bluuebunny/crossref_metadata_2025_split huggingface dataset:
One single large intramuscular dose of naloxone is effective and safe in suspected heroin poisoning
Authors: Harris Keith , Page Colin B , Samantray Sikta , Parker Lachlan , Brier Andrew JA , Isoardi Katherine Z 
Published: July 2019

AbstractObjectiveNaloxone is an established antidote for the treatment of heroin poisoning; however, dosing regimens vary widely, with a current trend towards small titrated intravenous dosing. This study aims to characterise naloxone use in the treatment of patients presenting with suspected heroin poisoning.MethodsThis was a retrospective review of poisoned patients presenting to a clinical toxicology unit in Brisbane from January 2015 to December 2017. Patient demographics, clinical effects, naloxone dosing, observation periods and complications were extracted from the patient's medical records.ResultsThere were 117 presentations accounted for by 108 patients. Prehospital naloxone was provided to 57 (49%) patients, 46 of which received a standardised 1.6 mg i.m. dose. The remaining 60 (51%) patients received their first naloxone in hospital, with 58 (97%) receiving this by titrated i.v. doses. A subsequent naloxone infusion was required significantly more often in those treated with i.v. titrated naloxone compared to i.m. dose (27/69 [39%] vs 5/48 [10%], P = 0.0006). The need for parenteral sedation to manage acute behavioural disturbance following naloxone provision was rare (3/117 [3%]).ConclusionsIn this retrospective observational study, a single large i.m. dose of naloxone reversed the toxicity of suspected heroin overdose in the majority of patients. In addition, patients were less likely to require repeated intermittent doses or naloxone infusion than those treated solely with i.v. naloxone. Further comparison in a prospective study is warranted to validate these observations in confirmed heroin overdose. Requirement for sedation secondary to acute behavioural disturbance was rare regardless of the route.
Can Emergency Physician Gestalt “Rule In” or “Rule Out” Acute Coronary Syndrome: Validation in a Multicenter Prospective Diagnostic Cohort Study
Authors: Oliver Govind , Reynard Charlie , Morris Niall , Body Richard 
Published: July 2019

AbstractBackgroundChest pain is a common problem presenting to the emergency department (ED). Many decision aids and accelerated diagnostic protocols have been developed to help clinicians differentiate those needing admission from those who can be safely discharged. Some early evidence has suggested that clinician judgment or gestalt alone could be sufficient.ObjectivesOur aim was to externally validate whether emergency physician's gestalt could “rule in” or “rule out” acute coronary syndromes (ACS).MethodsWe performed a multicenter prospective diagnostic accuracy study including consenting patients presenting to the ED in whom the physician suspected ACS. At the time of arrival, clinicians recorded their perceived probability of ACS using a 5‐point Likert scale. The primary outcome was a diagnosis of ACS, defined as acute myocardial infarction or major adverse cardiac events within 30 days.ResultsA total of 1,391 patients were included; 240 (17.3%) had ACS. Overall, gestalt had fair diagnostic accuracy with a C‐statistic of 0.75 (95% confidence interval = 0.72 to 0.79). If ACS was “ruled out” in the 60 (4.3%) patients where clinicians perceived that the diagnosis was “definitely not” ACS, a sensitivity of 98.0% and negative predictive value of 95.0% could have been achieved. If ACS was only ruled out in patients who also had no electrocardiographic (ECG) ischemia and a normal initial cardiac troponin (cTn) concentration, 100.0% sensitivity and NPV could be achieved. However, this strategy only applied to 4.1% of patients. If patients with “probably not” ACS who had normal ECG and cTn were also ruled out (n = 418, 30.8%), sensitivity fell to 86.2% with 99.2% NPV. Using gestalt “definitely” ACS to rule in ACS gave a specificity of 98.5% and positive predictive value of 71.2%.ConclusionClinician gestalt is not sufficiently accurate or safe to either rule in or rule out ACS as a decision‐making strategy. This study will enable emergency physicians to understand the limitations of our clinical judgment.
Experiences of interventions aiming to improve the mental health and well‐being of children and young people with a long‐term physical condition: A systematic review and meta‐ethnography
Authors: Shaw Liz , Moore Darren , Nunns Michael , Thompson Coon Jo , Ford Tamsin , Berry Vashti , Walker Erin , Heyman Isobel , Dickens Christopher , Bennett Sophie , Shafran Roz , Garside Ruth 
Published: July 2019

AbstractBackgroundChildren and young people with long‐term physical health conditions are at increased risk of experiencing mental health and well‐being difficulties. However, there is a lack of research that explores the experiences of and attitudes towards interventions aiming to improve their mental health and well‐being. This systematic review seeks to address this gap in the literature by exploring what children and young people with long‐term conditions, their caregivers, and health practitioners perceive to be important aspects of interventions aiming to improve their mental health and well‐being.MethodsAn information specialist searched five academic databases using predefined criteria for qualitative evaluations of interventions aiming to improve the mental health or well‐being of children with long‐term physical conditions. Reviewers also performed supplementary citation and grey literature searches. Two reviewers independently screened titles, abstracts, and full texts that met the inclusion criteria and conducted data extraction and quality assessment. Meta‐ethnography was used to synthesize the findings.ResultsScreening identified 60 relevant articles. We identified five overarching constructs through the synthesis: (a) Getting In and Staying In, (b) Therapeutic Foundation, (c) Social Support, (d) A Hopeful Alternative, and (e) Empowerment. The line of argument that links these constructs together indicates that when interventions can provide an environment that allows young people to share their experiences and build empathetic relationships, it can enable participants to access social support and increase feelings of hope and empowerment.ConclusionThese findings may provide a framework to inform the development of mental health interventions for this population and evaluate existing interventions that already include some of the components or processes identified by this research. Further research is needed to establish which of the constructs identified by the line of argument are most effective in improving the mental well‐being of young people living with long‐term conditions.
Transferrin and H‐ferritin involvement in brain iron acquisition during postnatal development: impact of sex and genotype
Authors: Chiou Brian , Neely Elizabeth B. , Mcdevitt Dillon S. , Simpson Ian A. , Connor James R. 
Published: July 2019

AbstractIron delivery to the developing brain is essential for energy and metabolic support needed for processes such as myelination and neuronal development. Iron deficiency, especially in the developing brain, can result in a number of long‐term neurological deficits that persist into adulthood. There is considerable debate that excess access to iron during development may result in iron overload in the brain and subsequently predispose individuals to age‐related neurodegenerative diseases. There is a significant gap in knowledge regarding how the brain acquires iron during development and how biological variables such as development, genetics, and sex impact brain iron status. In this study, we used a mouse model expressing a mutant form of the iron homeostatic regulator protein HFE, (Hfe H63D), the most common gene variant in Caucasians, to determine impact of the mutation on brain iron uptake. Iron uptake was assessed using 59Fe bound to either transferrin or H‐ferritin as the iron carrier proteins. We demonstrate that at postnatal day 22, mutant mice brains take up greater amounts of iron compared with wildtype. Moreover, we introduce H‐ferritin as a key protein in brain iron transport during development and identify a sex and genotype effect demonstrating female mutant mice take up more iron by transferrin, whereas male mutant mice take up more iron from H‐ferritin at PND22. Furthermore, we begin to elucidate the mechanism for uptake using immunohistochemistry to profile the regional distribution and temporal expression of transferrin receptor and T‐cell immunoglobulin and mucin domain 2, the latter is the receptor for H‐ferritin. These data demonstrate that sex and genotype have significant effects on iron uptake and that regional receptor expression may play a large role in the uptake patterns during development.
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Open Science: This manuscript was awarded with the Open Materials BadgeFor more information see: https://cos.io/our-services/open-science-badges/Cover Image for this issue: doi: 10.1111/jnc.14731.
How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients
Authors: Smith Duncan , Sekhon Mandeep , Francis Jill J. , Aitken Leanne M. 
Published: July 2019

AbstractBackgroundTo optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an “afferent” and “efferent” limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust‐level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff.AimTo identify how deteriorating patient policy documents provide “actionable” behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system.DesignA structured content analysis of a national guideline and local policies using a behaviour specification framework.MethodsLocal deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist.ResultsThere were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%).ConclusionDelay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability.Relevance to clinical practiceNumerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time‐sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.
Healthcare transition for adolescents and young adults with long‐term conditions: Qualitative study of patients, parents and healthcare professionals’ experiences
Authors: Coyne Imelda , Sheehan Aisling , Heery Emily , While Alison E. 
Published: July 2019

AbstractAim and objectivesTo examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long‐term conditions: diabetes, cystic fibrosis and congenital heart disease.BackgroundTransition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long‐term conditions. Yet, limited empirical evidence exists regarding transition experiences.DesignQualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1).MethodsSemi‐structured interviews with AYAs aged 14–25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed‐methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland.ResultsTransfer occurred between the ages of 16–early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self‐management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following‐up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults’ prerogative.ConclusionsThe amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents.Relevance to clinical practiceNurses in collaboration with the multidisciplinary team can help AYAs develop their self‐management skills and guide parents on how to relinquish responsibility gradually prior to transition.
Different type and dosage of heparin were not associated with the progression of coronary artery calcification in haemodialysis patients
Authors: Niu Qingyu , Yang Shuo , Gan Liangying , Zhao Huiping , Zuo Li 
Published: July 2019

ABSTRACTAimSeveral studies have verified that unfractionated heparin (UFH) and low molecular heparin (LWMH) can induce bone loss, and bone mineral density has been inversely associated with vascular calcification in some clinical researches. But few have focused on the relationship between types and dosages of heparin and the progression of vascular calcification. We observed the progression of coronary artery calcification (CAC) in maintenance haemodialysis (MHD) patients who were treated with UFH and LMWH.MethodsThis was a prospective prevalent cohort study of MHD patients. Computed tomography was performed at enrolment and 2 years after enrolment, and CAC score was obtained. Demographic and clinical data, baseline and time‐average laboratory indices were collected. Multiple linear regression and logistic regression were used to estimate the influencing factors of progression of CAC.ResultsIn this study, (i) we initially enrolled 69 HD patients, and then 56 patients finished the follow‐up. (ii) Among the total 56 patients, 27 patients (48.2%) were treated with UFH, 14 (25.0%) with LMWH and 15 (26.8%) with both. The median baseline CAC scores of three groups (UFH, LMWH and both users) were 91.0 (1.0, 1052.0), 134.0 (0, 1292.0) and 250.5 (27.0, 1139.0), respectively, with no significant difference (P = 0.663); the median CAC progression scores were 42.0 (0, 364.0), 172.0 (7.0, 653.0) and 118.5 (0, 434.0), respectively, with no significant difference (P = 0.660). (iii) Pearson and spearman correlation analysis shown that the progression of CAC was not associated with cumulative dosage of heparin used. (iv) After adjusted for diabetes mellitus, time‐averaged intact parathyroid hormone, phosphate and alkaline phosphatase, logistic regression analysis showed using different types of heparin was not an independent risk factor for CAC progression; and multiple linear regression analysis showed that the type of heparin used was not associated with CAC progression.ConclusionThere were no significant differences in the effects of the types and dosages of heparin on CAC progression in patients on haemodialysis.
Sacral nerve stimulation improves colonic inflammation mediated by autonomic‐inflammatory cytokine mechanism in rats
Authors: Guo Jie , Jin Haifeng , Shi Zhaohong , Yin Jieyun , Pasricha Trisha , Chen Jiande D. Z. 
Published: July 2019

AbstractBackgroundVagal nerve stimulation (VNS) was reported to have a therapeutic potential for inflammatory bowel disease (IBD). This study was designed to determine effects and mechanisms of SNS on colonic inflammation of in rodent models of IBD and compare the difference among SNS, VNS, and SNS plus VNS.MethodsIntestinal inflammation in rats was induced by intrarectal administration of TNBS (2,4,6‐Trinitrobenzenesulfonic acid) on the first day. Five days after intrarectal TNBS, the rats were treated with sham‐VNS, VNS, Sham‐SNS, SNS, and SNS + VNS for 10 days. In another experiment, after 10 days of 4% DSS (dextran sodium sulfate) in drinking water, rats were treated with 10‐day sham‐SNS and SNS. Various inflammatory responses were assessed; mechanisms involving autonomic functions and inflammatory cytokines were investigated.Key Results(a) VNS, SNS, and VNS + SNS significantly and equally decreased the disease activity index and macroscopic scores, and normalized colon length; (b) IL‐10 was decreased by TNBS but increased with SNS, VNS, and SNS + VNS; pro‐inflammatory cytokines, IL‐6, IL‐17A, MCP‐1 and TNF‐α, were increased by TNBS but decreased with SNS, VNS, and SNS + VNS (P < .05); MPO activity was decreased by SNS, VNS, and SNS + VNS; (c) SNS, VNS, and SNS + VNS remarkably increased vagal activity that was suppressed by TNBS (P < .05); (d) smilar SNS effects were noted in rats with DSS‐induced colitis.Conclusions & InferencesSNS presents similar anti‐inflammatory effects as VNS by inhibiting pro‐inflammatory cytokines and increasing anti‐inflammatory cytokines via the autonomic pathway. Similar to VNS, SNS may also have a therapeutic potential for colonic inflammation.
Americans’ Views of Voluntary Protective Actions Against Zika Infection: Conceptual and Measurement Issues
Authors: Johnson Branden B. 
Published: July 2019

AbstractUnderstanding factors affecting decisions by people to protect themselves, or not, is critical to designing supportive communications. Here, threat, protective‐action, and stakeholder perceptions were evaluated for effects on mainland Americans’ behavioral intentions regarding Zika in April 2017, as postulated by the Protective Action Decision Model. Although all three perception types (including a novel resource sufficiency measure) affected intentions, these relationships varied widely depending upon the method used to measure adoption of actions (e.g., total count of all behaviors adopted vs. behavior‐specific analyses), the behaviors involved, and whether analysis focused on the full sample or only on people who had a reasonable opportunity to enact the behavior or who believed it relevant to their lives. There was a general contrast between mosquito control actions (removal of mosquito breeding areas and pesticide spraying) and travel‐related behaviors (avoiding travel to areas of local transmission of the virus, protecting oneself from mosquito bites after potential exposure, and practicing safe sex after potential exposure). Reported action or inaction during the 2016 mosquito season, and stages of behavior change, were both elicited in January–February 2017; both drove intentions in April 2017 for the upcoming season, although direct and indirect effects varied widely. Collectively these findings present theoretical, measurement, and practical implications for understanding, tracking, and promoting voluntary protective actions against hazards.
Superficial skin cancer therapy with Y‐90 microspheres: A feasibility study on patch preparation
Authors: Pashazadeh Ali , Landes Rainer , Boese Axel , Kreissl Michael C. , Klopfleisch Maurice , Friebe Michael 
Published: July 2019

AbstractBackgroundRadiation therapy using beta particles is an interesting treatment for very superficial skin lesions. Due to their low penetration in tissue and rapid dose fall‐off, beta particles can protect underlying bony structures and surrounding healthy tissue while irradiating the skin tumor. In the current work, a simple method for the fabrication of a radioactive patch for use in skin cancer therapy based on a beta‐emitting isotope is presented.Materials and methodsThe beta radiation sources were Y‐90 microspheres currently used for catheter‐based radioembolization of unresectable liver tumors. The microspheres were filtered through a syringe filter to trap them on the cellulose nitrate paper of the filter and create a radioactive patch. In the current study, to avoid the need for a hot laboratory, the experiment was done using nonradioactive microspheres. An optical microscope was used to verify the distribution of the particles on the filter paper.ResultsVisual evaluation of the patches showed that using the proposed method, therapeutic skin patches with a fairly uniform distribution of microspheres can be created.ConclusionThe proposed simple method may be used in creating radiotherapeutic patches using Y‐90 microspheres for radiation therapy of thin skin lesions located close to sensitive structures.