bluuebunny/crossref_metadata_2025 huggingface dataset:
Fenestrated Endografting After Bare Metal Dissection Stent Implantation
Authors: Barbante Matteo , Sobocinski Jonathan , Maurel Blandine , Azzaoui Richard , Martin-Gonzalez Teresa , Haulon Stéphan
Published: March 2015

Purpose: To present a case that demonstrates the ability to deploy a 4-fenestrated endograft in an aorta previously treated with an endovascular graft and additional distal bare stents for acute type B dissection. Case Report: Five years ago, a 61-year-old man had a Zenith TX2 endovascular graft and 2 distal bare metal stents deployed for acute type B dissection. In follow-up, a distal extension endograft was deployed below the bare stent for false lumen reperfusion and aortic growth. The ascending aorta and the arch were replaced surgically at 3 years, with the distal end of the graft sewn to the existing endograft. At the current admission, a Crawford type III thoracoabdominal aortic aneurysm was found and excluded with a 4-fenestration endograft. Using 3-dimensional fusion imaging, there was no major conflict with the struts of the bare dissection stent during catheterization and bridging stent placement. A distal bifurcated endograft was also implanted. The total procedure time was 240 minutes, the radiation dose was 8066 cGy·cm2, and the contrast volume was 100 mL. The patient was discharged on the sixth postoperative day and continues to do well at 9 months. Conclusion: Prior dissection stent deployment within the thoracoabdominal segment does not preclude further fenestrated endograft placement. Intraoperative fusion imaging can be very helpful to the successful completion of these complex procedures.
Initial Clinical Experience With the Micromesh Roadsaver Carotid Artery Stent for the Treatment of Patients With Symptomatic Carotid Artery Disease
Authors: Hopf-Jensen Silke , Marques Leonardo , Preiß Michael , Müller-Hülsbeck Stefan
Published: March 2015

Purpose: To assess the effectiveness, technical aspects, handling, and safety of the micromesh Roadsaver Carotid Artery Stent in the treatment of atherosclerotic carotid artery stenosis and tandem lesions in ischemic stroke patients. Methods: Seven patients (5 men; mean age 75±11.4 years, range 53–86) suffering from symptomatic internal carotid artery (ICA) stenosis (mean 76% diameter reduction) were treated with the dual layer closed-cell stent without embolic protection. Postdilation was performed in 6 of 7 patients. Two patients were treated in the context of ischemic stroke and concurrent middle cerebral artery occlusion. Mean National Institutes of Health Stroke Scale score at admission was 12.8±5. Results: All devices were deployed satisfactorily. One wall-adherent thromboembolus in a proximal ICA was covered with the Roadsaver stent in a tandem lesion setting. The modified Rankin Scale (mRS) declined from 3.7±0.7 to 2.4±0.8 in hospital, showing an improvement in clinical symptoms. No complications were detected during or after the procedure. The 30-day mRS was 1.7±1.1. At 6 months, ultrasound examination demonstrated patency of stents and the external carotid arteries. Conclusion: The Roadsaver double layer micromesh stent seems to be safe and effective in the treatment of extracranial ICA stenosis and in the context of tandem lesions in ischemic stroke. Further studies with larger populations are warranted.
Transcription Factor AP2ε
Authors: Sun Jingyue , Du Nan , Li Jin , Zhou Jianwei , Tao Guoquan , Sun Suan , He Jingdong
Published: March 2015

Chemotherapy is a mainstay of therapy for advanced gastric cancer (GC); however, owing to drug resistances, the effectiveness of chemotherapy is not satisfactory for some patients with GC. Therefore, identification of a marker that predicts treatment response is beneficial to patients. Hypermethylation of transcription factor activating enhancer-binding protein 2∊ (TFAP2E) has been implicated in chemotherapy resistance to fluorouracil-based chemotherapy in patients with colorectal cancer, but its role in GC is still unknown. In this study, we investigated TFAP2E as a predictor of treatment response in GC. We used methylation-sensitive high-resolution melting analysis to study the methylation of TFAP2E in 141 GC tissue specimens and 45 adjacent nontumor tissue specimens. In vitro experiments, we analyzed the expression and methylation of TFAP2E and to examine the sensitivity of GC cell lines to 5-fluorouracil (5-FU). The TFAP2E methylation occurred at a significantly higher incidence rate in tumor tissues compared to adjacent nontumor tissues (chi-square [χ2] = 38.919, P < .001). Hypermethylation of TFAP2E occurred more frequently in tumors with lower differentiation grades ( P < .001) and was significantly associated with nonresponse to fluorouracil-based chemotherapy ( P = .010). Hypermethylation was also associated with decreased expression of TFAP2E ( P < .01) and nonresponse to 5-FU exposure in vitro ( P < .001). Hypermethylation of TFAP2E was associated with lack of response to fluorouracil-based chemotherapy, indicating that it might be a potential predictor of treatment response in patients with GC.
Early glucose variability in cardiogenic shock following acute myocardial infarction: a pilot study
Authors: Lazzeri Chiara , Valente Serafina , Chiostri Marco , Attanà Paola , Gensini Gian Franco
Published: March 2015

Background:

No data are so far available on the association between glycaemic variability and outcomes in patients with cardiogenic shock (CS) following ST elevation myocardial infarction (STEMI).

Methods:

We assessed the relationship between glycaemic variability and mortality, both short term and long term, in 67 consecutive patients with cardiogenic shock following STEMI admitted to our Intensive Cardiac Care Unit. Glycaemic variability was measured in the first 48 h by means of standard deviation (SD) of glucose values and the mean absolute glucose change per hour (MAGC) defined as the sum of all absolute glucose change divided by the time in hours.

Results:

Lower glycaemic variability was observed in survivors when compared with nonsurvivors, as indicated by lower values of SD and MAGC, respectively. In Cox regression analysis, MAGC and SD were independent predictors of death (MAGC: adjusted hazard ratio [HR]: 8.60, 95% confidence interval [CI]: 2.21–33.41, p = 0.002; SD: adjusted HR: 6.64, 95% CI: 1.92–22.99, p = 0.003), as well as peak glycaemia (adjusted HR: 1.95, 95% CI: 1.20–3.15, p = 0.007).

Conclusions:

According to our results, in patients with CS following acute myocardial infarction, early glycaemic variability is an independent predictor of mortality. Further studies are needed to confirm our results in larger cohorts and eventually to assess the effect of strategies specifically targeting glucose variability reduction on mortality.
Specialized enteral nutrition therapy in Crohn’s disease patients on maintenance infliximab therapy: a meta-analysis
Authors: Nguyen Douglas L. , Palmer Lena B. , Nguyen Emily T. , McClave Stephen A. , Martindale Robert G. , Bechtold Matthew L.
Published: March 2015

Objectives:

Many patients with Crohn’s disease on infliximab maintenance therapy have recurrent symptoms despite an initial clinical response. Therefore, concomitant therapies have been studied. We conducted a meta-analysis to assess the effect of specialized enteral nutrition therapy with infliximab versus infliximab monotherapy in patients with Crohn’s disease.

Methods:

A comprehensive search of multiple databases was performed. All studies of adult patients with Crohn’s disease comparing specialized enteral nutrition therapy (elemental or polymeric diet with low-fat or regular diet) with infliximab versus infliximab monotherapy without dietary restrictions were included. Meta-analysis was performed using the Mantel–Haenszel (fixed effect) model with odds ratio (OR) to assess for clinical remission.

Results:

Four studies ( n = 342) met inclusion criteria. Specialized enteral nutrition therapy with infliximab resulted in 109 of 157 (69.4%) patients reaching clinical remission compared with 84 of 185 (45.4%) with infliximab monotherapy [OR 2.73; 95% confidence interval (CI): 1.73–4.31, p < 0.01]. Similarly, 79 of 106 (74.5%) patients receiving enteral nutrition therapy and infliximab remained in clinical remission after one year compared with 62 of 126 (49.2%) patients receiving infliximab monotherapy (OR 2.93; 95% CI: 1.66–5.17, p < 0.01). No publication bias or heterogeneity was noted for either outcome.

Conclusions:

The use of specialized enteral nutrition therapy in combination with infliximab appears to be more effective at inducing and maintaining clinical remission among patients with Crohn’s disease than infliximab monotherapy.
Chest pain and high-sensitivity troponin: What is the evidence?
Authors: Ashmore Daniel
Published: March 2015

The number of attendances and admissions of patients with chest pain to hospitals in England and Wales is increasing. Initial assessment may be unrewarding. Consequently, cardiac troponin has become the mainstay of investigation for non-ST-segment-elevation myocardial infarction and unstable angina, although only a small proportion of patients are eventually diagnosed as such. Current National Institute for Healthcare and Clinical Excellence guidance recommends measuring cardiac troponin levels on presentation and 10–12 h after onset of symptoms. A more effective diagnostic tool is needed. The aims are twofold: to increase accuracy of acute coronary syndrome diagnosis thus implementing the most appropriate management at an earlier stage while reducing costs and to provide a more rapid diagnosis to ease the anxieties of patients. Three key issues have been highlighted. The first is that many current studies do not have a ‘normal/reference’ population, making comparison between two studies difficult to interpret. Second, whether newer ‘high-sensitivity’ cardiac troponin tests can be used to rule out a myocardial infarction in a patient with chest pain is discussed. Third, whether a ‘high-sensitivity’ cardiac troponin has great enough specificity to differentiate between the number of other causes of raised troponin in a single test or whether serial testing is needed is assessed. A strategy for such serial testing is discussed. Finally, use of ‘high-sensitivity’ cardiac troponin in risk stratification of other disease processes is highlighted, which is likely to become common practice, changing the way we manage patients with, and without, chest pain.
Representative Bureaucracy
Authors: Morabito Melissa , Shelley Tara O’Connor
Published: March 2015

The domination of policing by White males has long been considered a threat to the legitimacy of the profession, as police agencies have struggled with attracting, retaining, and promoting women and minorities within their agencies for decades. Female and minority representation are hardly stable across agencies with some agencies employing no women or people of color, while others are more representative of the communities they serve. Using a national sample of 1,478 police jurisdictions, this study further explores the correlates of diversity of women and racial minorities using a framework informed by representative bureaucracy theory. Findings suggest that the same factors are not predictive of representation of women and racial minorities.
Instructional Style, Cognitive Processing, and Achievement Behavior Patterns of Schoolchildren
Authors: Mohanty Atasi , Das Swati Preeti
Published: March 2015

The objective of the study was to examine the performance characteristics and differences between English and Oriya medium school children on various cognitive processing, reading, academic achievement, and teacher perception measures. The sample consists of 243 schoolchildren, 120 from Grade IV and 123 from Grade VII from three different schools of Cuttack city in Orissa, India. The children were individually administered the Figure-Copying, Raven’s Progressive Matrices, Matching Familiar Figure Task, Serial Recall, Digit-Span, Wechsler’s Intelligence Scale for Children, Block Design, Cloze Reading Comprehension, and Oral Reading tasks. Classroom Achievement scores on different subjects and the teachers’ ratings about their students were also taken. Results revealed that children reading in English medium schools outperformed their Oriya medium counterparts in some cognitive measures such as Figure Copying, MFFT, RPM, and Digit-Span tasks irrespective of levels. However, the children studying in Oriya medium schools scored higher in Reading Comprehension task and commit less error compared with their English medium counterparts. However, in case of academic achievement measures at primary level, the Oriya medium children performed better in social science, whereas the English medium students excelled in first language and mathematics. The teachers of Oriya medium schools also rated their children better in general conduct, motivation, and effort in schoolwork, whereas, at the secondary level, there was no difference between these two groups in academic achievement or teacher perception measures.
Rethinking Extrasensory Perception
Authors: Marwaha Sonali Bhatt , May Edwin C.
Published: March 2015

In this article, we define precognition as an atypical perceptual ability that allows the acquisition of non-inferential information arising from a future point in spacetime. The Multiphasic Model of Precognition (MMPC) identifies two distinct phases: The first is the physics domain, which addresses the question of retrocausation and how it is possible for information to traverse from one spacetime point to another. We suggest that the solution might be found within entropic considerations. The second is the neuroscience domain, which addresses the acquisition and interpretation of retrocausal signals. We propose that this occurs across three stages: (a) perception of signals from an information carrier, based on psychophysical variability in a putative signal transducer; (b) cortical processing of the signals, mediated by a cortical hyper-associative mechanism; and (c) cognition, mediated by normal cognitive processes, leading to a response based on retrocausal information. The model is comprehensive, brain-based, and provides a new direction for research requiring multidisciplinary expertise.
Three-Stage Data Envelopment Analysis as a Tool for Nurse Leader Performance Appraisals
Authors: Seljak Janko , Kvas Andreja
Published: March 2015

As in other sectors, increasingly higher performance and efficiency are also being required from health care employees. To achieve this goal, every health care organization should have a suitable human resource management system. The selection, education, training, effective performance appraisal, and evaluation of leaders are particularly of key importance for every organization. Data envelopment analysis (DEA) is used in this study to develop a model of practice outputs and inputs to help identify the most efficient nurse leaders. The employees’ performance appraisals are often closely related to their specific organizations. As leaders’ behaviors are also influenced by external, non-discretionary factors, the three-stage DEA was used to include inputs not controlled by individual leaders. This article proposes a performance appraisal based on competency models of leadership for a larger professional group working across several different organizations, yet in similar professional and institutional environments. The empirical data in this article are based on two surveys that were conducted in 15 Slovenian public hospitals.
Mapping Geographical Knowledge and Skills Needed for Pre-Service Teachers in Teacher Education
Authors: Bourke Terri , Lidstone John
Published: March 2015

In Australia, for more than two decades, a “social science” integrated framework was the favored approach for delivering subjects such as history and geography. However, such interdisciplinary approaches have continued to attract criticism from various parts of the academic and public spheres, and since 2009, a return to teaching the disciplines has been heralded as the “new” way forward. Using discourse analysis techniques associated with Foucauldian archeology, the purpose of this article is to examine the Australian Curriculum: Geography document to ascertain the discourses necessary for pre-service teachers to enact effective teaching of geography in a primary setting. Then, based on pre-service teachers’ online survey responses, the article investigates whether such future teachers have the knowledge and skills to interpret, deliver, and enact the new geography curriculum in primary classrooms. Finally, as teacher educators, our interest lies in preparing pre-service teachers effectively for the classroom, so that the findings are used to inform the content of a teacher education course for pre-service primary teachers.
Comparison of a Pharmacist-Performed and Physician or Advanced Practice Provider–Performed Medication History in Pediatric Patients
Authors: Heath Travis , O’Mara Keliana , Krushinski Joseph H. , Bush Paul
Published: March 2015

Background: In the adult population, a high rate of discrepancies exists between provider-performed and pharmacist-performed medication histories. Limited data exist regarding pharmacist-performed medication histories in hospitalized pediatric patients. Objective: Identify the incidence and severity of discrepancies in medication histories performed by practitioners compared with pharmacists in the pediatric population. Methods: After institutional review board approval, a retrospective analysis of pediatric patients admitted to inpatient pediatric units in a tertiary hospital was performed. The primary endpoint of the study was the percentage of provider-performed medication histories with any discrepancies compared with the pharmacist-performed medication history. Secondary endpoints included the number and type of discrepancies and the discrepancy’s potential risk of patient harm. Results: A total of 101 subjects were included. Nineteen patients (18.8%) had at least one medication discrepancy. Missing medications accounted for the majority of the discrepancies. Advance practice providers performed a small number of the initial medication histories (5%) and had at least one discrepancy for each history performed. The percentages of Grades 1, 2, and 3 discrepancies were 57.2%, 17.1%, and 25.7%, respectively. Medications with the most frequent discrepancies included anticonvulsants, antihistamines, and histamine receptor antagonists. Limitations include the retrospective nature of the study and lower than expected discrepancy rate. Conclusion: In this study, 18.8% of pediatric patients had a discrepancy between medication histories. Missing medications accounted for the largest amount of discrepancies. A large percentage of discrepancies had the potential to cause patient harm.
IL8-CXCR2 pathway inhibition as a therapeutic strategy against MDS and AML stem cells
Authors: Schinke Carolina , Giricz Orsolya , Li Weijuan , Shastri Aditi , Gordon Shanisha , Barreyro Laura , Bhagat Tushar , Bhattacharyya Sanchari , Ramachandra Nandini , Bartenstein Matthias , Pellagatti Andrea , Boultwood Jacqueline , Wickrema Amittha , Yu Yiting , Will Britta , Wei Sheng , Steidl Ulrich , Verma Amit
Published: March 2015

Key Points

IL8-CXCR2 is overexpressed in purified stem cells from AML and MDS, and CXCR2 expression is associated with worse prognosis. Inhibition of CXCR2 by genetic and pharmacologic means leads to decreased viability in AML/MDS stem cells and in vitro and in vivo models.
Genetics, structure, and prevalence of FP967 (CDC Triffid) T-DNA in flax
Authors: Young Lester , Hammerlindl Joseph , Babic Vivijan , McLeod Jamille , Sharpe Andrew , Matsalla Chad , Bekkaoui Faouzi , Marquess Leigh , Booker Helen M
Published: March 2015

The detection of T-DNA from a genetically modified flaxseed line (FP967, formally CDC Triffid) in a shipment of Canadian flaxseed exported to Europe resulted in a large decrease in the amount of flax planted in Canada. The Canadian flaxseed industry undertook major changes to ensure the removal of FP967 from the supply chain. This study aimed to resolve the genetics and structure of the FP967 transfer DNA (T-DNA).

The FP967 T-DNA is thought to be inserted in at single genomic locus. The junction between the T-DNA and genomic DNA consisted of two inverted Right Borders with no Left Border (LB) flanking genomic DNA sequences recovered. This information was used to develop an event-specific quantitative PCR (qPCR) assay. This assay and an existing assay specific to the T-DNA construct were used to determine the genetics and prevalence of the FP967 T-DNA. These data supported the hypothesis that the T-DNA is present at a single location in the genome.

The FP967 T-DNA is present at a low level (between 0.01 and 0.1%) in breeder seed lots from 2009 and 2010. None of the 11,000 and 16,000 lines selected for advancement through the Flax Breeding Program in 2010 and 2011, respectively, tested positive for the FP967 T-DNA, however.

Most of the FP967 T-DNA sequence was resolved via PCR cloning and next generation sequencing. A 3,720 bp duplication of an internal portion of the T-DNA (including a Right Border) was discovered between the flanking genomic DNA and the LB. An event-specific assay, SAT2-LB, was developed for the junction between this repeat and the LB.
Intestinal Pregnane X Receptor Links Xenobiotic Exposure and Hypercholesterolemia
Authors: Sui Yipeng , Helsley Robert N. , Park Se-Hyung , Song Xiulong , Liu Zun , Zhou Changcheng
Published: March 2015

Recent studies have associated endocrine-disrupting chemical (EDC) exposure with the increased risk of cardiovascular disease in humans, but the underlying mechanisms responsible for these associations remain elusive. Many EDCs have been implicated in activation of the nuclear receptor pregnane X receptor (PXR), which acts as a xenobiotic sensor to regulate xenobiotic metabolism in the liver and intestine. Here we report an important role of intestinal PXR in linking xenobiotic exposure and hyperlipidemia. We identified tributyl citrate (TBC), one of a large group of Food and Drug Administration–approved plasticizers for pharmaceutical or food applications, as a potent and selective PXR agonist. TBC efficiently activated PXR and induced PXR target gene expression in vitro and in vivo. Interestingly, TBC activated intestinal PXR but did not affect hepatic PXR activity. Exposure to TBC increased plasma total cholesterol and atherogenic low-density lipoprotein cholesterol levels in wild-type mice, but not in PXR-deficient mice. TBC-mediated PXR activation stimulated the expression of an essential cholesterol transporter, Niemann-Pick C1-like 1 (NPC1L1), in the intestine. Promoter analysis revealed a DR-4 type of PXR response element in the human NPC1L1 promoter, and TBC promoted PXR recruitment onto the NPC1L1 promoter. Consistently, TBC treatment significantly increased lipid uptake by human and murine intestinal cells and deficiency of PXR inhibited TBC-elicited lipid uptake. These findings provide critical mechanistic insight for understanding the impact of EDC-mediated PXR activation on lipid homeostasis and demonstrate a potential role of PXR in mediating the adverse effects of EDCs on cardiovascular disease risk in humans.
The Role of Connections in Academic Promotions
Authors: Zinovyeva Natalia , Bagues Manuel
Published: March 2015

This paper analyzes how evaluators' private information and subjective biases affect evaluations in academia. We use evidence from centralized selection exams in Spain, where evaluators are randomly assigned to promotion committees. Candidates are significantly more likely to be promoted when they are evaluated by an acquainted evaluator, but the source of the premium depends on the nature of this relationship. Our findings suggest that, when candidates are evaluated by their PhD advisor, a colleague or a coauthor, evaluation biases dominate the potential impact of informational gains. Weaker links, on the other hand, may improve the efficiency of the selection process. (JEL D82, I23, J44, M51)
One Laptop per Child at Home: Short-Term Impacts from a Randomized Experiment in Peru
Authors: Beuermann Diether W. , Cristia Julian , Cueto Santiago , Malamud Ofer , Cruz-Aguayo Yyannu
Published: March 2015

This paper presents results from a randomized controlled trial whereby approximately 1,000 OLPC XO laptops were provided for home use to children attending primary schools in Lima, Peru. The intervention increased access and use of home computers, with some substitution away from computer use outside the home. Children randomized to receive laptops scored about 0.8 standard deviations higher in a test of XO proficiency but showed lower academic effort as reported by teachers. There were no impacts on academic achievement or cognitive skills as measured by the Raven's Progressive Matrices test. Finally, there was little evidence for spillovers within schools. (JEL I21, I28, J13, O15)
Do Opposites Detract? Intrahousehold Preference Heterogeneity and Inefficient Strategic Savings
Authors: Schaner Simone
Published: March 2015

This paper uses a field experiment to test whether intrahousehold heterogeneity in discount factors leads to inefficient strategic savings behavior. I gave married couples in rural Kenya the opportunity to open both joint and individual bank accounts at randomly assigned interest rates. I also directly elicited discount factors for all individuals in the experiment. Couples who are well matched on discount factors are less likely to use costly individual accounts and respond robustly to relative rates of return between accounts, while their poorly matched peers do not. Consequently, poorly matched couples forgo significantly more interest earnings on their savings. (JEL D13, D14, J12, O12)
Labor Market Effects of Social Programs: Evidence from India's Employment Guarantee
Authors: Imbert Clément , Papp John
Published: March 2015

We estimate the effect of a large rural workfare program in India on private employment and wages by comparing trends in districts that received the program earlier relative to those that received it later. Our results suggest that public sector hiring crowded out private sector work and increased private sector wages. We compute the implied welfare gains of the program by consumption quintile. Our calculations show that the welfare gains to the poor from the equilibrium increase in private sector wages are large in absolute terms and large relative to the gains received solely by program participants. (JEL I38, J31, J45, J68, O15)
Channeling Remittances to Education: A Field Experiment among Migrants from El Salvador
Authors: Ambler Kate , Aycinena Diego , Yang Dean
Published: March 2015

We implement a randomized experiment offering Salvadoran migrants matching funds for educational remittances, which are channeled directly to a beneficiary student in El Salvador chosen by the migrant. The matches lead to increased educational expenditures, higher private school attendance, and lower labor supply of youths in El Salvador households connected to migrant study participants. We find substantial “crowd-in” of educational investments: for each $1 received by beneficiaries, educational expenditures increase by $3.72. We find no shifting of expenditures away from other students, and no effect on remittances. (JEL F24, I21, I22, J13, O15, O19)
Legal Status and the Criminal Activity of Immigrants
Authors: Mastrobuoni Giovanni , Pinotti Paolo
Published: March 2015

We exploit exogenous variation in legal status following the January 2007 European Union enlargement to estimate its effect on immigrant crime. We difference out unobserved time-varying factors by (i) comparing recidivism rates of immigrants from the “new” and “candidate” member countries; and (ii) using arrest data on for eign detainees released upon a mass clemency that occurred in Italy in August 2006. The timing of the two events allows us to setup a difference-in-differences strategy. Legal status leads to a 50 percent reduction in recidivism, and explains one-half to two-thirds of the observed differences in crime rates between legal and illegal immigrants. (JEL F22, K42, C41)
Reduction of suicidal ideation in patients undergoing psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders and neurotic symptoms reported by them before the hospitalization
Authors: Rodziński Paweł , Rutkowski Krzysztof , Sobański Jerzy , Murzyn Białas Agnieszka , Cyranka Katarzyna , Grządziel Karolina , Smiatek-Mazgaj Bogna , Klasa Katarzyna , Müldner-Nieckowski Łukasz , Dembińska Edyta , Mielimąka Michał
Published: March 2015

Cel

Analiza związków pomiędzy objawami zgłaszanymi przed rozpoczęciem hospitalizacji a prawdopodobieństwem redukcji myśli samobójczych (ich ustąpienia lub zmniejszenia się ich intensywności) do czasu zakończenia owej hospitalizacji u pacjentów dziennego oddziału leczenia nerwic i zaburzeń behawioralnych.

Metoda

Kwestionariusz objawowy KO”0” i Ankieta życiorysowa wypełnione przez 473 kobiety i 207 mężczyzn leczonych za pomocą intensywnej psychoterapii integracyjnej z przewagą podejścia psychodynamicznego w oddziale dziennym z powodu zaburzeń nerwicowych, behawioralnych i zaburzeń osobowości w latach 2005-2013. Odsetki pacjentów deklarujących występowanie MS wynosiły początkowo i pod koniec terapii odpowiednio 29,1% i 10,2% u kobiet oraz odpowiednio 36,5% i 13,7% u mężczyzn. Poprawę w zakresie początkowo zgłaszanych MS uzyskało 84,3% kobiet oraz 77,5% mężczyzn. Pacjenci zgłaszający MS na tle pozostałych odznaczali się wyraźnie wyższym nasileniem dolegliwości typowych dla zaburzeń nerwicowych (p<0,001) i wyższym nasileniem niemal wszystkich z 14-tu grup owych dolegliwości (p<0,05).

Wyniki

Pośród zgłaszających MS, kobiety o wyższym nasileniu objawów obsesyjno-kompulsyjnych (p=0,003), neurastenii (p=0,005) i zaburzeń autonomicznych układu krążenia (p=0,044) oraz kobiety zgłaszające występowanie napadów głodu (p<0,01) stanowiły podgrupy o istotnie mniejszych szansach na uzyskanie poprawy w zakresie MS, niż pozostali.

Wnioski

Pacjenci wyjściowo deklarujący obecność MS stanowili znaczną część leczonych (około 1/3) u obojga płci i stanowili podgrupy o wyższym nasileniu objawów typowych dla zaburzeń nerwicowych. Wśród nich, kobiety o szczególnie wysokim nasileniu zaburzeń obsesyjno-kompulsyjnych, neurastenii i zaburzeń autonomicznych układu krążenia oraz kobiety skarżące się na napady głodu odznaczają się występowaniem MS, które wydają się cechować większą opornością wobec oddziaływań psychoterapeutycznych. Wobec tego pacjentki te wymagają szczególnej uwagi i starannego doboru oddziaływań leczniczych.
Bipolar spectrum features in obese individuals
Authors: Siwek Marcin , Dudek Dominika , Jaeschke Rafał , Dembińska–Kieć Aldona , Witkowski Leszek , Arciszewska Aleksandra , Hebal Ferdynand , Matłok Maciej , Malczewska-Malec Małgorzata , Wnęk Dominika , Pilecki Maciej , Major Piotr , Epa Roksana , Rybakowski Janusz
Published: March 2015

Cel

Relacje między otyłością a spektrum zaburzeń afektywnych dwubiegunowych (bipolar spectrum disorders – BSD) pozostają niejasne. Dlatego też autorzy niniejszej pracy podjęli próbę określenia częstości występowania miękkich cech dwubiegunowości u pacjentów zgłaszających się na leczenie otyłości.

Metoda

Badanie kliniczno-kontrolne zagnieżdżone. Grupę badaną tworzyło 90 pacjentów, u których średnia wartość wskaźnika masy ciała (body mass index – BMI) wynosiła 38,1±7,0 (zakres: 30,1–62,5), a grupę kontrolną – 70 zdrowych ochotników o średnim BMI=21,6±2,1 (zakres: 18,5–24,9). Korzystając z Kwestionariusza Zaburzeń Nastroju (Mood Disorder Questionnaire – MDQ), przeprowadzano badania przesiewowe w kierunku objawów BSD.

Wyniki

W grupie osób z otyłością stwierdzono znamiennie większe prawdopodobieństwo uzyskania ≥7 pkt. w MDQ (25,6% vs. 8,6%; p=0,01). W porównaniu do osób zdrowych, pacjenci otyli zdobywali istotnie więcej punktów w sekcji 1 MDQ i w pozycjach MDQ odnoszących się do wymiaru hipomanii "drażliwość–gonitwa myśli". Korzystając z modelu wieloczynnikowej regresji logistycznej wykazano, że otyłość wiąże się z istotnie większą szansą uzyskania ≥7 pkt. w sekcji 1 MDQ (iloraz szans (odds ratio – OR): 2,07; 95% przedział ufności [95% confidence interval – CI]: 1,17–3,63)) oraz z granicznie większą szansą doświadczania okresów "wyżów" i "niżów" (OR: 1,67; 95% CI: 1,00–2,81)).

Wnioski

Uzyskane wyniki zdają się przemawiać na rzecz tezy, że otyłość może być istotnie związana z BSD. Jednak określenie implikacji klinicznych tego stwierdzenia wymaga, przeprowadzenia dalszych badań, zgodnych z paradygmatem medycyny opartej na wiarygodnych i aktualnych danych naukowych (evidence-based medicine – EBM).
Reduction of suicidal ideation in patients undergoing psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders and their neurotic personality traits measured before the hospitalization
Authors: Rodziński Paweł , Rutkowski Krzysztof , Sobański Jerzy , Murzyn Agnieszka , Mielimąka Michał , Smiatek-Mazgaj Bogna , Cyranka Katarzyna , Dembińska Edyta , Grządziel Karolina , Klasa Katarzyna , Müldner-Nieckowski Łukasz
Published: March 2015

Cel

Analiza powiązań pomiędzy wyjściowym profilem osobowości nerwicowej a późniejszą poprawą w zakresie myśli samobójczych (MS) u pacjentów, którzy przebyli cykl intensywnej psychoterapii prowadzonej w podejściu integracyjnym z przewagą podejścia psychodynamicznego.

Metoda

Kwestionariusz objawowy KO”0”, Kwestionariusz osobowości nerwicowej KON-2006 i Ankieta życiorysowa wypełnione przez 473 kobiety i 207 mężczyzn leczonych w oddziale dziennym z powodu zaburzeń nerwicowych, behawioralnych i zaburzeń osobowości w latach 2005-2013. Podczas kwalifikacji MS zadeklarowało 134 kobiet i 80 mężczyzn, z czego poprawę uzyskało odpowiednio 84,3% oraz 77,5%.

Wyniki

Kobiety o osobowości cechującej się wyższym poziomem skłonności do ryzyka (p=0,002) i wyższym poziomem impulsywności (p=0,038) stanowiły podgrupy o mniejszych szansach na uzyskanie poprawy w zakresie MS, zaś mężczyźni z wyższym poziomem zawiści (p=0,041), jak też kobiety przyjmujące postawy sugerujące trudności w adekwatnym wyrażaniu złości(p<0,05), mieli większe szanse na poprawę w zakresie MS.

Wnioski

Wyjściowo nasilona skłonność do ryzyka i impulsywność u kobiet mogą współwystępować z MS o podwyższonej oporności w stosunku do psychoterapii. Skłania to do zwrócenia szczególnej uwagi na owe podgrupy i starannego doboru stosowanych wobec nich oddziaływań leczniczych. Prawdopodobnie, zogniskowanie oddziaływań terapeutycznych wokół wyżej wymienionych komponentów osobowości mogłoby skutkować u tych pacjentek wzrostem skuteczności leczenia MS. Z kolei, redukowanie MS podczas psychoterapii wydaje się szczególnie skuteczne u kobiet, które przejawiały trudności w adekwatnym wyrażaniu złości, oraz u mężczyzn o wyjściowo wysokim poziomie zawiści, co potwierdza zasadność kierowania tych pacjentów do oddziału psychoterapeutycznego i koncentracji terapii na tych właśnie obszarach psychopatologii.
Pain and tactile dissociation, derealization and depersonalization symptoms in women and recalled traumatic events in childhood, adolescence and early adulthood
Authors: Smiatek-Mazgaj Bogna , Sobański Jerzy , Rutkowski Krzysztof , Klasa Katarzyna , Dembińska Edyta , Müldner-Nieckowski Łukasz , Cyranka Katarzyna , Mielimąka Michał
Published: March 2015

Cel

Ocena ryzyka związanego z rozmaitymi urazowymi wydarzeniami w dzieciństwie i adolescencji, dotyczącego objawów dysocjacyjnych czucia bólu i dotyku oraz depersonalizacji i derealizacji.

Metoda

Współwystępowanie dawnych okoliczności życiowych oraz aktualnie obecnych objawów badano na podstawie kwestionariuszy objawowych KO”0” oraz Ankiet Życiorysowych, wypełnianych przed leczeniem w dziennym oddziale leczenia nerwic.

Wyniki

W grupie 2582 kobiet, pacjentek dziennego oddziału leczenia zaburzeń nerwicowych i osobowości stwierdzono występowanie dysocjacji czucia bólu i dotyku, depersonalizacji i derealizacji u 24-36% pacjentek, natomiast maksymalne nasilenie tych objawów zgłosiło ok. 4-8% badanych. Badane pacjentki informowały o narażeniu w okresie dzieciństwa i dorastania (przed 18rż) na liczne wydarzenia urazowe o zróżnicowanym nasileniu i częstości, m.in. wrogości jednego z rodziców (ok. 5% badanych), rozpoczęcia współżycia przed 13rż (1%), gorszych niż rówieśnicy warunkach materialnych (23%), prześladowania rodziny pochodzenia (2%), niechęci ze strony rówieśników (9%). Przeprowadzone analizy regresji wykazały zilustrowane za pomocą współczynników OR (ilorazów szans) istotne statystycznie powiązania między większością z analizowanych objawów a wieloma spośród wymienionych wydarzeń, np. byciem uważaną za gorszą od rodzeństwa, złością matki w sytuacji choroby pacjentki w dzieciństwie, brakiem wsparcia, obojętnością rodzica, biedą i gorszością rodziny pochodzenia, gorszą pozycją w klasie i wynikami w nauce, całkowitym nieuświadomieniem seksualnym, kazirodztwem lub jego próbą.

Wnioski

Objawy dysocjacji, depersonalizacji i derealizacji występowały u badanych pacjentek istotnie częściej wraz z obciążającymi wydarzeniami życiowymi - sytuacjami trudnymi z okresu dzieciństwa i adolescencji. W związku z powyższym w codziennej praktyce klinicznej u pacjentek zgłaszających tego rodzaju objawy, niezależnie od rozpoznania (np. szczegółowego zaburzenia nerwicowego), można się spodziewać ujawnienia informacji na temat takich wydarzeń.
Changes in neurotic personality profile associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders
Authors: Rodziński Paweł , Rutkowski Krzysztof , Sobański Jerzy , Mielimąka Michał , Murzyn Agnieszka , Cyranka Katarzyna , Dembińska Edyta , Grządziel Karolina , Klasa Katarzyna , Müldner-Nieckowski Łukasz , Smiatek-Mazgaj Bogna
Published: March 2015

Cel

Analiza związków pomiędzy zmianami w profilu osobowości nerwicowej a redukcją myśli samobójczych (MS) – definiowaną jako ich ustąpienie lub redukcja ich nasilenia – u pacjentów, którzy przebyli cykl intensywnej psychoterapii prowadzonej w podejściu integracyjnym z przewagą podejścia psychodynamicznego w oddziale dziennym.

Metoda

Kwestionariusz objawowy KO”0”, Kwestionariusz osobowości nerwicowej KON-2006 oraz Ankieta życiorysowa wypełnione przez 473 kobiety i 207 mężczyzn leczonych z powodu zaburzeń nerwicowych, behawioralnych i zaburzeń osobowości w latach 2005-2013. Podczas kwalifikacji MS zadeklarowało 134 kobiet i 80 mężczyzn, z czego poprawę w tym zakresie uzyskało odpowiednio 84,3% oraz 77,5%.

Wyniki

Pacjentom obu płci, którzy uzyskali poprawę w zakresie MS, towarzyszyła istotnie większa redukcja globalnej nerwicowej dezintegracji osobowości (neurotyczności), niż pozostałym (p<0,0005 u kobiet oraz p=0,015 u mężczyzn). Z poprawą w zakresie MS istotnie powiązana była również większa redukcja nasilenia wielu cech osobowości nerwicowej (p<0,05) u obu płci: Negatywna samoocena, Impulsywność, Poczucie wyobcowania, Demobilizacja, Trudności w relacjach emocjonalnych, Brak witalności, Poczucie braku wpływu, Poczucie winy, Trudności w relacjach interpersonalnych, Poczucie zagrożenia, Egzaltacja, Rozpamiętywanie; zaś wyłącznie u kobiet: Poczucie uzależnienia od otoczenia, Astenia, Trudności podejmowania decyzji, Przekonanie o niezaradności życiowej, Brak wewnątrzsterowności i Wyobraźnia, fantazjowanie.

Wnioski

Uzyskane wyniki potwierdzają skuteczność intensywnej psychoterapii, jako metody leczenia prowadzącej do kompleksowej poprawy obejmującej zmniejszenie nasilenia nerwicowych zaburzeń osobowości (poziomu neurotyczności) oraz większości cech osobowości nerwicowej, jak i redukcję MS. Ujawnione powiązania wspierają hipotezę o neurotyczności u pacjentów z zaburzeniami nerwicowymi, behawioralnymi i zaburzeniami osobowości, jako czynniku predysponującym do występowania MS.
Changes in personality functioning as a result of group psychotherapy with elements of individual psychotherapy in persons with neurotic and personality disorders – MMPI-2
Authors: Cyranka Katarzyna , Rutkowski Krzysztof , Mielimąka Michał , Sobański Jerzy , Smiatek-Mazgaj Bogna , Klasa Katarzyna , Dembińska Edyta , Müldner-Nieckowski Łukasz , Rodziński Paweł
Published: March 2015

Cel

Analiza wpływu psychoterapii grupowej na funkcjonowanie osobowości pacjentów leczonych z powodu zaburzeń nerwicowych i wybranych zaburzeń osobowości (F4 i F6 wg ICD-10).

Metoda

W badaniu uczestniczyło 82 pacjentów (61 kobiet i 21 mężczyzn) leczonych intensywną krótkoterminową psychoterapią grupową w oddziale dziennym. Dokonano kompleksowej oceny funkcjonowania osobowości pacjentów na początku i na końcu psychoterapii przy użyciu kwestionariusza MMPI-2.

Wyniki

U większości pacjentów objętych badaniem uzyskane w pomiarze na początku terapii wyniki w pięciu skalach klinicznych MMPI-2 (Depresja, Histeria, Odchylenia Psychopatyczne, Psychastenia, Schizofrenia) wskazywały na znaczny poziom zaburzeń, a w zakresie Hipochondrii na patologię umiarkowaną. W skali Manii większość pacjentów rozpoczynających leczenie uzyskała wyniki podobne do uzyskiwanych w populacji osób zdrowych. W wyniku zastosowania psychoterapii u większości badanych pacjentów zaobserwowano korzystne zmiany w tych obszarach funkcjonowania osobowości, w których na początku terapii stwierdzono znaczną lub umiarkowaną patologię.

Wnioski

Krótkoterminowa, intensywna, kompleksowa psychoterapia grupowa z elementami psychoterapii indywidualnej prowadzi do uzyskania pożądanych zmian w funkcjonowaniu osobowości.
The Emergence of Online Community Leadership
Authors: Johnson Steven L. , Safadi Hani , Faraj Samer
Published: March 2015

Compared to traditional organizations, online community leadership processes and how leaders emerge are not well studied. Previous studies of online leadership have often identified leaders as those who administer forums or have high network centrality scores. Although communication in online communities occurs almost exclusively through written words, little research has addressed how the comparative use of language shapes community dynamics. Using participant surveys to identify leading online community members, this study analyzes a year of communication network history and message content to assess whether language use differentiates leaders from other core community participants. We contribute a novel use of textual analysis to develop a model of language use to evaluate the utterances of all participants in the community. We find that beyond communication network position—in terms of formal role, centrality, membership in the core, and boundary spanning—those viewed as leaders by other participants, post a large number of positive, concise posts with simple language familiar to other participants. This research provides a model to study online language use and points to the emergent and shared nature of online community leadership.
Duty of candour: the impact on dental nurses
Authors: Griffith Richard
Published: March 2015

The revised Essential Standards for Quality and Safety come into force on 1 April 2015. This article considers the organisational and professional duties of candour and their impact on a dental professional's practice
Record keeping for best practice
Authors: Cox Richard
Published: March 2015

High-quality clinical notes are essential for dental assessment and treatment planning. However, best practice has evolved, so records should also demonstrate the process by which a patient consented to their treatment option
How to improve patient recall numbers
Authors: Talati Shilla
Published: March 2015

Ensuring patients return to the practice is a challenging aspect of practice management. This article provides tips on how to improve patient recall numbers using simple, yet effective, strategies
Dietary challenges in patients with diabetes and chronic kidney disease
Authors: Ramlan Gabby
Published: March 2015

For patients with diabetes and chronic kidney disease, several dietary restrictions are necessary to prevent episodes of hyperglycaemia and fluid overloading. Patients should be advised by specialist dietitians in renal medicine and diabetes when modifying their nutritional intake and lifestyle. Gabby Ramlan reviews the key dietary recommendations in national clinical guidelines.
Supporting patients better on self-care haemodialysis: a survey
Authors: Wong Davina , Walker Diane , Cove Jeff , Pires-Yfantouda Renata
Published: March 2015

Self-care haemodialysis is cost-effective and associated with better health-related quality of life in renal patients. Support for self-care is a core component of the management of long-term conditions. This paper discusses findings of a survey undertaken to gain knowledge of how to improve support for individuals learning self-care dialysis and also to understand how individuals overcome challenges.
Using allopurinol to prevent and manage hyperuricaemia in a patient with chronic kidney disease
Authors: Chai Mee Onn , Coleman Adrian
Published: March 2015

Allopurinol is a commonly prescribed medicine for the management and prevention of gout. In this drug focus, Mee Onn Chai and Adrian Coleman discuss the use of allopurinol in a patient with chronic kidney disease and provide an overview of the drug's mechanism of action and interactions.
Development of ‘smart’ insulin to change lives of diabetes patients
Authors: Biela Chris
Published: March 2015

In the UK, there are at least 3 million patients with a known diagnosis of diabetes—a condition with serious long-term health consequences, such as diabetic nephropathy. Chris Biela discusses the discovery of ‘smart’ insulin, which could be a breakthrough treatment for this patient group.
Encouraging patients to exercise: motivational interviewing, observation and learning
Authors: Davis Ben , Reston Jonathan , Bierraugel Rebecca , Wellsted David , Wilson Patricia , Silva Gane Maria Da , Sridharan Sivakumar , Scarlino Rebecca , Scarlino Andy , Vilar Enric , Farrington Ken
Published: March 2015

The physical and psychological health benefits of exercise are well established, yet patients undergoing dialysis commonly live sedentary lives, contributing to comorbidities with other health problems. Motivational interviewing was used to promote exercise during dialysis; the levels of patient exercise correlated positively with the fidelity of the intervention delivery and levels of change talk, and correlated negatively with the levels of sustain talk. Patients were also motivated by seeing other patients engage in intradialytic exercise, and this was an effective method to increase the number of patients engaging in exercise. Patients welcomed the opportunity to try out the exercise; they were motivated by improvements to their health as well as reductions in their boredom and restlessness during a dialysis session. Sustainability proved to be a key issue and efforts should be made to improve staff engagement in promoting an exercise culture that helps continued exercise uptake.
Quality improvement project for chronic kidney disease patients
Authors: Lumsdon Angela
Published: March 2015

Delayed referral to secondary care can make it more challenging for patients with chronic kidney disease (CKD) to transition to dialysis or prepare for a transplant. To ensure patients with progressive CKD get early specialist treatment and to reduce the rate of kidney function decline, Kidney Research UK has launched a project to drive measurable, sustainable change.