bluuebunny/crossref_metadata_2025_split huggingface dataset:
Informal Caregivers’ Administration of Concentrated Liquid Morphine to Hospice Patients Receiving Home Care: Does Regimen Matter?
Authors: Cravo Emma , Weisse Carol S. 
Published: March 2022

Background: Hospice patients receiving care at home rely on caregivers to manage liquid morphine for pain and dyspnea during the dying process. Medication is prescribed under varying regimens, yet caregivers are not required to record when morphine is used. Therefore, it is not known whether morphine use varies by regimen for hospice patients dying at home. Design and methods : A retrospective review of medication records from 227 deceased hospice patients who received routine home care in a residential setting in the U.S. Concentrated liquid morphine doses prescribed by hospice and doses administered by caregivers were calculated 7 days prior to death and on the day of death. Percent of maximum dose prescribed was determined by regimen type (scheduled, pro re nata, or combination) and by prescription flexibility (varied vs set doses/times). Results : Morphine was prescribed to 60.4% of patients a week prior to death and to 86.8% of patients on the day they died. Doses prescribed and percent morphine administered increased over the last week ( P < .05), but percent of morphine administered was low 1 week prior to death (23.40%) and on the day of death (30.68%). On patients’ day of death, nearly half (48.6%) of prescriptions included flexibility, and administration rates were lower ( P < .01) with flexible prescriptions (21.84%) than with structured regimens (39.52%). Conclusion: Morphine was frequently prescribed in the last week of life, but administration rates by caregivers were low, especially with less structured regimens. Caregivers may need more guidance regarding morphine’s use at home, especially with more flexible regimens.
Arthroscopic management of a cavitated calcaneum following gunshot injury
Authors: Sakka Samir A 
Published: March 2022

We report a 35 year old man who sustained a close range through and through gunshot injury to his calcaneum causing a comminuted cavitated fracture with contamination from his socks and shoe. He was successfully treated by a novel technique of intra-osseous arthroscopic removal of contamination debris, debridement and extensive arthroscopic washout. At a second stage, the fracture was bone grafted from his iliac crest with subsequent union of the fracture and reconstitution of the trabeculae, meaning he regained excellent hindfoot function. At 2 years follow-up there has been no sequelae from his injury and he remains pain and infection free.
Effects of a community-based chronic disease self-management programme on chronic disease patients in Singapore
Authors: Hoong Jian Ming , Koh Hui An , Wong Karen , Lee Hee Hoon 
Published: March 2022

Objective The Chronic Disease Self-Management Programme (CDSMP) is a small-group intervention attended by people with chronic diseases and aims to promote self-efficacy and improve health. We adopted this programme to improve population health in the Western region of Singapore. This study aimed to evaluate the association of the CDSMP with various health outcomes for people with chronic disease living in the community. Methods Validated instruments were used to measure various health outcomes. Participants completed baseline questionnaires before the programme. Post-intervention questionnaires were administered 6 months after programme. Primary outcome measures include self-efficacy and self-rated health status while secondary outcomes include several other self-management behaviours and healthcare utilisation. Results 461 participants attended the baseline questionnaire and 265 participants returned for the post-intervention questionnaire from November 2014 to August 2020. Post intervention, participants had statistically significant improvement in self-efficacy, self-rated health score, self-management behaviours and symptoms. The proportion of participants with depression and medication adherence also improved. There were no statistically significant changes in cognitive symptom management and healthcare utilisation. Conclusion CDSMP in the community can improve health outcomes and should be standard care for people with chronic disease. It can be an effective way for sustainable chronic disease management in Singapore.
Outcome prediction in large vessel occlusion ischemic stroke with or without endovascular stroke treatment: THRIVE-EVT
Authors: Flint Alexander C , Chan Sheila L , Edwards Nancy J , Rao Vivek A , Klingman Jeffrey G , Nguyen-Huynh Mai N , Yan Bernard , Mitchell Peter J , Davis Stephen M. , Campbell Bruce CV , Dippel Diederik W , Roos Yvo BWEM , van Zwam Wim H , Saver Jeffrey L , Kidwell Chelsea S , Hill Michael D , Goyal Mayank , Demchuk Andrew M , Bracard Serge , Bendszus Martin , Donnan Geoffrey A 
Published: March 2022

Introduction: The THRIVE score and the THRIVE-c calculation are validated ischemic stroke outcome prediction tools based on patient variables that are readily available at initial presentation. Randomized controlled trials (RCTs) have demonstrated the benefit of endovascular treatment (EVT) for many patients with large vessel occlusion (LVO), and pooled data from these trials allow for adaptation of the THRIVE-c calculation for use in shared clinical decision making regarding EVT. Methods: To extend THRIVE-c for use in the context of EVT, we extracted data from the Virtual International Stroke Trials Archive (VISTA) from 7 RCTs of EVT. Models were built in a randomly selected development cohort using logistic regression that included the predictors from THRIVE-c: age, NIH Stroke Scale (NIHSS) score, presence of hypertension, diabetes mellitus, and/or atrial fibrillation, as well as randomization to EVT and, where available, the Alberta Stroke Program Early CT Score (ASPECTS). Results: Good outcome was achieved in 366/787 (46.5%) of subjects randomized to EVT and in 236/795 (29.7%) of subjects randomized to control (P < 0.001), and the improvement in outcome with EVT was seen across age, NIHSS, and THRIVE-c good outcome prediction. Models to predict outcome using THRIVE elements (age, NIHSS, and comorbidities) together with EVT, with or without ASPECTS, had similar performance by ROC analysis in the development and validation cohorts (THRIVE-EVT ROC area under the curve (AUC) = 0.716 in development, 0.727 in validation, P = 0.30; THRIVE-EVT + ASPECTS ROC AUC = 0.718 in development, 0.735 in validation, P = 0.12). Conclusion: THRIVE-EVT may be used alongside the original THRIVE-c calculation to improve outcome probability estimation for patients with acute ischemic stroke, including patients with or without LVO, and to model the potential improvement in outcomes with EVT for an individual patient based on variables that are available at initial presentation. Online calculators for THRIVE-c estimation are available at www.thrivescore.org and www.mdcalc.com/thrive-score-for-stroke-outcome .
Successful treatment of hypodipsic/adipsic hypernatremia in a cat with lobar holoprosencephaly using oral desmopressin
Authors: Akashi Yoriko , Park Young Tae , Oetelaar Garrett S , Murakami Masahiro 
Published: March 2022

Case summary A 2-year-old female spayed domestic shorthair cat was presented with a history of collapse, possible hypodipsia/adipsia, severe dehydration and hypernatremia. MRI of the brain revealed a failure of separation of the cerebral hemispheres as characterized by an absence of the rostral part of the corpus callosum, fornix and septum pellucidum and the presence of a single fused lateral ventricle. A diagnosis of hypodipsic/adipsic hypernatremia with lobar holoprosencephaly was made. Dietary management of the cat’s condition was attempted by increasing oral water intake, but the cat’s hypernatremia and azotemia persisted. Plasma arginine vasopressin (AVP) analysis revealed a low concentration of circulating AVP (2.3 pg/ml), prompting therapy with oral desmopressin in addition to the dietary management. This combined therapy decreased water consumption of the cat from 200 ml/day (85 ml/kg/day) to 100 ml/day (30 ml/kg/day), normalized plasma sodium concentration and resolved the azotemia. Relevance and novel information To our knowledge, this is the second case report of an MRI diagnosis of lobar holoprosencephaly with hypodipsic/adipsic hypernatremia in a cat and the first case report of the successful management of this condition using oral desmopressin. This case report emphasizes that holoprosencephaly should be suspected in cats presented with hypodipsic/adipsic hypernatremia and highlights the utility of MRI in establishing the diagnosis. Measurements of plasma osmolality and AVP concentration corroborate the pathophysiology and support the use of oral desmopressin in addition to dietary management to resolve the hypernatremia.
Shoulder Arthroplasty Options for Glenohumeral Osteoarthritis in Young and Active Patients (<60 Years Old): A Systematic Review
Authors: Fonte Hélder , Amorim-Barbosa Tiago , Diniz Sara , Barros Luís , Ramos Joaquim , Claro Rui 
Published: March 2022

Aim This study aims to describe the shoulder arthroplasty options for young and active patients (<60 years old) with glenohumeral osteoarthritis. Methods A systematic review of the literature was conducted by searching on Pubmed database. Studies that reported outcomes of patients with glenohumeral arthritis, younger than 60 years, that underwent shoulder arthroplasty [(Hemiarthroplasty (HA), Hemiarthroplasty with biological resurfacing (HABR), Total shoulder arthroplasty (TSA), Reversed total shoulder arthroplasty (RSA)] were included. Data include patient characteristics, surgical technique, range of motion, pain relief, outcome scores, functional improvement, complications, need for and time to revision. Results A total of 1591 shoulders met the inclusion criteria. Shoulder arthroplasty provided improvements in terms of ROM on the 3 plains, forward flexion (FF), abduction (Abd) and external rotation (ER), in different proportions for each type of implant. Patients submitted to RSA had lower preoperative FF (p = 0.011), and the highest improvement (Δ) in Abd, but the worst in terms of ER (vsTSA, p = 0.05). HA had better ER postoperative values (vsRSA p = 0.049). Pain scores improved in all groups but no difference between them (p = 0.642). TSA and RSA groups had the best CS Δ (p = 0.012). HA group had higher complication rates (21.7%), RSA (19.4%, p = 0.034) and TSA (19.4%, p = 0.629) groups the lowest, and HABR had the highest rate of revisions (34.5%). Conclusions HA had the highest rate of complications and HABR unacceptable rates of revision. These implants have been replaced by modern TSAs, with RSA reserved for complex cases. Surgeons should be aware of the common pitfalls of each option.
Combined photorefractive keratectomy and corneal collagen cross-linking for treatment of keratoconus: a 2-year follow-up study
Authors: De Rosa Giuseppe , Rossi Settimio , Santamaria Carmine , Boccia Rosa , De Rosa Luigi , D’Alterio Francesco Maria , Simonelli Francesca 
Published: March 2022

Background: Corneal collagen cross-linking (CXL) is considered an effective procedure for slowing down or eliminating the progression of keratoconus. New techniques, in combination with CXL, have been proposed to stop the evolution of keratoconus and improve the visual function. Objective: To evaluate the effectiveness of combined photorefractive keratectomy (PRK) with mitomycin-C (MMC) application and CXL in the management of grade 1–2 keratoconus over a 2-year follow-up. Methods: Fifteen eyes underwent topography-guided PRK with 0.02% MMC application immediately followed by standard CXL. Results: Best corrected visual acuity improved from 0.15 ± 0.11 logMAR to 0.08 ± 0.09 logMAR at 24 months ( p < 0.0001) in treated eyes. Mean steepest meridian keratometry reduced from 48.79 ± 3.22 D at baseline to 46.16 ± 3.11 D at 24 months ( p < 0.0001). Mean flattest meridian keratometry reduced from 45.18 ± 2.17 D preoperatively to 44.35 ± 2.19 D at 24 months ( p < 0.0001). Conclusion: Simultaneous topography-guided PRK with MMC 0.02% application and standard CXL is a safe, promising and effective procedure in the treatment of mild and moderate keratoconus.
A single-arm pilot study of a mobile health exercise intervention (GO-EXCAP) in older patients with myeloid neoplasms
Authors: Loh Kah Poh , Sanapala Chandrika , Watson Erin Elizabeth , Jensen-Battaglia Marielle , Janelsins Michelle C. , Klepin Heidi D. , Schnall Rebecca , Culakova Eva , Vertino Paula , Susiarjo Martha , Lin Po-Ju , Mendler Jason H. , Liesveld Jane L. , Huselton Eric J. , Taberner Kathryn , Mohile Supriya G. , Mustian Karen 
Published: March 2022

Abstract
Many older patients with myeloid neoplasms experience treatment-related toxicities. We previously demonstrated that a home-based, progressive aerobic walking and resistance exercise program (EXCAP) improved physical and psychological outcomes in patients with cancer. However, older patients have more difficulty adhering to exercise than younger patients. Reasons may include low motivation, difficulty with transportation, and limited access to exercise professionals. To improve exercise adherence, we integrated a mobile app with EXCAP (GO-EXCAP) and assessed its feasibility and usability in a single-arm pilot study among older patients with myeloid neoplasms undergoing outpatient chemotherapy. GO-EXCAP intervention lasts for 2 cycles of treatment, and the primary feasibility metric was data reporting on the app. Usability was evaluated via the system usability scale (SUS). Patients were interviewed at mid and postintervention to elicit their feedback, and deductive thematic analysis was applied to the transcripts. Twenty-five patients (mean age, 72 years) were recruited. Recruitment and retention rates were 64% and 88%, respectively. Eighty-two percent (18/22) of patients entered some exercise data on the app at least half of the study days, excluding hospitalization (a priori, we considered 70% as feasible). Averaged daily steps were 2848 and 3184 at baseline and after intervention, respectively. Patients also performed resistance exercises 26.2 minutes per day, 2.9 days per week at low intensity (rate of perceived exertion 3.8/10). Usability was above average (SUS, 70.3). In qualitative analyses, 3 themes were identified, including positive experience with the intervention, social interactions, and flexibility. The GO-EXCAP intervention is feasible and usable for older patients with myeloid neoplasms undergoing outpatient chemotherapy. This trial was registered at www.clinicaltrials.gov as #NCT04035499.
RAD6 Positively Affects Tumorigenesis of Esophageal Squamous Cell Carcinoma by Regulating Histone Ubiquitination of CCNB1
Authors: Deng Yu , Li Yujiang , Wu Tiantong , Chen Xuyuan , Li Xiang , Cai Kaican , Wu Xu 
Published: March 2022

AbstractObjective Esophageal carcinoma (ESCA) is deadly cancer worldwide with unknown etiology. This study aimed to investigate the impact and mechanism of RAD6 on the development of Esophageal squamous cell carcinoma (ESCC).Expressions of RAD6A and RAD6B in ESCA were investigated from TCGA dataset and their expressions in tissue sample of ESCA patients and cells were determined. Functional experiments were conducted to explore the impact of RAD6A and RAD6B on malignant characteristics of several kinds of ESCC cells. Animal experiment was established and injected with RAD6A and RAD6B shRNA to evaluate the effect on tumor growth.RAD6A and RAD6B were up-regulated in ESCC cells and tissues. Overexpressed RAD6A and RAD6B similarly increased ESCC cell proliferation, invasion and migration and silencing of RAD6 exerted opposite effects. Knockdown of RAD6A suppressed tumor growth and decreased the level of H2B, as data demonstrated positive correlation between RAD6A and CCNB1 in ESCC tissues.Collectively, this study elucidates that RAD6 is up-regulated in ESCC and promotes the progression of ESCC through up-regulation of CCNB1 to enhance H2B ubiquitination. These evidence provide a novel insight into the pathogenesis of ESCC and might contribute to the development of targeted therapy.
Cardiorespiratory impact of intrathoracic pressure overshoot during artificial carbon dioxide pneumothorax: a randomized controlled study
Authors: Ren Yunqin , Zhu Xing , Yan Hong , Chen Liyong , Mao Qingxiang 
Published: March 2022

Abstract
Background
The aim of this study is to evaluate cardiovascular and respiratory effects of intrathoracic pressure overshoot (higher than insufflation pressure) in patients who underwent thoracoscopic esophagectomy procedures with carbon dioxide (CO2) pneumothorax.

Methods
This prospective research included 200 patients who were scheduled for esophagectomy from August 2016 to July 2020. The patients were randomly divided into the Stryker insufflator (STR) group and the Storz insufflator (STO) group. We recorded the changes of intrathoracic pressure, peak airway pressure, blood pressure, heart rate and central venous pressure (CVP) during artificial pneumothorax. The differences in blood gas analysis, the administration of vasopressors and the recovery time were compared between the two groups.

Results
We found that during the artificial pneumothorax, intrathoracic pressure overshoot occurred in both the STR group (8.9 mmHg, 38 times per hour) and the STO group (9.8 mmHg, 32 times per hour). The recorded maximum intrathoracic pressures were up to 58 mmHg in the STR group and 51 mmHg in the STO group. The average duration of intrathoracic pressure overshoot was significantly longer in the STR group (5.3 ± 0.86 s) vs. the STO group (1.2 ± 0.31 s, P < 0.01). During intrathoracic pressure overshoot, a greater reduction in systolic blood pressure (SBP) (5.6 mmHg vs. 1.1 mmHg, P < 0.01), a higher elevation in airway peak pressure (4.8 ± 1.17 cmH2O vs. 0.9 ± 0.41 cmH2O, P < 0.01), and a larger increase in CVP (8.2 ± 2.86 cmH2O vs. 4.9 ± 2.35 cmH2O, P < 0.01) were observed in the STR group than in the STO group. Vasopressors were also applied more frequently in the STR group than in the STO group (68% vs. 43%, P < 0.01). The reduction of SBP caused by thoracic pressure overshoot was significantly correlated with the duration of overshoot (R = 0.76). No obvious correlation was found between the SBP reduction and the maximum pressure overshoot.

Conclusions
Intrathoracic pressure overshoot can occur during thoracoscopic surgery with artificial CO2 pneumothorax and may lead to cardiovascular adverse effects which highly depends on the duration of the pressure overshoot.

Trial registration
Clinicaltrials.gov (NCT02330536; December 24, 2014).
How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study
Authors: Jansen Trine-Lise , Danbolt Lars Johan , Hanssen Ingrid , Hem Marit Helene 
Published: March 2022

Abstract
Background
There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts.

Methods
Qualitative interview study, individual and focus group interviews, with altogether 30 nurses working in acute psychiatric wards in two mental health hospitals in Norway. Interviews were recorded and transcribed. A thematic analytic approach was chosen.

Results
While nurses sense a strong expectation to minimise the use of restraints/coercion, patients on acute psychiatric wards are being increasingly ill with a greater tendency to violence. This creates moral doubt and dilemmas regarding how much nurses should endure on their own and their patients’ behalf and may expose patients and healthcare personnel to greater risk of violence. Nurses worry that new legislation and ideals may prevent acutely mentally ill and vulnerable patients from receiving the treatment they need as well as their ability to create a psychological safe climate on the ward. Furthermore, persuading the patient to stay on the ward can cause guilt and uneasiness. Inadequate resources function as external constraints that may frustrate nurses from realising the treatment ideals set before them.

Conclusions
Mental health nurses working in acute psychiatric care are involved in a complex interplay between political and professional ideals to reduce the use of coercion while being responsible for the safety of both patients and staff as well as creating a therapeutic atmosphere. External constraints like inadequate resources may furthermore hinder the healthcare workers/nurses from realising the treatment ideals set before them. Caught in the middle nurses may experience moral distress that may lead to physical discomfort, uneasiness and feelings of guilt, shame, and defeat.
Pressure on nurses and care providers to reduce or eliminate the use of coercion and reduction of health care spending are incompatible demands.
Exploring the impact of COVID-19 on substance use patterns and service access of street involved individuals in Kingston, Ontario: a qualitative study
Authors: McCann Victoria , Allen Rachael , Purkey Eva 
Published: March 2022

AbstractThis study aims to understand the experiences of street-involved individuals during the COVID-19 pandemic regarding substance use patterns and service access. With the collision of the COVID-19 pandemic and Canadian opioid epidemic came an increase in opioid related overdoses and increased barriers in accessing essential services since March 2020. Semi-structured interviews were conducted in June and July 2021, with 30 street-involved individuals in Kingston, Ontario. Analysis followed a phenomenological approach to qualitative research. Themes were coded by two independent researchers using NVIVO12. COVID-19 had detrimental effects on the lives of street-involved folks who use substances. Increased substance use to combat feelings of isolation and hopelessness related to loss of income and housing was commonly described. Increased fentanyl usage was considered the major contributor to the rise in overdoses over the pandemic. Restrictions on public access to businesses and services disproportionately impacted individuals with limited means. Harm reduction services and mental health support were considered extremely important throughout the pandemic. The coinciding COVID-19 pandemic and opioid epidemic place street-involved individuals who use substances in a uniquely dangerous position. As such, it is imperative that public policy decision-makers consider the differential needs of street-involved community members to provide safe, relevant, and compassionate solutions in future public health emergencies.