bluuebunny/crossref_metadata_2025 huggingface dataset:
Short‐term outcomes of single‐port surgery for palliative resection of the primary tumor in patients with incurable stage IV colon cancer
Authors: Tei Mitsuyoshi , Wakasugi Masaki , Akamatsu Hiroki
Published: April 2016

Introduction

The aim of this study was to evaluate the short‐term outcomes of single‐port surgery (SPS) for palliative resection of the primary tumor in patients with incurable stage IV colon cancer.

Methods

We studied 66 consecutive patients who underwent SPS or multiport surgery (MPS) for palliative resection of their primary tumor in our department from January 2008 to December 2013. Short‐term outcomes and the postoperative course were analyzed between groups retrospectively.

Results

Of the 66 patients, 32 underwent SPS, and 34 underwent MPS. The groups did not differ significantly in terms of preoperative evaluation and short‐term outcomes. In the SPS group, one patient was converted to MPS (3.1%); no patients were converted to open surgery. Oncological resection, the proportion of patients who received postoperative chemotherapy, and time to the beginning of postoperative chemotherapy was similar in both groups. The 1‐year overall survival rates were 76.7% in the SPS group and 79.4% in the MPS group (P = 0.711).

Conclusions

SPS is safe and feasible for palliative resection of the primary tumor in patients with incurable stage IV colon cancer.
Diagnosis and ultrasonographic appearance of hepatic metastasis in six cases of canine appendicular osteosarcoma (2005–2013)
Authors: Cesario L , Garrett LD , Barger AM , O'Brien RT , Fan TM
Published: April 2016

Objectives

The aims of this retrospective study were to identify clinical cases of dogs with appendicular osteosarcoma (OSA) in which hepatic metastasis was confirmed, to highlight the use of cytology for its diagnosis and to describe the radiographic and ultrasonographic appearances of the lesion.

Methods

Medical records were retrospectively reviewed for dogs with appendicularOSAand hepatic metastases between January 2005 and January 2013. Reviews of radiographs, ultrasounds and cytology were performed.

Results

Six dogs with appendicularOSAand hepatic metastases were identified. The ultrasonographic appearance of metastatic lesions varied, including hyperechoic with shadowing, hyperechoic without shadowing, hypoechoic and mixed echogenicity. In two cases, the hepatic metastases were also evident on thoracic radiographs. The mean survival time from diagnosis of appendicularOSAwas 188 days (range 69–363 days) and from diagnosis of hepatic metastases was 35 days (range 2–69 days). Death was tumour‐related in all cases.

Conclusions

Hepatic metastasis varies widely in its ultrasonographic appearance. In three of six cases, hepatic metastasis was identified without concurrent pulmonary metastasis; therefore, abdominal ultrasound may be useful at regular intervals for patient evaluation, especially in clinical trials where accurate identification of the disease‐free interval is crucial. Once hepatic metastasis is confirmed, survival times appear limited.
Evolution and oncological outcomes of a contemporary radical prostatectomy practice in a UK regional tertiary referral centre
Authors: Gnanapragasam Vincent J. , Thurtle David , Srinivasan Anandagopal , Volanis Dimitrios , George Anne , Lophatananon Artitaya , Stearn Sara , Warren Anne Y. , Lamb Alastair D. , Shaw Greg , Sharma Naomi , Thomas Ben C. , Tran Maxine G. , Neal David E. , Shah Nimish C.
Published: April 2016

Objective

To investigate the clinical and pathological trends, over a 10‐year period, in robot‐assisted laparoscopic prostatectomy (RALP) in a UK regional tertiary referral centre.

Patients and Methods

In all, 1 500 consecutive patients underwent RALP between October 2005 and January 2015. Prospective data were collected on clinicopathological details at presentation as well as surgical outcomes and compared over time.

Results

The median (range) age of patients throughout the period was 62 (35–78) years. The proportion of preoperative high‐grade cases (Gleason score 8–10) rose from 4.6% in 2005–2008 to 18.2% in 2013–2015 (P < 0.001). In the same periods the proportion of clinical stage T3 cases operated on rose from 2.4% to 11.4% (P < 0.001). The median prostate‐specific antigen (PSA) level at diagnosis did not alter significantly. Overall, 11.6% of men in 2005–2008 were classified preoperatively as high‐risk by National Institute for Health and Care Excellence criteria, compared with 33.6% in 2013–2015 (P < 0.001). The corresponding proportions for low‐risk cases were 48.6% and 17.3%, respectively. Final surgical pathology showed an increase in tumour stage, Gleason grade, and nodal status over time. The proportion of pT3 cases rose from 43.2% in 2005–2008 to 55.5% in 2013–2015 (P < 0.001), Gleason score 9–10 tumours increased from 1.8% to 9.1% (P < 0.001) and positive nodal status increased from 1.6% to 12.9% (P < 0.001) between the same periods. Despite this, positive surgical margin rates showed a downward trend in all pT groups across the different eras (P = 0.72).

Conclusion

This study suggests that the patient profile for RALP in our unit is changing, with increasing proportions of higher stage and more advanced disease being referred and operated on. However, surgical margin outcomes have remained good.
The contribution of community wisdom to conservation ecology
Authors: Predavec Martin , Lunney Daniel , Hope Ben , Stalenberg Eleanor , Shannon Ian , Crowther Mathew S. , Miller Indrie
Published: April 2016

Scientists have traditionally collected data on whether a population is increasing, decreasing, or staying the same, but such studies are often limited by geographic scale and time frame. This means that for many species, understanding of trends comes from only part of their ranges at particular periods. Working with citizen scientists has the potential to overcome these limits. Citizen science has the added benefit of exposing citizens to the scientific process and engaging them in management outcomes. We examined a different way of using citizen scientists (instead of data collection). We asked community members to answer a question directly and thus examined whether community wisdom can inform conservation. We reviewed the results of 3 mail‐in surveys that asked community members to say whether they thought koala populations were increasing, decreasing, or staying the same. We then compared the survey results with population trends derived from more traditional research. Population trends identified through community wisdom were similar to the trends identified by traditional research. The community wisdom surveys, however, allowed the question to be addressed at much broader geographical scales and time frames. Studies that apply community wisdom have the benefit of engaging a broad section of the community in conservation research and education and therefore in the political process of conserving species.
Conservation and monitoring of a persecuted African lion population by Maasai warriors
Authors: Dolrenry Stephanie , Hazzah Leela , Frank Laurence G.
Published: April 2016

Although Africa has many threatened species and biological hot spots, there are few citizen science schemes, particularly in rural communities, and there has been limited evaluation of existing programs. We engaged traditional Maasai warriors (pastoralist men aged 15 to 35) in community‐based conservation and demographic monitoring of a persecuted African lion (Panthera leo) population. Through direct engagement, we investigated whether a citizen science approach employing local warriors, who had no formal education, could produce reliable data on the demographics, predation, and movements of a species with which their communities have been in conflict for generations. Warriors were given benefits such as literacy training and skill enhancement and engaged in the monitoring of the lions. The trained warriors reported on lion sign across an area nearly 4000 km2. Scientists worked together with the warriors to verify their reports and gather observations on the lion population. Using the verified reports and collected observations, we examined our scientific knowledge relative to the lion population preceding and during the citizen science program. Our observations showed that data quality and quantity improved with the involvement and training of the participants. Furthermore, because they engaged in conservation and gained personal benefits, the participants came to appreciate a species that was traditionally their foe. We believe engaging other local communities in biodiversity conservation and monitoring may be an effective conservation approach in rural Africa.
Intramyocardial Dissecting Hematoma: Cardiac Trauma and Ischemic Heart Disease: Multimodality Imaging Techniques
Authors: Urmeneta Ulloa Javier , Molina Borao Isabel , Portolés Ocampo Ana , Lapuente González Pilar , Moreno Esteban Eva , Calvo Cebollero Isabel
Published: April 2016

Mini‐Abstract

A 37‐year‐old male patient came to hospital after an accidental fall from 8.20 feet high. CT scan showed an image compatible with an old myocardial infarction at the apex of the left ventricle (LV) and a thrombosed aneurysm. At the echocardiography, adjacent to LV apex, an image of low echoic density was seen, as well as a mobile endocardial flap, suggesting a contained subacute ventricular rupture. Three multisegment arterial diseases were found at the coronary angiography. It was agreed to choose a conservative treatment. The patient was controlled with the performance of 3D, contrast echocardiography, and cardiac MRI confirming diagnosis of intramyocardial dissecting hematoma.
Pathways to care of young people accessing a pilot specialist youth mental health service in Norfolk, United Kingdom
Authors: Hodgekins Jo , Clarke Timothy , Cole Hannah , Markides Constantina , Ugochukwu Uju , Cairns Peter , Lower Rebecca , Fowler David , Wilson Jon
Published: April 2016

Aim

Pathways to care (PtC) are a means of examining and understanding routes into mental health care. It is important to examine PtC in order to identify ways in which individuals access services, as well as highlighting barriers or delays to appropriate treatment. This study aimed to examine PtC experienced by young people accessing a pilot specialist youth mental health service (SYMHS) for those with non‐psychotic, severe and complex mental health conditions in Norfolk, UK.

Methods

Data were collected on a subsample of referrals accepted into the pilot SYMHS (n = 94) over a 12‐month period. Duration and number of PtC were assessed using a semi‐structured interview augmented by health record examination. Measures of premorbid history, symptoms and functioning were also collected.

Results

The mean length of PtC was 3.74 years, and a mean of 5.53 pathways was experienced before appropriate services were accessed. Individuals were most likely to first seek help from their general practitioner followed by an educational provider. There were no associations between PtC and current symptoms, although individuals with a premorbid history of mental health problems experienced shorter PtC. There was a trend suggesting that individuals with long pathways had poorer functioning compared with those with shorter pathways.

Conclusions

Pathways to care are variable in a group of young people presenting to mental health services. A majority of participants experienced ‘long pathways’, which may negatively impact on outcome. The results indicate the need to improve access to appropriate services by overcoming pathway barriers. Service implications are discussed.
Invasive blue mussels threaten regional scale genetic diversity in mainland and remote offshore locations: the need for baseline data and enhanced protection in the Southern Ocean
Authors: Gardner Jonathan P. A. , Zbawicka Małgorzata , Westfall Kristen M. , Wenne Roman
Published: April 2016

Human‐mediated biological transfers of species have substantially modified many ecosystems with profound environmental and economic consequences. However, in many cases, invasion events are very hard to identify because of the absence of an appropriate baseline of information for receiving sites/regions. In this study, use of high‐resolution genetic markers (single nucleotide polymorphisms – SNPs) highlights the threat of introduced Northern Hemisphere blue mussels (Mytilus galloprovincialis) at a regional scale to Southern Hemisphere lineages of blue mussels via hybridization and introgression. Analysis of a multispecies SNP dataset reveals hotspots of invasive Northern Hemisphere blue mussels in some mainland New Zealand locations, as well as the existence of unique native lineages of blue mussels on remote oceanic islands in the Southern Ocean that are now threatened by invasive mussels. Samples collected from an oil rig that has moved between South Africa, Australia, and New Zealand were identified as invasive Northern Hemisphere mussels, revealing the relative ease with which such non‐native species may be moved from region to region. In combination, our results highlight the existence of unique lineages of mussels (and by extension, presumably of other taxa) on remote offshore islands in the Southern Ocean, the need for more baseline data to help identify bioinvasion events, the ongoing threat of hybridization and introgression posed by invasive species, and the need for greater protection of some of the world's last great remote areas.
Boom and bust: rapid feedback responses between insect outbreak dynamics and canopy leaf area impacted by rainfall and CO2
Authors: Gherlenda Andrew N. , Esveld Jessica L. , Hall Aidan A. G. , Duursma Remko A. , Riegler Markus
Published: April 2016

Frequency and severity of insect outbreaks in forest ecosystems are predicted to increase with climate change. How this will impact canopy leaf area in future climates is rarely tested. Here, we document function of insect outbreaks that fortuitously and rapidly occurred in an ecosystem under free‐air CO2 enrichment. Over the first 2 years of CO2 fumigation of a naturally established mature Eucalyptus woodland, we continuously assessed population responses of three sap‐feeding insect species of the psyllid genera Cardiaspina, Glycaspis and Spondyliaspis for up to ten consecutive generations. Concurrently, we quantified changes in the canopy leaf area index (LAI). Large and rapid shifts in psyllid community composition were recorded between species with either flush (Glycaspis) or senescence‐inducing (Cardiaspina, Spondyliaspis) feeding strategies. Within the second year, two psyllid species experienced significant and rapid population build‐up resulting in two consecutive outbreaks: first, rainfall stimulated Eucalyptus leaf production increasing LAI, which supported population growth of flush‐feeding Glycaspis without impacting LAI. Glycaspis numbers then crashed and were followed by the outbreak of senescence‐feeding Cardiaspina fiscella that led to significant defoliation and reduction in LAI. For all three psyllid species, the abundance of lerps, protective coverings excreted by the sessile nymphs, decreased at e[CO2]. Higher lerp weight at e[CO2] for Glycaspis but not the other psyllid species provided evidence for compensatory feeding by the flush feeder but not the two senescence feeders. Our study demonstrates that rainfall drives leaf phenology, facilitating the rapid boom‐and‐bust succession of psyllid species, eventually leading to significant defoliation due to the second but not the first outbreaking psyllid species. In contrast, e[CO2] may impact psyllid abundance and feeding behaviour, with psyllid species‐specific outcomes for defoliation severity, nutrient transfer and trophic cascades. Psyllid populations feeding on Eucalyptus experience rapid boom‐and‐bust cycles depending on availability of suitable foliage driven by rainfall patterns and leaf phenology.
Doctors’ engagements with patient experience surveys in primary and secondary care: a qualitative study
Authors: Farrington Conor , Burt Jenni , Boiko Olga , Campbell John , Roland Martin
Published: April 2016

Background

Patient experience surveys are increasingly important in the measurement of, and attempts to improve, health‐care quality. To date, little research has focused upon doctors’ attitudes to surveys which give them personalized feedback.

Aim

This paper explores doctors’ perceptions of patient experience surveys in primary and secondary care settings in order to deepen understandings of how doctors view the plausibility of such surveys.

Design, setting and participants

We conducted a qualitative study with doctors in two regions of England, involving in‐depth semi‐structured interviews with doctors working in primary care (n = 21) and secondary care (n = 20) settings. The doctors in both settings had recently received individualized feedback from patient experience surveys.

Findings

Doctors in both settings express strong personal commitments to incorporating patient feedback in quality improvement efforts. However, they also concurrently express strong negative views about the credibility of survey findings and patients’ motivations and competence in providing feedback. Thus, individual doctors demonstrate contradictory views regarding the plausibility of patient surveys, leading to complex, varied and on balance negative engagements with patient feedback.

Discussion

Doctors’ contradictory views towards patient experience surveys are likely to limit the impact of such surveys in quality improvement initiatives in primary and secondary care. We highlight the need for ‘sensegiving’ initiatives (i.e. attempts to influence perceptions by communicating particular ideas, narratives and visions) to engage with doctors regarding the plausibility of patient experience surveys.

Conclusion

This study highlights the importance of engaging with doctors’ views about patient experience surveys when developing quality improvement initiatives.
Genetically modified human CD4+ T cells can be evaluated in vivo without lethal graft‐versus‐host disease
Authors: Ali Riyasat , Babad Jeffrey , Follenzi Antonia , Gebe John A. , Brehm Michael A. , Nepom Gerald T. , Shultz Leonard D. , Greiner Dale L. , DiLorenzo Teresa P.
Published: April 2016

Adoptive cell immunotherapy for human diseases, including the use of T cells modified to express an anti‐tumour T‐cell receptor (TCR) or chimeric antigen receptor, is showing promise as an effective treatment modality. Further advances would be accelerated by the availability of a mouse model that would permit human T‐cell engineering protocols and proposed genetic modifications to be evaluated in vivo. NOD‐scid IL2rγnull (NSG) mice accept the engraftment of mature human T cells; however, long‐term evaluation of transferred cells has been hampered by the xenogeneic graft‐versus‐host disease (GVHD) that occurs soon after cell transfer. We modified human primary CD4+ T cells by lentiviral transduction to express a human TCR that recognizes a pancreatic beta cell‐derived peptide in the context of HLA‐DR4. The TCR‐transduced cells were transferred to NSG mice engineered to express HLA‐DR4 and to be deficient for murine class II MHC molecules. CD4+ T‐cell‐depleted peripheral blood mononuclear cells were also transferred to facilitate engraftment. The transduced cells exhibited long‐term survival (up to 3 months post‐transfer) and lethal GVHD was not observed. This favourable outcome was dependent upon the pre‐transfer T‐cell transduction and culture conditions, which influenced both the kinetics of engraftment and the development of GVHD. This approach should now permit human T‐cell transduction protocols and genetic modifications to be evaluated in vivo, and it should also facilitate the development of human disease models that incorporate human T cells.
Impact of tailored patient education on adherence of patients with chronic myeloid leukaemia to tyrosine kinase inhibitors: a randomized multicentre intervention study
Authors: Kekäle Meri , Söderlund Tim , Koskenvesa Perttu , Talvensaari Kimmo , Airaksinen Marja
Published: April 2016

Aims

The aim of this study was to evaluate the influence of tailored patient education on adherence to tyrosine kinase inhibitor medication among patients with chronic myeloid leukaemia.

Background

Management of chronic myeloid leukaemia has changed dramatically during the last decade. While medication adherence is crucial to clinical response, little is known about how to improve patients' adherence.

Design

Randomized multicentre intervention study.

Methods

The study was conducted between June 2012–August 2014. Eighty‐six patients with chronic myeloid leukaemia who had been on tyrosine kinase inhibitor medication for at least six months from eight hospitals were randomized into intervention and control groups. Intervention combined nurse‐conducted medication counselling, an information booklet, video and website and text message reminders. Patients were interviewed to assess medication adherence using Morisky's 8‐Item Medication Adherence Scale at baseline and nine months.

Results

Medication adherence improved with the adherence aids used. At nine months, 51% of patients were highly adherent in the intervention group, compared with 21% in the control group. Adherence improved for a higher proportion of patients in the intervention group than the control group (49% vs. 18%). Morisky's score decreased in almost half of control group cases. Patients were most satisfied with face‐to‐face counselling (86%) and the information booklet (83%) and least satisfied with text messages (9%).

Conclusion

Tailored patient education improved the medication adherence of patients with chronic myeloid leukaemia. Without this, adherence behaviour tended to decline. Personal communication with a nurse proved to be an essential part of adherence support and should not be ignored.
Interaction of uromodulin and complement factor H enhances C3b inactivation
Authors: Liu Maojing , Wang Yaqin , Wang Fengmei , Xia Min , Liu Ying , Chen Yuqing , Zhao Ming‐Hui
Published: April 2016

Recent studies suggest that uromodulin plays an important role in chronic kidney diseases. It can interact with several complement components, various cytokines and immune system cells. Complement factor H (CFH), as a regulator of the complement alternative pathway, is also associated with various renal diseases. Thus, we have been suggested that uromodulin regulates complement activation by interacting with CFH during tubulointerstitial injury. We detected co‐localization of uromodulin and CFH in the renal tubules by using immunofluorescence. Next, we confirmed the binding of uromodulin with CFH in vitro and found that the affinity constant (KD) of uromodulin binding to CFH was 4.07 × 10−6M based on surface plasmon resonance results. The binding sites on CFH were defined as the short consensus repeat (SCR) units SCR1–4, SCR7 and SCR19–20. The uromodulin‐CFH interaction enhanced the cofactor activity of CFH for factor I‐mediated cleavage of C3b to iC3b. These results indicate that uromodulin plays a role via binding and enhancing the function of CFH.
Genome editing in nonhuman primates: approach to generating human disease models
Authors: Chen Y. , Niu Y. , Ji W.
Published: April 2016

Nonhuman primates (NHPs) are superior than rodents to be animal models for the study of human diseases, due to their similarities in terms of genetics, physiology, developmental biology, social behaviour and cognition. Transgenic animals have become a key tool in functional genomics to generate models for human diseases and validate new drugs. However, until now, progress in the field of transgenic NHPs has been slow because of technological limitations. Many human diseases, including neurodegenerative disorders, are caused by mutations in endogenous genes. Fortunately, recent developments in precision gene editing have led to the generation of NHP models for human diseases. Since 2014, there have been several reports of the generation of monkey models using transcription activator‐like endonucleases (TALENs) or clustered regularly interspaced short palindromic repeats (CRISPR/Cas9); some of these NHP models showed symptoms that were much closer to those of human diseases than have been seen previously in mouse models. No off‐targeting was observed in the NHP models, and multiple gene knockout and biallelic mutants were feasible with low efficiency. These findings suggest that there are many possibilities to establish NHP models for human diseases that can mimic human diseases more faithfully than rodent models.
Governance and the Sustainable Development Goals: The Increasing Relevance of Access Rights in Principle 10 of the Rio Declaration
Authors: Orellana Marcos
Published: April 2016

The United Nations General Assembly has adopted 17 Sustainable Development Goals (SDGs) for the 2030 sustainable development agenda. Governance underlies all of the SDGs, because effective, accountable and inclusive institutions and procedures are essential to their realization. This article identifies and describes the features and structures of governance necessary for the attainment of the SDGs. Drawing on Principle 10 of the Rio Declaration and other legal sources, the article deconstructs the procedural rights which are integral to governance for sustainable development and emphasizes the need for effective accountability mechanisms at various levels. The article concludes that procedural rights and effective accountability at all levels is the key to governance that will transform political commitments to the 2030 sustainable development agenda into actual realities for people on the ground.
The Effects of Perfectionism in Elite Sport: Experiences of Unhealthy Perfectionists
Authors: Sellars Paul A. , Evans Lynne , Thomas Owen
Published: April 2016

This study examined the perfectionism experiences of 10 elite perfectionist athletes (5 male and 5 female). Following completion of the Sport Multidimensional Perfectionism Scale-2 (Gotwals & Dunn, 2009), a purposeful sample of unhealthy perfectionists were interviewed in relation to the study aims. Several themes emerged from the data that related to: effects of perfectionism and its antecedents on sporting experiences, specificity and level of perfectionism, and the coping skills and techniques used to counter the potentially detrimental effects of perfectionism. The findings highlighted the multidimensional nature of perfectionism and the need for future research to further explore the efficacy of techniques athletes use to promote healthy and reduce unhealthy facets of perfectionism.
Transformational Leadership in Elite Sport: A Qualitative Analysis of Effective Leadership Behaviors in Cricket
Authors: Smith Matthew J. , Young David J. , Figgins Sean G. , Arthur Calum A.
Published: April 2016

We examined transformational leadership behaviors are exhibited in an elite sport environment. Semistructured interviews were conducted with 9 professional county cricket players to explore perceptions of transformational leadership behaviors of their captain and head-coach. Behaviors were firstly deductively categorized based on the Differentiated Transformational Leadership Inventory, with the most frequently cited being high performance expectations and individual consideration from the coach, and appropriate role-modeling of the captain. Further inductive analyses revealed a range of other factors which may influence players’ perceptions of transformational leadership. From these findings, suggestions are offered for those working in an applied context with sporting leaders.
Native functionality in triple catalytic cross-coupling: sp
3
C–H bonds as latent nucleophiles
Authors: Shaw Megan H. , Shurtleff Valerie W. , Terrett Jack A. , Cuthbertson James D. , MacMillan David W. C.
Published: April 2016

A tip of the HAT to C-C bond formation

Iridium and nickel are already a proven team for forging carbon-carbon bonds. The iridium harvests blue light from a simple light-emitting diode and orchestrates the coupling by the nickel. Shaw
et al.
now add a third player to the team, a hydrogen atom transfer (HAT) catalyst (see the Perspective by Fruit). Together, the trio of catalysts can link bromo- or chloroaryl rings directly to C-H sites adjacent to nitrogen or oxygen, with no need for prior modification. The reaction is highly selective across a broad range of substrates.

Science
, this issue p.
1304
; see also p.
1277
Neuropilin-1 mediates vascular permeability independently of vascular endothelial growth factor receptor-2 activation
Authors: Roth Lise , Prahst Claudia , Ruckdeschel Tina , Savant Soniya , Weström Simone , Fantin Alessandro , Riedel Maria , Héroult Mélanie , Ruhrberg Christiana , Augustin Hellmut G.
Published: April 2016

Blood vessel leakiness can be induced through the co-receptor NRP1 independently of VEGFR.
How Ca
2+
-permeable AMPA receptors, the kinase PKA, and the phosphatase PP2B are intertwined in synaptic LTP and LTD
Authors: Hell Johannes W.
Published: April 2016

Interplay of PKA and PP2B mediates AMPA receptor trafficking in synaptic plasticity.
Papers of note in
Science Translational Medicine
Authors: Ferrarelli Leslie K.
Published: April 2016

This week’s articles describe new ways to treat sepsis and pain.
The challenge of consent in clinical genome-wide testing
Authors: Burke Katherine , Clarke Angus
Published: April 2016

Genome-wide testing methods include array comparative genomic hybridisation (aCGH), multiple gene panels, whole exome sequencing (WE) and whole genome sequencing (WGS). Here we introduce some of the key ethical and social considerations relating to informed consent for the testing of children, particularly the management of incidental findings and variants of unknown significance.
Newborn with severe epidermolysis bullosa: to treat or not to treat?
Authors: Boesen Martin Lehmann , Bygum Anette , Hertz Jens Michael , Zachariassen Gitte
Published: April 2016

Epidermolysis bullosa (EB) is an inherited skin disease with four main subtypes that cannot be distinguished clinically at birth. All subtypes may present with widespread life-threatening blisters and fragile skin, making treatment and handling of the newborn with EB challenging. The prognosis of EB depends on the subtype, and therefore maximum treatment is necessary until the final diagnosis is known. In this case, it took 2 weeks before a final diagnosis was reached. In the meantime, we had several ethical discussions on the treatment level. The most important issues were management of pain and nutrition. For immediate pain relief, intranasal fentanyl worked best and gabapentin was successfully used for chronic pain. The feeding difficulties were handled first by a nasogastric feeding tube. Later a normal feeding bottle proved to be adequate.
An evaluation of entecavir treatment among nucleos(t)ide-naïve Moroccan patients with chronic hepatitis B
Authors: Chakkor Amal , Rouibaa Fedoua , Elaboudi Safiaa , Aourarh Aziz
Published: April 2016

Objective

To analyse the efficacy and safety of entecavir (ETV) treatment in nucleos(t)ide (NUC)-naïve Moroccan patients with chronic hepatitis B.

Methods

We retrospectively analysed 41 NUT-naïve Moroccan patients with chronic hepatitis B who received ETV 0,5 mg/day monotherapy for at least 3 months, of whom 3 were HBV envelope antigen (HbeAg) positive and 38 were HBeAg negative. The primary end point was the proportion of patients achieving virological response. Secondary end points included biochemical response (alanine transaminase (ALT) normalisation), serological response (HbeAg and HBV surface antigen (HBsAg) loss or seroconversion) and safety.

Results

The median follow-up duration was 74 weeks (48–144 weeks) and mean age was 43.8 years. Of 41 patients, 6 were primary non-responders and 2 achieved partial virological response at week 48, whereas 35 achieved undetectable hepatitis B virus (HBV) DNA at month 12. Viral suppression was maintained in 97.6% of patients after 3 years of ETV treatment. One patient experienced a virological breakthrough at month 12 of treatment. ALT normalisation occurred in 100% of the patients after 1 year of treatment. Only three patients in our study were HbeAg positive, of whom one has experienced seroconversion at month 12 of treatment. However, HBsAg loss or seroconversion was not achieved during the period of the study. No serious adverse event was reported.

Conclusions

These preliminary results showed that ETV is a safe and potent inhibitor of HBV in NUC-naïve Moroccan patients, but we need to observe more patients for a longer period of time, in order to assess the long-term effectiveness, safety, resistance profile and predictive factors for virological and serological response of ETV.
Improving hospital death certification in Viet Nam: results of a pilot study implementing an adapted WHO hospital death report form in two national hospitals
Authors: Walton Merrilyn , Harrison Reema , Chevalier Anna , Esguerra Esmond , Van Duong Dang , Chinh Nguyen Duc , Giang Huong
Published: April 2016

Background

Viet Nam does not have a system for the national collection of death data that meets international requirements for mortality reporting. It is identified as a ‘no-report’ country by the WHO. Verbal autopsy reports are used in the community but exclude deaths in hospitals.

Methods

This project was undertaken in Bach Mai National General Hospital and Viet Duc Surgical and Trauma Hospital in Viet Nam from 1 March 2013 to 31 March 2015. In phase 1, a modified hospital death report form, consistent with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, was developed. Small group training in use of the report form was delivered to 427 doctors. In phase two, death data were collected, collated and analysed. In phase three, a random sample (7%) of all report forms was checked for accuracy and completeness against medical records.

Findings

During the 23 months of the study, 3956 deaths were recorded. Across both hospitals, 222 distinct causes of deaths were recorded. Traumatic cerebral oedema was the immediate cause of death (15% of cases, 575/3956 patients), followed by septic shock (13%, 528/3956), brain compression (11%, 416/3956), intracerebral haemorrhage (8%, 336/3956) and pneumonia (5%, 186/3956); 67% (2639/3956) of patients were discharged home to die and 33% (1314/3956) of deaths were due to a road traffic accident, or injury at home or at work.

Conclusions

This study confirms the viability of implementing a death report form system compliant with international standards in hospitals in Viet Nam and provides the foundation for introducing a national death report form scheme. These data are critical to comprehensive knowledge of causes of death in Viet Nam. Death data about patients discharged home to die is presented for the first time, with implications for countries where this is a cultural preference.
Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain
Authors: Yamada Keiko , Matsudaira Ko , Imano Hironori , Kitamura Akihiko , Iso Hiroyasu
Published: April 2016

Objectives

Working is a common cause of chronic pain for workers. However, most of them need to continue working despite the pain in order to make a living unless they get a sick leave or retirement. We hypothesised that the therapeutic effect of vocational rehabilitation may depend on psychosocial factors related to the workplace. To test this hypothesis, we examined the association of work-related psychosocial factors with the prevalence of chronic pain or health-related quality of life (HRQoL) among workers with chronic pain.

Methods

We examined 1764 workers aged 20–59 years in the pain-associated cross-sectional epidemiological survey in Japan. The outcomes were (1) chronic pain prevalence among all workers and (2) low Euro QoL (EQ-5D <0.76; mean value of the current study) prevalence among workers with chronic pain according to the degree of workplace social support and job satisfaction. Workplace social support and job satisfaction were measured using the Brief Job Stress Questionnaire. Multivariable-adjusted ORs were calculated using a logistic regression model including age, sex, smoking, exercise, sleep time, work hours, body mass index, personal consumption expenditure, intensity of pain and the presence of severe depressive symptoms.

Results

Chronic pain prevalence was higher among males reporting job dissatisfaction compared with those reporting job satisfaction. No difference was observed among women. Chronic pain prevalence did not differ between workers of either sex reporting poor workplace social support compared with those reporting sufficient support. Among workers with chronic pain, low HRQoL was more frequent in those reporting job dissatisfaction. Similarly, low HRQoL was more frequent in patients with chronic pain reporting poor social support from supervisors or co-workers compared with patients reporting sufficient support.

Conclusions

Work-related psychosocial factors are critical for HRQoL in patients with chronic pain.
What are the barriers to implementation of cardiopulmonary resuscitation training in secondary schools? A qualitative study
Authors: Zinckernagel Line , Malta Hansen Carolina , Rod Morten Hulvej , Folke Fredrik , Torp-Pedersen Christian , Tjørnhøj-Thomsen Tine
Published: April 2016

Objective

Cardiopulmonary resuscitation (CPR) training in schools is recommended to increase bystander CPR and thereby survival of out-of-hospital cardiac arrest, but despite mandating legislation, low rates of implementation have been observed in several countries, including Denmark. The purpose of the study was to explore barriers to implementation of CPR training in Danish secondary schools.

Design

A qualitative study based on individual interviews and focus groups with school leadership and teachers. Thematic analysis was used to identify regular patterns of meaning both within and across the interviews.

Setting

8 secondary schools in Denmark. Schools were selected using strategic sampling to reach maximum variation, including schools with/without recent experience in CPR training of students, public/private schools and schools near to and far from hospitals.

Participants

The study population comprised 25 participants, 9 school leadership members and 16 teachers.

Results

School leadership and teachers considered it important for implementation and sustainability of CPR training that teachers conduct CPR training of students. However, they preferred external instructors to train students, unless teachers acquired the CPR skills which they considered were needed. They considered CPR training to differ substantially from other teaching subjects because it is a matter of life and death, and they therefore believed extraordinary skills were required for conducting the training. This was mainly rooted in their insecurity about their own CPR skills. CPR training kits seemed to lower expectations of skill requirements to conduct CPR training, but only among those who were familiar with such kits.

Conclusions

To facilitate implementation of CPR training in schools, it is necessary to have clear guidelines regarding the required proficiency level to train students in CPR, to provide teachers with these skills, and to underscore that extensive skills are not required to provide CPR. Further, it is important to familiarise teachers with CPR training kits.
Talking about human papillomavirus and cancer: protocol for a patient-centred study to develop scripted consultations
Authors: Hendry Maggie , Pasterfield Di , Adams Richard , Evans Mererid , Fiander Alison , Robling Michael , Campbell Christine , Makin Matthew , Gollins Simon , Hiscock Julia , Nafees Sadia , Bekkers Marie-Jet , Rose Jan , Williams Olwen , Stanley Margaret , Wilkinson Clare
Published: April 2016

Introduction

Persistent infection with sexually transmitted, high-risk human papillomavirus (HPV) types is the cause of all cervical cancers and some anogenital and oropharyngeal cancers. HPV is an extremely common asymptomatic infection but little known and poorly understood by the public. Patients with HPV-related cancers have new and challenging information needs due to the complex natural history of HPV and the stigma of sexual transmission. They may ask questions that are outside the remit of the traditional cancer consultation, and there is a lack of guidance on how to counsel them. This study aims to fulfil that need by developing and testing cancer site-specific scripted consultations.

Methods and analysis

A synthesis of findings generated from previous work, a systematic review of information-based interventions for patients with HPV-related cancers, and interviews with cancer clinicians will provide the evidence base underpinning provisional messages. These will be explored in three phases of face-to-face interviews with 75–90 purposively selected patients recruited in cancer clinics to: (1) select and prioritise the most salient messages, (2) phrase the messages appropriately in plain English and, (3) test their acceptability and usefulness. Phases 1 and 2 will draw on card-sorting methods used in website design. In phase three, we will create cancer site-specific versions of the script and test them using cognitive interviewing techniques.

Ethics and dissemination

The study has received ethical approval. Findings will be published in a peer-reviewed journal. The final product will be cancer-specific scripted consultations, most likely in the form of a two-sided information sheet with the most important messages to be conveyed in a consultation on one side, and frequently asked questions for later reading on the reverse. However, they will also be appropriate and readily adaptable to web-based uses.
Perceived clinician–patient communication in the emergency department and subsequent post-traumatic stress symptoms in patients evaluated for acute coronary syndrome
Authors: Chang Bernard P , Sumner Jennifer A , Haerizadeh Myrta , Carter Eileen , Edmondson Donald
Published: April 2016

Objectives

Evaluation for a potentially life-threatening cardiac event in the emergency department (ED) is a stressful experience that can result in symptoms of post-traumatic stress disorder, which are associated with increased risk of morbidity and mortality in patients. No study has tested whether good clinician–patient communication in the ED is associated with better psychological outcomes in these individuals and whether it can mitigate other risk factors for post-traumatic stress symptoms (PSS) such as perception of life threat and vulnerability in the ED.

Methods

Data were analysed from 474 participants in the Reactions to Acute Care and Hospitalization (REACH) study, an observational cohort study of ED predictors of medical and psychological outcomes after evaluation for suspected acute coronary syndrome. Participants were recruited from November 2013 to January 2015 at a single-site academic medical centre (New York-Presbyterian-Columbia University Medical Center). Participants reported threat perceptions in the ED and provided information on their perceptions of clinician–patient communication using the Interpersonal Process of Care Survey. PSS were assessed using the Acute Stress Disorder Scale during follow-up.

Results

474 subjects were enrolled in the study. Median length of follow-up was 3 days after ED presentation, range 0–30 days, 80% within 8 days. Perceptions of good clinician–patient communication in the ED were associated with lower PSS, whereas increased threat perception was associated with higher PSS. A significant interaction between clinician–patient communication and threat perception on PSS suggested that patients with higher threat perception benefited most from good clinician–patient communication.

Conclusion

Our study found an association between good clinician–patient communication in the ED during evaluation of potentially life-threatening cardiac events and decreased subsequent post-traumatic stress reactions. This association is particularly marked for patients who perceive the greatest degree of life threat and vulnerability during evaluation.
Hiatus hernia in healthy volunteers is associated with intrasphincteric reflux and cardiac mucosal lengthening without traditional reflux
Authors: Robertson Elaine V , Derakhshan Mohammad H , Wirz Angela A , Mitchell David R , Going James J , Kelman Andrew W , Ballantyne Stuart A , McColl Kenneth E L
Published: April 2016

Background and aims

Hiatus hernia (HH) is a key mediator of gastro-oesophageal reflux disease but little is known about its significance in the general population. We studied the structure and function of the gastro-oesophageal junction in healthy volunteers with and without HH.

Methods

We compared 15 volunteers with HH, detected by endoscopy or MRI scan, but without gastro-oesophageal reflux disease with 15 controls matched for age, gender and body weight. Jumbo biopsies were taken across the squamocolumnar junction (SCJ). High-resolution pH metry (12 sensors) and manometry (36 sensors) were performed upright and supine, before and after a meal. The SCJ was marked with an endoscopically placed clip and visualised fluoroscopically.

Results

Cardiac mucosa was longer in volunteers with HH (3.5 vs 2.5 mm, p=0.01). There was no excessive acid reflux 5 cm above the upper border of the lower oesophageal sphincter (LOS) in either group but those with HH had short segment reflux 11 mm above the pH transition point after the meal when supine (pH<4 for 5.5% vs 0.3% of time, p=0.01). The SCJ and pH transition point were proximally displaced within the gastro-oesophageal junction in those with HH versus controls (p<0.05). The pH transition point was proximal to the peak LOS pressure point in HH subjects but distal to it in controls after the meal (p<0.05). When supine, the postprandial pH transition point crossed the SCJ in those with HH (p=0.03).

Conclusions

Healthy volunteers with HH have increased intrasphincteric reflux and lengthening of cardiac mucosa in the absence of traditional transsphincteric reflux.
Doubly distributing special obligations: what professional practice can learn from parenting
Authors: Tilburt Jon , Brody Baruch
Published: April 2016

A traditional ethic of medicine asserts that physicians have special obligations to individual patients with whom they have a clinical relationship. Contemporary trends in US healthcare financing like bundled payments seem to threaten traditional conceptions of special obligations of individual physicians to individual patients because their population-based focus sets a tone that seems to emphasise responsibilities for groups of patients by groups of physicians in an organisation. Prior to undertaking a cogent debate about the fate and normative weight of special obligations and a traditional ethic for contemporary healthcare, we need a deeper examination of what the traditional ethic of special obligations really means. Here we offer a conception of ‘doubly distributed’ special obligations. Physicians and similarly minded healing professionals abiding by a traditional ethic have always spread their devotion and attention across multiple patients and have shared responsibilities with physician and non-physician colleagues in much the same way devoted parents have frequently distributed their special obligations across multiple children and across multiple parents. By taking up the extended analogy of parent we argue that doubly distributing special obligations need not contradict the possibility of special obligations in restructured collective forms of healthcare delivery and financing.