bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of clinical practice guidelines and factors related to their uptake: a survey of health professionals in Spain
Authors: Kotzeva Anna , Guillamón Imma , Gracia Javier , Díaz del Campo Petra , Gich Ignasi , Calderón Enrique , Gaminde Idoia , Louro‐González Arturo , Martínez Flora , Orrego Carola , Rotaeche Rafa , Salcedo Flavia , Alonso‐Coello Pablo ,   Spanish CPGs Working Group
Published: December 2013

AbstractRationale, aims and objectiveThis study aims to assess the use of clinical practice guidelines (CPGs) among health professionals and factors related to their uptake in clinical practice.MethodsCross‐sectional study based on an online survey conducted among primary care (PC) and hospital‐based care (HC) doctors in Spain in 2011. Questionnaire development included adaptation of similar surveys and contextualization through a qualitative study. After a pilot study and review, the final survey contained five domains: demographics, involvement in CPGs, consultation of CPGs, perceptions and attitudes regarding CPGs and Spanish NHS CPGs Programme. Professionals from selected health care centres in seven regions were contacted by email with an invitation and link to the Web‐based questionnaire. We analysed between‐group differences and explored potential predictors of CPGs use by means of a logistic regression.ResultsSix hundred seventy‐six doctors responded to the survey (27.7% response rate). 47.1% were PC and 49.5% were HC doctors. 32.5% stated previous involvement in CPGs and 56.5% stated training in research methodology. 67.5% of the surveyed professionals reported using CPGs more than one time per week. The use of a system for classifying the quality of evidence (62.3%) and for grading the strength of the recommendations (58.6%), as well as the use of a rigorous methodology (49.6%), were the most frequently reported aspects related to CPG credibility. The lack of time (56.4%), especially in PC (65.3% versus 49.5% in HC; P < 0.001), and the absence of brief and easily accessible format (42.2%) were the main reported barriers to using CPGs. None of the studied factors showed statistically significant association in the logistic regression model.ConclusionsStudy results suggest that, in general, Spanish doctors trust and use CPGs frequently. To improve uptake by health professionals and to overcome existing barriers, CPGs should be rigorously developed and made accessible at the point‐of‐care in user‐friendly electronic formats. Due to the low response rate, findings should be extrapolated with caution.
Stathmin overexpression identifies high risk for lymphatic metastatic recurrence in pN0 esophageal squamous cell carcinoma patients
Authors: Akhtar Javed , Wang Zhou , Jiang Wen Peng , Bi Ming Ming , Zhang Zhi Ping 
Published: December 2013

AbstractBackground and AimCommon patterns of the operative failure after Ivor‐Lewis esophagectomy in esophageal squamous cell carcinoma (ESCC) patients are locoregional lymph node metastasis. It is clinically significant to investigate the biological markers to predict the subset of patients who are at higher risk of lymphatic metastatic recurrence. Our research aimed to investigate the association between the Stathmin (STMN‐1) gene expression and lymphatic metastatic recurrence in pN0 ESCC patients after surgery.MethodsOne hundred seventy‐four patients who suffered from mid‐thoracic ESCC and completely resected with Ivor‐Lewis esophagectomy were enrolled in our study. The entire patients were restricted to pN0 ESCC. Tissue specimens were examined for STMN‐1 expression levels by immunohistochemistry and Western blotting methods. The correlation of STMN‐1 levels with clinicopathological variables, prognosis, and metastatic potential was analyzed.ResultsOne hundred patients had STMN‐1 protein overexpression (57.47%), and the patients with overexpression were accompanied by significantly higher rate of lymphatic metastatic recurrence as compared with patients who had low STMN‐1 expression (P = 0.003). Multivariable Cox regression analysis revealed that the STMN‐1 protein expression and T classification were independent factors to predict the lymphatic metastatic recurrence (P = 0.007, P = 0.000, respectively).ConclusionsEven pN0 ESCC are a potential to lymphatic metastatic recurrence. Stathmin overexpression can be used as a marker to identify those patients who are at high risk for lymphatic metastatic recurrence in pN0 ESCC after an Ivor‐Lewis esophagectomy.
Primary hepatic angiosarcoma and potential treatment options
Authors: Zheng Ya‐wen , Zhang Xin‐wei , Zhang Jia‐li , Hui Zhen‐zhen , Du Wei‐jiao , Li Run‐mei , Ren Xiu‐bao 
Published: December 2013

AbstractAngiosarcomas account for a mere 2–3% of adult soft tissue sarcomas, with an overall poor outcome. Depending on the primary site, angiosarcomas have distinct prognosis. Primary hepatic angiosarcomas (PHAs) are much rare tumors, with worse prognosis compared with other angiosarcomas. PHA is reported to be associated with vinyl chloride, but the majority of patients were still with unknown etiology. As PHA lacks specific symptoms, signs, or images, pathological diagnosis is necessary. The review summarizes 25 articles published from January 2000 to December 2012, including 64 cases of PHA with detailed information. Survival curves are estimated using the Kaplan–Meier method by SPSS 21.0. We find that the median survival time is 5 months; local excision alone or combination with adjuvant therapy is the optimal choice, with median survival time of 17 months. In addition, liver transplant is abandoned for high recurrence rate; emergent transcatheter arterial embolization is thought to be an efficient method for controlling intra‐abdominal bleeding; and transcatheter arterial chemoembolization and chemotherapy may be helpful in improving survival.
Long‐term outcome of patients with gastric varices treated by balloon‐occluded retrograde transvenous obliteration
Authors: Naeshiro Noriaki , Aikata Hiroshi , Kakizawa Hideaki , Hyogo Hideyuki , Kan Hiromi , Fujino Hatsue , Kobayashi Tomoki , Fukuhara Takayuki , Honda Yohji , Ohno Atsushi , Miyaki Daisuke , Kawaoka Tomokazu , Tsuge Masataka , Hiraga Nobuhiko , Hiramatsu Akira , Imamura Michio , Kawakami Yoshiiku , Takahashi Shoichi , Awai Kazuo , Chayama Kazuaki 
Published: December 2013

AbstractBackground and AimTo assess the short‐ and long‐term outcome of patients with gastric varices (GV) after balloon‐occluded retrograde transvenous obliteration (B‐RTO) by comparing bleeding cases with prophylactic cases.MethodsConsecutive 100 patients with GV treated by B‐RTO were enrolled in this retrospective cohort study. We compared the technical success, complications, and survival rates between bleeding and prophylactic cases.ResultsOf 100 patients, 61 patients were bleeding cases and 39 patients were prophylactic cases. Technical success was achieved in 95% of bleeding case and in 100% of prophylactic case, with no significant difference between these groups (overall technical success rate, 97%). The survival rates at 5 and 10 years were 50% and 22% in bleeding case, and 49% and 36% in prophylactic case, respectively. There was also no significant difference (P = 0.420). By multivariate analysis, survival rates correlated significantly with liver function (hazard ratio 2.371, 95% CI 1.457–3.860, P = 0.001) and hepatocellular carcinoma development (HR 4.782, 95% CI 2.331–9.810, P < 0.001). The aggravating rates of esophageal varices (EV) were 21%, 50%, and 54% at 12, 60, and 120 months after B‐RTO. By multivariate analysis, aggravating rates significantly correlated with EV existing before B‐RTO (HR 18.114, 95% CI 2.463–133.219, P = 0.004).ConclusionB‐RTO for GV could provide the high rate of complete obliteration and favorable long‐term prognosis even in bleeding cases as well as prophylactic cases. Management of EV after B‐RTO, especially in coexisting case of GV and EV, would be warranted.
Endotoxemia unrequired in the pathogenesis of pediatric nonalcoholic steatohepatitis
Authors: Yuan Jianye , Baker Susan S , Liu Wensheng , Alkhouri Razan , Baker Robert D , Xie Jianqun , Ji Guang , Zhu Lixin 
Published: December 2013

AbstractBackground and AimNonalcoholic steatohepatitis (NASH), the severe form of nonalcoholic fatty liver disease, is a serious liver complication associated with obesity. Several studies suggest that endotoxemia is associated with nonalcoholic fatty liver disease and NASH. We aimed to study the correlation of gut microbiome composition and the incidence of endotoxemia in obese patients and NASH patients in comparison with normal controls.MethodsThe abundance of Gram‐negative bacteria in the gut microbiomes of normal controls, obese patients with normal liver, and biopsy‐proven NASH patients were assessed using 16S rRNA pyrosequencing data. Serum endotoxin was determined by endpoint limulus amebocyte lysate assay.ResultsHigher abundance of Gram‐negative bacteria in gut microbiome was observed in obese and NASH patients in comparison with normal controls, but no difference was detected between obese and NASH patients. Serum endotoxin is higher in the NASH group than the normal controls. In addition, the obese and NASH patients had a higher incidence of endotoxemia compared with normal controls. However, Spearman's test found no correlation between the abundance of Gram‐negative bacteria and serum endotoxin levels. The majority of the NASH patients and the obese patients had low serum endotoxin level. Among NASH patients, serum endotoxin is not correlated with disease severity.ConclusionsOur data suggest that the gut microbiome composition does not contribute to the incidence of endotoxemia in NASH, and endotoxemia is not required in the pathogenesis of NASH. Our observations highlight the current concept that multiple factors contribute to the development of NASH.
Association of greater intravenous volume infusion with shorter hospitalization for patients with post‐ERCP pancreatitis
Authors: Sagi Sashidhar V , Schmidt Suzette , Fogel Evan , Lehman Glen A , McHenry Lee , Sherman Stuart , Watkins James , Coté Gregory A 
Published: December 2013

AbstractBackground and AimThere are no data specifically correlating early intravenous volume infusion (IVI) with the length of hospitalization for postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).MethodsWe conducted a retrospective cohort study of patients admitted within 24 h after ERCP to our institute with PEP. IVI during the first 24 h after ERCP was assessed. Primary outcome was severity of PEP, defined by length of hospitalization according to consensus guidelines: mild ≤ 3, moderate 4–10, and severe > 10 days.ResultsOf 72 eligible patients, 41 (56.9%) had mild and 31 (43.1%) moderate/severe PEP. Both groups had comparable demographics, indications, and procedural factors except patients with moderate/severe PEP were older (median age 49 vs 36 years, P = 0.05) and more likely to be discharged and readmitted within the first 24 h (41.9% vs 14.6%, P < 0.01). Patients with mild PEP received significantly greater IVI during the first 24 h (2834 mL [2046, 3570] vs 2044 mL [1227, 2875], P < 0.02) and 50% more fluid post‐ERCP (2270 mL [1435, 2961] vs 1515 [950–2350], P < 0.02) compared with those with at least moderate PEP.ConclusionIn patients with PEP, greater IVI during the first 24 h after ERCP is associated with reduced length of hospitalization. Lower IVI was more commonly observed in individuals who were discharged and then readmitted during the first 24 h.
Evaluation of pigtail macaques as a model for the effects of copper intrauterine devices on HIV infection
Authors: Engel Robyn M. , Morris Monica , Henning Tara , Ritter Jana M. , Jones Tara L. , Dietz Sharon , Ayers Jessica , Vishwanathan Sundaram A. , Jenkins Leecresia , Zaki Sherif , Wildemeersch Dirk , Garber David , Powell Nathaniel , Michael Hendry R. , McNicholl Janet , Kersh Ellen N. 
Published: December 2013

AbstractBackgroundLong‐acting, hormonal contraception may increase HIV risk. Copper intrauterine devices (IUDs) could serve as non‐hormonal alternatives. We pilot a pigtail macaque model for evaluating HIV susceptibility factors during copper IUD use.MethodsFrameless and flexible GyneFix® copper IUDs were surgically implanted into three SHIVSF162p3‐positive macaques via hysterotomy and monitored for up to 4 months. Four macaques served as non‐IUD controls.ResultsAll animals retained the devices without complications. No consistent change in vaginal viral RNA or inflammatory cytokines was seen. Two animals had altered menstrual cycles and experienced marked thinning of vaginal epithelium after IUD insertion. Histological examination of uterine tissue at necropsy revealed endometrial ulceration and lymphocytic inflammation with glandular loss at sites of direct IUD contact.ConclusionsAlthough the need for insertion surgery could limit its usefulness, this model will allow studies on copper IUDs and SHIV shedding, disease progression, and HIV susceptibility factors.
Incidence and risk factors for winged scapula after surgical treatment for breast cancer
Authors: Mastrella Adriana de S , Freitas‐Junior Ruffo , Paulinelli Régis R , Soares Leonardo R 
Published: December 2013

Aims and objectivesTo evaluate the incidence of winged scapula following surgical breast cancer treatment, determine its evolution over time and correlate factors that might influence this incidence.BackgroundWinged scapula is a complication that may occur as a result of exposing the long thoracic nerve during axillary lymphadenectomy for the treatment for breast cancer. There is no consensus in the literature about the incidence of this complication after surgical treatment for breast cancer, and complication rates range from 1·5–74%.DesignThis is a prospective cohort study.MethodsA prospective cohort study was conducted including 57 patients with breast cancer who underwent surgical treatment. Each patient was assessed before and after the surgery, by means of Hoppenfeld manoeuvre. The incidence rate of winged scapula was calculated at four different times.ResultsAt the preoperative assessment, none of the patients presented with winged scapula, while 16 patients (28·1%) were shown to have this complication after the procedure. The incidence of winged scapula decreased over time. Factors associated with winged scapula were as follows: patients younger than 50 years, clinical stage I and II and no neoadjuvant chemotherapy. Other factors that were evaluated, such as type of surgery, number of lymph nodes compromised and removed, as well as body mass index, were not associated with the risk of winged scapula.ConclusionsThis study demonstrated that the incidence of winged scapula is low and decreased over time. Furthermore, a greater incidence of winged scapula was noted in young women at an initial stage of the disease who had not been treated with neoadjuvant chemotherapy.Relevance to clinical practiceThe result of this work may have great impact, for demonstrating what risk factors are significantly associated with winged scapula after surgical treatment for breast cancer.
Anxiety and fear in patients with short waiting times before coronary artery bypass surgery – a qualitative study
Authors: Feuchtinger Johanna , Burbaum Christina , Heilmann Claudia , Imbery Claudia , Siepe Matthias , Stotz Ulrike , Fritzsche Kurt , Beyersdorf Friedhelm 
Published: December 2013

Aims and objectivesTo obtain qualitative information on fears and anxieties of coronary artery bypass grafting patients with short waiting periods (up to a maximum of four weeks) before surgery.BackgroundCoronary artery bypass grafting is a standard procedure in cardiac surgery. However, many patients suffer significant anxiety and fear before the operation. Preoperative anxiety and fear correlate with adverse outcomes, but there is a lack of data on the emotional stressors for patients with short waiting periods as applicable in Germany. This knowledge would be a prerequisite for the development of in‐hospital interventions to reduce patients' anxieties and fears.DesignAn exploratory study was chosen to learn about patients' anxieties and fears.MethodThe day before coronary artery bypass grafting, 24 patients were examined with respect to their emotional experience using semi‐structured interviews. The results were categorised by inductive content analysis.ResultsThe overall waiting time for coronary artery bypass grafting was 6 ± 6 days. According to the analysis, the patients' statements were grouped in ‘fears', ‘negation of fears' and ‘other emotional and physical conditions'. The interviews could cover all categories simultaneously. Eighteen patients mentioned fears, and most of them referred to specific issues. However, 16 of the 18 patients also named nonspecific fears and uncertainties. Fifteen patients negated fear. Twenty‐three patients described their emotions and/or somatic conditions.ConclusionsPatients with short waiting periods before coronary artery bypass grafting experience specific as well as nonspecific fears on the day before surgery. In contrast to patients with long waiting (longer than four weeks), uncertainty and frustration about waiting time and feelings of disability are no concerns.Relevance to clinical practiceThe detailed insight into the emotional experiences of patients with a short waiting time before coronary artery bypass grafting surgery is a basis for targeted anxiety‐reducing interventions.
Nurse's perspectives on care provided for patients with gamma‐hydroxybutyric acid and gamma‐butyrolactone abuse
Authors: Lundahl Maja‐Klara , Olovsson Karl Johan , Rönngren Ylva , Norbergh Karl‐Gustaf 
Published: December 2013

Aims and objectivesTo describe registered nurses' views and experiences providing care for gamma‐hydroxybutyric acid and gamma‐butyrolactone abuse inpatients in a psychiatric unit.BackgroundGamma‐hydroxybutyric acid and gamma‐butyrolactone are illegal drugs with potentially fatal outcomes that are entering wider use in Scandinavia. Gamma‐hydroxybutyric acid‐dependent persons with withdrawal symptoms often require forceful withdrawal treatment provided in psychiatric units.DesignA qualitative study with a purposive sample including interviews from registered nurses.MethodsData were collected from interviews with 15 registered nurses working in specialised dependency units in psychiatric wards. The data collected were analysed through a descriptive, qualitative analysis.ResultsThe registered nurses' narratives revealed four main areas of convergence: feelings of anxiety and despair, preparation for unpredictable and precarious situations, striving for good relationship and striving to optimise and develop nursing care. The interviews revealed that registered nurses reflect on and discuss their feelings about their patients' situations with colleagues; prepare themselves for potential aggressiveness and unpredictable situations; improve their care through conscious attitude adjustment and relationship‐forming behaviours; and strive to increase their personal knowledge, maintain a hopeful outlook and exhibit a positive approach. These themes were found in all nine categories and sixteen subcategories.DiscussionThe findings based on the registered nurses' narratives indicated that the registered nurses experienced their work situation when caring for these patients to be very complex and demanding.ConclusionThe study revealed that registered nurses worked extensively to craft their approach and attitude towards their patients. It is clear that registered nurses use themselves as tools or instruments for the creation of good relationships, thus providing the best care possible.Relevance to clinical practiceRegistered nurses should be given more education, clearer guidelines and better guidance to assist them in facing such challenging and often problematic situations. One‐on‐one shadowing provides the possibility to create and develop relationship.
Maternal parental self‐efficacy in newborn care and social support needs in Singapore: a correlational study
Authors: Shorey Shefaly , Chan Sally Wai‐Chi , Chong Yap Seng , He Hong‐Gu 
Published: December 2013

Aim and objectiveTo examine the correlation between maternal parental self‐efficacy and social support as well as predictors of self‐efficacy in the early postpartum period.BackgroundMaternal parental self‐efficacy is important for mothers’ adaptation to motherhood. Lack of support could result in decreased maternal parental self‐efficacy in newborn care. Limited studies have focused on maternal parental self‐efficacy in the postpartum period in Asia and none in Singapore.Study designA correlational study design was adopted.MethodsData were collected from both primiparas and multiparas during the first to third days postpartum in a public hospital, using the Perceived Maternal Parental Self‐efficacy and Perinatal Infant Care Social Support Scales. The data were analysed using descriptive and inferential statistics.ResultsMaternal parental self‐efficacy in newborn care and the level of social support that mothers received were moderate. In terms of the social support subscales, informational and instrumental support was lower than emotional and appraisal support. Informal support from husbands, parents and parents‐in‐law was the main source of support. A significant correlation was found between maternal parental self‐efficacy and total social support in addition to the informational, instrumental and appraisal subscales of functional support. The predictors of maternal parental self‐efficacy were parity, social support and maternal age.ConclusionThe findings highlight the predictors and correlates of maternal parental self‐efficacy in newborn care and the social support needs of mothers in the early postpartum period. Healthcare professionals could provide more information and instrumental support and involve family members to enhance maternal parental self‐efficacy.Relevance to clinical practiceBecause maternal parental self‐efficacy and social support in the early postpartum period are interrelated components, they could be assessed to identify at‐risk mothers. There is a need to develop perinatal educational programmes to provide culturally competent individualised support to mothers in need.
Investigation of p16INK4a as a prognostic biomarker in oral epithelial dysplasia
Authors: Nankivell Paul , Williams Hazel , Webster Keith , Pearson David , High Alec , MacLennan Kenneth , Senguven Burcu , McConkey Christopher , Rabbitts Pamela , Mehanna Hisham 
Published: December 2013

BackgroundHuman papilloma virus is a risk factor for oropharyngeal cancer. Evidence for a similar aetiological role in the development of oral dysplasia or its transformation to oral cancer is not as clear. Meta‐analyses estimate the prevalence of high‐risk human papilloma virus (HPV) serotypes to be three times higher in pre‐malignant lesions and cancer than in normal oral mucosa. However, this does not imply a causal relationship. Conflicting results are reported from the few studies examining the prognostic significance of HPV positivity in the development of oral cancer.We aimed to examine the ability of p16INK4a protein expression, a surrogate marker of HPV infection, to predict malignant progression in a large cohort of oral dysplasia patients.MethodsOne hundred forty eight oral dysplasia cases underwent immunohistochemical analysis using a monoclonal antibody against p16INK4a. Clinical factors were also collated on each case. Slides were double scored independently by two trained observers. Univariate analyses using both logistic and Cox regression models were performed.ResultsThirty nine of 148 cases progressed to cancer. Ten of 148 cases (7%) were p16INK4a positive. High grade of dysplasia (P = 0.0002) and lesion morphology (P = 0.03) were found to be prognostic of malignant progression. p16INK4a score was not prognostic in this cohort (P = 0.29). This did not change with a time to event analysis (P = 0.24).ConclusionFew studies have assessed the aetiological role of HPV in cancer development from dysplastic lesions. Our study, using one of the largest cohorts of oral dysplasia, demonstrated a low rate of p16INK4a positivity and was unable to confirm a prognostic ability for this biomarker.