Miracle-dz/UniFAR-FTUs huggingface dataset:
Effects of a surgical ward care protocol following open colon surgery as part of an enhanced recovery after surgery programme

AIMS AND OBJECTIVES To investigate the effects of a standardised care protocol as part of an enhanced recovery after surgery programme on the management of patients who underwent open colon surgery at the University Hospital, South Korea. BACKGROUND Patients who undergo open colon surgery often have concerns about their care as they prepare for hospitalisation. By shortening hospital stay lengths, enhanced recovery after surgery programmes could reduce the number of opportunities for patient education and communication with nurses. Therefore, our surgical team developed an enhanced recovery after surgery programme, applied using a care protocol for patients with colorectal cancer, that spans the entire recovery process. DESIGN A retrospective, comparative study was conducted using a care protocol as part of an enhanced recovery after surgery programme. Comparisons were made before and after the implementation of an enhanced recovery after surgery programme with a care protocol. METHODS Records of 219 patients who underwent open colon surgery were retrospectively audited. The records were grouped according to the care protocol used (enhanced recovery after surgery programme with a care protocol or traditional care programme). The outcomes, including postoperative bowel function recovery, postoperative pain control, recovery time and postoperative complications, were compared between two categories. RESULTS Patients who were managed using the programme with a care protocol had shorter hospital stays, fewer complications, such as postoperative ileus wound infections, and emergency room visits than those who were managed using the traditional care programme. CONCLUSION The findings can be used to facilitate the implementation of an enhanced recovery after surgery programme with a care protocol following open colon surgery. RELEVANCE TO CLINICAL PRACTICE We present a care protocol that enables effective management using consistent and standardised education providing bedside care for patients who undergo open colon surgery. This care protocol empowers long-term patient self-care capacity, which contributes to increasing the effectiveness of clinical nursing care.
Urinary incontinence and its management in patients aged 65 and older in orthopaedic care – what nursing and rehabilitation staff know and do

AIMS AND OBJECTIVES To describe what nursing and rehabilitation staff know and do with regard to urinary incontinence and risk of urinary incontinence in patients 65 years or older undergoing hip surgery. BACKGROUND Urinary incontinence is a common but often neglected issue for older people. Despite the existence of evidence-based guidelines on how to assess, manage and prevent urinary incontinence, there are indications that these guidelines are not applied in hospital care. DESIGN A qualitative study with descriptive design was conducted in two orthopaedic units. METHODS Forty-six interviews and 36 observations of care were conducted from January-October 2014 and analysed with qualitative content analysis. RESULTS Enrolled nurses performed most of the care related to bladder function, with focus on urinary catheterisation and preventing urinary tract infection and urinary retention. Registered nurses' role in urinary matters mainly comprised documentation, while the rehabilitation staff focused on making it possible for the patient to be independent in toileting. The nursing staff considered urinary incontinence a common condition for older people and that it was convenient for the patients to have an indwelling catheter or incontinence pad/pant, although they acknowledged some of the risks associated with these procedures. CONCLUSIONS Urinary incontinence is not a priority in orthopaedic care, and urinary incontinence guidelines are not applied. Further, attitudes and actions are mainly characterised by a lack of urinary incontinence knowledge and the nursing and rehabilitation staff do not take a team approach to preventing and managing urinary incontinence. RELEVANCE TO CLINICAL PRACTICE An increased focus on knowledge on urinary incontinence and evidence-based guidelines is needed. To secure evidence-based practice, the team of nursing and rehabilitation staff and managers must be aligned and work actively together, also including the patient in the team.
Nursing home manager's knowledge, attitudes and beliefs about advance care planning for people with dementia in long‐term care settings: a cross‐sectional survey

AIMS AND OBJECTIVES To examine nursing home managers' knowledge, attitudes, beliefs and current practice regarding advance care planning for people with dementia in long-term care settings informed by the theory of planned behaviour. BACKGROUND Internationally, advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regard to advance care planning and the perceived factors which influence this. DESIGN A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed-methods study between January-March 2015. SETTING AND PARTICIPANTS Nursing home managers in a region in the UK (n = 178). RESULTS A response rate of 66% (n = 116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning, with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently, they do not view advance care planning as part of their role, with lack of ownership impacting upon current practice behaviours. CONCLUSIONS Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident; therefore, long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia. RELEVANCE TO CLINICAL PRACTICE Increased cognisance of the context in which advance care planning takes place is vital for improved implementation in this context. In addition strong nursing leadership is imperative to facilitate initiation, engagement and re-evaluation of the process of advance care planning.
Preparation, blood coagulation and cell compatibility evaluation of chitosan-graft-polylactide copolymers

Biodegradable chitosan-graft-polylactide (PLA–CS) copolymers were prepared by the grafting of a poly(L-lactide) (PLLA) or poly(D-lactide) (PDLA) precursor to the backbone of chitosan using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC ⋅ HCl) and N-hydroxysuccinimide (NHS) as a coupling agent. The blood and cell compatibility of the graft copolymers were investigated in comparison to PLLA and PDLA homopolymers. The coagulation properties of PLA–CS were evaluated by hemolysis, plasma recalcification, dynamic blood clotting and protein absorption assays. PLA–CS copolymers present similar hemolysis ratio and plasma recalcification time as PLA, but slower dynamic blood clotting and lower protein absorption. The cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), agar diffusion and lactate dehydrogenase (LDH) experiments. All the samples presented no effect on the viability to cells. Inflammatory cytokine analysis using sandwich ELISAs revealed that PLA–CS would not stimulate inflammatory activity.
What do psychologists think about mandatory continuing education? A survey of Pennsylvania practitioners.

Would psychologists voluntarily participate in continuing education (CE) if it were not mandatory to do so? Does CE help make psychologists more effective clinicians? These and other aspects of mandatory CE were explored in a survey of 168 licensed psychologists in Pennsylvania. Although 75% of respondents were in favor of mandatory CE, the sample was divided over the question of whether they would obtain the required credits if not mandatory. Forty-five percent of respondents reported that attendance at CE programs often increases their clinical effectiveness, whereas 41% reported this as occurring sometimes, and 11% as only rarely. Because this survey was conducted in Pennsylvania, the results are discussed in light of varying CE requirements in other states.
Generation of an rhBMP-2-loaded beta-tricalcium phosphate/hydrogel composite and evaluation of its efficacy on peri-implant bone formation

Dental implant insertion on a site with low bone quality or bone defect should be preceded by a bone graft or artificial bone graft insertion to heal the defect. We generated a beta-tricalcium phosphate (β-TCP) and poloxamer 407-based hydrogel composite and penetration of the β-TCP/hydrogel composite into the peri-implant area of bone was evaluated by porous bone block experiments. The maximum penetration depth for porous bone blocks and dense bone blocks were 524 μm and 464 μm, respectively. We report the in-vivo performance of a composite of β-TCP/hydrogel composite as a carrier of recombinant human bone morphogenetic protein (rhBMP-2), implanted into a rabbit tibial defect model. Three holes drilled into each tibia of eight male rabbits were (1) grafted with dental implant fixtures; (2) filled with β-TCP/hydrogel composite (containing 5 μg of rhBMP-2), followed by grafting of the dental implant fixtures. Four weeks later, bone-implant contact ratio and peri-implant bone formation were analyzed by radiography, micro-CT and histology of undecalcified specimens. The micro-CT results showed a significantly higher level of trabecular thickness and new bone and peri-implant new bone formation in the experimental treatment compared to the control treatment. Histomorphometry revealed a significantly higher bone-implant contact ratio and peri-implant bone formation with the experimental treatment. The use of β-TCP/poloxamer 407 hydrogel composite as a carrier of rhBMP-2 significantly promoted new bone formation around the dental implant fixture and it also improved the quality of the new bone formed in the tibial marrow space.
Utilising technology for rehabilitation of the upper limb following stroke: the Ulster experience

Abstract Objectives: The aim of this research team has been to develop and test a range of virtual technologies for their feasibility and effectiveness in upper limb stroke rehabilitation. The principles of neural plasticity, motor control and skill training have informed the design and development of our systems and practice tasks. The purpose of this paper is to present a summary of our work to date and discuss what we have learned throughout the development, testing and implementation of this type of intervention in people with stroke. Methods: Virtual technologies are being used to provide people who have stroke with opportunities to practice in a more focused way, and to offer support to continue having access to therapy for more extended periods of time. The systems reported on in this paper are at various stages of development and user testing. Methods employed during the course of our investigations have been both qualitative and quantitative, including questionnaires, participant interviews, single case series and a randomized controlled trial design. Results: Our work has focused mainly on incorporating the principles of motor learning which seem to be most effective in promoting motor recovery following stroke, i.e. repetitive, functional and task related practice of active movement of the limbs. A number of other research groups have prioritised game style activities which concentrate on the motivation to practice. Results from a series of studies, with both non disabled and stroke users, indicate that the use of virtual technologies to augment and support rehabilitation after stroke is feasible and has positive effects on motor impairment and activity levels. Discussion/conclusion: This paper has presented an overview of the work our research team has been engaged in since 2003. There have been developments in two key areas, moving from unilateral practice to bilateral practice and incorporating these movements into game based systems. We plan to continue to test our systems against current standard care with a long-term aim to empower stroke users in their own rehabilitation.
The Role of Procalcitonin in Community-Acquired Pneumonia: A Literature Review

Community-acquired pneumonia (CAP) is a significant clinical and public health problem. Recently, attention has been paid to the potential for procalcitonin (PCT) both to differentiate the diagnosis and to indicate the prognosis of pneumonia. The purpose of this literature review was to evaluate the eligibility of PCT for defining typical bacterial infections and for predicting severity and mortality in trials for CAP. The literature review suggests that PCT has the ability to supplement clinical information to determine whether or not the cause of the infection is likely to be bacterial. In addition, PCT seems to be superior to the most prevalent inflammatory biomarker C-reactive protein and also demonstrates a significant correlation between the current clinical scoring systems and actual mortality.
Adsorption and binding dynamics of graphene-supported phospholipid membranes using the QCM-D technique

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Dyadic incongruence in chronic heart failure: Implications for patient and carer psychological health and self‐care

AIMS AND OBJECTIVES To examine whether chronic heart failure patient-carer dyads who disagree about the division of illness management tasks (incongruent) experience poorer psychosocial health and self-care, than those who agree (congruent). BACKGROUND Informal carers often assist patients with chronic heart failure in the complex management of their illness, but little is known about how relationship dynamics may affect psychosocial health. DESIGN A prospective cross-sectional study was adopted with a purposeful sample of 25 chronic heart failure patient-carer dyads residing in Australia. METHODS Data were collected via mail-out questionnaires. Dyads were classified as congruent or incongruent using the Heart Failure Care Assessment Scale. Depression, anxiety, stress and quality of life were assessed in patients and carers. Additionally, self-care and relationship quality were assessed in patients; and burden and esteem were assessed in carers. Differences in congruent and incongruent patient and carer outcomes were examined. RESULTS Dyads were predominantly spousal and around a third demonstrated incongruence. No significant differences were found between congruent (n = 16) and incongruent (n = 9) dyads, although patients in incongruent dyads tended to have been diagnosed more recently. CONCLUSION In chronic heart failure patient-carer dyads incongruence exists even for patients with relatively mild chronic heart failure symptoms. These findings indicate that dyadic incongruence in illness management might not affect high-functioning chronic heart failure heart failure patients or their carers. RELEVANCE TO CLINICAL PRACTICE Given the prevalence of dyadic incongruence and the possibility of further negative outcomes with disease progression, it is important to examine factors such as length of time since diagnosis or type of carer relationship. By implementing self-care education and management strategies that focus on the dyad, rather than the individual, nurses have the potential to improve both patient and carer outcomes.
Calm to chaos: Engaging undergraduate nursing students with the complex nature of interruptions during medication administration.

AIMS AND OBJECTIVES To describe undergraduate student nurse responses to a simulated role-play experience focussing on managing interruptions during medication administration. BACKGROUND Improving patient safety requires that we find creative and innovative methods of teaching medication administration to undergraduate nurses in real-world conditions. Nurses are responsible for the majority of medication administrations in health care. Incidents and errors associated with medications are a significant patient safety issue and often occur as a result of interruptions. Undergraduate nursing students are generally taught medication administration skills in a calm and uninterrupted simulated environment. However, in the clinical environment medication administration is challenged by multiple interruptions. DESIGN/METHODS A qualitative study using convenience sampling was used to examine student perceptions of a simulated role-play experience. Data were collected from 451 of a possible 528 student written reflective responses and subject to thematic analysis. RESULTS Students reported an increased understanding of the impacts of interruptions while administering medications and an improved awareness of how to manage disruptions. This study reports on one of three emergent themes: "Calm to chaos: engaging with the complex nature of clinical practice. " CONCLUSIONS Interrupting medication administration in realistic and safe settings facilitates awareness, allows for students to begin to develop management strategies in relation to interruption and increases their confidence. Students were given the opportunity to consolidate and integrate prior and new knowledge and skills through this role-play simulation.
Exploring attribution of responsibility for visitor safety in a US national park

Attracting millions of visitors each year, US national parks represent one context in which unintentional injuries are recurrent and fatal. Given unique environmental and infrastructural risks, as well as varied recreational opportunities and social contexts, who is perceived as responsible for preventing visitor injuries, and how might this relate to risk perception? Further, how does attribution of responsibility relate to support for preventative risk management? Limited research has considered these questions yet increasing promotion of parks to diverse audiences suggests a need to build public support for risk management. Using quantitative and qualitative survey data, this study found that most visitors perceived themselves as responsible for their own safety, and perceptions of the uncontrollability of risks were positively related to these attributions; however, attribution failed to predict support for preventative risk management. Significant predictors included perceptions of risk, participation in high-risk activities, and travelling companions. Future directions for this research, including the role of voluntary risk-taking in recreational settings, are discussed.
Gonadotropins: potential targets for preventive and therapeutic interventions in Alzheimer’s disease

Increased prevalence of Alzheimer’s disease (AD) in women has led to an interest in the role of hormonal changes in the neurodegenerative process. In particular, research has been directed towards investigating the effect of changes in sex hormone levels following reproductive senescence. Clinical trials of hormone-replacement therapy for the prevention of AD are proving contentious, and considerably more research is necessary before the benefit of the hormone replacement strategy can be ascertained. However, evidence is now emerging to support the notion that increased gonadotropin levels may confer an increased risk of AD. Gonadotropins have been implicated in the metabolism of β-amyloid, a key protein that is central to the pathogenesis of AD. Gonadotropin reduction represents a promising new target for therapeutic intervention in AD and, potentially, dementia in general. In this review, the authors discuss the therapeutic and preventive potential of gonadotropin-reducing agents in the management of AD.
“Pain relieved, but still struggling”—Critically ill patients experiences of pain and other discomforts during analgosedation

AIMS AND OBJECTIVES To explore how critically ill patients treated according to a strategy of analgosedation experience and handle pain, other discomforts and wakefulness. BACKGROUND Patients experience both pain and discomfort while in the intensive care unit. International guidelines recommend focused pain treatment and light sedation. An analgosedation protocol favouring pain management, light sedation and early mobilisation was implemented in our university hospital medical and surgical intensive care unit in Norway in 2014. The analgosedation approach may affect patients' experiences of the intensive care unit stay. DESIGN Exploratory, descriptive design using semi-structured interviews. METHOD Eighteen adult patients treated in intensive care unit >24 hr and receiving mechanical ventilation were interviewed 1-9 days after intensive care unit discharge. Ten patients were re-interviewed after 3 months. Data were analysed using the "systematic text condensation" approach. FINDINGS Four main categories emerged from the analysis: "In discomfort, but rarely in pain," "Struggling to get a grip on reality," "Holding on" and "Handling emotionally trapped experiences. " "Pain relieved, but still struggling" was the overarching theme. Analgosedation provided good pain relief, but patients still described frequent physical and psychological discomforts, in particular related to mechanical ventilation, not understanding what was going on, and experiences of delusions. To come to terms with their intensive care unit stay, patients needed to participate, trust in others and endure suffering. After hospital discharge, patients described both repression of experiences and searching for recognition of what they had gone through. RELEVANCE TO CLINICAL PRACTICE Despite good pain relief during analgosedation, other discomforts were commonly described. Critically ill patients still experience an intensive care unit stay as a traumatic part of their illness trajectory. Nurses need to attend carefully also to discomforts other than pain.
Calcium and phosphate ions as simple signaling molecules with versatile osteoinductivity

Due to the continually increasing clinical need to heal large bone defects, synthetic bone graft substitutes have become ever more necessary with calcium phosphates (CaP) widely used due to their similarity to the mineral component of bone. In this research, different concentrations of calcium ions (Ca2+), phosphate ions (Pi), or their combination were provided to mesenchymal stem cells (MSCs) to evaluate their influence on proliferation and differentiation. The results suggest that 1–16 mM Ca2+ and 1–8 mM Pi is osteoinductive, but not cytotoxic. Furthermore, three distinct calcium phosphates (i.e. monobasic, dibasic, and hydroxyapatite) with different dissolution rates were investigated for their Ca2+ and Pi release. These biomaterials were then adjusted to release ion concentrations within the established therapeutics window for which MSC bioactivity was assessed. These findings suggest that CaP-based biomaterials can be leveraged to achieve Ca2+ and Pi dose-dependent osteoinduction for bone regenerative engineering applications.