bluuebunny/crossref_metadata_2025_split huggingface dataset:
Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review
Authors: Jünger Saskia , Payne Sheila A , Brine Jenny , Radbruch Lukas , Brearley Sarah G 
Published: February 2017

Background: The Delphi technique is widely used for the development of guidance in palliative care, having impact on decisions with relevance for patient care. Aim: To systematically examine the application of the Delphi technique for the development of best practice guidelines in palliative care. Design: A methodological systematic review was undertaken using the databases PubMed, CINAHL, Web of Science, Academic Search Complete and EMBASE. Data sources: Original articles (English language) were included when reporting on empirical studies that had used the Delphi technique to develop guidance for good clinical practice in palliative care. Data extraction included a quality appraisal on the rigour in conduct of the studies and the quality of reporting. Results: A total of 30 empirical studies (1997–2015) were considered for full-text analysis. Considerable differences were identified regarding the rigour of the design and the reporting of essential process and outcome parameters. Furthermore, discrepancies regarding the use of terms for describing the method were observed, for example, concerning the understanding of a ‘round’ or a ‘modified Delphi study’. Conclusion: Substantial variation was found concerning the quality of the study conduct and the transparency of reporting of Delphi studies used for the development of best practice guidance in palliative care. Since credibility of the resulting recommendations depends on the rigorous use of the Delphi technique, there is a need for consistency and quality both in the conduct and reporting of studies. To allow a critical appraisal of the methodology and the resulting guidance, a reporting standard for Conducting and REporting of DElphi Studies (CREDES) is proposed.
Variations in the cost of formal and informal health care for patients with advanced chronic disease and refractory breathlessness: A cross-sectional secondary analysis
Authors: Dzingina Mendwas D , Reilly Charles C , Bausewein Claudia , Jolley Caroline J , Moxham John , McCrone Paul , Higginson Irene J , Yi Deokhee 
Published: February 2017

Background: Refractory breathlessness in advanced chronic disease leads to high levels of disability, anxiety and social isolation. These result in high health-resource use, although this is not quantified. Aims: To measure the cost of care for patients with advanced disease and refractory breathlessness and to identify factors associated with high costs. Design: A cross-sectional secondary analysis of data from a randomised controlled trial. Setting/participants: Patients with advanced chronic disease and refractory breathlessness recruited from three National Health Service hospitals and via general practitioners in South London. Results: Of 105 patients recruited, the mean cost of formal care was £3253 (standard deviation £3652) for 3 months. The largest contributions to formal-care cost were hospital admissions (>60%), and palliative care contributed <1%. When informal care was included, the total cost increased by >250% to £11,507 (standard deviation £9911). Increased patient disability resulting from breathlessness was associated with high cost (£629 per unit increase in disability score; p = 0.006). Increased breathlessness on exertion and the presence of an informal carer were also significantly associated with high cost. Patients with chronic obstructive pulmonary disease tended to have higher healthcare costs than other patients. Conclusion: Informal carers contribute significantly to the care of patients with advanced disease and refractory breathlessness. Disability resulting from breathlessness is an important clinical cost driver. It is important for policy makers to support and acknowledge the contributions of informal carers. Further research is required to assess the clinical- and cost-effectiveness of palliative care interventions in reducing disability resulting from breathlessness in this patient group.
Potential cost savings by dose down-rounding of monoclonal antibodies in a community cancer center
Authors: Copur Mehmet S , Gnewuch Curtis , Schriner Megan , Tharnish Mark , Gonen Mithat , McDonald Monica , Kezeor Jami , Ramaekers Ryan C , Gauchan Dron , Clark Douglas , Greenwalt Lois , Mickey Mary , Norvell Max 
Published: February 2017

Purpose Increasing new cancer cases and approval of effective but expensive new drugs extending survival have led to unsustainable cancer care costs. Potential cost savings by a hypothetical dose down-rounding project of monoclonal antibodies at a community-based cancer center is presented. Methods From October 2014 through October 2015, metastatic cancer patients receiving monoclonal antibodies at CHI-Health St Francis Cancer Treatment Center in Grand Island, Nebraska, were identified through electronic health records. A total of 11 different types of monoclonal antibodies that were administered during the study period were identified. Trastuzumab, ofatumumab, and obinutuzumab did not require dose-rounding; thus, they were excluded from the analyses. Available vial size(s) and costs per milligram per average wholesale price for each monoclonal antibody were recorded. Costs of actual amounts prescribed were compared to the costs of theoretically reduced ≤5% and ≤10% doses rounded to the nearest vial sizes. Reduced doses resulting in a decreased number of opened vials qualified for meaningful dose down-rounding and were included in the analysis. Average actual dose reduction percentage resulting in cost savings for both groups was also calculated. Results A total of 728 doses of eight monoclonal antibodies suitable for dose down-rounding were identified. Vial sizes of pembrolizumab and ipilimumab did not allow for a meaningful dose down-rounding. At the ≤5% dose down-rounding, 255 of 728 doses (35%) qualified with a potential annual cost savings of $220,793.80. At the ≤10% dose down-rounding, 526 of 728 doses (72%) qualified with a potential annual cost savings of $454,461.00. The average actual dose reduction was 2.4% for the ≤5% dose reduction group and 4.9% for the ≤10% dose reduction group. Overall average cost savings per qualifying dose reduction was around $865.00. More doses qualified for cost savings in the ≤10% dose reduction group. Significant differences between different monoclonal antibodies for dose rounding at either ≤5% (p = 0.002) or ≤10% (p < 0.001) were observed. Conclusion A practical dose down-rounding procedure may allow significant cost reduction in metastatic cancer setting, where the cure is not the goal. Drug waste can be avoided by convenient vial sizes or can even be eliminated by lyophilized forms like in trastuzumab. Our data reflect the monoclonal antibody use and potential cost savings with the proposed dose down-rounding approach in a community-based cancer program.
Apixaban, concomitant medicines and spontaneous reports of haemorrhagic events
Authors: Caughey Gillian E. , Kalisch Ellett Lisa M. , Barratt John D. , Shakib Sepehr 
Published: February 2017

Introduction: Little is known about the potential safety issues associated with apixaban in clinical practice and their reporting in spontaneous adverse event (SAE) databases. Objective: To describe SAE reports associated with the oral anticoagulant apixaban from Australia, Canada and USA and to examine associated concomitant medicine use. Methods: SAE report databases from Australia, Canada and the USA were examined for all reports of adverse events associated with apixaban and concomitant medicines from 1 January 2012 to 30 September 2014. Disproportionality analysis (proportional reporting ratio (PRR) and reporting odds ratio (ROR)) was conducted for the quantitative detection of signals using the USA database. Results: There were 97 SAE reports associated with apixaban from Australia, 77 from Canada and 2877 from the USA. Reporting of haemorrhage (any type) was common, ranging from 18% for USA to 31% for Australia. Gastrointestinal (GI) haemorrhage was the most commonly reported haemorrhage, accounting for approximately 10% of adverse event reports across all countries. Positive signals were confirmed in the USA data (haemorrhage (any type) PRR, 12.1; χ2, 5582.2 and ROR, 13.4; 95% CI: 12.13–14.6; GI haemorrhage PRR, 11.8; χ2, 2325.4 and ROR, 12.3; 95% CI, 10.8–14.0). Reporting of concomitant use of medicines with the potential to increase bleeding risk ranged from 47.6% in Canada to 65.5% in Australia. Conclusion: A large proportion of adverse event reports for apixaban were associated with use of concomitant medicines which may have increased the risk of haemorrhage.
DPP-4 inhibition has no acute effect on BNP and its N-terminal pro-hormone measured by commercial immune-assays. A randomized cross-over trial in patients with type 2 diabetes
Authors: Fadini Gian Paolo , Bonora Benedetta Maria , Albiero Mattia , Zaninotto Martina , Plebani Mario , Avogaro Angelo 
Published: February 2017

Abstract
Background
Use of dipeptidyl peptidase-4 inhibitors (DPP4-i) for the treatment of type 2 diabetes (T2D) has been associated with a possible increase in the risk for heart failure (HF). B-type natriuretic peptide (BNP), which is both a biomarker of HF and a hemodynamically active hormone, is a substrate of DPP-4. We herein tested the acute effects of the DPP-4i linagliptin on BNP and NT-proBNP in a cross-over placebo-controlled trial in patients with T2D with and without chronic kidney disease (CKD).

Methods
B-type natriuretic peptide and NT-proBNP were measured using commercially available clinical-grade immune-assays at baseline and at the end of a 4-day treatment with placebo and linagliptin. Changes from baseline during each treatment arm, as well as placebo-subtracted effects of linagliptin on BNP and NT-proBNP were calculated.

Results
46 patients completed the study, 18 of whom were affected by CKD. Baseline BNP and NT-proBNP levels increased with age, were elevated in CKD patients, and inversely correlated with estimated glomerular filtration rate. No significant change was detected in BNP and NT-proBNP levels after treatment with linagliptin or placebo in patients with or without CKD. Only in CKD patients the placebo-subtracted effect of linagliptin indicated a significant reduction in NT-proBNP levels, but this finding was not statistically robust.

Conclusions
Acute treatment with a DPP-4i exerts no clinically-meaningful effects on BNP and NT-proBNP. As routinely used immunoassays do not discriminate between intact/active and cleaved BNP, these data cannot rule out an effect of DPP-4i on HF pathophysiology.
Trial registration NCT01617824
Caring for relatives with agitation at home: A qualitative study of positive coping strategies
Authors: Hoe Juanita , Jesnick Leah , Turner Rebecca , Leavey Gerard , Livingston Gill 
Published: February 2017

BackgroundTrials of psychological interventions for reducing agitation in people with dementia living at home have been unsuccessful.AimsTo inform future interventions by identifying successful strategies of family carers with relatives with dementia and agitation living at home.MethodQualitative in-depth individual interviews were performed with 18 family carers. We used thematic analysis to identify emerging themes.ResultsCarers described initial surprise and then acceptance that agitation is a dementia symptom and learned to respond flexibly. Their strategies encompassed: prevention of agitation by familiar routine; reduction of agitation by addressing underlying causes and using distraction; prevention of escalation by risk enablement, not arguing; and control of their emotional responses by ensuring their relative's safety then walking away, carving out some time for themselves and using family and services for emotional and practical help.ConclusionsThese strategies can be manualised and tested in future randomised controlled trials for clinical effectiveness in reducing agitation in people with dementia living at home.
Use of empathy in psychiatric practice: Constructivist grounded theory study
Authors: Ross James , Watling Chris 
Published: February 2017

BackgroundPsychiatry has faced significant criticism for overreliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and medications with purported disregard for empathetic, humanistic interventions.AimsTo develop an empirically based qualitative theory explaining how psychiatrists use empathy in day-to-day practice, to inform practice and teaching approaches.MethodThis study used constructivist grounded theory methodology to ask (a) ‘How do psychiatrists understand and use empathetic engagement in the day-to-day practice of psychiatry?’ and (b) ‘How do psychiatrists learn and teach the skills of empathetic engagement?’ The authors interviewed 17 academic psychiatrists and 4 residents and developed a theory by iterative coding of the collected data.ResultsThis constructivist grounded theory of empathetic engagement in psychiatric practice considered three major elements: relational empathy, transactional empathy and instrumental empathy. As one moves from relational empathy through transactional empathy to instrumental empathy, the actions of the psychiatrist become more deliberate and interventional.ConclusionsParticipants were described by empathy-based interventions which are presented in a theory of ‘empathetic engagement’. This is in contrast to a paradigm that sees psychiatry as purely based on neurobiological interventions, with psychotherapy and interpersonal interventions as completely separate activities from day-to-day psychiatric practice.
Management of Unruptured Intracranial Aneurysms and Cerebrovascular Malformations
Authors: Flemming Kelly D. , Lanzino Giuseppe 
Published: February 2017

ABSTRACT

Purpose of Review: Unruptured intracranial aneurysms and vascular malformations are detected more frequently because of the increased use and availability of brain imaging. Management of these entities requires knowledge of which patients are at high risk for hemorrhage and what treatment options are available. This article summarizes the epidemiology, natural history, and management strategies for unruptured intracranial aneurysms, arteriovenous malformations, cavernous malformations, developmental venous anomalies, and capillary telangiectasias.

Recent Findings: Pooled cohort studies and meta-analyses have improved the ability to predict hemorrhage for each vascular abnormality. Scores and tools have been developed to aid the practitioner in predicting hemorrhage risk for unruptured intracranial aneurysms. Advances in endovascular techniques for unruptured intracranial aneurysms have improved the ability to treat difficult wide-necked aneurysms.

Summary: Unruptured intracranial aneurysms are a common incidental finding. The PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, site of aneurysm) score and Unruptured Intracranial Aneurysm Treatment Score may be useful tools for predicting natural history and treatment recommendations. The overall risk of hemorrhage for both arteriovenous malformations and cavernous malformations is about 2% to 4% per year. With both of these entities, prior hemorrhage predicts future hemorrhage. In addition, other select patient and radiologic factors influence risk of hemorrhage. The risk of future hemorrhage should be compared to the risk of treatment. Developmental venous anomalies and capillary telangiectasias are largely benign entities and rarely symptomatic.
Cardioembolic Stroke
Authors: O’Carroll Cumara B. , Barrett Kevin M. 
Published: February 2017

ABSTRACT

Purpose of Review: Cardioembolic stroke is common and disproportionately more disabling than nonembolic mechanisms of stroke. Its incidence is expected to rise because of the age-related incidence of atrial fibrillation and an aging population. This article summarizes the different causes of cardioembolism and outlines current management guidelines.

Recent Findings: Since cardioembolic stroke is not a single disease entity, its diagnosis requires initial clinical suspicion and a comprehensive evaluation, including ECG, echocardiography, brain imaging, and cardiac monitoring. Atrial fibrillation is the most common cause of cardioembolic stroke, and anticoagulation is usually recommended. This article reviews risk stratification models to assist in the decision-making process and highlights the increased use of novel oral anticoagulants for stroke prevention in atrial fibrillation. New data support the importance of prolonged cardiac monitoring for diagnosing occult atrial fibrillation. Current data on other mechanisms of cardioembolic stroke, such as prosthetic heart valves and aortic arch atherosclerosis, are also presented, and the available evidence regarding patent foramen ovale closure in cryptogenic stroke is summarized.

Summary: Cardioembolism is an important cause of ischemic stroke, with diverse underlying mechanisms requiring a tailored approach to diagnosis, management, and prevention.
Large Artery Atherosclerotic Occlusive Disease
Authors: Cole John W. 
Published: February 2017

ABSTRACT

Purpose of Review: Extracranial or intracranial large artery atherosclerosis is often identified as a potential etiologic cause for ischemic stroke and transient ischemic attack. Given the high prevalence of large artery atherosclerosis in the general population, determining whether an identified atherosclerotic lesion is truly the cause of a patient’s symptomatology can be difficult. In all cases, optimally treating each patient to minimize future stroke risk is paramount. Extracranial or intracranial large artery atherosclerosis can be broadly compartmentalized into four distinct clinical scenarios based upon the individual patient’s history, examination, and anatomic imaging findings: asymptomatic and symptomatic extracranial carotid stenosis, intracranial atherosclerosis, and extracranial vertebral artery atherosclerotic disease. This review provides a framework for clinicians evaluating and treating such patients.

Recent Findings: Intensive medical therapy achieves low rates of stroke and death in asymptomatic carotid stenosis. Evidence indicates that patients with severe symptomatic carotid stenosis should undergo carotid revascularization sooner rather than later and that the risk of stroke or death is lower using carotid endarterectomy than with carotid stenting. Specific to stenting, the risk of stroke or death is greatest among older patients and women. Continuous vascular risk factor optimization via sustained behavioral modifications and intensive medical therapy is the mainstay for stroke prevention in the setting of intracranial and vertebral artery origin atherosclerosis.

Summary: Lifelong vascular risk factor optimization via sustained behavioral modifications and intensive medical therapy are the key elements to reduce future stroke risk in the setting of large artery atherosclerosis. When considering a revascularization procedure for carotid stenosis, patient demographics, comorbidities, and the periprocedural risks of stroke and death should be carefully considered.
Clinical Evaluation of the Patient With Acute Stroke
Authors: Southerland Andrew M. 
Published: February 2017

ABSTRACT

Purpose of Review: This article reviews the clinical evaluation of the patient with acute stroke, including key questions in the focused stroke history, important aspects of the National Institutes of Health Stroke Scale and focused neurologic examination, and the significance of the basic head CT scan in informing a timely treatment decision.

Recent Findings: Advances in both stroke treatment and enhanced diagnostics support an evolving paradigm for acute stroke care, ranging from the prehospital setting to the rehabilitative setting. An international emphasis on best practice strategies promotes efficiency and standardization in stroke systems of care.

Summary: Despite continual changes and augmentations to the field of acute stroke, several fundamentals remain. Central among these is in-depth knowledge of neurovascular anatomy, clinical stroke syndromes, and common mimics, which are foundational to the bedside evaluation of the patient with acute stroke.
Formation of Calligraphic Correct Hand Writing As Pedagogical Problem
Authors: Пяткова  , Pyatkova V. 
Published: February 2017

The article considers the problem of teaching first-grade pupil calligraphic correct letter as a basis of handwriting, which is a stable personality characteristic in the future is difficult to correcting. As the process of writing is extremely complex and covers various areas of mental activity, the teacher is recommended to take into account the hygiene, physiological and educational components that contribute to conscious mastery of technique first-grade pupil letters formation of skills of visual-motor development of self-control on the basis of geometric eye estimation. The
author offers the technique “Line-art formation of calligraphic writing”, characterizes its components, compares with the traditional method of teaching writing.
Purposes of Education Understanding in the Domestic Pedagogy in the End of XVIII – Middle of XIX Century
Authors: Никулина  , Nikulina E. 
Published: February 2017

The article is addressed to the period of formation in the Russian pedagogical anthropology, when various aspects of philosophical and anthropological foundations of pedagogy, including - the question of the ultimate goal of teaching were actively discussed. Various interpretations
of the concept of “goal of education”, which are represented in the works of local authors and the secular clergy, and under the influence of any foreign pedagogy and teaching of the Orthodox tradition. Common and distinct features in the views of the authors of the period are revealed, as well as the inability to prove the formal separation of them secular and religious in determining the purpose of pedagogical activity.
The new Red 1 ambulance response time definition: evaluating clinical impact
Authors: Lynde Jessica , Trebilcock Hannah , Kirby Kim , Tuckett Susan , Perris Andy , South Adrian , Black Sarah 
Published: February 2017

Rapid identification of patients with life-threatening conditions is the main priority for any ambulance telephone triage system. Historically there has been a focus on the identification of patients in cardiac arrest; however, the clinical benefits of early recognition of patients in peri-arrest could be considered equally important. An expanded definition of the highest priority response, Red 1, was introduced to identify patients who are critically unwell, at high risk of cardiac arrest, and who would benefit clinically from the fastest level of response from the ambulance service. An evaluation of the impact of the new Red 1 definition was completed in South Western Ambulance Service NHS Foundation Trust during 2013. It demonstrated that the new Red 1 definition was more sensitive than the previous Red 1 definition in identifying patients in cardiac arrest and those at high risk of out-of-hospital cardiac arrest. The total number of patients who required resuscitation decreased by 11.7% under the new Red 1 definition, supporting the hypothesis that more patients are captured by the new Red 1 definition and a more rapid response diminishes their likelihood of experiencing a cardiac arrest.