bluuebunny/crossref_metadata_2025_split huggingface dataset:
Double-Chamber Syringe Versus Classical Syringes For Peripheral Intravenous Drug Administration And Catheter Flushing: A Study Protocol For A Randomised Controlled Trial
Authors: Parreira Pedro Miguel , Sousa Liliana B. , Marques Inês A. , Costa Paulo Santos , Braga Luciene M. , Cruz Arménio G. , Salgueiro-Oliveira Anabela 
Published: November 2019

Abstract
Background: The prevention of catheter-related complications is nowadays an important topic of research. Flushing the catheters is considered an important clinical procedure in preventing malfunction and several complications such as phlebitis or infection. Considering the latest guidelines of the Infusion Nurses Society, the flushing involves a pre and post-drug administration, requiring different syringes (with associated overall increased times of preparation/administration of intravenous medication by nurses, also increasing the need for manipulation of the venous catheter).
Methods: A multi-centre, two-arm randomised controlled trial with partially blinded outcome assessment, of 146 adult patients. After eligibility analysis and informed consent, participants will receive usual intravenous administration of drugs with subsequent flushing procedures, with the double-chamber syringe (arm A) or with the classical syringes (arm B). The outcomes assessment will be performed on a daily basis by the unblinded ward team, with the same procedures in both groups. Some main outcomes, such as phlebitis and infiltration, will also be evaluated by nurses from a blinded research team and registered once a day.
Discussion: The study outlined in this protocol will provide valuable insight regarding the effectiveness and safety of this new medical device. The development of a new medical device (dual-chamber syringe, for drug and flush solution) seems to be an important step to facilitate the nurses’ adoption of good clinical practices in intravenous procedures, reducing the catheter manipulations.
Near-infrared auto-fluorescence spectroscopy combining with Fisher’s linear discriminant analysis improves intraoperative real-time identification of normal parathyroid in thyroidectomy
Authors: Liu Junsong , Wang Xiaoxia , Wang Rui , Xu Chongwen , Zhao Ruimin , Li Honghui , Zhang Shaoqiang , Yao Xiaobao 
Published: November 2019

Abstract
Background To evaluate the efficacy of a sensitive, real-time tool for identification and protection of parathyroid glands during thyroidectomy. Methods Near-infrared (NIR) auto-fluorescence was measured intraoperatively from 20 patients undergoing thyroidectomy. To determine the accuracy of NIR identification furtherly, intraoperative fast frozen pathological examination and postoperative immunohistochemical staining were performed on the suspicious parathyroid glands and other neck tissues. Data were extracted for Fisher’s linear discriminant analysis. Results The auto-fluorescence intensity of parathyroid was significantly higher than that of thyroid, fat and lymph node. The peak intensity of auto-fluorescence from parathyroid was 5.55 times as much as that from thyroid at the corresponding wave number. Of the 20 patients, the parathyroid was accurately detected and identified in 19 patients by NIR system, compared with their histopathological results. One suspicious parathyroid tissue did not exhibit characteristic spectra, and finally was proved to be fat tissue by histopathological examination. The NIR auto-fluorescence method had a 100% (19/19) sensitivity of parathyroid glands identification and a high accuracy of 95% (19/20). The positive predictive value was 95%. The parathyroid gland has specific auto-fluorescence spectrum and can be separated from the other three types of tissues through the Fisher’s linear discriminant analysis with the average accuracy rate around 90%.Conclusions NIR auto-fluorescence spectoscopy can accurately identify normal parathyroid glands during thyroidectomy. The Fisher’s linear discriminant analysis demonstrated the specificity of the NIR auto-fluorescence of parathyroid tissue and its efficacy in parathyroid discrimination.
Occupational hazards in medium and large scale industrial sectors in Sri Lanka – Experience of a developing country
Authors: Arnold S.M. , Wickrematilake MSK , Fernando RMSD , Sampath HMRC , Karunapema RPP , Mahesh PKB , Munasinghe PM , Denawaka CJ 
Published: November 2019

Abstract
Objective Occupational hazards is an area where many countries have begun to pay more emphasis as it affects the health of many particularly in developing countries. However, documented literature is scarce in this regard although occupational hazards are common in workplaces. The study was carried out with the objective of describing the physical hazards and control measures adopted in the formal medium and large-scale industrial sector in Sri Lanka. Results Physical hazards detected in the workplaces were; excessive noise (78.3%), poor light (58%), increased temperature (65.2%), and poor ventilation (68.1%). Over 50% of large machinery and 33% of medium-scale machinery were not adequately guarded. Nearly 41% of the machinery were difficult to operate, of them 36.2% had controls in positions which were hard to reach. Of safety measures adopted, only 34.8% had proper demarcation of areas with 28.9% displaying safety signs. Housekeeping was poor in 59.4% and less than 40% had safe storage of raw materials and end products.
Glycogen synthase kinase 3 (GSK-3) controls T-cell motility and interactions with antigen presenting cells
Authors: Taylor Alison , Rudd Christopher E. 
Published: November 2019

Abstract
Objective: The threonine/serine kinase glycogen synthase kinase 3 (GSK-3) targets multiple substrates in T-cells, regulating the expression of Tbet and PD-1 on T-cells. However, it has been unclear whether GSK-3 can affect the motility of T-cells and their interactions with antigen presenting cells.
Results: Here, we show that GSK-3 can regulate T-cell motility. Inhibition of GSK-3, by small molecule SB415286, reduced T-cell motility in terms of distance and displacement. Although SB415286 reduced the number of contacts, the dwell times of established contacts did not differ between T-cells treated with SB415286. These data indicate show that the inhibition of GSK-3 can influence the motility of T-cells and interactions with other cells without affecting the dwell times of cells that make productive contacts.
Successful management of severe diabetic ketoacidosis in a patient with type 2 diabetes with insulin allergy: a case report
Authors: Nguyen Anh Dat , Luong Chinh Quoc , Chi Hieu Chu , Nguyen Van Khoa Dieu , Nguyen Chi Van , Nguyen Anh Tuan , Nguyen Quan Huu , Mai Ton Duy , Nguyen Dinh Van , Nguyen Bay Quang , Tran Thong Huu , Dao Phuong Viet , Nguyen Dat Tuan , Nguyen Nguyet Nhu , Do Son Ngoc 
Published: November 2019

Abstract
BackgroundDiabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that requires immediate treatment. Allergic reaction to insulin is rare, especially when using recombinant human insulin. The clinical presentation of insulin allergy can range from minor local symptoms to a severe generalized allergic reaction such as anaphylaxis. A limited number of cases have been reported on the treatment of severe DKA in patients with type 2 diabetes with insulin allergy. Here, we describe a patient with type 2 diabetes with insulin allergy in which severe DKA resolved after the initiation of continuous intravenous (IV) recombinant human insulin infusion.Case presentationA 58-year-old man with type 2 diabetes initiated subcutaneous insulin administration (SIA) after failure of oral antidiabetic treatment. Symptoms of an allergic reaction developed, including pruritic wheals appearing within 10 minutes of injection and lasting over 24 hours. Both skin prick and intradermal tests were positive with different types of insulin. Two days before admission, he stopped SIA because of allergic symptoms and then experienced weakness and upper abdominal pain. On admission, he was in severe metabolic acidosis with a pH of 6.984 and bicarbonate of 2.5 mmol/litre. The blood glucose level was 20.79 mmol/litre, BUN 4.01 mmol/litre, creatinine 128 µmol/litre, and urinary ketone 11.44 mmol/litre. Over 24 hours, metabolic acidosis was refractory to IV fluids, bicarbonate and potassium replacement, as well as haemodialysis. Ultimately, he received continuous IV recombinant human insulin infusion at a rate of 0.1 units/kg/hour, in combination with haemodiafiltration, and no further allergic reactions were observed. On day 5, ketonaemia and metabolic acidosis completely resolved. He had transitioned from IV insulin infusion to SIA on day 14. He was discharged on day 21 with SIA treatment. Three months later, he had good glycaemic control but still had allergic symptoms at the insulin injection sites.ConclusionsIn this patient, SIA caused an allergic reaction, in contrast to continuous IV insulin infusion for which allergic symptoms did not appear. Continuous IV recombinant human insulin infusion in combination with haemodiafiltration could be an option for the treatment of severe DKA in patients with diabetes with insulin allergy.
Distribution and antimicrobial resistance profiles of bacterial species in stray cats, hospital-visiting cats, and veterinary staff in South Korea
Authors: Jung Woo Kyung , Shin Sook , Park Young Kyung , Lim Suk-Kyung , Moon Dong-Chan , Park Kun Taek , Park Yong Ho 
Published: November 2019

Abstract
Background

Antimicrobial resistance is becoming increasingly important in both human and veterinary medicine. According to the One Health concept, an important step is to monitor the resistance patterns of pathogenic bacteria. In this study, the antimicrobial susceptibility patterns and trends of bacteria isolated from stray cats, hospital-visiting cats, and veterinary staff in South Korea between 2017 and 2018 were investigated.

Results

The minimum inhibitory concentrations of different antibiotics for Staphylococcus spp., Enterobacteriaceae , and Enterococcus spp. were determined to establish representatives of different antibiotic classes relevant for treatment or surveillance. For Coagulase-positive and Coagulase-negative Staphylococci, resistance to fluoroquinolones was below 13%, but resistance to ampicillin and penicillin was high (20–88%). A total of 9.5%, 12.1%, and 40.3% of staphylococcal isolates from stray cats, hospital-visiting cats, and veterinary staff, respectively, were confirmed to be mecA positive. For Enterobacteriaceae , resistance to carbapenems, fluoroquinolones, and 3rd generation cephalosporins was low (0–11.1%). The Enterococcus spp. isolates showed no resistance to vancomycin. The antimicrobial resistance rates of the Staphylococcus spp. and Enterobacteriaceae isolates from stray cats were usually lower than those of isolates from hospital-visiting cats and veterinary staff, but the Enterococcus spp. isolates revealed the opposite. Thus, the antimicrobial resistance varied across bacterial species according to the source from which they were isolated.

Conclusions

Resistance to critically important compounds were low. These results emphasize the fact that more attention should be paid to the use of antimicrobials and the occurrence of antimicrobial resistance in cats.
Durvalumab in frail and elder patients with stage four NSCLC: Study protocol of the randomized phase II DURATION trial
Authors: Kuon Jonas , Hommertgen Adriane , Krisam Johannes , Lasitschka Felix , Stenzinger Albrecht , Bozorgmehr Farastuk , Maenz Martin , Kieser Meinhard , Schneider Marc , Thomas Michael 
Published: November 2019

Abstract
Background

Elderly patients represent a major fraction of non-small cell lung cancer (NSCLC) patients in routine clinical practice, yet are underrepresented in clinical trials. In particular, data regarding efficacy and safety in frail or elderly patients with respect to immunotherapy is lacking. Importantly, immunosenescence in elderly patients might interfere with activities of immune-modulating drugs such as PD-1/PD-L1 inhibitors. Thus, there is an urgent need to assess safety and efficacy of such inhibitors in this group.

Methods/design

In this prospective, open label, treatment stratified, and randomized phase II study, 200 patients with stage IV NSCLC amenable at least to single-agent chemotherapy. Eligible patients must be 70 years or older and/or “frail” (Charlson Comorbidity Index >1), or have a restricted performance score (ECOG >1). Patients are stratified according to modified Cancer and Age Research Group (CARG) Score: ”fit” patients are allocated to combination chemotherapy (carboplatin/ nab -paclitaxel), “less fit” patients receive single-agent chemotherapy (gemcitabine or vinorelbine). After allocation to strata, patients are randomized 1:1 to receive either 4 cycles of chemotherapy or 2 cycles of chemotherapy followed by 2 cycles of durvalumab and subsequent maintenance treatment with durvalumab every 4 weeks. The primary endpoint is the rate of treatment related grade III/IV adverse events (CTCAE V4.03). As secondary endpoints, progression-free survival according to RECIST 1.1, response rate, overall survival, descriptive subgroup analyses according to PD-L1 expression, and quality of life are addressed. Geriatric screening assessments and functional tests will be performed to complete the phenotyping of a potential “frail” and “elderly” patient cohort (G8-questionnaire, Timed up & go test, 6MWT). The trial is accompanied by a biomaterial repository (FFPE-tissue, Blood samples) to explore potential biomarkers.

Discussion

The DURATION trial will prospectively investigate the safety and tolerability of anti-PD-L1 treatment with durvalumab after chemotherapy in elderly and frail patients and thereby provide new insights into the effect of PD-L1 blockade and the impact of immunosenescence in this cohort of patients.
The effects of washing without water versus the traditional bed bath with water and soap on comfort and physical demands: protocol of a cross-over randomized trial
Authors: Groven Fabian , Zwakhalen Sandra , Odekerken-Schröder Gaby , Tan Frans , Hamers Jan 
Published: November 2019

Abstract
Background The traditional bed bath with water and soap often leads to emotional and physical discomfort among bedridden patients. In addition, the traditional bed bath is physically demanding for nurses. The washing without water concept is increasingly used in healthcare to bathe bedridden patients and is likely to affect emotional and physical comfort dimensions. This protocol describes a study that will assess how washing without water performs compared to the traditional bed bath regarding emotional and physical comfort experienced by the bathed bedridden person and regarding physical demands for the provider of the bed bath.Methods This study uses a randomized cross-over design in which nursing students will simulate the bed baths of patients in a laboratory setting. Students will be randomly allocated to a patient or a nurse group and consequently will respectively receive or provide two bed baths: the traditional bed bath and a washing without water bed bath. The order of the bed baths will be randomly determined. Students will receive instructions about the steps of the bathing methods and case descriptions about their role as a patient or nurse. Questionnaires will be used before and after each bed bath to collect data for the primary outcomes of experienced emotional and physical comfort (among students receiving the bed bath) and physical demands (among students providing the bed bath); and, for secondary outcomes related to bed bathing preferences, grades given to the bathing methods and perceived importance of the bed bath. Differences between the two bathing methods will be analyzed, taking the order of the bed baths into account.Discussion This study will add to the scientific knowledge of the washing without water bed bath, for which evidence on comfort is currently lacking. If differences in comfort between washing without water and the traditional bed bath are detected among nursing students, it is likely these differences will also be present among actual patients and nurses, as generally, patients are more vulnerable and nurses spend more time bathing patients compared to students.
Early gastrografin administration after ileus tube insertion does not improve the clinical outcomes in patients with adhesive small bowel obstruction
Authors: Tamura Yu , Esaki Mitsuru , Ichijima Ryoji , Suzuki Sho , Iwamoto Maho , Moriyama Mitsuhiko , Gotoda Takuji 
Published: November 2019

Abstract
Background

Gastrointestinal decompression through ileus tube is useful for the treatment of adhesive small bowel obstruction (ASBO). Gastrografin administration through the ileus tube is performed if decompression therapy fails to relieve obstruction. However, the appropriate timing of gastrografin administration is unclear. The present study aimed to evaluate the efficacy of gastrografin administration within 48 h after admission.Methods

This retrospective study used the data of patients with ASBO admitted to our hospital between January 2014 and August 2018. The study included those who underwent ileus tube intubation but did not achieve obstruction relief for over 24 h after admission. The patients were classified into the following two groups: those treated with gastrografin administration within 48 h after admission (EGA group) and those treated without gastrografin administration within 48 h after admission (non-EGA [NEGA] group). Propensity-score matching was performed to compensate for confounding differences between the groups. The short-term outcomes of therapeutic effectiveness such as the rate of surgery avoidance, the period until the first stool, period of ileus tube intubation, and total period of hospital admission were evaluated and compared between the two groups.Results

This study included 152 patients: 67 in the EGA group and 85 in the NEGA group. Fifty-five pairs were matched with similar background characteristics. After matching, the rates of surgery avoidance were 89.1% (49/55) and 94.5% (52/55) in the matched EGA and NEGA groups, respectively (P = 0.49). Although the median insertion days of ileus tube in the NEGI group were significantly lesser than those in the EGA group (7 [5–9] vs. 5 [4.5–7], P = 0.017), other therapeutic outcomes were not significantly different between the two groups. In the non-EGA group, 5.5% (3/55) achieved obstruction relief without gastrografin administration.Conclusions

Early gastrografin administration might not be superior to non-early gastrografin administration in clinical outcomes of patients with ASBO. Follow-up by decompression with ileus tube for at least 48 h after admission is required in patients with ASBO, which may avoid unnecessary gastrografin administration and consequently reduce the total cost of treatment.
An Evaluation of the Zambia Sentinel Surveillance System, 2011-2017
Authors: simusika paul , Tempia Stefano , Chentulo Edward , Polansky Lauren , Mazaba Mazyanga , Ndumba Idah , Mbewe Quinn K , Monze Mwaka Anna 
Published: November 2019

Abstract
Background Over the past decade, influenza surveillance has been established in several African countries including Zambia. However, information on the on data quality and reliability of established influenza surveillance systems in Africa are limited. Such information would enable countries to assess the performance of their surveillance systems, identify shortfalls for improvement and provide evidence of data reliability for policy making and public health interventions. Methods We used the Centers for Disease Control and Prevention guidelines to evaluate the performance of the influenza surveillance system (ISS) in Zambia during 2011-2017 using 9 attributes: (i) data quality and completeness, (ii) timeliness, (iii) representativeness, (iv) flexibility, (v) simplicity, (vi) acceptability, (vii) stability, (viii) utility, and (ix) sustainability. Each attribute was evaluated using pre-defined indicators. For each indicator we obtained the proportion (expressed as percentage) of the outcome of interest over the total. A scale from 1 to 3 was used to provide a score for each attribute as follows: <60% (as obtained in the calculation above) scored 1 (weak performance); 60-79% scored 2 (moderate performance); ≥80% scored 3 (good performance). An overall score for each attribute and the ISS was obtained by averaging the scores of all evaluated attributes. Results The overall mean score for the ISS in Zambia was 2.6. Key strengths of the system were the quality of data generated (score: 2.9), its flexibility (score: 3.0) especially to monitor viral pathogens other than influenza viruses, its simplicity (score: 2.8), acceptability (score: 3.0) and stability (score: 2.6) over the review period and its relatively low cost ($310,000 per annum). Identified weaknesses related mainly to geographic representativeness (score: 2.0), timeliness (score: 2.5), especially in shipment of samples from remote sites, and sustainability (score: 1.0) in the absence of external funds. Conclusions The system performed moderately well in our evaluation. Key improvements would include improvements in the timeliness of samples shipments and geographical coverage. However, these improvements would result in increased cost and logistical complexity. The ISSS in Zambia is largely reliant on external funds and the acceptability of maintaining the surveillance system through national funds would require evaluation.
Working with patients suffering from chronic diseases – a balancing act for health care professionals. A meta-synthesis of qualitative studies
Authors: Holmen Heidi , Larsen Marie Hamilton , Sallinen Merja Helena , Thoresen Lisbeth , Ahlsen Birgitte , Andersen Marit Helen , Borge Christine Råheim , Eik Hedda , Wahl Astrid Klopstad , Mengshoel Anne Marit 
Published: November 2019

Abstract
Background: The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs’ experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). Method: A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs’ experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes. Results : Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs’ experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 sub-categories that formed three overarching main themes of work experiences: 1) individualizing one’s professional approach within the clinical encounter; 2) managing one’s emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs’ work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one’s own emotions. Conclusion: Few qualitative studies highlighted HCPs’ general working experiences, as they mainly focused on the patients’ experiences or HCPs’ experiences of using particular clinical procedures. This study brings new insights about the complexity embedded in HCPs’ work in terms of weighing different, often contrasting aspects, in order to deliver appropriate practice. Acknowledging, discussing and supporting this complexity can empower HCPs to avoid burning out. Leaders, health organizations, and educational institutions have a particular responsibility to provide HCPs with thorough professional knowledge and systematic support.