Miracle-dz/UniFAR-FTUs huggingface dataset:
Opioid and benzodiazepine withdrawal syndromes in the paediatric intensive care unit: a review of recent literature.

AIMS AND OBJECTIVES This paper aims to critically review and analyse available literature to inform and advance patient care. BACKGROUND Withdrawal syndromes related to the routine administration of sedation and analgesia in paediatric intensive care unit (PICU) have been recognized since the 1990 s. Common symptoms include tremors, agitation, inconsolable crying and sleeplessness. SEARCH STRATEGIES A critical review was undertaken to assess developments in this area. Four databases were searched using Ovid Online. These were Ovid Medline, CINAHL, BNI and Embase. Key terms included were 'Paediatric', 'Sedation', 'Withdrawal' and 'Intensive care'. INCLUSION AND EXCLUSION CRITERIA Articles from 1980 onwards were reviewed for their relevance to paediatric iatrogenic withdrawal. Additionally, seminal work from the 1970s was included. Because of the scarcity of literature, relevant editorials and opinion pieces were included. RESULTS A total of 2,232,586 papers resulted from keyword searches. Use of Boolean operators to combine terms reduced the number of results to 62. Exclusion criteria reduced the number of suitable papers to 20. Tracking reference lists yielded a further 18 papers. In total, 38 papers were retrieved examining 1375 patients. Four papers surveyed drug usage on PICU, 14 listed withdrawal symptoms, 4 described the frequency of withdrawal in the PICU population, 9 described risk factors, 4 presented or validated clinical tools and 14 describe treatment strategies. CONCLUSIONS Withdrawal syndromes may affect 20% of exposed children and are related to infusion duration and total dose. Fifty-one symptoms are described in the literature. Future studies need accurate, validated clinical tools to be effective. Risk factors, signs and symptoms have been identified, and validation studies must now take place. RELEVANCE TO CLINICAL PRACTICE Withdrawal syndromes continue to be widespread and difficult to diagnose. Awareness of their causes and treatments should influence clinical decisions at the bedside.
APPEARANCE OF NOVEL G‐BACTERIA BELONGING TO ACIDOBACTERIA IN A DAIRY WASTEWATER TREATMENT PLANT

Abstract A dairy wastewater treatment plant operates a sequencing batch reactor (SBR) and stimulates enhanced biological phosphorus removal (EBPR) process with alternating anaerobic and aerobic cycles. Occasionally, the plant suffers from a high suspended solids problem in the supernatant. Interestingly, the occurrence of high suspended solids coincided with times when the EBPR process failed to remove phosphorus. To find out if there was a relationship between the EBPR failure and the high suspended solids problem, effluent samples were collected from the site during the period of poor phosphorus removal and examined microscopically. It was found that cocci‐shaped bacteria (3–4 µm in diameter) were abundant in the effluent samples and they were clustered in tetrads. These were believed to be G‐bacteria and results of both Gram and Neisser staining tests were negative, suggesting that they had few intracellular polyphosphate granules. Using polymerase chain reaction (PCR), cloning and deoxyribonucleic acid (DNA) sequence analysis, the phylogenetic information of in situ G‐bacteria was obtained. It was found that all of the recovered clones were clustered in the phylum of Acidobacteria.
SYSTEMIC RISK FACTORS ASSOCIATED WITH POLYPOIDAL CHOROIDAL VASCULOPATHY AND NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

Purpose: To compare the association of systemic risk factors between neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV). Methods: Seven hundred and three patients (235 with nAMD and 468 with PCV) were included. Associated systemic conditions, including hypertension, cardiovascular disease, stroke, diabetes mellitus, and end-stage renal disease, were investigated through an interview and questionnaire. Results: The prevalence of diabetes mellitus and end-stage renal disease in nAMD was significantly higher than that in PCV (P < 0.001 and P = 0.021, respectively, multivariate logistic regression analysis). Moreover, in diabetic patients with nAMD or PCV, the more severe form of diabetic retinopathy was more prevalent in nAMD cases than in PCV cases (P = 0.006, multivariate logistic regression analysis). Conclusion: Diabetes mellitus and end-stage renal disease are more prevalent in patients with nAMD than in those with PCV. Specific systemic conditions might be associated with the development of nAMD.
Leiomyosarcoma in Poland's Syndrome

We describe a 56-year-old female with absence of the right pectoralis muscles, aplasia of the right breast, and skeletal deformities of the right hand, typical of Poland's syndrome. Following complaints of lower abdominal pain, a CT examination revealed an 8-cm mass in the right anterior pelvic wall. Surgical resection of the mass revealed a high-grade, poorly differentiated leiomyosarcoma. Poland's syndrome is known to be associated with a high incidence of leukemia but this is the first description of its association with leiomyosarcoma. Although we cannot exclude the possibility of a chance association, it is reasonable to assume that, similar to other syndromes with multiple congenital anomalies, the association with an increased incidence of malignancy is an integral part of the underlying genetic abnormality.
Acute leukemia as a secondary malignancy in children and adolescents: Current findings and issues

Secondary acute leukemia is a devastating complication in children and adolescents who have been treated for cancer. Secondary acute lymphoblastic leukemia (s‐ALL) was rarely reported previously but can be distinguished today from recurrent primary ALL by comparison of immunoglobulin and T‐cell receptor rearrangement. Secondary acute myeloid leukemia (s‐AML) is much more common, and some cases actually may be second primary cancers. Treatment‐related and host‐related characteristics and their interactions have been identified as risk factors for s‐AML. The most widely recognized treatment‐related risk factors are alkylating agents and topoisomerase II inhibitors (epipodophyllotoxins and anthracyclines). The magnitude of the risk associated with these factors depends on several variables, including the administration schedule, concomitant medications, and host factors. A high cumulative dose of alkylating agents is well known to predispose to s‐AML. The prevalence of alkylator‐associated s‐AML has diminished among pediatric oncology patients with the reduction of cumulative alkylator dose and limited use of the more leukemogenic alkylators. The best‐documented topoisomerase II inhibitor‐associated s‐AML is s‐AML associated with epipodophyllotoxins. The risk of s‐AML in these cases is influenced by the schedule of drug administration and by interaction with other antineoplastic agents but is not consistently found to be related to cumulative dose. The unpredictable risk of s‐AML after epipodophyllotoxin therapy may discourage the use of these agents, even in patients at a high risk of disease recurrence, although the benefit of recurrence prevention may outweigh the risk of s‐AML. Studies in survivors of adult cancers suggest that, contrary to previous beliefs, the outcome of s‐AML is not necessarily worse than that of de novo AML when adjusted for cytogenetic features. More studies are needed to confirm this finding in the pediatric patient population. Cancer 2009. © 2008 American Cancer Society.
Acyclovir to prevent reactivation of varicella zoster virus (herpes zoster) in multiple myeloma patients receiving bortezomib therapy

Humoral‐mediated as well as cell‐mediated immunity is compromised in myeloma patients receiving treatment. Immunocompromised patients are at risk of developing herpes zoster. There is evidence from clinical trials that bortezomib therapy is associated with a significant risk of herpes zoster. It is the authors' clinical policy to administer long‐term acyclovir prophylactically to all symptomatic myeloma patients.
Benefits and limits of sediment toxicity tests as an aid to decision‐making

With respect to the management of dredged sediments, a crucial issue is whether the removed materials (watered and/or processed) are disposed of or reused in an environmentally sound manner. In this context, the number of studies dealing with hazard or risk assessment has exponentially increased. This emphasis has resulted in the promotion and application of a very large variety of ecotoxicological tests. As a consequence, there is a clear need to highlight the scope and limitations of these tests for their appropriate selection and interpretation. In this paper we discuss the choice, implementation and interpretation of laboratory tests carried out on aquatic organisms at various levels of biological organization. We examine some experimental tools and methods in order to determine how suitable they are in regard to the objectives for which they are employed. To make this discussion more consistent our paper is based on results from research programmes conducted for governmental organizations and industrial partners. The Laboratoire des Sciences de l’Environnement (LSE) was involved with Cemagref de Lyon in a first methodological programme on risk assessment of scenarios of dredged sediment deposition. Another programme for a chemical company was implemented to assess the benefits of a physico‐chemical treatment applied to contaminated dredged sediments in a scenario of reuse or deposit in gravel pits. Currently, the LSE is working on a programme of risk assessment for road sediments in valorization scenarios. From these programmes, we expose how single‐species tests, as well as more complex bioassays and microcosm tests, can be used in an iterative step of risk assessment. Concerning microcosm tests, we also introduce a more realistic system that has been designed to simulate natural hydraulic conditions of gravel pits to assess the effects of toxicants on gravel pit aquatic biota during the sediment immersion phase and the sediment post‐deposition phase (paper in preparation). The benefits of these ecotoxicological approaches are underlined, but limits are discussed with regard to several criteria: ecological relevance, realism, use for decision‐making, cost and complexity of methods involved.
A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment.

Objectives The overall aim of this comprehensive systematic review was to identify the best available evidence on the effect of team characteristics, processes, structure and composition within the context of collaborative practice among nursing teams that create a healthy work environment. Search strategy The search strategy sought to find both published and unpublished studies and papers written in the English language. An initial limited search of Medline and CINAHL databases was undertaken to identify optimal search terms. A second extensive search using all identified keywords and index terms was then undertaken. Methodological quality Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package. Results The papers included in the review included nine experimental or quasi-experimental studies, 11 descriptive studies and four qualitative studies. A variety of different team structures such as interdisciplinary teams, primary nursing, team nursing, multidisciplinary models of care delivery and the use of a Partner in Patient Care model were investigated. Team characteristics should include accountability, commitment, enthusiasm and motivation. Social support within a team from a supervisor or colleague increased satisfaction levels of staff. Conclusion The results of the review lead to the development of a number of recommendations for practice that could assist with creating a health work environment.
Teleneurology: ethics of devolving responsibilities from clinicians to families and/or carers

E-care involving telemedicine, telecare, telehealth and teleneurology is the focus of health-care policy makers seeking to respond to demographic changes and the increasing prevalence of long term neurological conditions by adapting means of service delivery. E-care and teleneurology promise to provide high quality health-care services at a distance, allocate clinicians' time more effectively and enable the elderly and ill to remain in their own homes rather than occupy expensive beds in hospitals and care homes. The evidence base underpinning this is unsystematic, with marked shortcomings in economic evaluation methodology and a troubling paucity of ethical evaluations. Specific ethical issues arise in the application of teletechnologies to neurological conditions, particularly clinicians' ethical relations with family and/or carers. These ethical considerations should be recognized explicitly in policies promoting teleneurology in telemedicine, telecare and telehealth, that research needs to be directed.
Minimising undernutrition in the older inpatient

Background Malnutrition among elderly hospitalised patients is widespread and has been shown to lead to adverse health outcomes. The effectiveness of interventions to minimise undernutrition in elderly inpatients is not well documented. Objectives To identify the best available practices, in the hospital setting, that minimise undernutrition or the risk of undernutrition, in the acute care patient especially for the older patient. The review will assesses the effectiveness of a range of interventions designed to promote adequate nutritional intake in the acute care setting, with the aim of determining what practices minimise malnutrition in the elderly inpatients. Search strategy English language articles from 1980 onwards were sought using Medline, Premedline, Cinahl, Austrom‐Australasian Medical Index and AustHealth, Embase and Science Citations Index. Selection criteria For inclusion the study had to include an intervention aiming to minimise undernutrition in hospitalised elderly patients aged 65 years or older. All study designs were included. Data collection and analysis Two independent reviewers assessed the eligibility of each study for inclusion into the review, critically appraised the study quality and extracted data using standardised tools. For each outcome measure results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta‐analyses where appropriate. Main results Twenty‐nine studies met the inclusion criteria, with a total of 4021 participants. The focus of 15 interventions was the supplying of oral supplements to the participants, six focused on enteral nutrition therapy, four interventions made changes to the foods provided as part of the hospital diet, one included the services of an additional staff member and three incorporated the implementation of evidence‐based guidelines. Ten meta‐analyses were conducted from which the main findings were: significant improvements in weight status and arm muscle circumferences with an oral supplement intervention, P < 0.05. Reviewers' conclusions The findings of the review support the use of oral supplements to minimise undernutrition in elderly inpatients. The results also emphasise the need for more high‐quality research using appropriate outcome measures in the area of minimisation of undernutrition, particularly interventions that make alterations to the hospital diet and address support for feeding patients at the ward level.
Surgimiento y diseminación de Staphylococcus aureus meticilinorresistente

Las infecciones nosocomiales ocasionadas por cepas de Staphylococcus aureus meticilinorresistentes (SAMR) son un problema de salud importante en todo el mundo. Este microorganismo produce una gran variedad de infecciones incluyendo osteomielitis, endocarditis invasora, artritis septica y septicemia. La multirresistencia es un factor que influye en la persistencia de los SAMR dentro del ambito hospitalario. La introduccion de tecnicas de tipificacion molecular dentro de las investigaciones epidemiologicas ha provisto nuevas herramientas para conocer el origen y las vias de diseminacion de este microorganismo. Una de las conclusiones importantes que han surgido de este tipo de estudios es que un numero pequeno de clonas son las responsables de las infecciones estafilococicas en todo el mundo.
The EML4‐ALK fusion gene is involved in various histologic types of lung cancers from nonsmokers with wild‐type EGFR and KRAS

The echinoderm microtubule‐associated protein‐like 4‐anaplastic lymphoma kinase (EML4‐ALK) fusion gene resulting from the chromosome inversion inv(2)(p21;p23) recently was identified in nonsmall cell lung cancer (NSCLC). The authors of this study investigated the frequency, genetic and clinicopathologic profiles of EML4‐ALK in Chinese patients with NSCLC.
Left Ventricular Geometrical Characterization in Patients With Diastolic Heart Failure

Objectives. Conventional echocardiography was used to clarify left ventricular (LV) geometrical characterization in patients with preserved LV systolic function (diastolic heart failure, DHF). Background. Despite a growing awareness of the importance of DHF, LV geometry has not been characterized in patients with DHF so far. Methods. LV mass index (LVMI) and relative wall thickness (RWTh) were determined in 147 consecutive patients who fulfilled the following inclusion criteria: (1) presence of symptoms of HF, (2) pulmonary arterial systolic pressure that was estimated from continuous-wave Doppler tricuspid regurgitant velocity by applying simplified Bernoulli equation of 35mmHg or greater, and (3) preserved LV ejection fraction (≧0.50). Results. LV geometry showed normal geometry (RWTh<0.41, LVMI<120 g/m2) in 49 patients (33%), concentric remodeling (RWTh≧0.41, LVMI<120 g/m2) in 39 patients (27%), concentric hypertrophy (RWTh≧0.41, LVMI≧120 g/m2) in 35 patients (24%), and eccentric hypertrophy (RWTh<0.41, LVMI≧120 g/m2) in 24 patients (16%). LV concentric geometry was more frequently observed in females than in males (55 vs. 46%). If those of 85 years or older were analyzed, the incidence of concentric remodeling increased to 47% while incidence of eccentric hypertrophy
Brain Control: A Critical Examination of Brain Stimulation and Psychosurgery

The book is best when dealing with laboratory studies, since the author was a behavioral physiologist. The inquisitive reader will find here an introduction to the whole field of electrical stimulation in animals and in man. Dr. Valenstein's comments will help him realize that this field has been harvested by individuals of widely ranging experience, precision, self-criticism, and enthusiasm. The clinical sections are decidedly weaker. Few neurosurgeons will understand the inclusion of the surgical treatment of involuntary movement, epilepsy, and pain under the heading of psychosurgery, which is the surgical treatment of psychiatric illness. Few will agree with the cursory review given these subjects in which the dangers and uncertainties are emphasized without recognition of the happiness experienced by those patients who have thrown off their dyskinesia, their epilepsy, or their intractable pain. The sections on psychosurgery itself receive a more adequate treatment, but the uninformed reader might emerge from
Ocular ischemic syndrome presenting as retinal vasculitis in a patient with moyamoya syndrome.

PURPOSE To report a case of ocular ischemic syndrome presenting as retinal vasculitis in a patient with Moyamoya syndrome. METHODS A retrospective chart review was conducted to record clinical data including fluorescein angiography, optical coherence tomography, and serologic testing. A review of the literature from 1969 to 2014 of ocular involvement in Moyamoya syndrome was performed. RESULTS A 51-year-old woman with long history of bilateral retinal vasculitis and refractory cystoid macular edema was eventually diagnosed with Moyamoya syndrome after sustaining a perioperative cerebrovascular accident. Moyamoya syndrome has been associated in the literature with ocular ischemic syndrome, presenting with narrowed retinal arteries, dilated veins, and midperipheral retinal hemorrhages, but retinal vasculitis with cystoid macular edema has not been reported. CONCLUSION Moyamoya-related ocular ischemic syndrome can present as retinal vascular leakage and macular edema. Ophthalmologists should be cognizant that signs of the disease may be first observed in the eye before manifestations in the cerebrovascular system.
Telephone focus groups in physiotherapy research: Potential uses and recommendations

The use of telephone focus groups as a research approach within health-related qualitative studies is emerging as a method of choice for some researchers. A variety of research applications of the telephone focus group method have been used within health settings over the last 10 years and have typically investigated specific health conditions, training needs, and resource development, as well as health practices and knowledge; these are all issues and contexts applicable to physiotherapy and rehabilitation research. The aim of this review is to explore the use of the telephone focus group methodology, update knowledge on its use in disciplines relevant to physiotherapy, and provide potential users with key information to conduct a telephone focus group. We advocate incorporating recent advances in telephone technology into focus group methodology for physiotherapy and rehabilitation studies, which may benefit from wider geographical representation, increased participation rates, and discussion of sensitive issues. We suggest that the telephone focus group could become a practical and valuable methodology for physiotherapy and rehabilitation researchers.