bluuebunny/crossref_metadata_2025_split huggingface dataset:
How smart homes are used to support older people: An integrative review
Authors: Turjamaa Riitta , Pehkonen Aki , Kangasniemi Mari 
Published: July 2019

AbstractBackgroundThe number of healthy older people is increasing, and most of them want to live in their own homes for as long as possible. Smart home technology can support living at home, but synthetised knowledge of previous studies about their suitability for the everyday lives of older people is rare.MethodsData for this integrated review were obtained by searching the PubMed, CINAHL and Scopus databases from 2012 to 2019, based on inclusion and exclusion criteria, and then carrying out quality appraisals of the papers that were selected.ResultsWe identified 944 papers, and 16 were included in the review. According to our analysis, smart home solutions for older people focused on devices for daily and healthy living and older people's safety. The smart home solutions they discussed were used to help older people carry out everyday activities and lead healthier and more fulfilled lives, by improving their physical safety and social communication. Older people reported that smart homes improved their sense of security, quality of daily life and activities and provided them with information about the care they could receive. However, research on older people playing an active role in developing smart home technology was lacking.ConclusionThe existing literature focused on evaluating daily activities with routine measurements. There has been a lack of research that has focused on older people's experiences as the end users of this technology. However, the papers lacked data on how older people could maintain their social relationships and become more proactive in daily living.Implications for practiceWith further development, smart homes can be used to support older people to perform daily activities and help them maintain their social relationships. These steps will ensure that they can continue to live independently in their own homes for longer.
Over‐ and under‐treatment of TB patients in Eastern China: an analysis based on health insurance claims data
Authors: Mao Wenhui , Jiang Weixi , Hamilton Carol , Zhang Hui , Huang Fei , Lucas Henry , Huan Shitong , Tang Shenglan 
Published: July 2019

AbstractObjectivePoor compliance with existing guidelines for tuberculosis (TB) care and treatment is an issue of concern in China. We assessed health service use by TB patients over the entire treatment process and compared it to the recommended guidelines.MethodsWe collected insurance claims data in three counties of one province of Eastern China. Patient records with a diagnosis of ‘pulmonary TB’ in 2015 and 2016 were extracted. Treatment duration, number of outpatient (OP) visits and hospital admissions, as well as total cost, out‐of‐pocket (OOP) payments and effective reimbursement rates were analysed.ResultsA total of 1394 patients were included in the analysis. More than 48% received over the 8 months of treatment that TB guidelines recommend, and over 28% received less. 49% of Urban and Rural Resident Basic Medical Insurance (URRBMI) TB patients were hospitalised while 30% of those with Urban Employee Basic Medical Insurance (UEBMI) had at least one admission. Median total cost for patients with hospital admission was almost 10 times that of patients without. By comparison, the average OOP was 5 times higher. UEBMI patients had a shorter treatment period, more outpatient visits but considerably fewer hospital admissions than URRBMI patients.ConclusionsWe found an alarming extent of TB over‐ and under‐treatment in our study population. There is an urgent need to improve compliance with treatment guidelines in China and to better understand the drivers of divergence. Extending the coverage of health insurance schemes and increasing reimbursement rates for TB outpatient services would seem to be key factors in reducing both the overall cost and financial burden on patients.
Pathogen reduction with amotosalen/UVA reduces platelet refractoriness in a dog platelet transfusion model
Authors: Slichter Sherrill J. , Bailey S. Lawrence , Gettinger Irena , Pellham Esther , Christoffel Todd , Castro Grace , Green Jennifer M. , Stassinopoulos Adonis 
Published: July 2019

Background and objectivesPathogen reduction of donor platelets with amotosalen/UVA has been shown to effectively inactivate pathogens and also contaminating white blood cells (WBCs). We wanted to determine whether WBC inactivation could also decrease alloimmune refractoriness to donor platelets.Materials and methodsPlatelets were prepared from a donor dog's whole blood, and the platelets were either transfused without modification [standard (STD) platelets] or treated with amotosalen/UVA under conditions modelling the amotosalen/UVA Blood System for human platelets (APR) using either 4 or 3 J/cm2of UVA exposure. Platelets were transfused weekly from a single donor dog for 8 weeks or until the recipient dog became refractory to their donor's platelets. Antibody samples were drawn weekly and tested against the donor dog's platelets and WBCs (CD8 and B cells).ResultsOnly 1/7 (14%) dogs that received STD platelets accepted 8 weeks of donor transfusions. Following APR 4 J/cm2donor transfusions, 3/9 (33%) recipients accepted their donor's transfusions, but only one recipient remained antibody negative. Following APR 3 J/cm2donor transfusions, the same dose as used for human platelet transfusions, 7/10 (70%) recipients accepted their donor's transfusions, but only two remained antibody negative.ConclusionAs a very high percentage of recipient dogs (70%) accepted APR 3 J/cm2donor transfusions, these data suggest that preventing alloimmune platelet refractoriness may be another benefit of pathogen reduction using amotosalen/UVA.
Capnography monitoring of patients with obstructive sleep apnea in the post-anesthesia care unit: a best practice implementation project
Authors: Borczynski Elizabeth , Worobel-Luk Pamela 
Published: July 2019

ABSTRACT

Introduction:
The prevalence of OSA is substantial in North America. Post-operative patients with OSA are at risk for respiratory complications, but about 60% of surgical patients with this condition go undiagnosed. If the presence of sleep apnea is known, non-invasive capnography monitoring can be applied post-operatively to help detect early respiratory compromise during the recovery phase. The STOP-Bang Questionnaire, a validated screening tool to evaluate the risk of OSA, can efficiently be used as part of the pre-surgical evaluation.

Objectives:
The aim of this project was to improve safety by averting post-operative respiratory events in patients with obstructive sleep apnea (OSA) through early detection of compromise during recovery from anesthesia. Specific objectives focused on implementing nurse-initiated capnography monitoring of patients with OSA in two post-anesthesia care units and, when indicated, expediently communicating abnormal end-tidal carbon dioxide excursions.

Methods:
Strategies and audit data were organized and evaluated using the Joanna Briggs Institute's Getting Research into Practice (GRiP) and Practical Application of Clinical Evidence Systems (PACES) tools. Medical record review was used for the baseline audit and three follow-up compliance audits of evidence-based practice. Multiple teaching methodologies were employed to reach and engage post-anesthesia care unit nurses. Equipment was maintained at the point of care. Nurses’ participation in the project was voluntary.

Results:
There was nearly full compliance with the new practice of initiating capnography, when indicated. Compliance with escalating abnormal capnography results with associated concerning assessment findings was 100%, but the escalation sample size was only two patients.

Conclusions:
Patients with known OSA benefited from non-invasive capnography monitoring during recovery from anesthesia because post-anesthesia care unit nurses were empowered to initiate evidence-based technology. Expedient adoption of the new practice was due to comprehensive nurse education, familiarity with a similar capnography monitoring process and the value nurses placed on capnography as another assessment tool to safeguard patients. A larger sample of patients is needed to evaluate compliance with escalating concerning findings to providers. Sustainability will be impacted if the post-anesthesia care unit's standards of care include capnography for patients with OSA.
Impact of unit design on intensive care unit clinicians: a scoping review protocol
Authors: Frechette Julie , Frati Francesca Y. E. , Octeau Daphné , Bitzas Vasiliki , Lavoie-Tremblay Mélanie 
Published: July 2019

ABSTRACT

Objective:
This scoping review aims to identify the known impact of unit design on intensive care unit clinicians, and more specifically, to explore similarities and differences across critical care settings.

Introduction:
Construction and infrastructure renewal represent great opportunities for designing units that enhance patient care, as well as support the work of clinicians. A growing body of evidence is showing how unit design can impact clinical staff, but no reviews have been found that focus exclusively on clinicians within intensive care units.

Inclusion criteria:
The review will consider studies that include healthcare staff who offer direct patient care in adult or pediatric intensive care units. Studies that focus on the impact of design (related to physical environment features) on clinicians will be included.

Methods:
The proposed systematic review will be conducted in accordance with JBI methodology for scoping reviews. The search strategy aims to find published and unpublished studies. The databases to be searched will include Embase MEDLINE, PsycINFO, Healthstar and CINAHL. Retrieved studies will be assessed against the inclusion criteria by two independent reviewers. For the papers included in the scoping review, data will be extracted and quality assessed by two independent reviewers. The extracted data will be presented in tabular form, and a narrative summary will describe how the results relate to the review objective.
Effectiveness of deep general anesthesia compared to the standard depth of general anesthesia for acute postoperative pain and patient safety: a systematic review protocol
Authors: FitzGerald Haile , Anderson Emily , Anderson Lori Rae , Tracy Andy J. , Thomson J. Scott 
Published: July 2019

ABSTRACT

Objective:
The objective of this systematic review is to synthesize the best available evidence related to the effectiveness of deep general anesthesia on acute postoperative pain and patient safety in adult patients.

Introduction:
Acute postoperative pain is a common physiological side effect of surgery that should be alleviated as soon as possible to reduce suffering and other detrimental effects. Given the adverse effects related to the use of opioids for pain management, and in the current opioid epidemic, evidence-based clinical practice recommendations are needed to reduce the use of opioids in the treatment of acute postoperative pain.

Inclusion criteria:
This review will include studies of adult patients that incorporate the intervention of deep general anesthesia (bispectral index values of 45 or less), compared to the provision of a standard depth of general anesthesia (bispectral index values 45–60). Included studies will report acute postoperative pain (within the first 48 hours after surgery) as a primary outcome variable. Secondary outcomes of interest include opioid consumption and any reported adverse outcomes.

Methods:
A three-step search strategy will be used to locate studies published in English from 1992 (advent of electroencephalography index monitoring technology) in Ovid MEDLINE, Embase and CINAHL databases. Two independent reviewers will assess retrieved studies against inclusion criteria, complete critical appraisal for methodological quality and extract data using a standardized tool. Data will be synthesized using statistical meta-analysis, where possible.
Effectiveness of serial focused ultrasound of the lungs and inferior vena cava for monitoring patients with acute dyspnea: a systematic review protocol
Authors: Arvig Michael Dan , Laursen Christian B. , Jacobsen Niels , Gæde Peter Haulund , Lassen Annmarie Touborg 
Published: July 2019

ABSTRACT

Objective:
The objective of this review is to evaluate the effectiveness of serial focused ultrasound of the lungs (FLUS) and/or inferior vena cava (IVC) compared to standard care for monitoring patients with acute dyspnea.

Introduction:
Acute dyspnea is one of the most common complaints reported by patients in hospital emergency departments, and has high in-hospital mortality rates. The current methods of monitoring patients with acute dyspnea lack both sensitivity and specificity. Point-of-care FLUS and IVC is a promising monitoring tool, but an overview of the existing evidence is absent.

Inclusion criteria:
This review will include studies of adult patients admitted to hospital with acute dyspnea that is examined via FLUS, IVC or both a minimum of twice during hospitalization compared to standard care.

Methods:
The following electronic databases will be searched: PubMed, Cochrane, Embase, Scopus, Web of Science and Google Scholar. Gray literature will be sought in OpenGrey and ProQuest. The search is limited to articles written in English, Danish, Swedish, Norwegian and German. Articles published before 2003 will be excluded from the search and duplicates will be removed. Two independent reviewers will screen and critically appraise the included studies and perform the data extraction. If possible, data will be synthesized with statistical meta-analysis; otherwise, data will be presented in narrative form.

Systematic review registration number:
PROSPERO CRD42018116608
Complex spike clusters and false‐positive rejection in a cerebellar supervised learning rule
Authors: Titley Heather K. , Kislin Mikhail , Simmons Dana H. , Wang Samuel S.‐H. , Hansel Christian 
Published: July 2019

Key points
Spike doublets comprise ∼10% of in vivo complex spike events under spontaneous conditions and ∼20% (up to 50%) under evoked conditions.
Under near‐physiological slice conditions, single complex spikes do not induce parallel fibre long‐term depression.
Doublet stimulation is required to induce long‐term depression with an optimal parallel‐fibre to first‐complex‐spike timing interval of 150 ms.
AbstractThe classic example of biological supervised learning occurs at cerebellar parallel fibre (PF) to Purkinje cell synapses, comprising the most abundant synapse in the mammalian brain. Long‐term depression (LTD) at these synapses is driven by climbing fibres (CFs), which fire continuously about once per second and therefore generate potential false‐positive events. We show that pairs of complex spikes are required to induce LTD. In vivo, sensory stimuli evoked complex‐spike doublets with intervals ≤150 ms in up to 50% of events. Using realistic [Ca2+]o and [Mg2+]o concentrations in slices, we determined that complex‐spike doublets delivered 100–150 ms after PF stimulus onset were required to trigger PF‐LTD, which is consistent with the requirements for eyeblink conditioning. Inter‐complex spike intervals of 50–150 ms provided optimal decoding. This stimulus pattern prolonged evoked spine calcium signals and promoted CaMKII activation. Doublet activity may provide a means for CF instructive signals to stand out from background firing.
Immunity toStaphylococcus aureus: Implications for Vaccine Development
Authors: Proctor Richard A. 
Published: July 2019

ABSTRACTCell-mediated immunity seems to be critical for prevention and resolution of invasiveS. aureusinfections, but an imbalance in this immunity may also produce SIRS and death or an inadequate protective response with prolonged bacteremia and death. This dysregulation is likely at the heart of mortality and severe disease in humans. Anti-toxin antibodies may also come into play in reducing the severity ofS. aureusinfections, but these antibodies might also address superantigen-induced immune dysregulation. Thus, while changing intrinsic T cell responses may be therapeutically difficult, monoclonal antibodies against superantigens may have utility in addressing dysfunctional immune responses toS. aureus. The models above are hypotheses for examining, and potentially dramatically improving immune response to and safety ofS. aureusvaccines.
Observed compliance with safe sleeping guidelines in licensed childcare services
Authors: Staton Sally , Pattinson Cassandra , Smith Simon , Pease Anna , Blair Peter , Young Jeanine , Irvine Susan , Thorpe Karen 
Published: July 2019

ObjectiveTo independently assess compliance with safe sleeping guidelines for infants <12 months in licensed childcare services.DesignFull-day, in-situ observations of childcare practices (including sleep and non-sleep periods) conducted in 2016–2017.SettingAustralian home-based and centre-based licensed childcare services. All subject to national regulation and legislation to comply with safe sleeping guidelines.ParticipantsThe sample was 18 licensed childcare settings (15 centre-based, 3 home-based) that had infants <12 months (n=49) attending at the time of observation. 31 educators completed self-report surveys.Main outcomes and measuresStandard observations of childcare practices, including a 20-item infant Safe Sleeping Guideline checklist. Educator characteristics, including each individual’s knowledge, beliefs and attitudes regarding safe sleeping practices.Results83% of childcare services were observed to be non-compliant on at least 1 of 20 target guidelines (median 2.5, max=7); 44% were observed placing infants prone/side and 67% used loose bedding, quilts, doonas/duvets, pillows, sheepskins or soft toys in cots. 71% of the childcare settings had a copy of current safe sleeping guidelines displayed either in or at entry to the infant sleep room.ConclusionDespite 25 years of public health messaging, non-compliance with safe sleeping guidelines was observed to be high in childcare services. Understanding of the reasons underlying non-compliance, particularly in contexts were legislative mandate and access to information regarding safe sleeping is high, is critical to informing ongoing public health messaging and should be the focus of future studies.Trial registration numberANZCTR 12618001056280—pre-results.
How fair is our service? Evaluating access to specialist paediatric care
Authors: Neale Francesca K , Armstrong Edward J , Cohen Jonathan M , Segal Terry Y , Hargreaves Dougal S 
Published: July 2019

ObjectiveTo assess equity of access to paediatric outpatient clinics in our hospital.Design/settingRetrospective analysis of consecutive accepted referrals to allergy, asthma, epilepsy, general paediatrics, rapid access, chronic fatigue syndrome, diabetes and endocrine outpatient clinics.Patients32 369 new patients, April 2007 to June 2018.ResultsAmong local patients (58.1%) 0.2%–2.5% of patients referred to each clinic lived in the least deprived quintile, and 43.5%–48.4% in the most deprived quintile—similar to inpatient admissions and the local population. Tertiary clinics showed a much higher proportion of patients from the least deprived quintiles (15.9%–26.2%).ConclusionsLocal outpatient referrals broadly reflected the socioeconomic distribution, although not necessarily the distribution of need, of our local population. A relatively high proportion of patients in tertiary clinics were from more affluent postcodes, highlighting the need for referral inequalities to be evaluated across networks or regions.
Is the apparently protective effect of maternal nicotine replacement therapy (NRT) used in pregnancy on infant development explained by smoking cessation?: secondary analyses of a randomised controlled trial
Authors: Iyen Barbara , Vaz Luis R , Taggar Jaspal , Cooper Sue , Lewis Sarah , Coleman Tim 
Published: July 2019

ObjectiveTo investigate relationships between maternal smoking status in pregnancy and infant development. The largest randomised controlled trial of nicotine replacement therapy (NRT) for smoking cessation in pregnancy, the smoking, nicotine and pregnancy (SNAP) trial, found that at 1 month after randomisation, smoking cessation rates were doubled in the NRT group compared with the placebo group. At delivery, there was no significant difference in cessation rates between groups. Surprisingly, infants born to women randomised to NRT were more likely to have unimpaired development at 2 years. We hypothesised that this apparently protective effect was due to smoking cessation caused by NRT and so, investigate this relationship using the same cohort.DesignSecondary analysis of a randomised controlled trial.SettingSeven antenatal hospitals in the Midlands and North-West England.ParticipantsEight hundred and eighty-four pregnant smokers randomised to receive either NRT patches or visually-identical placebo in the SNAP trial. Participants’ smoking behaviour were recorded at randomisation, 1 month after their target quit date and at delivery.MethodsUsing logistic regression models, we investigated associations between participants’ smoking measures and infant development (assessed using the Ages and Stages questionnaire) at 2 years.Main outcome measures2 year infant development.ResultsDevelopmental impairment was reported for 12.7% of study 2 year olds. Maternal heaviness of smoking at randomisation (OR: 1.26, 95% CI: 0.82 to 1.96, p=0.091), validated smoking abstinence recorded at 1 month after a quit date (OR: 1.02, 95% CI: 0.60 to 1.74, p=0.914) and validated smoking abstinence recorded at both 1 month after a quit date and at the end of pregnancy (OR: 1.52, 95% CI: 0.81 to 2.85, p=0.795) were not independently associated with infant developmental impairment at 2 years.ConclusionWe found no evidence that NRT treatment improved infants' developmental outcomes through smoking cessation.Trial registration numberCTA03057/0002/001-0001; Post-results
Comparison of manual and computer assigned injury severity scores
Authors: Otto Lauren , Wang Angela , Wheeler Krista , Shi Junxin , Groner Jonathan I , Haley Kathryn J , Nuss Kathryn E , Xiang Henry 
Published: July 2019

BackgroundThe study objective was to compare the ISS manually assigned by hospital personnel and those generated by the ICDPIC software for value agreement and predictive power of length of stay (LOS) and mortality.MethodsWe used data from the 2010–2016 trauma registry of a paediatric trauma centre (PTC) and 2014 National Trauma Data Bank (NTDB) hospitals that reported manually coded ISS. Agreement analysis was performed between manually and computer assigned ISS with severity groupings of 1–8, 9–15, 16–25 and 25–75. The prediction of LOS was compared using coefficients of determination (R2) from linear regression models. Mortality predictive power was compared using receiver operating characteristic (ROC) curves from logistic regression models.ResultsThe proportion of agreement between manually and computer assigned ISS in PTC data was 0.84 and for NTDB was 0.75. Analysing predictive power for LOS in the PTC sample, the R2=0.19 for manually assigned scores, and the R2=0.15 for computer assigned scores (p=0.0009). The areas under the ROC curve indicated a mortality predictive power of 0.95 for manually assigned scores and 0.86 for computer assigned scores in the PTC data (p=0.0011).ConclusionsManually and computer assigned ISS had strong comparative agreement for minor injuries but did not correlate well for critical injuries (ISS=25–75). The LOS and mortality predictive power were significantly higher for manually assigned ISS when compared with computer assigned ISS in both PTC and NTDB data sets. Thus, hospitals should be cautious about transitioning to computer assigned ISS, specifically for patients who are critically injured.