Miracle-dz/UniFAR-FTUs huggingface dataset:
Enhanced staff communication and reduced near-miss errors with a neurointerventional procedural checklist

Introduction Over the past several decades, checklists have emerged in a variety of different patient care settings to help reduce medical errors and ensure patient safety. To date, there have been no published accounts demonstrating the effectiveness of checklists designed specifically for the unique demands of neurointerventional procedures. Methods A three-part, 20-item checklist was developed specific to neurointerventional procedures using the WHO surgical checklist as a template. Staff members (nurses, radiation technologists and physicians) were surveyed regarding near-miss adverse events and the quality of communication immediately following each neurointerventional procedure for 4 weeks prior to implementation of the checklist and again for 4 weeks after using the checklist. Staff members were asked to complete final surveys at the end of the study period. Results 71 procedures were performed during the 4 weeks prior to checklist implementation and 60 procedures were performed during the 4 weeks after institution of the checklist. Post-checklist surveys indicated significantly improved communication compared with pre-checklist surveys (χ2 29.4, p<0.001). The number of adverse events was lower after checklist implementation for eight of the nine adverse event types (not individually significant), but the total number of adverse events was significantly lower after checklist implementation (χ2 11.4, p=0.001). Final staff surveys were uniformly positive with 95% of individuals indicating that the checklist should be continued in the department. Conclusions Use of a neurointerventional procedural checklist resulted in statistically significant improvements in team communication and a significant reduction in total adverse events, with uniformly positive staff feedback.
Hormonal and gender‐related immune changes in multiple sclerosis

Similarly to many other autoimmune diseases, multiple sclerosis (MS) is more common among women than men, and its incidence among women is rising. There are also qualitative differences in the disease course between men and women, with male patients experiencing increased disease progression, brain atrophy, and cognitive impairment. During pregnancy, women with MS typically have a greatly reduced relapse rate, whereas very soon after the delivery, the disease activity returns, often even at a higher level than seen in the prepregnancy year. The reasons for the increased postpartum activity are not entirely clear, but factors such as the abrupt decrease in estrogen levels immediately after the delivery and the loss of the immunosuppressive state of pregnancy are likely of importance. There is compelling evidence that estrogen, progesterone, and testosterone control MS pathology by influencing immune responses and by contributing to repair mechanisms in the nervous system. Hormones may thus offer important insights into MS disease prevention and treatment. In this review, the possible reasons for the sex bias in autoimmune diseases will be discussed. The pregnancy‐related alterations in MS, including the effect of pregnancy on disease activity, long‐term disability accumulation, and prevalence will be reviewed, as well as the hormonal and immunological mechanisms potentially underlying these changes. Finally, the present thinking on the effect of hormones on the changing incidence of MS will be elucidated.
Review Paper: Will the Wave Finally Break? A Brief View of the Adoption of Electronic Medical Records in the United States

For over thirty years, there have been predictions that the widespread clinical use of computers was imminent. Yet the "wave" has never broken. In this article, two broad time periods are examined: the 1960's to the 1980's and the 1980's to the present. Technology immaturity, health administrator focus on financial systems, application "unfriendliness," and physician resistance were all barriers to acceptance during the early time period. Although these factors persist, changes in clinicians' economics, more computer literacy in the general population, and, most importantly, changes in government policies and increased support for clinical computing suggest that the wave may break in the next decade.
Review paper: Informatics Systems to Promote Improved Care for Chronic Illness: A Literature Review

OBJECTIVE To understand information systems components important in supporting team-based care of chronic illness through a literature search. DESIGN Systematic search of literature from 1996-2005 for evaluations of information systems used in the care of chronic illness. MEASUREMENTS The relationship of design, quality, information systems components, setting, and other factors with process, quality outcomes, and health care costs was evaluated. RESULTS In all, 109 articles were reviewed involving 112 information system descriptions. Chronic diseases targeted included diabetes (42.9% of reviewed articles), heart disease (36.6%), and mental illness (23.2%), among others. System users were primarily physicians, nurses, and patients. Sixty-seven percent of reviewed experiments had positive outcomes; 94% of uncontrolled, observational studies claimed positive results. Components closely correlated with positive experimental results were connection to an electronic medical record, computerized prompts, population management (including reports and feedback), specialized decision support, electronic scheduling, and personal health records. Barriers identified included costs, data privacy and security concerns, and failure to consider workflow. CONCLUSION The majority of published studies revealed a positive impact of specific health information technology components on chronic illness care. Implications for future research and system designs are discussed.
Technology Evaluation: Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety

The authors develop a typology of clinicians' workarounds when using barcoded medication administration (BCMA) systems. Authors then identify the causes and possible consequences of each workaround. The BCMAs usually consist of handheld devices for scanning machine-readable barcodes on patients and medications. They also interface with electronic medication administration records. Ideally, BCMAs help confirm the five "rights" of medication administration: right patient, drug, dose, route, and time. While BCMAs are reported to reduce medication administration errors--the least likely medication error to be intercepted--these claims have not been clearly demonstrated. The authors studied BCMA use at five hospitals by: (1) observing and shadowing nurses using BCMAs at two hospitals, (2) interviewing staff and hospital leaders at five hospitals, (3) participating in BCMA staff meetings, (4) participating in one hospital's failure-mode-and-effects analyses, (5) analyzing BCMA override log data. The authors identified 15 types of workarounds, including, for example, affixing patient identification barcodes to computer carts, scanners, doorjambs, or nurses' belt rings; carrying several patients' prescanned medications on carts. The authors identified 31 types of causes of workarounds, such as unreadable medication barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient identification wristbands (chewed, soaked, missing); nonbarcoded medications; failing batteries; uncertain wireless connectivity; emergencies. The authors found nurses overrode BCMA alerts for 4.2% of patients charted and for 10.3% of medications charted. Possible consequences of the workarounds include wrong administration of medications, wrong doses, wrong times, and wrong formulations. Shortcomings in BCMAs' design, implementation, and workflow integration encourage workarounds. Integrating BCMAs within real-world clinical workflows requires attention to in situ use to ensure safety features' correct use.
SEMINARS IN RESPIRATORY MEDICINE-VOLUME 9, NUMBER 6 OCTOBER 1988 Snoring: Pathophysiology and Clinical Consequences

Snoring was for a long time regarded merely as a troublesome noise, a nuisance to the snorer's unfortunate bedor roommate. Kleitman devoted to snoring only 22 lines of the 370 pages and 10 of the 4370 references of his comprehensive textbook Sleep and Wakefulness, now a classic. A surge of interest in this apparently trivial phenomenon of sleep was, however, spurred by the discovery of the clinical and pathogenic links between snoring and obstructive sleep apnea syndrome (OSAS). We now regard snoring and full-blown OSAS as the opposite endpoints of one basic disorder, sleep-related narrowing of the upper airways. Since trivial snoring is in time followed by snoring interspersed with more and more sleep apneas, the patient inadvertently lapses from an apparent state of health into a slowly worsening disease state. The close relationship between snoring and OSAS is emphasized by the term "heavy snorers disease" (HSD), which we prefer to its synonym OSAS.
AVM Management Equipoise Survey: physician opinions regarding the management of brain arteriovenous malformations

Introduction Management of unruptured brain arteriovenous malformations (AVMs) is controversial, and conducting clinical trials in this area has been a challenge. We sought to determine which, if any, patient/AVM characteristics were most likely to influence clinicians’ decisions regarding management and clinical trial enrollment. Methods We performed an online survey (Survey Monkey) of members of the American Association of Neurological Surgeons (AANS) (n=4836) and Society of NeuroInterventional Surgeons (SNIS) (n=512). Physicians were asked to rate the likelihood that various patient/AVM characteristics would influence their treatment decisions and recommendations for clinical trial enrollment. 10 hypothetical case vignettes were also provided, and respondents were asked to select a management recommendation. Results 277 (5.2%) responses were received. Characteristics that the majority (>50%) of respondents felt should lead to treatment included size <3 cm, superficial or cerebellar location, single draining vein, age <30 years, venous aneurysm, prior AVM hemorrhage, poorly controlled seizures, intranidal aneurysm, and patient's desire for treatment. However, a significant minority (>30%) felt that six of these same characteristics should lead to observation or should not influence treatment decisions. Characteristics that the majority (>50%) of respondents felt should lead to clinical trial enrollment included size > 6cm, deep or eloquent location, and age 51–70 years. The only characteristic that the majority felt should not lead to enrollment was the presence of an intranidal aneurysm. For the 10 vignettes, the majority of respondents (>50%) favored a specific course of management in only five cases. Conclusions Clinicians’ opinions on which patient/AVM characteristics are important for decisions regarding treatment or trial enrollment vary widely. These results suggest that there is no uniform opinion of clinical equipoise with regard to the management of brain AVMs.
The unknown soldiers of foster care: Foster care as loss for the foster parents’ own children

Abstract This paper explores the effects of the foster care experience on foster parents’ biological children. In spite of having been accepted for over 40 years as the best form of residential care for most children and adolescents requiring alternative living arrangements, very little research has been done into the foster care experience. Almost nothing is known about the effects of foster care on either the foster family as a unit or its individual members, yet one of the major concerns foster parents present is the effect of the foster care experience on their own children. This concern leads many experienced foster families to leave foster care and many potential foster families to decide not to foster. This paper discusses the losses experienced by the children of foster parents.
Use of electronic information systems in nursing homes: United States, 2004.

OBJECTIVES This study sought to define the extent of utilization of 12 types of electronic information system (EIS) function in U.S. nursing homes (NH), to relate EIS utilization to selected facility characteristics and to contrast these findings to previous estimates of EIS use in NH. DESIGN This study used data from the National Nursing Home Survey (NNHS), a nationally representative, cross-sectional sample of U.S. NH. MEASUREMENTS Data on current use of EIS in 12 functional areas, including administrative and resident care activities, were collected. Information was also collected on facility characteristics including ownership, bed size, and whether the facility was a member of a chain. RESULTS Essentially all (99.6%) U.S. NH had >or=1 EIS, a figure that was driven by the nearly universal use of EIS for Minimum Data Set (MDS) reporting (96.4%) and for billing (95.4%). Nearly 43% of U.S. NH had EIS for medical records, including nurse's notes, physician notes, and MDS forms. EIS use ranged from a high of 79.6% for admission, transfer, and discharge to a low of 17.6% for daily care by certified nursing assistants (CNAs). Ownership, membership in a chain, and bed size were associated with use of selected EIS. Larger facilities and those that were part of a chain used more EIS than smaller standalone facilities. CONCLUSION In 2004, NH use of EIS for functions other than MDS and billing was highly variable, but considerably higher than previous estimates.
Risk factors for mortality in patients with anti‐NMDA receptor encephalitis

Anti‐N‐methyl‐D‐aspartate receptor (NMDAR) encephalitis is a severe autoimmune disorder with a mortality of 5%‐7%, but few studies have focused on the predictors of death in this disease. In this study, we aim to investigate predictors and causes of death in patients with anti‐NMDAR encephalitis.
M1 is not M1 in ischemic stroke: the disability-free survival after mechanical thrombectomy differs significantly between proximal and distal occlusions of the middle cerebral artery M1 segment

Aims Recent recommendations on the designation of target artery lesions in acute ischemic stroke include the anatomical differentiation between a proximal and a distal occlusion site of the M1 segment of the middle cerebral artery (MCA). The aim of this study was to evaluate whether these occlusion types differ in terms of a disability-free (modified Rankin Scale (mRS) 0 or 1) clinical outcome at 90 days. Methods A retrospective analysis was performed of all patients with MCA M1 occlusions who had a successful revascularization result after mechanical thrombectomy between October 2009 and September 2013 and for whom follow-up at 90 days was available. Imaging data were regraded and re-evaluated according to the modified Thrombolysis In Cerebral Infarction (mTICI) scale and the respective vessel occlusion site definitions. Outcome measures included National Institutes of Health Stroke Scale (NIHSS), mRS, Alberta Stroke Program Early CT Score (ASPECTS) scoring and procedural timings. Results 62 patients were successfully recanalized; follow-up at 90 days was available for 42/62 patients (68%). There were proximal MCA occlusions in 24/42 patients (57%) and distal occlusions in 18/42 (43%). Baseline NIHSS, ASPECTS, procedural timings and final mTICI scores did not differ significantly between proximal and distal M1 occlusions. There was a statistically significant difference between proximal and distal M1 occlusions regarding a disability-free early outcome (mRS 0 or 1) at discharge (p=0.03) and at 90 days (p=0.04). Conclusions Proximal occlusions of the M1 segment of the MCA incorporating the lenticulostriate perforators are associated with a poorer clinical outcome than distal M1 occlusions that spare these perforators. Involvement of these perforators might become an additional predictor of clinical outcome after mechanical thrombectomy in ischemic stroke.
Pipeline endovascular device for the treatment of intracranial aneurysms at the level of the circle of Willis and beyond: multicenter experience

Background and purpose The aim of our study was to evaluate the safety and efficacy of the pipeline endovascular device for the treatment of anterior circulation aneurysms at the level of the circle of Willis and beyond. Methods A consecutive series of 25 patients (24 unruptured and one ruptured) with anterior circulation aneurysms treated with a pipeline endovascular device were included in the analysis. Results We found two minor clinical events (resolved within 7 days of the procedure), one major event (symptoms present after 7 days), and no mortality. There were no aneurysm ruptures or parenchymal hemorrhages during follow-up. The modified Rankin Scale (mRS) scores at 3 and 6 months did not change from the prior mRS score for all cases except 1. There was one asymptomatic periprocedural event. There were three intraprocedural complications which resolved without clinical consequences. Six month follow-up angiograms were obtained for 22 aneurysms, showing complete occlusion in 14 (64%) and significantly decreased residual filling in 8 (36%). The status of branches originating from the aneurysm sacs was evaluated in 14 angiograms: 11 were patent (79%), 2 had moderate reduction (14%) and 1 (7%) was occluded. We found six cases of in-stent stenosis (27%) on 6 month DSA, with only one symptomatic case. Conclusions The pipeline embolization device provides a feasible and technically safe solution for aneurysms at and beyond the circle of Willis. Preliminary results are promising but larger series with longer term follow-up examinations are required to show the long term safety and durability of this treatment alternative.
Is the hygiene hypothesis relevant for the risk of multiple sclerosis?

The hygiene hypothesis, suggesting that low exposure to pathogens early in life can increase the risk for immune‐mediated diseases, has been proposed as an explanation for the increase in incidence of allergy and autoimmune diseases in industrialized countries during the last decades. Several aspects of the hygiene hypothesis have been related to MS. Already in 1966, the risk of MS was suggested to be higher in individuals with high hygienic standard during childhood. Further, an episode of infectious mononucleosis is an independent risk factor for MS and can be regarded as an indicator of low exposure to pathogens early in life, as infection with Epstein‐Barr virus often is asymptomatic when it occurs in young children. Conflicting results have been reported regarding number of siblings, attendance in a day care center and exposure to animals during childhood in relation to MS risk, but common childhood infections and vaccinations do not seem to influence the risk of MS. In line with the hygiene hypothesis, two large meta‐analyses have recently shown that infection with Helicobacter pylori is negatively correlated with MS. Moreover, a protective influence of helminth infection on MS has been observed in several, small clinical studies, but more knowledge is needed before a potential role of helminth‐derived therapy in MS is determined. Also, it has been hypothesized that infection with the parasite Toxoplasma gondii could be protective against MS.
The role of men in fertility and family planning program in Tigray Region

Objective: To assess men's role on fertility and their attitudes towards family planning, to compare in which ways and to what extent they differ from their wives/partners and its implications for future family planning programs. Design: The study involved a cross-sectional comparative study design. Both closed and open-ended questionnaires were used. Subject: The study included couples of the reproductive age group, who were married or in union for greater than six months at the time of the survey. Four hundred and ten respondents (205 men and 205 wives/partners) were included. Setting: sub-Districts-Mekelle and Kuha (urban and semi-urban) in Tigray, Ethiopia. Main outcome measures: Couples' fertility intentions, ideal mean family size preferences and attitude towards family planning. Results: The study for the two sample proportions showed that Tigrian men in general wanted a greater number of children than their wives/partners (2=11.08, df=1,P Conclusion: Men's fertility intentions, reproductive preferences and their attitude towards family planning seem to influence the fertility behavior of their wives and their attitudes towards the use of modern contraceptives. Traditional socio-cultural norms, economic and property ownership status mean that Tigrian men dominate decision-making at all levels of the reproductive processes. Men's attitudes towards family planning (which was assessed in terms of partner approval and discussion were important in determining the role of husbands regarding the use of family planning methods by women, and on the fertility level of the family. Therefore in an attempt to promote reproductive health through the increasing use of modern contraceptives, family planning programs need to target men specifically at all levels of the program. Men should be actively involved at 'knowledge' level, 'supportive' level and 'acceptor' level. Their decision-making role should be used (exploited) in order to promote contraceptive use by couples in the study population. [Ethiop.J.Health Dev.2002; 16(3):247-255].
The Dotter method revisited: early experience with a novel method of rapid internal carotid artery revascularization in the setting of acute ischemic stroke

Background Tandem occlusive disease in the setting of acute ischemic stroke involving cervical and cerebral arteries has been associated with poor neurological outcome and poses significant challenges to neurointerventionists. Previously described endovascular methods typically involve carotid revascularization with stent placement prior to or following intracranial thrombectomy. Stent-based approaches, however, require the use of antiplatelet therapy which may increase the risk of hemorrhagic transformation. We describe a novel modified Dotter technique which may be used for carotid revascularization in lieu of stenting. This technique can eliminate the need for antiplatelet therapy, reduce procedure times, and possibly reduce hemorrhagic conversion rates. Methods Seven patients presenting between April 2013 and January 2014 were treated with this technique. All patients had carotid stenosis of 65–100% and tandem middle cerebral artery occlusions. National Institutes of Health (NIH) Stroke Scale scores as well as clinical and procedural times were recorded. Pre- and post-Dotter stenosis was measured using the NASCET criteria. Follow-up imaging and clinical data were reviewed. Results The mean age was 64 years and mean initial NIH Stroke Scale score was 11.7. Mean groin to recanalization time was 26 min. Thrombolysis In Cerebral Infarction grade 2b–3 was achieved in all patients. The mean stenosis was 88% preoperatively and 61% postoperatively. There were no intracranial hemorrhages. The modified Rankin Scale score was 0 in six patients (86%) and 6 in one patient (14%). Conclusions The Dotter stroke technique is a feasible and safe alternative to carotid stenting in the setting of acute ischemic stroke and may reduce the risk of hemorrhagic conversion. No re-occlusion occurred during follow-up in patients with post-Dotter stenosis ≤65%.