nils-herrmann/clean_scirepeval huggingface dataset:
'A coal face option': GPs' perspectives on the rise in antidepressant prescribing.

Levels of antidepressant prescribing have dramatically increased in Western countries in the last two decades.



To explore GPs' views about, and explanations for, the increase in antidepressant prescribing in Scotland between 1995 and 2004.



Qualitative, interview study.



General practices, Scotland.



GPs in 30 practices (n = 63) purposively selected to reflect a range of practice characteristics and levels of antidepressant prescribing.



Interviews with GPs were taped and transcribed. Analysis followed a Framework Approach.



GPs offered a range of explanations for the rise in antidepressant prescribing in Scotland. Few doctors thought that the incidence of depression had increased, and many questioned the appropriateness of current levels of prescribing. A number of related factors were considered to have contributed to the increase. These included: the success of campaigns to raise awareness of depression; a willingness among patients to seek help; and the perceived safety of selective serotonin reuptake inhibitors, making it easier for GPs to manage depression in primary care. Many GPs believed that unhappiness, exacerbated by social deprivation and the breakdown of traditional social structures, was being 'medicalised' inappropriately.



Most antidepressant prescriptions in Scotland are issued by GPs, and current policy aims to reduce levels of prescribing. To meet this aim, GPs' prescribing behaviour needs to change. The findings suggest that GPs see themselves as responders to, rather than facilitators of, change and this has obvious implications for initiatives to reduce prescribing.
Significant inverse associations of serum n-6 fatty acids with plasma plasminogen activator inhibitor-1.

Epidemiological studies suggested that n-6 fatty acids, especially linoleic acid (LA), have beneficial effects on CHD, whereas some in vitro studies have suggested that n-6 fatty acids, specifically arachidonic acid (AA), may have harmful effects. We examined the association of serum n-6 fatty acids with plasminogen activator inhibitor-1 (PAI-1). A population-based cross-sectional study recruited 926 randomly selected men aged 40-49 years without CVD during 2002-2006 (310 Caucasian, 313 Japanese and 303 Japanese-American men). Plasma PAI-1 was analysed in free form, both active and latent. Serum fatty acids were measured with gas-capillary liquid chromatography. To examine the association between total n-6 fatty acids (including LA and AA) and PAI-1, multivariate regression models were used. After adjusting for confounders, total n-6 fatty acids, LA and AA, were inversely and significantly associated with PAI-1 levels. These associations were consistent across three populations. Among 915 middle-aged men, serum n-6 fatty acids had significant inverse associations with PAI-1.
Experience with various surgical options for the treatment of atrial fibrillation.

New alternatives exist using various energy sources and lesion lines for the surgical treatment of atrial fibrillation (AF). The efficacy of these options compared to the cut-and-sew maze III procedure is unknown.



From August 1996 to August 2003, 79 patients have undergone a procedure for AF, with 70 patients currently more than 3 months postsurgery. The patients (58 continuous, 12 paroxysmal) underwent a surgical procedure for AF, lone AF (12) and with concomitant procedures (58). Techniques included cut and sew (23), bipolar radiofrequency (RF) (28) and unipolar-RF (10), and cryothermy (9). Lesions included maze III (46), pulmonary vein isolation (16), and pulmonary vein isolation plus mitral annular connecting line only (8).



Follow-up was complete in 58 (83%) of 70 patients at a mean time of 595 +/- 750 days (range, 24-2530 days). The operative mortality was 0% in lone AF patients and 7.1% (5/70) in patients undergoing concomitant procedures. Need for perioperative pacemaker was 22.9%. Overall, normal sinus rhythm (NSR) was restored in 82.7% of patients, with success in 83.3% (10/12) lone procedures and 82.6% (38/46) concomitant procedures ( P = NS); the rate of continuous AF was 85.1% (40/47) and SR with paroxysmal fibrillation was 72.7% (8/11) ( P = NS). Traditional maze was successful in 80.6% (29/36) patients, pulmonary vein isolation was successful 93.3% (14/15), and left-sided maze in 71.4% (5/7) ( P = NS). Cut and sew procedures were successful in 88.2% (15/17), RF-bipolar in 84.0% (21/25), RFunipolar in 77.8% (7/9), and cryothermy in 71.4% (5/7) ( P = NS). Energy source, lesion set, AF duration, and lone/concomitant procedure were the factors subjected to logistic regression analysis. No factors were predictive of achieving postoperative NSR.



Our early experience with newer surgical techniques employing different energy sources and fewer incision lines suggests that the success rate may approach the results obtained with traditional cut-and-sew Cox-maze III procedures.
Multivariate spatial covariance analysis of 99mTc-exametazime SPECT images in dementia with Lewy bodies and Alzheimer's disease: utility in differential diagnosis.

We examined (99m)Tc-exametazime brain blood flow single-photon emission computed tomography (SPECT) images using a spatial covariance analysis (SCA) approach to assess its diagnostic value in distinguishing dementia with Lewy bodies (DLB) from Alzheimer's disease (AD). Voxel SCA was simultaneously applied to a set of preprocessed images (AD, n=40; DLB, n=26), generating a series of eigenimages representing common intercorrelated voxels in AD and DLB. Linear regression derived a spatial covariance pattern (SCP) that discriminated DLB from AD. To investigate the diagnostic value of the model SCP, the SCP was validated by applying it to a second, independent, AD and DLB cohort (AD, n=34; DLB, n=29). Mean SCP expressions differed between AD and DLB (F(1,64)=36.2, P<0.001) with good diagnostic accuracy (receiver operating characteristic (ROC) curve area 0.87, sensitivity 81%, specificity 88%). Forward application of the model SCP to the independent cohort revealed similar differences between groups (F(1,61)=38.4, P<0.001), also with good diagnostic accuracy (ROC 0.86, sensitivity 80%, specificity 80%). Multivariate analysis of blood flow SPECT data appears to be robust and shows good diagnostic accuracy in two independent cohorts for distinguishing DLB from AD.
MMPI-2 patterns in electrical injury: a controlled investigation.

The psychological consequences of electrical injury (EI) are many. Depression, posttraumatic stress disorder, anxiety, and somatic preoccupation are often concomitant with this type of injury (Kelley, Pliskin, Meyer, & Lee, 1994). The present study utilized the MMPI-2 as a tool for characterizing profiles of psychological distress in EI. We examined MMPI-2 profiles in 79 EI patients and their relationship to both injury parameters (i.e., time since injury, LOC, voltage), and extra-diagnostic factors, such as litigation status. EI patient profiles were also compared to individuals with mild traumatic brain injury (TBI), and chronic pain sufferers (CP). Results indicated that in EI, clinical elevations (T > or = 65) were found on the Hs and Hy scales, and approached clinical levels on the D scale. The injury parameter of time since injury was predictive of a distinctive profile, with individuals in the post acute phase experiencing more distress. Compared to other clinical groups, MMPI-2 scores on the Hs and Hy scales were significantly higher within the EI cohort as compared with their CP peers, with higher scores on the Pd scale for CP than EI. No statistically significant differences emerged between the EI and TBI groups. However, TBI patients showed significant elevations on Hy and D compared to CP, and EI patients endorsed more somatic symptoms than CP patients. Implications of these findings and future directions will be discussed.
Lung cancer screening trials: Denmark and beyond.

Lung cancer is the leading cause of cancer death worldwide, with fewer than 15% of patients surviving 5 years after diagnosis, despite advances in treatment during the past 20 years. Lung cancer screening (secondary prevention), in addition to smoking cessation programs (primary prevention), might be the most exciting improvement in methods to reduce lung cancer mortality. The great interest in lung cancer screening was started by the introduction of low-dose multidetector computed tomography (CT) in the 1990s. The nonrandomized International Early Lung Cancer Action Project study (n 1⁄4 32,000) was followed by several randomized clinical trials of high-risk current and former smokers. These included the National Lung Screening Trial (NLST) in the United States (n 1⁄4 53,500), the DutchBelgian screening trial (n1⁄4 15,822), the Danish Lung Cancer Screening Trial (DLCST, n1⁄4 4104 ), and several other collaborating trials in Europe. Recently, the National Cancer Institute published the report that the NLST gave evidence for a mortality reduction of 20.3% with low-dose CT screening compared with chest radiographic screening and a 7% overall mortality reduction after 3 annual screening rounds and 8 years of follow-up. The NLSTwas a very well-performed randomized trial and has convincingly shown for the first time that CT screening, in high-risk subjects, can lead to a substantial reduction in lung cancer mortality and that the screening overall was not detrimental, because a reduction of 7% in general mortality was also observed. These are extremely important findings. The European trials have been smaller, but all have had a control group without any screening performed (usual care) and, therefore, potentially, the difference between the mortality in the CTand control arms could bemore pronounced. In addition, the trials were started 2 to 3 years after the NLSTand, therefore, have not yet performed a pooling of data and presented a combined mortality analysis. The Dutch-Belgian screening trial and theDLCSTare expected to perform afinal mortality analysis in 2015 but contemplated a preliminary pooling of data in 2011.
Oxytocin improves compassion toward women among patients with PTSD

Although impairments in social skills, including empathic abilities, are common in post-traumatic stress disorder (PTSD), the ability to feel compassion-a pro-social behavior that is based on empathy and drives us to help others-has never been assessed among these patients. The first aim of this study was to examine whether patients with PTSD suffer from deficits in compassion and to examine the association between the clusters of PTSD symptoms and these deficits. Furthermore, given that intranasal oxytocin (OT) has been suggested to possibly modulate social behaviors, the second aim of this study was to investigate whether intranasal OT may enhance compassion in these patients. Using a randomized, double-blind, placebo-controlled crossover design, we administered 24 IU of OT and placebo at a one-week interval to 32 patients with PTSD and to 30 matched healthy control participants. The results indicate that patients with PTSD exhibit deficits in compassion and that the numbing cluster emerged as the key predictor of those deficits. Moreover, the results indicate that a single intranasal dose of OT enhances compassion toward women (but not towards men), both in patients with PTSD and in controls. These results offer support for recent suggestions that intranasal OT may potentially be an effective pharmacological intervention for patients with PTSD.
Predicting walking-induced oxygen desaturations in COPD patients: a statistical model.

Oxygen desaturation during walking can have important consequence on prognosis of COPD patients. However, a standard 6-min walk test (6MWT), useful in detecting desaturation in COPD patients, can be difficult to execute in some settings of COPD management, as in the community healthcare service. We evaluated a new scoring system for the risk of oxygen desaturation during walking in COPD patients: the walking desaturation score.



We collected data from symptomatic COPD in-patients admitted for rehabilitation (derivation cohort) and out-patients referred to the local community health service (validation cohort). S(pO2) was monitored during 6MWT, and the subjects were classified as walking desaturators or non-desaturators. By a regression analysis model we assigned a weighted score proportional to the measured percentage of explained variance for each variable. Risk estimates were computed as odds ratios. A receiver operating characteristic curve analysis and a Hosmer-Lemeshow goodness-of-fit test were then performed to measure discrimination and calibration of walking desaturation score.



Baseline characteristics in the derivation cohort (n = 435, 74% of whom were walking desaturators) and the validation cohort (n = 238, 37% of whom were walking desaturators) were different. Resting arterial oxygen saturation measured from an arterial blood sample, P(aO2), and percent-of-predicted FEV1 were the variables that predicted walking desaturation. The proportion of walking desaturators (and odds ratio estimate) gradually increased according to walking desaturation score (range 0-6) and associated categories of desaturation risk (total walking desaturation score: low 0 or 1, high 2-3, very high 4-6) (chi-square P < .001). There was considerable predictive discrimination (area under the curve 0.90, 95% CI 0.86-0.93, P < .001), and calibration (Hosmer-Lemeshow chi-square 1.31, P = .86) values have been shown.



Walking desaturation score accurately predicts and classifies the risk of walking desaturation in COPD patients.
Nepafenac 0.3% after Cataract Surgery in Patients with Diabetic Retinopathy: Results of 2 Randomized Phase 3 Studies.

To demonstrate the efficacy and safety of once-daily nepafenac 0.3% ophthalmic suspension versus vehicle, based on clinical outcomes, after cataract surgery in patients with diabetes.



Two prospective, randomized, multicenter, double-masked, vehicle-controlled phase 3 studies.



Total, 615 patients in study 1 and 605 patients in study 2.



Patients were randomized (1:1) to topical nepafenac 0.3% or vehicle once-daily starting the day before surgery and continuing for 90 days thereafter.



Key efficacy variables were: patients (%) in whom macular edema (ME) developed (≥30% increase from preoperative baseline central subfield macular thickness) within 90 days after cataract surgery and the patients (%) with a best-corrected visual acuity (BCVA) improvement of ≥15 letters from preoperative baseline through day 14 maintained through day 90. Secondary end points included: patients (%) with a BCVA improvement of ≥15 letters from preoperative baseline through days 90 and 60 and safety over 3 months.



A significantly lower percentage of patients demonstrated ME within 90 days after surgery with nepafenac 0.3% versus vehicle (study 1: 2.3% vs. 17.3%; P < 0.001; study 2: 5.9% vs. 14.3%; P = 0.001; pooled: 4.1% vs. 15.9%; P < 0.001). The percentage of patients achieving a ≥15-letter improvement from baseline through day 14 maintained through day 90 with nepafenac 0.3% versus vehicle was 61.7% versus 43.0% (P < 0.001) in study 1, 48.8% versus 50.5% (P = 0.671) in study 2, and 55.4% versus 46.7% (P = 0.003) in the pooled analysis. A greater percentage of patients treated with nepafenac 0.3% versus vehicle in study 1 and similar percentage in study 2 had a BCVA improvement of ≥15 letters from preoperative baseline through day 90 (77.2% vs. 67.7% [P = 0.009] and 65.4% vs. 65.9% [P = 0.888]) and through day 60 (76.2% vs. 64.7% [P = 0.002] and 68.9% vs. 62.1% [P = 0.092]). No unanticipated adverse events were observed.



These studies demonstrated the clinical benefits of nepafenac 0.3% over vehicle in reducing the risk of postoperative ME, with the integrated analysis showing improved BCVA after cataract surgery in patients with diabetic retinopathy, with no unanticipated safety events.
High altitude sleep disturbances monitored by actigraphy and polysomnography.

Data on sleep at altitude are scant due to the limited availability of polysomnography. Therefore, we investigated whether actigraphy might serve as a simple tool for monitoring sleep during altitude field studies.



Fourteen mountaineers participating in studies on dexamethasone prophylaxis of high altitude pulmonary edema were monitored by actigraphy and polysomnography during 1 night at Zurich (490 m) and 4 nights at the Regina Margherita hut (4559 m). Total sleep time (TST) estimated by actigraphy was compared to polysomnography and subjective sleep quality.



In 64 comparisons, mean differences±2SD (bias±limits of agreement) between actigraphy and polysomnography were 5±35 min for TST and 1±7% for sleep efficiency. Correlations between subjective and polysomnographic estimates of sleep efficiency and sleep latency were nonsignificant. Medians of nocturnal oxygen saturation were 96% at 490 m and 74%-81% during nights 1 to 4 at 4459 m (p<0.05 vs. 490 m). Medians of polysomnographic TST were similar at 490 m (451 min) and 4559 m (377-456 min during nights 1 to 4, p=NS) but the proportions of slow wave and REM sleep were reduced and arousals were more common (p<0.05 all instances).



Actigraphy accurately estimates sleep efficiency and duration. Due to its portability and simple use and the potential application over several weeks, it is a convenient tool for investigating altitude effects on sleep during field studies.
Phase I clinical and pharmacokinetic study of trabectedin and cisplatin given every three weeks in patients with advanced solid tumors

The aim of this phase I study was to identify a feasible dose and schedule for the combination of cisplatin and trabectedin. The regimen evaluated consisted of cisplatin at a fixed dose of 75 mg/m2 1-hour intravenous (i.v.) infusion followed by escalating doses of trabectedin 3-hour i.v. infusion, both administered on day 1 every 3 weeks (q3wks). Two dose-limiting toxicities (DLTs), grade 4 neutropenia longer than 7 days duration and grade 3 vomiting despite standard antiemetic therapy, occurred at the starting dose of trabectedin (0.75 mg/m2). The immediately lower dose (trabectedin 0.60 mg/m2) was evaluated in a total of 8 patients; no DLTs occurred and this was declared the recommended dose (RD). The safety profile of the combination at this dose and schedule was consistent with the known side effects of each agent alone: nausea, fatigue, transient transaminase elevations and neutropenia. No new or unexpected adverse reactions were observed. Two partial responses were reported at the RD in patients with pretreated ovarian cancer. Comparison with population pharmacokinetic data suggests a PK interaction between trabectedin and cisplatin leading to increased plasma exposure of trabectedin in the first 48 h, lower platinum clearance and longer half-life. In conclusion, although the trabectedin dose achieved with this combination was low (50 % of single-agent when given q3wks), this day 1 q3wks trabectedin plus cisplatin combination showed a feasible administration, a tolerable safety profile and some antitumor activity.
Study protocol for a randomised controlled trial of insulin delivery by continuous subcutaneous infusion compared to multiple daily injections

Intensive insulin therapy with continuous subcutaneous insulin infusion (CSII) devices or multiple daily injections (MDI) reduces the risk of long-term vascular complications of type I diabetes (TID). Both treatments are used routinely, but there is little evidence to demonstrate superiority of either treatment. If CSII treatment reduces the risk of long-term complications or is associated with an improved quality of life (QoL), the additional cost of this therapy may be compensated for by a reduction in long-term health expenditure. If there is no demonstrable difference between treatments, health-care resources may be better invested elsewhere. This study aims to address this gap in knowledge.



This is a pragmatic, randomised controlled trial (RCT). Fifteen centres, selected to represent a population with a broad demographic, will recruit 316 patients, newly diagnosed with TID, aged between 7 months and 15 years. Exclusion criteria include additional pathologies or treatments likely to affect glycaemic control and a first-degree relative with TID. Randomisation to CSII or MDI is stratified for age, gender and recruiting centre. The randomised treatment starts within 15 days of diagnosis. Patients will be trained to adjust their insulin dose according to carbohydrate intake and blood glucose level. Study visits coincide with routine clinic appointments at 3, 6, 9 and 12 months when data relating to routine clinical assessments, adverse events and concomitant medications are collected. Health utilities questionnaires are completed at each visit and a diabetes-specific QoL questionnaire (PedsQL) at diagnosis, 6 and 12 months. The primary outcome is glycaemic control (HbA1c) at 12 months. Secondary outcome measures include QoL, insulin use, growth and weight gain, adverse events and a health economics appraisal.



This is the first adequately powered RCT comparing CSII and MDI in a non-selected population, treated according to standard practice guidelines. It will produce data that are meaningful to individual patients and local and national policymakers.
Serum levels and metabolic clearance of the isoflavones genistein and daidzein in hemodialysis patients.

Genistein and daidzein are biologically active isoflavones that are especially abundant in soybeans. After intestinal absorption, circulating genistein and daidzein are eliminated primarily by the kidneys. This study was undertaken to assess the metabolism of genistein and daidzein in patients with end-stage renal disease (ESRD) on hemodialysis therapy, and to test whether this treatment modality can replace the lack of kidney function, with respect to the elimination of the isoflavones. Twenty-three hemodialysis patients and 10 healthy subjects were studied. While consuming a self-selected low isoflavone diet, baseline blood levels were undetectable in eight of 10 healthy subjects and in 14 of 23 dialysis patients. The remaining participants had detectable levels, with the nine dialysis patients displaying much higher blood concentrations than the two healthy control subjects. After the evening intake of one dose of an isoflavone-rich soy protein isolate drink, the early morning blood levels of genistein and daidzein were higher in seven dialysis patients than in eight healthy subjects (genistein 1271+/-321 versus 425+/-104, P<0.05; daidzein 1304+/-352 versus 292+/-78, P<0.05). The blood clearance of the isoflavones was studied in two healthy subjects and in three dialysis patients. Genistein and daidzein were eliminated within 2 d in the healthy subjects, but had not returned to baseline in two of three ESRD patients, 7 d after intake. The half-life of both compounds was estimated to be 10-fold longer in the ESRD patients than in the healthy subjects. Finally, genistein and daidzein levels were measured before and after dialysis in five patients, both while on their regular diet and after one dose of a soy protein isolate drink. In both instances, the dialysis treatment did not affect the blood isoflavone levels. In conclusion, approximately one-third of hemodialysis patients eating the standard American renal diet experience high blood levels of the isoflavones genistein and daidzein, while the remaining two-thirds have undetectable levels. After ingestion of isoflavone-rich food such as soy products, all patients have detectable levels that remain very high for several days due to lack of renal excretion.