bluuebunny/crossref_metadata_2025 huggingface dataset:
UBAP2L is a novel BMI1-interacting protein essential for hematopoietic stem cell activity
Authors: Bordeleau Marie-Eve , Aucagne Romain , Chagraoui Jalila , Girard Simon , Mayotte Nadine , Bonneil Éric , Thibault Pierre , Pabst Caroline , Bergeron Anne , Barabé Frédéric , Hébert Josée , Sauvageau Martin , Boutonnet Christel , Meloche Sylvain , Sauvageau Guy
Published: September 2014

Key Points

UBAP2L interacts with BMI1 as part of a novel Polycomb subcomplex. UBAP2L regulates HSC activity via a mechanism unrelated to the repression of the Ink4a/Arf locus.
Quasi-log concavity conjecture and its applications in statistics
Authors: Wen Jia Jin , Han Tian Yong , Cheng Sui Sun
Published: September 2014

This paper is motivated by several interesting problems in statistics. We first define the concept of quasi-log concavity, and a conjecture involving quasi-log concavity is proposed. By means of analysis and inequality theories, several interesting results related to the conjecture are obtained; in particular, we prove that log concavity implies quasi-log concavity under proper hypotheses. As applications, we first prove that the probability density function of k-normal distribution is quasi-log concave. Next, we point out the significance of quasi-log concavity in the analysis of variance. Next, we prove that the generalized hierarchical teaching model is usually better than the generalized traditional teaching model. Finally, we demonstrate the applications of our results in the research of the allowance function in the generalized traditional teaching model.

MSC:26D15, 62J10.
Anti-inflammatory activity of the ethanol extract of Dictamnus dasycarpus leaf in lipopolysaccharide-activated macrophages
Authors: Ghosh Chiranjit , Hong Bora , Batabyal Subhasis , Jeon Tae-Il , Yang Seung-Hak , Hwang Seong Gu
Published: September 2014

Background

Dictamnus dasycarpus is widely used as a traditional remedy for the treatment of eczema, rheumatism, and other inflammatory diseases in Asia. The current study investigates the molecular mechanism of anti-inflammatory action of the ethanol extract of Dictamnus dasycarpus leaf (DE) in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells.

Methods

Nitric oxide (NO) production was assessed by Griess reaction and the mRNA and protein expressions of pro inflammatory cytokines, transcription factor, and enzymes were determined by real-time RT-PCR and immunoblotting analysis.

Results

DE (0.5 and 1 mg/mL) suppressed the NO production by 10 and 33%, respectively, compared to the untreated group in LPS-stimulated RAW 264.7 cells. DE (0.5 and 1 mg/mL) reduced the mRNA expression of key transcription factor nuclear factor-κB by 7 and 24%, respectively compared to the untreated group in LPS activated macrophage. The pro inflammatory cytokines such as tumor necrosis factor α and interleukin 1β were also decreased by DE treatment. Moreover, the protein expression of pro inflammatory enzymes, inducible nitric oxide synthase and cyclooxygenase 2 were also dramatically attenuated by DE in a dose dependent manner.

Conclusions

These results suggest that Dictamnus dasycarpus leaf has a potent anti-inflammatory activity and can be used for the development of new anti-inflammatory agents.
First report on the molecular epidemiology of Malaysian Staphylococcus epidermidis isolated from a University Teaching Hospital
Authors: Sani Nurul Azirah Mohamad , Sapri Hassriana Fazilla , Neoh Hui-min , Hussin Salasawati
Published: September 2014

Background

Staphylococcus epidermidis is a pathogen associated with nosocomial infections whose medical importance has increased due to progressively invasive medical procedures. In this study, we characterized the molecular epidemiology of S. epidermidis strains circulating in our university hospital situated in Kuala Lumpur, Malaysia.

Findings

A total of 798 S. epidermidis were isolated from our university hospital, where 56.3% of the isolates were found to be cefoxitin (methicillin) resistant and also positive for the mecA gene. Staphylococcus Cassette Chromosome mec (SCCmec) typing revealed that 39.6% of the methicillin-resistant S. epidermidis (MRSE) were SCCmec-untypeable, with 54.6% harboring the cassette chromosome recombinase C (ccrC) gene. A total of 67 isolates from the neonatal intensive care unit (NICU) was selected for pulsed-field gel electrophoresis (PFGE) typing, where 13 pulsotypes were identified at a cut-off value of 80% similarity. No significant association was found between the PFGE pulsotypes, SCCmec types and antibiotic susceptibilities. Polymerase chain reaction (PCR) assays to detect biofilm-associated genes in the ica operon and also 4 staphylococcal toxin genes (cna, seh, PVL genes and tst-1) revealed that only 8.0% isolates had the complete operon, while cna was the most prevalent toxin gene detected amongst the isolates (35.8%).

Conclusion

To our knowledge, this is the first report on the molecular epidemiology of Malaysian S. epidermidis. We found the strains to be low in virulence potential; nevertheless further studies have to be conducted to determine if this phenomenon translates into a better clinical outcome for patients.
On the origin of jets from disc-accreting magnetized stars
Authors: Lovelace Richard VE , Romanova Marina M , Lii Patrick , Dyda Sergei
Published: September 2014

A brief review of the origin of jets from disc-accreting rotating magnetized stars is given. In most models, the interior of the disc is characterized by a turbulent viscosity and magnetic diffusivity (‘alpha’ discs) whereas the coronal region outside the disc is treated using ideal magnetohydrodynamics (MHD). Extensive MHD simulations have established the occurrence of long-lasting outflows in the case of both slowly and rapidly rotating stars. (1) Slowly rotating stars exhibit a new type of outflow, conical winds. Conical winds are generated when stellar magnetic flux is bunched up by the inward motion of the accretion disc. Near their region of origin, the winds have a thin conical shell shape with half opening angle of ∼30∘. At large distances, their toroidal magnetic field collimates the outflow forming current carrying, matter dominated jets. These winds are predominantly magnetically and not centrifugally driven. About 10-30% of the disc matter from the inner disc is launched in the conical wind. Conical winds may be responsible for episodic as well as long lasting outflows in different types of stars. (2) Rapidly rotating stars in the ‘propeller regime’ exhibit twocomponent outflows. One component is similar to the matter dominated conical wind, where a large fraction of the disc matter may be ejected in this regime. The second component is a high-velocity, low-density magnetically dominated axial jet where matter flows along the open polar field lines of the star. The axial jet has a mass flux of about 10% that of the conical wind, but its energy flux, due to the Poynting flux, can be as large as for the conical wind. The jet’s magnetically dominated angular momentum flux causes the star to spin down rapidly. Propeller-driven outflows may be responsible for protostellar jets and their rapid spin-down.

When the artificial requirement of symmetry about the equatorial plane is dropped, the conical winds are found to come alternately from one side of the disc and then the other, even for the case where the stellar magnetic field is a centered axisymmetric dipole.

Recent MHD simulations of disc accretion to rotating stars in the propeller regime have been done with no turbulent viscosity and no diffusivity. The strong turbulence observed is due to the magneto-rotational instability. This turbulence drives accretion in the disc and leads to episodic conical winds and jets.
Comparison of Local Recurrence With Conventional and Intensity-Modulated Radiation Therapy for Primary Soft-Tissue Sarcomas of the Extremity
Authors: Folkert Michael R. , Singer Samuel , Brennan Murray F. , Kuk Deborah , Qin Li-Xuan , Kobayashi Wendy K. , Crago Aimee M. , Alektiar Kaled M.
Published: September 2014

Purpose

The use of intensity-modulated radiation therapy (IMRT) in the treatment of soft tissue sarcoma (STS) of the extremity is increasing, but no large-scale direct comparison has been reported between conventional external-beam radiation therapy (EBRT) and IMRT.

Methods

Between January 1996 and December 2010, 319 consecutive adult patients with primary nonmetastatic extremity STS were treated with limb-sparing surgery and adjuvant radiotherapy (RT) at a single institution. Conventional EBRT was used in 154 patients and IMRT in 165 with similar dosing schedules. Median follow-up time for the cohort was 58 months.

Results

Treatment groups were comparable in terms of tumor location, histology, tumor size, depth, and use of chemotherapy. Patients treated with IMRT were older (P = .08), had more high-grade lesions (P = .05), close (< 1 mm) or positive margins (P = .04), preoperative radiation (P < .001), and nerve manipulation (P = .04). Median follow-up was 90 months for patients treated with conventional EBRT and 42 months for patients treated with IMRT. On multivariable analysis adjusting for patient age and tumor size, IMRT retained significance as an independent predictor of reduced LR (hazard ratio = 0.46; 95% CI, 0.24 to 0.89; P = .02).

Conclusion

Despite a preponderance of higher-risk features (especially close/positive margin) in the IMRT group, IMRT was associated with significantly reduced local recurrence compared with conventional EBRT for primary STS of the extremity.
Risk of Fracture After Radical Cystectomy and Urinary Diversion for Bladder Cancer
Authors: Gupta Amit , Atoria Coral L. , Ehdaie Behfar , Shariat Shahrokh F. , Rabbani Farhang , Herr Harry W. , Bochner Bernard H. , Elkin Elena B.
Published: September 2014

Purpose

Radical cystectomy and urinary diversion may cause chronic metabolic acidosis, leading to long-term bone loss in patients with bladder cancer. However, the risk of fractures after radical cystectomy has not been defined. We assessed whether radical cystectomy and intestinal urinary diversion are associated with increased risk of fracture.

Patients and Methods

Population-based study using SEER-Medicare–linked data from 2000 through 2007 for patients with stage 0-III bladder cancer. We evaluated the association between radical cystectomy and risk of fracture at any site, controlling for patient and disease characteristics.

Results

The cohort included 50,520 patients, of whom 4,878 had cystectomy and urinary diversion. The incidence of fracture in the cystectomy group was 6.55 fractures per 100 person-years, compared with 6.39 fractures per 100 person-years in those without cystectomy. Cystectomy was associated with a 21% greater risk of fracture (adjusted hazard ratio, 1.21; 95% CI, 1.10 to 1.32) compared with no cystectomy, controlling for patient and disease characteristics. There was no evidence of an interaction between radical cystectomy and age, sex, comorbidity score, or cancer stage.

Conclusion

Patients with bladder cancer who have radical cystectomy and urinary diversion are at increased risk of fracture.
Phase II Study of the Safety and Antitumor Activity of the Hypoxia-Activated Prodrug TH-302 in Combination With Doxorubicin in Patients With Advanced Soft Tissue Sarcoma
Authors: Chawla Sant P. , Cranmer Lee D. , Van Tine Brian A. , Reed Damon R. , Okuno Scott H. , Butrynski James E. , Adkins Douglas R. , Hendifar Andrew E. , Kroll Stew , Ganjoo Kristen N.
Published: September 2014

Purpose

TH-302, a prodrug of the cytotoxic alkylating agent bromo-isophosphoramide mustard, is preferentially activated in hypoxic conditions. This phase II study investigated TH-302 in combination with doxorubicin, followed by single-agent TH-302 maintenance therapy in patients with first-line advanced soft tissue sarcoma (STS) to assess progression-free survival (PFS), response rate, overall survival, safety, and tolerability.

Patients and Methods

In this open-label phase II study, TH-302 300 mg/m2 was administered intravenously on days 1 and 8 with doxorubicin 75 mg/m2 on day 1 of each 21-day cycle. After six cycles, patients with stable and/or responding disease could receive maintenance monotherapy with TH-302.

Results

Ninety-one patients initiated TH-302 plus doxorubicin induction treatment. The PFS rate at 6 months (primary efficacy measure) was 58% (95% CI, 46% to 68%). Median PFS was 6.5 months (95% CI, 5.8 to 7.7 months); median overall survival was 21.5 months (95% CI, 16.0 to 26.2 months). Best tumor responses were complete response (n = 2 [2%]) and partial response (n = 30 [34%]). During TH-302 maintenance (n = 48), five patients improved from stable disease to partial response, and one patient improved from partial to complete response. The most common adverse events during induction were fatigue, nausea, and skin and/or mucosal toxicities as well as anemia, thrombocytopenia, and neutropenia. These were less severe and less frequent during maintenance. There was no evidence of TH-302–related hepatic, renal, or cardiac toxicity.

Conclusion

PFS, overall survival, and tumor response compared favorably with historical outcomes achieved with other first-line chemotherapies for advanced STS. A phase III study of TH-302 is ongoing (NCT01440088).
Risk of Subsequent Malignant Neoplasms in Long-Term Hereditary Retinoblastoma Survivors After Chemotherapy and Radiotherapy
Authors: Wong Jeannette R. , Morton Lindsay M. , Tucker Margaret A. , Abramson David H. , Seddon Johanna M. , Sampson Joshua N. , Kleinerman Ruth A.
Published: September 2014

Purpose

Hereditary retinoblastoma (Rb) survivors have increased risk of subsequent malignant neoplasms (SMNs). Previous studies reported elevated radiotherapy (RT) -related SMN risks, but less is known about chemotherapy-related risks.

Patients and Methods

In a long-term follow-up study of 906 5-year hereditary Rb survivors diagnosed from 1914 to 1996 and observed through 2009, treatment-related SMN risks were quantified using cumulative incidence analyses and multivariable Cox proportional hazards regression models with age as the underlying time scale.

Results

Nearly 90% of Rb survivors were treated with RT, and almost 40% received alkylating agent (AA) –containing chemotherapy (predominantly triethylenemelamine). Median follow-up time to first SMN diagnosis was 26.3 years. Overall SMN risk was not significantly elevated among survivors receiving AA plus RT versus RT without chemotherapy (hazard ratio [HR], 1.27; 95% CI, 0.99 to 1.63). AA-related risks were significantly increased for subsequent bone tumors (HR, 1.60; 95% CI, 1.03 to 2.49) and leiomyosarcoma (HR, 2.67; 95% CI, 1.22 to 5.85) but not for melanoma (HR, 0.74; 95% CI, 0.36 to 1.55) or epithelial tumors (HR, 0.89; 95% CI, 0.48 to 1.64). Leiomyosarcoma risk was significantly increased for survivors who received AAs at age < 1 (HR, 5.17; 95% CI, 1.76 to 15.17) but not for those receiving AAs at age ≥ 1 year (HR, 1.75; 95% CI, 0.68 to 4.51). Development of leiomyosarcoma was significantly more common after AA plus RT versus RT (5.8% v 1.6% at age 40 years; P = .01).

Conclusion

This comprehensive quantification of SMN risk after chemotherapy and RT among hereditary Rb survivors also demonstrates an AA-related contribution to risk. Although triethylenemelamine is no longer prescribed, our findings warrant further follow-up to investigate potential SMN risks associated with current chemotherapies used for Rb.
High-throughput mutate-map-rescue evaluates SHAPE-directed RNA structure and uncovers excited states
Authors: Tian Siqi , Cordero Pablo , Kladwang Wipapat , Das Rhiju
Published: September 2014

The three-dimensional conformations of noncoding RNAs underpin their biochemical functions but have largely eluded experimental characterization. Here, we report that integrating a classic mutation/rescue strategy with high-throughput chemical mapping enables rapid RNA structure inference with unusually strong validation. We revisit a 16S rRNA domain for which SHAPE (selective 2′-hydroxyl acylation with primer extension) and limited mutational analysis suggested a conformational change between apo- and holo-ribosome conformations. Computational support estimates, data from alternative chemical probes, and mutate-and-map (M2) experiments highlight issues of prior methodology and instead give a near-crystallographic secondary structure. Systematic interrogation of single base pairs via a high-throughput mutation/rescue approach then permits incisive validation and refinement of the M2-based secondary structure. The data further uncover the functional conformation as an excited state (20 ± 10% population) accessible via a single-nucleotide register shift. These results correct an erroneous SHAPE inference of a ribosomal conformational change, expose critical limitations of conventional structure mapping methods, and illustrate practical steps for more incisively dissecting RNA dynamic structure landscapes.
Monitoring the formation of physical culture of student�s personality in a higher institution
Authors: ���������  , Nagovitsyn Roman
Published: September 2014

One of the programmes of realization the strategy, directed to the solving the problem of saving and strengthening health of growing generation is the introduction of the subject �Physical Culture� into higher institutions, whose main idea is the formation of physical culture of student�s personality. The development of monitoring the formation of physical culture of student�s personality in a higher institution contributes to the effectiveness of solving the problem of worsening physical and functional characteristics of growing generation. The introduction of the complex of diagnostic methods into the educational process in the discipline �Physical Culture� on the basis of defining criterion- level apparatus allows to realize systematical management to achieve aims and solving set tasks in this discipline in a higher institution. The defined system of criteria and levels of development contributes to the effectiveness of the realization of the process of formation of physical culture of student�s personality on the basis of all-round monitoring of achieving the optimal health level, physical, mental, intellectual and functional development of growing generation.
Gylcoprotein IIb/IIIa inhibitors in acute coronary syndromes and PCI
Authors: O'Donovan Kate
Published: September 2014

The advent of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes and in those undergoing percutaneous coronary intervention has added a new dimension in the anti-ischaemic treatment strategy. These agents work by blocking the fi nal common pathway of platelet aggregation in thrombus formation. This is achieved by preventing fi brinogen from binding to the activated glycoprotein IIb/IIIa receptors on the platelet's surface. There are three agents: abciximab, eptifi batide and tirofi ban, each with its own indications and licence for use. The trials that are discussed in this article have demonstrated a reduction in death, myocardial infarction and urgent or repeat coronary revascularization in those who received a glycoprotein IIb/IIIa inhibitor when compared to placebo. Two adverse effects associated with these agents are bleeding—particularly from the femoral artery access point—and thrombocytopenia. For nurses working in the cardiac catheterization laboratories and coronary care units there needs to be an awareness of the benefi ts of receiving these agents, who should have them and the effect on platelets in the prevention of thrombus formation.
Patients' satisfaction with a phase III cardiac rehabilitation programme
Authors: McKee Gabrielle , Kerins Mary , FitzGerald Geraldine
Published: September 2014

This questionnaire study aimed to identify patient satisfaction with a phase III cardiac rehabilitation programme. The instrument used provided qualitative and quantitative information. Overall, patients were well satisfi ed with the specifi c parts of the programme, but believed that the exercise component was the most benefi cial. Thematic analysis showed that improved confi dence was an important positive benefi t while failure to meet individual needs was a concern. Indicators for quality improvement and recommendations are proposed.
Research Roundup
Authors: Linden Belinda
Published: September 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the field of cardiovascular nursing. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Detecting and managing undernutrition of older people in the community
Authors: Todorovic Vera
Published: September 2014

Undernutrition is an important public health issue which is frequently undetected and untreated. Disease and illness are the major causes of undernutrition in this country, and older people are a particularly vulnerable group. Effective screening is needed to reduce the prevalence of malnutrition in older people and when this is established, action can then be taken to address the problem. Community nurses and the primary care team have a key role to play in making this happen. The recently developed Malnutrition Advisory Group (MAG) nutrition screening tool, for adults will help community staff and primary care staff to identify those older patients most at risk of malnutrition in the community. Routine nutrition screening of vulnerable individuals is the first stage in raising standards of nutrition care. Further improvements can be made through the development of appropriate nutritional guidelines, policies and procedures. Integration of nutritional guidelines into local clinical risk management strategies provides opportunities to highlight the importance of nutrition care of older people.
A multidisciplinary education project in primary care
Authors: Partis Mary
Published: September 2014

The Department of Health (DoH) document, The New NHS — Working Together (1998b) recognizes that education and training have a crucial role to play in the development of effective interprofessional work among practitioners. The aim of this article is to provide an account of a project that has been implemented in an East London National Health Service (NHS) Primary Health Trust as well as the experience of using practice-based shared learning with a group of clinical nurse specialists and other health professionals. It outlines the beginnings of the development of the group and discusses the process of facilitating learning, which would enable practitioners to develop inhouse training for their staff in clinical practice throughout the Trust. Evaluation of the experience and reflection on the learning that occurred, highlighted both positive and negative outcomes at individual and group levels. Findings revealed that shared learning included wider appreciation of each other's skills and increased confidence in multidisciplinary working. Disadvantages, however, included shared learning being considered time-consuming and difficult to facilitate, with participants struggling to cover their normal workloads as well as attending the training programme.
MRSA care in the community: why patient education matters
Authors: Robinson Jude , Edgley Alison , Morrell Jane
Published: September 2014

In primary care, patients are prescribed decolonisation treatment to eradicate meticillin-resistant Staphylococcus aureus (MRSA). This complex treatment process requires the patient to apply a topical antimicrobial treatment as well as adhering to rigorous cleaning regimens to ensure the environment is effectively managed. A pilot study was carried out that involved developing an enhanced, nurse-delivered education tool, training a community nurse to use it, then testing its use with a patient. Three interviews were carried out: one with a patient who received usual care, one with a patient who received the enhanced education and one with the community nurse who delivered the enhanced education tool. The patient who received the enhanced education reported better knowledge and understanding of the application of treatment than the patient who did not. These results are interesting and point the way forward for larger research studies to build on the learning from this limited exploration and develop more effective management of MRSA in primary care.
Stroke: helping recovery
Authors: Swann Julie
Published: September 2014

Healthcare staff should have a basic understanding of the principles behind rehabilitation and work as part of a team. If everyone follows the same techniques, the maximum benefit can be provided to patients. This article discusses problems that a person with a stroke may encounter, and explores some rehabilitation techniques used in treatment programmes.
Award-winning work
Authors: Vaughan Paul
Published: September 2014

How fantastic that Great Britain has continued their Olympic success in Beijing at the Paralympics. At the time of writing this month's column, Great Britain is second in the medals table, only behind the host nation China. I was interested to see how my home country, Ireland was doing at the games as my cousin's niece is representing Ireland. However, on looking in today's newspaper for news of what is happening in Beijing, there is not one mention of the games in the national broadsheet I got free on the train this morning. Chris Evans from Radio Two was upset on his show earlier this week as the young girl, Eleanor Simmonds, who is the youngest ever British Olympian to win a gold medal only got a tiny mention in the press for such an amazing achievement. Surely Great Britain should be celebrating this extraordinary feat. Especially in view of the media hype about the young diver, Tom Daley who represented GB in the diving at the Olympics a few weeks ago who sadly did not win a medal. And what of swimmer Rebecca Adlington? She made front page news. Well-deserved and I am not suggesting for one minute that they should not get the credit they deserve but it just seems wrong that the achievements of those competing in the Paralympics should pass by with a whimper. If it was not for the BBC and their excellent coverage of the games it might have completely pass us by altogether.
HCAs: A uniform workforce
Authors: Hand Tanis
Published: September 2014

Winter is here, and I am seriously getting into it. Plans for Christmas are being made and scarves are being worn. Yes, you have guessed it. I am one of those crazy people who loves the Winter.
Ear irrigation: anatomy, process and patient care
Authors: Rawles Zoë
Published: September 2014

Healthcare assistants (HCAs) and assistant practitioners (APs) are beginning to take on more complex tasks and may be required to add ear irrigation to their job descriptions. A good understanding of ear anatomy and suitable training in ear care procedures is vital to ensure this task is carried out safely and at a satisfactory level. This article explains the basic anatomy and physiology of the ear and describes the procedure of ear irrigation, as well as considering what steps HCAs need to take to ensure best practice.
Water-resistant casting: non-surgically managed fractures
Authors: Butler Stephen , Smith Toby , Donell Simon T.
Published: September 2014

While synthetic casts used to immobilize fractures are water-repellent, conventional cast liners are not. Accordingly, patients are instructed to cover casts while washing and showering, and are advised not to swim or bath. Healthcare assistants (HCAs) should be aware of water-resistant casts because the expanding scope of the role may lead to contact with cast patients. Patients may also ask HCAs about the conditions of casting. We present the findings of a retrospective audit of 30 children and adult patients immobilized following minimally displaced extremity fractures, treated with a water-repellent cast padding and synthetic casts. All patients reported excellent or very good patient satisfaction, with no skin integrity complications. No patient presented skin maceration, itchy or flaky dermatology on cast removal. All patients showered and bathed with their cast. Further study of this material with a larger population of weight-bearing and non weight-bearing patients is reccommended.
Ensuring baby safety in hospitals: role of the MCA
Authors: Gregory Irene
Published: September 2014

Maternity hospital staff should ensure that all newborn babies are protected by a series of systems that identify them at birth, track their location within different hospital departments and prevent them from being illegally removed from the premises. Hospital systems include local policies and guidelines on baby security in hospitals, baby labelling, baby tracking with technical support, CCTV cameras and security guards.
Penney-wise: the legal implications of the Penney judgment on the ‘risk–benefit’ analysis in court
Authors: Jaycock Clare
Published: September 2014

The recent Court of Appeal judgement over Penney vs. East Kent Health Authority again raises the vexed legal question of medical negligence. We examine the questionable interpretation of ‘risk-benefit’ analysis before the courts.
The Disability Discrimination Act 1995
Authors: Peace Sue , McGough Stewart
Published: September 2014

The issue of equal access for the disabled is now facing all public access organisations. The impact and potential consequences of the Disability Discrimination Act 1995 are examined here — issues of which no manager can afford to be unaware.
Firmer foundations: the potential of foundation PCTs
Authors: Dixon Michael , Sang Bob , Cowper Andy
Published: September 2014

As the pace of debate over PCT reform looks set to slow following Patricia Hewitt's statements at health questions on 25th October, this article proposes a different way to rebalance health economies. Primary care spends 2/3 of the NHS budget, and delivers the majority of the care – with more healthcare outside hospitals on the way. It's time to look at how to create foundation PCTs.
Rays of sunshine and storm clouds
Authors: Timmins Nick
Published: September 2014

Nick Timmins, Financial Times public policy editor, examines the same old problems emerging amid the recently achieved targets for the NHS and private sector.
A ‘world-class’ idea for the NHS
Authors: Maynard Alan
Published: September 2014

Alan Maynard, professor of health economics at the University of York, discusses the Government's plans for world-class commissioning in the NHS
A three letter analytical soup
Authors: Appleby John
Published: September 2014

John Appleby, chief economist of the King's Fund, considers whether cost-benefit analyses and health impact assessments might be a waste of time.
Causes and effects of chronic obstructive pulmonary disease
Authors: Jones Anne
Published: September 2014

Chronic obstructive pulmonary disease (COPD) is a chronic, slowly progressive disease which is a significant cause of disability and death (British Thoracic Society (BTS), 1997). Despite the clinical and economic burden it creates, it is a relatively poorly understood disease, with many of those with COPD being undiagnosed. This article will discuss some of the causes and effects of COPD and give particular consideration to its impact on patients. It will also consider how the impact of the disease may be reduced, giving greater attention to two speclfic intervenions, namely pulmonary rehabilitation and smoking cessation. The BTS guidelines as a framework for the management of COPD, and the need for a collaborative approach between primary and secondary care, will also be highlighted.
Care study: the effect of pain on a patient with leg ulcers
Authors: Flurrie Karen Lay
Published: September 2014

The following care study aims to explore the effects of wound-related pain on a patient with leg ulceration. The study illustrates current deficits within the author's clinical area, a day hospital for elderly people, in relation to how both a patient's pain and quality of life are measured. It suggests means by which this could be overcome, e.g. by the use of appropriate pain and quality of life pain measurement scales. The case study also highlights the hospital–community divide, with reference to communication and the exchange of information relating to a patient's pain. It advocates optimizing interdisciplinary team communication and discusses how developing closer working relationships and improving education can play a part in enhancing communication. While this case study is concerned with an individual patient, it aims to demonstrate that the problems identified and the resulting indications for clinical practice will promote an increasingly holistic view of the patient and benefit all future patients with leg ulceration.
The Theracute alternating pressure replacement mattress
Authors: Newton Heather
Published: September 2014

The use of alternating pressure mattresses is still acknowledged as an effective adjunct in the prevention and treatment of pressure damage; however, with the plethora of equipment now available, there is an increasing need to provide information that supports the practitioners' decisions ensuring individual patients' clinical needs are met. This article reviews a new addition to the Talley Medical range of alternating pressure mattresses, the Theracute mattress replacement system.
Can we standardize titles and levels in nursing?
Authors: Castledine George
Published: September 2014

In the last issue (Vol 10(12): 822), I reported that it was now possible to recognize nurses who were working at a higher level of clinical practice. I also pointed out that using the same principles (developed in the UKCC Higher Level Project), criteria for all clinical nurses working at lower levels could be identified.
Day surgery preoperative anxiety reduction and coping strategies
Authors: Grieve Robert John
Published: September 2014

Hospitalization, even in patients who are not faced with the prospect of surgery, is known to cause anxiety. One may, therefore, expect some degree of anxiety in patients attending for day surgery. Anxiety provokes a physiological stress response which impedes the healing process. Thus, the reduction of preoperative anxiety is widely accepted as part of nursing care. This article investigates the coping strategies which patients adopt and the suitability of current anxiety-reduction interventions. It argues that individual coping styles do not remain static but adapt according to need and proposes that, as a result of lack of awareness, the therapeutic potential of the nurse-patient relationship in anxiety-reduction is being overshadowed by uncertainty-reduction approaches which place a disproportionate emphasis on the provlslon of informatlon.
Parents with colorectal cancer: ‘What do I tell the children?’
Authors: Black Patricia K , Hyde Christine
Published: September 2014

Whatever the age of the child, there is no easy way for a parent to explain serious, life-threatening illness. For children to hear that their parent is ill is devastating, especially if the parent has cancer and needs a permanent colostomy. The diagnosis of cancer can produce feelings of fear, confusion and uncertainty in patients and their close relatives. How difficult does this then become for the child battling to understand long medical words, alien hospital environments and an ill parent? The social taboos that surround body matter elimination are legion and therefore the surgical outcome of having a permanent stoma changes the individual's body image perception long-term. The two case studies presented in this article highlight this problem as well as the lack of suitable available literature.
Vicair Academy Mattress in the prevention of pressure damage
Authors: Collins Fiona
Published: September 2014

There are many costs associated with the development of pressure ulcers, both in terms of the patient experience and those associated with healing. If patients who are deemed to be at risk are identified and suitable preventive equipment is provided, incidence of pressure ulcer development can be reduced significantly. Pressure-reducing mattresses are primarily used to prevent pressure ulcers from occurring, in conjunction with other preventive measures, such as repositioning. The Vicair Academy Mattress, manufactured by Vicair BV and distributed by Gerald Simonds, uses Vicair's ‘dry air’ flotation system to offer maximum pressure and shear protection to patients who are at high risk of developing pressure ulcers.

There are many different types of pressure-reducing mattresses currently on the market, the majority of which are constructed from polyurethane or viscoelastic foam. However, more recently, mattresses such as the Vicair Academy Mattress have incorporated the use of air flotation as an alternative method of supporting the body surface. This method of construction is able to cradle and support the body without exerting upward pressures.
A snapshot view of the impact of chronic pain on adolescents
Authors: Matthews Elizabeth
Published: September 2014

This study provides a snapshot view on the impact that chronic pain has on the daily functioning of a small group of adolescents (n=10). Chronic, severe pain in childhood and adolescence is not common, but is increasingly recognized to occur and be worthy of treatment. Referrals come from a variety of sources including paediatric orthopaedic surgeons, paediatric rheumatologists, paediatric neurologists, child psychiatrists and GPs. Examples of the types of conditions seen are complex regional pain syndromes, low back pain, pain caused by congenital or degenerative disease and chronic headaches. Additionally, chronic pain affects the wellbeing of the family as well as the adolescent. Many adolescents have been unable to attend school for months or years, and their educational and social development is impaired. The aim of treatment is to rehabilitate the adolescents within the context of their families and to return them to school and to participating in normal social activities within the limits of their condition.
The DARTNet Institute: Seeking a Sustainable Support Mechanism for Electronic Data
Enabled Research Networks
Authors: Pace Wilson D. , Fox Chet , White Turner , Graham Deborah , Schilling Lisa M. , West David R.
Published: September 2014

Context: Clinical data research networks require large investments in
infrastructure support to maintain their abilities to extract, transform, and load data
from varied data sources, expand electronic data sources and develop learning
communities.Case Description: This paper outlines a sustainable business model of
ongoing infrastructure support for clinical data research activities. The DARTNet
Institute is a not-for-profit 501(c)(3) organization that serves as a support entity for
multiple practice-based research networks. Several clinical data research networks
working closely with a professional society began collaborating to support shared goals
in 2008. This loose affiliation called itself the “DARTNet Collaborative.” In 2011, the
DARTNet Institute incorporated as an independent, not-for-profit entity. The business
structure allows DARTNet to advocate for all partners without operating its own
practice-based research network, serve as a legal voice for activities that overlap
multiple partners, share personnel resources through service contracts between partners,
and purchase low-cost (nonprofit rate) software.Major Themes: DARTNet’s business model
relies upon four diverse sources of revenue: (1) DARTNet licenses and provides access to
a propriety software system that extracts, transforms, and loads data from all major
electronic health records (EHRs) utilized in the United States, and which also provides
clinical decision support for research studies; (2) DARTNet operates a recognized,
national professional-society-quality improvement registry that enables organizations to
fulfill Meaningful Use 2 criteria; (3) DARTNet provides access to data for research
activities that are funded by direct research dollars, provided at prices that generate
excess revenue; and (4) DARTNet provides access to large primary care datasets for
observational studies and pregrant analyses such as for sample size development. The
ability of the system to support pragmatic trials will be described.Conclusion: The
DARTNet model facilitates the use of direct grant dollars to generate revenue to support
the overall enterprise through a purchased services arrangement. Other services provided
through subcontracting provide facilities and administration fees as well as direct
dollars to support the system. The flexibility of the business model overcomes the
complicated financial arrangements and governance requirements of many professional
associations and academic medical centers.
The effects and effectiveness of electromotive drug administration and chemohyperthermia for treating non-muscle invasive bladder cancer
Authors: Slater SE , Patel P , Viney R , Foster M , Porfiri E , James ND , Montgomery B , Bryan RT
Published: September 2014

Introduction

Preliminary studies show that device assisted intravesical therapies appear more effective than passive diffusion intravesical therapy for the treatment of non-muscle invasive bladder cancer (NMIBC) in specific settings, and phase III studies are now being conducted. Consequently, we have undertaken a non-systematic review with the objective of describing the scientific basis and mechanisms of action of electromotive drug administration (EMDA) and chemohyperthermia (CHT).

Methods

PubMed, ClinicalTrials.gov and the Cochrane Library were searched to source evidence for this non-systematic review. Randomised controlled trials, systematic reviews and meta-analyses were evaluated. Publications regarding the scientific basis and mechanisms of action of EMDA and CHT were identified, as well as clinical studies to date.

Results

EMDA takes advantage of three phenomena: iontophoresis, electro-osmosis and electroporation. It has been found to reduce recurrence rates in NMIBC patients and has been proposed as an addition or alternative to bacillus Calmette–Guérin (BCG) therapy in the treatment of high risk NMIBC. CHT improves the efficacy of mitomycin C by three mechanisms: tumour cell cytotoxicity, altered tumour blood flow and localised immune responses. Fewer studies have been conducted with CHT than with EMDA but they have demonstrated utility for increasing disease-free survival, especially in patients who have previously failed BCG therapy.

Conclusions

It is anticipated that EMDA and CHT will play important roles in the management of NMIBC in the future. Techniques of delivery should be standardised, and there is a need for more randomised controlled trials to evaluate the benefits of the treatments alongside quality of life and cost-effectiveness.
An ovary as unusual contents of an incarcerated umbilical hernia
Authors: Ahmed U , Ahmed R , Kamat S , Elkholy K
Published: September 2014

We present the unusual case of a woman presenting with an incarcerated umbilical hernia. Intraoperatively, the contents of the hernia were found to be an ovary. We outline the clinical presentation of our patient, investigations and management as well as a discussion on unusual contents of umbilical hernias. To our knowledge, this is the first case of a non-malignant ovary incarcerated in an umbilical hernia.
Hearing outcomes following primary malleostapedial rotation ossiculoplasty in patients undergoing modified radical mastoidectomy
Authors: Kanegaonkar RG , Whittaker M , Najuko-Mafemera A
Published: September 2014

Introduction

Treatment of cholesteatoma consists of either excision or exteriorisation of disease. Approaches have traditionally included a radical or modified radical mastoidectomy and combined approach tympanoplasty. Hearing thresholds following a modified radical mastoidectomy alone have been reported as poor. We assessed hearing outcomes in patients undergoing a primary malleostapedial reconstruction combined with their open cavity surgery.

Methods

All patients undergoing open cavity mastoidectomy with primary malleostapedial rotation ossiculoplasty between 2009 and 2013 were identified. Case notes were reviewed, and demographic data, recurrence rate and audiometry were recorded.

Results

Twenty-one patients were identified. The age range was 10–65 years. There was no evidence of recurrence of cholesteatoma. The mean postoperative air-bone gap was 20dBHL, 23dBHL, 10dBHL and 27dBHL at 0.5kHz, 1kHz, 2kHz and 4kHz respectively. Excluding cases consistent with a postoperative ossicular discontinuity (n=3), the mean postoperative air-bone gap was 15dBHL, 19dBHL, 8dBHL and 26dBHL at 0.5kHz, 1kHz, 2kHz and 4kHz respectively.

Conclusions

The improvement in hearing thresholds demonstrated in this cohort of patients supports the use of this form of ossiculoplasty in those undergoing open cavity procedures. This would also suggest that the subsequent use of hearing aids in these patients would require less amplification and therefore provide superior hearing outcomes. As hearing loss remains a significant concern following modified radical mastoidectomy, we suggest an open cavity with primary malleostapedial rotation ossiculoplasty as a viable alternative to modified radical mastoidectomy alone, in selected cases.
Association of ABO blood group with fracture pattern and mortality in hip fracture patients
Authors: Uzoigwe CE , Smith RP , Khan A , Aghedo D , Venkatesan M
Published: September 2014

Introduction

The mechanism of falling has been proposed as the exclusive explanation for hip fracture pattern. Evidence exists that other genetic factors also influence proximal femoral fracture configuration. The ABO blood group serotype has been associated with other pathologies but any role in hip fracture has yet to be definitively characterised.

Methods

Our National Hip Fracture Database was interrogated over a four-year period. All patients had their blood group retrieved, and this was compared with hip fracture pattern and mortality rates. Confounding factors were accounted for using logistic regression and the Cox proportional hazards model.

Results

A total of 2,987 consecutive patients presented to our institution. Those with blood group A were significantly more likely to sustain intracapsular fractures than ‘non-A’ individuals (p=0.009). The blood group distribution of patients with intracapsular fractures was identical to that of the national population of England. However, blood group A was less common in patients with intertrochanteric fractures than in the general population (p=0.0002). Even after correction for age and sex, blood group A was associated with a decrease in the odds of suffering an intertrochanteric fracture to 80% (p=0.002). Blood group A had inferior survivorship correcting for age, sex and hip fracture pattern (hazard ratio: 1.14, p=0.035). This may be due to associated increased prevalence of co-morbid disease in this cohort.

Conclusions

Blood group is an independent predictor of hip fracture pattern, with group A patients more likely to sustain an intracapsular fracture and non-A individuals more likely to sustain an intertrochanteric fracture. The determinants of fracture pattern are likely to be related to complex interactions at a molecular level based on genetic susceptibility. The mechanism of fall may not be the only aetiological determinant of proximal femoral fracture configuration.
Isolated proximal rupture of flexor digitorum longus tendon in a traumatic open subtalar dislocation
Authors: Ghani Y , Marenah K , Kumar PA
Published: September 2014

Tendon ruptures associated with ankle fractures and dislocations or subtalar dislocations are very rare entities with only a few reports of these in the literature. We report a case of an open subtalar dislocation and associated isolated proximal rupture of the flexor digitorum longus tendon at the musculotendinous junction, following a relatively low energy trauma. The finding of the avulsed flexor digitorum longus tendon was intraoperative, and management involved thorough washout of the joint and a primary side-to-side tenodesis with the flexor hallucis longus tendon. The patient has made a good functional recovery from his injuries. This case is reported because of the rarity of this combination of injuries and the associated management dilemma with which it presented us.