bluuebunny/crossref_metadata_2025_split huggingface dataset:
The perspective of allied health staff on the role of nurses in subacute care
Authors: Digby Robin , Bolster Danielle , Perta Andrew , Bucknall Tracey K 
Published: June 2018

Aims and objectivesTo explore allied health staff perceptions on the role of nurses in subacute care wards.BackgroundA consequence of earlier discharge from acute hospitals is higher acuity of patients in subacute care. The impact on nurses’ roles and required skill mix remains unknown. In the same way, nurses’ integration into the rehabilitation team is ambiguous.DesignDescriptive qualitative inquiry.MethodsSemistructured interviews conducted with 14 allied health staff from one subacute care facility in Melbourne, Australia. Interviews were audio‐recorded and transcribed verbatim. Analysis using the framework approach.ResultsThree main themes were evident: (a) the changing context of care: patient acuity, rapid patient discharge and out‐dated buildings influenced care; (b) generalist as opposed to specialist rehabilitation nurses: a divide between traditional nursing roles of clinical and personal care and a specialist rehabilitation role; and (c) interdisciplinary relations and communication demonstrated lack of respect for nurses and integrating holistic care into everyday routines.ConclusionsAllied health staff had limited understanding of nurses’ role in subacute care, and expectations varied. Power relationships appeared to hamper teamwork. Failure to include nurses in team discussions and decision‐making could hinder patient outcomes. Progressing patients to levels of independence involves both integrating rehabilitation into activities of daily living with nurses and therapy‐based sessions. Promotion of the incorporation of nursing input into patient rehabilitation is needed with both nurses and allied health staff.Relevance to clinical practice

Lack of understanding of the nurses’ role contributes to lack of respect for the nursing contribution to rehabilitation.

Nurses have a key role in rehabilitation sometimes impeded by poor teamwork with allied health staff.

Processes in subacute care wards need examination to facilitate more effective team practices inclusive of nurses.

Progressing patients’ independence in rehabilitation units involves activities of daily living with nurses as much as therapy‐based sessions.
Patient autonomy in a high‐tech care context—A theoretical framework
Authors: Lindberg Catharina , Fagerström Cecilia , Willman Ania 
Published: June 2018

Aims and objectivesTo synthesise and interpret previous findings with the aim of developing a theoretical framework for patient autonomy in a high‐tech care context.BackgroundPutting the somewhat abstract concept of patient autonomy into practice can prove difficult as when it is highlighted in healthcare literature, the patient perspective is often invisible. Autonomy presumes that a person has experience, education, self‐discipline and decision‐making capacity. Reference to autonomy in relation to patients in high‐tech care environments could therefore be considered paradoxical, as in most cases, these persons are vulnerable, with impaired physical and/or metacognitive capacity, thus making extended knowledge of patient autonomy for these persons even more important.DesignTheory development.MethodsThe basic approaches in theory development by Walker and Avant were used to create a theoretical framework through an amalgamation of the results from three qualitative studies conducted previously by the same research group.ResultsA theoretical framework—the control‐partnership‐transition framework—was delineated disclosing different parts cocreating the prerequisites for patient autonomy in high‐tech care environments. Assumptions and propositional statements that guide theory development were also outlined, as were guiding principles for use in day‐to‐day nursing care. Four strategies used by patients were revealed as follows: the strategy of control, the strategy of partnership, the strategy of trust and the strategy of transition.ConclusionsAn extended knowledge base, founded on theoretical reasoning about patient autonomy, could facilitate nursing care that would allow people to remain/become autonomous in the role of patient in high‐tech care environments.Relevance to clinical practiceThe control‐partnership‐transition framework would be of help in supporting and defending patient autonomy when caring for individual patients, as it provides an understanding of the strategies employed by patients to achieve autonomy in high‐tech care contexts. The guiding principles for patient autonomy presented could be used in nursing guidelines.
Stroke survivors’ experiences transitioning from hospital to home
Authors: Connolly Teresa , Mahoney Ellen 
Published: June 2018

Aims and objectivesTo investigate the experiences of ischaemic stroke survivors during the transitional period from the hospital through the first 4 weeks after discharge home.BackgroundIschaemic stroke survivors describe the transition from hospital to home as an important time in their recovery and describe various physical and cognitive concerns early within the recovery period. Adequate transitional care interventions should be informed by such experiences.DesignThis is a qualitative descriptive study.MethodThis study used semistructured telephone interviews and an inductive approach to enable thematic analysis of information from 31 persons experiencing an ischaemic stroke.ResultsFive major themes emerged: (a) the shock of a stroke interrupting a normal day; (b) transition to an unfamiliar home; (c) uncertainty; (d) understanding a new sense of self; and (e) adjusting to a new sense of self. All participants articulated a need to cope with uncertainty and adjusting to a new sense of self. Ischaemic stroke survivors who experienced less uncertainty described that return to their prior daily routine, preventing another stroke, depended on a helpful support system including frequent follow‐up and communication with healthcare professionals.ConclusionAll ischaemic stroke survivors are at risk for complications during recovery, regardless of stroke severity. This study found that, even after experiencing minimal physical or cognitive symptoms, ischaemic stroke survivors can have difficulty adjusting to life after discharge.Relevance to clinical practiceAdjusting to life after a stroke during the first 4 weeks after discharge home is an in individualised experience. For the complex psychosocial and physical needs of ischaemic stroke survivors, nurses can play an important role beyond symptom management by fostering a dynamic relationship through individualised transitional care based on ischaemic stroke survivors experiences.
Social adjustment experiences of adolescents with Tourette syndrome
Authors: Lee Mei‐Yin , Wang Huei‐Shyong , Chen Chen‐Jung , Lee Mei‐Hua 
Published: June 2018

Aims and objectivesTo explore and describe the experience of social adjustment of adolescents with Tourette syndrome in Taiwan.BackgroundAlthough Tourette syndrome is a non‐life‐threatening disease, the inherent difficulties in controlling tics and comorbidities can cause long‐term physical and psychological issues, as well as social maladjustment among adolescents. Good social adjustment can promote mental health among adolescents. Currently, it is not clear how adolescents with Tourette syndrome can self‐adjust and maintain harmonious social interaction with others.DesignDescriptive phenomenological approach was used in this study. Four criteria were applied to establish the trustworthiness or methodological rigour.MethodsSixteen adolescents with Tourette syndrome were recruited by purposive sampling from a medical centre in Northern Taiwan. Semistructured one‐on‐one interviews were performed from March 2014–April 2015 for data collection. Every participant was interviewed once or twice, and each interview lasted for duration of around 60–90 min. Data were analysed with Giorgi's phenomenological method for data analysis.ResultsThree themes were identified from the adolescent’ interviews. The themes were included visible and invisible destitution, moulding a socially acceptable self and coexisting friends and foes.ConclusionsAdolescents with Tourette syndrome experienced that tics are often not understood nor accepted during social interactions with others. However, with age and autonomy of adolescents, they were able to adjust and develop a socially acceptable body image and maintain amicable social interactions with others. Accompanied by positive thinking, support from friends and families, the adolescents could achieve good social adjustments for living with Tourette syndrome.Relevance to clinical practiceThe experiences and feelings highlighted in this study can bring awareness to nurses and healthcare professionals for developing interventions that promote healthy social adjustment and mental health for adolescents with Tourette syndrome.
Yakovlev's Basolateral Limbic Circuit in Multiple Sclerosis Related Cognitive Impairment
Authors: Keser Zafer , Kamali Arash , Younes Kyan , Schulz Paul E. , Nelson Flavia M. , Hasan Khader M. 
Published: June 2018

ABSTRACTBACKGROUND AND PURPOSEIn 1948, Paul Yakovlev described an additional limbic circuit located basolateral to James Papez's circuit (1937) and included orbitofrontal cortex, amygdala, and dorsomedial nucleus of thalamus. This circuit is shown to be an important component of subcortical cognitive abilities. We aimed to demonstrate this circuit in a multiple sclerosis (MS) cohort using diffusion tensor imaging (DTI) and evaluate its role in MS‐related cognitive impairment (CI).METHODSWe enrolled cognitively intact (n = 10) and impaired (n = 36) MS patients who underwent a comprehensive cognitive assessment; the minimal assessment of cognitive function in MS (MACFIMS) and structural magnetic resonance imaging. Correlation analyses between volumetric and DTI‐derived values of the orbitofrontothalamic (OFT), amygdalothalamic tracts (ATTs), and dorsomedial nucleus of thalamus and CI index derived from MACFIMS were computed after adjustment for age, education, and lesion load.RESULTSWe observed a consistent trend between CI index and bilateral dorsomedial nucleus’ mean diffusivity (MD) (r = .316; P = .02), left OFT Fractional anisotropy (FA) (r = −.302; P = .02), MD (r = .380; .006), and radial diffusivities (RDs) (r = .432; P = .002), also with right ATT FA (r = −.475; P = .0006) and left ATT FA ( = −.487; P = .0005). After Bonferroni correction, correlations of left OFT RD and right and left ATT FA with CI were found to be significant.CONCLUSIONSOur study provides in vivo DTI delineation of Yakovlev's historical basolateral limbic circuit and establishes a role in MS‐related CI. These findings may potentially pave the way for future clinical studies using targeted invasive and noninvasive neurostimulation modalities for CI in MS.
Pharmacokinetics of low‐dose methotrexate in healthy beagle dogs
Authors: Rostang Antoine , Mosca Marion , Jeannin Morgan , Luissiez Coralie , Berny Philippe , Fourel Isabelle , Pin Didier , Prouillac Caroline 
Published: June 2018

AbstractMethotrexate may be an alternative to ciclosporin in the treatment of canine atopic dermatitis (cAD) as suggested by recent data. The aim of the study was to investigate both the tolerance and the pharmacokinetic behavior of methotrexate (MTX) in plasma, following intravenous (i.v.), subcutaneous (s.c.) or oral (OR) administration over several weeks. Six healthy dogs were given oral MTX once a week, respectively, per dog at 2.5 mg/1 week, 5 mg/4 weeks, 7.5 mg/3 weeks, 10 mg/6 weeks and 12.5 mg/5 weeks. No clinically relevant abnormalities of laboratory parameters were noticed. A high inter‐individual variation of MTX plasma concentration was observed with a suspicion of saturation phenomenon in absorption. To compare with other routes of administration, six healthy beagle dogs followed a crossover design study at 7.5 mg per dog MTX. The absolute bioavailability was 93% for SC injection and 30% for the oral route. The inter‐individual variability was quite low following SC administration compared to oral route. Just as in human, given the substantial variability of oral absorption, clinicians cannot assume consistent oral bioavailability of MTX. Therefore, they may consider switching dogs to the SC route in case of absence of clinical response with a weekly oral dose.
Staphylococcus pseudintermedius biofilms secrete factors that induce inflammatory reactions in vitro
Authors: Arima S. , Ochi H. , Mitsuhashi M. , Kibe R. , Takahashi K. , Kataoka Y. 
Published: June 2018

Abstract
Biofilms, composed of bacterial cells embedded in a secreted polysaccharide and protein matrix, often cause problems such as chronic and refractory infections. Staphylococcus pseudintermedius, which is an important pathogen in veterinary medicine, has a high rate of biofilm production. Although it is considered that S. pseudintermedius biofilms are associated with prolonged inflammatory disorders, there are no reports that S. pseudintermedius biofilm directly regulates inflammatory reactions. In this study, we focused on the metabolites derived from biofilm cultures of S. pseudintermedius and evaluated their inflammatory effects in vitro. Expression levels of interleukin-1 beta and interleukin-6 mRNA significantly increased in RAW264.7 cells that were cultured with biofilm-conditioned medium (BCM). The secreted proteins in BCM were heat resistance and activated a Toll-like receptor (TLR) signalling pathway. Moreover, based on SDS-PAGE analysis, isolates with stronger biofilm-forming capabilities induced more inflammatory reactions and had specific banding patterns compared with those of weak biofilm producers. Collectively, our results suggest that the proteins derived from S. pseudintermedius biofilm induce a host inflammatory response via a TLR pathway. Furthermore, the severity of inflammation depends on the biofilm formation capacity of the S. pseudintermedius strain.

Significance and Impact of the Study
Staphylococcus pseudintermedius is a biofilm-forming bacterium. We identified some biofilm secreted heat-resistant proteins that induce inflammatory reactions through Toll-like receptor signalling. The expression of the secreted protein varied depending on the potency of biofilm production. Our data suggest that these proteins may be the factors causing biofilm-related inflammation during S. pseudintermedius infections. Identification of these proteins may lead to the development of novel medications to prevent the exacerbation of infections caused by S. pseudintermedius.
An exploration of the optimum dosage and number of cycles of itraconazole pulse therapy for severe onychomycosis
Authors: Zhang Li , Xu Hui , Shi Yuling , Yu Jing , Tao Yunjiao , Li Xiuli 
Published: June 2018

SummaryAlthough standard itraconazole pulse therapy is a well‐established regimen for toenail onychomycosis, the cure rate for onychomycosis remains low. To evaluate the efficacy and safety of different cycles of itraconazole pulse therapy, determine the optimal dosage and number of cycles for onychomycosis. A total of 90 outpatients of our hospital with onychomycosis were randomised into three treatment groups: (1) standard itraconazole pulse therapy (200 mg twice per day, 1 week each month for three pulses); (2) long‐term pulse therapy (200 mg twice per day, 1 week each month for six pulses); (3) low‐dose and long‐term pulse therapy (200 mg/d, 1 week per month for six pulses) and were followed up for 15 months. Of the initial patients, the trial was completed by 81 patients. The complete cure rates were 32.43% for three cycles and 75% for six cycles (P < .001). For six cycles, despite the administration of half‐dose for patients weighing no more than 55 kg, there was no statistical difference in the complete cure rate (P = .862). Long‐term therapy is effective and safe for the treatment of toenail onychomycosis. For patients weighing no more than 55 kg, long‐term half‐dose itraconazole pulse therapy is recommended .
Evaluation of three MALDI‐TOF mass spectrometry libraries for the identification of filamentous fungi in three clinical microbiology laboratories in Manitoba, Canada
Authors: Stein Markus , Tran Vanessa , Nichol Kimberly A. , Lagacé‐Wiens Philippe , Pieroni Peter , Adam Heather J. , Turenne Christine , Walkty Andrew J. , Normand Anne‐Cécile , Hendrickx Marijke , Piarroux Renaud , Karlowsky James A. 
Published: June 2018

SummaryMatrix‐assisted laser desorption ionisation‐time of flight mass spectrometry (MALDI‐TOF MS) is commonly used by clinical microbiology laboratories to identify bacterial pathogens and yeasts, but not for the identification of moulds. Recent progress in extraction protocols and the composition of comparative libraries support potential application of MALDI‐TOF MS for mould identification in clinical microbiology laboratories. We evaluated the performance of the Bruker Microflex™ MALDI‐TOF MS instrument (Billerica, MA, USA) to identify clinical isolates and reference strains of moulds using 3 libraries, the Bruker mould library, the National Institutes of Health (NIH) library and the Mass Spectrometry Identification (MSI) online library, and compared those results to conventional (morphological) and molecular (18S/ITS; gold standard) identification methods. All 3 libraries demonstrated greater accuracy in genus identification (≥94.9%) than conventional methods (86.4%). MALDI‐TOF MS identified 73.3% of isolates to species level compared to only 31.7% by conventional methods. The MSI library demonstrated the highest rate of species‐level identification (72.0%) compared to NIH (19.5%) and Bruker (13.6%) libraries. Greater than 20% of moulds remained unidentified to species level by all 3 MALDI‐TOF MS libraries primarily because of library limitations or imperfect spectra. The overall identification rate of each MALDI‐TOF MS library depended on the number of species and the number of spectra representing each species in the library.
Kimura disease in a patient of Arabic descent – a rare finding
Authors: Savla A. , Shah K. , Gormley M. , Sittampalam G. 
Published: June 2018

AbstractThis case reports a slow growing lesion in a 37‐year‐old male patient of Arabic descent in the left anterior parotid gland, which once excised was diagnosed as Kimura disease (KD). KD is a rare, chronic lymphoproliferative inflammatory disease, most commonly presenting in males of Asian descent, usually in their third and fourth decades. Given the frequently associated skin conditions, dermatologists were reported to have diagnosed most patients with KD. This case reminds us that the first presentation may be in an oral and maxillofacial setting. The disease develops in subcutaneous tissue, predominantly found in the head and neck region, and regional lymphadenopathy is common. Peripheral eosinophilia and raised serum IgE levels are also present. Although the disease is benign and remains largely asymptomatic, it could clinically be misdiagnosed as a neoplasm or angiolymphoid hyperplasia with eosinophilia (AHLE), which could affect treatment planning.
Clinical and electrophysiological properties of atrial tachycardia after pediatric heart transplantation
Authors: Drogalis‐Kim Diana E. , Gallotti Roberto G. , Blais Benjamin A. , Perens Greg , Moore Jeremy P. 
Published: June 2018

AbstractBackgroundPediatric heart transplant recipients are at an elevated risk for development of atrial tachycardia (AT); however, the underlying mechanisms and long‐term outcomes are unclear.ObjectiveWe hypothesized that occurrence of AT in pediatric heart transplant recipients would be associated with a higher frequency of adverse events during follow‐up.MethodsA single‐center retrospective review of all pediatric heart transplant recipients with suspected AT between 1997 and 2017 was performed. Unaffected controls were matched with cases for age and transplant era. Clinical characteristics and long‐term outcomes were compared between groups.ResultsOf 294 heart transplant recipients, 13 with AT at electrophysiology study (4.4%) were identified and compared with 29 controls. The most common mechanism was focal (11), followed by atrial flutter (two), and electrical reconnection of a surgical atrial anastomosis (two). Focal AT was only observed in the right atrium or atrial septum, and was frequently found on or near the crista terminalis. Relative to controls, cases exhibited more frequent clinical evidence of rejection (9/13 vs 10/29, P = 0.037). For patients with AT, there was a higher rate of death/retransplant among cases (log‐rank P = 0.022), which remained significant in multivariate analysis.ConclusionIn this cohort, the most common form of AT after pediatric heart transplantation was focal, with predilection for sites near the crista terminalis. Transplant patients with AT experienced a higher rate of clinical rejection and the composite end‐point of retransplantation or death relative to unaffected controls.
Effect of defibrillation threshold testing on effectiveness of the subcutaneous implantable cardioverter defibrillator
Authors: Peddareddy Lakshmi , Merchant Faisal M. , Leon Angel R. , Smith Paige , Patel Akshar , El‐Chami Mikhael F. 
Published: June 2018

AbstractBackgroundDefibrillation threshold (DFT) testing is recommended with the subcutaneous implantable cardioverter defibrillator (SICD).ObjectiveTo describe first shock efficacy for appropriate SICD therapies stratified by the presence of implant DFT testing.MethodsWe reviewed all patients receiving SICDs at our institution and stratified them based on whether implant DFT testing was performed. Appropriate shocks were reviewed to see if ventricular tachycardia/ventricular fibrillation (VT/VF) terminated with a single shock. First shock efficacy was stratified by implant DFT status.Results178 patients implanted with SICDs and followed in our center were included in this study. Of these, 135 (76%) underwent DFT testing (DFT (+) group). In the DFT (+), 80 appropriate shocks were needed to treat 69 episodes of VT/VF. The first shock was effective in 61 out of 69 episodes (88.4%), whereas multiple shocks were required to terminate VT/VF in the remaining eight episodes. Among 43 patients without implant DFT testing (DFT (−) group), 20 appropriate shocks to treat 17 episodes of VT/VF occurred in seven patients. VT/VF was successfully terminated with the first shock in 16 out of 17 episodes (first shock efficacy 94.1 %). There was no significant difference in first shock effectiveness between those with and without implant DFT testing (P = 0.97).ConclusionA strategy that omits DFT testing at implant did not appear to compromise the effectiveness of the SICD. These data suggest that routine DFT testing at SICD implant might not be necessary. Randomized trials are needed to confirm this finding.