nils-herrmann/clean_scirepeval huggingface dataset:
Introduction of an Acute Stroke Team: An effective approach to hasten assessment and management of stroke in the emergency department

Recombinant tissue plasminogen activator (rtPA) reduces the combined endpoint of death and disability if given within three hours of onset of ischaemic stroke. However few patients receive rtPA, with delays in in-hospital evaluation and treatment being key barriers to therapy. The Austin Hospital Acute Stroke Team (AST) was introduced with the aim of improving the speed of assessment and management of acute stroke patients presenting to the emergency department. We sought to assess the effect of the AST on number of eligible patients receiving rtPA and assessment times within our already active stroke service. Data were obtained prospectively for all AST calls during the period from 17 January 2005--31 December 2005. Information recorded included: demographics, time of call, clinical features, diagnosis and any treatment with rtPA. Information prospectively acquired from patients receiving stroke thrombolysis the previous year was also analysed. There were 663 stroke unit admissions and 224 AST calls during the study period. 53% of calls occurred within working hours and 68% had a final diagnosis of stroke. Twenty-seven patients received treatment with rtPA (12% of calls), whereas only ten patients received rtPA in 2004. The most common reason for not treating was mild or rapidly resolving deficit. Onset-needle time and door-needle times significantly improved following introduction of the AST. Thus, we conclude that the introduction of the AST emergency call system has increased the number of eligible patients receiving rtPA. Improved onset-needle and door-needle times are achievable by this team approach.
Symptom endorsement differences on the Children's Depression Inventory with children and adolescents on an inpatient unit.

Responses to the Children's Depression Inventory (CDI; Kovacs, 1992), administered during intake, were collected from 521 children and adolescents (aged 7 to 17) at an inpatient crisis stabilization unit. Participants were grouped into 1 of 3 diagnostic groups: solely depressive, solely aggressive, or both depressive and aggressive. Self-report of symptoms for each diagnostic group, age and gender differences, and racial and ethnic differences in symptoms were examined in this study. There was a significant difference between the endorsement pattern of solely depressive and solely aggressive participants, whereas those categorized as both depressive and aggressive displayed an endorsement pattern similar to those who were solely aggressive. There was a significant gender difference in overall symptom report, with girls showing higher overall symptom levels than boys. This gender difference was significant for both the younger and the older age groups. These results held true even when gender was covaried out of the diagnostic group analyses and when diagnostic group was covaried out of the gender analyses. Symptom endorsement did not differ based on race and ethnicity. The primary contribution of this study centers around the findings from the item analyses of the CDI. These results are discussed in relation to the discriminant validity of the CDI and the need for additional research into comorbidity.
Pain education combined with neck- and aerobic training is more effective at relieving chronic neck pain than pain education alone--A preliminary randomized controlled trial.

To evaluate the effect of training and pain education vs pain education alone, on neck pain, neck muscle activity and postural sway in patients with chronic neck pain.



Twenty women with chronic neck pain were randomized to receive pain education and specific training (neck-shoulder exercises, balance and aerobic training) (INV), or pain education alone (CTRL). Effect on neck pain, function and Global Perceived Effect (GPE) were measured. Surface electromyography (EMG) was recorded from neck flexor and extensor muscles during performance of the Cranio-Cervical Flexion Test (CCFT) and three postural control tests (two-legged: eyes open and closed, one-legged: eyes open). Sway parameters were calculated.



Fifteen participants (CTRL: eight; INV: seven) completed the study. Per protocol analyses showed a larger pain reduction (p = 0.002) for the INV group with tendencies for increased GPE (p = 0.06), reduced sternocleidomastoid activity during the CCFT (p = 0.09), reduced sway length (p = 0.09), and increased neck extensor activity (p = 0.02) during sway compared to the CTRL group.



Pain education and specific training reduce neck pain more than pain education alone in patients with chronic neck pain. These results provide encouragement for a larger clinical trial to corroborate these observations.
MRI in neuro-Behçet's syndrome: comparison of conventional spin-echo and FLAIR pulse sequences

We compared the sensitivity of a fluid-attenuated inversion-recovery (FLAIR) sequence with that of a conventional dual-echo spin-echo (SE) sequence) to brain lesions in 20 patients with Behçet's syndrome. They underwent 25 MRI examinations. The images were independently analysed for the number, type and anatomical location of lesions shown. There were 18 abnormal studies (13 initial and 5 follow-up). The FLAIR sequence detected significantly more lesions than the SE TE 80 (P < 0.05) and SE TE 20 (P < 0.01) sequences. It was particularly useful for demonstrating lesions in the juxtacortical white matter, which accounted for over half the lesions detected on the FLAIR images. Of patients presenting with nonspecific symptoms such as headache, seven had normal and five had abnormal studies. All patients presenting with focal neurological signs had abnormal imaging. We found supratentorial and, in particular, juxtacortical lesions to be more frequent than previously described.
Assessment of false-negative cases of breast MR imaging in women with a familial or genetic predisposition

In order to assess the characteristics of malignant breast lesions those were not detected during screening by MR imaging. In the Dutch MRI screening study (MRISC), a non-randomized prospective multicenter study, women with high familial risk or a genetic predisposition for breast cancer were screened once a year by mammography and MRI and every 6 months with a clinical breast examination (CBE). The false-negative MR examinations were subject of this study and were retrospectively reviewed by two experienced radiologists. From November 1999 until March 2006, 2,157 women were eligible for study analyses. Ninety-seven malignant breast tumors were detected, including 19 DCIS (20%). In 22 patients with a malignant lesion, the MRI was assessed as BI-RADS 1 or 2. One patient was excluded because the examinations were not available for review. Forty-three percent (9/21) of the false-negative MR cases concerned pure ductal carcinoma in situ (DCIS) or DCIS with invasive foci, in eight of them no enhancement was seen at the review. In six patients the features of malignancy were missed or misinterpreted. Small lesion size (n = 3), extensive diffuse contrast enhancement of the breast parenchyma (n = 2), and a technically inadequate examination (n = 1) were other causes of the missed diagnosis. A major part of the false-negative MR diagnoses concerned non-enhancing DCIS, underlining the necessity of screening not only with MRI but also with mammography. Improvement of MRI scanning protocols may increase the detection rate of DCIS. The missed and misinterpreted cases are reflecting the learning curve of a multicenter study.
Unique challenges of hospice for patients with heart failure: A qualitative study of hospice clinicians.

Patients with heart failure have end-of-life care needs that may benefit from hospice care. The goal of this descriptive study was to understand hospice clinicians' perspectives on the unique aspects of caring for patients with heart failure to inform approaches to improving end-of-life care.



This qualitative study explored experiences, observations, and perspectives of hospice clinicians regarding hospice care for patients with heart failure. Thirteen hospice clinicians from a variety of professional disciplines and clinical roles, diverse geographic regions, and varying lengths of time working in hospice participated in semistructured interviews. Through team-based, iterative qualitative analysis, we identified 3 major themes.



Hospice clinicians identified 3 themes regarding care for patients with heart failure. First, care for patients with heart failure involves clinical complexity and a tailored approach to cardiac medications and advanced cardiac technologies. Second, hospice clinicians describe the difficulty patients with heart failure have in trusting hospice care due to patient optimism, prognostic uncertainty, and reliance on prehospice health care providers. Third, hospice clinicians described opportunities to improve heart failure-specific hospice care, highlighting the desire for collaboration with referring cardiologists.



From a hospice clinician perspective, caring for patients with heart failure is unique compared with other hospice populations. This study suggests potential opportunities for hospice clinicians and referring providers who seek to collaborate to improve care for patients with heart failure during the transition to hospice care.
Be precise and suffer less pain! A comment on ``A brief intervention utilising visual feedback reduces pain and enhances tactile acuity in CLBP patients''.

of multisensory information can lead people to over24 generalize their responses (i.e. pain) to a sensory in25 put, which may itself contribute to the development of 26 maldaptive behavior which may lead to the develop27 ment of chronic pain [3,4]. On a similar path, the fear28 avoidance model predicts that imprecision in encoding 29 may contribute to the acquisition of pain-related fear 30 which also can contribute to development and mainte31 nance of persistent pain problems [4]. In line with as32 sumption of these models, results of the study by Trapp 33 and colleagues showed that the learned fear through 34 the imprecise association between sensory experience 35 and pain can be changed through new learning. Precise 36 encoding of sensory experiences in chronic low back 37 pain patients helped them to reduce their pain.
An open-label trial of tomoxetine in pediatric attention deficit hyperactivity disorder.

To collect pilot data assessing the safety, tolerability, and efficacy of tomoxetine, a nonstimulant norepinephrine enhancer, in pediatric attention deficit hyperactivity disorder (ADHD).



An open-label trial of tomoxetine in pediatric ADHD was conducted as part of a multisite clinical trial. Following a baseline assessment, an ascending dose titration was completed during 10 weekly visits.



Ten subjects were enrolled at baseline, with eight completing the study. Seven of the eight remaining subjects met efficacy criteria. Significant decreases in symptom severity ratings by parents and study investigators were found. The medication was well tolerated, with transient appetite suppression the most frequently reported side effect. However, subjects' weights remained stable across study visits.



These preliminary findings suggest that tomoxetine may hold promise as a treatment for pediatric ADHD.
A controlled trial of the effectiveness of a diabetes education programme in a multi-ethnic community in Glasgow [ISRCT28317455]

Epidemiologic data have shown that the prevalence of Type 2 diabetes varies with ethnic origin. Type 2 diabetes is up to four times more common in British South Asians than in the indigenous white population. The aim of this study was to develop a culturally appropriate educational intervention programme for South Asians with Type 2 diabetes. We then investigated whether this intervention could produce an improvement, and finally whether any improvement was greater than background changes in knowledge in comparison groups.



A multi-site prospective, randomised controlled study was conducted in all day care centres and three general practice registers with high proportion patients from different ethnic minority groups in Glasgow, Scotland. The intervention consisted of 18 educational sessions in 6 separate programmes. A modified questionnaire was used to measure the knowledge, attitudes, and practice of diabetes before and after intervention.



Baseline assessment showed that Indian and Pakistani subjects had less knowledge about diabetes, regarded the disease less seriously, and had a lesser understanding of the relationship between control and complications than the white population. No differences in initial responses were found between those who completed the second assessment and those who did not. The intervention group showed significant improvements in scores for Knowledge (+12.5%); Attitudes toward seriousness (+13.5%), complications (+8.1%), Practice (+20.0%). However there were also changes in the ethnic control group scores; respectively +5.0%, +16.3% (significant P < 0.001), +1.5%, +1.7%. The single white control group also showed some improvements; respectively +12.2%, +12.4% (P = 0.04), +6.0%, +25.0% (P = 0.007), but the differences in improvement between these two control groups were not significant. Overall, the improvement seen was similar in both intervention and ethnic control groups and there was no significant difference in the amount of change (P = 0.36 CI -0.9 to +2.6).



This study has shown that conducting a culturally-competent educational intervention in patients with Type 2 diabetes from ethnic minority groups is feasible and can improve their knowledge and attitudes and practice. However there was no net benefit compared with the control group.
Feasibility of mindfulness-based therapy in patients recovering from a first psychotic episode: a pilot study.

Recently, a mindfulness therapy for people with psychotic disorders was developed. However, clinicians and researchers are cautious given case reports in which extensive meditation provoked psychotic symptoms in people with a psychotic disorder. The purpose of this study was to examine the feasibility, adverse effects and possible favourable effects of mindfulness-based therapy (MBT) in people recently recovering from a first episode of psychosis.



A nonrandomized, non-controlled prospective follow-up study. Patients were offered an MBT that consisted of eight 1-hour sessions within a 4-week time span. Positive and Negative Syndrome Scale, Symptoms Checklist 90 and the Southampton Mindfulness Questionnaire were assessed before and after the therapy.



Of the 16 persons who started MBT, 13 completed (81.5%) the therapy. No significant increase in psychotic symptoms was found. Between two meetings, one participant initially misunderstood the mindfulness instructions, which led to an increase in distress. No increased awareness of intrusive thoughts or visual or auditory hallucinations was reported by participants. We found a decrease in agoraphobic symptoms (p < 0.028) and in psychoneuroticism (P < 0.025).



The MBT had no significant adverse effect on psychotic symptoms in patients in this small pilot study, neither did it raise the level of mindfulness in the participants. A decrease in psychological symptoms was found, although one patient experienced an increase in symptoms of distress. Our study demonstrates that therapists should be cautious that therapy and practice instructions are understood properly. Future studies are feasible and needed, in larger samples with an RCT design, in order to draw conclusions regarding the effects of the MBT.
Effects of inhaled salmeterol and salbutamol (albuterol) on morning dips compared in intensive care patients recovering from an acute severe asthma attack

To assess the effect of a long-acting inhaled β 2-agonist, salmeterol (SM), compared to a short-acting inhaled β 2-agonist, salbutamol (or albuterol, SB), on the occurrence of morning dip (MD) in patients recovering from an acute severe asthma attack (ASA).  18-bed, medical intensive care unit (ICU) in a university hospital.  19 patients suffering from an ASA.  Serial measurements of the peak expiratory flow rate (PEFR), arterial blood gases, vital capacity and forced expiratory volume in one second (FEV1) were performed from admission. All patients were first treated with i. v. methyl prednisolone and i.v. SB. Once the PEFR was stable and > 35 % of predicted value, i. v. SB was stopped while i. v. steroids were maintained, and patients were randomised to either inhaled SB (9 patients, 400 μg every 4 h) or inhaled SM (10 patients, 100 μg every 12 h).  The mean admission PEFR was 26.1 ± 11.7 % of the predicted value and was not different between the two groups. MD was more frequent with SB (6/9 patients) than with SM (4/10). The severity of MD, expressed in 1/min fall in PEFR, was higher in SB than in SM (106 ± 25 vs 55±37;p<0.05).  MD is frequent in ASA. In ASA, SM appears to reduce the frequency and the severity of MD more than SB. The clinical implications of this observation, particularly a lowering of mortality and a shortening of the ICU stay, remain to be investigated.
The origins of age-related proinflammatory state.

We hypothesized that the rising levels of inflammatory markers with aging is explained by cardiovascular risk factors and morbidity becoming progressively more prevalent in older persons. Information on inflammatory markers, cardiovascular risk factors, and diseases was collected in 595 men and 748 women sampled from the general population (age, 20-102 years). In both men and women, older age was associated with higher levels of interleukin-6 (IL-6), IL-1 receptor antagonist (IL-1ra), IL-18, C-reactive protein (CRP), and fibrinogen, while soluble IL-6 receptor (sIL-6r) increased significantly with age only in men. Adjusting for cardiovascular risk factors and morbidity, the age regression coefficients became substantially smaller in models predicting IL-6, IL-1ra, IL-18, and fibrinogen and larger in the model predicting sIL6r. Adjustment for cardiovascular morbidity substantially reduced the effect of age on CRP in men but not in women. Findings were confirmed in a subgroup of 51 men and 45 women with low risk profile and no cardiovascular morbidity. Part of the "proinflammatory state" in older persons is related to the high prevalence of cardiovascular risk factor and morbidity.
Effect of unawareness on rehabilitation outcome in a randomised controlled trial of multicomponent intervention for patients with mild Alzheimer's disease.

Unawareness of deficit has been shown to affect the outcome of targeted cognitive intervention programmes applied to patients with Alzheimer' disease (AD), but the effects on multimodal therapeutic approaches have not yet been explored. This research investigated the efficacy of the Multi-Intervention Programme (MIP) approach on improving cognitive, functional, affective, and behavioural symptoms in people with mild AD. In addition, we examined whether the presence of unawareness influences the MIP outcomes. Sixty-one mild stage AD patients were randomly assigned to either an experimental group which carried out an MIP individually (48 sessions, 16 weeks duration), combining diverse cognitive tasks, training in daily life and recreational activities, or a waiting list group which did not receive any treatment for the same time period. The efficacy of MIP (vs. waiting list) was tested using various standardised neuropsychological, functional, and behavioural outcome measures. Planned analyses were carried out to determine the effect of unawareness versus awareness on such outcomes. The results showed that patients overall benefited from the MIP in terms of both cognitive and non-cognitive symptoms. AD patients with awareness of deficits showed positive effects on all outcome measures in comparison with the waiting list group, while AD patients with unawareness showed improvements in non-cognitive symptoms only. In conclusion, the presence of unawareness reduces the cognitive and functional effects of MIP in patients with mild AD.
A Randomized, Open-Label, Multicenter Trial for the Safety and Efficacy of Adult Mesenchymal Stem Cells after Acute Myocardial Infarction

Recent studies suggest that the intracoronary administration of bone marrow (BM)-derived mesenchymal stem cells (MSCs) may improve left ventricular function in patients with acute myocardial infarction (AMI). However, there is still argumentative for the safety and efficacy of MSCs in the AMI setting. We thus performed a randomized pilot study to investigate the safety and efficacy of MSCs in patients with AMI. Eighty patients with AMI after successful reperfusion therapy were randomly assigned and received an intracoronary administration of autologous BM-derived MSCs into the infarct related artery at 1 month. During follow-up period, 58 patients completed the trial. The primary endpoint was changes in left ventricular ejection fraction (LVEF) by single-photon emission computed tomography (SPECT) at 6 month. We also evaluated treatment-related adverse events. The absolute improvement in the LVEF by SPECT at 6 month was greater in the BM-derived MSCs group than in the control group (5.9% ± 8.5% vs 1.6% ± 7.0%; P=0.037). There was no treatment-related toxicity during intracoronary administration of MSCs. No significant adverse cardiovascular events occurred during follow-up. In conclusion, the intracoronary infusion of human BM-derived MSCs at 1 month is tolerable and safe with modest improvement in LVEF at 6-month follow-up by SPECT.
Effects of general practice-based nurse-counselling on ambulatory blood pressure and antihypertensive drug prescription in patients at increased risk of cardiovascular disease

Lifestyle programmes delivered by academic nurse-counsellors in a primary care setting lowered blood pressure (BP) among at-risk patients. We examined whether the programmes could be successfully implemented by nurses employed in Australian general practices. In a randomised controlled trial, 212 of 591 eligible 20–75-year olds with hypertension, Type II diabetes or coronary disease from seven practices volunteered. Patients were randomised to: a ‘Low’ group with one face-to-face individual counselling session, then monthly telephone contacts for 1 year (n=69); a ‘High’ group with individual face-to-face counselling up to 1 h monthly for 1 year (n=74) or a control group receiving usual care only (n=69), and were evaluated at baseline and 12 and 18 months later; 164 individuals completed the study. Patients' usual doctors continued to prescribe in all groups. Changes in 24 h ambulatory BP did not differ significantly between groups at 12 months (Low, −2±2/1±1 mmHg; High, +4±2/1± 1 mmHg; usual care, +1±2/1±1 mmHg) or 18 months (−2±2/2±1 mmHg; −4±2/3±2 mmHg; −1±2/2± 1 mmHg, respectively). Antihypertensive drugs prescribed decreased by 12 months in 33% of the High, 5% of the Low and 13% of the control groups (P=0.008) and by 36, 7 and 16% at 18 months (P=0.018). After 18 months, targets for BP control were not met in about 60% of patients and almost 50% had clinic BP above 140/90 mmHg. Year-long interaction with nurse-counsellors may influence longer-term antihypertensive drug prescription, possibly by improving compliance. Suboptimal BP control suggests that continuing physician education on BP targets is needed.