bluuebunny/crossref_metadata_2025_split huggingface dataset:
Palliative care in patients with haematological neoplasms: An integrative systematic review
Authors: Moreno-Alonso Deborah , Porta-Sales Josep , Monforte-Royo Cristina , Trelis-Navarro Jordi , Sureda-Balarí Anna , Fernández De Sevilla-Ribosa Alberto 
Published: November 2017

Background: Palliative care was originally intended for patients with non-haematological neoplasms and relatively few studies have assessed palliative care in patients with haematological malignancies. Aim: To assess palliative care interventions in managing haematological malignancies patients treated by onco-haematology departments. Design: Integrative systematic review with data extraction and narrative synthesis (PROSPERO #: CRD42016036240). Data sources: PubMed, CINAHL, Cochrane, Scopus and Web-of-Science were searched for articles published through 30 June 2015. Study inclusion criteria were as follows: (1) published in English or Spanish and (2) containing data on palliative care interventions in adults with haematological malignancies. Results: The search yielded 418 articles; 99 met the inclusion criteria. Six themes were identified: (1) end-of-life care, (2) the relationship between onco-haematology and palliative care departments and referral characteristics, (3) clinical characteristics, (4) experience of patients/families, (5) home care and (6) other themes grouped together as ‘miscellany’. Our findings indicate that palliative care is often limited to the end-of-life phase, with late referral to palliative care. The symptom burden in haematological malignancies patients is more than the burden in non-haematological neoplasms patients. Patients and families are generally satisfied with palliative care. Home care is seldom used. Tools to predict survival in this patient population are lacking. Conclusion: Despite a growing interest in palliative care for haematological malignancies patients, the evidence base needs to be strengthened to expand our knowledge about palliative care in this patient group. The results of this review support the need to develop closer cooperation and communication between the palliative care and onco-haematology departments to improve patient care.
Caregiver quality of life in advanced cancer: Qualitative results from a trial of early palliative care
Authors: McDonald Julie , Swami Nadia , Pope Ashley , Hales Sarah , Nissim Rinat , Rodin Gary , Hannon Breffni , Zimmermann Camilla 
Published: November 2017

Background: Early involvement of palliative care improves patient quality of life; however, quantitative studies have not yet demonstrated a similar effect for caregivers, for whom the construct of quality of life is less well developed. Aim: To conceptualise quality of life of caregivers from their own perspective and to explore differences in themes between those who did or did not receive an early palliative care intervention. Design: Qualitative grounded theory study. Setting: Tertiary comprehensive cancer centre. Participants: Following participation in a cluster-randomised trial of early palliative care, 23 caregivers (14 intervention and 9 control) of patients with advanced cancer participated in semi-structured interviews to discuss their quality of life. Results: The core category was ‘living in the patient’s world’. Five related themes were ‘burden of illness and caregiving’, ‘assuming the caregiver role’, ‘renegotiating relationships’, ‘confronting mortality’ and ‘maintaining resilience’. There was thematic consistency between trial arms, except for the last two themes, which had distinct differences. Participants in the intervention group engaged in open discussion about the end of life, balanced hope with realism and had increased confidence from a range of professional supports. Controls tended to engage in ‘deliberate ignorance’ about the future, felt uncertain about how they would cope and lacked knowledge of available supports. Conclusions: Caregiver quality of life is influenced profoundly by the interaction with the patient and should be measured with specific questionnaires that include content related to confronting mortality and professional supports. This would improve delineation of quality of life for caregivers and allow greater sensitivity to change. Registration: clinicaltrials.gov NCT01248624
Folate Deficiency and Anemia Among Women of Reproductive Age (15-49 Years) in Senegal: Results of a National Cross-Sectional Survey
Authors: Ndiaye Ndèye Fatou , Idohou-Dossou Nicole , Diouf Adama , Guiro Amadou Tidiane , Wade Salimata 
Published: November 2017

Background: Widely spread throughout the world, folate and iron deficiencies are risk factors for many diseases. However, contrary to iron deficiency and anemia, which have been documented in depth, the prevalence of folate deficiency among women has not been well-studied. Objective: The aim of this study is to determine the prevalence of folate deficiency and anemia and their association among Senegalese women of reproductive age. Methods: A national cross-sectional survey using a stratified 2-stage cluster sampling was conducted. Data were collected from 1012 women (aged 15-49 years). Plasma folate and hemoglobin (Hb), as well as protein markers of subclinical infections, were equally measured. Results: The mean folate concentration was 8.50 nmol/L (8.16-8.85 nmol/L), and 54.8% of the women were folate deficient (<10 nmol/L). Plasma folate concentration of rural women (7.27 nmol/L [6.89-7.68 nmol/L]) and urban women (10.45 nmol/L [9.88-11.05 nmol/L]) was significantly different ( P < .0001), the highest concentration being observed in women living in Dakar, the capital of Senegal. The breastfeeding women showed lower plasma folate concentration compared to nonbreastfeeding ones: 6.97 nmol/L (6.37-7.63 nmol/L) versus 9.03 nmol/L (8.61-9.46 nmol/L). Overall, 27% of the women were suffering from inflammation/infections. Mean Hb concentration was 116.86 (1.18) g/L, and 47.63% of the women involved in the study were anemic (pregnant women Hb <110 g/L; nonpregnant Hb <120 g/L). Also, a positive and significant correlation was found between plasma folate and Hb concentrations ( r = .07; P = .0167). Conclusions: This study showed a high prevalence of folate deficiency and anemia among Senegalese women (15-49 years), particularly those living in rural settings and breastfeeding women.
Healthcare Needs of Patients with Amyotrophic Lateral Sclerosis (ALS) in Singapore: A patient-centred qualitative study from multiple perspectives
Authors: Ang Kexin , Umapathi Thirugnanam , Tong Jieli , Ng Justin , Tseng Liang Jun , Woo Ivan Mun Hong 
Published: November 2017

Background One challenge for those who manage amyotrophic lateral sclerosis (ALS) is to understand patients’ needs. Aim The aim of this study was to examine the needs of Singapore ALS patients from their perspective as well as that of their caregivers and healthcare professionals in order to develop a template for better services. Methods A cross-sectional qualitative study was conducted, with one-to-one interviews and focus group discussions. Results All 30 participants, key stakeholders in the field of caring for ALS patients, identified these needs categories: psychological – diagnosis must be staged and comfortably paced, and efforts must be made to encourage patients’ resilience; social – positive relationships, open communication, and spiritual support must be developed; physical – attention should be paid to alleviating discomfort and disability; and environmental -appropriate services should be made available. Conclusion The identified needs categories do overlap, but there are significant differences. Our findings provide a template for developing individualized patient services, which should be done within the framework of a comprehensive palliative care program.
Opinions of nurses regarding conscientious objection
Authors: Toro-Flores Rafael , Bravo-Agüi Pilar , Catalán-Gómez María Victoria , González-Hernando Marisa , Guijarro-Cenisergue María Jesús , Moreno-Vázquez Margarita , Roch-Hamelin Isabel , Velasco-Sanz Tamara Raquel 
Published: November 2017

Background: In the last decades, there have been important developments in the scientific and technological areas of healthcare. On certain occasions this provokes conflict between the patients' rights and the values of healthcare professionals which brings about, within this clinical relationship, the problem of conscientious objection. Aims: To learn the opinions that the Nurses of the Madrid Autonomous Community have regarding conscientious objection. Research design: Cross-cutting descriptive study. Participants and research context: The nurses of 9 hospitals and 12 Health Centers in the Madrid Autonomous Community. The study was done by means of an auto completed anonymous questionnaire. The variables studied were social-demographical and their opinions about conscientious objections. Ethical considerations: The study was approved by the Ethical Community of Clinical Research of the University Hospital Príncipe de Asturias. Participants were assured of maximum confidentiality and anonymity. Findings: A total of 421 nurses answered the questionnaire. In total, 55.6% of the nurses confirmed they were religious believers, and 64.3% declared having poor knowledge regarding conscientious objection. The matters that caused the greatest objections were voluntary abortions, genetic embryo selection, refusal of blood transfusions, and therapy refusal. Discussion: Different authors state that the most significant cases of conscientious objections for health professionals are those regarding carrying out or assisting in abortions, euthanasia, the practice of assisted reproduction and, finally, the prescription and dispensing of the morning-after pill. In our study, the most significant cases in which the nurses would declare conscientious objections would be the refusal to accept treatment, the selection of embryos after genetic diagnosis preimplantation, the patient’s refusal to receive blood transfusions due to religious reasons and pregnant women’s request for voluntary abortions within the first 14 weeks. Conclusion: Nurses’ religious beliefs influence their opinions regarding conscientious objection. The nurses who declare themselves as religious believers object in a higher percentage than those without religious beliefs.
The ultrasound neck imaging for tracheostomy study: A study prompting ultrasound screening prior to percutaneous tracheostomy procedures to improve patient outcomes
Authors: Rees James , Haroon Yumna , Hogan Christopher , Saha Shibaji , Derekshani Sharam 
Published: November 2017

Introduction Percutaneous tracheostomy procedures are commonplace in intensive care units worldwide. Haemorrhagic complications, though potentially fatal, are thought to be under-reported. Ultrasonography use has not established itself in these procedures. This study assesses the prevalence and characteristics of pre-tracheal blood vessels, to aid intensivists on potential procedural hazards. Method A retrospective, observational study was performed in the UK. Computed tomography angiograms from January 2012 to October 2014 were randomly retrieved and analysed for vessel data. Results A total of 343 adult patients were included (mean age: 65 (inter-quartile range 52–79), male: 63%). Forty-one percent of patients demonstrated a vessel overlying percutaneous tracheostomy insertion sites (C6–T1); veins were more common than arteries (69%, p = 0.001). Males were more likely to display veins (78 vs. 53%, p < 0.001). Discussion A substantial proportion of patients exhibited pre-tracheal vessels. Front-of-neck ultrasonography has huge potential to identify these. Based on these data, we believe ultrasonography may be an effective screening tool for percutaneous tracheostomy procedures to reduce complications. Further research is required to study outcomes.
Discrepancies in measuring bladder volumes with bedside ultrasound and bladder scanning in the intensive care unit: A pilot study
Authors: Prentice Donna M , Sona Carrie , Wessman Brian T , Ablordeppey Enyo A , Isakow Warren , Arroyo Cassandra , Schallom Marilyn 
Published: November 2017

Objective Intensive care unit patients are at risk for catheter-associated urinary tract infection. Earlier removal of catheters may be possible with accurate measurement of bladder volume. The purpose was to compare measured bladder volumes with bedside ultrasound, bladder scanner, and urine volume. Design Prospective correlational descriptive study. Setting Surgical/trauma intensive care unit and medical intensive care unit. Patients Renal dialysis patients with less than 100 ml of urine in 24 h prior to urinary catheter removal and patients with suspected catheter obstruction. Measurements and main results A physician trained in ultrasound and an advanced practice registered nurse trained in bladder scanning measured bladder volume; each blinded to the other’s measurement. Device used first (ultrasound or bladder scanner) alternated daily. The intensive care unit team determined need for intermittent catheterization or treatment for suspected obstruction. Fifty-one measurements from 13 patients were obtained with results reported in milliliters. Ultrasound measurements were a mean volume of 72.1 ± 127 (range: 1.7–666) and the bladder scanner measurements were 117 ± 131 (0–529). On six occasions in five dialysis patients, urine volume measurement was available. The mean difference in ultrasound–urine volume mean difference was 0.5 ± 37.8 (range: −68 to 38.2) and the bladder scanner–urine volume was 132 ± 167 (−72 to 397). Two patients with suspected catheter obstructions had ultrasound, bladder scanner, urine volume measurements, respectively: (1) 539, 51, >300 (began voiding before catheter replaced); (2) 666, 68, 1000 with catheter replacement. Conditions leading to greatest differences were obesity, indwelling catheter and ascites. Conclusions These results demonstrate the inaccuracy of the bladder scanner. Ultrasound measurements appear more accurate. To remove urinary catheters in patients with minimal to low urine output, serial ultrasound measurements can be used to monitor bladder volumes and return of renal function.
Using the experience-sampling method to examine the psychological mechanisms by which participatory art improves wellbeing
Authors: Holt Nicola J 
Published: November 2017

Aims: To measure the immediate impact of art-making in everyday life on diverse indices of wellbeing (‘in the moment’ and longer term) in order to improve understanding of the psychological mechanisms by which art may improve mental health. Methods: Using the experience-sampling method, 41 artists were prompted (with a ‘beep’ on a handheld computer) at random intervals (10 times a day, for one week) to answer a short questionnaire. The questionnaire tracked art-making and enquired about mood, cognition and state of consciousness. This resulted in 2,495 sampled experiences, with a high response rate in which 89% of questionnaires were completed. Results: Multi-level modelling was used to evaluate the impact of art-making on experience, with 2,495 ‘experiences’ (experiential-level) nested within 41 participants (person-level). Recent art-making was significantly associated with experiential shifts: improvement in hedonic tone, vivid internal imagery and the flow state. Furthermore, the frequency of art-making across the week was associated with person-level measures of wellbeing: eudemonic happiness and self-regulation. Cross-level interactions, between experiential and person-level variables, suggested that hedonic tone improved more for those scoring low on eudemonic happiness, and further that, those high in eudemonic happiness were more likely to experience phenomenological features of the flow state and to experience inner dialogue while art-making. Conclusion: Art-making has both immediate and long-term associations with wellbeing. At the experiential level, art-making affects multiple dimensions of conscious experience: affective, cognitive and state factors. This suggests that there are multiple routes to wellbeing (improving hedonic tone, making meaning through inner dialogue and experiencing the flow state). Recommendations are made to consider these factors when both developing and evaluating public health interventions that involve participatory art.
Risk of Complications of Vitrectomy for Floaters Based on Attached or Detached Status of Posterior Hyaloid Face
Authors: Rahman Rubina , Gormley Jack , Stephenson John 
Published: November 2017

Purpose: To ascertain whether posterior hyaloid face (PHF) status (attached vs detached) affects the risk of intraoperative retinal breaks and number of operations in patients undergoing vitrectomy for floaters. Methods: Consecutive, comparative single-surgeon case series. All patients undergoing vitrectomy for visually disabling floaters between July 2003 and June 2016 were included in this study. Data were collected prospectively into a vitreoretinal database and reviewed retrospectively for the purpose of the study.The following data were collected on each patient: age in years, sex, axial length (mm), presence of myopia, pre- and postoperative visual acuity in logarithm of the minimal angle of resolution. The status of the PHF was ascertained using preoperative clinical and optical coherence tomography assessment that was confirmed intraoperatively. The presence or absence of a retinal break was considered the primary outcome measure. Significant visual loss (reduction in ≥2 log units visual acuity), number of operations, and time from surgery to discharge were considered the secondary outcomes. Sequential multiple logistic and Cox regression analyses were conducted. Results: Data were collected from 97 patients (55 males and 42 females). Indications for surgery were Fuchs heterochromic cyclitis (9 patients), asteroid hyalosis (12 patients), and vitreous syneresis (76 patients). Twenty-one patients were pseudophakic on presentation, while 76 underwent combined phacovitrectomy. Vitreous status was significantly associated with retinal breaks ( P = .010). Controlling for other parameters, the odds of a retinal break in patients with PHF attached were about 5.5 times those in patients with PHF detached (95% confidence interval [CI], 1.52 -20.4). Number of operations was also significantly associated with this outcome ( P = .027); the odds of a retinal break increase by 6.28 times (95% CI, 1.23 -32.1). A substantive difference in the proportion of patients with retinal breaks was observed between the 2 groups, with a 50% prevalence rate in the attached group and a 9.1% prevalence rate in the detached group. Vitreous status was not associated with either secondary outcome measures. Number of operations was also significantly associated with time to discharge ( P = .008; hazard ratio, 2.78; 95% CI, 1.30 -5.91) in a multiple Cox model. Hence an increasing number of operations is associated with longer time to discharge. Conclusion: The analysis has found evidence to link vitreous status with the primary outcome of the presence of a retinal break. Particular care should be taken in, cases with vitreous attached status, to prevent missed breaks and subsequent rhegmatogenous retinal detachment.
Genotype-Specific Minimal Residual Disease Interpretation Improves Stratification in Pediatric Acute Lymphoblastic Leukemia
Authors: O’Connor David , Enshaei Amir , Bartram Jack , Hancock Jeremy , Harrison Christine J. , Hough Rachael , Samarasinghe Sujith , Schwab Claire , Vora Ajay , Wade Rachel , Moppett John , Moorman Anthony V. , Goulden Nick 
Published: November 2017

Purpose Minimal residual disease (MRD) and genetic abnormalities are important risk factors for outcome in acute lymphoblastic leukemia. Current risk algorithms dichotomize MRD data and do not assimilate genetics when assigning MRD risk, which reduces predictive accuracy. The aim of our study was to exploit the full power of MRD by examining it as a continuous variable and to integrate it with genetics. Patients and Methods We used a population-based cohort of 3,113 patients who were treated in UKALL2003, with a median follow-up of 7 years. MRD was evaluated by polymerase chain reaction analysis of Ig/TCR gene rearrangements, and patients were assigned to a genetic subtype on the basis of immunophenotype, cytogenetics, and fluorescence in situ hybridization. To examine response kinetics at the end of induction, we log-transformed the absolute MRD value and examined its distribution across subgroups. Results MRD was log normally distributed at the end of induction. MRD distributions of patients with distinct genetic subtypes were different ( P < .001). Patients with good-risk cytogenetics demonstrated the fastest disease clearance, whereas patients with high-risk genetics and T-cell acute lymphoblastic leukemia responded more slowly. The risk of relapse was correlated with MRD kinetics, and each log reduction in disease level reduced the risk by 20% (hazard ratio, 0.80; 95% CI, 0.77 to 0.83; P < .001). Although the risk of relapse was directly proportional to the MRD level within each genetic risk group, absolute relapse rate that was associated with a specific MRD value or category varied significantly by genetic subtype. Integration of genetic subtype–specific MRD values allowed more refined risk group stratification. Conclusion A single threshold for assigning patients to an MRD risk group does not reflect the response kinetics of the different genetic subtypes. Future risk algorithms should integrate genetics with MRD to accurately identify patients with the lowest and highest risk of relapse.
The Pediatric Endurance Athlete
Authors: Solomon Mary L. , Briskin Susannah M. , Sabatina Nicole , Steinhoff Jennifer E. 
Published: November 2017

Abstract
Youth sports participation numbers continue to grow in the United States. A shift toward sport specialization has caused an increase in sport training frequency and intensity that places the growing athlete at risk for overtraining, nutritional deficits, and injuries. Individuals who participate in endurance sports are at especially high risk. Youth runners and swimmers are high-risk populations that require special attention to their training schedules, nutritional intake, and injuries. Appropriate scheduling of training, dedicating time to rest, and nutrition education can help prevent problems in the endurance athlete.