bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vestibular dysfunction in people who fall: A systematic review and meta-analysis of prevalence and associated factors
Authors: Donovan Jacquelin , De Silva Luckshica , Cox Hayley , Palmer Gretta , Semciw Adam Ivan 
Published: April 2023

Objectives To evaluate the prevalence and factors associated with vestibular dysfunction in people who fall. Data Sources All electronic records from MEDLINE, CINAHL, Embase and psycINFO databases were searched to 9 December 2022. Review Methods Participants were adults with at least one fall within the previous year who were exposed to at least one vestibular function test. Any published peer reviewed trial designs were accepted. Included studies were assessed for risk of bias using a modified Epidemiological Appraisal Instrument. The quality of each meta-analysis was assessed using modified Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Ten trials (468 participants) were identified, six of which had high methodological quality. Vestibular dysfunction was found in 61% (48.01–72.32) I2 =  78% of participants. The most prevalent type of dysfunction was from tests of vestibulo-ocular reflex at 61% (49.79 to 70.49) I2 =  68%, followed by benign paroxysmal positional vertigo at 22% (10.30–40.32) I2  =  87% and central dysfunction at 11% (2.24–37.76) I2  =  50%. People who fall with vestibular dysfunction had reduced walking function compared to those without dysfunction −0.51 (−0.85 to −0.16) I2  =  11%. Dizziness was not related to vestibular dysfunction in people who fall 0.25 (−0.10 to 0.60), I2  =  0%. The quality of the body of evidence ranged from very low to high. Conclusion More than one in two people who fall have vestibular dysfunction. Clinicians cannot rely on dizziness report to indicate need for vestibular screening in those who fall. A vestibular screen should be incorporated into a comprehensive falls assessment.
Existential experiences and perceptions of death among children with terminal cancer: An interpretative qualitative study
Authors: Lin Nan , Lv Danni , Hu Yan , Zhu Jihua , Xu Hongzhen , Lai Dengming 
Published: April 2023

Background: Exploring the experience and understanding of death in children with terminal cancer is important to provide them with appropriate care. However, most studies have focused on the perspectives of parents and healthcare professionals, and few have focused on the end-of-life experiences of children. Aim: To advance the understanding of end-of-life experiences and perceptions of death in children with cancer. Design: Interpretative qualitative study using semi-structured interviews. Data were analyzed using reflexive thematic analysis. Setting/participants: The study was conducted at the department of oncological surgery, Children’s Hospital, Zhejiang University School of Medicine. Ten children aged 8–17 with terminal cancer were included in the study. Results: Four major themes (and eight sub-themes) were identified from the findings: (1) helplessness in the face of death (loneliness, loss of control); (2) desire to connect with the world they left (reluctantly to be forgotten, sense of self-worth); (3) perceptions and attitudes toward death (separating from loved ones, embracing death); (4) expectations of future life (promoting comfort, fulfilling wishes). Conclusions: Children with terminal cancer have a strong sense of loneliness and a desire to connect with the world they have left behind. Differences in children’s perceptions and attitudes about death suggest that healthcare professionals should focus on their experiences and needs and provide personalized palliative care services to children and their families to improve their quality of life.
Identifying Patterns in Preoperative Communication about High-Risk Surgical Intervention: A Secondary Analysis of a Randomized Clinical Trial
Authors: Stalter Lily N. , Baggett Nathan D. , Hanlon Bret M. , Buffington Anne , Kalbfell Elle L. , Zelenski Amy B. , Arnold Robert M. , Clapp Justin T. , Schwarze Margaret L. 
Published: April 2023

Introduction Surgeons are entrusted with providing patients with information necessary for deliberation about surgical intervention. Ideally, surgical consultations generate a shared understanding of the treatment experience and determine whether surgery aligns with a patient’s overall health goals. In-depth assessment of communication patterns might reveal opportunities to better achieve these objectives. Methods We performed a secondary analysis of audio-recorded consultations between surgeons and patients considering high-risk surgery. For 43 surgeons, we randomly selected 4 transcripts each of consultations with patients aged ≥60 y with at least 1 comorbidity. We developed a coding taxonomy, based on principles of informed consent and shared decision making, to categorize surgeon speech. We grouped transcripts by treatment plan and recorded the treatment goal. We used box plots, Sankey diagrams, and flow diagrams to characterize communication patterns. Results We included 169 transcripts, of which 136 discussed an oncologic problem and 33 considered a vascular (including cardiac and neurovascular) problem. At the median, surgeons devoted an estimated 8 min (interquartile range 5–13 min) to content specifically about intervention including surgery. In 85.5% of conversations, more than 40% of surgeon speech was consumed by technical descriptions of the disease or treatment. “Fix-it” language was used in 91.7% of conversations. In 79.9% of conversations, no overall goal of treatment was established or only a desire to cure or control cancer was expressed. Most conversations (68.6%) began with an explanation of the disease, followed by explanation of the treatment in 53.3%, and then options in 16.6%. Conclusions Explanation of disease and treatment dominate surgical consultations, with limited time spent on patient goals. Changing the focus of these conversations may better support patients’ deliberation about the value of surgery. Trial registration: ClinicalTrials.gov Identifier: NCT02623335. Highlights In decision-making conversations about high-risk surgical intervention, surgeons emphasize description of the patient’s disease and potential treatment, and the use of “fix-it” language is common. Surgeons dedicated limited time to eliciting patient preferences and goals, and 79.9% of conversations resulted in no explicit goal of treatment. Current communication practices may be inadequate to support deliberation about the value of surgery for individual patients and their families.
Quantification of cardiac iron in patients with thalassemia with 3-T MRI calibrated by 1.5-T MRI
Authors: Xu Fengming , Luo Chaotian , Li Meicheng , Guan Kaiming , Peng Fei , Yang Gaohui , Peng Peng 
Published: April 2023

Background Due to the small sample size of many studies, it remained unclear what standardized reference range the T2* cutoff at 3 T would be used to assess the severity of cardiac iron load. In addition, the number of patients with moderate to severe cardiac iron load was small in some studies, especially the sample of patients with severe cardiac iron load. Purpose To explore the feasibility, reproducibility, and reliability of using T2* values in quantifying cardiac iron load in patients with thalassemia at 3 T. Material and Methods A total of 122 patients with thalassemia underwent cardiac T2* imaging at both 1.5 T and 3 T. Cardiac R2* (1000/T2*) values of the 100 patients at 3 T were fitted against the values at 1.5 T using linear regression and the prediction equation was derived. The remaining 22 cases were used to test the prediction accuracy of the equation. Results The combined R2* values exhibited a strong linear relationship between 1.5 T and 3 T ( r = 0.830， P<0.001). At the center, it had a slope of 1.348 and an intercept of 37.279. According to the equation, the truncated T2* values of cardiac iron overload and cardiac heavy iron overload at 3 T were <10 ms and <6 ms, respectively. The two truncated T2* values were used to diagnose different levels of cardiac iron overloaded of 22 patients at 3 T; the accuracy rates were 95.5% and 100.0%, respectively. Conclusion T2* quantification of cardiac iron load at 3 T MRI resulted to be feasible, reproducible, and reliable.
Impact of Inpatient Initiation of SGLT2 Inhibitors on Diuretic Requirements in Patients With Heart Failure
Authors: Cavagnini Megan E. , Best Emily E. , Skersick Preston T. , Truitt Kelsey P. , Musick Kaitlin L. , Mangum Blake R. , Hollis Ian B. , Rodgers Jo E. 
Published: April 2023

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been shown to improve outcomes in patients with heart failure (HF) and are now included in guideline-directed medical therapy. Trials reporting the change in loop diuretic dose following SGLT2i initiation have indicated conflicting results. There is no clear guidance on whether reducing loop diuretic doses following SGLT2i initiation is appropriate. Objective: The purpose of this study is to assess the impact of SGLT2i initiation on diuretic adjustment in hospitalized patients with known or new HF. Methods: This was a retrospective, single health-system study assessing the change in loop diuretic dose in the 60 days following discharge for patients with HF initiated on SGLT2i therapy during a hospital admission or upon discharge. Secondary outcomes assessed effect on renal function and discontinuation of SGLT2i within the 60 day follow up period. Results: Forty percent of patients required loop diuretic dose adjustment, with 29% requiring a dose reduction within the 60 days following discharge. There was minimal change in serum creatinine or blood urea nitrogen. The SGLT2i was discontinued in 6 patients. Conclusions: After inpatient initiation of SGLT2is, approximately one-third of patients required a reduction in loop diuretic dose within 60 days following hospital discharge. Further study is recommended to confirm if empiric diuretic dose adjustments are appropriate in this HF population.
Characterising variability in youth mental health service populations: A detailed and scalable approach using digital technology
Authors: Capon William , Hickie Ian B , McKenna Sarah , Varidel Mathew , Richards Matthew , LaMonica Haley M , Rock Daniel , Scott Elizabeth M , Iorfino Frank 
Published: April 2023

Objective This study utilised digital technology to assess the clinical needs of young people presenting for care at headspace centres across Australia. Method 1490 young people (12–25 years) who presented to one of 11 headspace services from four geographical locations (urban New South Wales, urban South Australia, regional New South Wales, and regional Queensland) completed a digital multidimensional assessment at initial presentation. Characteristics were compared between services and geographical locations. Results We identified major variation in the demographics, and the type and severity of needs across different services. Individuals from regional services were more likely to be younger, of Aboriginal and Torres Strait Islander origin, and present with psychotic-like symptoms and suicidality, while those in urban areas were more likely to have previously sought help and have problematic alcohol use. Further differences in age, distress, depressive symptoms, psychotic-like experiences, trauma, family history, alcohol use, education/employment engagement, and days out of role were identified between different urban sites. Conclusions The variability between services provides insight into the heterogeneity of youth mental health populations which has implications for appropriate early intervention and prevention service provisions. We propose that integrating digital technologies has the potential to provide insights for smarter service planning and evaluation.
“I’m Doing Okay”: Strengths and Resilience of Children With and Without ADHD
Authors: Charabin Emma , Climie Emma A. , Miller Courtney , Jelinkova Kristina , Wilkins Jessica 
Published: April 2023

Background: The body of research directed at understanding the strengths and resilience of this population is growing. Research has indicated there are strengths for individuals with ADHD, and found factors important for promoting good outcomes. This study investigates positive qualities by examining the strengths and resilience of children with and without ADHD. Methods: The final sample included 56 children between the ages of 10 and 17 years (ADHD: n = 38; without ADHD: n = 18). Results: Children in both groups tended to report average levels of strengths and resilience except for school functioning, where significant differences were found between groups. Significant correlations between strengths and resilience for both groups were found. Only family involvement was not significantly correlated with resilience for the without ADHD group. Conclusions: Results from this study emphasize the importance of taking a strength-based perspective when working with children diagnosed with ADHD.
Effects of Trainer Continuity and Experience on Neurofeedback Treatment of ADHD in Children
Authors: Cash Shelby , Rogge Carson , Schrader Constance , deBeus Roger , Kerson Cynthia , Arnold Lawrence Eugene 
Published: April 2023

Objective: To examine whether trainer continuity and experience impacted the significantly improved inattention scores (pre-post d = 1.44–1.53) seen in both the control and active treatment groups of “Double-Blind Placebo-Controlled Randomized Clinical Trial of Neurofeedback for Attention-Deficit/Hyperactivity Disorder” (2021). Methods: The primary trainer was the one who coached the most treatment sessions with a participant. A trainer was considered experienced after coaching 100 sessions. The percentage of sessions each participant had with their primary trainer and percentage with an experienced trainer were entered as independent variables into linear mixed models in SASv.9.4 with improvement in inattention ratings by parents and teachers (primary outcome) as dependent variable. Results: Effect of trainer continuity on primary outcome was not significant ( B = −0.016, SE = 0.153, t(123) = −0.11, p = .916). However, percent of sessions with an experienced trainer correlated with increased improvement ( B = 0.238, SE = 0.095, t(123) = 2.51, p = .013). Conclusion: Neurofeedback trainer continuity does not appear important, while trainer experience with at least 100 sessions correlates with better outcomes.
Teleneurocritical care is associated with equivalent billable charges to in-person neurocritical care for patients with acute stroke
Authors: Murray Nick M , Thomas Katherine , Roller Dean , Marshall Scott , Martinez Julie , Hoesch Robert , Hobbs Kyle , Smith Shawn , Meier Kevin , Puttgen Adrian 
Published: April 2023

Introduction Teleneurocritical care (TNCC) provides virtual care for hospitals who do not have continuous neurointensivist coverage. It is not known if TNCC is cost effective nor which variables impact the total billed charges per patient encounter. We characterize cost, defined by charge characteristics of TNCC compared to in-person neurocritical care (NCC), for patients with acute ischemic or hemorrhagic stroke requiring ICU care. Methods We performed a retrospective review from 2018 to 2021 of prospectively collected multinstitutional databases from a large, integrated, not-for-profit health system with an in-person NCC and spoke TNCC sites. The primary outcome was the total billable charge per TNCC patient with acute ischemic or hemorrhagic stroke compared to in-person NCC. Secondary outcomes were functional outcome, transfer rate, and length of stay (LOS). Results A total of 1779 patients met inclusion criteria, 1062 at the hub in-person NCC hospital and 717 at spoke TNCC hospitals. Total billed patient charges of TNCC were similar to in-person NCC (median 104% of the cost per in-person NCC patient, 95% CI: 99%–108%). From 2018 to 2021, the charge difference between TNCC and NCC was not different ( r2  =  0.71, p  =  0.16). Both age and length stay were independently predictive of charges: for every year older the charge increased by US $6.3, and every day greater LOS the charge increased by $2084.3 ( p < 0.001, both). TNCC transfer rates were low, and TNCC had shorter LOS and greater favorable functional outcome. Discussion TNCC was associated with similar patient financial charges as compared to in-person NCC. Standardization of care and the integrated hub-spoke value-focused operational procedures of TNCC may be applicable to other healthcare systems, however, further prospective study is needed.
A review of questionnaires used for the assessment of telemedicine
Authors: Agbali Raphael A , Balas E Andrew , Beltrame Francesco , Heboyan Vahe , De Leo Gianluca 
Published: April 2023

Introduction Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. Methods We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. Results and Discussion We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.
Understanding dementia care pathways for policy development and service planning in Kenya
Authors: Musyimi Christine W , Muyela Levi A , Mutiso Victoria N , Mutunga Elizabeth , Ndetei David M 
Published: April 2023

Background In Kenya, there is lack of evidence on existing dementia care pathways, with minimal or no presentation for dementia-related symptoms in health care settings. Understanding the services available for people with dementia as well as how communities access the services could offer a practical pattern for policy makers to identify strategies that encourage early detection, care and support for people with dementia and their families. Objectives To elucidate initial responses of individuals and their families to dementia and challenges encountered in help seeking through care pathways to inform dementia care-related policies and practice. Methods The Strengthening Responses to dementia in Developing Countries (STRiDE) Kenya team adapted case vignettes (brief hypothetical stories meant to elicit responses on how the characters would behave) developed by the entire STRiDE team. A total of 29 stakeholders were then asked to provide feedback on the completed vignettes and summarize a common pathway to dementia care in Kenya while using the proposed case vignettes. Findings We found four initial responses to dementia suspicion in Kenya where individuals:(i) Perceive symptoms as normal part of ageing, (ii) Consult a spiritual or traditional healer, (iii) Visit a private clinic or primary health care facilities, or (iv) No action taken. These were the first points within the care pathways which determined the care trajectory the person with dementia would follow. Conclusions Identification of dementia care pathways could form a basis for improving the way communities perceive dementia etiology and establish standard pathways to care whilst ensuring that some pathways do not further pose an impediment to care and treatment for dementia.
Dose Dependent Effects of Aqueous Extract of Garcinia cambogia Desr. Against Letrozole Induced Polycystic Ovarian Syndrome in Female Adult Rats With Possible Mechanisms Exploration
Authors: Rana Saba , Hussain Liaqat , Saleem Uzma , Asif Muhammad , Lodhi Arslan H. , Barkat Muhammad Q. , Riaz Muhammad , Jamil Alina 
Published: April 2023

Background Polycystic ovarian syndrome (PCOS) is an endocrine metabolic disorder of women. Purpose This study aimed to explore the potential of aqueous extract of Garcinia cambogia Desr. (AEGC) in PCOS. Methodology The HPLC was used to determine the phytoconstituents present in Garcinia cambogia. Thirty adult female albino rats were divided into 6 groups: Normal control (NC) disease Control (PCOS; letrozole 1 mg/kg), plant extract (AEGC 100, 300, 500 mg/kg) and standard (metformin; 20 mg/kg). Disease was confirmed by vaginal smear cytology. After 10 weeks, animals were euthanized, ovaries dissected for histopathology, blood collected for hormonal and biochemical analysis. Results HPLC analysis showed the presence of phenolic contents; chlorogenic acid, gallic acid, coumaric acid while flavonoid contents were quercetin, kaempferol, and rutin. After treatment, there was dose dependent reduction of weight, ovarian cysts, improvement of follicle growth. DPPH radical scavenging percentage was 67.89%. Hormonal analysis showed a significant improvement ( P < .05) in follicle stimulating hormone (FSH), estrogen, and progesterone while a reduction in testosterone, luteinizing hormone (LH) and insulin level. Antioxidant enzymatic markers were significantly ( P < .05) increased. Lipid profile and LFTs were also improved. Conclusions The study validated the potential of Garcinia cambogia in the management of PCOS.
“My body is a cage”: A qualitative investigation into the self-discrepancy experiences of young women with metastatic cancer
Authors: Kahraman-Erkus Ozlem , Ar-Karci Yagmur , Gençöz Tülin 
Published: April 2023

Objectives The current study investigated self-discrepancy experiences of young women with metastatic cancer. Methods Semistructured interviews were conducted. Data were analyzed through interpretative phenomenological analysis. Findings Eight female patients with metastatic cancer aged between 27 and 38 years formed the sample. Three superordinate themes emerged: (1) compulsory changes in self-concept with ambivalent evaluations; (2) new ideals not on the agenda of a healthy young woman; and (3) so-called ‘minimalist’ expectations from others. Discussion Findings indicated that diagnosis and treatment of metastatic cancer impose unique developmental challenges for young adult women. Advanced cancer disrupted the tasks and responsibilities of young adulthood, resulting in frustration, grief, isolation, and overcompensation. These findings suggest that a developmental perspective is crucial when working with self-discrepancy experiences of young women with metastatic cancer.