bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decision tree for ward admissions of older patients at the emergency department after a fall
Authors: Trevisan Caterina , Di Gregorio Patrizia , Debiasi Eugenio , Pedrotti Martina , La Guardia Mario , Manzato Enzo , Sergi Giuseppe , March Albert 
Published: August 2018

AimFalls are a prevalent issue for the older population, and for the healthcare system in terms of emergency department (ED) access and hospitalizations. There is still a lack of knowledge and guidelines, however, regarding the need to hospitalize older patients accessing the ED after a fall. In the present study, we aimed to analyze the factors and the decisional process that led to older patients accessing the ED after a fall being admitted to hospital or discharged.MethodsThe study sample included 2144 older people who accessed the ED after a fall. For each patient, we obtained information on the nature of the fall and the related injuries, previous falls, dementia and ongoing medical therapies. As the outcome variable, we considered the indication for ward admission after the ED visit.ResultsOf the 2144 individuals who accessed the ED after a fall, 38% had at least one fracture, and 40.1% were admitted to a ward. The decision tree obtained using the chi‐squared automatic interaction detection algorithm showed that the indication for ward admission could be accurately predicted (risk estimate 0.205) by just five factors, namely: presence and severity of fall‐related injuries, reportedly suspicious fall dynamics, use of anticoagulants, polypharmacy, and dementia.ConclusionsThe need for ward admission in older patients who access the ED after a fall seems to be determined not only by the severity of fall‐related injuries, but also by the fall dynamics and the individual's clinical complexity. Geriatr Gerontol Int 2018; 18: 1388–1392.
Abnormal coagulation and enhanced fibrinolysis due to lysinuric protein intolerance associates with bleeds and renal impairment
Authors: Pitkänen H. H. , Kärki M. , Niinikoski H. , Tanner L. , Näntö‐Salonen K. , Pikta M. , Kopatz W. F. , Zuurveld M. , Meijers J. C. M. , Brinkman H. J. M. , Lassila R. 
Published: August 2018

IntroductionLysinuric protein intolerance (LPI), a rare autosomal recessive transport disorder of cationic amino acids lysine, arginine and ornithine, affects intestines, lungs, liver and kidneys. LPI patients may display potentially life‐threatening bleeding events, which are poorly understood.AimsTo characterize alterations in haemostatic and fibrinolytic variables associated with LPI.MethodsWe enrolled 15 adult patients (8 female) and assessed the clinical ISTH/SSC‐BAT bleeding score (BS). A variety of metabolic and coagulation assays, including fibrin generation test derivatives, clotting time (CT) and clot lysis time (CLT), thromboelastometry (ROTEM), and PFA‐100 and Calibrated Automated Thrombogram (CAT), were used.ResultsAll patients had mild‐to‐moderate renal insufficiency, and moderate bleeding tendency (BS 4) without spontaneous bleeds. Mild anaemia and thrombocytopenia occurred. Traditional clotting times were normal, but in contrast, CT in fibrin generation test, and especially ROTEM FIBTEM was abnormal. The patients showed impaired primary haemostasis in PFA, irrespective of normal von Willebrand factor activity, but together with lowered fibrinogen and FXIII. Thrombin generation (TG) was reduced in vitro, according to CAT‐derived endogenous thrombin potential, but in vivo TG was enhanced in the form of circulating prothrombin fragment 1 and 2 values. Very high D‐dimer and plasmin‐α2‐antiplasmin (PAP) complex levels coincided with shortened CLT in vitro.ConclusionsDefective primary haemostasis, coagulopathy, fibrin abnormality (FIBTEM, CT and CLT), low TG in vitro and clearly augmented fibrinolysis (PAP and D‐dimer) in vivo were all detected in LPI. Altered fibrin generation and hyperfibrinolysis were associated with the metabolic and renal defect, suggesting a pathogenetic link in LPI.
The Foundation Pharmacist Project: exploring new models of dual-sector postgraduate pharmacy training
Authors: Rathbone Adam P , Rokib Tahmina , Baqir Wasim , Campbell David 
Published: August 2018

AbstractObjectivesTo explore the experiences of primary care-based professional stakeholders in a dual-sector training programme for foundation pharmacists.MethodsProfessional stakeholders were defined as foundation pharmacists or members of staff working with foundation pharmacists such as general medical or nurse practitioners and administrative staff. Stakeholders were invited to participate via email and through gatekeepers. Participants were asked how they were involved in the training pathway, what their experiences had been and what they hoped for the future. Interviews were audio-recorded, transcribed and thematically analysed using computer software.Key findingsTwenty-eight face-to-face semi-structured interviews were conducted. Five major themes were identified (1) benefits of integration (2) appropriateness of the work (3) perceived impact (4) identity development and (5) training and peer support. These findings outline participants’ experiences of establishing a scope of practice in primary and secondary care settings and developing mechanisms to negotiate non-prescriber status to save general practitioners, practice nurse, community pharmacy and administrator time. Foundation pharmacists were able to develop a professional identity whilst working in each care setting, highlighting the dominance of hospital pharmacy exposure in clinical knowledge acquisition and establishing a community of practice across organisational and geographical boundaries using WhatsApp as a peer support tool.ConclusionsFoundation pharmacists are able to work within their own competencies in two different care settings, developing scopes of practice and contributing clinically to service provision. This work provides evidence that this type of training pathway can offer an appropriate landscape for pharmacy practitioner development. Further work is needed to explore the longitudinal outcomes of the programme.
When should the driver with a history of substance misuse be allowed to return to the wheel? A review of the substance misuse section of the Australian national guidelines
Authors: Ogden Edward J. D , Verster Joris C. , Hayley Amie C. , Downey Luke A. , Hocking Bruce , Stough Con K. , Scholey Andrew B. , Bonomo Yvonne 
Published: August 2018

AbstractAssessing fitness to drive in applicants with a historical or current substance use disorder presents a specific clinical challenge. The Australian guidelines require evidence of remission and absence of cognitive change when considering applications for re‐licensing driver or individuals applying to reengage in safety‐sensitive work. This paper reviews some of the clinical and biochemical indicators that determine whether a particular person is in ‘remission’ and meets the criteria for return to driving or other safety‐sensitive occupation. It provides an overview of the challenges in establishing an evidence‐based approach to determining fitness for safety critical activities. There is no internationally accepted definition of ‘remission’. Review of the literature and examination of assessment protocols from other national jurisdictions are available for alcohol and the more important drugs of interest in road safety. Assessing fitness to drive when there is a history of substance misuse and/or substance use disorders is a complex issue that requires assessment of biomarkers, clinical findings and clinical assessment before the person returns to driving. We propose that hair testing provides a reliable and reproducible way to demonstrate remission and provide cost‐effective monitoring. Standardised psychological tests could provide a reproducible assessment of the cognitive effects of drug use and suitability to resume driving. We recommend that AustRoads amend the national guidelines to reflect an evidence‐based approach to assessing fitness to drive after conviction for offences related to alcohol and drug use.
The vitamin epidemic: what is the evidence for harm or value?
Authors: Kennedy Michael 
Published: August 2018

AbstractComplementary medicines are a multibillion‐dollar industry of which vitamin supplements are an important component. Most of the claims of benefit are not evidenced‐based, and vitamin supplements may be associated with severe adverse reactions that are uncommon but can occur with high doses of some vitamins. There is no case for vitamin supplementation in normal, healthy, non‐pregnant or lactating adults who are receiving the recommended daily intake of nutrients.
Enhancing self‐care strategies in heart failure through patient‐reported outcome measures
Authors: Segan Louise , Nanayakkara Shane , Mak Vivian , Kaye David 
Published: August 2018

AbstractHeart failure (HF) is a major cause of morbidity and mortality, requiring collaborative patient‐centred care. Patient engagement is fundamental to long‐term management; patient‐reported outcome measures are an increasingly recognised method of assessing medical interventions. A qualitative study of 31 patients with HF found they were twice as likely to use their own management strategies including electronic platforms rather than existing resources. Barriers to self‐care included patient education, timely recognition of signs and symptoms of HF with an appropriate escalation plan, non‐adherence and polypharmacy.
Qualitative study on the experiences of hepatitis B carriers in coping with the disease
Authors: Valizadeh Leila , Zamanzadeh Vahid , Zabihi Ali , Negarandeh Reza , Jafarian Amiri Seyedeh Roghayeh 
Published: August 2018

AbstractAim: Hepatitis is a systemic infection that causes restrictions in the life of many patients due to its chronic nature and it necessitates the use of coping strategies to improve the quality of life. This study aims to demonstrate the experiences of hepatitis B carriers in coping with the disease.Methods: The present study was conducted by using a qualitative content analysis. The data were collected through 18 unstructured and in‐depth interviews from 2014 to 2016 at medical centers, a gastrointestinal and liver diseases research center in the cities of Babol and Amol (northern Iran) and Tabriz (north‐western Iran) with patients infected with hepatitis B. The study was carried out by using purposive sampling.Results: The data analysis led to the extraction of the main theme, “attempting an active expansion of interactions,” and its three subthemes, including: “denial of the disease,” “protecting oneself or others,” and “coping with the disease.”Conclusion: Patients with hepatitis B use different strategies to cope with this disease. In order for patients to properly face the disease and to live with minimum challenges and limitations, they need to be suitably understood and supported. Therefore, consideration of education and consultation programs regarding the different aspects of this disease is urgent.
Human dynamics in space and time: A brief history and a view forward
Authors: Yuan May 
Published: August 2018

AbstractThis article highlights the key intellectual development in human dynamics research, examines the modeling emphases in publications, and argues for research directions in need. Human dynamics research is discussed in two broad directions: spacing time and timing space, to model human activities and interactions. Time is essential to human dynamics research. Space, while often being overlooked, in complement with time is critical to understanding human dynamics because knowing where activities take place is essential to knowing how and why people act and interact. Some interactions allow remote or asynchronized participations, and others require movement to collocate individuals for participating in synchronized activities. A spacing time approach examines the temporal gaps between interactions. A timing space approach investigates the spatial pulses between interactions. Primary research in the spacing time of human dynamics established queueing theories to explain the bursts and heavy‐tailed distribution of human interactions. Although research on the timing space of human dynamics enjoys growing popularity with data from geo‐tagged social media and location‐aware social internet of things (SIoT), its publications remain mostly exploratory. This article suggests a hierarchical framework to systematically study human dynamics and relate findings to build the body of knowledge about human dynamics.
Patient-reported experience measure in sickle cell disease
Authors: Chakravorty Subarna , Tallett Amy , Witwicki Cara , Hay Harriet , Mkandawire Catherine , Ogundipe Avanelle , Ojeer Patrick , Whitaker Antonia , Thompson Jessica , Sizmur Stephen , Sathyamoorthy Ganesh , Warner John O 
Published: August 2018

ObjectivesTo develop patient-reported experience measure surveys for patients with sickle cell disease (SCD) to understand their healthcare and lived experience in the UK and for their use in future to inform healthcare service development.DesignPicker methodology was used as follows: (1) qualitative scoping by focus group discussions; (2) questionnaire development through stakeholder consultations; (3) construct validation of questionnaires through cognitive testing; and (4) further assessment of construct validity by a nationwide pilot survey.SettingPatients with SCD and their carers were eligible. Focus group discussions took place in non-hospital settings, arranged out of hours. Cognitive testing took place in specialist sickle cell clinics. The pilot survey was available to UK participants only and was administered through web-based questionnaires, face-to face completion and in sickle cell community events.ParticipantsThirty-three patients and carers took part in the focus groups, 21 participants undertook cognitive testing and 722 respondents completed the pilot survey.ResultsFindings highlighted a widespread prevalence of poor knowledge about SCD among healthcare providers and the public. Poorer experience of care was present in the emergency setting compared with planned care, of which lack of timely provision of pain relief was of concern. Adolescents and young people reported significantly poorer experience of care in several domains compared with children or adults.ConclusionsThe new surveys functioned well, with good evidence of validity, and were accessible to the SCD patient population, supporting their future use in assessing patient experience to inform service delivery and improvements in care quality.
Long-term results of photodynamic therapy or ranibizumab for polypoidal choroidal vasculopathy in LAPTOP study
Authors: Miyamoto Noriko , Mandai Michiko , Oishi Akio , Nakai Shunichiro , Honda Shigeru , Hirashima Takafumi , Oh Hideyasu , Matsumoto Yoshiko , Uenishi Mamoru , Kurimoto Yasuo 
Published: August 2018

Background/aimWe previously reported that ranibizumab performed better on visual prognosis than photodynamic therapy (PDT) in a Ranibizumab (Lucentis)AndPhotodynamicTherapyOnPolypoidal choroidal vasculopathy (LAPTOP) study. To determine if the first-choice treatment, either PDT or intravitreal ranibizumab, has a long-term effect in patients with polypoidal choroidal vasculopathy (PCV).MethodsWe reviewed medical records of patientsrandomised to either PDT (29 eyes) or ranibizumab (27 eyes) from July 2009 to June 2011 in LAPTOP study. Retreatment or switching to other treatments were at the investigator’s discretion after release from the 2-year LAPTOP study up to 5years. We evaluated visual acuity (VA), continuity of initial treatment, percentage of dry macula achievement and macular atrophy at 5 years.ResultsThe logarithm of minimal angle of resolution VA was 0.56 in the PDT and 0.44 in the ranibizumab groups at baseline (p=0.101) and was 0.55 and 0.28 at 5years, respectively (p<0.05). More than 70% of the patients converted to aflibercept in following years. Achievement percentages of dry macula were 74% (PDT) and 63% (ranibizumab) at 5years, and macular atrophy was detected in 78% (PDT) and 60% (ranibizumab) with a mean area of 7.7 and 3.5 mm2, respectively (p=0.155).ConclusionsThe better VA in the initial ranibizumab group compared with the PDT group at 2 years was retained at the 5-year follow-up.
Achieving just outcomes: forensic evidence collection in emergency department sexual assault cases
Authors: Muldoon Katherine A , Drumm Allegra , Leach Tara , Heimerl Melissa , Sampsel Kari 
Published: August 2018

BackgroundAchieving just outcomes in sexual assault cases is one of the most serious and complex problems facing the healthcare and justice systems. This study was designed to determine the prevalence and correlates of Sexual Assault Evidence Kit (SAEK) completion and release to police among sexual assault cases presenting to the ED.MethodsData for this retrospective study come from the Sexual Assault and Partner Abuse Care Programme (SAPACP) case registry (1 January to 31 December, 2015) at The Ottawa Hospital, a unique medical-forensic access point and the only facility offering SAEK collection in Ottawa. Bivariable and multivariable logistic regression models were conducted using ORs, adjusted ORs (AORs) and 95% CIs.ResultsIn 2015, 406 patients were seen by the SAPACP and 202 (77.1%) were eligible for a SAEK. Among eligible cases, 129 (63.9%) completed a SAEK and 60 (29.7%) released the SAEK to police for investigation. Youth cases (≤24 years) had the highest odds of completing a SAEK (AOR 2.23, 95% CI 1.18 to 4.23). Cases who were uncertain of the assailant (AOR 3.62, 95% CI 1.23 to 10.67) and assaults that occurred outdoors (AOR 3.14, 95% CI 1.08 to 9.09) were most likely to release the SAEK to police.ConclusionEven with access to specialised forensic evidence collection, many sexual assault survivors do not complete a SAEK, and even fewer release the evidence to police for investigation. The ED is a common entry points into the healthcare system, and this study has highlighted the need to strengthen services and reduce attrition along the health-justice continuum.
Segmental aortic stiffness in patients with bicuspid aortic valve compared with first-degree relatives
Authors: Goudot Guillaume , Mirault Tristan , Rossi Aude , Zarka Samuel , Albuisson Juliette , Achouh Paul , Pernot Mathieu , Messas Emmanuel 
Published: August 2018

AimsTo compare the stiffness index in patients with bicuspid aortic valve (BAV) with first-degree relatives at each segment of the thoracic ascending aorta and to compare segmental analysis of aortic stiffness in association with BAV morphotype and function.Methods219 patients with BAV and 148 first-degree relatives (without BAV) were consecutively included at a reference centre for BAV. Ultrasound assessment of aortic and carotid stiffness was based on the variation of the segmental arterial diameters during the cardiac cycle and on blood pressure.ResultsWithout adjustment, the ascending aorta of patients with BAV seemed stiffer at each segment compared with controls (stiffness index at the sinus of Valsalva: 17.0±10.9 vs 8.9±6.1, p<0.001; tubular aorta: 20.4±31.3 vs 12.7±4.8, p=0.04). However, after adjustment on aortic diameter and age, only the sinus of Valsalva remained stiffer (p<0.001), whereas the tubular aorta no longer differed (p=0.610). In patients with BAV, aortic diameters were not influenced by the valve morphotype, except for the arch, which was more dilated in the case of 1- Non coronary sinus-Right subtype of BAV : 36.1 vs 27.6 mm, p<0.001. Aortic regurgitation was associated with an increase in aortic diameters at the sinus of Valsalva (p<0.001) and the tubular aortic levels (p=0.04).ConclusionStiffness increase at the sinus of Valsalva level is independent of aortic dilatation in patients with BAV, contrary to the classic relationship between stiffness and dilatation found on the other segments. The relationship between stiffness and clinical impact needs to be assessed at each aortic segment.
Avoidable mortality among parents whose children were placed in care in Sweden: a population-based study
Authors: Wall-Wieler Elizabeth , Vinnerljung Bo , Liu Can , Roos Leslie L , Hjern Anders 
Published: August 2018

BackgroundSeparation from one’s child can have significant consequences for parental health and well-being. We aimed to investigate whether parents whose children were placed in care had higher rates of avoidable mortality.MethodsData were obtained from the Swedish national registers. Mortality rates among parents whose children were placed in care between 1990 and 2012 (17 503 mothers, 18 298 fathers) were compared with a 1:5 matched cohort of parents whose children were not placed. We computed rate differences and HRs of all-cause and avoidable mortality.ResultsAmong mothers, deaths due to preventable causes were 3.09 times greater (95% CI 2.24 to 4.26) and deaths due to amenable causes were 3.04 times greater (95% CI 2.03 to 4.57) for those whose children were placed in care. Among fathers, death due to preventable causes were 1.64 times greater (95% CI 1.32 to 2.02) and deaths due to amenable causes were 1.84 times greater (95% CI 1.33 to 2.55) for those whose children were placed in care. Avoidable mortality rates were higher among mothers whose children were young when placed in care and among parents whose children were all placed in care.ConclusionsParents who had a child placed in out-of-home care are at higher risk of avoidable mortality. Interventions targeting mothers who had a child aged less than 13 placed in care, and parents whose children were all placed in care could have the greatest impact in reducing avoidable mortality in this population.