bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introduction and Impact of a Human Immunodeficiency Virus Education Package on the Knowledge and Confidence of Pharmacists
Authors: Karabatsos Victoria , Mantas Stav , Lord Louise 
Published: June 2023

Background: Without specific pharmaceutical knowledge in specialist areas such as Human Immunodeficiency Virus (HIV) management, pharmacists may lack the ability and confidence to provide optimal pharmaceutical care and optimization of outcomes. Objective: To develop a pharmacy-specific, foundational HIV education and assessment package, and assess impact on pharmacist knowledge and confidence. Methods: A foundational HIV education package with assessment was developed. Participants’ baseline knowledge and self-reported confidence in HIV management were determined via an anonymous online questionnaire. Only participants who completed the pre-education questionnaire were then provided access to the self-paced, online education package. Participants completed a second questionnaire after completion of the package at a time of their choosing, within 2 months of the first questionnaire completion. Both questionnaires were similar in knowledge difficulty and addressed similar clinical domains. Mean differences in knowledge and confidence levels were analyzed, with further subgroup analyses of knowledge categories. Results: A total of 57 pharmacists completed both questionnaires. HIV knowledge was higher post-education compared with pre-education (mean correct score of 83.7% and 56.5% respectively, P < .001). The mean self-rated confidence of pharmacists in managing medications of people living with HIV, was higher post-education (73.3%) compared with pre-education (33.9%) ( P < .001). Conclusion: The use of a pharmacy-specific, foundational HIV management education package significantly increased pharmacist knowledge in HIV management and improved self-reported confidence in the management of this specialty area. Future studies should assess the sustained impact of educational materials on pharmacist knowledge and confidence and investigate translation into improved outcomes for people living with HIV.
Cost-effectiveness of FOLFOX6+Bevacizumab Versus FOLFOX6+Cetuximab in Stage IV Colorectal Cancer Patients in Shiraz, Iran
Authors: Jafari Abdosaleh , Tabatabaei Far Sedighe Sadat , Dehghani Mehdi , Ravangard Ramin 
Published: June 2023

Background Colorectal cancer is one of the most common cancers in the world, with about one million cases diagnosed annually. Various treatment methods can be used to treat colorectal cancer, including chemotherapy with different drug regimens. Considering the need to opt for more effective and less expensive drugs in the treatment of this disease, the present study aimed to compare the cost-effectiveness of FOLFOX6+Bevacizumab with FOLFOX6+Cetuximab in patients with stage IV colorectal cancer referred to medical centers in Shiraz, Iran, in 2021. Materials and Methods Using a decision tree, the cost-effectiveness and cost-utility of the 2 drug regimens were compared in all studied patients through the census method. Having a societal perspective, this study considered direct medical costs, direct non-medical costs, and indirect costs. The effectiveness indicators included the rate of major response to the drug combination used and the Quality-adjusted Life Year (QALY). The data were analyzed using Treeage 2011 and Excel 2016 software. In order to ensure the robustness of the results, one-way and probabilistic sensitivity analyses were performed as well. Results The results showed that the expected costs, the effectiveness (major response rate), and the QALYs of the FOLFOX6+Bevacizumab drug regimen were $16746.13(USD), .49, and .19, respectively, and those of the FOLFOX6+Cetuximab regimen were, respectively, $15191.05 (USD), .68, and .22. Therefore, FOLFOX6+Cetuximab compared to FOLFOX6+Bevacizumab was less costly and more effective and had a greater QALY, thus being considered as the dominant option. Also, the results of the sensitivity analyses showed that there was a bit of uncertainty. Conclusion Considering that the FOLFOX6+Cetuximab regimen was more cost-effective, it is suggested to be prioritized in preparing clinical guidelines for Iranian colorectal cancer patients. In addition, increasing the basic and supplementary insurance coverage for this drug combination as well as the use of remote technology to guide patients by oncologists can be solutions to reduce direct and indirect costs of the patients.
Survival Outcome and Prognostic Factors Among Patients With Hepatocellular Carcinoma: A Hospital-Based Study
Authors: Le Dinh Cong , Nguyen Thang Minh , Nguyen Duong Hoang , Nguyen Dung Thi , Nguyen Lan Thi Mai 
Published: June 2023

Background: Hepatocellular carcinoma (HCC) is a leading cancer with very high incidence and mortality and low survival rate in Vietnam and worldwide. This study aimed to investigate the survival outcome and its prognostic factors among HCC patients. Methods: This is a retrospective descriptive study on patients newly diagnosed with HCC at Hanoi Oncology Hospital, Vietnam from January 2018 to December 2020. Overall survival (OS) was calculated by the Kaplan-Meier method. Log-rank test and Cox regression were used to investigate the association among patients’ OS and their diagnosis and treatment factors. Results: A total of 674 patients were included. The median OS was 10.0 months. The survival rates at 6, 12, 24, and 36 months were 57.3%, 46.6%, 34.8%, and 29.7%, respectively. The initial performance status (PS), Child-Pugh score, and Barcelona Clinic Liver Cancer (BCLC) stage at the time of diagnosis are prognostic factors of HCC OS. A total of 451 (66.8%) patients have died, most of them (375 equally 83.1%) died at home, and only 76 (16.9%) died at hospital. Hepatocellular carcinoma patients living in the rural area more likely died at home than those living in the urban area (85.9% vs 74.8%, P = .007). Conclusions: Hepatocellular carcinoma has a poor prognosis with low OS. Performance status, Child-Pugh score, and BCLC stage were the independent prognostic factors for the survival outcome of HCC patients. The fact that most HCC patients died at home suggested that home-based hospice care needs to be paid special attention.
Feasibility of an observational procedure to enhance early identification of autism spectrum disorder in paediatric settings: A mixed-methods study on an Ecuadorian sample
Authors: Buffle Paulina , Armijos Cristina , Naranjo Alfredo , Gentaz Edouard 
Published: June 2023

Identification procedures for autism spectrum disorders in paediatric settings include screening and routine clinical surveillance. Screening tools are perceived as challenging, and a preference for direct observation has been reported in Ecuadorian paediatric settings. Augmentative observational procedures could prompt the application of screening tools, increase professionals’ sense of self-efficacy and support referral decision-making. Following the recommendations that identification procedures should be tested in a group of children without autism from local populations, we tested a set of observational tasks on 125 children from 12 to 59 months of age in various socio-economic settings, in semi-experimental conditions and on a group of 33 non-autistic children in a paediatric-setting condition. Results indicated that the social referencing task did not produce the expected response in most children in semi-experimental conditions. Responses to the elicitation of a gesture were significantly influenced by socio-economic status and geographic area. Three other tested tasks (response to name, eye contact, response to joint attention) produced the expected responses in semi-experimental and clinical conditions, suggesting that they could be used in daily routines if fidelity to training is ensured. We discuss the implication of those findings in clinical practice and professional education in an Ecuadorian context. Lay abstract In Ecuador, the low official estimate of the number of persons with autism spectrum disorder suggest that many children are not identified and are not receiving support. Screening tools are short parent-addressed questionnaires used to identify children that may be developing with autism. Their use is recommended, but their application can be perceived as challenging in paediatric routines. Some professionals prefer looking for autism-related behaviours in a child rather than using screening questionnaires. Although a short observation does not replace the use of validated screening questionnaires, tasks to guide the observation of autistic early signs can help professionals decide to screen or refer the family for assessment and early intervention. In this study, we tested observational tasks that could be adapted to the Ecuadorian paediatric contexts.
Strategies to deliver smoking cessation interventions during targeted lung health screening - a systematic review and meta-analysis
Authors: Williams Parris J , Philip Keir EJ , Alghamdi Saeed M , Perkins Alexis M , Buttery Sara C , Polkey Michael I , Laverty Anthony A , Hopkinson Nicholas S 
Published: June 2023

Introduction Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established. Methods We undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published prior to 20/07/2022 MEDLINE, PsychINFO, CENTRAL, EMBASE, CINAHL and Scopus databases. Two reviewers screened titles, and abstracts, four reviewed each full text using prespecified criteria, extracted relevant data, assessed risk of bias and confidence in findings using the GRADE criteria. The review was registered prospectively on PROSPERO (CRD42021242431). Results 10 randomised controlled trials and three observational studies with a control group were identified. Meta-analysis of nine RCTs demonstrated that smoking cessation interventions delivered during lung screening programmes increased quit rates compared to usual care (odds ratios: 2.01, 95%: 1.49–2.72 p < 0.001). Six RCTs using intensive (≥3 behavioural counselling sessions) interventions demonstrated greater quit rates compared to usual care (OR: 2.11, 95% CI 1.53–2.90, p < 0.001). A meta-analysis of two RCTs found intensive interventions were more effective than non-intensive (OR: 2.07, 95%CI 1.26–3.40 p = 0.004), Meta-analysis of two RCTs of non-intensive interventions (≤2 behavioural counselling sessions or limited to online information audio take home materials such as pamphlets) did not show a higher quit rate than usual care (OR: 0.90, 95% CI 0.39–2.08 p = 0.80). Discussion Moderate quality evidence supports smoking cessation interventions delivered within a lung screening setting compared to usual care, with high-quality evidence that more intensive interventions are likely to be most effective.
Flexible Total Ring Annuloplasty With Continuous Wrapping Suture Considering the Anatomy and Histology of the Tricuspid Valve
Authors: Kawase Takumi , Takahashi Yosuke , Sumii Yosuke , Nishiya Kenta , Inno Goki , Sakon Yoshito , Morisaki Akimasa , Shibata Toshihiko 
Published: June 2023

Objective: About half of tricuspid valves (TVs) have 2 posterior leaflets, and the fibrous tissue of the tricuspid annulus is poor. Considering the anatomy and histology of the TV, we devised a secure ring annuloplasty technique. We herein report the outcomes of our continuous wrapping suture annuloplasty technique using a flexible total ring. Methods: We used a Tailor™ ring (Abbott, Chicago, IL, USA) as a full ring. The mark on the left side of the ring was fixed to the anteroseptal commissure, and the midpoint of the ring’s markers was fixed at the center of the septal leaflet annulus. Using a continuous suture, all stitches were passed around the annuloplasty ring without penetration. One suture from the anteroseptal commissure ran toward the left side and another from the midpoint of the septal leaflet annulus ran toward the right, leading to annuloplasty without TV deformation. Results: Eighty patients underwent TV repair with this technique. The tricuspid regurgitation (TR) score in all patients improved from 1.9 ± 0.7 to 0.8 ± 0.4 ( P < 0.001) at 3 years postoperatively. The TR score of TVs with 2 posterior leaflets also improved from 1.9 ± 0.7 to 0.6 ± 0.4 after the operation and was unchanged during follow-up. The median follow-up period was 1.3 (0.5 to 2.0) years, and no patients required TV reoperation. The 3-year survival rate was 93%, and the 3-year rate of freedom from pacemaker implantation was 95%. Conclusions: The continuous wrapping suture technique using a flexible total ring is a useful procedure without TV deformation even when 2 posterior leaflets are present.
Bailout technique for entangled stent retriever and carotid stent during tandem large vessel occlusion endovascular therapy
Authors: Malik Kunal , Nogueira Raul G , Doheim Mohamed F , Mohammaden Mahmoud , Rajani Ravi , Haussen Diogo C , Al-Bayati Alhamza R 
Published: June 2023

Background and Importance Endovascular thrombectomy for patients with tandem occlusions could be challenging. Exposure to potential technical complications and bailout rescue techniques are of utmost importance. Clinical Presentation A 73-year-old woman with tandem internal carotid artery and middle cerebral artery lesions underwent an unsuccessful retrograde revascularization approach in the setting of tortuous anatomy. Antegrade approach revascularization was then pursued. Following cervical internal carotid artery revascularization, a triaxial system of aspiration catheter, microcatheter and micro guidewire was navigated through the stented curved cervical ICA and intracranial stent retriever pass was performed. Upon retrieving the clot-incorporated stent retriever with the intention to retrieve the entire stent retriever into the locally placed aspiration catheter, the triaxial system collapsed into the distal common carotid artery. Large thrombus was recovered from the aspiration catheter aspirate however the proximal end of stent retriever and distal internal carotid artery stent got tangled. After unsuccessful maneuvering to disentangle stent retriever from the internal carotid artery stent, we decided to attempt safe separation of the stent retriever from its pusher wire and leave behind the patent internal carotid artery stent/stent retriever metal construct in place. Gradual pulling pressure was applied to the stent retriever wire while maintaining distal exchange-length microwire access and fully inflated extracranial balloon over the entangled portion to ensure continuous vascular access. The stent retriever wire was then safely separated from the stent retriever and fully retracted outside the body. Delayed angiographic runs continued to demonstrate full patency of the internal carotid artery lumen. No residual dissection, spasm, or thrombus was noted. Conclusion This case illustrates a novel bailout endovascular salvage technique that could be considered in such cases. These techniques minimize intraoperative complication, focus on patient safety, and promote efficiency for endovascular thrombectomy in unfavorable anatomy.
Impact of COVID-19 on stage migration in bladder cancer: A single-centre retrospective comparative cohort analysis
Authors: Haq Kamran , Whyte Eleanor , Poulopoulou Dimitra , Shannon Oliver , Couper Sinclair , Lye Jonathan , Illinca Cristina , Reynolds Martin , Veeratterapillay Rajan , Rai Bhavan Prasad 
Published: June 2023

Objectives: To evaluate whether the COVID-19 pandemic has increased the proportion of patients diagnosed with muscle invasive bladder cancer (MIBC) at first presentation and explore potential causes for this hypothesised stage migration. Subjects/Patients and Methods: All patients undergoing first transuretheral resection of bladder tumour (TURBT) between 2 January 2018 and 30 June 2021. The date of the lockdown restrictions was used to divide patients into pre-COVID and COVID cohorts. Data were collated retrospectively from electronic patient records. Variables included demographics data, TNM stage and presentation (emergent/elective). A comparative analysis of the two cohorts was undertaken using the chi-square test to evaluate for statistical significance. A p-value of <0.05 was regarded as significant. Results: A total of 1064 patient underwent a TURBT for a suspected bladder cancer in the study period. The number of patients in the pre-COVID and COVID cohorts was 704 and 360, respectively. Mean age was comparable between cohorts (74.7 vs 74.2 ( p = 0.46)) as was sex ratio (F:M (1:2.84 vs 1:2.95) p = 0.80). The proportion of patients with MIBC pre-COVID was 18% compared to 23.6% in the COVID cohort. This represents a 5.6% increase in the prevalence of first presentation MIBC during the COVID era ( p = 0.03 [95% confidence interval (CI) = 0.2–10.4]). The odds of a patient presenting with MIBC was 38% higher during the COVID era versus pre-COVID (odds ratio (OR) [95% CI] = 1.38 [1.01–1.85]). A significantly higher proportion of patients had metastases at presentation in the COVID cohort versus pre-COVID (4.4% vs 2.1% ( p = 0.034)). Conclusion: Our data would support the hypothesis that the COVID pandemic has precipitated a stage migration in the presentation of bladder cancer towards muscle invasive disease. This has implications in terms of patient outcomes as well as an increased demand on services to provide radial treatment. Potential reasons for the stage migration are patient-related factors and pathway failure due to widespread service disruption caused by COVID-19. Level of evidence: 3
Variation in Kidney Transplant Referral Across Chronic Kidney Disease Programs in Ontario, Canada
Authors: Yohanna Seychelle , Naylor Kyla L. , Luo Bin , Dixon Stephanie N. , Bota Sarah E. , Kim S. Joseph , Blake Peter G. , Elliott Lori , Cooper Rebecca , Knoll Gregory A. , Treleaven Darin , Wang Carol , Garg Amit X. 
Published: June 2023

Background: Eligible patients with kidney failure should have equal access to kidney transplantation. Transplant referral is the first crucial step toward receiving a kidney transplant; however, studies suggest substantial variation in the rate of kidney transplant referral across regions. The province of Ontario, Canada, has a public, single-payer health care system with 27 regional chronic kidney disease (CKD) programs. The probability of being referred for kidney transplant may not be equal across CKD programs. Objective: To determine whether there is variability in kidney transplant referral rates across Ontario’s CKD programs. Design: Population-based cohort study using linked administrative health care databases from January 1, 2013, to November 1, 2016. Setting: Twenty-seven regional CKD programs in the province of Ontario, Canada. Patients: Patients approaching the need for dialysis (advanced CKD) and patients receiving maintenance dialysis (maximum follow-up: November 1, 2017). Measurements: Kidney transplant referral. Methods: We calculated the 1-year unadjusted cumulative probability of kidney transplant referral for Ontario’s 27 CKD programs using the complement of Kaplan-Meier estimator. We calculated standardized referral ratios (SRRs) for each CKD program, using expected referrals from a 2-staged Cox proportional hazards model, adjusting for patient characteristics in the first stage. Standardized referral ratios with a value less than 1 were below the provincial average (maximum possible follow-up of 4 years 10 months). In an additional analysis, we grouped CKD programs according to 5 geographic regions. Results: Among 8641 patients with advanced CKD, the 1-year cumulative probability of kidney transplant referral ranged from 0.9% (95% confidence interval [CI]: 0.2%-3.7%) to 21.0% (95% CI: 17.5%-25.2%) across the 27 CKD programs. The adjusted SRR ranged from 0.2 (95% CI: 0.1-0.4) to 4.2 (95% CI: 2.1-7.5). Among 6852 patients receiving maintenance dialysis, the 1-year cumulative probability of transplant referral ranged from 6.4% (95% CI: 4.0%-10.2%) to 34.5% (95% CI: 29.5%-40.1%) across CKD programs. The adjusted SRR ranged from 0.2 (95% CI: 0.1-0.3) to 1.8 (95% CI: 1.6-2.1). When we grouped CKD programs according to geographic region, we found that patients residing in Northern regions had a substantially lower 1-year cumulative probability of transplant referral. Limitations: Our cumulative probability estimates only captured referrals within the first year of advanced CKD or maintenance dialysis initiation. Conclusions: There is marked variability in the probability of kidney transplant referral across CKD programs operating in a publicly funded health care system.
Immune restoration with ibrutinib plus venetoclax in first-line chronic lymphocytic leukemia: the phase 2 CAPTIVATE study
Authors: Moreno Carol , Solman Isabelle G. , Tam Constantine S. , Grigg Andrew , Scarfò Lydia , Kipps Thomas J. , Srinivasan Srimathi , Mali Raghuveer Singh , Zhou Cathy , Dean James P. , Szafer-Glusman Edith , Choi Michael 
Published: June 2023

Abstract
We evaluated immune cell subsets in patients with chronic lymphocytic leukemia (CLL) who received first-line therapy with 3 cycles of ibrutinib then 13 cycles of ibrutinib plus venetoclax in the minimal residual disease (MRD) cohort of the CAPTIVATE study (NCT02910583). Patients with Confirmed undetectable MRD (uMRD) were randomly assigned to placebo or ibrutinib groups; patients without Confirmed uMRD were randomly assigned to ibrutinib or ibrutinib plus venetoclax groups. We compared immune cell subsets in samples collected at 7 time points with age-matched healthy donors. CLL cells decreased within 3 cycles after venetoclax initiation; from cycle 16 onward, levels were similar to healthy donor levels (HDL; ≤0.8 cells per μL) in patients with Confirmed uMRD and slightly above HDL in patients without Confirmed uMRD. By 4 months after cycle 16, normal B cells had recovered to HDL in patients randomly assigned to placebo. Regardless of randomized treatment, abnormal counts of T cells, classical monocytes, and conventional dendritic cells recovered to HDL within 6 months (median change from baseline −49%, +101%, and +91%, respectively); plasmacytoid dendritic cells recovered by cycle 20 (+598%). Infections generally decreased over time regardless of randomized treatment and were numerically lowest in patients randomly assigned to placebo within 12 months after cycle 16. Sustained elimination of CLL cells and recovery of normal B cells were confirmed in samples from patients treated with fixed-duration ibrutinib plus venetoclax in the GLOW study (NCT03462719). These results demonstrate promising evidence of restoration of normal blood immune composition with ibrutinib plus venetoclax.