bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obtaining Consent for Organ Donation in Nine NSW Metropolitan Hospitals
Authors: Chapman J. R. , Hibberd A. D. , Mccosker C. , Thompson J. F. , Ross W. , Mahony J. , Byth P. , Macdonald G. J. 
Published: January 2019

Organ donation rates vary markedly around the world. In an attempt to analyse why some patients’ families are not asked about organ donation, the case notes of 6080 patients who died over a twelve-month period from April 1991 to March 1992 in nine hospitals in Sydney, NSW, were studied. Irreversible coma occurred in 515 patients. Of these, 177 were considered to be potentially brain dead donors, 126 of whom had a formal diagnosis of brain death. The clinicians caring for the patients at the time of death were asked at follow-up about the reasons for not considering donation, or the reasons for family refusal. Consent to proceed to organ donation was requested in 112 cases (49 donated and 63 refused) and not requested in 65. Analysis of the proportions asked and consenting in each hospital revealed no correlation. Half of the families refusing gave no reason (24/50) while eleven gave religious or cultural reasons, and six expressed a desire to prevent mutilation of the body as their primary reason for not consenting. There was universal failure to gain consent from families when the patient was not in an Intensive Care Unit. Analysis of those patients of whom consent was not sought showed that they died more quickly after admission, were older and died from causes other than trauma or intracranial haemorrhage. The odds of the family being asked dropped by about half as the age increased from one group to the next. Increases in organ donation may be achieved by ensuring that potential donors reach intensive care units; that criteria for medical suitability for donation are unambiguous and widely known; and that changes occur in public attitudes to consent for donation.
Comparison of Halothane, Enflurane and Isoflurane Kidney Effects through Alanine Aminopeptidase/Urine Creatinine Values
Authors: Dural O. , Kanbak M. , Ciliv G. , Aypar U. , Erdem K. 
Published: January 2019

The kidney effects of halothane, enflurane and isoflurane were evaluated by using the ratio of urinary excretion of alanine aminopeptidase (AAP) to urine creatinine. Thirty patients in ASA class 1 or 2 were studied. None had renal disease nor received nephrotoxic drugs. Groups 1, 2 and 3 received halothane, enflurane and isoflurane respectively. Creatinine and AAP activities in urine spot tests, serum creatinine and BUN levels were determined preoperatively and on the first and second postoperative days. Urine AAP activity and AAP/urine creatinine values increased significantly on the first and second postoperative days compared with the preoperative values in all groups (P<0.05). The present study did not reveal any significant difference in the kidney effects of halothane, enflurane and isoflurane through AAP/creatinine in spot urine values.
A Meta-Analysis on the Efficacy of Epidural Corticosteroids in the Treatment of Sciatica
Authors: Watts R. W. , Silagy C. A. 
Published: January 2019

The efficacy of epidural corticosteroids in the treatment of sciatica was investigated by meta-analysis of all randomized controlled trials. Eleven suitable trials of good quality were identified involving a total of 907 patients. The use of epidural (caudal or lumbar) steroid in the short-term (up to 60 days) increased the odds ratio (OR) of pain relief (>75% improvement) to 2.61 (95% CI 1.90–3.77) when compared with placebo. Despite some variations in trial characteristics there was little evidence of significant heterogeneity (P=0.07). When the trials were analysed for near or total relief of pain in the short-term the OR is 2.79 (95% CI 1.92–4.06), for heterogeneity (P=0.07). For longterm relief of pain (up to 12 months) the OR is 1.87 (95% CI 1.31–2.68). Efficacy is independent of the route of injection; for caudal epidural steroid the OR is 3.80 (95% CI 1.36–10.6) and for the lumbar epidural steroid 2.43 (95% CI 1.77–3.74). Adverse events included dural tap (2.5%), transient headache (2.3%) and a transient increase in pain (1.9%). There were no reported longterm adverse events. In conclusion we present quantitative evidence from meta-analysis of pooled data from randomized trials that epidural administration of corticosteroids is effective in the management of lumbosacral radicular pain.
The Perioperative System: A New Approach to Managing Elective Surgery
Authors: Kerridge R. , Lee A. , Latchford E. , Beehan S. J. , Hillman K. M. 
Published: January 2019

A Perioperative Service has recently been introduced at Liverpool Hospital, a 460-bed university teaching hospital. This provides a co-ordinated system for managing all elective surgical patients from the time an admission is booked until hospital discharge. This paper describes the patient assessment, structure and staff requirements, benefits of and problems encountered with this service. The patient's preoperative preparation occurs before hospital admission. Where possible, patients are admitted on the day of procedure, either as a day-only patient, or a day-of-surgery patient. Patients are initially admitted to a specifically designed Perioperative Unit, adjacent to the Operating Theatre Suite. Patients do not enter the surgical wards until after their operation. Planning of the hospital discharge process commences at the time of booking for operation. Introduction of the Perioperative Service was staged process commencing in mid-1992. The hospital admits approximately 6,400 elective surgery cases each year. From July 1992 to December 1994, day-only patients were approximately 45% of these cases. Day-of-surgery admission patients increased from 6% to 35% of all cases over the same period. Appproximately 22% of elective surgical cases were seen in the Perioperative Clinic. As the Perioerative Service became fully operational, the average length of stay for elective surgical procedures fell. There has been a reduction in the areas of cancellations due to unavailablity of beds, inappropriate preparation of patients, and non-attendance of patients for booked procedures. Patient acceptance is high. The existence of a perioperative system facilitates the planning and management of elective surgery with maximum quality and efficiency.
Respiratory Drive and Pulmonary Mechanics during Haemodialysis with Ultrafiltration in Ventilated Patients
Authors: Huang C. C. , Tsai Y. H. , Lin M. C. , Yang C. T. , Hsieh M. J. , Lan R. S. 
Published: January 2019

The improvements of respiratory drive and pulmonary mechanics which follow haemodialysis with ultrafiltration in mechanically ventilated renal failure patients seem predictable but have not been studied before. In this study, 14 renal failure patients with stable haemodynamics mechanically ventilated with pressure support ventilation (PSV) were enrolled. Respiratory drive (represented as P0.1), pulmonary mechanics, breathing pattern, arterial blood gas and haemodynamics were measured according to the time schedule: pre-dialysis (Time 0), and at 60, 120, 180, 240 minutes thereafter. Following the removal of excess lung water during haemodialysis, auto-PEEP and patient's work of breathing (WOBp) decreased gradually. P0.1 lessened progressively along with the improvement in pulmonary mechanics. The changes in auto-PEEP and WOBp correlated closely to the pre- and post-dialysis decline of P0.1 (ΔP0.1). There was a negative, moderately significant correlation between the amount of fluid ultrafiltrated during dialysis (ΔUF) and the ΔP0.1 (R = -0.54). The breathing pattern remained stable during dialysis. No hypoventilation or hypoxaemia occurred despite the development of metabolic alkalosis induced by bicarbonate dialysate. We have shown that respiratory drive decreases gradually during bicarbonate haemodialysis. The improvements of pulmonary mechanics, rather than the rapid alkalization of body fluids, responds to the decrease of P0.1 in renal failure patients ventilated with PSV.
Predicting Difficult Intubation—A Comprehensive Scoring System
Authors: Nath G. , Sekar M. 
Published: January 2019

A study was conducted in an attempt to devise a simple and more accurate method of predicting difficult intubation. Prospective assessments were made in 282 patients and retrospective assessment in 16 patients with regard to 21 anatomical factors which were correlated with the laryngoscopic view at intubation. Twelve factors correlated significantly with difficult intubation. Four of these were eliminated after multifactorial analysis. A scoring system was devised, assigning points to each variable based on its discriminative value. A score of 6 or more correctly identified 22 out of the 23 difficult intubations and there were 50 false positives (sensitivity, specificity and PPV of 96%, 82% and 31% respectively). When negative scoring was done for factors favouring easy intubation, false positives were reduced to 36, but only 20 difficult cases could be identified correctly.
Rapid Alterations in Cerebral White Matter Lipid Profiles After Ischemic-Reperfusion Brain Injury in Fetal Sheep as Demonstrated by MALDI-Mass Spectrometry
Authors: Gallucci Gina M , Tong Ming , Chen Xiaodi , Stonestreet Barbara S , Lin Amy , de la Monte Suzanne M 
Published: January 2019

Background Perinatal ischemia-reperfusion (I/R) injury of cerebral white matter causes long-term cognitive and motor disabilities in children. I/R damages or kills highly metabolic immature oligodendroglia via oxidative stress, excitotoxicity, inflammation, and mitochondrial dysfunction, impairing their capacity to generate and maintain mature myelin. However, the consequences of I/R on myelin lipid composition have not been characterized. Objective This study utilized matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) to assess alterations in cerebral supraventricular white matter myelin lipid profiles in a fetal sheep model of perinatal I/R. Methods Fetal sheep (127 days gestation) were studied after 30 minutes of bilateral carotid artery occlusion followed by 4 (n = 5), 24 (n = 7), 48 (n = 3), or 72 (n = 5) hours of reperfusion, or sham treatment (n = 5). White matter lipids were analyzed by negative ion mode MALDI-MS. Results Striking I/R-associated shifts in phospholipid and sphingolipid expression occurred over the 72-hour time course with most responses detected within 4 hours of reperfusion and progressing at the 48- and 72-hour points. I/R decreased expression of phosphatidic acid and phosphatidylethanol amine and increased phosphatidylinositol, sulfatide, and lactosylceramide. Conclusions Cerebral I/R in mid-gestation fetal sheep causes rapid shifts in white matter myelin lipid composition that may reflect injury, proliferation, or recovery of immature oligodendroglia.
The role of chronic kidney disease-associated dysbiosis in cardiovascular disease
Authors: Bryniarski Mark A , Hamarneh Fares , Yacoub Rabi 
Published: January 2019

Survival outcomes of patients with end stage renal disease are worse than those of many metastatic cancers. Kidney disease patients are often inflicted with higher rates of cardiovascular disease, in which nearly half of the mortalities are attributed to adverse cardiovascular events. Of the multifarious reasons for this detrimental impact, dysbiosis in the intestinal microbiome is surfacing as a potential participant. This is likely due to the numerous metabolic and inflammatory shifts found in chronic kidney disease, as well as environmental changes within the intestinal lumen. Studies are beginning to link microbiota alterations mediated by chronic kidney disease to negative cardiovascular outcomes. Here, recent findings connecting dysbiosis in chronic kidney disease and various cardiovascular insults are reviewed.Impact statementNegative alterations, or dysbiosis, in the intestinal microbial community balance in response to chronic kidney disease is emerging as a substantial and important factor in inducing and exacerbating multiple comorbid conditions. Patients with renal insufficiency experience a substantial increase in cardiovascular risk, and recent evidence is shedding light on the close interaction between microbiome dysbiosis and increased cardiovascular events in this population. Previous association and recent causality studies utilizing experimental animal models have enriched our understanding and confirmed the impact of microbial community imbalance on cardiac health in both the general population and in patients with renal impairment.
Chronic liver disease promotes lesions of the colorectal adenoma‐carcinoma sequence, independent of liver cirrhosis
Authors: Troschel Amelie S. , Miks Alexander , Troschel Fabian M. , Hüsing-Kabar Anna , Maschmeier Miriam , Heinzow Hauke S. , Schmidt Hartmut H. , Kabar Iyad 
Published: January 2019

BackgroundResearch increasingly focuses on identifying individuals at greater risk of colorectal cancer (CRC) to enhance colonoscopy screening efficacy.ObjectiveThe objective of this article is to determine associations between chronic liver disease and lesions along the colorectal adenoma‐carcinoma sequence.MethodsThis retrospective study encompasses consecutive liver disease patients (LDPs) of all etiologies evaluated for liver transplantation at a single institution and a control group of liver‐healthy patients (LHPs) undergoing colonoscopy as part of the German CRC screening program.Rates of polyps, adenomas, high‐risk situations (HRS) and CRC were analyzed in univariable and multivariable settings adjusting for age, gender, body mass index and number of colonoscopies. Differences between LHPs and LDPs and between cirrhotic and noncirrhotic hepatopathy were assessed.ResultsIn total, 1046 patients (52.6% male, median age 59.6 years) were included, of whom 38.9% had liver disease. A total of 41.0% of all patients showed polyps, 23.2% adenomas, 10.0% HRS, and 0.5% CRC. LDPs were more likely to develop polyps, adenomas and HRS than LHPs, both in univariable and multivariable analysis. There were no significant differences between cirrhotic and noncirrhotic patients.ConclusionChronic liver disease of any etiology is associated with colonic lesions of the colorectal adenoma‐carcinoma sequence, independent of cirrhosis. LDPs should receive intensified, and earlier, colonoscopy screening.
Female stress urinary incontinence MDT
Authors: Sihra Néha , Kujawa Magda , Solomon Eskinder , Harding Chris , Sahai Arun , Malde Sachin 
Published: January 2019

The management of female stress urinary incontinence (SUI) has come under scrutiny in recent years following growing reports of mesh-related complications. Patients require thorough evaluation and management as part of a multidisciplinary team, and extensive counselling about the surgical treatment options is imperative. There is no clear consensus on the optimal management of the complex group of patients with mesh-related complications or recurrent SUI. We present two cases of female SUI to highlight the key factors to be considered when managing these patients. Level of evidence: Level 5.
Novel Noninvasive Assessment of Microvascular Structure and Function in Humans
Authors: SMITH KURT J. , ARGARINI RADEN , CARTER HOWARD H. , QUIRK BRYDEN C. , HAYNES ANDREW , NAYLOR LOUISE H. , MCKIRDY HAMISH , KIRK RODNEY W. , MCLAUGHLIN ROBERT A. , GREEN DANIEL J. 
Published: January 2019

ABSTRACT

Introduction
Optical coherence tomography (OCT) is a novel high-resolution imaging technique capable of visualizing in vivo structures at a resolution of ~10 μm. We have developed specialized OCT-based approaches that quantify diameter, speed, and flow rate in human cutaneous microvessels. In this study, we hypothesized that OCT-based microvascular assessments would possess comparable levels of reliability when compared with those derived using conventional laser Doppler flowmetry (LDF).

Methods
Speckle decorrelation images (OCT) and red blood cell flux (LDF) measures were collected from adjacent forearm skin locations on 2 d (48 h apart), at baseline, and after a 30-min rapid local heating protocol (30°C–44°C) in eight healthy young individuals. OCT postprocessing quantified cutaneous microvascular diameter, speed, flow rate, and density (vessel recruitment) within a region of interest, and data were compared between days.

Results
Forearm skin LDF (13 ± 4 to 182 ± 31 AU, P < 0.05) and OCT-derived diameter (41.8 ± 6.6 vs 64.5 ± 6.9 μm), speed (68.4 ± 9.5 vs 89.0 ± 7.3 μm·s−1), flow rate (145.0 ± 60.6 vs 485 ± 132 pL·s−1), and density (9.9% ± 4.9% vs 45.4% ± 5.9%) increased in response to local heating. The average OCT-derived microvascular flow response (pL·s−1) to heating (234% increase) was lower (P < 0.05) than the LDF-derived change (AU) (1360% increase). Pearson correlation was significant for between-day local heating responses in terms of OCT flow (r = 0.93, P < 0.01), but not LDF (P = 0.49). Bland–Altman analysis revealed that between-day baseline OCT-derived flow rates were less variable than LDF-derived flux.

Conclusions
Our findings indicate that OCT, which directly visualizes human microvessels, not only allows microvascular quantification of diameter, speed, flow rate, and vessel recruitment but also provides outputs that are highly reproducible. OCT is a promising novel approach that enables a comprehensive assessment of cutaneous microvascular structure and function in humans.
Perceptions and use of technology in older people with ophthalmic conditions
Authors: Ali Zaria C. , Shakir Savana , Aslam Tariq Mehmood 
Published: January 2019

Background: Technologies such as mobile applications are increasingly being developed for patients to help manage their clinical conditions. However there is a paucity of information confirming the capacity or willingness of older patients with ophthalmic complaints to engage with such computer applications. The aim of this paper is to assess the perception and use of a range of common computing technologies by older ophthalmic patients, in order to guide future ophthalmology-specific development and clinical use. Methods: Patients attending Manchester Royal Eye Hospital were surveyed with questions designed to measure their perceptions, attitudes and experiences of using technology. Inclusion criteria included any patient aged 40 or over who attended the ophthalmology outpatients department. Results: A total of 300 patients completed the questionnaire. The male-to-female ratio was 169:127. The majority of patients owned predominantly mobile forms of technology such as tablets and smart phones. The most common uses of technology were for communicating with friends, watching television and gathering information. Patients aged over 80 had particular difficulty using technology and used it less regularly. Less than 10% overall stated eyesight as a reason for stopping using technology. Conclusions: Technology is used regularly by a large proportion of older ophthalmic patients, with numbers reducing significantly only in those aged 80 years or over. There appears to be potential for further medical use, though developers and clinicians should consider the perceptions and challenges highlighted through this survey.
What is research? Educators’ conceptions and alignment with United States federal policies
Authors: Mills Kristen J. , Lawlor Jennifer A. , Neal Jennifer Watling , Neal Zachary P. , McAlindon Kathryn 
Published: January 2019

Background:This study draws on two communities theory to address two major research questions related to conceptions of research in educational practice and policy. First, how do educators conceptualise research? Second, to what extent do educators’ conceptions of research align with recent US federal educational policies?
Methods:We conducted 90 semi-structured interviews with educators in the US, asking them what comes to mind when they think of research. We used open, axial, and selective coding to characterise educators’ conceptions of research. We also compared educators’ conceptions of research to two US federal educational policies that define scientifically-based research and evidence-based interventions.
Findings:Findings indicate that educators and policies defined research in similar ways, but each included some unique characteristics.
Discussion and conclusions:Implications from the study include the need for increased communication between federal policymakers and educators and improved reporting by researchers to better attend to the needs of educators and policymakers.
Collective knowledge brokering: the model and impact of an embedded team
Authors: Wye Lesley , Cramer Helen , Beckett Kate , Farr Michelle , le May Andrée , Carey Jude , Robinson Rebecca , Anthwal Rachel , Rooney James , Baxter Helen 
Published: January 2019

Background:The Bristol Knowledge Mobilisation (KM) Team was an unusual collective brokering model, consisting of a multi-professional team of four managers and three academics embedded in both local healthcare policymaking (aka commissioning) and academic primary care.
Aims and objectives:They aimed to encourage ‘research-informed commissioning’ and ‘commissioning-informed research’. This paper covers context, structure, processes, advantages, challenges and impact.
Methods:Data sources from brokers included personal logs, reflective essays, exit interviews and a team workshop. These were analysed inductively using constant comparison. To obtain critical distance, three external evaluations were conducted, using interviews, observations and documentation.
Findings:Stable, solvent organisations; senior involvement with good inter-professional relationships; secure funding; and networks of engaged allies in host organisations supported the brokers. Essential elements were two-way embedding, ‘buddying up’, team leadership, brokers’ interpersonal skills, and two-year, part-time contracts. By working collectively, the brokers fostered cross-community interactions and modelled collaborative behaviour, drawing on each other’s ‘insider’ knowledge, networks and experience. Challenges included too many taskmasters, unrealistic expectations and work overload. However, team-brokering provided a safe space to be vulnerable, share learning, and build confidence. As host organisations benefitted most from embedded brokers, both communities noted changes in attitude, knowledge, skills and confidence. The team were more successful in fostering ‘commissioning-informed research’ with co-produced research grants than ‘research-informed commissioning’.
Discussion and conclusions:Although still difficult, the collective support and comradery of an embedded, two-way, multi-professional team made encouraging interactions, and therefore brokering, easier. A team approach modelled collaborative behaviour and created a critical mass to affect cultural change.