bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethical conflict among nurses working in the intensive care units
Authors: Pishgooie Amir-Hossein , Barkhordari-Sharifabad Maasoumeh , Atashzadeh-Shoorideh Foroozan , Falcó-Pegueroles Anna 
Published: October 2018

Background: Ethical conflict is a barrier to decision-making process and is a problem derived from ethical responsibilities that nurses assume with care. Intensive care unit nurses are potentially exposed to this phenomenon. A deep study of the phenomenon can help prevent and treat it. Objectives: This study was aimed at determining the frequency, degree, level of exposure, and type of ethical conflict among nurses working in the intensive care units. Research design: This was a descriptive cross-sectional research. Participants and research context: In total, 382 nurses working in the intensive care units in Iranian hospitals were selected using the random sampling method. Data were collected using the Ethical Conflict in Nursing Questionnaire-Critical Care Version (Persian version). Ethical considerations: This study was approved by the Medical Research Ethics Committee. Ethical considerations such as completing the informed consent form, ensuring confidentiality of information, and voluntary participation were observed. Findings: The results showed that the average level of exposure to ethical conflict was 164.39 ± 79.06. The most frequent conflict was related to “using resources despite believing in its futility,” with the frequency of at least once a week or a month (68.6%, n = 262). The most conflictive situation was violation of privacy (76.9%, n = 294). However, the level of exposure to ethical conflict according to the theoretical model followed was the situation of “working with incompetent staff.” The most frequently observed type of conflict was moral dilemma. Conclusion: The moderate level of exposure to ethical conflict was consistent with the results of previous studies. However, the frequency, degree, and type of ethical conflict were different compared to the results of other studies. Recognizing ethical conflict among intensive care unit nurses can be useful as it allows to consolidate those measures that favor low levels of ethical conflict, design appropriate strategies to prevent ethical conflicts, and improve the nursing work environment.
Fostering Situated Conversation Through Game Play
Authors: Corredor Javier 
Published: October 2018

Background. Prior research suggests that video games function as spaces for informal interaction. In this way, they foster spontaneous conversation that supports gameplay. Such conversation can facilitate learning. In particular, conversations that connect gameplay with the learning materials have positive effects on learning. In this article, those conversations are called situated conversations and used as an important concept to understand video games as educational tools. Aim. This study explores the conversations produced in educational activities supported by video games and the effects of these conversations on the learning of subject matter. Method. This randomized design experiment compares the conversations of a group of students using traditional text-based learning materials with the conversations of a group of students using an educational video game, during a four week intervention focused on the viral-replication process. In both conditions, spontaneous conversation among students was allowed and registered, and learning was assessed using a think-aloud task at the end of the intervention. Results. Students using the video game produced high-quality conversations focused on disciplinary content. The results show, additionally, that only conversations connecting different resources in the learning setting had a significant effect on learning, highlighting the importance of situated conversations for video game learning. Conclusions. The concept of situated conversation is proposed to characterize conversations that connect different resources available in the social environment. This type of conversation increases knowledge levels by bringing external information into the learning process.
Using telehealth to improve access to hepatitis C treatment in the direct-acting antiviral therapy era
Authors: Schulz Thomas R , Kanhutu Kudzai , Sasadeusz Joseph , Watkinson Sally , Biggs Beverley-Ann 
Published: October 2018

Introduction One-third of the Australian population lives outside major cities and this group has worse health outcomes. Telehealth is becoming an accepted way to improve patient access to specialist healthcare. Over 200,000 Australian’s have hepatitis C virus (HCV) and new treatments are very effective and well tolerated. We aim to demonstrate that HCV treatment utilising telehealth support for care delivery has cure rates similar to onsite care in clinical trials. We also report length of consultation and calculate reductions in travel and carbon output. Methods Patient demographic, clinical, and treatment outcome data were collected prospectively from hospital software and analysed retrospectively. This was an audit of all patients treated for HCV in one year from a single tertiary hospital that included telehealth in their care delivery. Results Sustained virological response was achieved in 51/52 (98%) patients with completed treatment courses, and 51/58 (88%) of those who had a planned telehealth consultation as part of their management. A median of 634 km of patient travel was saved per telehealth consultation. Discussion We found that a telehealth-supported outreach programme for patients in regional Australia with HCV produced similar outcomes to clinical trials. There was a considerable saving in time and cost for the patients and significant environmental benefit through the reduction in carbon footprint associated with travel to distant specialist health services. We conclude that telehealth facilitated outreach is a feasible and effective way to access HCV treatment and cure in regional Australia.
Efficacy of Combined Regional Inductive Moderate Hyperthermia and Chemotherapy in Patients With Multiple Liver Metastases From Breast Cancer
Authors: Klimanov Mykhailo Yu , Syvak Liubov A. , Orel Valerii E. , Lavryk G. V. , Tarasenko Tetiana Ye , Orel Valerii B. , Rykhalskyi Alex Yu , Stegnii Viadysiav V. , Nesterenko Andrii O. 
Published: October 2018

Purpose: Regional inductive moderate hyperthermia in combination with chemotherapy can improve the therapeutic efficacy in patients with breast cancer with multiple liver metastases. Methods: The study included 103 patients with breast cancer with multiple liver metastases: 53 patients (main group) who received a combined chemotherapy (TC drug combination) and regional inductive moderate hyperthermia treatment and 50 patients (control group) who received chemotherapy (TC drug combination) alone. Regional inductive moderate hyperthermia exploited electromagnetic fields with an operating frequency of 27.17 ± 0.16 MHz and output power of 75 W. Treatment results were assessed by computed tomography and ultrasound imaging. Results: Partial regression was defined as a 30% decrease in the sum of the maximum diameters of investigated tumors. In the current study, partial regression was described in 8 (15.1%) patients assigned to the main group and 2 (4%) patients in the control ( P < .05). The process stabilization was reported in 32 (60.4%) patients receiving the combined treatment and 19 (38%) in the control ( P < .05). Equally important, tumor progression was observed in 13 (24.5%) patients representing the main group and 29 (58%) in the control. During a 30-minute treatment session, a temperature increase overlaying greater than 90% of the liver projection exposed to electromagnetic irradiation was not exceeding 40°C. Conclusion: The combined regional inductive moderate hyperthermia and chemotherapy treatment increased the overall therapeutic efficacy by 33.9% (χ2 = 12.182; P < .01).
Endograft Infection Due to Secondary Aortoenteric Fistula Treated With Custom-Made Bovine In Situ Aortic Bifurcation Graft
Authors: Walter Corinna , Taher Fadi , Rieger Hannes , Assadian Afshin , Falkensammer Jürgen 
Published: October 2018

Purpose: To increase awareness of the clinical presentation, diagnostic workup, and treatment options for endograft infections. Case Report: A 75-year-old male patient was admitted with suspected endograft infection 4 years after endovascular aortic aneurysm repair (EVAR). Although preoperative diagnostics showed no definitive signs of endograft infection, eventual surgical exposure of the endograft revealed signs of advanced inflammation, including the unexpected finding of an aortoduodenal fistula. Conclusion: A detailed evaluation of patient history and clinical examination, performed as a part of routine follow-ups, may be beneficial in identifying possible severe complications after EVAR early on. Regarding options for aortic reconstruction in case of endograft infection, bovine pericardium deserves consideration as a promising, feasible, and easily available graft material.
“It’s Lonely”: Patients’ Experiences of the Physical Environment at a Newly Built Stroke Unit
Authors: Anåker Anna , von Koch Lena , Heylighen Ann , Elf Marie 
Published: October 2018

Objective: The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit. Background: For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce. Method: This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis. Results: Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows. Conclusions: The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.
A Systematic Review of the Outcome Evaluation Tools for the Foot and Ankle
Authors: Shazadeh Safavi Pejma , Janney Cory , Jupiter Daniel , Kunzler Daniel , Bui Roger , Panchbhavi Vinod K. 
Published: October 2018

Background. The goal of this systematic review is to determine the most commonly used outcome measurement tools used by foot and ankle specialists and determine their limitations, such as whether they are validated, have floor/ceiling effects, and so on. Methods. A literature search was conducted to identify primary publications between January 1, 2012 and July 1, 2017 that concern care of the foot and ankle and use any established grading criteria to evaluate patients. Results. In 669 publications, 76 scoring systems were used. The 10 most common were American Orthopaedic Foot and Ankle Score (AOFAS), visual analog scale (VAS), Short Form–36 (SF-36), Foot Function Index (FFI), Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), SF-12, Short Musculoskeletal Function Assessment (SMFA), Ankle Osteoarthritis Scale (AOS), and Foot and Ankle Disability Index (FADI). AOFAS was used in 393 articles, VAS in 308, and SF-36 in 133 publications. AOFAS, VAS, and SF-36 were used to evaluate 23,352, 20,759, and 13,184 patients respectively. AOFAS and VAS were used simultaneously in 172 publications. Conclusion. While there are many different scoring systems available for foot and ankle specialists to use to assess or demonstrate the effectiveness of treatments, the AOFAS, while it is an unvalidated scoring system, is the most commonly used scoring system in this review. Clinical Relevance. This review presents data about commonly used patient reported outcomes systems in foot and ankle surgery. Levels of Evidence: Level III: Systematic review.
A Comparative Analysis of Clinical Outcomes in Noninsertional Versus Insertional Tendinopathy Using PROMIS
Authors: Bernstein David N. , Anderson Michael R. , Baumhauer Judith F. , Oh Irvin , Flemister A. Samuel , Ketz John P. , DiGiovanni Benedict F. 
Published: October 2018

Background. Achilles tendinopathy is a common clinical disorder. Utilizing the Patient-Reported Outcomes Measurement Information System, we aim to determine clinical response to nonoperative achilles tendinopathy rehabilitative care of insertional achilles tendinopathy compared to non-insertional achilles tendinopathy. Methods. Prospective Patient-Reported Outcomes Measurement Information System Physical Function, Pain Interference, and Depression scores were collected for patients with achilles tendinopathy at presentation and following a standard course of nonoperative care. A distribution-based method was used to determine the minimal clinically important difference. Descriptive statistics were reported and bivariate analysis was used to compare insertional achilles tendinopathy and non-insertional achilles tendinopathy. Receiver operating characteristic curve analysis was used to predict clinical improvement. Results. A total of 102 patients with an average follow-up of 68 days were included. For the non-insertional achilles tendinopathy group: Fifteen (46%), 12 (36%) and 9 (27%) patients reached clinical improvement for Physical Function, Pain Interference and Depression, respectively. For the insertional achilles tendinopathy group: Seventeen (25%), 20 (29%) and 22 (32%) patients reached clinical improvement for Physical Function, Pain Interference and Depression, respectively. Physical Function scores improved more in non-insertional achilles tendinopathy patients (4.0 vs. -0.046; p = 0.035) and more patients clinically improved (45.5% vs. 24.6%; p = 0.034). Patients with non-insertional and insertional achilles tendinopathy clinically improved functionally when initial Physical Function scores were equal to or lower than 40.25 and 38.08, respectively. Conclusions. Nonoperative care in achilles tendinopathy is often successful. The Patient-Reported Outcomes Measurement Information System can be used to evaluate and help determine clinical success. Levels of Evidence: Level II: Prospective comparative study
Multimorbidity, inflammation, and disability: a longitudinal mediational analysis
Authors: Friedman Elliot M. , Mroczek Daniel K. , Christ Sharon L. 
Published: October 2018

Background: Using longitudinal data from the Survey of Mid-Life Development in the United States, this study examined the role of systemic inflammation in mediating the link between multimorbidity and increases in and onset of functional limitations over a 17–19 year follow-up period. Methods: Participants completed questionnaire assessments of chronic conditions and functional limitations. Interleukin-6, C-reactive protein, and fibrinogen were assayed in serum. Structural equation models were used to predict increases in and onset of functional limitations associated with baseline multimorbidity status; mediation by inflammation was also determined. Results: Multimorbidity ( versus 0–1 conditions) predicted more functional limitations and greater odds of onset of limitations over time. Significant indirect effects showed that inflammation partially mediated the link between multimorbidity and changes in, but not onset of, limitations. Discussion: These results show that inflammation, a nonspecific marker of multiple disease conditions, explains in part the degree to which multimorbidity is disabling.
The impact of trisomy 21 on treatment modalities and outcome in adults with congenital heart disease in Switzerland
Authors:   SACHER, Johannes Judith , Greutmann Matthias , Tobler Daniel , Bouchardy Judith , Stambach Dominik , Wustmann Kerstin , Schwitz Fabienne , Schwerzmann Markus 
Published: October 2018

Trisomy 21 (T21) is associated in 40–45% of cases with heart defects, most commonly shunt lesions. These defects, if not repaired, can lead to irreversible shunt‐induced pulmonary hypertension (i.e. Eisenmenger syndrome [ES]). In ES patients, intracardiac repair is no longer possible, but selective pulmonary vasodilators may increase exercise capacity and improve prognosis. This study aimed to estimate the prevalence of cardiac defects and ES in adult T21 patients and to assess the impact of T21 on treatment modalities and outcome in ES patients. A questionnaire was sent to 6906 Swiss physicians inviting them to indicate the number of adults with T21 under their care (survey report). We also analyzed all adults with ES (with and without T21) included in the Swiss Adult Congenital HEart disease Registry (SACHER) and studied the impact of T21 on the use of selective pulmonary vasodilators and survival. In the survey, 348 physicians cared for 695 adult T21 patients. Overall, 24% of T21 survey patients were known to have a cardiac defect, one in four with a defect had developed ES and 13% of those with ES were on specific pulmonary vasodilators. In SACHER, ES was present in 2% of adults with congenital heart disease and selective pulmonary vasodilators were used in 68% of ES patients with T21. In SACHER, survival during follow‐up was worse with higher nt‐proBNP levels (hazard ratio [HR] = 1.15 per 1000 units, 95% confidence interval [CI] = 1.02–1.29) and lower left ventricular ejection fraction (HR = 1.07 per percent decrease, 95% CI = 1.01–1.13). Age at inclusion and T21 did not affect survival. The prevalence of cardiac defects in adults with T21 in Switzerland is half the prevalence in children. T21 is over‐represented among adults with ES. Raised awareness of the therapeutic options for T21 patients with ES is warranted.
Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative
Authors: Domagk Dirk , Oppong Kofi W , Aabakken Lars , Czakó Laszlo , Gyökeres Tibor , Manes Gianpiero , Meier Peter , Poley Jan-Werner , Ponchon Thierry , Tringali Andrea , Bellisario Cristina , Minozzi Silvia , Senore Carlo , Bennett Cathy , Bretthauer Michael , Hassan Cesare , Kaminski Michal F , Dinis-Ribeiro Mario , Rees Colin J , Spada Cristiano , Valori Roland , Bisschops Raf , Rutter Matthew D 
Published: October 2018

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at centre and endoscopist level: 1 Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90%); 2 antibiotic prophylaxis before EUS‐guided puncture of cystic lesions (key performance measure, at least 95%); 3 bile duct cannulation rate (key performance measure, at least 90%); 4 tissue sampling during EUS (key performance measure, at least 85%); 5 appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95%); 6 bile duct stone extraction (key performance measure, at least 90%); 7 post‐ERCP pancreatitis (key performance measure, less than 10%); and 8 adequate documentation of EUS landmarks (minor performance measure, at least 90%).This present list of quality performance measures for ERCP and EUS recommended by the ESGE should not be considered to be exhaustive; it might be extended in future to address further clinical and scientific issues.
Perceived Significance of Engagement in Research Prioritization Among Chronic Kidney Disease Patients, Caregivers, and Health Care Professionals: A Qualitative Study
Authors: Elliott Meghan J. , Goodarzi Zahra , Sale Joanna E. M. , Wilhelm Linda A. , Laupacis Andreas , Hemmelgarn Brenda R. , Straus Sharon E. 
Published: October 2018

Background: Patients and other stakeholders are increasingly engaging as partners in research, although how they perceive such experiences, particularly over the long term, is not well understood. Objective: To characterize how participants from a nondialysis chronic kidney disease (CKD) research priority-setting project conducted 2 years previously perceived the significance of their involvement. Design: Qualitative descriptive study with semi-structured, individual interviews. Setting: Participants resided across Canada. Participants: Eligible participants included stakeholders (ie, patients with nondialysis CKD, caregivers, health care professionals, and policy makers) who had taken part in a prior CKD research priority-setting project. Measurements: We explored stakeholder experiences and perspectives on engagement in CKD research prioritization. Methods: We purposively sampled across stakeholder roles and engagement types (ie, involvement in the priority-setting workshop, wiki online tool, and/or steering committee). All interviews were conducted by a single investigator by telephone or face-to-face, and audio-recordings were transcribed verbatim. The data were inductively coded and analyzed by 2 investigators using a thematic analysis approach. Results: We conducted 23 interviews across stakeholder roles and engagement types. Participants appreciated the integration of distinct stakeholder communities of patients, researchers, and health care professionals that occurred through engagement in research priority setting. Their opportunity to interact with patients and others directly impacted by CKD outside of the clinical setting contributed to an enhanced understanding of the CKD lived experience and value of patient-oriented research. This interaction helped participants refine and refocus their commitment to patient-centered CKD care and research, characterized by enhanced knowledge and confidence (patients/caregivers), adaptations to existing clinical practices and policies (health care providers/policy makers), and subsequent research engagement. Limitations: The views of participants may not reflect those of individuals in other research or health care settings. Conclusions: Stakeholder engagement in nondialysis CKD research prioritization encouraged the integration of stakeholder communities, an appreciation of the CKD experience, and a refocusing of participants’ commitment to research and care. Findings highlight considerations for future health research engaging stakeholders, particularly those living with CKD, as research partners.