bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Pulse Therapy with Glucocorticoids and Cyclophosphamide in Patients with Paraquat Poisoning
Authors: Ghorbani A , Masoumi K , Forouzan A , Rahmani AH , Rahim F , Taeybi B Taherinezhad , Feli M
Published: December 2017

Introduction

Paraquat (PQ) is a widely used herbicide with a high mortality rate when ingested. The aim of the present study was to assess the effectiveness of repeated cyclosphosphamide (CP) and methylprednisolone (MP) combination in the treatment of PQ poisoning.

Design

Randomised, double‐blinded, placebo‐controlled trial.

Methods

Eligible participants were 47 patients with moderate to severe PQ poisoning within 24 hours of hospitalisation. Patients were allocated in a random fashion, 24 as the intervention and 23 as the control group. All patients received two cycles of eight hours of haemoperfusion with charcoal, and underwent emergency haemodialysis. After the dialysis, the intervention group received 15 mg/kg CP for two days and 1g MP for three days. The control group received routine supportive care. Outcome parameters, including mortality, incidence of hypoxia, hepatitis and renal failure were compared between the two groups.

Results

There were no significant differences between the two groups with regard to age, sex, baseline liver function test, creatinine, time from poisoning to dialysis, and time from poisoning to the hospitalisation. Although the incidence of hepatitis and acute renal failure did not differ significantly between the two groups, the incidence of hypoxia and mortality rate was lower in the intervention group. The number need‐to‐treat to reduce one mortality was 2.8.

Conclusion

The results suggest that CP and MP repeated treatment can reduce the mortality rate in moderate to severe PQ intoxication.
Streamlined Liner of the Pharynx Airway: Randomised Comparison of Size Selection Strategies with Regard to Patient Height versus Thyroid Cartilage Width
Authors: Ahn EJ , Kang H , Choi GJ , Yang SY , Shin HY , Baek CW , Jung YH , Woo YC , Han SS
Published: December 2017

Introduction

Streamlined Liner of the Pharynx Airway (SLIPA) is a disposable supraglottic airway. There are two strategies to select the size of SLIPA: by height and width of thyroid cartilage. This study compared the utility of the two strategies in selecting the optimal size.

Methods

One hundred forty-two patients were randomly divided into two groups with size selection by height (H) and the maximal width of the thyroid cartilage (T). The SLIPA size was selected by height in group H, and by the width of thyroid cartilage in group T. After inserting SLIPA, the investigator made note of the oropharyngeal leakage pressure (OLP) and the degree of insertion difficulty. We set the OLP as a primary outcome. In cases of an OLP <15 cmH2O, the investigator manipulated the apparatus to try to reposition it. If air still leaked, another attempt was made using a SLIPA one size larger until an OLP >15 cmH2O was achieved in up to three attempts. After insertion, the investigator measured the inspiratory and expiratory tidal volume. Post-operatively, the presence of blood or regurgitated fluid on the device was evaluated.

Results

OLP for group T was higher than that of group H (p=0.009). The need for manipulation and the leak fraction was higher in group H than in group T (p=0.008 and 0.034, respectively). The degree of insertion difficulty, number of trials and incidence of blood and regurgitated fluid on the device were similar between the two groups.

Conclusions

Both the width and height of thyroid cartilage can be used for selecting the optimal SLIPA size. (Hong Kong j.emerg.med. 2015;22:303-311)
A Comparison of the Performance of Different Age-Based Paediatric Weight Estimation Formulae in Hong Kong Children
Authors: So Jlt , Chow Epf , Cattermole Gn , Graham Ca , Rainer Th
Published: December 2017

Objective

To evaluate the performance of five existing age-based weight estimation formulae - the original and updated Advanced Paediatric Life Support (APLS) formulae, Luscombe formula, Best Guess formula, Chinese Age Weight Rule (CAWR) - as well as a new two-part weight estimation formula, the Chinese Age Weight Rule-3 (CAWR-3), in Hong Kong children presenting to the emergency department (ED).

Methods

Data based on children aged 1-12 who presented to the ED of a tertiary referral centre in Hong Kong over a six-month period. Actual weight was compared against estimated weight from the weight estimation formulae. Level of agreement was assessed by Bland-Altman analysis using mean percentage difference (MPD) and 95% limits of agreement (LOA). Root mean squared error (RMSE) and proportions of weight estimates within 10%, 15% and 20% of actual weight were calculated.

Results

A total of 4600 children were included. The CAWR-3 outperformed the five existing weight estimation formulae. The CAWR-3 had the least MPD in age 4-12 (MPD +3.2%), as well as the second least MPD in age 1-12 (MPD -0.7%). The CAWR-3 had narrowest 95% LOA in age 1-3 (95% LOA -32.6% to 21.9%) and the second narrowest 95% LOA in age 1-12 (95% LOA -37.5% to 36.1%). The CAWR-3 had the smallest RMSE of 6.33 kg in age 4-12 and the smallest RMSE of 4.90 kg in age 1-12. Furthermore, the CAWR-3 had the highest proportion of weight estimates within 10%, 15% and 20% of actual weight.

Conclusion

The CAWR-3 outperforms the five existing age-based weight estimation formulae in Hong Kong children presenting to the emergency department.
A Retrospective Study of Patients with Minor Head Injury to Compare the Canadian CT Head Rule and the New Orleans Criteria
Authors: Lo Ws , Shih Yn , Leung Cs , Cheung Lw , Leung M , Yeung Hc , Lit Ach
Published: December 2017

Objective

To compare the performance of the Canadian CT Head Rule (CCHR) and the New Orleans Criteria (NOC) in minor head injury patients.

Method

This retrospective cohort study collected data and CT head reports of all minor head injury patients from 1 January 2008 to 31 December 2010. We compared the sensitivity, specificity, positive and negative predictive values of both rules in predicting clinically important brain injury on CT and the need of neurosurgical intervention.

Results

We reviewed 474 patients with minor head injury. Seventy seven patients had clinically important brain injury and 11 underwent neurosurgical intervention. The sensitivity of the CCHR and NOC in predicting clinically important brain injury were 80% (95% confidence interval [CI] 70-88%) and 92% (95% CI 86-98%), respectively; and the specificity of the CCHR and NOC were 39% (95% CI 33-44%) and 17% (95% CI 13-21%), respectively. The sensitivity of the CCHR and NOC in predicting the need of neurosurgical intervention were 80% (95% CI 55-100%) and 100% (95% CI 100-100%), respectively; and the specificity of the CCHR and NOC were 36% (95% CI 31-41%) and 15% (95% CI 12-19%), respectively. The negative predictive values (NPV) of the CCHR and NOC for clinically important brain injury were 88% (95%CI 83-94%) and 91% (95%CI 84-98%); and for the need of neurosurgical intervention were 99% (95% CI 96-100%) and 100% (95% CI 100-100%). Amongst those missed cases, 88% in the CCHR group and 83% in the NOC group reported loss of consciousness.

Conclusions

The NOC is more sensitive but less specific than the CCHR in predicting both outcomes. Both rules have excellent NPV to rule out the need of neurosurgical intervention.
Validation of a Modified Glasgow‐Blatchford Score for Risk Stratification of Patients with Suspected Upper Gastrointestinal Bleeding in an Accident and Emergency Department in Hong Kong
Authors: Tsui ATS , Chau CW , Leung JKS
Published: December 2017

Objectives

To validate the use of a modified Glasgow‐Blatchford Score (mGBS) for risk stratification of patients with suspected upper gastrointestinal bleeding (UGIB) in an accident and emergency department in Hong Kong.

Methods

This was a retrospective cohort study of patients who attended the emergency department of the study centre from January 2014 to June 2014 who were subsequently admitted to surgical wards with suspected UGIB. High risk patients were considered to be those who required in‐patient clinical interventions (blood transfusion, therapeutic endoscopy, angiographic embolisation, or surgery). The mGBS was calculated for each patient. The sensitivity, specificity, and area under the receiver‐operating characteristic curve (AUC) of the score were calculated.

Results

A total of 372 patients were included in the study. With an mGBS of 0 (low risk) for detecting the primary outcome, the sensitivity was 99.2% (95% CI, 95.6100%), and the specificity was 25.91 (95% CI 20.6‐31.8%). The negative likelihood ratio was 0.031 (95% CI 0.004‐0.2). The AUC was 0.90 (95% CI 0.87 to 0.93).

Conclusion

The modified Glasgow‐Blatchford Score is a clinically useful tool for emergency physician to identify UGIB patients at low‐risk of requiring in‐hospital clinical interventions. (Hong Kong j.emerg.med. 2016;23:3‐11)
Thrombolysis during Extended Cardiopulmonary Resuscitation for Autoimmune-Related Pulmonary Embolism
Authors: Gao JP , Ying KJ
Published: December 2017

Massive pulmonary embolism (MPE) is one of the potentially reversible causes of cardiac arrest and pulseless electrical activity. At present, a fear of lethal haemorrhage makes thrombolytic therapy prohibitive during cardiopulmonary resuscitation. Blood hypercoagulability in autoimmune disorders (such as autoimmune haemolytic anaemia) carries a risk of MPE. Prompt diagnosis is critical for timely thrombolytic intervention. We reported a 23-year-old female with 10 years medical history of autoimmune haemolytic anaemia developed cardiac arrest in our emergency intensive care unit. Electrocardiogram and echocardiogram findings indicated the possibility of MPE, so fibrinolytic therapy with alteplase was administered along with prolonged cardiopulmonary resuscitation. Her neurological recovery was generally good, and no major bleeding occurred. MPE was confirmed by computed tomography pulmonary angiography afterwards. We regard that once there is presumptive diagnosis of MPE, initiating early thrombolysis during cardiopulmonary resuscitation may be considered. (Hong Kong j.emerg.med. 2016;23:180-185)
Paddle Position and Contact Force: An Important Step to Check When Troubleshooting for Refractory Ventricular Fibrillation
Authors: Chang HC , Lin JF , Yeh KH
Published: December 2017

Ventricular fibrillation (VF) is a lethal medical emergency that requires immediate defibrillation. VF is resistant when it persists after three or more defibrillator shocks. Successful defibrillation requires depolarisation of a critical mass of myocardium. Several variables, such as the length of time in VF, body type, total energy used, and energy waveform have been reported to be associated with the success rate of defibrillation. Correct paddle position and good contact force to create an adequate current flow through the heart is essential for defibrillation. We report a patient who developed VF because of acute myocardial infarction that was resistant to a total of 13 shocks. The cause of shock‐resistant VF was diagnosed by noticing the skin marks caused by the defibrillator paddle that indicated incorrect paddle position and inadequate paddle force. By checking the skin marks, an emergency physician could make a correct diagnosis within a few seconds and save a patient.
Posterior Reversible Encephalopathy Syndrome and Maternal Death in an Obstetric Patient: Case Report
Authors: Sargin MA , Tug N , Karadogan FO , Yassa M , Guner D
Published: December 2017

Cerebral events occur more often in the postpartum period and are associated with hypertensive diseases of pregnancy. Superimposed with pre‐eclampsia, these cause severe complications. Posterior reversible encephalopathy syndrome occurs because of acute elevation of blood pressure above the upper limit of cerebral blood flow auto‐regulation. We present a case of posterior reversible encephalopathy syndrome that developed with superimposed pre‐eclampsia resulting in intraparenchymal haemorrhage and maternal death.
Toxicology Training Unit in Emergency Department Reduces Admission to other Specialties and Hospital Length of Stay
Authors: Choi KM , Chan CK , Lau FL
Published: December 2017

Objective

To evaluate the outcome of intoxicated patients presented to Accident and Emergency Department (AED) in Hong Kong with Toxicology Training Unit accreditation and AED without toxicology team.

Method

A retrospective observational study with data collection from all intoxicated cases reported through Pre-hospital Activated Charcoal Programme, a protocol driven poisoning reporting system, from 1/7/2011 to 30/6/2013 (2 years). Data on basic demographic data (e.g. sex, age), receiving AED, admission rate to other specialty, length of stay in hospital exclude psychiatry ward admission and clinical outcome were collected and analysed. Five AEDs with Toxicology Training Unit (study group) and 7 AEDs without toxicology team (control group) were included.

Results

A total of 329 intoxicated cases were included in this study. The basic epidemiological data were similar in both groups. There was a significantly lower in hospital admissions in study group (16.9%) than in control group (69.3%; p<0.001) and significant shorter median of hospital stay of 22.1 hours (interquartile range [IQR] 12.8-43.5 hours) in study group compare to 42.7 hours (IQR 20.4-76.1 hours) in control group (p<0.001).

Conclusion

Our findings show that the establishment of the toxicology training unit can achieve significant reduction in admissions to other specialty and the length of stay in hospital in the management of patients with acute intoxication.
Nurse Performed Ultrasonography in Confirming the Position of Nasogastric Tube in the Emergency Department: A Prospective Single Group Diagnostic Test Study
Authors: Tai PH , Lau WS , Chan PY , Ng SY , Lam YC , Mak HT , Mak YT
Published: December 2017

Introduction

Emergency nurses often encounter patients with nasogastric tube (NGT) dislodgements who require reinsertion. Empirical evidence supporting the use of ultrasonography in verifying the position of NGT in local accident and emergency departments (AED) is scanty. There is also a lack of validation of nurse performed ultrasonography in Hong Kong. With the support from hospitals and medical personnel, a prospective, single group diagnostic test study was conducted to review the possibility of nurse performed ultrasonography in verifying the position of NGT in AED.

Methods

This study was conducted in the AED of three local hospitals. Investigators with specific ultrasound training performed ultrasonography scans to the subjects in addition to conventional pH test and “whoosh” test. Results were compared with chest or abdominal X-ray for evaluation of accuracies.

Results

This study confirmed a high sensitivity and specificity of nurse performed ultrasonography in confirming the position of NGT in the AED. The high positive predictive value and positive likelihood ratio supported the confirmation of NGT position by bedside ultrasound. The high specificities and minimal negative likelihood ratios of ultrasonography tests also suggested the application of bedside ultrasound in ruling out patients with misplaced NGTs.

Conclusions

Nurse performed ultrasonography allows immediate bedside confirmation of the position of NGT in the overcrowded AED. Considered the limitations of conventional methods, nurse performed ultrasonography can be incorporated into daily practice for providing extra evidence for the confirmation of NGT position.
Epidemiology of Paediatric Out-of-Hospital Cardiac Arrest Presented to a Local Emergency Department: A Retrospective Case Series
Authors: Ho YK , Mok YT
Published: December 2017

Objective

To outline the epidemiology of paediatric out-of-hospital cardiac arrest (OHCA) cases presented to a regional hospital.

Design

Retrospective case series.

Methods

Attendance records of critical cases aged from 0 to 17 years old from year 2001 to 2014 attending Emergency Department (ED) of Yan Chai Hospital were searched. Demographic data and predictive parameters were analysed for association with outcome.

Results

There were 40 cases of paediatric OHCA throughout the study period. A total of 21 (52.5%) had witnessed arrest; 27 (67.5%) had cardiac arrest at home. Twenty-eight (70%) of the cardiac arrest were first noted by family members; 8 (20%) received bystander cardiopulmonary resuscitation (CPR). Only 13 (32.5%) cases had return of spontaneous circulation (ROSC) in the ED and were admitted. Seven patients (17.5%) survived to hospital discharge.

Conclusion

Paediatric OHCA, although a rare occurrence, has a high mortality of 82.5% in our series. Majority of the cases occur at home, and are witnessed. Family members are often the first persons to detect the arrest. Yet the rate of providing bystander CPR is low in Hong Kong.
Swollen Arm in a Former Athlete
Authors: Sorić M , Grabovac V
Published: December 2017

We reported a case of a former water polo player who suffered from a non-traumatic right subclavian vein thrombosis. An otherwise healthy former athlete developed thrombosis of the right subclavian vein. He presented with swelling of his right arm. Diagnosis was made by colour doppler ultrasonography. He received low molecular weight heparin as initial treatment followed by thrombolytic therapy with alteplase and heparin infusion. He continued with outpatient anticoagulant therapy for six months before returning to usual daily activities. There is no evidence or report on the time length after ending of an athletic pursuit that would predispose to the formation of subclavian vein thrombosis. Early diagnosis and treatment of patients with subclavian vein thrombosis is important in order to avoid complications, occupational disability and the adverse impact on the patient's quality of life.
Cervical Emphysema and Pneumomediastinum following “Light Strangulation” Injury
Authors: Jung MH , Kim SE , Lee DH , Hong JH , Hong JY , Kim CW
Published: December 2017

Pneumomediastinum is an uncommon radiographic finding resulting from various causes, such as trauma, infection and unknown causes. The pneumomediastinum due to minor trauma is rarely reported and treatment and diagnostic process is not established. We report on a 20-year-old female patient who initially presented with neck pain and dyspnoea following manual strangulation. Her chest X-ray and computed tomography (CT) of neck imaging showed subcutaneous emphysema and extensive pneumomediastinum, but pneumothorax was not shown. She was transferred to the thoracic surgery and admitted to the general ward. The patient's condition improved and she was discharged on the sixth hospital day. In conclusion, patients with pneumomediastinum following a minor strangulation injury can be observed alone without invasive testing or repeated imaging. CT scans are of great value for safe observation in determined patients and for the further evaluation of pneumomediastinum.
Impact of a Sepsis Guideline in Emergency Department on Outcome of Patients with Severe Sepsis
Authors: Tse CL , Lui CT , Wong CY , Ong KL , Fung HT , Tang SYH
Published: December 2017

Objective

A dedicated program with guideline to enhance sepsis care was launched in July 2014 in Emergency Department (ED) of two regional hospitals. The study aimed to evaluate the effectiveness of the interventional program for severe sepsis patients, in antibiotic delivery rate and survival outcome.

Methods

It is a before‐and‐after interventional study with data from July to December 2013 and August 2014 to January 2015. A dedicated program for severe sepsis patients was introduced in July 2014. The outcome measures were blood culture rate, antibiotic administration rate in ED and mortality. Kaplan‐Meier analysis and log‐rank test was used for comparison of the survival. Multivariate Cox proportional hazards model was constructed to predict time to mortality adjusted for covariates.

Results

64 patients were included, 31 patients were in the pre‐intervention group whereas 33 post‐intervention. Both blood culture rate (29% vs 72.7%; p<0.001) and antibiotics administration in ED (38.7% vs 72.7%, p=0.0011) were significantly increased. Survival outcome was significantly improved in patients receiving timely antibiotics in ED (log‐rank test p=0.016). Antibiotics administered in ED had hazard ratio of 0.178 (95% CI 0.053 to 0.595; p=0.005) in the Cox Proportional hazard regression model with adjustment of covariates. Age (adjusted odds ratio 1.06, 95% CI 1.01 to 1.12, p=0.033) and initial hypotension (adjusted odds ratio 0.97, 95% CI 0.95 to 0.99, p=0.005) were significant predictors of mortality.

Conclusion

A dedicated guideline for severe sepsis management could improve blood culture rate, early antibiotics administration in the emergency department. Patients received early antibiotic had better outcome and survival.
Nonocclusive Mesenteric Ischaemia Induced by Diltiazem Overdose: A Case Report
Authors: Kim JW , Park SO , Hong DY , Baek KJ , Lee KR
Published: December 2017

Acute mesenteric ischaemia is a rare complication of calcium channel blocker (CCB) overdose. A previous study reported a case of mesenteric ischaemia induced by poisoning with CCBs other than diltiazem. We present a case of nonocclusive mesenteric ischaemia (NOMI) induced by diltiazem poisoning. Through this case report, we wish to emphasize that the clinicians should keep the possibility of intestinal ischaemia in mind from the early phase of calcium channel blocker poisoning. In addition, close monitoring and intense abdominal examination including the abdominal computed tomography scan should be done if CCBs poisoning patients complained of an abdominal pain.
Public Health Law as a Way to Explore and Develop Professional Identity
Authors: Herbst Jennifer L.
Published: December 2017

Lawyers are most often portrayed and understood to be zealous advocates for individual clients in adversarial litigation or zero-sum transactions. Law schools provide excellent preparation for this type of lawyer role, but lawyers' unique understanding of the law is also needed for systemic advocacy, policymaking, and legal education to solve the most difficult societal problems. An interdisciplinary public health law class is one way for law schools to provide students an opportunity to explore and develop these other professional identities.
Expanding Interdisciplinary Learning Opportunities on a Shoestring through a Medical-Legal Partnership
Authors: Hermer Laura D.
Published: December 2017

This article describes why and how the author started a medical-legal partnership at her small law school, the curricula associated with the medical-legal partnership, and the experience she and her students have had with the curricula to date. It also provides “lessons learned” which may be useful for individuals interested in expanding interdisciplinary and experiential opportunities at institutions that presently lack traditional sources of such opportunities.
Tearing Down the Silos: An Interdisciplinary, Practice-Based Approach to Graduate School Education
Authors: Van Nostrand Elizabeth (Bjerke)
Published: December 2017

“Law in Public Health Practice” is an interdisciplinary, practice-based course in which the University of Pittsburgh's Graduate School of Public Health, its School of Law, and the Allegheny County Health Department work collaboratively to identify an issue needing the expertise of multiple disciplines. For the first iteration, students in over four disciplines explored the possible regulation of tattoo parlors. The lessons learned are adaptable to any topic that engages students in more than one discipline to address real-world public health problems.
Screening of Newborns for Disorders with High Benefit-Risk Ratios Should Be Mandatory
Authors: Kelly Nicole , Makarem Dalia Chehayeb , Wasserstein Melissa P.
Published: December 2017

Newborn screening has evolved to include an increasingly complex spectrum of diseases, raising concerns that screening should be optional and require parental consent. Early detection of disorders like PKU and MCAD is essential to prevent serious disability and death in affected children. These are examples of high benefit-risk ratio disorders because of the irrefutable health benefits of early detection, coupled with the low risks of treatment. The dire consequences of not diagnosing an infant with a treatable disorder because of parental refusal to screen are wholly unacceptable. Thus, we believe that newborn screening for disorders with high benefit-risk ratios should continue to be mandatory.
After the Affordable Care Act: Health Reform and the Safety Net
Authors: Shin Peter , Regenstein Marsha
Published: December 2017

Two major safety net providers – community health centers and public hospitals – continue to play a key role in the health care system even in the wake of coverage reform. This article examines the gains and threats they face under the Affordable Care Act.
Mitigating Risks to Pregnant Teens from Zika Virus
Authors: Maynard Andrew D. , Bowman Diana M. , Hodge James G.
Published: December 2017

Zika infection in pregnant women is associated with an elevated probability of giving birth to a child with microcephaly and multiple other disabilities. Public health messaging on Zika prevention has predominantly targeted women who know they are pregnant or intend to become pregnant, but not teenage females for whom unintended pregnancy is more likely. Vulnerabilities among this population to reproductive risks associated with Zika are further amplified by restrictive abortion laws in several Zika-impacted states. Key to prevention is enhanced, targeted public health messaging centered on teens nationally and particularly in certain high-risk regions.
Dancing the Strata: Investigating Affective Flows of Moving/Dancing Bodies in the Exploration of Bodily (Un)Becoming
Authors: Borovica Tamara
Published: December 2017

This article draws on recent sociological work that explores the intangible, sensory, and affective dimensions of social life. In particular, I look at elusive, sensory, and affective elements of young women’s bodily becoming, through feminist lens. My intention behind this is to problematize narrow understandings of (women’s) embodiment in social sciences. I explore the stratification of bodies (through sex, gender, class, and race) and the way in which stratification works on bodies, what it produces, and how it limits and/or enforces bodily potentials. To this end, I follow affective flows between young women’s dancing bodies as they participate in a performance ethnography I have conducted to explore embodiment. To work with partial, dynamic, multisensory data, and to explore the potentiality of what bodies sense, feel, and do, I use a poetic analysis of the participants’ dance encounters.
‘Negative Capability or Dealing with the Complexity of the Iraqi War’
Authors: Misztal Barbara
Published: December 2017

The paper develops an argument that the growing complexity of information and the widespread distrust of such information have created a need for a new foundation for the development of political action and that this demand has recently been satisfied with the help of the human rights discourse. On the surface of it, the global public's ability to judge and protest against the Iraqi war can be described with the help of Keats's concept of negative capability. The paper suggests that the unity of the anti- Iraqi war movement was illusory and made possible because of the availability of language in which people can express their opposition to the war, namely a human rights discourse. It concludes that only if we have a global public and an effectively working international system, are we able to respond to threats in a non-simplistic way.
Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement
Authors: Im Hyojin , Ferguson Aidan , Hunter Margaret
Published: December 2017

Westernized approaches to mental health care often place limited emphasis on refugees’ own experiences and cultural explanations of symptoms and distress. In order to effectively assess community mental health needs and develop interventions grounded in local needs, mental health programs need to be informed by an understanding of cultural features of mental health, including cultural idioms of distress (CIDs). The current study aims to explore CIDs among Somali refugees displaced in Kenya to understand mental health needs in cultural context and serve the community in a culturally responsive and sensitive manner. This research was conducted as a two-phase qualitative study. First, key informant interviews with Somali mental health stakeholders generated a list of 7 common Somali CIDs: buufis, buqsanaan, welwel, murug, qaracan, jinn, and waali. Typologies of each CID were further explored through four focus group interviews with Somali community members. The findings from a template analysis revealed Somali lay beliefs on how trauma and daily stressors are experienced and discussed in the form of CIDs and how each term is utilized and understood in attributing symptoms to associated causes. This study highlights the need to incorporate colloquial terms in mental health assessment and to adopt a culturally relevant framework to encourage wider utilization of services and religious/spiritual support systems.
Counting the cost of Afrophobia: Post-migration adaptation and mental health challenges of African refugees in South Africa
Authors: Thela Lindokuhle , Tomita Andrew , Maharaj Varsha , Mhlongo Mpho , Burns Jonathan K.
Published: December 2017

There are few studies on the role of migration within sub-Saharan Africa and its relation to the development of mental illness. We investigated post-resettlement adaptation and mental health challenges of African refugees/migrants in Durban, South Africa. We interviewed 335 African help-seeking refugees/migrants for anxiety, depression (25-item Hopkins Symptom Checklist) and post-traumatic stress symptoms (30-item Harvard Trauma Questionnaire). Socio-demographic and migration history, focusing on post-migration circumstances and experiences of discrimination in the host country, were obtained. Association between migration and post-settlement factors and mental health outcomes were assessed using adjusted logistic regression models. Prevalence of mental distress was high: 49.4% anxiety, 54.6% depression and 24.9% post-traumatic stress symptoms. After adjustment for family separation since migration, recent arrival in South Africa was associated with increased risk for depression (aOR = 4.0, 95% CI:1.3–11.8) and post-traumatic stress (aOR = 5.2, 95% CI:1.7–15.9), while in unadjusted models, older age on arrival was associated with anxiety (aOR = 5.3, 95% CI:1.4–19.8) and depression (aOR = 6.2, 95% CI:1.6–24.3). History of family separation since migration was independently associated with depression and post-traumatic stress in all models. Discriminatory experiences since migration was also an independent risk factor for all three mental health outcomes. Finally, being divorced/widowed was associated with an increased risk for post-traumatic stress, while higher income earners were protected against post-traumatic symptoms, even after adjustment. Refugees/migrants in South Africa show a significant burden of mental distress that is linked to challenges of adjustment in an often hostile context. Services addressing these and other health-related, social-economic needs should be developed as a priority.
Waterpipe use in adolescents in Northern Sweden: Association with mental well-being and risk and health behaviours
Authors: Ramji Rathi , Arnetz Bengt B. , Nilsson Maria , Wiklund Ywonne , Jamil Hikmet , Maziak Wasim , Arnetz Judy
Published: December 2017

Aims: There is a lack of studies examining the association between waterpipe smoking and mental well-being among adolescents. This study sought to determine whether waterpipe smoking is associated with mental well-being and other risk and health behaviours in adolescents. Methods: A questionnaire was distributed to 1006 adolescents in grades 9–12 (with a response rate of >95%), containing questions on measures of stress, mental energy and sleep. In addition, the questionnaire assessed risk and health behaviours, including use of a waterpipe, cigarettes, e-cigarettes, snus, alcohol, narcotics, gambling and exercise. Logistic regression was used to assess factors associated with waterpipe use. Results: Thirty-seven per cent ( n=371) of the participants had used a waterpipe at some point. Waterpipe use was associated with lower mental energy (odds ratio [OR] = 0.90, 95% confidence interval [CI] 0.81–0.99), higher stress (OR = 1.10, 95% CI 1.02–1.20) and use of cigarettes (OR = 3.82, 95% CI 2.33–6.03), e-cigarettes (OR = 3.26, 95% CI 2.12–4.99), snus (OR = 2.29, 95% CI 2.12–4.99), alcohol (OR = 1.92, 95% CI 1.07–3.44) and narcotics (OR = 3.64, 95% CI 1.75–7.58). Waterpipe use was not significantly associated with gambling, exercise or sleep quality. Conclusions: Waterpipe use in adolescents is associated with worse mental well-being, as well as use of other nicotine products, alcohol and narcotics. Prospective studies are needed to delineate causal and temporal relationships further between waterpipe use and mental well-being and its relationship to other risky behaviours in order to design effective prevention programs.
Reliability and validity of the Japanese version of the Alzheimer’s Disease Knowledge Scale
Authors: Amano Takashi , Yamanaka Katsuo , Carpenter Brian D
Published: December 2017

Concerned with the importance of prevailing knowledge about dementia in supporting those with dementia, large-scale educational programs have been implemented in some countries. Although Japan is one of those few countries, the experience from Japanese programs has been rarely shared because of the lack of a standardized measurement for assessing knowledge about dementia. This study aims to develop a Japanese version of the Alzheimer’s Disease Knowledge Scale (JADKS) and to examine its reliability and validity. The JADKS was developed through a translation–back-translation process and was distributed to 837 people including university students, community-dwelling older people, health and welfare professionals, and family caregivers. Using data from the 566 participants who fully completed the questionnaire, test–retest reliability, internal consistency, and concurrent validity were evaluated. The results indicate that the JADKS has acceptable psychometric properties. The JADKS may be useful in assessing knowledge about dementia and could help compare effectiveness of educational programs.
The Kintun program for families with dementia: From novel experiment to national policy (innovative practice)
Authors: Gajardo Jean , Aravena José M , Budinich Marilú , Larraín Alberto , Fuentes Patricio , Gitlin Laura N
Published: December 2017

The Kintun program is the first public health strategy specifically designed for dementia care in Chile. It was launched in 2013 in the city of Santiago with support from the National Service for the Elderly and the Municipality of Peñalolén. Using an interdisciplinary team, the program seeks to promote community integration and better support for persons with dementia and their caregivers. The multicomponent program includes: an activity-based day care center, training and education of family caregivers, home visits, and community outreach to increase dementia awareness. Case management helps to monitor ongoing needs and link families to resources. To date, 259 dyads (persons with dementia and their families) have been enrolled in the program. Due to its success in 2015, the Kintun program received funding from the Ministry of Health. This has led to the integration of previously disparate initiatives, better consistency across services, and the development of a comprehensive national dementia plan for Chile.
A holistic service for everyone with a dementia diagnosis (innovative practice)
Authors: Wood Julia H , Souris Helen , Weston-Clarke Sarah Maryse , Bristow Simon
Published: December 2017

The London borough of Islington has developed their memory service to provide care for all those living with dementia in the community. This article discusses this service and a new and innovative tool designed to guide decision making on the frequency of contact with service users.
An extended review of couple-centred interventions in dementia: Exploring the what and why — Part B
Authors: Bielsten Therése , Hellström Ingrid
Published: December 2017

This scoping review is an extended version of a narrative review of couple-centred interventions in dementia shared in part A and the previous publication in this edition. The rationale for expanding study A emerged through the fact that most dyadic interventions have samples consisting of a majority of couples. The exclusion of interventions with samples of mixed relationships in part A therefore contributed to a narrow picture of joint dyadic interventions for couples in which one partner has a dementia. The aim of this second review is to explore the ‘what’ (types of interventions) and the ‘why’ (objectives and outcome measures) of dyadic interventions in which sample consists of a majority of couples/spouses and in which people with dementia and caregivers jointly participate.

Method

A five-step framework for scoping reviews guided the procedure. Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science.

Results

Twenty-one studies with various types of psychosocial interventions were included. The main outcome measure for people with dementia was related to cognitive function, respectively caregiver burden and depression for caregivers.

Conclusions

The findings of this extended review of joint dyadic interventions in dementia are in line with the findings of part A regarding the negative approach of outcomes, lack of a genuine dyadic approach, lack of tailored support, neglect of interpersonal issues and the overlook of the views of people with dementia. This review also recognises that measures of caregiver burden, as well as relationship quality should be considered in samples of mixed relationships due to the different significance of burden and relationship quality for a spouse as opposed to an adult child or friend.
Quality nursing care in dementia specific care units: A scoping review
Authors: Gilbert Julia , Ward Louise , Gwinner Karleen
Published: December 2017

Background

The concept of quality nursing care in a dementia specific unit is perceived as being subject to the interpretation of individuals, nurses and healthcare organisations. As the number of dementia diagnoses increases, understanding what constitutes quality nursing care within dementia specific care units is vital to inform policy makers and healthcare organisations globally. Efforts to identify quality nursing care and improve dementia care within dementia specific care units, may significantly reduce the financial and emotional burden of care-giving and improve the quality of life for individuals living with dementia. This scoping review aimed to examine current literature to gain an understanding of what constitutes quality nursing care in a dementia specific care unit.

Design and methods

Five electronic databases (CINAHL, MEDLINE, ProQuest, Social Sciences Citation Index and Ovid) were used to search for articles published in English between 2011 and 2016 focusing on a definition of quality nursing care within dementia specific care units. Findings: Twenty journal articles were identified. From these articles, two content themes were identified: Challenges in the provision of quality nursing care in dementia specific care units, and Standardised approach to quality nursing care in a dementia specific care unit. The articles contained the following research designs, controlled pre-test and post-test design ( n = 1), focus group interviews ( n = 1), cross sectional survey ( n = 6), semi structured interviews ( n = 3), narrative review ( n = 1), survey ( n = 2), literature review ( n = 3), systematic review ( n = 1), and prospective longitudinal cohort study ( n = 2).

Conclusions

The concept of quality nursing care in a dementia specific unit remains subject to the interpretation of individuals, nurses and healthcare organisations, with current literature unable to provide a clear definition. Further research into what constitutes quality nursing care in dementia specific care units is recommended.
Improving graduation rates in drug court: A qualitative study of participants’ lived experiences
Authors: Gallagher John Robert , Nordberg Anne , Lefebvre Elyse
Published: December 2017

For nearly three decades, drug courts have provided a rehabilitative approach within the criminal justice system for individuals who have a substance use disorder. The goal of drug courts is to reduce criminal recidivism, and research has consistently suggested that participants that graduate drug court are less likely to recidivate than those who are terminated from the program. This qualitative study adds to the literature by asking drug court participants ( N = 42) their views on the most helpful aspects of the program that support them in graduating and how the program could be more helpful to support them in graduating. Two themes emerged from the data: (1) participants felt that interventions that are common to drug courts, such as drug testing and having frequent contact with the judge, were most helpful in supporting them in graduating the program; (2) participants felt that the agencies that offered treatment for their substance use disorders used punitive tactics and judgmental approaches that compromised the quality of treatment they received, and they felt that this was a barrier to them graduating the program. The findings are discussed in reference to drug court practice.
The effect of multiple segment interaction dynamics on elbow valgus load during baseball pitching
Authors: Naito Kozo , Takagi Tokio , Kubota Hideaki , Maruyama Takeo
Published: December 2017

Elbow valgus load generated in baseball pitching is a risk factor for throwing-related injuries. However, an induced acceleration analysis establishing the cause–effect relationship between elbow valgus load and causal joint kinematics is lacking. The purpose of this study was to identify the underlying mechanism of how the elbow valgus load is generated by muscular and non-muscular interactive torque effects. The throwing motions of five fastball pitches from 16 male collegiate baseball pitchers were measured by a three-dimensional motion capture system. The induced acceleration analysis developed in this study was used to separate the elbow valgus stress of the throwers into causal muscular and interactive torque components. The results showed that the shoulder internal rotation torque-induced component was greatest, accounting for 73.0% of the valgus-related contribution, while the other joint components in the muscular and interactive torque components were relatively smaller. This implied that the elbow valgus stress was highly influenced by the internal rotation torque effect, while the motion-dependent effect due to the trunk and shoulder kinematics was not influential. In conclusion, to reduce the risk of injury, pitchers should acquire proper coordination without excessive shoulder internal rotation action.
Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: The Campania Salute Network
Authors: Mancusi Costantino , Losi Maria A , Izzo Raffaele , Canciello Grazia , Carlino Maria V , Albano Giovanni , De Luca Nicola , Trimarco Bruno , de Simone Giovanni
Published: December 2017

Background

Increased pulse pressure is associated with structural target organ damage, especially in elderly patients, increasing cardiovascular risk.

Design

In this analysis, we investigated whether high pulse pressure retains a prognostic effect also when common markers of target organ damage are taken into account.

Methods

We analysed an unselected cohort of treated hypertensive patients from the Campania Salute Network registry ( n = 7336). Participants with available cardiac and carotid ultrasound were required to be free of prevalent cardiovascular disease, with ejection fraction ≥50%, and no more than stage III Chronic Kidney Disease. The median follow-up was 41 months and end-point was occurrence of major cardiovascular events (i.e. fatal and non-fatal stroke or myocardial infarction and sudden death). Based on current guidelines, pulse pressure ≥60 mm Hg was classified as high pulse pressure ( n = 2356), at the time of the initial visit, whereas pulse pressure <60 mm Hg was considered normal ( n = 4980).

Results

High pulse pressure patients were older, more likely to be women and diabetic, while receiving more antihypertensive medications than normal pulse pressure (all p < 0.0001). High pulse pressure exhibited greater prevalence of left ventricular hypertrophy, and carotid plaque than normal pulse pressure (all p < 0.0001). In Cox regression, high pulse pressure patients had 57% increased hazard of major cardiovascular events, compared to normal pulse pressure (hazard ratio = 1.57; 95% confidence interval: 1.12–2.22, p = 0.01), an effect that was independent of significant prognostic impact of older age, male sex, diabetes, left ventricular hypertrophy, carotid plaque and less prescription of anti-renin–angiotensin system therapy.

Conclusions

High pulse pressure is a functional marker of target organ damage, predicting cardiovascular events in hypertensive patients, even independently of well-known structural markers of target organ damage.
The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement
Authors: Boody Barrett S. , Hashmi Sohaib Z. , Rosenthal Brett D. , Maslak Joseph P. , McCarthy Michael H. , Patel Alpesh A. , Savage Jason W. , Hsu Wellington K.
Published: December 2017

Study Design:

Prospective randomized study.

Objectives:

To define the impact of an inexpensive, user-friendly, and reproducible lumbar pedicle screw instrumentation bioskills training module and evaluation protocol.

Methods:

Participants were randomized to control (n = 9) or intervention (n = 10) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 20-minute bioskills training module while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of pedicle breach and breach anatomic location was measured pre- and posttest in lumbar spine models.

Results:

The intervention group showed a 30.8% improvement in PPDIS scores, compared with 13.4% for the control group ( P = .01). The intervention group demonstrated statistically significant 66% decrease in breaches ( P = .001) compared with 28% decrease in the control group ( P = .06). Breach identification demonstrated no change in accuracy of the control group (incorrect identification from 32.2% pre- to posttest 35%; P = .71), whereas the intervention group’s improvement was statistically significant (42% pre- to posttest 36.5%; P = .0047).

Conclusions:

We conclude that a concise lumbar pedicle screw instrumentation bioskills training session can be a useful educational tool to augment clinical education.