bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving skills and care standards in the support workforce for older people: a realist synthesis of workforce development interventions
Authors: Williams L , Rycroft-Malone J , Burton C R , Edwards S , Fisher D , Hall B , McCormack B , Nutley S M , Seddon D , Williams R
Published: August 2016

Objectives

This evidence review was conducted to understand how and why workforce development interventions can improve the skills and care standards of support workers in older people's services.

Design

Following recognised realist synthesis principles, the review was completed by (1) development of an initial programme theory; (2) retrieval, review and synthesis of evidence relating to interventions designed to develop the support workforce; (3) ‘testing out’ the synthesis findings to refine the programme theories, and establish their practical relevance/potential for implementation through stakeholder interviews; and (4) forming actionable recommendations.

Participants

Stakeholders who represented services, commissioners and older people were involved in workshops in an advisory capacity, and 10 participants were interviewed during the theory refinement process.

Results

Eight context–mechanism–outcome (CMO) configurations were identified which cumulatively comprise a new programme theory about ‘what works’ to support workforce development in older people's services. The CMOs indicate that the design and delivery of workforce development includes how to make it real to the work of those delivering support to older people; the individual support worker's personal starting points and expectations of the role; how to tap into support workers' motivations; the use of incentivisation; joining things up around workforce development; getting the right mix of people engaged in the design and delivery of workforce development programmes/interventions; taking a planned approach to workforce development, and the ways in which components of interventions reinforce one another, increasing the potential for impacts to embed and spread across organisations.

Conclusions

It is important to take a tailored approach to the design and delivery of workforce development that is mindful of the needs of older people, support workers, health and social care services and the employing organisations within which workforce development operates. Workforce development interventions need to balance the technical, professional and emotional aspects of care.

Trial registration number

CRD42013006283.
Comparison of fracture rates between indigenous and non-indigenous populations: a systematic review protocol
Authors: Brennan-Olsen Sharon L , Quirk Shae E , Leslie William D , Toombs Maree , Holloway Kara L , Hosking Sarah M , Pasco Julie A , Doolan Brianna J , Page Richard S , Williams Lana J
Published: August 2016

Introduction

Over recent years, there has been concerted effort to ‘close the gap’ in the disproportionately reduced life expectancy and increased morbidity experienced by indigenous compared to non-indigenous persons. Specific to musculoskeletal health, some data suggest that indigenous peoples have a higher risk of sustaining a fracture compared to non-indigenous peoples. This creates an imperative to identify factors that could explain differences in fracture rates. This protocol presents our aim to conduct a systematic review, first, to determine whether differences in fracture rates exist for indigenous versus non-indigenous persons and, second, to identify any risk factors that might explain these differences.

Methods and analysis

We will conduct a systematic search of PubMed, OVID, MEDLINE, CINAHL and EMBASE to identify articles that compare all-cause fracture rates at any skeletal site between indigenous and non-indigenous persons of any age. Eligibility of studies will be determined by 2 independent reviewers. Studies will be assessed for methodological quality using a previously published process. We will conduct a meta-analysis and use established statistical methods to identify and control for heterogeneity where appropriate. Should heterogeneity prevents numerical syntheses, we will undertake a best-evidence analysis to determine the level of evidence for differences in fracture between indigenous and non-indigenous persons.

Ethics and dissemination

This systematic review will use published data; thus, ethical permissions are not required. In addition to peer-reviewed publication, findings will be presented at (inter)national conferences, disseminated electronically and in print, and will be made available to key country-specific decision-makers with authority for indigenous health.
Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial
Authors: Dixon Padraig , Hollinghurst Sandra , Edwards Louisa , Thomas Clare , Gaunt Daisy , Foster Alexis , Large Shirley , Montgomery Alan A , Salisbury Chris
Published: August 2016

Objectives

To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease (CVD) risk.

Design

A prospective within-trial patient-level economic evaluation conducted alongside a randomised controlled trial.

Setting

Patients recruited through primary care, and intervention delivered via telehealth service.

Participants

Adults with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, with at least 1 modifiable risk factor.

Intervention

A series of up to 13 scripted, theory-led telehealth encounters with healthcare advisors, who supported participants to make behaviour change, use online resources, optimise medication and improve adherence. Participants in the control arm received usual care.

Primary and secondary outcome measures

Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up, calculated from incremental cost and incremental quality-adjusted life years (QALYs). Productivity impacts, participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework.

Results

641 participants were randomised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care. 18% of participants had missing data on either costs, utilities or both. Multiple imputation was used for the base case results. The intervention was associated with incremental mean per-patient National Health Service (NHS) costs of £138 (95% CI 66 to 211) and an incremental QALY gain of 0.012 (95% CI −0.001 to 0.026). The incremental cost-effectiveness ratio was £10 859. Net monetary benefit at a cost-effectiveness threshold of £20 000 per QALY was £116 (95% CI −58 to 291), and the probability that the intervention was cost-effective at this threshold value was 0.77. Similar results were obtained from a complete case analysis.

Conclusions

There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £20 000 per QALY.

Trial registration number

ISRCTN27508731; Results. Prospectively registered 05 July 2012.
Lymphadenectomy and health-related quality of life after oesophageal cancer surgery: a nationwide, population-based cohort study
Authors: Schandl Anna , Johar Asif , Lagergren Jesper , Lagergren Pernilla
Published: August 2016

Objective

The purpose of this study was to clarify whether more extensive surgical lymph node resection during oesophageal cancer surgery influences patients' health-related quality of life (HRQOL).

Setting

This was a nationwide Swedish population-based study.

Participants

A total of 616 patients who underwent curatively intended oesophageal cancer surgery in 2001–2005 were followed up at 6 months and 5 years after surgery.

Outcome measures

HRQOL was assessed with the validated European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and the oesophageal cancer-specific module (EORTC QLQ-OES18). The number of removed lymph nodes in relation to HRQOL was analysed using multivariable linear regression, providing mean score differences in HRQOL scores with 95% CIs. The results were adjusted for age, comorbidity, body mass index, tumour stage, tumour histology, postoperative complications and surgeon volume.

Results

The study included 382 and 136 patients who completed the EORTC questionnaires at 6 months and 5 years following surgery, respectively. In general, HRQOL remained stable over time, with only improvements in role function and appetite loss. A larger number of removed lymph nodes did not decrease the HRQOL measure at 6 months or 5 years after surgery.

Conclusions

More extensive lymphadenectomy during oesophageal cancer surgery might not decrease patients' short-term or long-term HRQOL, but larger studies are needed to establish this potential lack of association.
Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study
Authors: Devasenapathy Niveditha , Ghosh Jerath Suparna , Sharma Saket , Allen Elizabeth , Shankar Anuraj H , Zodpey Sanjay
Published: August 2016

Objectives

Aggregate data on childhood immunisation from urban settings may not reflect the coverage among the urban poor. This study provides information on complete childhood immunisation coverage among the urban poor, and explores its household and neighbourhood-level determinants.

Setting

Urban poor community in the Southeast district of Delhi, India.

Participants

We randomly sampled 1849 children aged 1–3.5 years from 13 451 households in 39 clusters (cluster defined as area covered by a community health worker) in 2 large urban poor settlements. Of these, 1343 completed the survey. We collected information regarding childhood immunisation (BCG, oral polio vaccine, diphtheria–pertussis–tetanus vaccine, hepatitis B and measles) from vaccination cards or mothers’ recall. We used random intercept logistic regression to explore the sociodemographic determinants of complete immunisation.

Results

Complete immunisation coverage was 46.7% and 7.5% were not immunised. The odds of complete vaccination (OR, 95% CI) were lower in female children (0.70 (0.55 to 0.89)) and Muslim households (0.65 (0.45 to 0.94)). The odds of complete vaccination were higher if the mother was literate (1.6 (1.15 to 2.16)), if the child was born within the city (2.7 (1.97 to 3.65)), in a health facility ( 1.5 (1.19 to 2.02)), belonged to the highest wealth quintile (compared with the poorest; 2.46 (1.5 to 4.02)) or possessed a birth certificate (1.40 (1.03 to 1.91)). Cluster effect due to unmeasured neighbourhood factors expressed as median OR was 1.32.

Conclusions

Immunisation coverage in this urban poor area was much lower than that of regional surveys reporting overall urban data. Socioeconomic status of the household, female illiteracy, health awareness and gender inequality were important determinants of coverage in this population. Hence, in addition to enhancing the infrastructure for providing mother and child services, efforts are also needed to address these issues in order to improve immunisation coverage in deprived urban communities.

Trial registration number

CTRI/2011/091/000095.
Managers' use of nursing workforce planning and deployment technologies: protocol for a realist synthesis of implementation and impact
Authors: Burton Christopher , Rycroft-Malone Jo , Williams Lynne , Davies Siân , McBride Anne , Hall Beth , Rowlands Anne-M , Jones Adrian
Published: August 2016

Introduction

Nursing staffing levels in hospitals appear to be associated with improved patient outcomes. National guidance indicates that the triangulation of information from workforce planning and deployment technologies (WPTs; eg, the Safer Nursing Care Tool) and ‘local knowledge’ is important for managers to achieve appropriate staffing levels for better patient outcomes. Although WPTs provide managers with predictive information about future staffing requirements, ensuring patient safety and quality care also requires the consideration of information from other sources in real time. Yet little attention has been given to how to support managers to implement WPTs in practice. Given this lack of understanding, this evidence synthesis is designed to address the research question: managers’ use of WPTs and their impacts on nurse staffing and patient care: what works, for whom, how and in what circumstances?

Methods and analysis

To explain how WPTs may work and in what contexts, we will conduct a realist evidence synthesis through sourcing relevant evidence, and consulting with stakeholders about the impacts of WPTs on health and relevant public service fields. The review will be in 4 phases over 18 months. Phase 1: we will construct an initial theoretical framework that provides plausible explanations of what works about WPTs. Phase 2: evidence retrieval, review and synthesis guided by the theoretical framework; phase 3: testing and refining of programme theories, to determine their relevance; phase 4: formulating actionable recommendations about how WPTs should be implemented in clinical practice.

Ethics and dissemination

Ethical approval has been gained from the study's institutional sponsors. Ethical review from the National Health Service (NHS) is not required; however research and development permissions will be obtained. Findings will be disseminated through stakeholder engagement and knowledge mobilisation activities. The synthesis will develop an explanatory programme theory of the implementation and impact of nursing WPTs, and practical guidance for nurse managers.

Trial registration number

CRD42016038132.
Experience of acute noninvasive ventilation—insights from ‘Behind the Mask’: a qualitative study
Authors: Smith Tracy A , Agar Meera , Jenkins Christine R , Ingham Jane M , Davidson Patricia M
Published: August 2016

Objective

Non-invasive ventilation (NIV) is widely used in the management of acute and acute-on-chronic respiratory failure. Understanding the experiences of patients treated with NIV is critical to person-centred care. We describe the subjective experiences of individuals treated with NIV for acute hypercapnic respiratory failure.

Design

Qualitative face-to-face interviews analysed using thematic analysis.

Setting

Australian tertiary teaching hospital.

Participants

Individuals with acute hypercapnic respiratory failure treated with NIV outside the intensive care unit. Individuals who did not speak English or were unable or unwilling to consent were excluded.

Results

13 participants were interviewed. Thematic saturation was achieved. Participants described NIV providing substantial relief from symptoms and causing discomfort. They described enduring NIV to facilitate another chance at life. Although participants sometimes appeared passive, others expressed a strong conviction that they knew which behaviours and treatments relieved their distress. Most participants described gaps in their recollection of acute hospitalisation and placed a great amount of trust in healthcare providers. All participants indicated that they would accept NIV in the future, if clinically indicated, and often expressed a sense of compulsion to accept NIV. Participants' description of their experience of NIV was intertwined with their experience of chronic disease.

Conclusions

Participants described balancing the benefits and burdens of NIV, with the goal of achieving another chance at life. Gaps in recall of their treatment with NIV were frequent, potentially suggesting underlying delirium. The findings of this study inform patient-centred care, have implications for the care of patients requiring NIV and for advance care planning discussions.
Pain management strategies for patients on methadone maintenance therapy: a systematic review of the literature
Authors: Taveros Mel Clark , Chuang Elizabeth J
Published: August 2016

Context

Prescription opioid and heroin abuse has increased substantially in recent years. Enrolment on opioid agonist therapy programmes is consequently increasing as well. As a result of these trends, more patients who present with acute pain secondary to a malignancy are also on chronic methadone maintenance therapy (MMT) for substance abuse. This combination of diagnoses presents a pain management challenge for palliative care providers.

Objectives

This paper aims to gather and review the available medical literature pertaining to the use of opioid analgesia in methadone-maintained patients.

Methods

The authors searched PubMED, PsychINFO, EMBASE, Clinical Key, the Cochrane Library and CINAHL from their inception to May 2015 for relevant articles. All articles that discuss opioid therapy in adult patients on methadone maintenance for opioid addiction with cancer or advanced illness were included. Data were extracted and study quality was rated independently by the authors.

Results

Our searches resulted in 680 hits. Of those, only 7 met inclusion criteria for the study. Most of the studies favoured the use of methadone either in scheduled divided doses every 4–8 hours or by continuous intravenous infusion. The overall strength of the evidence was poor, consisting mainly of case series, case reports and 1 single-centre retrospective cohort study lacking a comparison group.

Conclusions

Treating MMT-maintained patients with methadone for analgesia may be preferable to using other opioid analgesics. However, there are many systems barriers that may make this approach challenging and the evidence favouring methadone over other opioid analgesics is weak.
Are eponyms used correctly or not? A literature review with a focus on shoulder and elbow surgery
Authors: Somford Matthijs Paul , Nieuwe Weme Rebecca A , van Dijk Cornelis Niek , IJpma Frank FA , Eygendaal Denise
Published: August 2016

Background

Eponymous terms are used frequently in daily patient care and scientific literature. They remind us of our predecessors in surgery. It is debatable whether eponymous terms are reliable in case of information transfer. The aim of our study was to investigate whether the original meaning of eponymous terms in shoulder and elbow surgery has been preserved in its use in contemporary literature.

Objective

To evaluate whether eponymous terms were used correctly, we analysed the use of frequently encountered eponymous terms from January to December 2014.

Study selection

By means of a PubMed search, articles with eponymous terms were identified and analysed for the way an eponymous term was used, and we compared it with the original description. The original description was traced back to the index publication. The use of the eponymous term was scored as similar, divergent or undefined. In the search for eponymous terms, we included those eponymous terms that were used more than 10 times in the English, German and Dutch literature of 2014. 6 eponymous terms were eligible for analysis: Bankart lesion, Bristow-Latarjet procedure, Essex-Lopresti injury of the forearm, Galeazzi fracture, Hill-Sachs lesion and Monteggia fracture.

Findings

We analysed 96 articles with the listed eponymous terms, of which 27 (28%) were scored divergent, 32 (33%) undefined and 37 (39%) similar. Bristow-Latarjet scored lowest, with 0% descriptions similar to the original, meaning that all articles had an undefined or divergent eponym, and Essex-Lopresti scored highest with 82% similarity.

Conclusions

Eponymous terms in shoulder and elbow trauma and surgery are used inadequately and inconsistently. The use of eponymous terms probably cannot be avoided, but since the majority of eponymous terms are not used properly and understanding of its meaning and content varies from surgeon to surgeon, we should be keen on explaining the meaning of eponymous terms when using them.
Capnography for procedural sedation in the ED: a systematic review
Authors: Dewdney Charlotte , MacDougall Margaret , Blackburn Rachel , Lloyd Gavin , Gray Alasdair
Published: August 2016

Introduction

Procedural sedation and analgesia (PSA) is commonplace in the ED. Previous studies have identified capnography as a reliable indicator of PSA-induced respiratory depression. This review investigates the potential effect on patient safety of the use of capnography in addition to standard monitoring for adult patients undergoing PSA in the ED.

Methods

MEDLINE, Embase, Scopus, CINAHL and Google Scholar were searched systematically for ED studies using capnography during PSA. Data extraction was performed by two independent authors. Using MedCalc V.13.3.3 and Meta-DiSc V.1.4, data were aggregated under the random-effects model and heterogeneity was assessed using Cochran's Q-test and the I2statistic.

Results

Of the 737 studies that were screened, 7 studies met the eligibility criteria, representing a total of 662 patients. The aggregate diagnostic accuracy for capnography identifying an adverse event included a diagnostic OR of approximately 6 (OR: 5.87; 95% CI 2.41 to 14.3; p<0.001), sensitivity 0.82 (95% CI 0.76 to 0.87), specificity 0.6 (95% CI 0.55 to 0.64), negative likelihood ratio 0.3 (95% CI 0.12 to 0.75) and positive likelihood ratio 1.89 (95% CI 1.53 to 2.34). There was a lack of statistical evidence for a difference in the proportion of adverse events detected when capnography was used in addition to standard monitoring (48.8% (95% CI 32.85 to 64.92)) compared with chance alone (50%).

Conclusions

There is no firm evidence that capnography provides additional safety compared with standard monitoring alone during PSA in adults in the ED. There is a paucity of published research involving preoxygenated patients who remain on high-flow oxygen throughout PSA. Well-powered randomised controlled trials, employing an accepted adverse event reporting tool in such patients, are required. Until then, we advocate continued compliance with current professional recommendations for the use of capnography during PSA in adults in the ED.
Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts
Authors: Body Richard , Carlton Edward , Sperrin Matthew , Lewis Philip S , Burrows Gillian , Carley Simon , McDowell Garry , Buchan Iain , Greaves Kim , Mackway-Jones Kevin
Published: August 2016

Background

The original Manchester Acute Coronary Syndromes model (MACS) ‘rules in’ and ‘rules out’ acute coronary syndromes (ACS) using high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid binding protein (H-FABP) measured at admission. The latter is not always available. We aimed to refine and validate MACS as Troponin-only Manchester Acute Coronary Syndromes (T-MACS), cutting down the biomarkers to just hs-cTnT.

Methods

We present secondary analyses from four prospective diagnostic cohort studies including patients presenting to the ED with suspected ACS. Data were collected and hs-cTnT measured on arrival. The primary outcome was ACS, defined as prevalent acute myocardial infarction (AMI) or incident death, AMI or coronary revascularisation within 30 days. T-MACS was built in one cohort (derivation set) and validated in three external cohorts (validation set).

Results

At the ‘rule out’ threshold, in the derivation set (n=703), T-MACS had 99.3% (95% CI 97.3% to 99.9%) negative predictive value (NPV) and 98.7% (95.3%–99.8%) sensitivity for ACS, ‘ruling out’ 37.7% patients (specificity 47.6%, positive predictive value (PPV) 34.0%). In the validation set (n=1459), T-MACS had 99.3% (98.3%–99.8%) NPV and 98.1% (95.2%–99.5%) sensitivity, ‘ruling out’ 40.4% (n=590) patients (specificity 47.0%, PPV 23.9%). T-MACS would ‘rule in’ 10.1% and 4.7% patients in the respective sets, of which 100.0% and 91.3% had ACS. C-statistics for the original and refined rules were similar (T-MACS 0.91 vs MACS 0.90 on validation).

Conclusions

T-MACS could ‘rule out’ ACS in 40% of patients, while ‘ruling in’ 5% at highest risk using a single hs-cTnT measurement on arrival. As a clinical decision aid, T-MACS could therefore help to conserve healthcare resources.
Quick-Wee: a novel non-invasive urine collection method
Authors: Kaufman Jonathan , Tosif Shidan , Fitzpatrick Patrick , Hopper Sandy M , Bryant Penelope A , Donath Susan M , Babl Franz E
Published: August 2016

Background

Clean catch urine (CCU) collection in precontinent children is often time-consuming, with associated collection failure. We hypothesise that stimulating cutaneous reflexes hastens voiding for CCU.

Methods

40 children aged 1–24 months in the ED. Standard CCU was augmented with gentle suprapubic cutaneous stimulation using saline-soaked gauze (Quick-Wee method).

Results

12/40 (30%) children voided within 5 min for successful CCU. Parental and clinician satisfaction was high.

Conclusions

Quick-Wee appears to be a simple method to speed CCU in young children.
Road traffic injuries in Peace Corps Volunteers, 1996–2014
Authors: Ferguson Rennie W , Henderson Susan J , Jung Paul
Published: August 2016

Introduction

Road traffic injuries are a leading cause of mortality and morbidity worldwide. Travellers are at risk given unfamiliarity with local road conditions and traffic rules. Peace Corps Volunteers are a unique population of long-term travellers who live and work in-country, often in remote settings, over a period of 27 months and use a range of transportation modes.

Methods

Data from Peace Corps' Epidemiologic Surveillance System (ESS) and Death In-Service (DIS) database were analysed in 2015 for non-fatal and fatal road traffic injuries among in-service Volunteers from 1996 to 2014. Volunteer-months were used to calculate incidence rates, and rates were compared among countries and regions.

Results

A total of 5047 non-fatal and 15 fatal road crash injuries were reported during 1 616 252 Volunteer-months for an overall rate of 3.12 non-fatal injuries and 0.01 fatalities per 1000 Volunteer-months. The total combined rate of nonfatal road traffic injuries among Volunteers generally declined from 4.01 per 1000 Volunteer-months in 1996 to 2.84 in 2014. Pedestrian and bicycle injuries emerged as the most frequent mechanisms of injury during this timeframe. Differences in rates of observed road traffic-related fatalities among Volunteers compared with expected age-matched cohort rates in the US were not statistically significant.

Conclusions

Peace Corps transportation policies and training, and changes to road environments worldwide, may have led to a decrease in the rate of road traffic injuries among Peace Corps Volunteers. Pedestrians and bicyclists remain at risk of road traffic injuries.
Traditional serrated adenomas and serrated carcinomas in carcinogen-treated rats
Authors: Rubio Carlos A
Published: August 2016

Aims

A recent review of archived sections from early experiments in rats showed neoplasias exhibiting serrated configurations. The aim was to assess the frequency of serrated neoplasias in the colon and small intestine of carcinogen-treated rats.

Methods

While reviewing archival sections from early experiments in Sprague-Dawley (SD) and Fisher-344 (F-344) rats, we recently detected colonic and intestinal traditional serrated adenomas (displaying serrated or microtubular patterns) and serrated carcinomas. SD rats were injected 1,2-dimethylhydrazine (DMH) for 27 weeks whereas F-344 rats were fed with a pyrolysate (GLU-1) for 24 months. Filed sections from 358 colonic and small intestinal neoplasias were re-evaluated.

Results

DMH-treated SD rats had 215 colonic neoplasias (1.4% were serrated adenomas, 7.9% microtubular adenomas, 2.8% serrated carcinomas and 2.8% microtubular carcinomas). GLU1-treated F-344 rats had 53 colonic neoplasias (1.9% were serrated adenomas and 20.8% microtubular adenomas), and 89 small intestinal neoplasias (1.1% were serrated adenomas, 42.7% microtubular adenomas and 6.7%, microtubular carcinomas).

Conclusions

DMH/SD-rats develop serrated and microtubular adenomas and carcinomas in the colon, whereas GLU1/F-344 rats develop microtubular adenomas in the colon and microtubular adenomas and carcinomas in the small intestine. The two rat-settings emerge as suitable models to study the molecular attributes of serrated and microtubular neoplasias under the standard conditions of the laboratory. This study is the first showing that a substantial number of serrated and particularly microtubular adenomas and carcinomas develop in the colon and small intestine of experimental rats. Importantly, serrated and microtubular neoplasias in rats recreate the histology of duodenal and colonic traditional serrated neoplasias in human beings.
Endovascular treatment of head and neck arteriovenous malformations: long-term angiographic and quality of life results
Authors: Meila Dan , Grieb Dominik , Greling Bjoern , Melber Katharina , Jacobs Collin , Hechtner Marlene , Schmitz Thomas , Schlunz-Hendann Martin , Lanfermann Heinrich , Brassel Friedhelm
Published: August 2016

Aim

To present the long-term angiographic and subjective results of patients with head and neck arteriovenous malformations (HNAVMs) after endovascular treatment.

Methods

We retrospectively analyzed the medical files of 14 patients with HNAVM who were treated between 2000 and 2014. The treatment of choice was a transarterial superselective microcatheter-based approach followed by embolization using liquid embolic agents. The patients were asked to answer a quality of life questionnaire about the following symptoms before and after treatment: pain, functional impairment, cosmetic deformity, impairment in daily life, and bleeding.

Results

Complete or >90% closure of the AVM was achieved in 6 of 14 patients (43%). >50% shunt reduction was achieved in 10 patients (71%). Three complications were encountered in a total of 86 interventional procedures. Six patients presented with bleeding which was cured in all cases (100%). Four of the 14 patients (29%) specified pain which was resolved in two of them. Another six patients (43%) presented with functional impairment; four were cured and two noted an improvement. All 14 patients presented with cosmetic concerns; four were cured and eight experienced a clearly visible improvement. Nine of 13 patients (69%) presented with impairment in daily life which was resolved in five patients and four reported an improvement.

Conclusions

Endovascular embolization is a well-tolerated therapy for HNAVM with a low complication rate. Good angiographic results, positive subjective results, and improvement in different aspects of quality of life can be achieved.
Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention
Authors: Baschet Louise , Bourguignon Sandrine , Marque Sébastien , Durand-Zaleski Isabelle , Teiger Emmanuel , Wilquin Fanny , Levesque Karine
Published: August 2016

Objective

To determine the cost-effectiveness of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients requiring a percutaneous coronary intervention in France, using a recent meta-analysis including second-generation DES.

Methods

A cost-effectiveness analysis was performed in the French National Health Insurance setting. Effectiveness settings were taken from a meta-analysis of 117 762 patient-years with 76 randomised trials. The main effectiveness criterion was major cardiac event-free survival. Effectiveness and costs were modelled over a 5-year horizon using a three-state Markov model. Incremental cost-effectiveness ratios and a cost-effectiveness acceptability curve were calculated for a range of thresholds for willingness to pay per year without major cardiac event gain. Deterministic and probabilistic sensitivity analyses were performed.

Results

Base case results demonstrated that DES are dominant over BMS, with an increase in event-free survival and a cost-reduction of €184, primarily due to a diminution of second revascularisations, and an absence of myocardial infarction and stent thrombosis. These results are robust for uncertainty on one-way deterministic and probabilistic sensitivity analyses. Using a cost-effectiveness threshold of €7000 per major cardiac event-free year gained, DES has a >95% probability of being cost-effective versus BMS.

Conclusions

Following DES price decrease, new-generation DES development and taking into account recent meta-analyses results, the DES can now be considered cost-effective regardless of selective indication in France, according to European recommendations.
Use of bioresorbable vascular scaffold: a meta-analysis of patients with coronary artery disease
Authors: Farag Mohamed , Spinthakis Nikolaos , Gorog Diana A , Prasad Abhiram , Sullivan Keith , Akhtar Zaki , Kukreja Neville , Srinivasan Manivannan
Published: August 2016

Background

Differences in outcomes between bioresorbable vascular scaffold (BVS) systems and drug-eluting metal stents (DES) have not been fully evaluated. We aimed to compare clinical and angiographic outcomes in randomised studies of patients with coronary artery disease (CAD), with a secondary analysis performed among registry studies.

Methods

A meta-analysis comparing outcomes between BVS and DES in patients with CAD. Overall estimates of treatment effect were calculated with random-effects model and fixed-effects model.

Results

In 6 randomised trials (3818 patients), BVS increased the risk of subacute stent thrombosis (ST) over and above DES (OR 2.14; CI 1.01 to 4.53; p=0.05), with a trend towards an increase in the risk of myocardial infarction (MI) (125 events in those assigned to BVS and 50 to DES; OR 1.36; CI 0.97 to 1.91; p=0.07). The risk of in-device late lumen loss (LLL) was higher with BVS than DES (mean difference 0.08 mm; CI 0.03 to 0.13; p=0.004). There was no difference in the risk of death or target vessel revascularisation (TVR) between the two devices. In 6 registry studies (1845 patients), there was no difference in the risk of death, MI, TVR or subacute ST between the two stents. Final BVS dilation pressures were higher in registry than in randomised studies (18.7±4.6 vs 15.2±3.3 atm; p<0.001).

Conclusions

Patients treated with BVS had an increased risk of subacute ST and slightly higher LLL compared with those with DES, but this might be related to inadequate implantation techniques, in particular device underexpansion.
International guideline changes and the incidence of infective endocarditis: a systematic review
Authors: Khan Omeair , Shafi Ahmed Mohamed Abdel , Timmis Adam
Published: August 2016

The objective of this study was to determine the impact on incident infective endocarditis (IE) of guideline recommendations to restrict indications for antibiotic prophylaxis. We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. PubMed and EMBASE databases were searched for articles published between 2007 and 2015 using mesh terms relevant to the research question. Included were English language articles published after 2009 that provided estimates of IE incidence before-and-after major international guideline changes. Seven studies were identified: 1 conducted in France, 4 in the USA and 2 in the UK. Only 1 study reported an increase in the rate of incident IE following guideline modification, and the remainder showed no change in upward (2 studies) or downward (4 studies) incidence trends. Study quality was generally poor for answering the question posed in this review, with serious risk of bias related to diagnostic ascertainment and unavailability of population risk data to adjust the incidence estimates. Moreover, the studies were often small, and relevant bacteriological data were not always available. Only 2 reported changes in antibiotic prescriptions, but these data were not linked to health records making it impossible to determine causal relations to changes in incident IE. The studies in this review were heterogenous in their design and variably limited by study size, duration of follow-up, diagnostic ascertainment, and absence of relevant prescription and bacteriological data. The studies were inconsistent in their conclusions and it remains uncertain what, if any, has been the impact of antibiotic prophylaxis guideline changes on the incidence of IE.
Emergency medicine educational resource use in Cape Town: modern or traditional?
Authors: Kleynhans A C , Oosthuizen A H , van Hoving D J
Published: August 2016

Background

The integration of online resources and social media into higher education and continued professional development is an increasingly common phenomenon.

Objective

To describe the usage of various traditional and modern educational resources by members of the divisions of emergency medicine at Stellenbosch University and the University of Cape Town.

Methods

Members affiliated with the divisions during 2014 were invited to participate in an online survey. Participants were given 8 weeks to complete the questionnaire; with weekly reminders until they responded or the deadline expired. Summary statistics were used to describe the variables.

Results

Eighty-seven divisional members completed the survey (69.6% response rate). The resources most preferred were textbooks (n=78, 89.7%), open access educational resources (n=77, 88.5%) and journals (n=76, 87.4%). Emergency medicine trainees (n=31, 92.1%) and respondents ≤30 years (n=17, 94.4%) were more inclined to use social media. International Emergency Medicine and Critical Care blogs are frequently being used by 71% of respondents. YouTube (35%) and podcasts (21%) were the most commonly used multimedia resources. Computers (desktop and laptop) were most frequently used to access educational resources except for social media where smart phones were preferred.

Conclusions

The use of modern and electronic resources is relatively common, but traditional educational resources are still preferred. This study illustrates an opportunity for greater integration of online resources and social media in educational activities to enhance multimodal and self-directed learning. Specific training in the use of these resources and how to appraise them may further improve their utility.
DOPAS full-scale experiments: approaches to compliance assessment
Authors: Doudou S. , White M. J. , Johnson M. , Bosgiraud J.-M. , Grahm Pär
Published: August 2016

The Full-Scale Demonstration Of Plugs And Seals (DOPAS) Project is a European Commission programme of work jointly funded by the Euratom Seventh Framework Programme and European nuclear waste management organizations (WMOs). The DOPAS Project aims to improve the industrial feasibility of plugs and seals, the measurement of their characteristics, the control of their behaviour over time in repository conditions, and their hydraulic performance with respect to safety objectives.

Within the project, an approach has been developed and applied to assess the compliance of two of the full-scale experiments to their design bases. The approach involves a review of each requirement in the design basis and the strategy used to demonstrate compliance of the experiment with that requirement. Feedback in the form of proposed updates to the design statements is captured by this approach. Learning points on plugs and seals from the compliance assessment are also noted for consideration in the DOPAS Project outcomes. This developed compliance and assessment approach can be employed as part of, or in conjunction with, other more generic approaches used by WMOs, including monitoring, full-scale testing and the documentation of construction procedures.
DOPAS EPSP experiment
Authors: Svoboda Jiří , Pacovský Jaroslav , Dvořáková Markéta , Hanusová Irena , Večerník Petr , Trpkošová Dagmar
Published: August 2016

The international DOPAS Project (Demonstration Of Plugs And Seals), which involves the participation of 14 European organizations (Posiva, ANDRA, DBE-TEC, GRS, NAGRA, RWA, SÚRAO, SKB, CTU, NRG, GSL, BTECH, VTT and ÚJV Řež), is concerned with the structural solution for sealing plugs to be used in deep geological radioactive waste repositories. The project is funded by the 7th Framework Programme – EURATOM.

The Czech contribution to the DOPAS project (the EPSP experiment – Experimental Pressure and Sealing Plug) consists of an experiment that is being conducted at the Josef Regional Underground Research Centre (Josef URC, Čelina-Mokrsko). The aims of the EPSP experiment are to develop, monitor and verify the functionality of such plugs, and to determine a detailed characterization of the materials from which the plug is constructed. The EPSP experiment is being conducted by a Czech consortium made up of SÚRAO, CTU and ÚJV Řež, a. s.
Role of IQGAP1 in endothelial barrier enhancement caused by OxPAPC
Authors: Tian Yufeng , Tian Xinyong , Gawlak Grzegorz , Sarich Nicolene , Sacks David B. , Birukova Anna A. , Birukov Konstantin G.
Published: August 2016

Oxidized 1-palmitoyl-2-arachidonoyl- sn-glycero-3-phosphatidylcholine (OxPAPC) attenuates agonist-induced endothelial cell (EC) permeability and increases pulmonary endothelial barrier function via enhancement of both the peripheral actin cytoskeleton and cell junctions mediated by Rac1 and Cdc42 GTPases. This study evaluated the role for the multifunctional Rac1/Cdc42 effector and regulator, IQ domain containing GTPase-activating protein (IQGAP1), as a molecular transducer of the OxPAPC-mediated EC barrier-enhancing signal. IQGAP1 knockdown in endothelial cells by gene-specific small-interfering RNA abolished OxPAPC-induced enlargement of VE-cadherin-positive adherens junctions, suppressed peripheral accumulation of actin polymerization regulators, namely cortactin, neural Wiskott-Aldrich syndrome protein (N-WASP), and actin-related protein 3, and attenuated remodeling of the peripheral actin cytoskeleton. Inhibition of OxPAPC-induced barrier enhancement by IQGAP1 knockdown was due to suppressed Rac1 and Cdc42 activation. Expression of an IQGAP1 truncated mutant showed that the GTPase regulatory domain of IQGAP1 was essential for the OxPAPC-induced membrane localization of cortactin, adherens junction proteins VE-cadherin and p120-catenin, as well as for EC permeability response. IQGAP1 knockdown attenuated the protective effect of OxPAPC against thrombin-induced cell contraction, cell junction disruption, and EC permeability. These results demonstrate for the first time the role of IQGAP1 as a critical transducer of OxPAPC-induced Rac1/Cdc42 signaling to the actin cytoskeleton and adherens junctions, which promotes cortical cytoskeletal remodeling and EC barrier-protective effects of oxidized phospholipids.
Systematic Review of Genetic Variation in Chromosome 5p15.33 and Telomere Length as Predictive and Prognostic Biomarkers for Lung Cancer
Authors: Kachuri Linda , Latifovic Lidija , Liu Geoffrey , Hung Rayjean J.
Published: August 2016

Lung cancer remains the leading cause of cancer mortality worldwide. Known histomolecular characteristics and genomic profiles provide limited insight into factors influencing patient outcomes. Telomere length (TL) is important for genomic integrity and has been a growing area of interest as agents targeting telomerase are being evaluated. Chromosome 5p15.33, an established cancer susceptibility locus, contains a telomerase-regulatory gene, TERT, and CLPTM1L, a gene associated with cisplatin-induced apoptosis. This review offers a summary of the clinical utility of 5p15.33 polymorphisms and TL. A total of 621 abstracts were screened, and 14 studies (7 for 5p15.33, 7 for TL) were reviewed. Endpoints included overall survival (OS), progression-free survival (PFS), therapy response, and toxicity. Of the 23 genetic variants identified, significant associations with OS and/or PFS were reported for rs401681 (CLPTM1L), rs4975616 (TERT-CLPTM1L), and rs2736109 (TERT). Both shorter and longer TL, in tumor and blood, was linked to OS and PFS. Overall, consistent evidence across multiple studies of 5p15.33 polymorphisms and TL was lacking. Despite the potential to become useful prognostic biomarkers in lung cancer, the limited number of reports and their methodologic limitations highlight the need for larger, carefully designed studies with clinically defined subpopulations and higher resolution genetic analyses. Cancer Epidemiol Biomarkers Prev; 25(12); 1537–49. ©2016 AACR.
The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System
Authors: Lin Jie , McGlynn Katherine A. , Carter Corey A. , Nations Joel A. , Anderson William F. , Shriver Craig D. , Zhu Kangmin
Published: August 2016

Background: Higher cancer-related mortality has been observed among people with mental health disorders than in the general population. Both delay in diagnosis and inadequate treatment due to health care access have been found to explain the higher mortality. The U.S. Military Health System (MHS), in which all beneficiaries have equal access to health care, provides an ideal system to study this disparity where there are no or minimal barriers to health care access. This study assessed preexisting mental health disorders and stage at diagnosis, receipt of cancer treatment, and overall survival among patients with non–small cell lung cancer (NSCLC) in the U.S. MHS.

Methods: The study used data from the linked database from the Department of Defense's Central Cancer Registry and the MHS Data Repository (MDR). The study subjects included 5,054 patients with histologically confirmed primary NSCLC diagnosed between 1998 and 2007.

Results: Patients with a preexisting mental disorder did not present with more advanced disease at diagnosis than those without. There were no significant differences in receiving cancer treatments between the two groups. However, patients with a mental health disorder had a higher mortality than those without [adjusted HR, 1.11; 95% confidence interval (CI), 1.03–1.20].

Conclusions: Poor survival in NSCLC in patients with a preexisting mental health disorder is not necessarily associated with delay in diagnosis and/or inadequate cancer treatment.

Impact: This study contributes to the current understanding that health care access may not be sufficient to explain the poor survival among patients with NSCLC with preexisting mental health disorders. Cancer Epidemiol Biomarkers Prev; 25(12); 1564–71. ©2016 AACR.
Heparanase Promotes Glioma Progression and Is Inversely Correlated with Patient Survival
Authors: Kundu Soumi , Xiong Anqi , Spyrou Argyris , Wicher Grzegorz , Marinescu Voichita D. , Edqvist Per-Henrik D. , Zhang Lei , Essand Magnus , Dimberg Anna , Smits Anja , Ilan Neta , Vlodavsky Israel , Li Jin-Ping , Forsberg-Nilsson Karin
Published: August 2016

Malignant glioma continues to be fatal, despite improved insight into its underlying molecular mechanisms. The most malignant form, glioblastoma (GBM), is characterized by aberrant activation of receptor tyrosine kinases (RTK) and infiltrative growth. Heparan sulfate proteoglycans (HSPG), integral components of the extracellular matrix of brain tumors, can regulate activation of many RTK pathways. This prompted us to investigate heparanase (HPSE), which cleaves HSPGs, for its role in glioma. This hypothesis was evaluated using tissue microarrays, GBM cells derived from patients, murine in vitro and in vivo models of glioma, and public databases. Downregulation of HPSE attenuated glioma cell proliferation, whereas addition of HPSE stimulated growth and activated ERK and AKT signaling. Using HPSE transgenic and knockout mice, it was demonstrated that tumor development in vivo was positively correlated to HPSE levels in the brain. HPSE also modified the tumor microenvironment, influencing reactive astrocytes, microglia/monocytes, and tumor angiogenesis. Furthermore, inhibition of HPSE reduces tumor cell numbers, both in vitro and in vivo. HPSE was highly expressed in human glioma and GBM cell lines, compared with normal brain tissue. Indeed, a correlation was observed between high levels of HPSE and shorter survival of patients with high-grade glioma. In conclusion, these data provide proof-of-concept for anti-HPSE treatment of malignant glioma, as well as novel insights for the development of HPSE as a therapeutic target.

Implications: This study aims to target both the malignant brain tumor cells per se and their microenvironment by changing the level of an enzyme, HPSE, that breaks down modified sugar chains on cell surfaces and in the extracellular space. Mol Cancer Res; 14(12); 1243–53. ©2016 AACR.