bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Function and Use of Common Spaces in Assisted Living for Older Persons
Authors: Andersson Morgan , Ryd Nina , Malmqvist Inga
Published: February 2015

OBJECTIVE:

This exploratory study examines the function and use of common spaces in assisted living facilities (ALFs) from the residential and workplace perspectives.

BACKGROUND:

The impact of the physical environment on human activities in healthcare settings has been emphasized in many studies. Few studies, however, have explored the daily use of common spaces and the impact on the usability of ALFs.

METHODS:

Four explorative methods–observation, group interviews, individual interviews, and questionnaires—were used to investigate 14 ALFs in Sweden. The study involves residents, staff, relatives, architects, and people responsible for planning and construction of eldercare. This research strategy combines quantitative and qualitative methods to enhance the validity of the results. Method triangulation and data triangulation were used and the data were analyzed using Qualitative Content Analysis (QCA).

RESULTS:

The results show that residents and staff have different objectives for use and these differences affect usability, although explicit conflicts are rare. The residents, staff, and other stakeholders have different views about the demarcation of home and workplace and the role of common spaces as venues for social interaction.

CONCLUSIONS:

Both the residential and the workplace perspective must be considered when planning assisted living facilities. Otherwise, inherent conflicts between these perspectives will manifest as a result of the physical design. Common spaces have diverse functions that are reflected in their spatial organization. Therefore, ALFs should be designed so the intended function of a specific space is apparent to all users.
The Legacy of Florence Nightingale's Environmental Theory: Nursing Research Focusing on the Impact of Healthcare Environments
Authors: Zborowsky Terri
Published: February 2015

OBJECTIVE:

The purpose of this paper is to explore nursing research that is focused on the impact of healthcare environments and that has resonance with the aspects of Florence Nightingale's environmental theory.

BACKGROUND:

Nurses have a unique ability to apply their observational skills to understand the role of the designed environment to enable healing in their patients. This affords nurses the opportunity to engage in research studies that have immediate impact on the act of nursing.

METHODS:

Descriptive statistics were performed on 67 healthcare design-related research articles from 25 nursing journals to discover the topical areas of interest of nursing research today. Data were also analyzed to reveal the research designs, research methods, and research settings. These data are part of an ongoing study.

RESULTS:

Descriptive statistics reveal that topics and settings most frequently cited are in keeping with the current healthcare foci of patient care quality and safety in acute and intensive care environments. Research designs and methods most frequently cited are in keeping with the early progression of a knowledge area.

CONCLUSIONS:

A few assertions can be made as a result of this study. First, education is important to continue the knowledge development in this area. Second, multiple method research studies should continue to be considered as important to healthcare research. Finally, bedside nurses are in the best position possible to begin to help us all, through research, understand how the design environment impacts patients during the act of nursing.
The Impact of Windows and Daylight on Acute-Care Nurses' Physiological, Psychological, and Behavioral Health
Authors: Zadeh Rana Sagha , Shepley Mardelle McCuskey , Williams Gary , Chung Susan Sung Eun
Published: February 2015

OBJECTIVE:

To investigate the physiological and psychological effects of windows and daylight on registered nurses.

BACKGROUND:

To date, evidence has indicated that appropriate environmental lighting with characteristics similar to natural light can improve mood, alertness, and performance. The restorative effects of windows also have been documented. Hospital workspaces generally lack windows and daylight, and the impact of the lack of windows and daylight on healthcare employees' well being has not been thoroughly investigated.

METHODS:

Data were collected using multiple methods with a quasi-experimental approach (i.e., biological measurements, behavioral mapping, and analysis of archival data) in an acute-care nursing unit with two wards that have similar environmental and organizational conditions, and similar patient populations and acuity, but different availability of windows in the nursing stations.

RESULTS:

Findings indicated that blood pressure ( p < 0.0001) decreased and body temperature increased ( p = 0.03). Blood oxygen saturation increased ( p = 0.02), but the difference was clinically insignificant. Communication ( p < 0.0001) and laughter ( p = 0.03) both increased, and the subsidiary behavior indicators of sleepiness and deteriorated mood ( p = 0.02) decreased. Heart rate ( p = 0.07), caffeine intake ( p = 0.3), self-reported sleepiness ( p = 0.09), and the frequency of medication errors ( p = 0.14) also decreased, but insignificantly.

CONCLUSIONS:

The findings support evidence from laboratory and field settings of the benefits of windows and daylight. A possible micro-restorative effect of windows and daylight may result in lowered blood pressure and increased oxygen saturation and a positive effect on circadian rhythms (as suggested by body temperature) and morning sleepiness.
Effects of Environmental Design on Patient Outcome: A Systematic Review
Authors: Laursen Jannie , Danielsen Anne , Rosenberg Jacob
Published: February 2015

OBJECTIVE:

The aim of this systematic review was to assess how inpatients were affected by the built environment design during their hospitalization.

BACKGROUND:

Over the last decade, the healthcare system has become increasingly aware of how focus on healthcare environment might affect patient satisfaction. The focus on environmental design has become a field with great potential because of its possible impact on cost control while improving quality of care.

METHODS:

A systematic literature search was conducted to identify current and past studies about evidence-based healthcare design. The following databases were searched: Medline/PubMed, Cinahl, and Embase. Inclusion criteria were randomized clinical trials (RCTs) investigating the effect of built environment design interventions such as music, natural murals, and plants in relation to patients' health outcome.

RESULTS:

Built environment design aspects such as audio environment and visual environment had a positive influence on patients' health outcomes. Specifically the studies indicated a decrease in patients' anxiety, pain, and stress levels when exposed to certain built environment design interventions.

CONCLUSIONS:

The built environment, especially specific audio and visual aspects, seems to play an important role in patients' outcomes, making hospitals a better healing environment for patients.
Space Planners' Perception of an Assessment Instrument for Briefs in the Pre-Design Phase of New Healthcare Environments
Authors: Elf Marie , Wijk Helle
Published: February 2015

OBJECTIVE:

The main purpose of the study was to investigate the usability of a newly developed instrument designed to assess the content and quality briefs (CQB-I) in programs for new healthcare environments. We studied the perception of using the instrument on a group of space planners.

BACKGROUND:

The study is part of a larger project designed to ensure the quality of the planning of new healthcare environments with a focus on documents (programs or briefs) created in the early phases of the planning process. In this study, we used an instrument that measures the clarity of the mission statement for the project based on user needs and care activities that will take place in the new healthcare environment. The instrument further evaluates whether there are clear patient-related outcome measures specified and whether the information in the documents is person-oriented and evidence-based.

METHODS:

The study used a mixed-method design where the relevance and usability of the instrument was estimated and a focus group interview was conducted.

RESULTS:

The study showed that a CQB-I is perceived to be a relevant instrument primarily as a guide for programming, but also for monitoring the produced programs.

CONCLUSIONS:

Instruments like CQB-I can help to bring research results into planning and contribute to dialogue and collaboration in the early phases of a planning process by orienting planning participants to user needs and facilitating the discussion and articulation of clear performance indicators.
Design Characteristics of Acute Care Units in China
Authors: Lu Yi , Wang Yijia
Published: February 2015

OBJECTIVE:

To describe the current state of design characteristics of acute care units in China's public hospitals and compare these with characteristics with acute care units in the United States.

BACKGROUND:

The healthcare construction industry in China is one of the fastest growing sectors in China and, arguably, in the world. Understanding the physical design of acute care units in China is of great importance because it will influence a large population.

METHODS:

Descriptive study was performed of unit configuration, size, patient visibility, distance to nursing station and supplies, and lighting conditions in 25 units in 19 public hospitals built after 2003. Data and information were collected based on spatial and visibility analysis.

RESULTS:

The study identified major design characteristics of the recently built (from 2003 onward) acute care units in China, comparing them, where appropriate, with those in U.S. It found there are three dominant types of unit layout: single-corridor (52%), triangular (36%), and double-corridor (12%). The number of private rooms is very low (11%), compared with two- or three-bed rooms. Centralized nursing stations are the only type of nurses' working area. China also has a large unit size in terms of number of patient beds. The average number of patient beds in a unit is 40.6 in China (versus 32.9 in U.S.). The care units in China have longer walking distance from nursing station to patient bedside. The percentage of beds visible from a nursing station is lower in China than in the U.S. The access to natural light and direct sunlight in patient rooms is greater in China compared with those in U.S.—100% of patient rooms in China have natural lighting. A majority of them face south or southeast and thus receiving direct sunlight (91.4%).

CONCLUSIONS:

Because of the differences in economies and building codes, there are dramatic differences between the spatial characteristics of acute care units in China and the United States.
Impact of the Design of the Built Environment on People with Dementia: An Evidence-Based Review
Authors: Marquardt Gesine , Bueter Kathrin , Motzek Tom
Published: February 2015

OBJECTIVE:

In this review the impact of the design of the built environment on people with dementia in long-term care settings is systematically analyzed and summarized. Architects and designers will be provided with credible evidence on which they can confidently base their design decisions. Researchers will be able to determine which environmental aspects have been well investigated and where there are gaps in the current state of the research.

BACKGROUND:

A great number of studies have established a relationship between the design of the physical environment of long-term care settings and outcomes of people with dementia. However, the methods employed are heterogeneous and the results are often conflicting. Consequently, the process of integrating the best evidence available into architectural designs may be hindered.

METHODS:

A systematic literature search was conducted reviewing studies that meet certain inclusion criteria. Using an evidence-based approach, the methodical quality of the studies was rated.

RESULTS:

One hundred sixty-nine studies were found. They were thematically summarized into four main categories: basic design decisions, environmental attributes, ambience, and environmental information. The effectiveness of the interventions on the behavior, cognition, function, well being, social abilities, orientation, and care outcomes on people with dementia was illustrated by matrices.

CONCLUSIONS:

Results of this review indicate that, with the exception of cognition, specific design interventions are beneficial to the outcomes of people with dementia. Overall, the field of environmental design for people with dementia is well researched in many aspects and only few gaps in knowledge were identified.
Assessing the Physical Service Setting
Authors: Steinke Claudia
Published: February 2015

Objective:

To determine the attributes of the physical setting that are important for developing a positive service climate within emergency departments and to validate a measure for assessing physical service design.

Background:

The design of the physical setting is an important and contributing factor for creating a service climate in organizations. Service climate is defined as employee perceptions of the practices, procedures, and behaviors that get rewarded, supported, and expected with regard to customer service and customer service quality. There has been research conducted which identifies antecedents within organization that promotes a positive service climate which in turn creates service-oriented behaviors by employees toward clients. The antecedent of the physical setting and its impact on perceptions of service climate has been less commonly explored.

Methods:

Using the concept of the physical service setting (which may be defined as aspects of the physical, built environment that facilitate the delivery of quality service), attributes of the physical setting and their relationship with service climate were explored by means of a quantitative paper survey distributed to emergency nurses ( n = 180) throughout a province in Canada.

Results:

The results highlight the validity and reliability of six scales measuring the physical setting and its relation to service. Respondents gave low ratings to the physical setting of their departments, in addition to low ratings of service climate.

Conclusions:

Respondents feel that the design of the physical setting in the emergency departments where they work is not conducive to providing quality service to clients. Certain attributes of the physical setting were found to be significant in influencing perceptions of service climate, hence service quality, within the emergency department setting.
An Exploration of the Nightstand and Over-the-Bed Table in an Inpatient Rehabilitation Hospital
Authors: Healy Stan , Manganelli Joe , Rosopa Patrick J. , Brooks Johnell O.
Published: February 2015

Objective:

This study seeks to determine where patients in a rehabilitation hospital keep the greatest percentage of their belongings, that is, in/on the nightstand or on the over-the-bed table.

Background:

This study provides an inventory of patient items located on the over-the-bed table and in/on the nightstand. Understanding the functions of furnishings within the patient room is key for future preparation for designing a next-generation over-the-bed table or for redesigning a more useful nightstand.

Methods:

The contents on the top of the nightstand; the contents in the top, middle, and bottom drawers of the nightstand; items next to the nightstand; and the contents on the over-the-bed table within patient rooms were inventoried and placed into categories using similar, patient item categories as the Brooks et al. (2011) study, which examined the contents of the nightstand and the over-the-bed table in assisted living and skilled nursing facilities.

Results:

Overall, patients in a rehabilitation hospital had a greater percentage of their belongings on the top of the nightstand as compared to their belongings located in all three combined drawers of the nightstand. Overall, patients had a greater percentage of their belongings located on the over-the-bed table as compared to their belongings located on the nightstand.

Conclusions:

Tabletop surface area was used extensively in patient rooms at a rehabilitation hospital, but nightstand drawers were underutilized.
Ambient Versus Traditional Environment in Pediatric Emergency Department
Authors: Robinson Patricia S. , Green Jeanette
Published: February 2015

Objective:

We sought to examine the effect of exposure to an ambient environment in a pediatric emergency department. We hypothesized that passive distraction from ambient lighting in an emergency department would lead to reduction in patient pain and anxiety and increased caregiver satisfaction with services.

Background:

Passive distraction has been associated with lower anxiety and pain in patients and affects perception of wait time. A pediatric ED was designed that optimized passive distraction techniques using colorful ambient lighting.

Methods:

Participants were nonrandomly assigned to either an ambient ED environment or a traditional ED environment. Entry and exit questionnaires assessed caregiver expectations and experiences. Pain ratings were obtained with age-appropriate scales, and wait times were recorded.

Results:

A total of 70 participants were assessed across conditions, that is, 40 in the ambient ED group and 30 in the traditional ED group. Caregivers in the traditional ED group expected a longer wait, had higher anxiety pretreatment, and felt more scared than those in the ambient ED group. Caregivers in the ambient ED group felt more included in the care of their child and rated quality of care higher than caregivers in the traditional ED group. Pain ratings and administrations of pain medication were lower in the ambient ED group.

Conclusions:

Mean scores for the ambient ED group were in the expected direction on several items measuring satisfaction with ED experiences. Results were suggestive of less stress in caregivers, less pain in patients, and higher satisfaction levels in the ambient ED group.
An Empirical Examination of the Impacts of Decentralized Nursing Unit Design
Authors: Pati Debajyoti , Harvey Thomas E. , Redden Pamela , Summers Barbara , Pati Sipra
Published: February 2015

Objective:

The objective of the study was to examine the impact of decentralization on operational efficiency, staff well-being, and teamwork on three inpatient units.

Background:

Decentralized unit operations and the corresponding physical design solution were hypothesized to positively affect several concerns—productive use of nursing time, staff stress, walking distances, and teamwork, among others. With a wide adoption of the concept, empirical evidence on the impact of decentralization was warranted.

Methods:

A multimethod, before-and-after, quasi-experimental design was adopted for the study, focusing on five issues, namely, (1) how nurses spend their time, (2) walking distance, (3) acute stress, (4) productivity, and (5) teamwork. Data on all five issues were collected on three older units with centralized operational model (before move). The same set of data, with identical tools and measures, were collected on the same units after move in to new physical units with decentralized operational model. Data were collected during spring and fall of 2011.

Results:

Documentation, nurse station use, medication room use, and supplies room use showed consistent change across the three units. Walking distance increased (statistically significant) on two of the three units. Self-reported level of collaboration decreased, although assessment of the physical facility for collaboration increased.

Conclusions:

Decentralized nursing and physical design models potentially result in quality of work improvements associated with documentation, medication, and supplies. However, there are unexpected consequences associated with walking, and staff collaboration and teamwork. The solution to the unexpected consequences may lie in operational interventions and greater emphasis on culture change.
“Doesn’t Anyone Believe How I Feel?”
Authors: Uhrich Alice E. , Hartung Sheila Q.
Published: February 2015

The school nurse is often the first person with whom a student may discuss untoward health symptoms and concerns. Being cognizant of the clinical features of postural orthostatic tachycardia syndrome (POTS) will help the nurse alleviate some of the student’s anxiety. Due to misunderstandings and misconceptions about POTS, family and peers may disbelieve a student who is experiencing symptoms. Displaying compassion and support will help the student understand that someone does believe his or her symptoms. As the student’s advocate, the school nurse will champion a plan for the student’s health and safety in the academic environment.
Leukemia in Children
Authors: Wessler Jacob M.
Published: February 2015

Cancer is the leading cause of death by disease past infancy. In 2014, nearly 16,000 children and adolescents 0 to 19 years of age will be diagnosed with cancer in the United States. More than 80% of those children will survive at least 5 years after their diagnosis. Much of the increase in survival has been seen in children diagnosed with acute lymphoblastic leukemia (ALL). Once cancer treatment ends, the real battle begins. Getting back to school helps cancer patients return to normal. Part 1 is a brief review of the diagnosis, prognosis, and treatment of ALL in children and adolescents with an introduction to Philadelphia chromosome positive ALL and is written in language that makes it ideal for use in teaching school personnel and other parents about ALL. Part 2 is a reflection of Abby Furco’s transition to school after being diagnosed with this type of leukemia at 4 1/2 years of age. The accommodations and strategies employed for this student are likely to be useful and adaptable to assist other families and school communities as they work with children entering school with physical challenges.
Engineering Exchanges
Authors: Hall William M. , Schmader Toni , Croft Elizabeth
Published: February 2015

Efforts to promote women in science, technology, engineering, and math (STEM) require a clearer understanding of the experience of social identity threat outside academic contexts. Although social identity threat has been widely studied among students, very little research has examined how the phenomenon occurs naturalistically among working professionals in ways that could undermine productivity and well-being. The present research employed daily diary methodology to examine conversations with colleagues as triggers of social identity threat among a sample of 44 male and 52 female working engineers. Results of multilevel modeling revealed that (1) women (but not men) reported greater daily experiences of social identity threat on days when their conversations with male (but not female) colleagues cued feelings of incompetence and a lack of acceptance, and (2) these daily fluctuations of social identity threat predicted daily levels of mental exhaustion and psychological burnout. The implications for social identity threat in working professionals are discussed.
Targeting polo-like kinase 1 in acute myeloid leukemia
Authors: Brandwein Joseph M.
Published: February 2015

Polo-like kinase 1 (Plk1) plays a number of important roles in the passage of cells through mitosis. It is expressed at high levels in a variety of malignancies, including acute myeloid leukemia (AML). Inhibition of Plk1 results in cell cycle arrest and apoptosis, and has anti-tumor effects in pre-clinical models. A number of Plk1 inhibitors have been developed, some of which have entered clinical trials. Of these, volasertib (BI6727) has been most extensively studied clinically in AML. Volasertib has demonstrated antileukemic activity in AML, both as a single agent and when combined with low-dose cytarabine. It is well tolerated, with the major toxicity being reversible myelosuppression. A recently completed phase III clinical trial in older AML patients will address the question of whether adding this agent to low-dose cytarabine is associated with a survival advantage.
Possible confounding factors on cerebral diffusion tensor imaging measurements
Authors: Nenonen Miina , Hakulinen Ullamari , Brander Antti , Ohman Juha , Dastidar Prasun , Luoto Teemu M
Published: February 2015

Background

Diffusion tensor imaging (DTI) is prone to numerous systemic confounding factors that should be acknowledged to avoid false conclusions.

Purpose

To investigate the possible effects of age, gender, smoking, alcohol consumption, and education on cerebral DTI parameters in a generally healthy homogenous sample with no neurological or psychiatric diseases.

Material and Methods

Forty ( n = 40) subjects (mean age, 40.3 years; SD, 12.3) underwent brain DTI with 3 T magnetic resonance imaging (MRI). At enrolment, all the subjects were interviewed with respect to general health, education, history of smoking, and alcohol consumption. Studied DTI parameters included: (i) fractional anisotropy (FA); and (ii) apparent diffusion coefficient (ADC). Region-of-interest (ROI)-based measurements were estimated at 13 anatomical locations bilaterally on the axial images, except for the corpus callosum in which the ROIs were placed on the sagittal images. Circular ROI measurements were mainly used. Freehand ROI method was used with the forceps minor, uncinate fasciculus, and thalamus. Intra-observer variability and repeatability were assessed.

Results

The most consistent finding was that aging decreased FA values in the frontal brain regions. Regarding the other confounding factors, the results were discontinuous and no concrete conclusions could be drawn from these findings. In general, intra-observer repeatability of the DTI measurement was considered relatively good.

Conclusion

Age should be noted as considerable confounding factors in ROI-based DTI analysis. More research on the effects of gender, smoking, alcohol consumption, and education is needed.
Adult onset asynchronous multifocal eosinophilic granuloma of bone: an 11-year follow-up
Authors: Dallaudière Benjamin , Kerger Joseph , Malghem Jacques , Galant Christine , Lecouvet Frederic E
Published: February 2015

Multifocal eosinophilic granuloma (EG) is a rare observation within the spectrum of histiocytosis X, generally described in children. We report the case of a 33-year-old man with multifocal EG showing an asynchronous evolution of bone lesions during a follow-up of 11 years. We also present the therapeutic approach chosen for this patient and the repeated magnetic resonance imaging (MRI) examinations used to monitor the disease with a final favorable outcome.
Intra-individual comparison of PET/CT with different body weight-adapted FDG dosage regimens
Authors: Geismar Jan H , Stolzmann Paul , Sah Bert-Ram , Burger Irene A , Seifert Burkhardt , Delso Gaspar , von Schulthess Gustav K , Veit-Haibach Patrick , Husmann Lars
Published: February 2015

Background

18F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET)/ computed tomography (CT) imaging demands guidelines to safeguard sufficient image quality at low radiation exposure. Various FDG dose regimes have been investigated; however, body weight-adapted dose regimens and related image quality (IQ) have not yet been compared in the same patient.

Purpose

To investigate the relationship between FDG dosage and image quality in PET/CT in the same patient and determine prerequisites for low dosage scanning.

Material and Methods

This study included 61 patients undergoing a clinically indicated PET/CT imaging study and follow-up with a normal (NDS, 5 MBq/kg body weight [BW]) and low dosage scanning protocol (LDS, 4 MBq/kg BW), respectively, using a Discovery VCT64 scanner. Two blinded and independent readers randomly assessed IQ of PET using a 5-point Likert scale and signal-to-noise ratio (SNR) of the liver.

Results

Body mass index (BMI) was significantly lower at LDS ( P = 0.021) and represented a significant predictor of SNR at both NDS ( P < 0.001) and LDS ( P = 0.005). NDS with a mean administered activity of 340 MBq resulted in significantly higher IQ ( P < 0.001) and SNR as compared with LDS with a mean of 264 MBq (F-value = 23.5, P < 0.001, mixed model ANOVA adjusted for covariate BMI). Non-diagnostic IQ at LDS was associated with a BMI > 22 kg/m2.

Conclusion

FDG dosage significantly predicts IQ and SNR in PET/CT imaging as demonstrated in the same patient with optimal IQ achieved at 5 MBq/kg BM. PET/CT imaging at 4 MBq/kg BW may only be recommended in patients with a BMI ≤ 22 kg/m2 to maintain diagnostic IQ.
Comparison of gadoxetic acid and gadopentetate dimeglumine-enhanced MRI for HCC detection: prospective crossover study at 3 T
Authors: Besa Cecilia , Kakite Suguru , Cooper Nancy , Facciuto Marcelo , Taouli Bachir
Published: February 2015

Background

Gadoxetic acid and gadopentetate dimeglumine are gadolinium-based contrast agents (GBCAs) with an established role in HCC detection and characterization.

Purpose

To compare gadopentetate dimeglumine and gadoxetic acid-enhanced magnetic resonance imaging (MRI) for image quality and hepatocellular carcinoma (HCC) detection/conspicuity.

Material and Methods

In this IRB approved cross-over pilot prospective study, 12 patients (all men; mean age, 56 years) with chronic liver disease at risk of HCC underwent two repeat MRI examinations using gadopentetate dimeglumine and gadoxetic acid (mean interval between studies, 5 days). Two independent observers analyzed images for image quality and HCC detection/conspicuity. Per-lesion sensitivity, positive predictive value, quantitative enhancement, and lesion-to-liver contrast ratio were calculated for both contrast agents.

Results

There was no significant difference in image quality scores between both GBCAs ( P = 0.3). A total of 20 HCCs were identified with reference standard in 12 patients (mean size 2.6 cm, range, 1.0–5.0 cm). Higher sensitivity was seen for observer 1 for gadoxetic acid-set in comparison with gadopentetate dimeglumine-set (sensitivity increased from 85.7% to 92.8%), while no difference was noted for observer 2 (sensitivity of 78.5%). Lesion conspicuity was significantly higher on hepatobiliary phase (HBP) images compared to arterial phase images with both GBCAs for both observers ( P < 0.05). Lesion-to-liver contrast ratios were significantly higher for HBP compared to all dynamic phases for both agents ( P < 0.05).

Conclusion

Our initial experience suggests that gadoxetic acid-set was superior to gadopentetate dimeglumine-set in terms of HCC detection for one observer, with improved lesion conspicuity and liver-to-lesion contrast on HBP images.
Autonomic dysfunction independently predicts poor cardiovascular outcomes in asymptomatic individuals with type 2 diabetes in the DIAD study
Authors: Chyun Deborah A , Wackers Frans JTh , Inzucchi Silvio E , Jose Powell , Weiss Curtis , Davey Janice A , Heller Gary V , Iskandrian Ami E , Young Lawrence H ,   for the DIAD Investigators
Published: February 2015

Objective:

The primary aim of this secondary analysis was to determine whether cardiac autonomic neuropathy independently predicted adverse cardiac outcomes in asymptomatic individuals with type 2 diabetes. Additional aims include the determination of the correlation of standard autonomic testing measures and power spectral analysis of heart rate variability, and the association of diabetes-related and cardiac risk factors with cardiac autonomic neuropathy measures.

Methods:

Cardiac autonomic neuropathy was assessed at the study entry into the Detection of Ischemia in Asymptomatic Diabetics study, using autonomic heart rate and blood pressure testing, and power spectral analysis of heart rate variability. All participants were prospectively followed for the composite clinical outcome of cardiac death, acute coronary syndromes, heart failure, or coronary revascularization.

Results:

Over 5 years of follow-up, 94 of 1119 (8.4%) subjects developed symptomatic cardiac disease. In unadjusted bivariate analyses, abnormalities in several cardiac autonomic neuropathy tests, including lower Valsalva and Standing Heart Rate Ratios, higher resting Heart Rate, greater systolic blood pressure decrease on standing, and lower low-frequency power, were predictive of symptomatic disease. Independent predictors of poor cardiac outcome were a lower Valsalva Heart Rate Ratio, non-Black ethnicity, longer diabetes duration, higher glycated hemoglobin (HbA1c), insulin use, reported numbness in the extremities, higher pulse pressure, family history of coronary artery disease, and higher waist-to-hip ratio. Clinical factors independently associated with a lower Valsalva Heart Rate Ratio were insulin use, clinical proteinuria, higher pulse pressure, use of angiotensin-converting enzyme inhibitor and non-Black ethnicity.

Conclusion:

Cardiac autonomic neuropathy predicted adverse cardiac outcomes in asymptomatic type 2 diabetes without known cardiac disease. Clinical variables may help to identify patients who might have cardiac autonomic neuropathy and warrant consideration for autonomic testing.
Obesity indices as predictors of pattern of self-reported arthritis among elderly women in Southwestern Nigeria
Authors: Adebimpe Wasiu O , Omobuwa Olubukunola , Omisore Akinlolu G , Adeoye Oluwatosin
Published: February 2015

Objectives:

This study assessed obesity indices and pattern of arthritis among elderly women in Osun State, Southwestern Nigeria.

Methods:

The cross-sectional descriptive study was carried out among 350 elderly women selected by multistage sampling technique. Research instruments used in data collection were semi-structured, interviewer-administered pre-tested questionnaires that were analyzed using the Statistical Package for Social Sciences software version 17.0.

Results:

The mean age of the participants was 69.1 (±1.4) years. A total of 232 (66.3%) of them had complaints of joint pains ( Awoka as expressed in the local language). Pattern of arthritis showed that 172 (74.0%) had recurrent joint pains, while 35 (15.1%) had joint swelling; the knee joint was mostly affected. A total of 97 (28.0%) were overweight while 84 (24.0%) were obese. Obese women were twice more likely to have arthritis when compared to the nonobese (odds ratio: 2.4, 95% confidence interval: 1.8–9.4, p = 0.001).

Conclusion:

There is a need to give high priority to weight reduction strategies targeted at the elderly and the entire population.
Indicative operative numbers in urology training in the UK and Ireland
Authors: Robinson Richard , O’Flynn Kieran J
Published: February 2015

Objectives:

In 2011 the Joint Committee on Surgical Training (JCST) issued guidelines for the award of a Certificate of Completed Training (CCT) in urology, including a list of 15 operative procedure groups for which a trainee must have achieved a minimum level of exposure (termed indicative number) and competence. This study evaluated whether the expected exposure correlated with that achieved by UK and Irish trainees.

Methods:

The operative logbooks of trainees who applied for a CCT in urology from 2010 to 2012 were reviewed. All exposure for each operative group, irrespective of the degree of supervision, was combined to give total operative experience.

Results:

Data on 154 trainees were available. More than 75% achieved the indicative number for radical prostatectomy, nephrectomy, ureteroscopy, PCNL and inguino-scrotal surgery. Only 70%, 68%, 64%, 25%, 21% and 8% reached the required level for cystectomy, TURBT, TURP, andrology, female and paediatric groin surgery, respectively. There was significant geographical variation in exposure, with the majority of trainees not achieving the minimum level for some procedure groups in certain training regions.

Conclusions:

There is a disparity between the operative exposure expected by the JCST and that achieved by urology trainees. To prevent large numbers of trainees failing to meet JCST requirements, an urgent and significant change to urology training, or further modification of the current guidelines, is required.
A violation of the Weigert-Meyer law – an ectopic ureter arising from the lower renal pole
Authors: Mishra Kirtishri , Elliott Christopher S
Published: February 2015

Ectopic ureters are a found in one of every 2000–4000 people. This abnormality can present with urinary tract infections, haematuria, and occasionally incontinence. Ectopic ureters traditionally follow the Weigert-Meyer Law, which describes the relationship of the lower and upper renal moieties. It states that the lower renal pole drains into a laterocranial ureteral orifice (and may reflux), while the upper renal pole drains into a mediocaudal ureteral orifice (and may be obstructed). If a duplicated ureter does not insert into the bladder, it by rule, originates from the upper pole. We present a case of a 42-year-old male who was incidentally found to have what appears to be an ectopic ureter draining from the lower renal pole into a structure contained in the scrotum, hence violating the Weigert-Meyer law.
Urethral involvement of myeloma: A rare case of visible haematuria leading to a diagnosis of relapsed multiple myeloma after curative stem cell transplantation
Authors: Patel C , Irwin PP , Dey D
Published: February 2015

Extramedullary multiple myeloma involving the urinary tract is extremely rare. We report an unusual case of visible haematuria in a 45-year-old male who had a stem cell transplant for multiple myeloma 18 months previously. Cysto-urethroscopy revealed a mid-urethral lesion that was then fully excised by endoscopic resection. Histology confirmed malignant plasma cell infiltrate with subsequent staging and skeletal biopsy of a rib lesion confirming relapse of multiple myeloma. We believe this is the first case of urethral involvement to reveal a relapse of multiple myeloma after autologous stem cell transplant.
Survey on the need for menopause education in Londonderry, Northern Ireland
Authors: Graham Orla , Orr Ancél
Published: February 2015

Menopause is part of the ageing process for all women. However, the experience of menopause is different for each person. To recognize and manage the menopause properly, healthcare professionals need to be well informed and should have access to the necessary resources. The purpose of this survey was to ascertain whether an educational need and a resource need exist among healthcare professionals in Londonderry, Northern Ireland. One hundred and eight surveys were completed by healthcare professionals. From the responses, it is clearly evident that the desire for more education and the establishment of a local specialist clinic exists.
Engaging Preservice Teachers in Critical Dialogues on Race
Authors: Durham-Barnes Joanna E.
Published: February 2015

Rarely do White, middle-class Americans, the population from which most teachers are drawn, have the opportunity to consider themselves as racialized beings. Although personal experience is usually the best teacher, our increasingly homogeneous teaching population oftentimes lacks experience with diversity, and schools of education often struggle to find appropriate and meaningful diverse field experiences for their teacher candidates. This study uses a documentary in an attempt to provoke thoughtful conversations about race and racism in the United States among the mostly White teacher candidates. The study identifies racial themes that emerge from the conversations, explores the ways the groups’ racial diversity alters conversations on race, and explores how the race of the group’s facilitator may affect the conversations. The study suggested that racially diverse groups are more likely to explore greater numbers of racial themes and engage each other more deeply through polite disagreement. Although racial diversity of any kind seemed to promote deeper conversations, participants reported greater satisfaction from the conversations when the students themselves were racially diverse rather than with the facilitator alone.
The Structure of Psychopathology in Adolescence
Authors: Laceulle Odilia M. , Vollebergh Wilma A. M. , Ormel Johan
Published: February 2015

This study aimed to replicate a study by Caspi and colleagues, which proposed that the structure of psychopathology is characterized by a general psychopathology factor, in addition to smaller internalizing and externalizing factors. Our study expanded the approach of the original by using continuous adolescent data and testing additional models, including both self- and parent-reported data, to bolster the robustness of the findings. Our findings indicate that the structure of psychopathology is best characterized by a model including a general factor, in addition to smaller internalizing and externalizing factors. These results emphasize the importance of this model for understanding the structure of psychopathology. Given the increasing emphasis on the importance of, and need for, replication, the overall evidence of a general factor seems rather robust.
Puberty, Socioeconomic Status, and Depression in Girls
Authors: Mendle Jane , Moore Sarah R. , Briley Daniel A. , Harden K. Paige
Published: February 2015

In the current study, we tested for Gene × Environment interactions in the association between pubertal timing and adolescent depression by examining how socioeconomic factors might moderate age at menarche’s relation with depressive symptoms. Participants comprised 630 female twin and sibling pairs from the National Longitudinal Study of Adolescent Health. Consistent with previous studies, results showed that genetic predispositions toward later menarche were associated with fewer depressive symptoms and that genetic predispositions toward earlier menarche were associated with more depressive symptoms. However, this pattern was subtle and evident only in girls from higher socioeconomic backgrounds. Although girls from lower socioeconomic families showed the highest overall levels of depression, their symptoms appeared unrelated to timing of physical development through either a genetic or an environmental path.
Clinical Features That Predict the Need for Operative Intervention in Gluteus Medius Tears
Authors: Chandrasekaran Sivashankar , Vemula S. Pavan , Gui Chengcheng , Suarez-Ahedo Carlos , Lodhia Parth , Domb Benjamin G.
Published: February 2015

Background:

Gluteus medius tears are a common cause of lateral hip pain. Operative intervention is usually prescribed for patients with pain despite physical therapy and/or peritrochanteric injections.

Purpose:

To identify clinical features that predict operative intervention in gluteus medius tears.

Study Design:

Case control study; Level of evidence, 3.

Methods:

A matched-pair controlled study was conducted on patients who underwent endoscopic gluteus medius repairs from June 2008 to August 2014 for full-thickness tears. The exclusion criterion was previous hip disorders (eg, Legg-Calve-Perthes disease, avascular necrosis). The control group contained patients with full-thickness gluteus medius tears on magnetic resonance imaging (MRI) who did not require operative intervention. Both groups had a minimum trial of 3 months of nonoperative management. Matching criteria included age within 5 years, sex, and body mass index (BMI) class. The following clinical parameters were analyzed: presence of lateral-sided hip pain, duration of symptoms, power of resisted hip abduction, gait deviation (antalgic or Trendelenburg), greater trochanter tenderness, and hip passive range of abduction.

Results:

Twenty-four patients who underwent isolated endoscopic gluteus medius repairs were identified; all patients were females, with a mean age of 65 years (range, 52-82 years) and mean BMI of 29.2 kg/m2 (range, 21.55-44.398 kg/m2). The matched control cohort contained 12 females treated nonoperatively for gluteus medius tears with mean age of 66 years (range, 52-81 years) and mean BMI of 29.9 kg/m2 (range, 20.20-43.59 kg/m2). There were significant differences between the groups in power of resisted abduction and presence of gait deviation. The operative cohort had a mean power grading of 3.63 (95% CI, 3.28-3.98) compared with 4.58 (95% CI, 4.29-4.87) for the matched cohort ( P < .05). Abnormal gait was found in 75% of the operative cohort, compared with 33% of the matched cohort ( P < .05). Specifically, 83.3% of the surgical cohort had a Trendelenburg gait, compared with 25% of the matched cohort ( P = .002). The odds of requiring surgical intervention was 14-fold higher for patients with a gluteus medius tear and gait deviation compared with those without gait deviation. There were no significant differences in the other parameters.

Conclusion:

Reduced power of resisted abduction and the presence of gait deviation on initial evaluation of patients with gluteus medius tears increases the likelihood of surgical intervention.
The Supine Internal Rotation Test
Authors: Moulton Samuel G. , Cram Tyler R. , James Evan W. , Dornan Grant J. , Kennedy Nicholas I. , LaPrade Robert F.
Published: February 2015

Background:

Biomechanical studies have reported that the posterior cruciate ligament (PCL) functions as a restraint against excessive tibial internal rotation at higher degrees of knee flexion.

Purpose:

To investigate the use of a supine internal rotation (IR) test for the diagnosis of grade III PCL injuries. The hypothesis was that internal rotation would be greater in patients with grade III PCL injuries compared with other knee injuries and that the supine IR test would demonstrate excellent diagnostic accuracy.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

A consecutive series of 309 patients underwent arthroscopic and/or open knee ligament reconstruction surgery. Seven patients were excluded based on the inability to perform a side-to-side comparison of internal rotation. Tibial internal rotation was assessed bilaterally on 302 patients during examination under anesthesia by a single orthopaedic surgeon measuring tibial tubercle excursion (mm) while applying internal rotation torque. Internal rotation was graded from 0 to 4 at 60°, 75°, 90°, 105°, and 120° of knee flexion. Data were collected and stored prospectively. The optimal threshold for the supine IR test was chosen based on maximization of the Youden index. Diagnostic accuracy parameters were calculated. Multiple logistic regression models were constructed to assess the influence of other knee pathologies on diagnostic accuracy.

Results:

Examination of the 22 PCL-deficient knees demonstrated an increase in tibial internal rotation at 60°, 75°, 90°, 105°, and 120° of knee flexion. The supine IR test had a sensitivity of 95.5%, a specificity of 97.1%, a positive predictive value of 72.4%, and a negative predictive value of 99.6% for the diagnosis of grade III PCL injuries. Posterolateral corner injury had a significant interaction with the supine IR test, increasing its sensitivity and decreasing its specificity.

Conclusion:

PCL-deficient knees demonstrated an increase in the side-to-side difference in tibial internal rotation compared with other knee pathologies. The supine IR test offers high sensitivity and specificity for grade III PCL injuries and may represent a useful adjunct for diagnosing PCL injuries.