bluuebunny/crossref_metadata_2025_split huggingface dataset:
Response Times to Visual and Auditory Alarms during Anaesthesia
Authors: Morris R. W. , Montano S. R. 
Published: January 2019

Objective To measure and compare the response times to audibly or visually presented alarms in the operating theatre. Methods The time taken by anaesthetists to cancel randomly generated visual and audible false alarms was measured during maintenance of routine anaesthesia. Alarms were generated and times recorded by a laptop computer on the anaesthetic machine. The visual signal was a 15mm diameter red light positioned next to the physiological monitor mounted on top of the machine. The audible alarm was a Sonalert® buzzer of the type incorporated into many medical devices. Results Nineteen anaesthetists provided a total of seventy-two hours of data (887 alarm events). The response times to visual alarms was significantly longer than to audible alarms (P=0.001 Mann Whitney U test). Conclusions The ability of anaesthetists to appreciate changes in patient physiology may be limited by delays in noticing information presented by monitors. The rapid response to the vast majority of alarms indicates a high level of vigilance among the anaesthetists studied. However, this study suggests that it is safer to rely on audible rather than visual alarms when time-critical information such as oxygenation, heart beat and ventilator disconnection is concerned. Visual alarms would appear to be more appropriate for conveying less urgent information.
Urgent Non-Emergency Surgery and Death Attributable to Anaesthetic Factors
Authors: Horan B. F. , Warden J. C. 
Published: January 2019

The Special Committee Investigating Deaths Under Anaesthesia in New South Wales classified 1503 deaths which occurred in the years 1984 to 1990 during, within 24 hours of, or as a result of anaesthesia. One hundred and seventy-two (11.4%) of these were attributed definitely, probably or jointly to factors under the anaesthetists’ control. One hundred and forty-four (9.6%) of the 1503 deaths classified occurred in patients undergoing urgent non-emergency operations of which 45 (31.3%) were attributed to anaesthetic factors. A specialist anaesthetist either gave the anaesthetic or was present for part or all of it in 35 of these 45 cases. In 22 the hospital was a metropolitan teaching hospital. General anaesthesia was employed in 31 cases and major regional block (10 spinals and 4 epidurals) in the others. The commonest type of surgery was orthopaedic (26 cases), particularly for fractured neck of femur (20 cases). There were no deaths attributed to anaesthetic factors in cases of this degree of urgency in patients less than 16 years old. The factors under the anaesthetists’ control most often identified as contributing to death were inadequate preparation for anaesthesia and surgery (18 cases, 12 of which were jointly attributed to the surgeon); inappropriate choice or application of technique (17); inadequate postoperative care (12 cases); and overdose (11 cases). If improved outcomes are to be achieved for patients having operations of this degree of urgency, greater attention must be paid to these aspects of their anaesthetic management.
A Prospective Clinical Comparison of Two Intravenous Polyurethane Cannulae
Authors: Russell W. J. , Micik S. , Gourd S. , Mackay H. , Wright S. 
Published: January 2019

Tissue irritation, as evidenced by phlebitis, associated with Optiva™ (Johnson & Johnson Medical) and Insyte™ (Becton Dickinson) polyurethane cannulae was studied. The integrity of the cannulae on removal, the incidence of infection at the cannula site and the factors which influence phlebitis were also examined. One thousand and eight patients had a polyurethane cannula placed for induction of anaesthesia for cardiac surgery. After surgery, the cannula was examined every 24 hours. If evidence of phlebitis occurred, the cannula was removed and sent for culture. All remaining cannulae were removed at 72 hours and the site examined daily for a further three days. There were 503 Optiva™ and 505 Insyte™ cannulae studied. The distributions between the two cannulae with respect to patient characteristics, gauge of cannula, number of attempts and difficulty of insertion, cannula site and anaesthetist inserting were similar. The early removal rate for both groups was 47%. Overall phlebitis rate with Optiva™ was 31% and Insyte™ 33%. This difference is not statistically significant. The cumulative phlebitis rate increased with time but did not differ between the two types of cannulae. Minor tip distortion or shaft kinking of the cannulae occurred in 16.2% of Optiva™ and 23.5% of Insyte™. This difference is statistically significant and may relate to the slightly more acute taper at the Optiva™ cannula tip. Both cannulae were similar in clinical performance.
Acute Weakness Syndromes in Critically Ill Patients—A Reappraisal
Authors: Nates J. L. , Cooper D. J. , Day B. , Tuxen D. V. 
Published: January 2019

Over the last twenty years, increasing numbers of critically ill, mechanically ventilated patients who develop acute profound muscle weakness have been described. These acute weakness syndromes have not been well understood and they have been given many names including: acute steroid myopathy, acute quadriplegic myopathy, the floppy person syndrome, critical illness polyneuropathy, critical illness polyneuromyopathy, and prolonged neurogenic weakness. Many of these “syndromes” either overlap or represent the same disease process in different patients. Many have been incompletely diagnosed. During this review it became evident that the acute weakness syndromes currently recognized in critically ill patients could be categorized into four major groups: myopathy, neuromuscular junction abnormalites, neuropathy and polyneuromyopathy. Each had different possible aetiologies. “Myopathy” includes acute necrotizing myopathy and disuse atrophy. Neuromuscular junction abnormalities are subdivided into myasthenia-like syndromes and prolonged neuromuscular blockade. Neuropathies are divided into critical illness polyneuropathy and acute motor neuropathy. The anterior horn cell injury in Hopkins syndrome should also be considered in this group. Polyneuromyopathies include various combinations of neuropathy and myopathy in the same patients.
Heart Rate Variability following Cardiac Surgery Fails to Predict Short-Term Cardiovascular Instability
Authors: McHugh G. J. , Sleigh J. W. , Bo H. , Henderson J. D. 
Published: January 2019

The heart rate variability of 40 patients has been examined by spectral analysis following cardiac surgery. The heart rate variability was measured upon patient arrival in ICU in both a resting supine position, and following passive straight-leg raising. After 12 hours in ICU, the patients were classified as having been cardiovascularly stable or unstable according to a specially devised inventory. Their heart rale variability data was then examined to seek any predictor of instability. Passive straight-leg raising induced a decrease in spectral power across all of the component frequency bands. The LF/HF ratio rose with passive straight-leg raising, but failed to reach significance. None of these changes were sustained. There was no significant difference in heart rate variability patterns between the stable and unstable groups, and so no predictor was identified. Initial clinical assessment was also studied, and it too provided no reliable prediction of short-term cardiovascular instability.
The Effects of Short Intravenous Infusions of Thiopentone on Myocardial Function, Blood Flow and Oxygen Consumption in Sheep
Authors: Huang Y. F. , Upton R. N. , Gray E. C. , Grant C. , Zheng D. , Ludbrook G. L. 
Published: January 2019

The cardiovascular effects of slow (over two minutes) intravenous infusions of thiopentone 750 mg in conscious instrumented sheep breathing 100% oxygen were examined for 30 minutes following the start of the infusion. The maximum rate of rise of left ventricular pressure (an index of myocardial contractility) decreased significantly from 1 to 10 minutes, to a minimum of 45% of baseline. Heart rate increased by up to 33% above baseline from 0.5 min onwards. Both mean arterial pressure and cardiac output were decreased from between 1 and 7 min. Left ventricular minute work was transiently decreased, but left coronary blood flow and myocardial oxygen consumption showed little or no change from baseline. We conclude that in vivo, thiopentone administered at a relatively slow rate caused large reductions in myocardial contractility, and therefore cardiac reserve, in the absence of significant changes in myocardial blood flow or oxygen consumption.
Intrathecal Pethidine: An Alternative Anaesthetic for Transurethral Resection of Prostate?
Authors: Sia A. T. H. , Chow M. Y. H. , Koay C. K. , Chong J. L. 
Published: January 2019

We aimed to determine the usefulness of intrathecal pethidine as the sole anaesthetic for transurethral resection of prostate (TURP) while comparing the incidence of hypotension with intrathecal bupivacaine. A double-binded randomized prospective trial was conducted involving 40 patients for TURP. The patients were divided equally into two groups; group A received 2 ml 0.5% bupivacaine intrathecally and group B received 40 mg pethidine intrathecally. Changes in blood pressure and heart rate were measured over the first 30 minutes. The highest sensory block and the time to reach it were documented. The degree of motor blockade was also recorded. There was no significant difference in the incidence of hypotension. The pethidine group had significantly greater reduction in heart rate, a lower degree of motor block, shorter period before requests for postoperative analgesia but a higher incidence of sedation, nausea and vomiting. Intrathecal pethidine did not offer any advantage over intrathecal bupivacaine for TURP.
Identifying Factors Associated With Severe Intellectual Disabilities in Teenagers With Cerebral Palsy Using a Predictive Learning Model
Authors: Bertoncelli Carlo M. , Altamura Paola , Vieira Edgar Ramos , Bertoncelli Domenico , Thummler Susanne , Solla Federico 
Published: January 2019

Background: Intellectual disability and impaired adaptive functioning are common in children with cerebral palsy, but there is a lack of studies assessing these issues in teenagers with cerebral palsy. Therefore, the aim of this study was to develop and test a predictive machine learning model to identify factors associated with intellectual disability in teenagers with cerebral palsy. Methods: This was a multicenter controlled cohort study of 91 teenagers with cerebral palsy (53 males, 38 females; mean age ± SD = 17 ± 1 y; range: 12-18 y). Data on etiology, diagnosis, spasticity, epilepsy, clinical history, communication abilities, behaviors, motor skills, eating, and drinking abilities were collected between 2005 and 2015. Intellectual disability was classified as “mild,” “moderate,” “severe,” or “profound” based on adaptive functioning, and according to the DSM-5 after 2013 and DSM-IV before 2013, the Wechsler Intelligence Scale for Children for patients up to ages 16 years, 11 months, and the Wechsler Adult Intelligence Scale for patients ages 17-18. Statistical analysis included Fisher’s exact test and multiple logistic regressions to identify factors associated with intellectual disability. A predictive machine learning model was developed to identify factors associated with having profound intellectual disability. The guidelines of the “Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis Statement” were followed. Results: Poor manual abilities ( P ≤ .001), gross motor function ( P ≤ .001), and type of epilepsy (intractable: P = .04; well controlled: P = .01) were significantly associated with profound intellectual disability. The average model accuracy, specificity, and sensitivity was 78%. Conclusion: Poor motor skills and epilepsy were associated with profound intellectual disability. The machine learning prediction model was able to adequately identify high likelihood of severe intellectual disability in teenagers with cerebral palsy.
The Sustainability of a Workplace Wellness Program That Incorporates Gamification Principles: Participant Engagement and Health Benefits After 2 Years
Authors: Lowensteyn Ilka , Berberian Violette , Berger Claudie , Da Costa Deborah , Joseph Lawrence , Grover Steven A. 
Published: January 2019

Purpose: To evaluate the results of a workplace wellness program that incorporates gamification principles. Design: In this prospective cohort study, the participation rate and observed health outcomes were evaluated after approximately 2 years. Setting and participants: All permanent employees (n = 775) of a national company located in Canada were eligible to participate. Intervention: The wellness program included web-based challenges (team or individual) incorporating gamification strategies to improve exercise, nutrition, weight reduction, and mental health management behaviors. Measures and analysis: The primary outcomes were employee participation rates. The secondary pre-specified outcomes were the sustained benefits of the program on physical and mental health measures. Results: Participation rates in the health screenings were 78% (baseline), 54% (year 1), and 56% (year 2). Participation in the 4 team web-based challenges ranged from 33% to 68% with 76% to 86% of participants tracking their activity on at least half of the days. After 2 years, there were significant clinical improvements in systolic blood pressure (−1.3mm Hg), total cholesterol/high-density lipoprotein (HDL) ratio (−0.14), glycated haemoglobin (HbA1c; −0.1%), weekly physical activity (+264 Metabolic Equivalents [METs]), perceived stress score (−17%), insomnia severity index (−16%), general fatigue (−10%), and reductions in the cardiovascular age gap (−0.3 years). Greater benefits occurred among employees at higher risk. Conclusions: Workplace wellness programs that evolve over time and focus primarily on fun and competitive challenges may support long-term participation, behavior change, and sustained improvements in clinical outcomes.
Development, validity and reliability testing the Swedish Ethical Climate Questionnaire
Authors: Grönlund Catarina Fischer , Söderberg Anna , Dahlqvist Vera , Andersson Lars , Isaksson Ulf 
Published: January 2019

Background: An ethical climate has been described as a working climate embracing shared perceptions about morally correct behaviour concerning ethical issues. Various ethical climate questionnaires have been developed and validated for different contexts, but no questionnaire has been found concerning the ethical climate from an inter-professional perspective in a healthcare context. The Swedish Ethical Climate Questionnaire, based on Habermas’ four requirements for a democratic dialogue, attempts to assess and measure the ethical climate at various inter-professional workplaces. This study aimed to present the construction of and to test the psychometric properties of the Swedish Ethical Climate Questionnaire. Method: An expert group of six researchers, skilled in ethics, evaluated the content validity. The questionnaire was tested among 355 healthcare workers at three hospitals in Sweden. A parallel analysis (PA), an exploratory factor analysis and confirmatory factor analysis were performed. Ethical considerations: The participants included in the psychometric analysis were informed about the study, asked to participate in person and informed that they could withdraw at any time without giving any reason. They were also assured of confidentiality in the reporting of the results. Findings: The parallel analysis (PA) recommended one factor as a solution. The initial exploratory factor analysis with a four-factor solution showed low concordance with a four-factor model. Cronbach’s alpha varied from 0.75 to 0.82; however, since two factors only consisted of one item, alpha could not be reported. Cronbach’s alpha for the entire scale showed good homogeneity (α = 0.86). A confirmatory factory analysis was carried out based on the four requirements and showed a goodness-of-fit after deleting two items. After deletion of these items, Cronbach’s alpha was 0.82. Discussion: Based on the exploratory factor analysis, we suggest that the scale should be treated as a one-factor model. The result indicates that the instrument is unidimensional and assesses ethical climate as a whole. Conclusion: After testing the Swedish Ethical Climate Questionnaire, we found support for the validity and reliability of the instrument. We found the 10-item version of Swedish Ethical Climate Questionnaire satisfactory. However, we found no support for measuring different dimensions and, therefore, this instrument should be seen as assessing ethical climate as of whole.
The Photographs of Meaning Program for Pediatric Palliative Caregivers: Feasibility of a Novel Meaning-Making Intervention
Authors: Levy Kathryn , Grant Pei C. , Depner Rachel M. , Tenzek Kelly E. , Pailler Megan E. , Beaupin Lynda K. , Breier Jennifer M. , Byrwa David J. 
Published: January 2019

Background: Research indicates that informal caregiving can have intense physical and mental impact on the individual. Relative to caregivers of adults, pediatric palliative caregivers appear less in literature despite experiencing greater mental, physical, financial, and social strain. There is limited research on the creation and evaluation of interventions specifically for this population despite clear need. Objective: This study aims to evaluate the feasibility and engagement of the Photographs of Meaning Program, a modified meaning-making intervention for pediatric palliative caregivers. Design: Participants completed a pre–post intervention meaning-in-life measure. Over a 9-week period, participants followed a meaning-making curriculum whereby they created and shared photo narratives via social media. As part of the intervention, a community photo exhibition was held featuring these photo narratives. Exit interviews were also conducted at study close. Setting/Participants: Nine individuals providing informal care to children in a pediatric palliative care program participated in the intervention. All participants were female and are older than 18 years. Settings for research include participant homes and at The Center for Hospice and Palliative Care in Cheektowaga, New York. Results: Participants posted 95 photographs and 96 narratives during the intervention, posting on average once each week. Statistical analysis within the small sample indicated an increased presence of meaning in the lives of participants ( P = .022). Exit interviews conveyed satisfaction with the intervention. Conclusions: Findings suggest that the Photographs of Meaning Program is a practical intervention with life-enhancing potential for pediatric palliative. Future research should aim to collect additional evidence of the intervention’s effectiveness.
Aligning the Tuning Forks: Using the Intersections of Organizational Frames and Systems Disciplines: Facilitating Effective Collaboration between Schools Needing Improvement and Regional Improvement Agencies
Authors: Bernato Richard 
Published: January 2019

The purpose of this article is to align the needs and wants of schools in need of improvement and state, federal, and regional agencies charged with assisting them in their reform efforts by using spreadsheet thinking through two lenses, Bolman and Deal's four organizational paradigms and Peter Senge's five disciplines of a learning organization. Taken together, in a force-fitting Tuning Forks model approach, where analysts use the intersection of each framework insofar as they act on each other, enables school improvement collaborators to align new action perspectives. This article is divided into three sections: The first part presents the context to the issues associated with collaboration between Regional Educational Improvement Agencies (REA) and Schools in Need of Improvement (SU). The second section provides descriptions of the two analytical dimensions. These are then synthesized into cross impact charts that demonstrate potential issues either driving or obstructing their collaborative efforts. A third section provides guidelines to minimize obstructions and promotes collaborative alignment between schools in need of reform and regional agencies charged with assisting their efforts.
Can Therapeutic Hypothermia Diminish the Impact of Traumatic Brain Injury in Drosophila melanogaster?
Authors: Lateef Shan , Holman Aubrie , Carpenter Jessica , James Jennifer 
Published: January 2019

Background/main objectives: No effective strategy exists to treat the well-recognized, devastating impact of traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE), which is the brain degeneration likely caused by repeated head trauma. The goals of this project were (1) to study the effects of single and recurrent TBI (rTBI) on Drosophila melanogaster’s (a) life span, (b) response to sedatives, and (c) behavioral responses to light and gravity and (2) to determine whether therapeutic hypothermia can mitigate the deleterious effects of TBI. Methods: Five experimental groups were created: (1) control, (2) single TBI or concussion; (3) concussion + hypothermia, (4) rTBI, and (5) rTBI + hypothermia. A “high-impact trauma” (HIT) device was built, which used a spring-based mechanism to propel flies against the wall of a vial, causing mechanical damage to the brain. Hypothermia groups were cooled to 15°C for 3 minutes. Group differences were analyzed with chi-square tests for the categorical variables and with ANOVA tests for the continuous variables. Results: Survival curve analysis showed that rTBI can decrease Drosophila lifespan and hypothermia diminished this impact. Average sedation time for control vs concussion vs concussion + hypothermia was 78 vs 52 vs 61 seconds ( P < .0001). Similarly, rTBI vs rTBI/hypothermia groups took 43 vs 59 seconds ( P < .0001). Concussed flies preferred dark environments compared with control flies (risk ratio 3.3, P < .01) while flies who were concussed and cooled had a risk ratio of 2.7 ( P < .01). Flies with rTBI were almost 4 times likely to prefer the dark environment but only 3 times as likely if they were cooled, compared with controls. Geotaxis was significantly affected by rTBI only and yet less so if rTBI flies were cooled. Conclusions: Hypothermia successfully mitigated many deleterious effects of single TBI and rTBI in Drosophila and may represent a promising breakthrough in the treatment of human TBI.
The Effect of Sodium Channel Blocker, Mexiletine, on Body Weight in Type 2 Diabetes Patients with Visceral Obesity
Authors: Ueno Naohiko 
Published: January 2019

Objective: Mexiletine is an anti-arrhythmic agent also used for the treatment of painful diabetic neuropathy. In this study, the effect of mexiletine on body weight was evaluated in type 2 diabetes patients with diabetic neuropathy exhibiting visceral obesity. Methods: Type 2 diabetes patients with neuropathy exhibiting visceral obesity (n = 21) treated by mexiletine (300 mg/day) and a control group of type 2 diabetes patients with the same condition who received vitamin B12 (n = 12) were retrospectively evaluated. Body weight, waist circumference, hemoglobin A1c (HbA1c), blood pressure, liver function, serum lipids, and serum uric acid were assessed before and 6 months after the treatment. Results: Mexiletine significantly decreased body weight and waist circumference. The changes in body weight and waist circumference in 6 months in the mexiletine group were greater than in the control group. In metabolic parameters, there were significant decreases in triglyceride (TG) and serum uric acid. There were positive relationships between the change in body weight and the changes in TG, uric acid, alanine aminotransferase (ALT), and HbA1c. Conclusions: Mexiletine may affect body weight regulation. It ameliorated the metabolic parameters possibly by decreasing visceral fat. Further study should be performed to clarify the mechanism of the effect.