bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ambulance-delivered transdermal glyceryl trinitrate versus sham for ultra-acute stroke: Rationale, design and protocol for the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2) trial (ISRCTN26986053)
Authors: Appleton Jason P , Scutt Polly , Dixon Mark , Howard Harriet , Haywood Lee , Havard Diane , Hepburn Trish , England Tim , Sprigg Nikola , Woodhouse Lisa J , Wardlaw Joanna M , Montgomery Alan A , Pocock Stuart , Bath Philip M ,   The RIGHT-2 Investigators
Published: August 2017

Rationale Vascular nitric oxide levels are low in acute stroke and donors such as glyceryl trinitrate have shown promise when administered very early after stroke. Potential mechanisms of action include augmentation of cerebral reperfusion, thrombolysis and thrombectomy, lowering blood pressure, and cytoprotection. Aim To test the safety and efficacy of four days of transdermal glyceryl trinitrate (5 mg/day) versus sham in patients with ultra-acute presumed stroke who are recruited by paramedics prior to hospital presentation. Sample size estimates The sample size of 850 patients will allow a shift in the modified Rankin Scale with odds ratio 0.70 (glyceryl trinitrate versus sham, ordinal logistic regression) to be detected with 90% power at 5% significance (two-sided). Design The Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2) is a multicentre UK prospective randomized sham-controlled outcome-blinded parallel-group trial in 850 patients with ultra-acute (≤4 h of onset) FAST-positive presumed stroke and systolic blood pressure ≥120 mmHg who present to the ambulance service following a 999 emergency call. Data collection is performed via a secure internet site with real-time data validation. Study outcomes The primary outcome is the modified Rankin Scale measured centrally by telephone at 90 days and masked to treatment. Secondary outcomes include: blood pressure, impairment, recurrence, dysphagia, neuroimaging markers of the acute lesion including vessel patency, discharge disposition, length of stay, death, cognition, quality of life, and mood. Neuroimaging and serious adverse events are adjudicated blinded to treatment. Discussion RIGHT-2 has recruited more than 500 participants from seven UK ambulance services. Status Trial is ongoing. Funding British Heart Foundation. Registration ISRCTN26986053.
Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain
Authors: de Andrés-Nogales Fernando , Álvarez María , de Miquel María Ángeles , Segura Tomás , Gil Alberto , Cardona Pere , Casado Miguel Ángel , Nogueira Raul G , Dávalos Antoni 
Published: August 2017

Introduction To assess the cost-effectiveness of stent-retriever mechanical thrombectomy and intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in patients with acute ischaemic stroke due to large vessel occlusions in Spain. Materials and methods Clinical data were taken from the SWIFT PRIME clinical trial. A lifetime Markov state transition model defined by the modified Rankin Scale score was developed to estimate costs and health outcomes (life years gained and quality adjusted life years). A Spanish National Health System perspective (direct medical costs) was considered. Resource utilisation and utilities were obtained from available published data and endorsed by an expert panel. Costs (€, 2016) were obtained from various Spanish sources. Deterministic and probabilistic sensitivity analyses were performed. Results Stent-retriever thrombectomy after intravenous tissue plasminogen activator was associated with better outcomes (1.17 life years gained and 2.51 quality adjusted life years) and savings of €44,378, resulting in a dominant therapy over intravenous tissue plasminogen activator alone. A net monetary benefit of €119,744 was obtained considering a willingness-to-pay threshold of €30,000/quality adjusted life year gained. The combined therapy was also dominant in all sensitivity analyses, deterministic and probabilistic. Discussion The results were consistent with a previously published cost-effectiveness analysis and reinforce the likeliness of the selection of stent-retriever mechanical thrombectomy plus intravenous tissue plasminogen activator over intravenous tissue plasminogen activator alone. Conclusion Stent-retriever thrombectomy after intravenous tissue plasminogen activator is a dominant alternative over intravenous tissue plasminogen activator alone (more effective and less costly) for the treatment of acute ischaemic stroke patients with large vessel occlusions in the Spanish setting.
Lipidomics and anti‐trypanosomatid chemotherapy
Authors: Biagiotti Michael , Dominguez Sedelia , Yamout Nader , Zufferey Rachel 
Published: August 2017

AbstractBackgroundTrypanosomatids such as Leishmania, Trypanosoma brucei and Trypanosoma cruzi belong to the order Kinetoplastida and are the source of many significant human and animal diseases. Current treatment is unsatisfactory and is compromised by the rising appearance of drug resistant parasites. Novel and more effective chemotherapeutics are urgently needed to treat and prevent these devastating diseases, which relies on the identification of essential, parasite specific targets that are absent in the host. Lipids constitute essential components of the cell and carry out multiple critical functions from building blocks of biological membranes to regulatory roles in signal transduction, organellar biogenesis, energy storage, and virulence. The recent technological advances of lipidomics has facilitated the broadening of our knowledge in the field of cellular lipid content, structure, functions, and metabolic pathways.Main bodyThis review highlights the application of lipidomics (i) in the characterization of the lipidome of kinetoplastid parasites or of their subcellular structure(s), (ii) in the identification of unique lipid species or metabolic pathways that can be targeted for novel drug therapies, (iii) as an analytic tool to gain a deeper insight into the roles of specific enzymes in lipid metabolism using genetically modified microorganisms, and (iv) in deciphering the mechanism of action of anti‐microbial drugs on lipid metabolism. Lastly, an outlook stating where the field is evolving is presented.ConclusionLipidomics has contributed to the expanding knowledge related to lipid metabolism, mechanism of drug action and resistance, and pathogen–host interaction of trypanosomatids, which provides a solid basis for the development of better anti‐parasitic pharmaceuticals.
Burnout and psychiatric morbidity among doctors in the UK: A systematic literature review of prevalence and associated factors
Authors: Imo Udemezue O. 
Published: August 2017

Aims and methodTo systematically review the prevalence and associated factors of burnout and stress-related psychiatric disorders among UK doctors. An extensive search was conducted of PubMed, EBSCOhost and British medical journals for studies published over a 20-year span measuring the prevalence of psychiatric morbidity (using the General Health Questionnaire) and burnout (using the Maslach Burnout Inventory).ResultsPrevalence of psychiatric morbidity ranged from 17 to 52%. Burnout scores for emotional exhaustion ranged from 31 to 54.3%, depersonalisation 17.4 to 44.5% and low personal accomplishment 6 to 39.6%. General practitioners and consultants had the highest scores. Factors significantly associated with increase in the prevalence of burnout and psychiatric morbidity include low job satisfaction, overload, increased hours worked and neuroticism.Clinical implicationsThe results indicate a worryingly high rate of burnout and psychiatric morbidity among UK doctors, which could have a huge negative impact on healthcare provision in general. Factors at personal and organisational levels contribute to burnout and psychiatric morbidity, and so efforts made to counter these problems should target both levels.
Strategies for Introducing Outpatient Specialty Palliative Care in Gynecologic Oncology
Authors: Hay Casey M. , Lefkowits Carolyn , Crowley-Matoka Megan , Bakitas Marie A. , Clark Leslie H. , Duska Linda R. , Urban Renata R. , Creasy Stephanie L. , Schenker Yael 
Published: August 2017

Purpose: Concern that patients will react negatively to the idea of palliative care is cited as a barrier to timely referral. Strategies to successfully introduce specialty palliative care to patients have not been well described. We sought to understand how gynecologic oncologists introduce outpatient specialty palliative care. Methods: We conducted a national qualitative interview study at six geographically diverse academic cancer centers with well-established palliative care clinics between September 2015 and March 2016. Thirty-four gynecologic oncologists participated in semistructured telephone interviews focusing on attitudes, experiences, and practices related to outpatient palliative care. A multidisciplinary team analyzed interview transcripts using constant comparative methods to inductively develop and refine a coding framework. This analysis focuses on practices for introducing palliative care. Results: Mean participant age was 47 years (standard deviation, 10 years). Mean interview length was 25 minutes (standard deviation, 7 minutes). Gynecologic oncologists described the following three main strategies for introducing outpatient specialty palliative care: focus initial palliative care referral on symptom management to dissociate palliative care from end-of-life care and facilitate early relationship building with palliative care clinicians; use a strong physician-patient relationship and patient trust to increase acceptance of referral; and explain and normalize palliative care referral to address negative associations and decrease patient fear of abandonment. These strategies aim to decrease negative patient associations and encourage acceptance of early referral to palliative care specialists. Conclusion: Gynecologic oncologists have developed strategies for introducing palliative care services to alleviate patient concerns. These strategies provide groundwork for developing system-wide best practice approaches to the presentation of palliative care referral.
Variability in the Use of Protective Mechanical Ventilation During General Anesthesia
Authors: Ladha Karim S. , Bateman Brian T. , Houle Timothy T. , De Jong Myrthe A. C. , Vidal Melo Marcos F. , Huybrechts Krista F. , Kurth Tobias , Eikermann Matthias 
Published: August 2017

BACKGROUND:
The purpose of this study was to determine whether significant variation exists in the use of protective ventilation across individual anesthesia providers and whether this difference can be explained by patient, procedure, and provider-related characteristics.

METHODS:
The cohort consisted of 262 anesthesia providers treating 57,372 patients at a tertiary care hospital between 2007 and 2014. Protective ventilation was defined as a median positive end-expiratory pressure of 5 cm H2O or more, tidal volume of <10 mL/kg of predicted body weight and plateau pressure of <30 cm H2O. Analysis was performed using mixed-effects logistic regression models with propensity scores to adjust for covariates. The definition of protective ventilation was modified in sensitivity analyses.

RESULTS:
In unadjusted analysis, the mean probability of administering protective ventilation was 53.8% (2.5th percentile of provider 19.9%, 97.5th percentile 80.8%). After adjustment for a large number of covariates, there was little change in the results with a mean probability of 51.1% (2.5th percentile 24.7%, 97.5th percentile 77.2%). The variations persisted when the thresholds for protective ventilation were changed.

CONCLUSIONS:
There was significant variability across individual anesthesia providers in the use of intraoperative protective mechanical ventilation. Our data suggest that this variability is highly driven by individual preference, rather than patient, procedure, or provider-related characteristics.
ESTUDIO DE INDICADORES DE CREATIVIDAD MATEMÁTICA EN LA RESOLUCIÓN DE PROBLEMAS
Authors: Mallart Alberto , Deulofeu Jordi 
Published: August 2017

La enseñanza de las matemáticas siempre se ha preocupado por la resolución de problemas. En la presente investigación se pretende determinar el grado de creatividad en la resolución de un problema de matemáticas. El instrumento elegido ha sido la Prueba de Matemáticas de Acceso a la Universidad de junio de 2012 en la Universidad de Barcelona constituida por 6 problemas. A partir de una muestra de 104 estudiantes se han analizado 7 indicadores por cada resolución. Los resultados indican más creatividad en el diseño de estrategias que en la ejecución o revisión, una detección correcta de las partes de una resolución, pero una pobre capacidad de transmisión, organización y síntesis de las resoluciones. La competencia matemática evalúa la resolución de problemas, y dado que en toda resolución participan aspectos creativos, conviene mejorar la creatividad matemática.
Orofacial Disease: Update for the Clinical Team: 9. Orofacial Pain
Authors: Scully Crispian , Porter Stephen 
Published: August 2017

Orofacial pain, the main reason why many patients seek dental advice, usually has a local cause—primarily the sequelae of dental caries—but a wide range of diseases, particularly neurological, psychogenic and vascular disorders, can cause orofacial pain. This article will discuss disorders that can present with pain and the neurological, psychogenic and vascular causes of orofacial pain. The first article in this series made several general observations on diagnosis and treatment which should be borne in mind in relation to the material presented here.
The Specialty of Family Dentistry: A Future for General Dental Practitioners?
Authors: Li Raymond W. K. , Chow Tak W. 
Published: August 2017

A new Specialty in dentistry, Family Dentistry, has been established to provide a structured, co-ordinated training for general dental practitioners who are the major oral health service providers. The training emphasizes the importance of continuing and comprehensive care, the interface between primary and secondary care, the relationship between the patient and his/her family and the community, and a holistic approach in treatment planning and delivery.
An Overview of Bleaching Techniques: 2. Night Guard Vital Bleaching and Non-Vital Bleaching
Authors: Sulieman M. 
Published: August 2017

Night Guard Vital Bleaching (NGVB) or dentist-monitored bleaching technique is probably the most widely used bleaching technique because of its relative ease of use, low cost, safety and high success rate. There are many non-vital bleaching techniques available, all of which have one thing in common, usually a successful result in the procedure returning the discoloured tooth to its original colour and beyond that when required. This article will give an overview of various home bleaching techniques: materials and regimens used, bleaching procedure and treatment of side-effects. In addition, it will review various in-surgery and at home techniques used for bleaching non-vital teeth.
Management of a Patient with a Failed Transmandibular Implant
Authors: Bousdras Vasileios A , Aghabeigi Ben , Griffiths Brigitte 
Published: August 2017

The Transmandibular Implant System (TMI) had been developed in order to provide a patient with a severely resorbed mandible with a stable and retensive implant-supported overdenture. Failure of the transmucosal posts may necessitate removal of the transmandibular implant in total and treatment with an implant-supported prosthesis. The purpose of this paper is to describe overcoming failure of a transmandibular implant without removal and synchronous placement of endosseous dental implants in the interforaminal region, providing an implant-retained overdenture to the patient.
A Retrospective Study to Assess Patient Satisfaction with Implant-Stabilized Prostheses
Authors: Dewan Karun , Hems Edward , Owens James 
Published: August 2017

This study measured the levels of patient satisfaction in those who received treatment with implant-retained overdentures, and compared their status before and after therapy. Satisfaction questionnaires were mailed to patients who had previously worn a removable prosthesis. Questions addressed eating, aesthetics and comfort before and after the treatment. Eighty-six (79.8%) subjects had problems regarding looseness of their denture prior to treatment. Patients were generally satisfied with their implant-retained overdentures in terms of function, comfort, appearance and speech. The results suggest that unstable, problematic complete dentures can be managed by providing patients with implant-retained overdentures.
Mandibular Implant-Retained Complete Overdenture using Retentive Abutments: A Case Report
Authors: Saha Shuva , Ray-Chaudhuri Arijit 
Published: August 2017

An implant-retained complete lower denture is considered by many as the gold standard in the oral rehabilitation of the edentulous mandible. Its relative simplicity, minimal invasiveness, predictability, efficacy and affordability make it an attractive treatment option. The commonly used methods for anchoring overdentures to implants utilize bars, studs and magnets. There is little evidence, however, to suggest that any one method is significantly superior to another. This paper reviews treatment options available to restore the edentulous mandible and also reports on a patient treated using the Locator® system, which is a relatively new type of stud attachment. This case report describes a chairside technique using the Locator® system to retain a complete lower denture.
A composite approach to the management of worn maxillary first molar teeth
Authors: Kalsi Jagdip S , Wilson Paul HR 
Published: August 2017

A lady with extrinsic acid erosion was referred to the restorative department at Bristol Dental Hospital by her General Dental Practitioner (GDP) for restoration of worn maxillary first molar teeth. These teeth were both causing symptoms of dentinal sensitivity and two attempts had been made to restore them with composite by her GDP. The restorations failed because there was insufficient space to bond the composite in place, which was due to dento-alveolar compensation of the first molars into the space created by the wear. Following relevant preventive advice, the maxillary first molar teeth were restored with ‘high’ direct composite resin, which allowed for adequate strength in bulk for retention while acting as fixed intrusion devices. These cured the patient's sensitivity and within four months her occlusion compensated for the composites and had re-established. Clinical Relevance: Direct composite can be used as both a fixed intrusion orthodontic appliance and routine restoration if placed to act under compression.
Indications for fissure sealants and their role in children and adolescents
Authors: Mejàre Ingegerd 
Published: August 2017

The aim of this article is to summarize and interpret present knowledge and evidence on the effect of fissure sealing permanent first and second molars in children and adolescents with two commonly used materials: resin sealants and glass ionomer sealants. Also, to identify important gaps in our knowledge. The results show that the conclusions from systematic reviews differ in several aspects, and that important knowledge gaps still exist, such as the costs and benefits of sealing low-versus high-risk populations. The effect of sealing non-cavitated caries lesions is uncertain and possible differences in effect between resin sealants and the high viscosity glass ionomers need to be investigated. Clinical Relevance: This article gives the reader a summary of the present evidence regarding fissure sealing. It also gives recommendations based on interpretation of available knowledge.
Case report of a family with benign familial neutropenia and the implications for the general dental practitioner
Authors: Casey Christine , Brooke Tony , Davies Rebecca , Franklin Deborah 
Published: August 2017

Benign familial neutropenia (BFN) is a condition where there is a decrease in circulating neutrophils in the blood and patients suffer from oral manifestations which include: persistant periodontal disease, recurrent neutropenic ulceration and candidal infections. This report discusses a family affected by BFN and the effects on their oral health. Clinical Relevance: Benign familial neutropenia is a rare condition and this article aims to raise awareness among general dental practitioners so that prompt referral and management in secondary care can be arranged.
Oromandibular dystonia treatment following a loss of vertical dimension
Authors: Chidiac José Johann 
Published: August 2017

Oromandibular dystonia is a rare condition of hyperkinetic motor dysfunction in the orofacial area. It is a centrally mediated disorder of unknown aetiology and manifested by a sustained contraction of masticatory muscles, involving one or both lateral pterygoids, and pushing the mandible forward. The prognosis is poor and the treatment is symptomatic. This paper describes a case of a 38-year-old woman referred for a locked left TMJ who was diagnosed as having an oromandibular dystonia. A step-by-step diagnosis and treatment procedure is described. Clinical Relevance: Knowledge of oromandibular dystonia may be valuable as rare medical diseases can be masked by common dental problems.
Fluoride in the media: a review of newspaper articles from 1999 to 2009
Authors: Howard Alan 
Published: August 2017

The effects of fluoride are regularly discussed in newspapers. This paper reviews this coverage over a ten-year period and compares the content with contemporary scientific evidence. The reporting used in a sample of daily newspapers when the subject of fluoride and its effects were mentioned was analysed and factual statements within the articles were compared with contemporary scientific studies, to assess the accuracy of reporting. Clinical Relevance: Practitioners may face questions from patients regarding the evidence base for the safety and efficacy of the use of fluoride in dentistry.
Toothwear and the older patient
Authors: Burke Francis M , McKenna Gerald 
Published: August 2017

Toothwear is commonly observed in dentate older patients and may be physiological or pathological in nature. Toothwear can be caused by abrasion, attrition, erosion or a combination of aetiologies. Where treatment is required, a number of options exist, including the use of adhesive materials and fixed and removable prosthodontics. Clinical Relevance: With patients retaining natural teeth into old age, physiological and pathological toothwear amongst dentate older patients is an increasingly common presentation.