholesterol trafficking and lipid rafts.

Summary
Novel findings of AIBP regulatory circuitry affecting lipid rafts and related cellular processes may provide new therapeutic avenues for angiogenic and inflammatory diseases.
Integrative roles of microRNAs in lipid metabolism and dyslipidemia
Authors: Sedgeman Leslie R. , Michell Danielle L. , Vickers Kasey C. 
Published: April 2019

Purpose of review
The purpose of the review is to discuss recent advances in microRNA (miRNA) regulation of lipid metabolism and highlight the importance of miRNA-mediated gene regulation in dyslipidemia and fatty liver disease. This article reviews examples of miRNAs that bridge disparate metabolic pathways in the liver. For example, we highlight miRNAs that are regulated by the sterol-sensing pathway in the liver that in turn regulate cellular or systemic cholesterol, fatty acid, and glucose levels.

Recent findings
The most widely studied of these miRNAs are miR-33a/b; however, we recently reported that miRNAs in the miR-183/96/182 cluster are also likely regulated by hepatic cholesterol content and mediate the observed glucose-lowering effects of the bile acid sequestrant colesevelam through the sterol-sensing pathway. In addition, several other hepatic and adipose miRNAs have been recently demonstrated to be key regulators of cellular lipid synthesis, storage, and catabolism, as well as systemic lipid metabolism. Moreover, many of these miRNAs are altered in fatty liver disease and dyslipidemia.

Summary
miRNAs are not just fine-tuners of lipid metabolism, but critical regulatory factors in lipid homeostasis and health. Loss of these miRNA regulatory modules very likely contributes to the underlying metabolic defects observed in lipid disorders.
Genetics-driven discovery of novel regulators of lipid metabolism
Authors: Ha Elizabeth E. , Van Camp Andrew G. , Bauer Robert C. 
Published: April 2019

Purpose of review
Residual cardiovascular disease risk and increasing metabolic syndrome risk underscores a need for novel therapeutics targeting lipid metabolism in humans. Unbiased human genetic screens have proven powerful in identifying novel genomic loci, and this review discusses recent developments in such discovery.

Recent findings
Recent human genome-wide association studies have been completed in incredibly large, detailed cohorts, allowing for the identification of more than 300 genomic loci that participate in the regulation of plasma lipid metabolism. However, the discovery of these loci has greatly outpaced the elucidation of the underlying functional mechanisms. The identification of novel roles for long noncoding RNAs, such as CHROME, LeXis, and MeXis, in lipid metabolism suggests that noncoding RNAs should be included in the functional translation of GWAS loci.

Summary
Unbiased genetic studies appear to have unearthed a great deal of novel biology with respect to lipid metabolism, yet translation of these findings into actionable mechanisms has been slow. Increased focus on the translation, rather than the discovery, of these loci, with new attention paid to lncRNAs, can help spur the development of novel therapeutics targeting lipid metabolism.
Substance Use in Adolescents and Young Adults With Inflammatory Bowel Diseases
Authors: Plevinsky Jill M. , Maddux Michele H. , Greenley Rachel N. 
Published: April 2019

ABSTRACTObjectives:Adolescents and young adults (AYAs) with chronic illnesses use substances at similar, if not greater, rates compared to healthy peers. The present study aimed to examine rates and patterns of tobacco use, marijuana use, and binge drinking in AYAs with inflammatory bowel diseases. We expected that substance use would be associated with poorer physical health, psychosocial functioning, and disease management.Methods:One hundred thirty‐two AYAs completed a single set of surveys assessing demographics, disease activity, healthcare utilization, health‐related quality of life (HRQoL), inflammatory bowel disease–specific self‐efficacy, adherence barriers, disease management skills, and substance use in the last 30 days (eg, tobacco use, marijuana use, binge drinking). Exploratory cluster analyses, followed by chi‐square tests and analyses of variance examined patterns of substance use and correlates of cluster membership.Results:Four patterns emerged from the sample: Global Users (n = 17), Marijuana Users Engaging in Binge Drinking (n = 18), Exclusive Binge Drinkers (n = 21), and Global Abstainers (n = 76). Groups differed by age, gender, disease activity, healthcare utilization, HRQoL, self‐efficacy, and adherence barriers with medium and large effect sizes (P < .05).Conclusions:Older age, male gender, active disease, at least 1 hospitalization in the past year, low self‐efficacy, low HRQoL, and high adherence barriers were significantly more likely for those reporting multisubstance use. In addition, all those reporting both marijuana use and binge drinking also reported tobacco use. Future research ought to examine these associations longitudinally and throughout the transition to adult care.
Mental Health Status of Medical Students
Authors: El-Gilany Abdel-Hady , Amro Mostafa , Eladawi Noha , Khalil Mohamed 
Published: April 2019

Abstract
Mental health illnesses are increasing in severity and number among medical students. This study aims to estimate the prevalence of mental disorders among medical students and their associated factors. Nine hundred students were selected from Mansoura Faculty of Medicine by the cluster sampling method. Data were collected using an Arabic self-administered questionnaire and the Arabic version of the Symptoms Checklist 90 Revised. Both bivariate and multivariate logistic regression analyses were done. Approximately 59% of students had one or more mental disorders. The prevalence of high Positive Symptom Distress Index (PSDI), depression, and somatization was 30.1%, 25.2%, and 21.7%, respectively. Logistic regression revealed that being male, younger than 20 years age, living away from family, rural families, and very low or low social class were independent risk factors for most of the mental disorders studied. In conclusion, mental disorders were common among medical students. Mental health care should be mandatory for these students.
Is Online Treatment as Effective as In-Person Treatment?
Authors: Church Dawson , Clond Morgan 
Published: April 2019

Abstract
Psychotherapy has undergone a widespread change recently, with many interventions now available as wireless device apps or online courses. The current study compared the efficacy of an online program with a personal group treatment intervention. The in-person group (n = 37) attended a 6-day workshop called Tapping Deep Intimacy that focused on the development of interpersonal skills. The online group (n = 37) consumed to the same information in the form of a 12-week online course. The content of both courses was drawn from the curriculum for Whole Energy Lifestyle, which trains participants in 12 evidence-based interpersonal and stress-reduction skills designed to reduce emotional triggering and promote health. These include mindfulness, breathwork, meditation (EcoMeditation), heart coherence, Clinical Emotional Freedom Techniques, active listening, and qigong. In both groups, depression, anxiety, and relationship satisfaction were assessed pre, post, and at 1-year follow-up. Anxiety reduced in the in-person but not the online group. Significant improvements in depression (p < 0.001) were found in both groups, although sharper symptom declines were found in the in-person group. A 29% improvement in relationship satisfaction was found in both groups (p < 0.003), and both maintained their gains over time. Anxiety and depression symptoms were much higher in the in-person group pretest despite similar demographic characteristics, suggesting differences in the population that uses online courses. These preliminary findings suggest that while online programs may play a role in the development of stress-reduction and interpersonal skills, it cannot be assumed that they mirror the therapeutic efficacy of in-person treatment in every dimension.
Recent Suicidal Ideation and Behavior in the General Population
Authors: Briere John , Kwon Omin , Semple Randye J. , Godbout Natacha 
Published: April 2019

Abstract
The multivariate relationship between suicidality and three potential etiologic variables (depression, posttraumatic stress, and reactive avoidance) was examined in a stratified sample of 679 individuals from the general population. Lifetime exposure to a trauma or another very upsetting event was prevalent among those reporting suicidal behavior in the previous 6 months (58%) and those reporting recent suicidal ideation alone (40%), relative to those with no recent suicidal thoughts or behaviors (26%). Canonical correlation analysis indicated two independent sources of variance: the first loading on both suicidal ideation and behavior, predicted by depression, posttraumatic stress, and reactive avoidance, and the second indicating a unique relationship between suicidal behavior and reactive avoidance alone. Results indicate that the etiology of suicidality is likely multidimensional, and point to a significant variant of suicidal behavior that is unrelated to depression or posttraumatic stress, but may reflect emotional dysregulation and subsequent distress reduction behaviors.
Comprehension of Embedded Clauses in Schizophrenia With and Without Formal Thought Disorder
Authors: Çokal Derya , Zimmerer Vitor , Varley Rosemary , Watson Stuart , Hinzen Wolfram 
Published: April 2019

Abstract
Formal thought disorder (FTD) in schizophrenia (SZ) is clinically manifested primarily through language production, where linguistic studies have reported numerous anomalies including lesser use of embedded clauses. Here, we explored whether problems of language may extend to comprehension and clause embedding in particular. A sentence-picture matching task was designed with two conditions in which embedded clauses were presupposed as either true (factive) or not. Performance across these two conditions was compared in people with SZ and moderate-to-severe FTD (SZ + FTD), SZ with minimal FTD (SZ-FTD), first-degree relatives of people with SZ, and neurotypical controls. The SZ + FTD group performed significantly worse than all others in both conditions, and worse in the nonfactive than in the factive one. These results demonstrate language dysfunction in comprehension specific to FTD is a critical aspect of grammatical complexity and its associated meaning, which has been independently known to be cognitively significant as well.