bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing Bias in Palliative Care: Professional Hazards in Goals of Care Discussions at the End of Life
Authors: Callaghan Katharine A. , Fanning Joseph B. 
Published: November 2017

Background: In the setting of end-of-life care, biases can interfere with patient articulation of goals and hinder provision of patient-centered care. No studies have addressed clinician bias or bias management specific to goals of care discussions at the end of life. Objectives: To identify and determine the prevalence of palliative care clinician biases and bias management strategies in end-of-life goals of care discussions. Design: A semistructured interview guide with relevant domains was developed to facilitate data collection. Participants were asked directly to identify biases and bias management strategies applicable to this setting. Two researchers developed a codebook to identify themes using a 25% transcript sample through an iterative process based on grounded theory. Inter-rater reliability was evaluated using Cohen κ. It was 0.83, indicating near perfect agreement between coders. The data approach saturation. Setting/Participants: A purposive sampling of 20 palliative care clinicians in Middle Tennessee participated in interviews. Results: The 20 clinicians interviewed identified 16 biases and 11 bias management strategies. The most frequently mentioned bias was a bias against aggressive treatment (n = 9), described as a clinician’s assumption that most interventions at the end of life are not beneficial. The most frequently mentioned bias management strategy was self-recognition of bias (n = 17), described as acknowledging that bias is present. Conclusion: This is the first study identifying palliative care clinicians’ biases and bias management strategies in end-of-life goals of care discussions.
The Impact of Teaching Prognostication at the End of Life: A Pre–Post Interventional Study
Authors: Bear Alexandria , Keuter Tucker , Patel Jayshil J. 
Published: November 2017

Background: Providing accurate and valid prognostic information significantly influences end-of-life care. Disclosing a poor prognosis can be among the most difficult of physician responsibilities, thus having appropriate knowledge during training is crucial for appropriate prognostication. Objective: To provide internal medicine (IM) house staff with a pre- and posteducational survey to determine their ability to accurately prognosticate 5 common end-stage diseases. Design: We conducted a pre- and posteducational intervention survey-based study. A preintervention survey was administered to IM postgraduate year 1 (PGY-1) and PGY-2-4 house staff. The survey consisted of case scenarios for 5 common end-stage diseases, containing 1 question on comfort level and 2 on prognostication (totaling 10 points). A 30-minute educational intervention was presented immediately after the initial survey. The same survey was readministered 4 weeks thereafter. An identical survey was administered once to palliative care faculty. Results: Forty house staff completed pre- and posteducational surveys. Eight palliative care faculty completed the survey. No difference was found between all house staff pre- and postscores (mean 2.70 [1.45] vs 2.78 [1.59], P = .141). There was no significant difference between PGY-1 and PGY-2-4 pretest scores (mean 2.63 [1.71] vs 2.81 [1.42], P = .72). The PGY-2-4 posttest score was significantly greater than PGY-1 posttest score (3.38 [1.58] vs 2.38 [1.58], P = .05). Total house staff posttest score was significantly lower than gold standard palliative care faculty (mean 4.71 [1.98] vs 2.78 [1.59], P = .006). Conclusions: Our pre–post intervention survey-based study demonstrates no significant increases in all house staff scores. The PGY-2-4 postintervention scores improved significantly. We speculate the optimal time for prognostication education may be after the PGY-1 year when house staff have had sufficient exposure to common conditions.
Fear, Pain, Denial, and Spiritual Experiences in Dying Processes
Authors: Renz M. , Reichmuth O. , Bueche D. , Traichel B. , Mao M. Schuett , Cerny T. , Strasser F. 
Published: November 2017

Purpose: Approaching death seems to be associated with physiological/spiritual changes. Trajectories including the physical–psychological–social–spiritual dimension have indicated a terminal drop. Existential suffering or deathbed visions describe complex phenomena. However, interrelationships between different constituent factors (e.g., fear and pain, spiritual experiences and altered consciousness) are largely unknown. We lack deeper understanding of patients’ inner processes to which care should respond. In this study, we hypothesized that fear/pain/denial would happen simultaneously and be associated with a transformation of perception from ego-based (pre-transition) to ego-distant perception/consciousness (post-transition) and that spiritual (transcendental) experiences would primarily occur in periods of calmness and post-transition. Parameters for observing transformation of perception (pre-transition, transition itself, and post-transition) were patients’ altered awareness of time/space/body and patients’ altered social connectedness. Method: Two interdisciplinary teams observed 80 dying patients with cancer in palliative units at 2 Swiss cantonal hospitals. We applied participant observation based on semistructured observation protocols, supplemented by the list of analgesic and psychotropic medication. Descriptive statistical analysis and Interpretative Phenomenological Analysis (IPA) were combined. International interdisciplinary experts supported the analysis. Results: Most patients showed at least fear and pain once. Many seemed to have spiritual experiences and to undergo a transformation of perception only partly depending on medication. Line graphs representatively illustrate associations between fear/pain/denial/spiritual experiences and a transformation of perception. No trajectory displayed uninterrupted distress. Many patients seemed to die in peace. Previous near-death or spiritual/mystical experiences may facilitate the dying process. Conclusion: Approaching death seems not only characterized by periods of distress but even more by states beyond fear/pain/denial.
Clinical Factors Associated With Adherence to the Premedication Protocol for Withdrawal of Mechanical Ventilation in Terminally Ill Patients: A 4-Year Experience at a Single Medical Center in Asia
Authors: Wang Chao-Hui , Huang Pei-Wei , Hung Chia-Yen , Lee Shu-Hui , Kao Chen-Yi , Wang Hung-Ming , Hung Yu-Shin , Su Po-Jung , Kuo Yung-Chia , Hsieh Chia-Hsun , Chou Wen-Chi 
Published: November 2017

Purpose: Data on end-of-life care practices in Asia are scarce. This study aimed to analyze the clinical factors associated with the recommended premedication protocol for mechanical ventilation withdrawal, in Taiwan. Methods: A total of 135 terminally ill patients who had mechanical ventilation withdrawn between 2013 and 2016 from a single medical center in Taiwan were enrolled. A premedication protocol of morphine and midazolam intravenous bolus was routinely recommended for the patients before mechanical ventilation withdrawal. Receipt of opioids and/or benzodiazepines during the withdrawal process was defined as full (both), partial (1 drug), and no (none) adherence. The clinical factors relevant to the adherence of recommended premedication protocol for mechanical ventilation withdrawal were analyzed. Results: Overall, 126 (93.3%) patients died, 8 (5.9%) patients were transferred to other institutions for further care, and 1 (0.7%) patient was discharged to home after mechanical ventilation withdrawal. The median survival time was 45 minutes, and 102 (75.6%) patients died within 1 day after the withdrawal process. The full, partial, and no adherence rates for premedication guideline were 17.8%, 40.0%, and 42.2%, respectively. The main diagnosis of cancer, receipt of hospice care, and preservation of spontaneous respiration were independent variables associated with the partial or full adherence to the premedication protocol. Conclusion: Our data show that adherence to the premedication protocol for mechanical ventilation withdrawal in terminally ill patients was inadequate in Taiwan. Promoting hospice care and educating medical personnel in the compassionate withdrawal of mechanical ventilation, especially in patients with noncancer disease, are warranted.
Combination Therapy with Budesonide and Formoterol in Single Inhaler of Asthma
Authors: Hamzavi Mohammad 
Published: November 2017

Inhaled corticosteroids are the mainstay of asthma therapy, but there is now compelling evidence that addition of a long-acting inhaled β2-agonist, such as formoterol, gives better control in terms of reduced symptoms, improved lung function and reduced exacerbations in patients with mild to severe persistent asthma than increasing the dose of corticosteroids in patients not fully in control by low dose. This has led to development of fixed dose combination inhalers such as budesonide/formoterol. Budesonide/formoterol combination in a single inhaler represents a safe, effective and convenient treatment option for management of patients with unstable asthma than inhaled steroid alone. This combination has shown effectiveness for both maintenance and rescue therapy. Clinical results show that the budesonide/formoterol by SMART approach prolongs the time to first severe asthma exacerbation, reduces frequency of exacerbation and maintains day to day asthma control at a reduced corticosteroid load and cost when compared with higher fixed maintenance dose of combination inhalers. With regular maintenance therapy by this approach it is more likely to improve patient compliance. Budesonide/formoterol combination inhaler has shown to have a faster bronchodialatory effect compared with other combination inhalers, a quality highly in demand during exacerbation episodes. Due to this rapid onset of action, budsonide/formoterol in a single inhaler lends itself to be used as a rescue medication, as well.
The presence of co-morbid mental health problems in a cohort of adolescents with chronic fatigue syndrome
Authors: Loades Maria Elizabeth , Rimes Katharine A , Ali Sheila , Lievesley Kate , Chalder Trudie 
Published: November 2017

Objective: To report on the prevalence of mental health disorders in adolescents with chronic fatigue syndrome (CFS) and to compare the diagnoses identified by a brief clinician-administered psychiatric interview with self-report screening questionnaires. Design: Cross-sectional study. Setting: Consecutive attenders to specialist CFS clinics in the United Kingdom. Patients: N = 52 adolescents, age 12–18 years with CFS. Measures: Self-report questionnaires and a brief structured psychiatric diagnostic interview, administered by a researcher. Results: On the psychiatric interview, 34.6% met a diagnosis of major depressive disorder and 28.8% had an anxiety disorder. Of these, 15% had co-morbid anxiety and depression. Those with a depression diagnosis reported significantly greater interference on the school and social adjustment scale. They also scored significantly higher on trait anxiety, but not on state anxiety. There were no differences between those who had an anxiety disorder and those who did not on fatigue, disability or depressive symptoms. Children’s Depression Inventory (CDI) score was associated with a depression diagnosis on the psychiatric interview. However, neither the state nor the trait subscale of the State-Trait Anxiety Inventory (STAI) was associated with an anxiety diagnosis. Conclusion: Clinicians should assess for the presence of anxiety and depressive disorders in adolescents with CFS using a validated psychiatric interview. Treatment should be flexible enough to accommodate fatigue, depression and anxiety. Transdiagnostic approaches may suit this purpose. Goals should include pleasurable activities particularly for those who are depressed.
Radial styloidectomy for scaphoid nonunion advanced collapse – relevance of nonunion location
Authors: Vutescu Emil S. , Jethanandani Rishabh , Sneag Darryl B. , Wolfe Scott W. , Lee Steve K. 
Published: November 2017

Radial styloidectomy along with scaphoid nonunion reconstructive surgery is considered an acceptable surgical treatment for stage 1 scaphoid nonunion advanced collapse. The extent of radioscaphoid joint wear that defines scaphoid nonunion advanced collapse stage 1 is unclear. An appropriate radial styloidectomy is limited to 6 mm styloid removal to prevent carpal instability. The aim of this study was to determine whether nonunion fracture location can be a guiding factor in determining whether the scaphoid bone can be retained with scaphoid nonunion reconstructive surgery and radial styloidectomy. We reviewed wrist radiographs and magnetic resonance imaging studies of 21 patients with a diagnosis of scaphoid nonunion advanced collapse stage 1, and quantified chondral wear as the length of a line (in mm) along the radioscaphoid joint traced from the tip of the radial styloid to the most ulnar position along the radioscaphoid joint. We concluded that scaphoid nonunion reconstructive surgery with radial styloidectomy is only appropriate for nonunions in the distal or middle third of the scaphoid. Level of evidence: III
The impact of structured physical activity on glycaemic control in diabetes prevention programmes: A systematic review
Authors: Edwards Joseph , Hosseinzadeh Hassan 
Published: November 2017

Background: Seven landmark randomised controlled trials, with some that began as early as the 1990s, observed the prediabetic state, namely, impaired glucose tolerance and impaired fasting glucose conditions, against the impact of lifestyle interventions such as physical activity, to prevent or delay the onset of type 2 diabetes mellitus. In addition to the landmark trials, this systematic review examines 14 studies that retained a focus on prediabetic individuals and measured the efficacy of physical activity on improving glucose tolerance. Results: Type, duration and intensity of structured physical activity can have unique benefits to prediabetic individuals. It is posited that diabetes prevention programmes must target prediabetic individuals as belonging to a high-risk group, separate and distinct from those identified with overall risk factors. While the transition from prediabetes to type 2 diabetes mellitus is not completely deterministic, the conversion rate is phenomenally higher among those with impaired glucose tolerance than those with normal glucose levels. Conclusion: Tenets of health behaviour models do support inferences that prediabetic individuals are potentially more inclined to weighing the risks and benefits of progressive illnesses and would therefore be more receptive to active participation in interventions. More research is required to develop evidence-based diabetes prevention programmes linked to structured physical activity intervention.
Neurocognitive Deficits of Concussed Adolescent Athletes at Self-reported Symptom Resolution in the Zurich Guidelines Era
Authors: Kriz Peter K. , Mannix Rebekah , Taylor Alex M. , Ruggieri Danielle , Meehan William P. 
Published: November 2017

Background: Previous studies have evaluated high school and collegiate athletes in the pre–Zurich guidelines era; whether adolescent athletes demonstrate similar neurocognitive decrements in the current concussion management era remains unclear. Purpose: To assess for the presence of neurocognitive deficits in adolescents with a sport-related concussion at the time of self-reported symptom resolution. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We conducted a prospective cohort study of 32 patients, aged 13 to 18 years, who sustained concussions during ice hockey and who were referred to 3 sports medicine clinics between September 1, 2012, and March 31, 2015. Demographic, anthropometric, and injury data were collected at the time of the initial postconcussion evaluation. To document symptoms, patients completed the Post-Concussion Symptom Scale (PCSS) at initial and follow-up visits. Baseline and postinjury neurocognitive function were assessed using computerized neurocognitive testing (Immediate Post-Concussion Assessment and Cognitive Test [ImPACT]), and a reliable change index was used to determine significant changes in composite scores. Statistical comparisons were conducted using the Student t test and Mann-Whitney U test. Results: A total of 9 of 32 athletes (28.1%; 95% CI, 14.8%-46.9%) demonstrated continued neurocognitive impairment on ≥1 composite score when no longer reporting concussion-related symptoms, while only 2 of 32 athletes (6.3%; 95% CI, 1.4%-23.2%) demonstrated continued neurocognitive impairment on ≥2 composite scores. Conclusion: Neurocognitive deficits persist in adolescent athletes who no longer report concussion-related symptoms, at rates similar to those of collegiate athletes but at longer time intervals. This finding provides further evidence that adolescent athletes with a sport-related concussion demonstrate a protracted recovery and resolution of neurocognitive deficits compared with collegiate and professional athletes. Computer-based neurocognitive testing as part of a multifaceted approach continues to play an important role in return-to-play decision making after a sport-related concussion in adolescent athletes. Test-taking strategies may erroneously identify asymptomatic athletes as exhibiting neurocognitive impairment.
Impaired Insulin Action Is Associated With Increased Glucagon Concentrations in Nondiabetic Humans
Authors: Sharma Anu , Varghese Ron T , Shah Meera , Man Chiara Dalla , Cobelli Claudio , Rizza Robert A , Bailey Kent R , Vella Adrian 
Published: November 2017

Abstract

Context
Abnormal glucagon concentrations contribute to hyperglycemia, but the mechanisms of α-cell dysfunction in prediabetes are unclear.

Objective
We sought to determine the relative contributions of insulin secretion and action to α-cell dysfunction in nondiabetic participants across the spectrum of glucose tolerance.

Design
This was a cross-sectional study. A subset of participants (n = 120) was studied in the presence and absence of free fatty acid (FFA) elevation, achieved by infusion of Intralipid (Baxter Healthcare, Deerfield, IL) plus heparin, to cause insulin resistance.

Setting
An inpatient clinical research unit at an academic medical center.

Participants
A total of 310 nondiabetic persons participated in this study.

Interventions
Participants underwent a seven-sample oral glucose tolerance test. Subsequently, 120 participants were studied on two occasions. On one day, infusion of Intralipid plus heparin raised FFA. On the other day, participants received glycerol as a control.

Main Outcome Measure(s)
We examined the relationship of glucagon concentration with indices of insulin action after adjusting for the effects of age, sex, and weight. Subsequently, we sought to determine whether an acute decrease in insulin action, produced by FFA elevation, altered glucagon concentrations in nondiabetic participants.

Results
Fasting glucagon concentrations correlated positively with fasting insulin and C-peptide concentrations and inversely with insulin action. Fasting glucagon was not associated with any index of β-cell function in response to an oral challenge. As expected, FFA elevation decreased insulin action and also raised glucagon concentrations.

Conclusions
In nondiabetic participants, glucagon secretion was altered by changes in insulin action.
Adrenocorticotropin Acutely Regulates Pregnenolone Sulfate Production by the Human Adrenal In Vivo and In Vitro
Authors: Rege Juilee , Nanba Aya T , Auchus Richard J , Ren Jianwei , Peng Hwei-Ming , Rainey William E , Turcu Adina F 
Published: November 2017

Abstract

Background
Dehydroepiandrosterone sulfate (DHEAS) is the most abundant steroid in human circulation, and adrenocorticotropic hormone (ACTH) is considered the major regulator of its synthesis. Pregnenolone sulfate (PregS) and 5-androstenediol-3-sulfate (AdiolS) have recently emerged as biomarkers of adrenal disorders.

Objective
To define the relative human adrenal production of Δ5-steroid sulfates under basal and cosyntropin-stimulated conditions.

Methods
Liquid chromatography-tandem mass spectrometry was used to quantify three unconjugated and four sulfated Δ5-steroids in (1) paired adrenal vein (AV) and mixed venous serum samples (21 patients) and (2) cultured human adrenal cells both before and after cosyntropin stimulation, (3) microdissected zona fasciculata (ZF) and zona reticularis (ZR) from five human adrenal glands, and (4) a reconstituted in vitro human 17α-hydroxylase/17,20-lyase/(P450 17A1) system.

Results
Of the steroid sulfates, PregS had the greatest increase after cosyntropin stimulation in the AV (32-fold), whereas DHEAS responded modestly (1.8-fold). PregS attained concentrations comparable to those of DHEAS in the AV after cosyntropin stimulation (AV DHEAS/PregS, 24 and 1.3 before and after cosyntropin, respectively). In cultured adrenal cells, PregS demonstrated the sharpest response to cosyntropin, whereas DHEAS responded only modestly (21-fold vs 1.8-fold higher compared with unstimulated cells at 3 hours, respectively). Steroid analyses in isolated ZF and ZR showed similar amounts of PregS and 17α-hydroxypregnenolone in both zones, whereas DHEAS and AdiolS were higher in ZR (P &lt; 0.05).

Conclusion
Our studies demonstrated that unlike DHEAS, PregS displayed a prominent acute response to cosyntropin. PregS could be used to interrogate the acute adrenal response to ACTH stimulation and as a biomarker in various adrenal disorders.
Identification of diverse defense mechanisms in trout red blood cells in response to VHSV halted viral replication
Authors: Nombela Ivan , Puente-Marin Sara , Chico Veronica , Villena Alberto J. , Carracedo Begoña , Ciordia Sergio , Mena Maria Carmen , Mercado Luis , Perez Luis , Coll Julio , Estepa Amparo , Ortega-Villaizan Maria del Mar 
Published: November 2017

Background:It has been described that fish nucleated red blood cells (RBCs) generate a wide variety of immune-related gene transcripts when viruses highly replicate inside them and are their main target cell. The immune response and mechanisms of fish RBCs against viruses targeting other cells or tissues has not yet been explored and is the objective of our study.Methods:Trout RBCs were obtained from peripheral blood, ficoll purified and exposed toViral Haemorrhagic Septicaemia virus(VHSV). Immune response was evaluated by means of RT-qPCR, flow cytometry, immunofluorescence and isobaric tag for relative and absolute quantification (iTRAQ) protein profilingResults:VHSV N gene transcripts incremented early postexposure and were drastically decreased after 6 hours postexposure (hpe). The expression of the type I interferon (ifn1) gene was significantly downregulated at early postexposure (3 hpe), together with a gradual downregulation of interferon-induciblemxandpkrgenes until 72 hpe. Type I IFN protein was downregulated and interferon-inducible Mx protein was maintained at basal levels. Co-culture assays of RBCs with TSS (stromal cell line from spleen) revealed the IFN crosstalk between both cell types. On the other hand, anti-microbial peptide β-defensin 1 and neutrophil chemotactic factor interleukin 8 were slightly upregulated in VHSV-exposed RBCs Isobaric tag for relative and absolute quantification (iTRAQ) revealed that VHSV exposure can induce a global protein downregulation in trout RBCs, mainly related to RNA stability and proteasome pathways. The antioxidant/antiviral response is also suggested to be involved in the response of trout RBCs to VHSV.Conclusions:A variety of mechanisms are proposed to be implicated in the antiviral response of trout RBCs against VHSV halted infection. Ongoing research is focused on understanding the mechanisms in detail. To our knowledge, this is the first report that implicates fish RBCs in the antiviral response against viruses not targeting RBCs.