bluuebunny/crossref_metadata_2025 huggingface dataset:
Distracting children during blood draw: Looking through distraction cards is effective in pain relief of children during blood draw
Authors: Inal Sevil , Kelleci Meral
Published: March 2012

Inal S, Kelleci M. International Journal of Nursing Practice 2012; 18: 210–219

Distracting children during blood draw: Looking through distraction cards is effective in pain relief of children during blood draw

This study aims to investigate the effects of distraction method by way of looking through distraction cards/Flippits® to reduce procedural pain and anxiety during blood draw. In this method we distract attention of the children with distraction cards/Flippits®. Flippits® consist of various eye‐catching pictures and shapes. Then we asked the children questions about the cards during the blood draw procedure that he or she can only answer if he or she examines the cards carefully.

This study is a prospective, randomized controlled trial. The sample consisted of 123 children of ages between 6 and 12. We randomly assigned subjects into two groups. Group 1 received no intervention, whereas Group 2 received distraction in the form of looking through distraction cards/Flippits®. Pre‐procedural and procedural anxiety was assessed using the anxiety scale from the Children's Anxiety and Pain Scales by parents' and observer's report. Procedural pain was assessed using Faces Pain Scale‐Revised by children, parent and observer reports.

Results show that pre‐procedural anxiety did not differ significantly. However, the experimental group had significantly lower pain levels than the control group during the blood draw procedure. Also experimental group had significantly lower anxiety levels than the control group.
Nominal group technique: An effective method for obtaining group consensus
Authors: Harvey Nichole , Holmes Colin A
Published: March 2012

Harvey N, Holmes CA. International Journal of Nursing Practice 2012; 18: 188–194

Nominal group technique: An effective method for obtaining group consensus

This paper aims to demonstrate the versatility and application of nominal group technique as a method for generating priority information. Nominal group technique was used in the context of four focus groups involving clinical experts from the emergency department (ED) and obstetric and midwifery areas of a busy regional hospital to assess the triage and management of pregnant women in the ED. The data generated were used to create a priority list of discussion triggers for the subsequent Participatory Action Research Group. This technique proved to be a productive and efficient data collection method which produced information in a hierarchy of perceived importance and identified real world problems. This information was vital in initiating the participatory action research project and is recommended as an effective and reliable data collection method, especially when undertaking research with clinical experts.
Nurses' perceptions of risk from emerging respiratory infectious diseases: A Singapore study
Authors: Koh Yiwen , Hegney Desley , Drury Vicki
Published: March 2012

Koh Y, Hegney D, Drury V. International Journal of Nursing Practice 2012; 18: 195–204

Nurses' perceptions of risk from emerging respiratory infectious diseases: A Singapore study

The recent emergence of virulent respiratory infectious diseases such as Severe Acute Respiratory Syndrome (SARS) and Influenza A/H1N1 viruses predisposes nurses to occupational risks. This qualitative study investigated how Chinese Singaporean nurses perceived the risks of exposure to these infectious diseases and the factors that influenced this risk perception.

Data were collected through face‐to‐face interviews and were analyzed using Braun and Clarke's process of thematic analysis. Three themes emerged: living with risk; the experience of SARS; and acceptance of risk. The nature of nursing work was perceived to place participants at risk of infection. Another significant finding of this study is that the government's, organizations' and nurses' perceptions of new emerging respiratory infectious diseases were influenced by their previous experience with SARS. Similar to previous studies, nurses working at the ‘front line’ believed that infection from these diseases was an unavoidable occupational hazard.
The influence of the professionalism behaviour of nurses working in health institutions on job satisfaction
Authors: Çelik Serpil , Hisar Filiz
Published: March 2012

Çelik S, Hisar F. International Journal of Nursing Practice 2012; 18: 180–187

The influence of the professionalism behaviour of nurses working in health institutions on job satisfaction

This study was carried out with the aim of determining the effect of the professional behaviour of nurses on their job satisfaction. The sample of the study included 531 nurses working in university, state and private hospitals in Turkey. Data were collected using two questionnaires which included the demographic characteristics of nurses, a Behavioral Inventory Form for Professionalism in Nursing (BIPN) and the Minnesota Satisfaction Questionnaire. The results from the BIPN showed that the mean score of nurses was low. The mean score of job satisfaction was at a medium level. The relationship between job satisfaction and professionalism was found to be statistically significant and in the positive direction. Based on this result, in order to increase job satisfaction, increasing the performance of arrangements directed towards the development of professional behaviour that is found within the scope of the professionalism scale is recommended.
Safety and tolerability of intermittent androgen deprivation therapy: A literature review
Authors: Gruca Damian , Bacher Peter , Tunn Ulf
Published: March 2012

Androgen deprivation therapy is commonly used in men with advanced prostate cancer; however, it is associated with many short‐ and long‐term side‐effects. Intermittent androgen deprivation therapy was first suggested as an alternative regimen in the early 1990s and is now part of treatment guidelines as a result of its ability to reduce adverse events associated with continuous androgen deprivation therapy without decreasing its efficacy. Although many publications evaluated intermittent androgen deprivation therapy's efficacy, the safety and tolerability information of this regimen is relatively limited. The goal of this literature review was to analyze clinical trials that have reported safety and tolerability data in prostate cancer patients treated with intermittent androgen deprivation therapy, as well as assessing quality of life outcomes. A literature search was carried out using biomedical and pharmaceutical databases for published information comparing intermittent androgen deprivation therapy with continuous androgen deprivation therapy. A total of 13 randomized and non‐randomized studies were selected and reviewed based on their relevance to the safety, tolerability and quality of life of intermittent androgen deprivation therapy. Benefits for intermittent androgen deprivation therapy were observed for the short‐term side‐effects (hot flushes and sexual functions) mainly during the off‐treatment phase, whereas the data for the long‐term side‐effects were not as conclusive. Quality of life evaluations are more in support of intermittent androgen deprivation therapy. Although there are some safety, tolerability and quality of life benefits associated with intermittent androgen deprivation therapy, the overall evidence is still limited.
Effect of menstrual blood‐derived stromal stem cells on proliferative capacity of peripheral blood mononuclear cells in allogeneic mixed lymphocyte reaction
Authors: Nikoo Shohreh , Ebtekar Massoumeh , Jeddi‐Tehrani Mahmood , Shervin Adel , Bozorgmehr Mahmood , Kazemnejad Somaieh , Zarnani Amir Hassan
Published: March 2012

Aim:  Menstrual blood stromal stem cells (MBSCs) have been demonstrated to exhibit stem cell properties such as the capability for self‐renewal and multipotency, allowing for multilineage differentiation. In addition, this cell type has various immunomodulatory effects. In this study, we examined the potential effect of MBSCs on proliferation of peripheral blood mononuclear cells (PBMCs) in allogeneic mixed lymphocyte reaction (MLR).

Materials and Methods:  Menstrual blood was collected from healthy donors after menstrual blood flow initiated and its mononuclear cell fraction was separated. Cells were subsequently cultured and adherent cells were allowed to propagate and used as stem cells. Flowcytometric immunophenotyping was performed using a panel of monoclonal antibodies including CD44, CD45, CD34, CD9, CD29, CD10, CD38, CD105, CD73, CD133, STRO‐1 and Oct‐4A. For functional analysis, PBMCs were co‐cultured with MBSCs, collected after 4 days and added to allogeneic PBMCs. 2,3‐Bis‐(2‐methoxy‐4‐nitro‐5‐sulfophenyl)‐2H‐tetrazolium‐5‐carboxanilide (XTT) assay was carried out to evaluate cell proliferation.

Results:  MBSCs showed surface and intracellular markers of mesenchymal stem cells with the exception of the high expression of Oct‐4A. MBSCs affected the proliferative response of PBMC in a dose‐dependent manner. At ratio of 1:1 to 1:2, MBSCs inhibited, while at lower ratios (1:32 to 1:64) stimulated the proliferative capacity of allogeneic PBMCs.

Conclusion:  According to the present study, MBSCs exert their immunoregulatory effects on allogeneic PBMCs in a dose‐dependent manner. This finding can be considered as a valuable point in future cell therapy strategies, when this cell population is used.
Congenital high airway obstruction syndrome in the breech presentation managed by ex utero intrapartum treatment procedure after intraoperative external cephalic version
Authors: Miwa Ichiro , Sase Masakatsu , Nakamura Yasuhiko , Hasegawa Keiko , Kawasaki Masahiro , Ueda Kazuyuki
Published: March 2012

Congenital high airway obstruction syndrome (CHAOS) caused by laryngeal atresia was diagnosed by prenatal ultrasound in a male fetus at 26 weeks of gestation. Findings included massive ascites, subcutaneous edema, enlarged hyperechogenic lungs with diaphragmatic inversion, dilated trachea, polyhydramnios, and breech presentation. Those findings of CHAOS spontaneously returned to normal by 33 weeks of gestation. However, the placenta was localized to the anterior uterine wall. In addition, the fetal position had been breech until delivery. At 36 weeks of gestation, a planned ex utero intrapartum treatment (EXIT) procedure was performed following intraoperative external cephalic version (ECV) in which the fetus was approached from the posterior wall of the uterus. Laryngoscopy revealed the predicted laryngeal obstruction, and tracheostomy was placed. Intraoperative ECV may be a useful technique in breech presentation before EXIT procedure.
Maternal serum C‐reactive protein in early pregnancy and occurrence of preterm premature rupture of membranes and preterm birth
Authors: Moghaddam Banaem Lida , Mohamadi Bita , Asghari Jaafarabadi Mohamad , Aliyan Moghadam Narges
Published: March 2012

Aim:  The aim of this study was to determine the relationship between maternal serum C‐reactive protein (CRP) levels in the first 20 weeks of pregnancy and later occurrence of preterm premature rupture of membranes and preterm birth.

Material and Methods:  A prospective cohort study that measured maternal serum CRP levels in 778 pregnant women in the first half of pregnancy was performed in the city of Noor (north Iran), and included follow‐up of patients up to time of delivery. Preterm premature rupture of membranes and preterm birth were defined as the occurrence of membranes rupture and birth, respectively before 37 weeks of gestation.

Results:  Of the 778 pregnancies studied, 19 (2.41%) preterm premature rupture of membranes and 58 (7.3%) preterm births were seen. Median CRP levels in preterm premature rupture of membranes and preterm birth cases were much higher than in term deliveries (7 and 6.8 respectively vs 2.4 mg/L; 66.67 and 64.76, respectively vs 24.38 nmol/L). CRP levels >4 mg/L had statistically significant relationships with preterm premature rupture of membranes (OR 5.91, 95% CI 2.07–16.89) and preterm birth (OR 8.95, 95% CI 4.60–17.43). With a cut‐off level of 4 mg/L of CRP, sensitivity, specificity, and likelihood ratios (LR+ and LR‐) for preterm birth were 81, 70, 2.70, 0.28%, respectively, and for preterm premature rupture of membranes they were 79, 67, 2.41 and 0.31%, respectively.

Conclusion:  It seems that the inflammatory marker, CRP, can be used in the early stages of pregnancy to identify women at risk of experiencing preterm premature rupture of membranes and preterm birth.
The role of vision in the host orientation behaviour of Hylobius warreni
Authors: Machial Laura A. , Lindgren B. Staffan , Aukema Brian H.
Published: March 2012

Visual stimuli, often in combination with olfactory stimuli, are frequently important components of host selection by forest‐dwelling phytophagous insects.

Warren root collar weevil Hylobius warreni Wood (Coleoptera: Curculionidae) is a native insect in western Canada, where larvae feed primarily on lodgepole pine Pinus contorta and can girdle and kill young trees. This weevil is an emerging problem in areas heavily impacted by mountain pine beetle Dendroctonus ponderosae Hopkins.

No olfactory attractants have been identified for this insect, making monitoring and management difficult. Thus, we investigated the role of vision in the host‐finding behaviour of Warren root collar weevil in the absence of known olfactory cues.

We conducted three experiments in field enclosure plots aiming to characterize aspects of host‐finding behaviour by adult Warren root collar weevil.

We found that both male and female weevils were readily attracted to vertical plastic silhouettes in the shape of a trunk, crown or tree at distances of less than 4 m. This pattern of attraction persisted over 2 years in two slightly different study designs. Blinding the insects removed their ability to orient to these silhouettes, indicating that host‐finding behaviour has a strong visual component. The use of different colour trunks and crowns (black, white and green) did not change the patterns of attraction of the insects to the silhouettes.

Exploiting visual attraction in this walking insect may present a new management tool in forest protection strategies.
LENDING RELATIONSHIPS AND MONETARY POLICY
Authors: AKSOY YUNUS , BASSO HENRIQUE S. , COTO‐MARTINEZ JAVIER
Published: March 2012

Financial intermediation and bank spreads are the important elements in the analysis of business cycle transmission and monetary policy. We present a simple framework that introduces lending relationships, a relevant feature of financial intermediation that has been so far neglected in the monetary economics literature, into a dynamic stochastic general equilibrium model with staggered prices and cost channels. Our main findings are (a) banking spreads move countercyclically generating amplified output responses, (b) spread movements are important for monetary policymaking even when a standard Taylor Rule is employed, (c) modifying the policy rule to include a banking spread adjustment improves stabilization of shocks and increases welfare when compared to rules that only respond to output gap and inflation, and finally (d) the presence of strong lending relationships in the banking sector can lead to indeterminacy of equilibrium forcing the Central Bank to react to spread movements. (JELE44, E52, G21)
Electoral Competition, Issue Salience and Public Policy for Older People: The Case of the Westminster and Regional UK Elections 1945–2011
Authors: Chaney Paul
Published: March 2012

Ageing societies and cohort-based differential turnout present challenges and opportunities in political parties' pursuit of electoral support. This article explores their response with reference to the issue salience of public policy for older people in the manifestos for Westminster and regional elections in the UK, 1945–2011. Qualitative and quantitative analysis of party programmes reveals: (1) a significant increase in issue salience and electoral competition around public policy for older people in the post-war era; (2) a continuing failure to adhere to EC and UN edicts on the need to mainstream older people's equality and welfare across portfolios and policy frames; and (3) the territorialisation of public policy based on inter- and intra-party differences in policy programmes as part of a formative process associated with the political opportunity structures afforded by quasi-federalism.
The Multiple Meanings of Peer Groups in Social Cognitive Mapping
Authors: Neal Jennifer Watling , Neal Zachary P.
Published: March 2012

Social cognitive mapping (SCM) is a common approach to identifying peer groups in developmental research. However, this approach involves three stages that each implies a unique conception of peer group. This article aims to bring conceptual clarity to the identification of peer groups using SCM by demonstrating how the meaning of peer groups differs at each stage of SCM. First, in the data collecting stage, interaction groups identify sets of children that hang out together. Second, in the data aggregating stage, co‐membership groups identify sets of children who are members of many of the same interaction groups. Third, in the data analyzing stage, similarity groups identify sets of children with similar patterns of relationships with their peers. After reviewing these three conceptions of peer groups, we briefly discuss some potential problems with using SCM as a tool to measure children's social networks and peer groups. Finally, we conclude by arguing that despite these issues, SCM remains a valuable methodology, and indeed one with untapped potential. Thus, we offer suggestions for the appropriate application of these theoretically and empirically distinct conceptions of peer group, noting that developmental researchers using SCM must identify which conception of peer group is used and justify why this conception is the appropriate one.
Do informed consent documents for cancer trials do what they should? A study of manifest and latent functions
Authors: Armstrong Natalie , Dixon‐Woods Mary , Thomas Anne , Rusk Gill , Tarrant Carolyn
Published: March 2012

Though patient information leaflets (PILs) are provided to those invited to take part in medical research, they usually fall short in facilitating informed decisions about participation. We aimed to explore why there is an enduring requirement for a process that seems not to ‘work’, and to explain why the problems have proven resistant to correction. We analysed applications for ethical approval for 13 oncology trials and related official guidance. We interviewed 26 patients invited to participate in the trials. Data analysis was based on the constant comparative method. We show that PILs function latently to satisfy purposes other than their manifest function as a decision‐facilitating tool. PILs are the outcome of a process of institutional scripting that is strongly shaped by the accountability demands inherent in the ethical review process. This results in the PIL being made to serve purposes both as a prospectus and as a contract. Though PILs have value for some patients, most do not recognise these documents as operating primarily in their interests. Patients make decisions in ways that deviate from official ideals. This analysis is important in recognising that no simple technical fix is available, and in enhancing sociological understanding of the institutional role of documents.
The Role of Task Complexity, Modality, and Aptitude in Narrative Task Performance
Authors: Kormos Judit , Trebits Anna
Published: March 2012

The study reported in this paper investigated the relationship between components of aptitude and the fluency, lexical variety, syntactic complexity, and accuracy of performance in two types of written and spoken narrative tasks. We also addressed the question of how narrative performance varies in tasks of different cognitive complexity in the written and spoken modes. Our findings indicate a complex interaction between aptitude components and task performance under different conditions. The components of aptitude that seemed to be most strongly related to the complexity and accuracy of production were inductive ability and grammatical sensitivity. The results also show that in writing the participants used more varied vocabulary than in speech, but their performance was similar in terms of syntactic complexity.
New Political Governance in Westminster Systems: Impartial Public Administration and Management Performance at Risk
Authors: AUCOIN PETER
Published: March 2012

This article examines the phenomenon of increased political pressures on governments in four Westminster systems (Australia, Britain, Canada, and New Zealand) derived from changes in mass media and communications, increased transparency, expanded audit, increased competition in the political marketplace, and political polarization in the electorate. These pressures raise the risk to impartial public administration and management performance to the extent that governments integrate governance and campaigning, allow political staff to be a separate force in governance, politicize top public service posts, and expect public servants to be promiscuously partisan. The article concludes that New Zealand is best positioned to cope with these risks, in part because of its process for independently staffing its top public service posts. The article recommends this approach as well as the establishment of independently appointed management boards for public service departments and agencies to perform the governance of management function.
Circulation of Security Models in Southern African Cities: Between Neoliberal Encroachment and Local Power Dynamics
Authors: BÉNIT‐GBAFFOU CLAIRE , DIDIER SOPHIE , PEYROUX ELISABETH
Published: March 2012

This symposium focuses on the circulation of security governance models in cities of Southern Africa (Johannesburg, Cape Town, Windhoek and Maputo). It consists of three articles analysing at different scales (regional, national and intra‐urban) the circulation of specific neighbourhood‐based solutions to security issues, such as road closures, gated residential developments and business improvement districts. This spreading process, with the South African case at its core, is analysed within the theoretical framework of neoliberalism. The symposium, via this discussion of security models and the way they reflect the changing relationships between state and private actors locally, discusses the relevance of this framework to a fuller understanding of the transformation of Southern African cities.

Cette collection d'articles porte sur la circulation de modèles de gouvernance sécuritaire dans les villes d'Afrique australe (Johannesburg, Cape Town, Windhoek et Maputo). Les trois articles qui la constituent analysent, à différentes échelles (régionale, nationale et intra‐urbaine), la circulation de certains dispositifs locaux de lutte contre l'insécurité, tels que les enclosures, les complexes résidentiels fermés et les Business Improvement Districts. Ces processus de diffusion, qui ont souvent pour centre l'Afrique du Sud, sont analysés à travers le cadre théorique du néolibéralisme. Cette collection, en analysant la manière dont ces modèles sécuritaires reflètent les relations dynamiques entre l'Etat et les acteurs privés locaux, questionne la pertinence de ce cadre théorique pour comprendre les transformations des villes d'Afrique australe.
Local Politics and the Circulation of Community Security Initiatives in Johannesburg
Authors: BÉNIT‐GBAFFOU CLAIRE , FOURCHARD LAURENT , WAFER ALEX
Published: March 2012

The article analyses the emergence and circulation of community‐driven security initiatives in two types of setting in Johannesburg, South Africa: street patrols and community courts in pre‐apartheid and apartheid townships on the one hand; road closures in post‐apartheid middle‐class suburbs on the other. In spite of the obvious contrasts, the two types of community security initiatives share two important features: originating in a series of confrontations between the state and community groups; and being shaped, used and driven in accordance with local political interests, by existing or emerging local elites building their constituencies in the city. This grid of analysis stressing the political dynamics of community‐driven security initiatives is applied to the global model of community policing, recently imported to South Africa. It usefully complements more classic neoliberal understandings of what community policing means for the governance of security in contemporary African cities.

Cet article analyse l'émergence et la circulation d'initiatives sécuritaires collectives, dans deux types de configurations à Johannesburg, Afrique du Sud: d'une part, les patrouilles de rue et les cours de justice communautaires, au sein des townships, avant et sous le régime d'apartheid; d'autre part, les enclosures en quartier suburbain dans la période post‐apartheid. Au‐delà des contrastes évidents, ces deux dispositifs sécuritaires de quartier ont en commun deux éléments: ils sont nés d'une série de confrontations entre l'Etat et des groupes locaux; ils sont construits, utilisés et instrumentalisés en fonction d'intérêts politiques locaux, par des élites locales cherchant a construire ou consolider leur clientèle politique. Cette grille d'analyse de la gouvernance sécuritaire «du bas», qui met l'accent sur les dynamiques politiques des initiatives sécuritaires de quartier, est appliquée au modèle global de la «police de quartier» (‘community policing’), récemment importé en Afrique du Sud. Cette approche complète utilement les analyses plus classiques de circulation de modèles en termes néolibéraux, et permet de mettre en lumière d'autres aspects de la gouvernance sécuritaire dans les villes africaines contemporaines.
Living in Limbo: Transnational Households, Remittances and Development
Authors: Castañeda Ernesto
Published: March 2012

In recent years, the reception of remittances by migrant‐sending countries has been quantified and well advertised. Many have predicted economic development based on the magnitude of these aggregate figures, leaving aside the fact that new family arrangements, emigration expectations, consumption patterns and demographic changes impact the prospects for development. This paper shows how remittances link distant locations economically, socially and culturally creating unique transnational dynamics that shape development at both ends. I use multi‐sited ethnographic work conducted over seven years in different places of migrant origin and destination. The paper challenges common assumptions regarding the developmental effect of remittances, by contrasting the hyper‐rational, atomistic and perfectly informed theoretical actors of the neoclassical account with the complex actors who make their decisions on the basis of imperfect information, and the values and meanings constructed within a transnational web of family and community ties.
Migration and Characteristics of Remittance Senders in South Africa
Authors: Makina Daniel
Published: March 2012

Since 2000, South Africa has experienced unprecedented migration from Zimbabwe. Surveys have estimated that by the end of 2007, between 1 million and 2 million Zimbabweans had migrated to South Africa as a result of a political and economic crisis that has been bedevilling their country. These migrants are supporting the livelihoods of relatives left at home through remittances. The nature of the remittance flows is not well documented, and the characteristics of the remittance senders and recipients are even less well understood. In this paper, I attempt to fill this research gap by focusing on the remittance behaviour of the senders. Using data from a survey of Zimbabwean migrants living in Johannesburg in South Africa, in this paper I examine the socio‐economic and demographic characteristics of the remittance senders. Pertinent findings are that remittance behaviour is seen to be positively correlated with age, the number of dependents supported in the home country, income level and the return migration decision. Furthermore, males and married persons make up a larger proportion of the remitters than females and single persons. There are more remitters among migrants with basic education than among those with tertiary education. I have found remittance behaviour to be independent of legal status and length of stay in the host country. The independence with regard to length of stay raises questions about the validity of the remittance decay hypothesis.
The purchase of moral positions: an essay on the markets of concerned parenting
Authors: Brusdal Ragnhild , Frønes Ivar
Published: March 2012

The markets directed towards the very youngest are rapidly expanding. This article looks into the mechanisms behind the expansion of this type of parental consumption, assigning children a position similar to what Veblen categorized as vicarious consumption. The assumption put forward is that the modern markets for babies and toddlers rooted not only in the need to stimulate, protect and support the child, or the desire to display cultural and economic capital through vicarious consumption, but also in the need to indicate positions in the moral economy of concerned parenting. The expanding markets of considered consumption are partly based on translation values, empathy and care made into tangible products with symbolic values in the moral economy.
Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography
Authors: Myers Robert P. , Pollett Aaron , Kirsch Richard , Pomier‐Layrargues Gilles , Beaton Melanie , Levstik Mark , Duarte‐Rojo Andres , Wong David , Crotty Pam , Elkashab Magdy
Published: March 2012

Background

Accurate tools for the noninvasive detection of hepatic steatosis are needed. The Controlled Attenuation Parameter (CAP) specifically targets liver steatosis using a process based on transient elastography.

Methods

Patients with chronic liver disease and body mass index (BMI) ≥28 kg/m2 underwent biopsy and liver stiffness measurement (LSM) with simultaneous CAP determination using the FibroScan® M probe. The performance of the CAP for diagnosing steatosis compared with biopsy was assessed using areas under receiver operating characteristic curves (AUROC).

Results

A total of 153 patients were included: 69% were male, median BMI was 32 kg/m2; 47% had nonalcoholic fatty liver disease (NAFLD); and 65% had significant (≥10%) steatosis. The CAP was significantly correlated with the percentage of steatosis (ρ = 0.47) and steatosis grade (ρ = 0.51; both P < 0.00005). The median CAP was higher among patients with significant steatosis (317 [IQR 284–339] vs. 250 [227–279] dB/m with <10% steatosis; P < 0.0005) and the AUROC for this outcome was 0.81 (95% CI 0.74–0.88). At a cut‐off of 283 dB/m, the CAP was 76% sensitive, 79% specific, and had positive and negative predictive values of 87% and 64%, respectively. CAP performance was not influenced by measurement variability, but was higher in patients with mild (F0‐F1) fibrosis (AUROC 0.89 vs. 0.72 with F2‐F4; P = 0.03). The AUROCs of the CAP for ≥5%, >33% and >66% steatosis were 0.79, 0.76 and 0.70, respectively.

Conclusions

The CAP is a promising tool for the noninvasive detection of hepatic steatosis. Advantages of CAP include its ease of measurement, operator‐independence and simultaneous availability with LSM for fibrosis assessment.
The significance of ICG‐R15 in predicting hepatic toxicity in patients receiving radiotherapy for hepatocellular carcinoma
Authors: Yoon Hong In , Koom Woong Sub , Lee Ik Jae , Jeong Kyoungkeun , Chung Yoonsun , Kim Ja Kyung , Lee Kwan Sik , Han Kwang‐Hyub , Seong Jinsil
Published: March 2012

Aim

To evaluate whether the retention rate of indocyanine green 15 min after administration (ICG‐R15) could predict radiation hepatotoxicity in patients treated with radiotherapy (RT) for hepatocellular carcinoma (HCC).

Methods

We retrospectively reviewed data of 146 HCC patients treated with RT between February 1994 and December 2008. The ICG‐R15 was measured within 1 month prior to the start of RT. Radiation hepatotoxicity was evaluated by incidence of radiation‐induced liver disease (RILD) between 2 weeks and 3 months after completion of RT. We analysed the correlation between the incidence rate of RILD and the ICG‐R15 before RT (pre‐RT ICG‐R15).

Results

The classic and non‐classic RILD occurred in 15 patients (10.3%): classic type in five patients (3.4%) and non‐classic RILD in 10 patients (6.9%). A positive correlation was shown between the probability of RILD and increase in pre‐RT ICG‐R15 (P < 0.0001). Univariate analysis indicated that cut‐off value of pre‐RT ICG‐R15 could predict RILD significantly. The incidence of RILD for the patients with 22% or higher pre‐RT ICG‐R15 levels was 40.7% as compared to 3.4% for those with levels lower than 22% (P < 0.0001). There was no clinical factor that significantly affected RILD in univariate analysis. Multivariate analysis indicated that the pre‐RT ICG‐R15 value was the only significant factor affecting RILD (P < 0.0001).

Conclusion

These results suggest that pre‐RT ICG‐R15 could be a useful factor in predicting radiation hepatotoxicity in HCC patients treated with RT.
Estimating Ideal Points in the British House of Commons Using Early Day Motions
Authors: Kellermann Michael
Published: March 2012

This article develops a new method for estimating the ideological preferences of members of the British House of Commons. Existing methods produce implausible results due to high levels of party cohesion and strategic voting on the part of opposition parties. To circumvent these problems, this article estimates MP preferences using Early Day Motions (EDMs) as an alternative to roll‐call votes. The Bayesian ideal point model for the decision to sign an EDM takes into account both policy preferences and signing costs. The estimates obtained have greater face validity than previous attempts to measure preferences in the House of Commons, recovering the expected order of parties and of members within parties. The estimates successfully predict voting behavior in the House of Commons. As with other Bayesian ideal point methods, this approach produces natural uncertainty estimates and allows for easy calculation of quantities of interest such as member ranks.
Point‐of‐care Urine Albumin:Creatinine Ratio Is Associated With Outcome in Emergency Department Patients With Sepsis: A Pilot Study
Authors: Drumheller Byron C. , McGrath Meghan , Matsuura Asako C. , Gaieski David F.
Published: March 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:259–264 © 2012 by the Society for Academic Emergency Medicine

Objectives:  Sepsis is characterized by an initial systemic proinflammatory response leading to endothelial damage and increased capillary permeability. The authors conducted a pilot study to determine if microalbuminuria, measured by the urine albumin:creatinine ratio (ACR), was associated with outcome in emergency department (ED) sepsis patients.

Methods:  This was an observational cohort study of a convenience sample of adult patients presenting to two EDs over 10 months with sepsis (two or more systemic inflammatory response syndrome [SIRS] criteria and suspected infection). Those who received a urinalysis were prospectively enrolled. Patients with anuria, grossly contaminated specimens, or concurrent noninfectious diagnoses were excluded. Urine ACR was measured on a point‐of‐care (POC) device. The primary study outcome was ED disposition (three groups): treated and discharged, admitted to the floor, or admitted to the intensive care unit (ICU). Kruskal‐Wallis testing was used to compare ACR based on disposition. Variables associated with ACR were identified by Spearman rank correlation or Mann‐Whitney rank‐sum testing. A post hoc subgroup analysis of patients with and without a genitourinary (GU) source of infection was also performed.

Results:  A total of 121 patients were screened, and 29 (24%) were excluded; 92 patients met criteria (mean ± SD age, 51.2 ± 17.0 years; 51 [55%] had severe sepsis, three [3%] had septic shock). There were three in‐hospital deaths. Median ACR for patients treated and discharged (n = 22), admitted to floor (n = 50), and admitted to ICU (n = 20) was 2.54 (interquartile range [IQR] = 0.89 to 6.16) versus 2.8 (IQR = 1.69 to 8.8) versus 12.15 (IQR = 4.76 to 20.95), respectively (p = 0.0049). Age, serum creatinine, and GU source of infection were associated with ACR. ACR was significantly associated with disposition among patients without a GU source of infection (p = 0.003), but not among patients with a GU source (p = 0.3744).

Conclusions:  In this pilot study, microalbuminuria measured by POC ACR was associated with disposition in ED patients with sepsis or severe sepsis. Larger studies using more robust outcomes comparing ACR with validated sepsis biomarkers are needed to elaborate on these results.
Effect of a Mass Casualty Incident: Clinical Outcomes and Hospital Charges for Casualty Patients Versus Concurrent Inpatients
Authors: Abir Mahshid , Choi Hwajung , Cooke Colin R. , Wang Stewart C. , Davis Matthew M.
Published: March 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:280–286 © 2012 by the Society for Academic Emergency Medicine

Objectives:  A mass casualty incident (MCI) may strain a health care system beyond surge capacity, affecting patterns of care for casualties and other patients. Prior studies of MCIs have assessed clinical care for casualty patients, but have not examined outcomes or expenditures for noncasualty inpatients in the same time period.

Methods:  This was a retrospective analysis of administrative hospital claims in a state where an MCI with over 200 casualties occurred; two hospitals that admitted casualties of >5% of their inpatient capacity were studied. The “surge period” was defined as 7 days after the MCI. Using diagnostic codes, patients admitted on the MCI day with diagnoses of burns or inhalation injury were included in the “MCI surge cohort.” Patients admitted within a time frame of 7 days prior to 7 days after the MCI who were inpatients during the surge period were included in the “non‐MCI surge cohort.” The authors compared the MCI and non‐MCI surge cohorts to a mutually exclusive reference cohort (all inpatients during 6 weeks prior to the MCI), regarding key outcomes of hospital length of stay (LOS) and hospital charges adjusted for age, sex, race/ethnicity, and severity of illness.

Results:  Fifty‐five patients met criteria for the MCI surge cohort, 1,369 for the non‐MCI surge cohort, and 5,980 for the reference group. Compared with the reference group and adjusted for covariates, the mean (±SD) hospital LOS was 4.90 (±1.85) days longer for the MCI surge cohort (95% confidence interval [CI] = 1.67 to 8.84) and 1.34 (±0.16) days longer for the non‐MCI surge cohort (95% CI = 1.00 to 1.65). The MCI cohort also had significantly longer mean hospital LOS than the non‐MCI surge cohort (difference = 3.56 days; 95% CI = 0.36 to 7.36). Also adjusted for covariates, mean (±SD) total hospital charges for the MCI surge cohort were $22,349 (±$8,342) greater than for the reference group (95% CI = $8,182 to $39,485). Mean (±SD) charges for the non‐MCI surge cohort were $4,028 (±$633) greater than for the reference group (95% CI = $2,792 to $5,196). The MCI cohort also had higher mean total charges than the non‐MCI surge cohort (difference = $18,321; 95% CI = $4,488 to $34,980).

Conclusions:  When adjusted for severity of illness, casualty patients and noncasualty patients receiving concurrent hospital care have significantly longer LOS and higher charges than typical hospital patients at times unaffected by MCIs. Spillover effects from MCIs for noncasualty patients have not been previously described and have implications for clinical and hospital management in MCI and other high‐surge circumstances.
Prognostic Value and Agreement of Achieving Lactate Clearance or Central Venous Oxygen Saturation Goals During Early Sepsis Resuscitation
Authors: Puskarich Michael A. , Trzeciak Stephen , Shapiro Nathan I. , Arnold Ryan C. , Heffner Alan C. , Kline Jeffrey A. , Jones Alan E. ,   on Behalf of the Emergency Medicine Shock Research Network (EMSHOCKNET)
Published: March 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:252–258 © 2012 by the Society for Academic Emergency Medicine

Objectives:  Lactate clearance (LC) and central venous oxygen saturation (ScvO2) have been proposed as goals of early sepsis resuscitation. The authors sought to determine the agreement and prognostic value of achieving ScvO2 or LC goals in septic shock patients undergoing emergency department (ED)‐based early resuscitation.

Methods:  This was a preplanned analysis of a multicenter ED randomized controlled trial of early sepsis resuscitation targeting three variables: central venous pressure, mean arterial pressure, and either ScvO2 or LC. Inclusion criteria included suspected infection, two or more systemic inflammation criteria, and either systolic blood pressure of <90 mm Hg after intravenous fluid bolus or lactate level of >4 mmol/L. Both ScvO2 and LC were measured simultaneously. The ScvO2 goal was defined as ≥70%. Lactate was measured at enrollment and every 2 hours until the goal was reached or up to 6 hours. LC goal was defined as a decrease of ≥10% from initial measurement. The primary outcome was in‐hospital mortality.

Results:  A total of 203 subjects were included, with an overall mortality of 19.7%. Achievement of the ScvO2 goal only was associated with a mortality rate of 41% (9/22), while achievement of the LC goal only was associated with a mortality rate of 8% (2/25; proportion difference = 33%; 95% confidence interval [CI] = 9% to 55%). No agreement was found between goal achievement (κ = –0.02), and exact test for matched pairs demonstrated no significant difference between discordant pairs (p = 0.78).

Conclusions:  No agreement was found between LC and ScvO2 goal achievement in early sepsis resuscitation. Achievement of a ScvO2≥ 70% without LC ≥ 10% was more strongly associated with mortality than achievement of LC ≥ 10% with failure to achieve ScvO2≥ 70%.
The Delivery of a Health Promotion Intervention by a Public Health Promotion Specialist Improves Patient Satisfaction in the Emergency Department
Authors: Rega Paul P. , Roberts Stephen M. , Khuder Sadik , Boardley Debra , Brickman Kris , Regent Cynthia
Published: March 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:313–317 © 2012 by the Society for Academic Emergency Medicine

Objectives:  The objective was to introduce a public health promotion specialist (PHPS) into the hospital emergency department (ED) to provide a brief health promotion intervention to patients and to determine the effect of the initiative on patient satisfaction.

Methods:  Patients in the intervention group were offered and received a 5‐ to 10‐minute presentation about exercise, heart health, healthy eating on a budget, or weight control by a trained PHPS. Patients in the control group received usual ED care. Both groups completed the patient satisfaction instrument. Ordinal logistic regression models were used to compare the two groups on patient satisfaction questions and to identify predictors of the likelihood of patients referring others to the ED.

Results:  Subjects in the intervention group were more likely to rate the services as great in areas of patient satisfaction such as provider listening, staff being friendly and helpful, comfort and safety, and privacy. Those in the intervention group were three times more likely than those in the control group to state that they would refer others to the ED.

Conclusions:  Health promotion and disease prevention interventions carried out by PHPS in the ED can improve patient satisfaction.
A Systematic Review of Emergency Department Technology‐based Behavioral Health Interventions
Authors: Choo Esther K. , Ranney Megan L. , Aggarwal Nitin , Boudreaux Edwin D.
Published: March 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:318–328 © 2012 by the Society for Academic Emergency Medicine

Objectives:  This systematic review evaluated the evidence for use of computer technologies to assess and reduce high‐risk health behaviors in emergency department (ED) patients.

Methods:  A systematic search was conducted of electronic databases, references, key journals, and conference proceedings. Studies were included if they evaluated the use of computer‐based technologies for ED‐based screening, interventions, or referrals for high‐risk health behaviors (e.g., unsafe sex, partner violence, substance abuse, depression); were published since 1990; and were in English, French, or Spanish. Study selection and assessment of methodologic quality were performed by two independent reviewers. Data extraction was performed by one reviewer and then independently checked for completeness and accuracy by a second reviewer.

Results:  Of 17,744 unique articles identified by database search, 66 underwent full‐text review, and 20 met inclusion criteria. The greatest number of studies targeted alcohol/substance use (n = 8, 40%), followed by intentional or unintentional injury (n = 7, 35%) and then mental health (n = 4, 20%). Ten of the studies (50%) were randomized controlled trials; the remainder were observational or feasibility studies. Overall, studies showed high acceptability and feasibility of individual computer innovations, although study quality varied greatly. Evidence for clinical efficacy across health behaviors was modest, with few studies addressing meaningful clinical outcomes. Future research should aim to establish the efficacy of computer‐based technology for meaningful health outcomes and to ensure that effective interventions are both disseminable and sustainable.

Conclusions:  The number of studies identified in this review reflects recent enthusiasm about the potential of computers to overcome barriers to behavioral health screening, interventions, and referrals to treatment in the ED. The available literature suggests that these types of tools will be feasible and acceptable to patients and staff.
Outcomes of Early, Late, and No Admission to the Intensive Care Unit for Patients Hospitalized with Community‐acquired Pneumonia
Authors: Renaud Bertrand , Brun‐Buisson Christian , Santin Aline , Coma Eva , Noyez Cécile , Fine Michael J. , Yealy Donald M. , Labarère José
Published: March 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:294–303 © 2012 by the Society for Academic Emergency Medicine

Objectives:  The objective was to compare outcomes associated with early, late, and no admission to the intensive care unit (ICU) for patients hospitalized with community‐acquired pneumonia (CAP).

Methods:  This was a post hoc analysis of the original data from the Emergency Department Community‐Acquired Pneumonia (EDCAP) and Pneumocom‐1 prospective multicenter cohort studies of adult patients hospitalized with CAP. Propensity score–adjusted analysis was used to compare 28‐day mortality and hospital length of stay (LOS) for 199, 144, and 2,215 patients with early (i.e., ICU admission on the day of emergency department [ED] presentation), late, and no ICU admission.

Results:  Unadjusted 28‐day mortality rates were 13.1, 19.4, and 5.7% for early, late, and no ICU admissions, respectively (p < 0.001). After adjusting for quintile of propensity score, the odds of 28‐day mortality were higher for late ICU admissions relative to early ICU admissions (odds ratio [OR] = 2.63; 95% confidence interval [CI] = 1.42 to 4.90), and no ICU admissions (OR = 3.40; 95% CI = 2.11 to 5.48), but did not differ between early and no ICU admissions (OR = 1.29; 95% CI = 0.79 to 2.09). The median hospital LOS was 10 days for early (interquartile range [IQR] = 7 to 18), 15 days for late (IQR 9 to 23), and 6 days (IQR 4 to 9) for no ICU admissions (p < 0.001).

Conclusions:  This study suggests that late but not early admission to the ICU is associated with higher 28‐day mortality for patients hospitalized with CAP. Patients admitted to the ICU have longer hospital LOS in comparison to those managed on the wards, particularly if they are admitted late to the ICU.

ACADEMIC EMERGENCY MEDICINE 2012; 19:#–# © 2012 by the Society for Academic Emergency Medicine