bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of exercise training on liver function in adults who are overweight or exhibit fatty liver disease: a systematic review and meta-analysis
Authors: Smart N A , King N , McFarlane J R , Graham P L , Dieberg G 
Published: June 2016

ObjectiveExercise training has been shown to have beneficial effects on liver function in adults overweight or with fatty liver disease. To establish which exercise programme characteristics were likely to elicit optimal improvements.DesignSystematic review and meta-analysis of randomised, controlled trials.Data sourcesPubMed, CINAHL and Cochrane controlled trials registry searched (1966 to 2 October 2015).Eligibility criteria for selecting studiesExercise intervention, with or without dietary intervention, versus usual care in adults undertaking, exercise training, who were overweight, obese or exhibited fatty liver disease (non-alcoholic fatty liver disease or non-alcoholic steatohepatitis).ResultsWe included 21 randomised controlled trials, totalling 1530 participants. Exercise intervention studies with total exercise programme workload >10 000 kcal produced significant improvements in intrahepatic fat, −3.46% (95% CI −5.20% to −1.73%), p<0.0001, I2=73%; effect size (standardised mean difference, SMD) −1.77 (−3.11 to −0.42), p=0.01, I2=77%. When data from only exercise studies were pooled, there was a reduction in fasting free fatty acids (FFAs) −74.15 µmol/L (95% CI −118.47 to −29.84), p=0.001, I2=67% with a large effect size (SMD) −0.94 (−1.36 to −0.52), p<0.0001, I2=0%. When data from only exercise studies were pooled, there was a significant reduction in insulin MD −1.88 UL (95% CI −3.43 to −0.34), p=0.02, I2=31%. The liver enzymes, alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transpeptidase, were not significantly altered with exercise.ConclusionsExercise training reduces intrahepatic fat and FFAs while increasing cardiorespiratory fitness. An aggregate exercise programme energy expenditure (>10 000 kcal) may be required to promote reductions in intrahepatic fat.
Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes
Authors: Bernstein Judith A , McCloskey Lois , Gebel Christina M , Iverson Ronald E , Lee-Parritz Aviva 
Published: June 2016

ObjectivesGestational diabetes mellitus (GDM) greatly increases the risk of developing diabetes in the decade after delivery, but few women receive appropriately timed postpartum glucose testing (PPGT) or a referral to primary care (PC) for continued monitoring. This qualitative study was designed to identify barriers and facilitators to testing and referral from patient and providers' perspectives.MethodsWe interviewed patients and clinicians in depth about knowledge, values, priorities, challenges, and recommendations for increasing PPGT rates and PC linkage. Interviews were coded with NVIVO data analysis software, and analyzed using an implementation science framework.ResultsWomen reported motivation to address GDM for the health of the fetus. Most women did not anticipate future diabetes for themselves, and focused on delivery outcomes rather than future health risks. Patients sought and received reassurance from clinicians, and were unlikely to discuss early onset following GDM or preventive measures. PPGT barriers described by patients included provider not mentioning the test or setting it up, transportation difficulties, work responsibilities, fatigue, concerns about fasting while breastfeeding, and timing of the test after discharge from obstetrics, and no referral to PC for follow-up. Practitioners described limited communication among multiple care providers during pregnancy and delivery, systems issues, and separation of obstetrics from PC.ConclusionsPatients' barriers to PPGT included low motivation for self-care, structural obstacles, and competing priorities. Providers reported the need to balance risk with reassurance, and identified systems failures related to test timing, limitations of electronic medical record systems (EMR), lack of referrals to PC, and inadequate communication between specialties. Prevention of early onset has great potential for medical cost savings and improvements in quality of life.
Does attractiveness influence condom use intentions in heterosexual men? An experimental study
Authors: Eleftheriou Anastasia , Bullock Seth , Graham Cynthia A , Stone Nicole , Ingham Roger 
Published: June 2016

ObjectivesJudgements of attractiveness have been shown to influence the character of social interactions. The present study sought to better understand the relationship between perceived attractiveness, perceived sexual health status and condom use intentions in a heterosexual male population.SettingThe study employed an electronic questionnaire to collect all data, during face-to-face sessions.Participants51 heterosexual, English-speaking men aged between 18 and 69 years.Outcome measuresMen were asked to rate the attractiveness of 20 women on the basis of facial photographs, to estimate the likelihood that each woman had a sexually transmitted infection (STI) and to indicate their willingness to have sex with or without a condom with each woman.ResultsThe more attractive a woman was judged to be on average, the more likely participants would be willing to have sex with her (p<0.0001) and the less likely they were to intend to use a condom during sex (p<0.0001). Multivariate analysis revealed that higher condom use intentions towards a particular woman were associated with lower ratings of her attractiveness (p<0.0005), higher ratings of her STI likelihood (p<0.0001), the participant being in an exclusive relationship (p=0.002), having a less satisfactory sex life (p=0.015), lower age (p=0.001), higher number of sexual partners (p=0.001), higher age at first intercourse (p=0.002), higher rates of condomless sex in the last 12 months (p<0.043) and lower confidence in their ability to assess whether or not a woman had an STI (p=0.001). The more attractive a participant judged himself to be, the more he believed that other men like him would engage in condomless sex (p=0.001) and the less likely he was to intend to use a condom himself (p=0.02).ConclusionsMale perceptions of attractiveness influence their condom use intentions; such risk biases could profitably be discussed during sex education sessions and in condom use promotion interventions.
Impact of integrated upper limb spasticity management including botulinum toxin A on patient-centred goal attainment: rationale and protocol for an international prospective, longitudinal cohort study (ULIS-III)
Authors: Turner-Stokes Lynne , Ashford Stephen , Jacinto Jorge , Maisonobe Pascal , Balcaitiene Jovita , Fheodoroff Klemens 
Published: June 2016

ObjectivesDescribe the rationale and protocol for the Upper Limb International Spasticity (ULIS)-III study, which aims to evaluate the impact of integrated spasticity management, involving multiple botulinum toxin A (BoNT-A) injection cycles and concomitant therapies, on patient-centred goal attainment. Outline novel outcome assessment methods for ULIS-III and report initial evaluation data from goal setting in early stages of the study.DesignLarge international longitudinal cohort study of integrated upper limb spasticity management, including BoNT-A.Participants and settingULIS-III is a 2-year study expected to enrol >1000 participants at 58 study centres across 14 countries.InterventionsThe study design is non-interventional and intended to reflect real-life clinical practice. It will describe injection practices and additional treatment strategies, and record clinical decision-making in a serial approach to long-term spasticity management.Outcome measuresULIS-III will use a goal-directed approach to selection of targeted standardised measures to capture the diversity of presentation, goals and outcomes. ULIS-III will implement the Upper Limb Spasticity Index, a battery of assessments including a structured approach to goal attainment scaling (Goal Attainment Scaling—Evaluation of Outcomes for Upper Limb Spasticity tool), alongside a limited set of standardised measures, chosen according to patients' selected goal areas. Concomitant therapy inputs, patient satisfaction with engagement in goal setting, health economic end points and health-related quality of life data will also be captured.Results of initial evaluation of goal qualityRecruitment started in January 2015. By June 2015, 58 sites had been identified and initial data collected for 79 patients across 13 sites in 3 countries. Goal setting data were quality-checked and centres rated on the basis of function-related and Specific, Measurable, Achievable, Realistic, Timed (SMART) characteristics of goal statements. Overall, 11/13 centres achieved the highest rating (A++).ConclusionsULIS-III will provide valuable information regarding treatment of and outcomes from real-life upper limb spasticity management worldwide.Trial registration numberNCT02454803; Pre-results.
Educational impact of paediatric palliative simulation study days
Authors: Renton Kate , Quinton Hilary , Mayer Anton-Paul Thomas 
Published: June 2016

BackgroundThe use of simulation-based medical/nursing teaching is increasingly widespread. Simulation-based teaching offers an immersive learning experience where professionals can practice communication and practical skills in a safe, authentic environment. We designed a paediatric palliative simulation study day primarily aimed at nursing staff who manage these patients in the community/hospice. We believe this is the first of its kind in the UK.AimsTo establish whether attendance at a paediatric palliative simulation study day improved confidence and knowledge in management of common and/or difficult situations in palliative care.MethodHealth professionals working at local paediatric hospices or in associated specialties to palliative care were invited to attend the free 1-day course. 5 scenarios were developed by experienced health professionals working in paediatric palliative care. On the day, participants were asked to complete a questionnaire to check basic demographic data, confidence levels and knowledge (50 true/false questions). Following participation/observation of 5 scenarios, they again completed the same questionnaire regarding confidence levels and knowledge. Results were analysed with Excel and XLStat using basic demographic data and Wilcoxon signed rank two-tailed test.Results57 healthcare workers participated in 5 study days. 81% (n=47) professionals described themselves as working primarily in palliative care. Only 35% (n=20) had previously experienced simulation. Based on confidence questions, attendees felt more confident in managing specific palliative scenarios (p<0.0001). Based on true/false questions prestudy and poststudy day, 86% (n=49) of participants improved their knowledge. The median improvement score for the cohort was 3 (p<0.0001).ConclusionsThe study demonstrated a significant improvement in confidence and knowledge following the simulation course. This supports further time/financial investment in developing this type of study day. Simulation is a useful teaching adjunct in paediatric palliative care. The course also provides a valuable opportunity for professionals to network and discuss/share experiences.
Exploring the relationship between general practice characteristics, and attendance at walk-in centres, minor injuries units and EDs in England 2012/2013: a cross-sectional study
Authors: Tammes Peter , Morris Richard W , Brangan Emer , Checkland Kath , England Helen , Huntley Alyson , Lasserson Daniel , MacKichan Fiona , Salisbury Chris , Wye Lesley , Purdy Sarah 
Published: June 2016

BackgroundFor several years, EDs in the UK NHS have faced considerable increases in attendance rates. Walk-in centres (WiCs) and minor injuries units (MIUs) have been suggested as solutions. We aimed to investigate the associations between practice and practice population characteristics with ED attendance rates or combined ED/WiC/MIU attendance, and the associations between WiC/MIU and ED attendance.MethodsWe used general practice-level data including 7462 English practices in 2012/2013 and present adjusted regression coefficients from linear multivariable analysis for relationships between patients' emergency attendance rates and practice characteristics.ResultsEvery percentage-point increase in patients reporting inability to make an appointment was associated with an increase in emergency attendance by 0.36 (95% CI 0.06 to 0.66) per 1000 population. Percentage-point increases in patients unable to speak to a general practitioner (GP)/nurse within two workdays and patients able to speak often to their preferred GP were associated with increased emergency attendance/1000 population by 0.23 (95% CI 0.05 to 0.42) and 0.10 (95% CI 0.00 to 0.19), respectively. Practices in areas encompassing several towns (conurbations) had higher attendance than rural practices, as did practices with more non-UK-qualified GPs. Practice population characteristics associated with increased emergency attendance included higher unemployment rates, higher percentage of UK whites and lower male life expectancy, which showed stronger associations than practice characteristics. Furthermore, higher MIU or WiC attendance rates were associated with lower ED attendance rates.ConclusionsImproving availability of appointments and opportunities to speak a GP/nurse at short notice might reduce ED attendance. Establishing MIUs and WiCs might also reduce ED attendance.
TREVO and Capture LP have equal technical success rates in mechanical thrombectomy of proximal and distal anterior circulation occlusions
Authors: Protto Sara , Pienimäki Juha-Pekka , Seppänen Janne , Matkaselkä Ira , Ollikainen Jyrki , Numminen Heikki , Sillanpää Niko 
Published: June 2016

PurposeMechanical thrombectomy (MT) is a proven method to treat large vessel occlusions in acute anterior circulation stroke. We compared the technical, imaging, and clinical outcomes of MT performed with either TREVO or Capture LP devices.MethodsThere were 42 and 43 patients in the TREVO and Capture LP groups, respectively. Baseline variables, technical outcome (Thrombolysis In Cerebral Infarction, TICI), 24 hours imaging outcome, and 3-month clinical outcome (modified Rankin Scale, mRS) were prospectively recorded. The patients were stratified according to clot location, groups compared, and logistic regression models devised to study the effect of device selection on the clinical outcome.ResultsThe technical success rates were equal in both proximal (internal carotid artery and proximal M1 segment) and distal occlusions (distal M1 and M2 segments). The proportion of TICI 2b or 3 was 96% and 87% with TREVO and 87% and 89% with Capture LP (p=0.25 and p=0.80, respectively). Device selection did not significantly predict good clinical outcome (mRS ≤2) in either proximal or distal occlusions. In multivariate analysis, selecting Capture LP borderline significantly increased the odds of an excellent outcome close to sixfold both in proximal and distal occlusions (OR 6.7, 95% CI 0.82 to 53.7, p=0.08 and OR 5.7, 95% CI 0.88 to 37.8, p=0.07, respectively).ConclusionsTREVO and Capture LP perform equally well in proximal and distal occlusions in the anterior circulation when technical and good clinical outcome are considered. Capture LP may have a small advantage in reaching mRS ≤1 at 3 months. However, this needs to be confirmed in a randomized study.
Impaired Peripheral Endothelial Function Assessed by Digital Reactive Hyperemia Peripheral Arterial Tonometry and Risk of In‐Stent Restenosis
Authors: Komura Naohiro , Tsujita Kenichi , Yamanaga Kenshi , Sakamoto Kenji , Kaikita Koichi , Hokimoto Seiji , Iwashita Satomi , Miyazaki Takashi , Akasaka Tomonori , Arima Yuichiro , Yamamoto Eiichiro , Izumiya Yasuhiro , Yamamuro Megumi , Kojima Sunao , Tayama Shinji , Sugiyama Seigo , Matsui Kunihiko , Nakamura Sunao , Hibi Kiyoshi , Kimura Kazuo , Umemura Satoshi , Ogawa Hisao 
Published: June 2016

Background

Drug‐eluting stents are replacing bare‐metal stents, but in‐stent restenosis (
ISR
) remains a problem. Reactive hyperemia index (
RHI
) assessed by peripheral arterial tonometry evaluates endothelial function noninvasively. We prospectively assessed the prognostic value of
RHI
in predicting
ISR
after percutaneous coronary intervention.

Methods and Results

RHI
was measured before percutaneous coronary intervention and at follow‐up (F/U) angiography (F/U
RHI
; 6 and 9 months post bare‐metal stents– and drug‐eluting stents– percutaneous coronary intervention, respectively) in 249 consecutive patients. At F/U,
ISR
(stenosis >50% of diameter) was seen in 68 patients (27.3%). F/U natural logarithm (
RHI
) was significantly lower in patients with
ISR
than in those without (0.52±0.23 versus 0.65±0.27,
P
<0.01); no between‐group difference in initial natural logarithm (
RHI
) (0.60±0.26 versus 0.62±0.25,
P
=0.56) was seen. By multivariate logistic regression analysis, even after adjusting for other significant parameters in univariate analysis, F/U natural logarithm (
RHI
) independently predicted
ISR
(odds ratio: 0.13; 95%
CI
: 0.04–0.48;
P
=0.002). In receiver operating‐characteristic analysis, F/U
RHI
was the strongest predictor of
ISR
(area under the curve: 0.67; 95%
CI
: 0.60–0.75;
P
<0.01;
RHI
<1.73 had 67.6% sensitivity, 64.1% specificity); area under the curve significantly improved from 0.62 to 0.70 when
RHI
was added to traditional
ISR
risk factors (
P
=0.02). Net reclassification index was significant after addition of
RHI
(26.5%,
P
=0.002).

Conclusions

Impaired
RHI
at F/U angiography independently correlated with
ISR
, adding incremental prognostic value to the
ISR
‐risk stratification following percutaneous coronary intervention.

Clinical Trial Registration

URL
:
https://www.clinicaltrials.gov/
. Unique identifier:
NCT
02131935.
Trends in Consent for Clinical Trials in Cardiovascular Disease
Authors: Kerkhoff Louis A. , Butler Javed , Kelkar Anita A. , Shore Supriya , Speight Candace D. , Wall Louisa K. , Dickert Neal W. 
Published: June 2016

Background
Cardiovascular clinical trials depend on patient enrollment. Enrollment rates appear inadequate, but little is known about how frequently patients accept or decline offers of enrollment. The objective of this study was to assess trends and predictors of patient acceptance of offers to enroll in clinical trials for cardiovascular disease.

Methods and Results

We utilized an established database containing all randomized, controlled trials (n=1224) in cardiovascular disease published between 2001 and 2012 in the 8 highest‐impact general medical and cardiology journals. Studies were eligible if the number of patients approached and number of patients declining enrollment could be ascertained from published materials. All studies were screened for eligibility. Each eligible study was reviewed by 3 co‐authors. All discrepancies were resolved by the group. The main outcome was acceptance rate, defined as the number of patients enrolled divided by the number patients who were eligible and approached. Only 21.7% (n=266) of studies provided information sufficient to assess patient enrollment and refusals. The median acceptance rate across trials was 83.2%. Significant predictors of higher enrollment included: enrollment in the acute setting (
P
=0.031); geographical region (
P
<0.001 for group); and trial sponsorship (
P
=0.006 for group).

Conclusions
Rates of reporting data sufficient to calculate acceptance rates are low. This compromises the ability to identify drivers of low enrollment and assess trial generalizability. However, the high rates of acceptance observed suggest that factors other than patients’ decisions may be the primary drivers of declining rates of trial enrollment.
Temporal Bone Mucormycosis
Authors: Katsantonis Nicolas-George , Hunter Jacob B. , O’Connell Brendan P. , He Jing , Lewis James S. , Wanna George B. 
Published: June 2016

Case Details: We present a case of temporal bone mucormycosis in a 71-year-old female with diabetes mellitus who presented to the emergency department with facial nerve paresis, otorrhea, and contralateral hemiparesis. After undergoing a tympanomastoidectomy, the patient’s pathology exhibited fungal hyphae consistent with mucormycosis. Discussion: To our knowledge, there have been 9 reported cases of temporal bone mucormycosis, 3 of which presented with facial nerve paresis, all with some subsequent improvement. In this case, facial paralysis persisted at the time of last follow-up (2 months) despite surgery and intravenous antifungals. We also review and summarize the temporal bone mucormycosis literature. Conclusion: Temporal bone mucormycosis is a rare and morbid infectious disease, though its outcomes appear to be different for patients who present with isolated temporal bone disease as compared to those individuals who develop temporal bone mucormycosis secondary to a rhinologic source.
A randomised, double blind, placebo-controlled trial of a fixed dose of N-acetyl cysteine in children with autistic disorder
Authors: Dean Olivia M , Gray Kylie M , Villagonzalo Kristi-Ann , Dodd Seetal , Mohebbi Mohammadreza , Vick Tanya , Tonge Bruce J , Berk Michael 
Published: June 2016

Objective: Oxidative stress, inflammation and heavy metals have been implicated in the aetiology of autistic disorder. N-acetyl cysteine has been shown to modulate these pathways, providing a rationale to trial N-acetyl cysteine for autistic disorder. There are now two published pilot studies suggesting efficacy, particularly in symptoms of irritability. This study aimed to explore if N-acetyl cysteine is a useful treatment for autistic disorder. Method: This was a placebo-controlled, randomised clinical trial of 500 mg/day oral N-acetyl cysteine over 6 months, in addition to treatment as usual, in children with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of autistic disorder. The study was conducted in Victoria, Australia. The primary outcome measures were the Social Responsiveness Scale, Children’s Communication Checklist–Second Edition and the Repetitive Behavior Scale–Revised. Additionally, demographic data, the parent-completed Vineland Adaptive Behavior Scales, Social Communication Questionnaire and clinician-administered Autism Diagnostic Observation Schedule were completed. Results: A total of 102 children were randomised into the study, and 98 (79 male, 19 female; age range: 3.1–9.9 years) attended the baseline appointment with their parent/guardian, forming the Intention to Treat sample. There were no differences between N-acetyl cysteine and placebo-treated groups on any of the outcome measures for either primary or secondary endpoints. There was no significant difference in the number and severity of adverse events between groups. Conclusion: This study failed to demonstrate any benefit of adjunctive N-acetyl cysteine in treating autistic disorder. While this may reflect a true null result, methodological issues particularly the lower dose utilised in this study may be confounders.