bluuebunny/crossref_metadata_2025 huggingface dataset:
A Repurposing Approach Identifies Off-Patent Drugs with Fungicidal Cryptococcal Activity, a Common Structural Chemotype, and Pharmacological Properties Relevant to the Treatment of Cryptococcosis
Authors: Butts Arielle , DiDone Louis , Koselny Kristy , Baxter Bonnie K. , Chabrier-Rosello Yeissa , Wellington Melanie , Krysan Damian J.
Published: December 2012

New, more accessible therapies for cryptococcosis represent an unmet clinical need of global importance. We took a repurposing approach to identify previously developed drugs with fungicidal activity toward
Cryptococcus neoformans
, using a high-throughput screening assay designed to detect drugs that directly kill fungi. From a set of 1,120 off-patent medications and bioactive molecules, we identified 31 drugs/molecules with fungicidal activity, including 15 drugs for which direct antifungal activity had not previously been reported. A significant portion of the drugs are orally bioavailable and cross the blood-brain barrier, features key to the development of a widely applicable anticryptococcal agent. Structural analysis of this set revealed a common chemotype consisting of a hydrophobic moiety linked to a basic amine, features that are common to drugs that cross the blood-brain barrier and access the phagolysosome, two important niches of
C. neoformans
. Consistent with their fungicidal activity, the set contains eight drugs that are either additive or synergistic in combination with fluconazole. Importantly, we identified two drugs, amiodarone and thioridazine, with activity against intraphagocytic
C. neoformans
. Finally, the set of drugs is also enriched for molecules that inhibit calmodulin, and we have confirmed that seven drugs directly bind
C. neoformans
calmodulin, providing a molecular target that may contribute to the mechanism of antifungal activity. Taken together, these studies provide a foundation for the optimization of the antifungal properties of a set of pharmacologically attractive scaffolds for the development of novel anticryptococcal therapies.
Using Moxibustion in Primary Healthcare to Correct Non-Vertex Presentation: A Multicentre Randomised Controlled Trial
Authors: Vas Jorge , Aranda-Regules José Manuel , Modesto Manuela , Ramos-Monserrat María , Barón Mercedes , Aguilar Inmaculada , Benítez-Parejo Nicolás , Ramírez-Carmona Carmen , Rivas-Ruiz Francisco
Published: December 2012

Objective

To compare the effectiveness of additional moxibustion at point BL67 with moxibustion at a non-specific acupuncture point and with usual care alone to correct non-vertex presentation.

Methods

This was a multicentre randomised controlled trial in which 406 low-risk pregnant women with a fetus in ultrasound breech presentation, with a gestational age of 33–35 weeks, were assigned to (1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Women were recruited at health centres in primary healthcare.

Results

In the true moxibustion group, 58.1% of the full-term presentations were cephalic compared with 43.4% in the sham moxibustion group (RR 1.34, 95% CI 1.05 to 1.70) and 44.8% of those in the usual care group (RR 1.29, 95% CI 1.02 to 1.64). The reduction in RR of the primary outcome in women allocated to the true moxibustion group compared with the usual care group was 29.7% (95% CI 3.1% to 55.2%) and the number needed to treat was 8 (95% CI 4 to 72). There were no severe adverse effects during the treatment.

Conclusions

Moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. We believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus.

Trial Registration

Current Controlled Trials ISRCTN10634508.
Ataxia telangiectasia: learning from previous mistakes
Authors: Kumar Naveen , Aggarwal Puneet , Dev Nishanth , kumar Gunjan
Published: December 2012

Ataxia telangiectasia is an early onset neurodegenerative disorder. We report a case of childhood onset ataxia and ocular telangiectasia, presenting with pulmonary infection. The patient was diagnosed as ataxia telangiectasia. The patient succumbed to death owing to late diagnosis and sepsis.
Interstitial keratitis and sensorineural hearing loss as a manifestation of rheumatoid arthritis: clinical lessons from a rare complication
Authors: Lee Lennard YW , Akhtar Mohammed Majid , Kirresh Othman , Gibson Terence
Published: December 2012

Cogan's syndrome or non-syphilitic interstitial keratitis with vestibule-auditory dysfunction is a serious and under-recognised complication of rheumatoid arthritis. It is an autoimmune condition characterised by inflammatory infiltrates on the cornea and extensive vestibulocochlear damage. If left untreated, patients progress to develop profound hearing loss. We present a case that was incorrectly diagnosed and treated as conjunctivitis by several emergency departments prior to being correctly recognised as Cogan's syndrome.
Freidreich's ataxia with retained reflexes: a phenotype and genotype correlation
Authors: Verma Rajesh , Gupta Mani
Published: December 2012

An 18-year-old lady had presented to us with insidious onset progressive gait ataxia of 5-year duration. Her sister had similar complaints and type 1 diabetes mellitus. Examination revealed, gait ataxia, impaired tandem gait, babinski sign and severe swaying on testing for Romberg's sign. All deep tendon reflexes were exaggerated. On investigations, there was no evidence for diabetes mellitus or nutritional deficiencies. Electrocardiogram and echocardiogram were normal. Magnetic spine resonance showed marked atrophy of cervical cord with normal cerebellum. The genetic testing disclosed expanded GAA repeat length on both alleles of FXN gene. The GAA repeat length on both alleles was much less than mean length observed in Friedreich's ataxia. This case highlights how strongly the genotype influences the neurological and systemic manifestations as well as severity of disease in Friedreich's ataxia.
Laceration of anterior mitral leaflet postpercutaneous balloon mitral valvuloplasty for rheumatic mitral stenosis
Authors: Jadoon Mehmood , Roberts M J , Dixon L , Jones Mark
Published: December 2012

A 37-year-old Caucasian female with known rheumatic mitral stenosis was admitted for Balloon mitral valvuloplasty which was complicated with a laceration of anterior mitral leaflet (A2 scallop) resulting in severe mitral regurgitation. Intra-aortic balloon pump (IABP) was instituted and the patient was referred for emergency mitral surgery. During surgery anterior mitral leaflet was excised. Most of the posterior leaflet was preserved. Mitral valve was replaced with St Jude mitral mechanical valve. Operation was uneventful and patient's recovery was uncomplicated. Complications associated with mitral valvuloplasty include ventricular perforation, leaflet laceration, rupture of chordae, sepsis, cardiac tamponade and premature ventricular contractions. Torrential mitral regurgitation postvalvuloplasty is a serious, life-threatening complication. Considering the risk of serious complication associated with percutaneous mitral balloon valvuloplasty (PMBV), this procedure should be performed in qualified cardiac catheterisation labs with a backup facility of cardiac surgery to deal with any potential life-threatening complications.
Odontomas—silent tormentors of teeth eruption, shedding and occlusion
Authors: Kulkarni Vinaya Kumar , Deshmukh Jeevanand , Banda Naveen Reddy , Banda Vanaja Reddy
Published: December 2012

Retracted due to duplicate publication.
Miller Fisher syndrome linked to Norovirus infection
Authors: Shimizu Taro , Tokuda Yasuharu
Published: December 2012

This is a case of Miller Fisher syndrome (MFS) linked to the Norovirus syndrome. To our best knowledge, this is the first case report describing MFS associated with Norovirus infection.
Knee function and knee muscle strength in middle-aged patients with degenerative meniscal tears eligible for arthroscopic partial meniscectomy
Authors: Stensrud Silje , Risberg May Arna , Roos Ewa M
Published: December 2012

Background

Functional limitations exist postmeniscectomy, but preoperative data are scarce.

Purpose

To examine knee function, knee muscle strength and performance in middle-aged patients with degenerative meniscal tears, eligible for arthroscopic partial meniscectomy.

Study design

Cross-sectional study.

Methods

Eighty-two participants with MRI verified degenerative meniscal tear (35% women, mean age 49 years) answered the Knee injury and Osteoarthritis Outcome Score (KOOS) and were tested for isokinetic knee muscle strength and lower extremity performance (one-leg hop for distance, 6 m timed hop and maximum number of knee-bends in 30 s). Limb Symmetry Index (LSI) was used to express side-to-side differences in per cent using the non-injured leg as the control. An LSI ≥90% was considered normal.

Results

Mean scores of the five subscales of the KOOS were from 13 to 36 points lower compared with a population-based reference group and similar to patients prior to anterior cruciate ligament reconstruction. Quadriceps strength and lower-extremity performance were impaired for the injured leg compared with the non-injured leg (p<0.001), with a mean difference of 13% in quadriceps strength and between 8% and 13% in lower-extremity performance. Between 41% and 52% of the participants had abnormal LSI values in quadriceps muscle strength and lower-extremity performance.

Conclusion

Middle-aged patients with a symptomatic degenerative meniscal tear experience functional knee problems when eligible for meniscectomy. Included participants reported difficulty with knee pain, symptoms, function and quality of life and quadriceps strength and lower-extremity performance were impaired. Approximately 50% of the study group had clinically relevant impairments in quadriceps strength and lower-extremity performance, defined as >10% differences between the injured and the non-injured leg.
Exposure-adjusted incidence rates and severity of competition injuries in Australian amateur taekwondo athletes: a 2-year prospective study
Authors: Lystad Reidar P , Graham Petra L , Poulos Roslyn G
Published: December 2012

Background/aim

The main purposes of this study were to determine the injury incidence and severity in Australian amateur taekwondo athletes, and to investigate potential risk factors for injury in competition taekwondo.

Methods

Data were collected at New South Wales State Championships in 2010 and 2011. Injuries were diagnosed by onsite sports medicine personnel and the actual number of days lost from full participation was used to determine injury severity. Injury incidence rates were calculated per 1000 athlete-exposures (injury incidence rate (IIRAE)) and per 1000 min of exposure (IIRME) and presented with 95% CI.

Results

The overall IIRAEand IIRMEwere 59.93 (95% CI 51.16 to 69.77) and 16.32 (95% CI 13.93 to 19.00), respectively. Children under 10 years had significantly lower IIRAEcompared with older age groups and black belts had significantly higher IIRAEcompared with yellow belts, however, after accounting for the exposure time it was revealed that 10-year-olds to 14-year-olds and red belts incurred higher IIRME. This study highlights the importance of including IIRs that account for exposure-time. In contrast with previous estimates, the current data indicated that one-third of injuries were moderate to severe. Relative to other body regions the upper limb had a higher proportion of moderate-to-severe injuries, and compared with the lower limb there was a disproportionate number of upper limb injuries resulting in fractures.

Conclusions

The findings suggest that the impact of injury on taekwondo athletes is significant, and should serve as an impetus to stakeholders to develop and implement injury prevention activities within the sport.
Sitting-time and 9-year all-cause mortality in older women
Authors: Pavey Toby G , Peeters GMEE (Geeske) , Brown Wendy J
Published: December 2012

Background

Studies of mid-aged adults provide evidence of a relationship between sitting-time and all-cause mortality, but evidence in older adults is limited. The aim is to examine the relationship between total sitting-time and all-cause mortality in older women.

Methods

The prospective cohort design involved 6656 participants in the Australian Longitudinal Study on Women's Health who were followed for up to 9 years (2002, age 76–81, to 2011, age 85–90). Self-reported total sitting-time was linked to all-cause mortality data from the National Death Index from 2002 to 2011. Cox proportional hazard models were used to examine the relationship between sitting-time and all-cause mortality, with adjustment for potential sociodemographic, behavioural and health confounders.

Results

There were 2003 (30.1%) deaths during a median follow-up of 6 years. Compared with participants who sat <4 h/day, those who sat 8–11 h/day had a 1.45 times higher risk of death and those who sat ≥11 h/day had a 1.65 times higher risk of death. These risks remained after adding sociodemographic and behavioural covariates, but were attenuated after adjustment for health covariates. A significant interaction (p=0.02) was found between sitting-time and physical activity (PA), with increased mortality risk for prolonged sitting only among participants not meeting PA guidelines (HR for sitting ≥8 h/day: 1.31, 95% CI 1.07 to 1.61); HR for sitting ≥11 h/day: 1.47, CI 1.15 to 1.93).

Conclusions

Prolonged sitting-time was positively associated with all-cause mortality. Women who reported sitting for more than 8 h/day and did not meet PA guidelines had an increased risk of dying within the next 9 years.
Development and validation of a questionnaire to measure the severity of functional limitations and reduction of sports ability in German-speaking patients with exercise-induced leg pain
Authors: Nauck Tanja , Lohrer Heinz , Padhiar Nat , King John B
Published: December 2012

Background

Currently, there is no generally agreed measure available to quantify a subject's perceived severity of exercise-induced leg pain symptoms. The aim of this study was to develop and validate a questionnaire that measures the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain.

Methods

The exercise-induced leg pain questionnaire for German-speaking patients (EILP-G) was developed in five steps: (1) initial item generation, (2) item reduction, (3) pretesting, (4) expert meeting and (5) validation. The resulting EILP-G was tested for reliability, validity and internal consistency in 20 patients with exercise-induced leg pain, 20 asymptomatic track and field athletes serving as a population at risk and 33 asymptomatic sport students.

Results

The patient group scored the EILP-G questionnaire significantly lower than both control groups (each p<0.001). Test–retest demonstrates an excellent reliability in all tested groups (Intraclass Correlation Coefficient, ICC=0.861–0.987). Concurrent validity of the EILP-G questionnaire showed a substantial agreement when correlated with the chronic exertional compartment syndrome classification system of Schepsis (r=−0.743; p<0.001). Internal consistency for the EILP-G questionnaire was 0.924.

Conclusions

EILP-G questionnaire is a valid and reliable self-administered and disease-related outcome tool to measure the severity of symptoms that impact on function and sports ability in patients with exercise-induced leg pain. It can be recommended as a robust tool for measuring the subjectively perceived severity in German-speaking patients with exercise-induced leg pain.
Are people who do yoga any better at a motor imagery task than those who do not?
Authors: Wallwork Sarah B , Butler David S , Wilson Dianne J , Moseley G Lorimer
Published: December 2012

Background

Yoga is a popular recreational activity in Western society and there is an abundance of literature suggesting that yoga may be beneficial for people with a chronic pain disorder. Despite consistently positive results in the literature, the mechanisms of effect are unclear. On the grounds that chronic pain is associated with disruptions of brain-grounded maps of the body, a possible mechanism of yoga is to refine these brain-grounded maps. A left/right body part judgement task is an established way of interrogating these brain-grounded maps of the body.

Objective

To determine if people who do regular yoga practice perform better at a left/right judgement task than people who do not.

Methods

Previously collected, cross-sectional data were used. Using a case–control design, participants who reported taking part in regular yoga were selected against age, gender, neck pain and arm pain-matched controls. Participants viewed 40 photographs of a model with their head turned to the left or right, and were asked to judge the direction of neck rotation. They then completed a left/right-hand judgement task.

Results

Of the 1737 participants, 86 of them reported regularly taking part in yoga. From the remaining participants, 86 matched controls were randomly selected from all matched controls. There was no difference between Groups (yoga and no yoga) for either response time (p=0.109) or accuracy (p=0.964). There was a difference between Tasks; people were faster (p<0.001) and more accurate (p=0.001) at making left/right neck rotation judgements than they were at making left/right-hand judgements, regardless of group.

Conclusions

People who do regular yoga perform no differently in a left/right judgement task than people who do not.
The older the better: are elderly study participants more non-representative? A cross-sectional analysis of clinical trial and observational study samples
Authors: Golomb Beatrice A , Chan Virginia T , Evans Marcella A , Koperski Sabrina , White Halbert L , Criqui Michael H
Published: December 2012

Objective

Study participants can differ from the target population they are taken to represent. We sought to investigate whether older age magnifies such differences, examining age-trends, among study participants, in self-rated level of activity compared to others of the same age.

Design

Cross-sectional examination of the relation of participant age to reported ‘relative activity’ (ie, compared to others of the same age), a bidirectionally correlated proxy for relative vitality, in exemplars of randomised and observational studies.

Setting

University of California, San Diego (UCSD)

Participants

2404 adults aged 40–79 including employees of UCSD, and their partners (San Diego Population Study, observational study). 1016 adults (aged 20-85) not on lipid medications and without known heart disease, diabetes, cancer or HIV (UCSD Statin Study, randomised trial).

Measurements

Self-rated activity relative to others’ age, 5-point Likert Scale, was evaluated by age decade, and related via correlation and regression to a suite of health-relevant subjective and objective outcomes.

Results

Successively older participants reported successively greater activity relative to others of their age (greater departure from the norm for their age), p<0.001 in both studies. Relative activity significantly predicted (in regression adjusted for age) actual activity (times/week exercised), and numerous self-rated and objective health-predictors. These included general self-rated health, CES-D (depression score), sleep, tiredness, energy; body mass index, waist circumference, serum glucose, high-density lipoprotein-cholesterol, triglycerides and white cell count. Indeed, some health-predictor associations with age in participants were ‘paradoxical,’ consistent with greater apparent health in older age—for study participants.

Conclusions

Study participants may not be representative of the population they are intended to reflect. Our results suggest that departures from representativeness may be amplified with increasing age. Consequently, the older the age, the greater the disparity may be between what is recommended based on ‘evidence, ’ and what is best for the patient.

Trial Registration

UCSD Statin Study—Clinicaltrials.gov #NCT00330980(http://ClinicalTrials.gov)
Managing waiting times in diagnostic medical imaging
Authors: Nuti Sabina , Vainieri Milena
Published: December 2012

Objective

This paper aims to analyse the variation in the delivery of diagnostic imaging services in order to suggest possible solutions for the reduction of waiting times, increase the quality of services and reduce financial costs.

Design

This study provides a logic model to manage waiting times in a regional context. Waiting times measured per day were compared on the basis of the variability in the use rates of CT and MRI examinations in Tuscany for the population, as well as on the basis of the capacity offered with respect to the number of radiologists available. The analysis was performed at the local health authority level to support the decision-making process of local managers.

Setting

Diagnostic imaging services, in particular the CT and MRI examinations. The study involved all the 12 local health authorities that provide services for 3.7 million inhabitants of the Italian Tuscany Region.

Primary and secondary outcome measures

Participants: the study uses regional administrative data on outpatients and survey data on inpatient diagnostic examinations in order to measure productivity.

Primary and secondary outcome measures

The study uses the volumes per 1000 inhabitants, the days of waiting times and the number of examinations per radiologist. Variability was measured using the traditional SD measures.

Results

A significant variation in areas considered homogeneous in terms of age, gender or mortality may indicate that the use of radiological services is not optimal and underuse or overuse occurs and that there is room for improvement in the service organisation.

Conclusions

Considering that there is a high level of variability among district use rates and waiting times, this study provides managers with a specific tool to find the cause of the problem, identify a possible solution, assess the financial impact and initiate the eventual reduction of waste.
Flemish adolescents’ perceptions of cigarette plain packaging: a qualitative study with focus group discussions
Authors: Van Hal Guido , Van Roosbroeck Sofie , Vriesacker Bart , Arts Matheus , Hoeck Sarah , Fraeyman Jessica
Published: December 2012

Objectives

To find out whether there is a potential impact of the appearance of a plain cigarette package on the smoking perceptions and behavioural intentions of Flemish adolescents.

Design

We performed a cross-sectional study using the qualitative method of focus group discussions.

Setting

Flemish adolescents.

Participants

We performed eight focus group discussions, in which 55 adolescents took part, 32 female and 23 male. Inclusion criteria were: Flemish male and female 15-year-olds to 16-year-olds and 17-year-olds to 18-year-olds attending regular high-school education or vocational training who were current or had ever been smokers.

Outcome measure (planned as well as measured)

The opinions and perceptions of young Flemish smokers regarding the impact of cigarette packaging on their smoking behaviour.

Results

Plain packages are perceived as less attractive, cheap and unreliable for young people. Because of the unattractiveness of the plain packaging, the health warnings catch the eye much more strongly.

Conclusions

In this first scientific study in Flanders on this topic, it emerged that plain packaging could be a strong policy tool to reduce the number of adolescents starting smoking. Validation of these findings by conducting a quantitative survey in the same target group is recommended.
Representativeness of the dabigatran, apixaban and rivaroxaban clinical trial populations to real-world atrial fibrillation patients in the United Kingdom: a cross-sectional analysis using the General Practice Research Database
Authors: Lee Sally , Monz Brigitta U , Clemens Andreas , Brueckmann Martina , Lip Gregory Y H
Published: December 2012

Objective

Three oral anticoagulants have reported study results for stroke prevention in patients with atrial fibrillation (AF) (dabigatran etexilate, rivaroxaban and apixaban); all demonstrated superiority or non-inferiority compared with warfarin (RE-LY, ARISTOTLE and ROCKET-AF). This study aimed to assess the representativeness for the real-world AF population, particularly the population eligible for anticoagulants.

Design

A cross-sectional database analysis.

Setting

Dataset derived from the General Practice Research Database (GPRD).

Primary and secondary outcomes measure

The proportion of real-world patients with AF who met the inclusion/exclusion criteria for RE-LY, ARISTOTLE and ROCKET-AF were compared. The results were then stratified by risk of stroke using CHADS2and CHA2DS2-VASc.

Results

83 898 patients with AF were identified in the GPRD. For the population at intermediate or high risk of stroke and eligible for anticoagulant treatment (CHA2DS2-VASc ≥1; n=78 783 (94%)), the proportion eligible for inclusion into RE-LY (dabigatran etexilate) was 68% (95% CI 67.7% to 68.3%; n=53 640), compared with 65% (95% CI 64.7% to 65.3%; n=51 163) eligible for ARISTOTLE (apixaban) and 51% (95% CI 50.7% to 51.4%; n=39 892) eligible for ROCKET-AF (rivaroxaban). Using the CHADS2method of risk stratification, for the population at intermediate or high risk of stroke and eligible for anticoagulation treatment (CHADS2≥1; n=71 493 (85%)), the proportion eligible for inclusion into RE-LY was 74% (95% CI 73.7% to 74.3%; n=52 783), compared with 72% (95% CI 71.7% to 72.3%; n=51 415) for ARISTOTLE and 56% (95% CI 55.6% to 56.4%; n=39 892) for ROCKET-AF.

Conclusions

Patients enrolled within RE-LY and ARISTOTLE were more reflective of the ‘real-world’ AF population in the UK, in contrast with patients enrolled within ROCKET-AF who were a more narrowly defined group of patients at higher risk of stroke. Differences between trials should be taken into account when considering the applicability of findings from randomised clinical trials. However, assessing representativeness is not a substitute for assessing generalisibility, that is, how well clinical trial results would translate into effectiveness and safety in everyday routine care.
Assessing the knowledge of sudden unexpected death in the young among Canadian medical students and recent graduates: a cross-sectional study
Authors: Huisma Felicity F , Potts James E , Gibbs Karen A , Sanatani Shubhayan
Published: December 2012

Objective

To determine the level of knowledge concerning Sudden Unexpected Death in the Young (SUDY) among Canadian medical students and recent graduates (≤5 years after graduating).

Design

A cross-sectional study was conducted by distributing a standardised, multiple choice, online questionnaire which assessed basic knowledge of SUDY.

Setting

Canadian medical schools and residency training programmes.

Participants

614 Canadian medical students (in either their penultimate or final year) and recent graduates (≤5 years after graduating) completed an anonymous online questionnaire.

Primary and secondary outcome measures

The level of knowledge regarding molecular aetiology, clinical presentation, pharmacological management and modes of inheritance of six of the commonest conditions causing SUDY, including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQT) and Wolff-Parkinson White syndrome (WPW), were compared between medical students and recent graduates. Questions were broken down into basic knowledge and advanced categories and analysed as a secondary outcome measure.

Results

Of 614 responses, approximately two-thirds were answered by recent graduates, who generally scored 10% higher on all subject categories than medical students. Overall, questions regarding HCM were best answered (40%), followed by WPW syndrome (32%), CPVT (30%), ARVC (23%), Brugada syndrome (21%) and LQT syndrome (17%). Questions categorised as basic knowledge were answered 30% and 39% correctly in medical student and recent graduate groups, respectively, and those in the advanced category were answered 20% and 25% correctly.

Conclusions

Survey respondents fared poorly when answering questions regarding SUDY, which may be a reflection of inadequate medical education regarding these disorders. Standardised teaching regarding SUDY needs to occupy a stronger focus in Canadian medical curricula in order to prevent more unnecessary deaths by these syndromes in the future.
Attitudes and beliefs about hand hygiene among paediatric residents: a qualitative study
Authors: Dixit Devika , Hagtvedt Reidar , Reay Trish , Ballermann Mark , Forgie Sarah
Published: December 2012

Background

Despite the knowledge that contaminated hands play an important role in the transmission of healthcare-associated pathogens, and that hand hygiene (HH) reduces the transmission of these organisms, healthcare worker's adherence with HH is poor.

Objective

To understand the common beliefs and attitudes held by paediatric residents about HH.

Design

Qualitative study design.

Setting

Tertiary care paediatric hospital in Edmonton, Canada.

Methods

Semistructured interviews were conducted and themes were identified from interviews.

Participants

22 paediatric residents.

Results

Paediatric residents self-reported their HH adherence at 70–99% and perceived hospital-wide adherence at 45–80%. Four major themes were identified during interviews including the importance of role modelling, balancing time spent on HH with other competing factors, self-protection as a driving factor for HH and cues as an important part of habit that stimulate HH.

Conclusions

Staff physicians were viewed as integral to initiating group HH events, but at times, the first person in the room acted as a role model for the rest of the group. In certain instances, such as a cardiac arrest, decreased adherence with HH was viewed as acceptable. Residents engaged in HH to protect their own health. Residents relied on personal cues, which they integrated into their own HH habit. Future HH adherence strategies should ensure that the physician training environments permit the formation of good attitudes and habits towards HH. There are no additional data available.
Identifying patients with chronic conditions in need of palliative care in the general population: development of the NECPAL tool and preliminary prevalence rates in Catalonia
Authors: Gómez-Batiste Xavier , Martínez-Muñoz Marisa , Blay Carles , Amblàs Jordi , Vila Laura , Costa Xavier , Villanueva Alicia , Espaulella Joan , Espinosa Jose , Figuerola Montserrat , Constante Carles
Published: December 2012

Palliative care (PC) has focused on patients with cancer within specialist services. However, around 75% of the population in middle-income and high-income countries die of one or more chronic advanced diseases. Early identification of such patients in need of PC becomes crucial. In this feature article we describe the initial steps of the NECPAL (Necesidades Paliativas[Palliative Needs]) Programme. The focus is on development of the NECPAL tool to identify patients in need of PC; preliminary results of the NECPAL prevalence study, which assessed prevalence of advanced chronically ill patients within the population and all socio-health settings of Osona; and initial implementation of the NECPAL Programme in the region. As first measures of the Programme, we present the NECPAL tool. The main differences from the British reference tools on which NECPAL is based are highlighted. The preliminary results of the prevalence study show that 1.45% of the total population and 7.71% of the population aged over 65 are ‘surprise question’ positive, while 1.33% and 7.00%, respectively, are NECPAL positive, and surprise question positive with at least one additional positive parameter. More than 50% suffer from geriatric pluri-pathology conditions or dementia. The pilot phase of the Programme consists of developing sectorised policies to improve PC in three districts of Catalonia. The first steps to design and implement a Programme to improve PC for patients with chronic conditions with a public health and population-based approach are to identify these patients and to assess their prevalence in the healthcare system.
Interpreting educational evidence for practice: are autopsies a missed educational opportunity to learn core palliative care principles?
Authors: Yardley Sarah
Published: December 2012

Objectives

UK policy requires undergraduate medical curricula to equip students to care for dying patients. The educational potential of autopsy attendance during authentic early experience to learn about the social context of death and dying has not been fully explored. In this paper the author: (1) explores how meaning is created from autopsies in authentic early experience; (2) compares views of students, curriculum designers and pathology supervisors; and (3) identifies actual/potential learning about death and dying.

Methods

This paper is based on a qualitative study of authentic early experiences situated in a UK medical school. Semistructured interviews were conducted with students in year two (n=12), workplace supervisors (n=2) and curriculum designers (n=13). Narrative analysis was used to contrast empirical data with socio-cultural perspectives on learning. Language and metaphor were used as tools to interpret knowledge construction and meaning-making in addition to a thematic approach.

Results

The autopsy enabled students to learn about death and dying in a social context. Variance between groups in perceptions of autopsy experiences may reduce educational value. Autopsies were considered by students to be opportunities for ‘meeting’ real people, albeit dead ones, and learning from them. Tensions between lay and medical perspectives influenced learning.

Conclusions

Increasing communication and collaboration between medical school curriculum designers and disciplines such as Palliative Medicine as well as Pathology could address concerns regarding student/doctor competencies to deal with death and dying. Further research is needed to evaluate changes in curriculum design and to establish if similar concerns are found in other settings.
Palliative care education in neonatal units: impact on knowledge and attitudes
Authors: Twamley Katherine , Kelly Paula , Moss Rebecca , Mancini Alexandra , Craig Finella , Koh Michelle , Polonsky Reen , Bluebond-Langner Myra
Published: December 2012

Objective

To facilitate improved and earlier access to palliative care for babies, a 4-h workshop on the principles, practice and resources in palliative care was delivered in 21 neonatal units across London. This paper assesses the impact of these workshops.

Design

As part of mixed methods, processual evaluation of a series of education workshops, a pre and post survey instrument was developed, consisting of open and closed questions assessing knowledge of services and attitudes towards palliative care. Before and after each workshop attendees were invited to complete the survey.

Setting

Neonatal units in hospitals across London, including examples of intensive care, high dependency and special care units.

Results

331 healthcare professionals attended the sessions, and 264 (80%) completed questionnaires. The majority of attendees were experienced neonatal nurses working in neonatal intensive care  (61% more than 7 years) but with limited experience of palliative care services. Over 79% of respondents reported that the workshop completely met their learning needs. Post-session 80% of respondents felt confident referring to palliative care services, compared with 46% before (p<0.001). Analysis of open and closed text responses revealed a shift in attitude after the sessions from a focus on dying/end-of-life, towards integrating palliative care as part of a holistic treatment plan.

Conclusions

A short (half day), locally delivered workshop can change attitudes and increase knowledge in neonatal staff. Such a workshop can serve as a first step in facilitating access to and utilisation of a variety of palliative care services.
Medical specialists’ motivations for referral to specialist palliative care: a qualitative study
Authors: Kirby Emma , Broom Alex , Good Phillip , Wootton Julia , Adams Jon
Published: December 2012

Objectives

The decision to refer a patient to palliative care is complex and often highly variable between medical specialists. In this paper, we examine medical specialists’ motivations and triggers underpinning decision-making around referral to palliative care in order to facilitate improvements in referral practices.

Methods

We completed semistructured, qualitative interviews with 20 referring medical specialists. Medical specialists were recruited from a range of specialties in a major metropolitan area in Australia. Participants were sampled through having referred at least one patient to the specialist palliative care unit during the previous 12 months. Analysis consisted of the framework approach augmented by NVivo 9 data analysis software. Key themes were identified and tested for rigour through inter-rater reliability and constant comparison.

Results

The major motivations/triggers identified were: (a) disease-based (eg, pain management and symptom control); (b) pre-emptive/strategic (eg, anticipation of need, preparatory objective); (c) crisis/parallel (eg, physical and psychosocial issues); and (d) team-based (eg, referral as policy/team strategy).

Conclusions

Referral to palliative care is motivated by a range of individual, interpersonal and organisational factors. In order to improve the care and quality of life of patients and family caregivers, further work is needed to develop streamlined practices that are sensitive to physical and psychosocial considerations, and patient/family caregiver desires.
Hypothermia in trauma
Authors: Moffatt Samuel Edwin
Published: December 2012

Hypovolaemic shock that results through traumatically inflicted haemorrhage can have disastrous consequences for the victim. Initially the body can compensate for lost circulating volume, but as haemorrhage continues compensatory mechanisms fail and the patient's condition worsens significantly. Hypovolaemia results in the lethal triad, a combination of hypothermia, acidosis and coagulopathy, three factors that are interlinked and serve to worsen each other. The lethal triad is a form of vicious cycle, which unless broken will result in death. This report will focus on the role of hypothermia (a third of the lethal triad) in trauma, examining literature to assess how prehospital temperature control can impact on the trauma patient. Spontaneous hypothermia following trauma has severely deleterious consequences for the trauma victim; however, both active warming of patients and clinically induced hypothermia can produce particularly positive results and improve patient outcome. Possible coagulopathic side effects of clinically induced hypothermia may be corrected with topical haemostatic agents, with the benefits of an extended golden hour given by clinically induced hypothermia far outweighing these risks. Active warming of patients, to prevent spontaneous trauma induced hypothermia, is currently the only viable method currently available to improve patient outcome. This method is easy to implement requiring simple protocols and contributes significantly to interrupting the lethal triad. However, the future of trauma care appears to lie with clinically induced therapeutic hypothermia. This new treatment provides optimism that in the future the number of deaths resulting from catastrophic haemorrhaging may be significantly lessened.
Diarrhoeal episodes in travellers suffering from IBD
Authors: Ellul Pierre , Fenech Valerie Anne , Azzopardi Christine , Callus Lara , Delicata Nicholas , Muscat Jeffrey , Azzopardi Neville , Vassallo Mario
Published: December 2012

Background and aims

There is limited data on the risk of developing diarrhoea in travelling patients with inflammatory bowel disease (IBD). We analysed the rate of developing diarrhoea among travellers suffering from IBD and their healthy controls.

Methods

We performed a retrospective case-controlled study among 78 patients with IBD and their healthy travelling companion controls, thus matching both groups to the same environmental conditions. Data was retrieved through a structured questionnaire, interview and clinical case notes review.

Results

Sixteen (20.5%) patients with IBD developed diarrhoea while abroad (p −0.0001) Statistical analysis using a χ2test for independence (with Yates Continuity Correction). Prior to travelling, they were in clinical remission. Only one healthy control (1.3%) developed diarrhoea while abroad. In 11 patients (14.1%), the duration of diarrhoea was 3 days or less, and resolved on its own without antibiotics, any increase in their IBD medications and without a medical consultation. The other five patients had a flare-up of their disease and needed medications to put them back into remission. There was no statistically significant difference between patients having immunomodulator medications versus those having aminosalicylates only in developing diarrhoea when abroad.

Conclusions

Patients with IBD have a higher rate of developing diarrhoea compared with controls when travelling. Thus, such patients must always seek a pretravel medical consultation.
Improving access to treatment for patients with chronic hepatitis C through outreach
Authors: Elsharkawy Ahmed Mohamed , Miller Carolyn , Hearn Andrea , Buerstedde Gertrud , Price Ashley , McPherson Stuart
Published: December 2012

Background

Chronic hepatitis C infection (HCV) is common in injecting drug users and is a major cause of liver disease. Antiviral treatment can ‘cure’ HCV, but is frequently associated with side effects and requires regular monitoring. Non-attendance at hospital appointments is frequent. To try and improve attendance and increase the number of current and previous injecting drug users treated we developed three outreach clinics.

Objective

To review the outcome of patients referred to the outreach clinics.

Methods

Retrospective service review of three clinics at drug treatment centres in Newcastle and Northumberland. Data was collected on attendance rates, patient demographics, treatment rates and outcomes.

Results

141 referrals were received across the three sites with an overall attendance rate of 75% (106 patients, 79% men and median age 36), which compared favourably with that at our hospital (50%). All patients were on methadone/subutex. 45% were infected with Genotype 1 HCV. 10% were cirrhotic. To date, 30% have started treatment and 21% are waiting to start or are still in workup. 13% elected to delay treatment due to early stage disease and 11% were not ready for treatment on psychological or social grounds. Only 12% failed to attend follow up after initial assessment. To date, 24 patients have completed full courses of treatment with sustained viral response in 13 patients. Results are awaited for seven patients.

Conclusions

The development of outreach clinics for HCV in drug treatment centres can substantially improve clinic attendance and increase access to treatment in this marginalised group.
Uptake and continuation rates of the intrauterine system in a university student general practice population in the UK
Authors: Armitage Catherine Marie , Mitchell Carolyn , Wigan Caroline , Smith Debbie A
Published: December 2012

Objective

To follow a series of 100 women attending for fitting of the levonorgestrel-releasing intrauterine system (LNG IUS) registered at a single urban general practice serving the students of the local universities and higher education colleges.

Methods

This was a prospective observational study. A questionnaire was completed by the fitter in discussion with the patient at the time of attendance for IUS fitting. Follow up was by telephone at 6 weeks, 6 months and 9–12 months after fitting.

Results

The age range of women within the series was 18–38 years. 97 women were nulliparous. 37 women selected the IUS as their preferred method of contraception. 12 women chose the IUS primarily for non-contraceptive reasons. 75 women still had the IUS at 12 months’ follow up with 11 lost to follow up at this point. No pregnancies or perforations were reported.

Conclusions

The IUS is an acceptable form of contraception in young women, including nulliparous women, and should be offered alongside other methods as first line without restriction when offering contraceptive options to this age group.
Circulating endothelial cells as potential diagnostic biomarkers in primary central nervous system vasculitis
Authors: Deb-Chatterji Milani , Gerdes Stefan , Heeren Meike , Lambrecht Jürgen , Worthmann Hans , Goldbecker Annemarie , Tryc Anita Blanka , Lovric Svjetlana , Schulz-Schaeffer Walter , Brandis Almuth , Dengler Reinhard , Weissenborn Karin , Haubitz Marion
Published: December 2012

Objective

Histological evidence is considered the only proof of primary central nervous system vasculitis (PCNSV). However, brain biopsy is often omitted or delayed because of the invasiveness and possible complications of the procedure. Circulating endothelial cells (CEC) were shown to be elevated in patients with active antineutrophil cytoplasmic antibody-associated vasculitis. We hypothesise that CEC are also elevated in patients with active PCNSV and may contribute to the diagnosis.

Methods

CEC were assessed in 18 patients, 3 of whom had biopsy-proven PCNSV and 15 clinical, cerebrospinal fluid and imaging data, highly suggestive of PCNSV. In 3 of these 15 patients CEC assessment was performed after initiation of successful immunosuppressive therapy. CEC numbers of all patients were compared to those of 16 healthy volunteers and 123 subjects with cerebrovascular risk factors and/or ischaemic stroke, who had been studied in our group before. CEC were assessed by immunomagnetic isolation from peripheral blood.

Results

In patients with proven and suspected active PCNSV, CEC were extremely elevated (>400 cells/ml in most of the patients) and significantly higher than in healthy and disease controls (p≤0.01 for each group). CEC significantly decreased with immunosuppressive treatment.

Conclusions

For the first time it is shown that CEC are significantly elevated in patients with active PCNSV in contrast to other pathologies associated with brain infarction and correlate with disease activity. Sensitivity and specificity of the method for diagnosing PCNSV and the use of the method for treatment monitoring should be addressed in future prospective studies with a larger patient group.
Mechanical revascularization of acute iatrogenic anterior cerebral artery occlusions: use of a new coaxial dual-lumen balloon catheter results in rapid access and flow restoration
Authors: James Robert F , Lamm John Richard , Kanaan Hilal A
Published: December 2012

Acute iatrogenic occlusion of cerebral vessels is a risk during the performance of neuroendovascular procedures. Most commonly this is a result of thrombus formation within the vessel, thromboembolism or an acute vasospastic response. There are several options for flow restoration including pharmacological, mechanical and microsurgical. Mechanical flow restoration, usually by thrombectomy, is typically performed in large cerebral vessels. Current mechanical thrombectomy devices have limited utility in smaller vessels that are more difficult to access, such as the anterior cerebral artery (ACA). We present two cases where successful flow restoration of an intraoperative acutely occluded or thrombotic ACA was rapidly achieved by balloon dilation using a new coaxial dual-lumen balloon catheter. The time elapsed from the decision to use the balloon catheter until revascularization for each patient was 5 min and 46 s (case 1) and 10 min and 25 s (case 2).