bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determinants and Effectiveness of Extending the Duration of Adjuvant Hormone Therapy beyond 5 Years in Patients with Breast Cancer
Authors: Zeng Erwei , He Wei , Sjölander Arvid , Bergqvist Jenny , Czene Kamila 
Published: August 2022

Abstract

Clinical guidelines have recommended patients with high-risk breast cancer to extend adjuvant hormone therapy beyond 5 years. However, the prevalence, predictors, and outcomes of extended adjuvant hormone therapy in the real world remain unknown. By linking six Swedish health registries, we prospectively followed 13,168 patients with breast cancer (2005–2020) from their first prescription of tamoxifen or aromatase inhibitors and categorized them as extending or not extending adjuvant hormone therapy. Cox regression analysis was used to investigate whether extended therapy was associated with breast cancer outcomes. Among patients with breast cancer who were recommended to extend adjuvant hormone therapy by the national guidelines, the proportion of women who extended therapy increased 5 folds during the past 10 years, reaching 80.9% during 2018 to 2020. Patients were more likely to extend therapy after completing 5-year adjuvant hormone therapy if they were young [40 vs. ≥65 years: OR, 1.71; 95% confidence interval (CI), 1.13–2.58], had positive lymph nodes (OR, 2.25; 95% CI, 1.85–2.73), had high tumor grade (grade 3 vs. 1: OR, 1.79; 95% CI, 1.34–2.39), received chemotherapy (OR, 5.22; 95% CI, 4.19–6.50), had first-degree relatives who died from breast cancer (OR, 1.84; 95% CI, 1.21–2.81), or had a high income (OR, 1.23; 95% CI, 1.01–1.49). Extended use of adjuvant hormone therapy was statistically significantly associated with improved disease-free survival (HR, 0.72; 95 CI%, 0.55–0.95). This study provides real-world evidence showing the use and improved breast cancer outcomes of extended adjuvant hormone therapy beyond 5 years.

Significance:
The proportion of patients with breast cancer extending adjuvant hormone therapy beyond 5 years has increased dramatically in recent years, which is associated with improved patient outcomes.
Prospective Assessment of the Diagnostic Accuracy of Multi-site Photoplethysmography Pulse Measurements for Diagnosis of Peripheral Artery Disease in Primary Care
Authors: Stansby Gerard , Sims Andrew J. , Wilson Lesley , Beale Tom A W , Wightman James , Guri Ina , Wilkes Scott , Haining Shona , Allen John ,   NOTEPAD Study Team
Published: August 2022

Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55 years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9–87.6%), with specificity 71.9% (95% CI 63.7–79.2%). ABPI sensitivity was 80.2% (95% CI 70.8–87.6%), with specificity 88.6% (95% CI 82–93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care.
The Relationship Between Market Culture, Clan Culture, Benevolent Leadership, Work Engagement, and Job Performance: Leader’s Dark Triad as a Moderator
Authors: Lee Michelle C. C. , Ding Alyssa Y. L. 
Published: August 2022

Benevolent leadership is one of the leadership styles which provides a positive influence on employees. However, the current leadership literature has yet to investigate how benevolent leadership leads to job performance, the processes involved, the relationship between organizational culture and benevolent leadership, and the role of dark side of leaders in affecting this relationship. Using the leader-culture fit framework within an Eastern context, the current study first investigates the relationship between benevolent leadership and job performance through work engagement. The study then compares two contrasting organizational culture (i.e., market culture and clan culture) on benevolent leadership. Finally, the study investigates how leaders’ dark triad affects the relationship between organizational culture and benevolent leadership. 374 full-time white-collar employees (Males = 54.01%; Mean age: 32.7 years) from various private organizations within the service industry participated in this study. The results showed that work engagement mediated benevolent leadership and job performance. Market culture showed a negative relationship with benevolent leadership while clan culture showed a positive relationship with benevolent leadership. Benevolent leadership mediated clan culture (but not market culture) and work engagement. Under a high market culture with a high dark triad leader, benevolent leadership is at its lowest level. Under a high clan culture with a low dark triad leader, benevolent leadership is at its highest level. The findings suggest the importance of benevolent leadership within a clan culture (rather than market culture), in aligning with the leader-culture fit framework in increasing employees’ work engagement and job performance.
Why 100 Patients Failed to Keep an Outpatient Appointment — Audit in a Dermatology Department
Authors: Verbov J 
Published: August 2022

Failure to keep outpatient appointments is common at all clinics and various explanations may be offered. One hundred attending patients who had failed to keep their previous dermatology clinic appointment were asked the reason for their non-attendance. Many and varied reasons were given but illness (28%), and problems related to appointments (33%) were prominent. They were also asked how. they had obtained a further appointment. Stricter follow-up of non-attenders by the hospital including informingthe GP, and subsequent GP action if necessary, may improve attendance figures.
General Practitioners' Use of Non-Steroidal Anti-Inflammatory Drugs in Tayside and Fife Regions
Authors: Keys J , Beardon P H G , Jau C , Lang C C , McDevitt D G 
Published: August 2022

The objectives of this study were to assess the prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) by general practitioners and to determine their attitudes to problems caused by this class of drugs. The study consisted of two parts. The first was a questionnaire survey among general practitioners in Fife and Tayside, and the second was an analysis of NSAID prescribing over 12 months among the doctors in the Carnoustie Health Centre, using duplicate prescriptions. In the questionnaire survey 61% of the general practitioners responded. The three most preferred drugs were buprofen (56%), naproxen (20%) and mefenamic acid (7%); choice of drug was determined by efficacy and personal experience. Gastrointestinal side effects were most frequently encountered, although there was little consensus amongst respondents as to their management. The duplicate prescription study showed that 14% of patients (1607 individuals) received at least one NSAID prescription in the year of study Ibuprofen (31%), naproxen (20%) and piroxicam (15%) were most frequently prescribed and up to 16% of the patients were co-prescribed a gastroprotective agent; ranitidine (75%) was the most commonly prescribed. Despite the introduction of newere NSAIDs, ibuprofen and naproxen are still the most commonly prescribed drugs. Furthermore, although gastrointestinal side effects are commonly encountered, there is some uncertainty about their management.
Cerebellar Ataxia in the Elderly
Authors: Safe A F , Cooper S , Windsor A C M 
Published: August 2022

In a retrospective study of 624 elderly patients referred with falls and gait disorders, 45 patients were found to have ataxia. Cerebrovascular diseases were the most common underlying cause of ataxia (15 patients, 37%). Nine patients had hereditary/degenerative cerebellar ataxia. History suggesting alcohol as an underlying cause was established in two patients with cerebellar ataxia. Three patients had normal pressure hydrocephalus and their condition improved remarkably after surgery. No definite cause was found in five patients. Cranial computed tomography (CT) showed cerebral atrophy in 16 patients and in three patients there was evidence of atrophy of the cerebellar vermis. Four patients had femoral neck fractures and three patients had other fractures. In a 5-year follow-up five patients died with bronchopneumonia (11% mortality) and patients with dementia showed rapid deterioration. All patients were referred to the day hospital for rehabilitation. The best treatment outcome was achieved in patients who had a single cerebrovascular accident with no cognitive impairment and in those whose ataxia was secondary to medication. Fourteen patients (44%) moved to residential care while 27 (66%) continued to live in their homes with community support. We concluded that there is no evidence of increased mortality in the elderly patients with cerebellar ataxia. CT scan is mainly helpful in diagnosing specific diseases such as tumours or hydrocephalus. A significant proportion of elderly patients with ataxia may have reversible or treatable conditions and can pursue an independent life.
Hypnoanalgesia for Chronic Pain: The Response to Multiple Inductions at One Session and to Separate Single Inductions
Authors: Lewis D O 
Published: August 2022

Serial hypnotic inductions conveying the same analgesic message produce a progressively longer response in an increasing number of patients. The resulting analgesia appears to be independent of the spacing of inductions — Whether given at a single session or on separate occasions — And to depend upon their number. However, multiple inductions at a single session save time. Elimination of pain can be achieved, by either approach, for a year or more in up to 70% of patients.
Breast Reconstruction at a District General Hospital
Authors: Evans Abigail A , Straker Virginia F , Rainsbury Richard M 
Published: August 2022

Breast reconstruction is normally carried out by plastic surgeons, but the advent of permanent tissue expanders places post-mastectomy reconstruction within easy reach of the general surgeon. Nineteen patients underwent breast reconstruction between 1989 and 1991 using a subpectoral silicone-based, double lumen tissue expander. Assessment of results was by: ( a) patient completed questionnaire; and ( b) third party evaluation of standardized photographs. The mean operating time was 58 min (40–80 min) and mean hospital stay 3 days (2–7 days). Complications included one flap necrosis and one leaking injection port. Outpatient tissue expansion required an average of seven visits (4–11) and was completed in an average of 12 months (7–19). The injection port was subsequently removed under local anaesthetic as a day case. The fully dressed appearance following reconstruction was graded good or excellent by 100% of patients and in over 80% of third-party assessments. Equivalent figures for the appearance when wearing a bra were 93% and 60% and undressed 57% and 47%, respectively. All patients recommended the procedure but 25% found inflation uncomfortable. Subpectoral tissue expansion is a safe, cosmetically acceptable method of breast reconstruction which is associated with a high level of patient satisfaction.
Increased quantity and diversity of patient referrals following the introduction of a novel vision rehabilitation model
Authors: Pucchio Aidan , Eden Karen , Foster Julia , Hopman Wilma , Bona Mark 
Published: August 2022

Despite effective vision rehabilitation (VR) interventions, no gold standard model of care delivery has been established. The institution of the South East Ontario Vision Rehabilitation Service (SOVRS) introduced a centralized intake, an occupational therapist as a systems navigator, and improved communication pathways between low vision services in order to optimize regional VR care. The aim of this study is to compare the SOVRS model of VR to a traditional, hospital-based pre-SOVRS-implementation model using referral data. A single-site (Vision Rehabilitation Clinic at Kingston Health Sciences Center), retrospective medical chart review was performed. Data were gathered from the electronic medical records of patients who received a low vision assessment at the pre-SOVRS-implementation clinic (2017) and the SOVRS clinics (2019). A total of 245 charts were reviewed over the two study periods. There were no significant differences in the age, gender, or diagnoses causing vision loss between 2017 and 2019. One hundred nine incoming referrals were received in 2017, with 136 in 2019, representing a 25% increase in incoming referrals ( p < .001). The proportion of incoming referrals from non-ophthalmologists rose from 3.7% in 2017 to 31.9% in 2019 ( p < .001). The number of outgoing referrals also increased significantly, from 113 outgoing referrals in 2017 to 259 in 2019 ( p < .001), equivalent to a mean of 1.04 ± 0.68 (± standard deviation) outgoing referrals per incoming referral in 2017 and 1.90 ± 0.97 outgoing referrals per incoming referral in 2019. Outgoing service referrals also diversified significantly in 2019 ( p < .001), with more referrals to services such as VR health service organizations and community services. The SOVRS model was able to increase both the quantity and diversity of incoming and outgoing referrals by adopting several key strategies during its development. By expanding referrals, SOVRS increased the services available to patients and enabled a larger population to receive VR care.
Rewarming from unwitnessed hypothermic cardiac arrest with good neurological recovery using extracorporeal membrane oxygenation
Authors: Gordon Les , Ferris John , Pauli Henning 
Published: August 2022

A 26-year-old man, who was training in bad weather for a mountain ultramarathon, became hypothermic after running for 4 h. He deteriorated and was unable to continue. His running partner went for help. The man suffered an unwitnessed hypothermic cardiac arrest. The on-site management and evacuation are described and included the use of intermittent cardiopulmonary resuscitation and a mechanical device during transport. The patient was successfully resuscitated and rewarmed by Extracorporeal Membrane Oxygenation (ECMO) after more than 2 h of cardiopulmonary resuscitation. After 14 h of ECMO support and five days of ventilation, the patient subsequently made a good neurological recovery. At hospital discharge, he had normal cerebral function, and an improving peripheral polyneuropathy affecting distal limbs, with paraesthesia in both feet and reduced coordination and fine motor skills in both hands.
Deep learning reconstruction allows for usage of contrast agent of lower concentration for coronary CTA than filtered back projection and hybrid iterative reconstruction
Authors: Otgonbaatar Chuluunbaatar , Ryu Jae-Kyun , Shin Jaemin , Kim Han Myun , Seo Jung Wook , Shim Hackjoon , Hwang Dae Hyun 
Published: August 2022

Background The demand for homogeneous and higher vascular contrast enhancement is critical to provide an appropriate interpretation of abnormal vascular findings in coronary computed tomography angiography (CTA). Purpose To evaluate the effect of various contrast media concentrations (Iohexol-370, Iohexol-300, Iohexol-240) and image reconstructions (filtered back projection [FBP], hybrid iterative reconstruction [IR], and deep learning reconstruction [DLR]) on coronary CTA. Material and Methods A total of 63 patients referred for coronary CTA between July and October 2021 were enrolled in this prospective study, and they randomly received one of three contrast media. CTA images were reconstructed with FBP, hybrid IR, and DLR. The CT attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for all three images. The images were subjectively evaluated by two radiologists in terms of overall image quality, artifacts, image noise, and vessel wall delineation on a 5-point Likert scale. Results The application of DLR resulted in significantly lower image noise; higher CT attenuation, SNR, and CNR; and better subjective analysis among the three different concentrations of contrast media groups ( P < 0.001). There was no significant difference in the CT attenuation of the left ventricle ( P = 0.089) and coronary arteries ( P = 0.072) between hybrid IR at Iohexol-300 and DLR at Iohexol-240. Furthermore, application of DLR to the Iohexol-240 significantly improved SNR and CNR; it achieved higher subjective scores compared with hybrid IR at Iohexol-300 ( P < 0.001). Conclusion We suggest that using DLR with Iohexol-240 contrast media is preferable to hybrid IR with Iohexol-300 contrast media in coronary CTA.
Association Between Statins and the Risk of Kidney Cancer Incidence and Mortality Using the Korean National Health Insurance Claims Database
Authors: Kim Dong-Sook , Kim Hyun Jung , Ahn Hyeong Sik 
Published: August 2022

Background Conflicting results have been reported regarding the potential preventive effects of statins on the risk of cancer. This study investigated the associations of statin use with the incidence and mortality of kidney cancer in South Korea. Methods In this retrospective population-based cohort study using the National Health Insurance claims database, we compared patients aged 45-70 years who had used statins for at least 6 months to non-statin users matched by age and sex from 2005 to June 2013. The main outcomes were kidney cancer incidence and mortality according to statin use. Cox proportional hazard regression was used to calculate the adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). Results In the cohort of 1 008 101 people, the aHRs for the association between statin use and the outcomes were .84 (95% CI: 0.71-.99) for kidney cancer incidence and .65 (95% CI: 0.41-.98) for kidney cancer mortality. In the matched cohort of 337 578, the risk per 1000 people of cancer incidence and mortality was 1.63, 1.07, and .24, .17 in statin users and non-users, respectively. In matched cohort, the risk of kidney cancer incidence and mortality decreased, but it is not statistically significant. Also, there was no linear relationship with increased doses. Conclusion Statin use might be associated with a decreased risk of kidney cancer incidence and mortality, but it showed no statistical significance. This study was a large-scale analysis, however, further studies that are larger and multinational in scope are needed to confirm the beneficial effects of statins on survival.
Prophylactic and Therapeutic Effect of Kynurenine for Experimental Autoimmune Encephalomyelitis (EAE) Disease
Authors: Sundaram Gayathri , Bessede Alban , Gilot David , Staats Pires Ananda , Sherman Larry S , Brew Bruce J , Guillemin Gilles J 
Published: August 2022

Background: The essential amino acid, tryptophan, is predominantly metabolised through the kynurenine pathway (KP) to generate kynurenine, an aryl-hydrocarbon receptor (AhR) pro-ligand that exerts its effects in a ligand-dependent manner. Interaction between kynurenine and the AhR is an effector mechanism of immunosuppression. We previously found that the KP is involved in multiple sclerosis (MS) disease progression. We postulated that AhR activation by kynurenine might be neuroprotective by encouraging differentiation of Tregs. In this study, we assess both the prophylactic and therapeutic efficiency of kynurenine on disease severity and progression in mice with experimental autoimmune encephalomyelitis (EAE), an MS model. Methods: Myelin oligodendrocyte glycoprotein induced EAE mice (n = 6 per group) were treated with 200 mg/kg L-kynurenine once daily for 10 days beginning on either day 1 of EAE induction (prophylactic) or once they demonstrated motor weakness (therapeutic). Clinical disease severity measured by disease score, time on rotarod, and body weight. Results: The prophylactic kynurenine treatment significantly ( P < .0001) prevented the development of a more severe disease course with mice demonstrating diminished relapse rate and improved clinical and behavioural outcomes. However, therapeutic kynurenine did not significantly ( P = .4463) decrease the clinical signs until 36 days following induction of disease; after 36 days, it also significantly ( P = .0479) reduced disease relapse. Mean body weight measurements only correlated with time on rotarod ( r = −.6410; P = .0007) but not clinical scores ( r = .1925; P = .3674). Conclusions: Kynurenine ameliorates EAE disease progression prophylactically and reduces relapses therapeutically. Further investigations are needed to elucidate the molecular mechanism explaining the therapeutic role of kynurenine for MS.
Deprescribing practices in Canada: A scoping review
Authors: Desai Mansi , Park Tanya 
Published: August 2022

Background: Excessive and inappropriate use of medications, defined as polypharmacy, can increase the risk of adverse drug reactions while affecting patient adherence and quality of life. Therefore, optimizing pharmacotherapies through deprescribing practices plays a crucial role in managing chronic conditions, avoiding adverse effects and improving patient outcomes. The purpose of this study was to explore research initiatives surrounding deprescribing in Canada. Methods: A scoping review was conducted that involved a search of 6 databases. Studies that highlighted deprescribing interventions, experiences and other effects on Canadian populations were included. Results: Searches yielded 2327 citations, of which 31 were included in this review. Five major themes and ideas were identified: deprescribing targeted medications, financial effects of deprescribing, deprescribing in special populations, insight from health care providers and deprescribing frameworks. Conclusion: Deprescribing practices in Canada have shown a wide range of beneficial results across various health care settings, populations and medication classes and have the potential to reduce medication-related harm in all Canadian health care settings.