bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
Authors: Clay-Williams Robyn , Blakely Brette , Lane Paul , Senthuran Siva , Johnson Andrew 
Published: March 2019

ObjectiveTo evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds.DesignPreintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data.SettingICU in a 700-bed regional tertiary care hospital in Australia.Participants31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments.InterventionImplementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan.Main outcome measuresInterview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds.ResultsImproved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ21=24.9, p<0.0001.ConclusionsBy establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.
Associations between effort–reward imbalance and health indicators among school teachers in Chuquisaca, Bolivia: a cross-sectional study
Authors: Solis-Soto Maria Teresa , Schön Anabel , Parra Manuel , Radon Katja 
Published: March 2019

ObjectiveTo assess the association between effort–reward imbalance (ERI) and health indicators among Bolivian school teachers.DesignSchool-based cross-sectional study.SettingSixty randomly selected schools from rural (33) and urban (27) schools in Chuquisaca, Bolivia.ParticipantsA total of 1062 school teachers were invited to participate, of which 597 answered the questionnaire (response 56.2%).Exposure measurePsychosocial factors at work were explored through the short version of the Effort–Reward Questionnaire.Primary and secondary outcome measuresHealth outcomes included self-rated overall health, mental distress (12-item General Health Questionnaire ≥5) and the 7-day prevalence of low back pain (LBP) as well as neck or shoulder pain (Nordic Questionnaire). Crude and adjusted ORs and their 95% CIs for each health outcome were calculated using logistic regression models.ResultsThe median value for the effort–reward ratio was 0.91 (range: 0.3–2.3) with higher values for teachers from rural versus urban schools. Overall, about 43% of the teachers reported their overall health as fair or poor; 45% suffered mental distress, 17% reported LBP and 29% neck or shoulder pain. Prevalences were higher for teachers employed at rural schools compared with those at urban schools. After adjusting for potential confounders and school location, ERI was statistically significantly associated with fair/poor self-rated health (adjusted OR 1.7, 95% CI 1.0 to 2.9); mental distress (1.9; 95% CI 1.2 to 3.1) and LBP (2.3; 95% CI 1.3 to 4.1).ConclusionOur results indicate the urgent need to improve psychosocial working conditions among Bolivian school teachers, in order to promote their health and well-being.
ETS-related gene(ERG) expression as a predictor of oncological outcomes in patients with high-grade prostate cancer treated with primary androgen deprivation therapy: a cohort study
Authors: Rezk Mark , Chandra Ashish , Addis Daniel , Møller Henrik , Youssef Mina , Dasgupta Prokar , Yamamoto Hide 
Published: March 2019

ObjectivesTo determine whetherETS-related gene(ERG) expression can be used as a biomarker to predict biochemical recurrence and prostate cancer-specific death in patients with high Gleason grade prostate cancer treated with androgen deprivation therapy (ADT) as monotherapy.MethodsA multicentre retrospective cohort study identifying 149 patients treated with primary ADT for metastatic or non-metastatic prostate cancer with Gleason score 8–10 between 1999 and 2006. Patients planned for adjuvant radiotherapy at diagnosis were excluded. Age at diagnosis, ethnicity, prostate-specific antigen and Charlson-comorbidity score were recorded. Prostatic tissue acquired at biopsy or transurethral resection surgery was assessed for immunohistochemical expression ofERG. Failure of ADT defined as prostate specific antigen nadir +2. Vital status and death certification data determined using the UK National Cancer Registry. Primary outcome measures were overall survival (OS) and prostate cancer specific survival (CSS). Secondary outcome was biochemical recurrence-free survival (BRFS).ResultsThe median OS of our cohort was 60.2 months (CI 52.0 to 68.3).ERGexpression observed in 51/149 cases (34%). Multivariate Cox proportional hazards analysis showed no significant association betweenERGexpression and OS (p=0.41), CSS (p=0.92) and BRFS (p=0.31). Cox regression analysis showed Gleason score (p=0.003) and metastatic status (p<1×10-5) to be the only significant predictors of prostate CSS.ConclusionsNo significant association was found betweenERGstatus and any of our outcome measures. Despite a limited sample size, our results suggest thatERGdoes not appear to be a useful biomarker in predicting response to ADT in patients with high risk prostate cancer.
Evaluating 3D-printed models of coronary anomalies: a survey among clinicians and researchers at a university hospital in the UK
Authors: Lee Matthew , Moharem-Elgamal Sarah , Beckingham Rylan , Hamilton Mark , Manghat Nathan , Milano Elena Giulia , Bucciarelli-Ducci Chiara , Caputo Massimo , Biglino Giovanni 
Published: March 2019

ObjectiveTo evaluate the feasibility of three-dimensional (3D) printing models of coronary artery anomalies based on cardiac CT data and explore their potential for clinical applications.DesignCardiac CT datasets of patients with various coronary artery anomalies (n=8) were retrospectively reviewed and processed, reconstructing detailed 3D models to be printed in-house with a desktop 3D printer (Form 2, Formlabs) using white resin.SettingA University Hospital (division of cardiology) in the UK.ParticipantsThe CT scans, first and then 3D-printed models were presented to groups of clinicians (n=8) and cardiovascular researchers (n=9).InterventionParticipants were asked to assess different features of the 3D models and to rate the models’ overall potential usefulness.Outcome measuresModels were rated according to clarity of anatomical detail, insight into the coronary abnormality, overall perceived usefulness and comparison to CT scans. Assessment of model characteristics used Likert-type questions (5-point scale from ‘strongly disagree’ to ‘strongly agree’) or a 10-point rating (from 0, lowest, to 10, highest). The questionnaire included a feedback form summarising overall usefulness. Participants’ imaging experience (in a number of years) was also recorded.ResultsAll models were reconstructed and printed successfully, with accurate details showing coronary anatomy (eg, anomalous coronary artery, coronary roofing or coronary aneurysm in a patient with Kawasaki syndrome). All clinicians and researchers provided feedback, with both groups finding the models helpful in displaying coronary artery anatomy and abnormalities, and complementary to viewing 3D CT scans. The clinicians’ group, who had substantially more imaging expertise, provided more enthusiastic ratings in terms of models’ clarity, usefulness and future use on average.Conclusions3D-printed heart models can be feasibly used to recreate coronary artery anatomy and enhance understanding of coronary abnormalities. Future studies can evaluate their cost-effectiveness, as well as potentially explore other printing techniques and materials.
Multiple challenges for people after transitioning to secondary progressive multiple sclerosis: a qualitative study
Authors: Bogosian Angeliki , Morgan Myfanwy , Moss-Morris Rona 
Published: March 2019

ObjectivesTransitioning to secondary progressive multiple sclerosis (SPMS) is demanding for both patients and healthcare professionals. The particular challenges and the ways patients cope are poorly understood. The present study examines what challenges people face when diagnosed with SPMS by exploring experiences of people who have transitioned recently (up to 5 years).DesignSemistructured qualitative interviews at two time points a year apart. Interviews were analysed using inductive thematic analysis.SettingUK.ParticipantsWe interviewed 21 people at baseline and 17 participated in the follow-up interviews.ResultsThe majority of participants reported expecting to transition to SPMS, and the diagnosis did not make much difference to them. Participants described increasing emotional and physical challenges after transitioning to SPMS and between the first and second interviews. Planning, using distractions and maintaining social roles helped participants cope with the increased challenges. The same coping strategies were used between the two interviews. Participants felt there was not much left to do regarding the management of their symptoms. A key theme was the sense of abandonment from healthcare services after transitioning to SPMS.ConclusionsAfter transitioning to SPMS, people are faced with multiple challenges. Participants described a lack of directions for symptoms management and lack of support from the healthcare system. An integrated multidisciplinary healthcare approach is crucial at the progressive stage of the disease to alleviate feelings of helplessness and promote symptom management.
What’s on your keyboard? A systematic review of the contamination of peripheral computer devices in healthcare settings
Authors: Ide Nicole , Frogner Bianca K , LeRouge Cynthia M , Vigil Patrick , Thompson Matthew 
Published: March 2019

ObjectiveTo determine the extent and type of microbial contamination of computer peripheral devices used in healthcare settings, evaluate the effectiveness of interventions to reduce contamination of these devices and establish the risk of patient and healthcare worker infection from contaminated devices.DesignSystematic reviewMethodsWe searched four online databases: MEDLINE, CINAHL, Embase and Scopus for articles reporting primary data collection on contamination of computer-related equipment (including keyboards, mice, laptops and tablets) and/or studies demonstrating the effectiveness of a disinfection technique. Pooling of contamination rates was conducted where possible, and narrative synthesis was used to describe the rates of device contamination, types of bacterial and viral contamination, effectiveness of interventions and any associations between device contamination and human infections.ResultsOf the 4432 records identified, a total of 75 studies involving 2804 computer devices were included. Of these, 50 studies reported contamination of computer-related hardware, and 25 also measured the effects of a decontamination intervention. The overall proportion of contamination ranged from 24% to 100%. The most common microbial contaminants were skin commensals, but also included potential pathogens including methicillin-resistantStaphylococcus aureus,Clostridiumdifficile, vancomycin-resistantenterococci andEscherichia coli. Interventions demonstrating effective decontamination included wipes/pads using isopropyl alcohol, quaternary ammonium, chlorhexidine or dipotassium peroxodisulfate, ultraviolet light emitting devices, enhanced cleaning protocols and chlorine/bleach products. However, results were inconsistent, and there was insufficient data to demonstrate comparative effectiveness. We found little evidence on the link between device contamination and patient/healthcare worker colonisation or infection.ConclusionsComputer keyboards and peripheral devices are frequently contaminated; however, our findings do not allow us to draw firm conclusions about their relative impact on the transmission of pathogens or nosocomial infection. Additional studies measuring the incidence of healthcare-acquired infections from computer hardware, the relative risk they pose to healthcare and evidence for effective and practical cleaning methods are needed.
Aggregated student confidence estimates support continuous quality improvements in a competencies-oriented curriculum
Authors: Papa Frank Joseph , Alexander Jerry H 
Published: March 2019

IntroductionCompetencies oriented medical curricula are intended to support the development of those specific tasks likely to improve patient care outcomes. In 2005, our institution developed curricular objectives and instructional activities intended to enable our students to competently perform four specific clinical tasks (diagnose, treat, manage and explain phenomena) for each of approximately 100 common and/or important patient presentations (eg, dyspnoea). However, competencies oriented curricula must also develop outcome metrics aligned with their objectives and instructional activities in order to launch a continuous quality improvement (CQI) programme. This investigation describes how a novel course evaluation methodology produced presentation and task-focused outcome metrics sufficient to support CQIs in our competencies-oriented curriculum.MethodsLiterature suggests that aggregated, group opinions are much more reliable than individual opinions in a variety of settings, including education. In 2010, we launched a course evaluation methodology using aggregated student self-assessments of their confidence in performing the four tasks trained to in each presentation-focused instructional activity. These aggregated estimates were transformed into a variety of graphic and tabular reports which faculty used to identify, and then remediate, those specific instructional activities associated with suboptimal presentation and task-focused confidence metrics.ResultsWith academic year 2010–2011 serving as a baseline and academic year 2015–2016 as an endpoint, analysis of variance revealed a sustained and statistically significant gain in student confidence across this 6-year study period (p<0.001).DiscussionThis investigation demonstrated that aggregated, presentation and task-specific confidence estimates enabled faculty to pursue and attain CQIs in a competencies-oriented curriculum. Suggestions for new approaches to confidence-related research are offered.
Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials
Authors: Lafrance Simon , Doiron-Cadrin Patrick , Saulnier Marie , Lamontagne Martin , Bureau Nathalie J , Dyer Joseph-Omer , Roy Jean-Sébastien , Desmeules François 
Published: March 2019

BackgroundRotator cuff calcific tendinopathy is characterised by the deposition of hydroxyapatite crystals in one of the rotator cuff tendons and can be managed by ultrasound-guided lavage. However, evidence regarding the efficacy of ultrasound-guided lavage for rotator cuff calcific tendinopathy remains inconclusive. The aim of this systematic review and meta-analysis is to update the available evidence on the efficacy of ultrasound-guided lavage in adults with rotator cuff calcific tendinopathy.MethodsA literature search was conducted up to April 2018 in four bibliographic databases to identify randomised control trials that compared ultrasound-guided lavage alone with other interventions to treat rotator cuff calcific tendinopathy. Randomised control trials were assessed with the Cochrane Risk of Bias Tool. Meta-analyses and/or qualitative synthesis of the evidence were performed.ResultsThree randomised control trials were included. Pooled results for pain (n=226) indicated that ultrasound-guided lavage may significantly decrease pain when compared with shockwave therapy, with a mean difference of −1.98 out of 10 points (95% CI −2.52 to −1.45) in the short term and of −1.84 (95% CI −2.63 to −1.04) in the long term. Based on one trial (n=25), ultrasound-guided lavage significantly improved function when compared with shockwave therapy (p<0.05). Based on another trial (n=48), the addition of ultrasound-guided lavage to a corticosteroid injection significantly improves function in the long term (p<0.05).ConclusionFor individuals with rotator cuff calcific tendinopathy, low-quality evidence suggests that ultrasound-guided lavage is more effective than shockwave therapy or a corticosteroid injection alone. Future trials could modify the present conclusions.Trial registration numberCRD42018095858.
Determinants of coronary artery disease risk factor management across three world regions
Authors: Zhao Min , Graham Ian , Cooney Marie Therese , Grobbee Diederick E , Vaartjes Ilonca , Klipstein-Grobusch Kerstin 
Published: March 2019

BackgroundThe SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD.Methods and resultsSURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region.ConclusionsOverall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.
Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2
Authors: Miura Masatomo , Yoshimura Shinichi , Sakai Nobuyuki , Yamagami Hiroshi , Uchida Kazutaka , Nagao Yoichiro , Morimoto Takeshi 
Published: March 2019

ObjectiveTo compare the efficacy of endovascular therapy (EVT) with that of medical treatment in ’real-world ’patients with M2 occlusion.MethodsThis was a post hoc analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2. Among 2420 patients in the registry, we evaluated patients with isolated M2 occlusion and those with functional independence before the stroke. Multivariable logistic regression analysis was used to evaluate and compare clinical outcomes between EVT and medical treatment. Additional propensity score-matched (PSM) analyses were performed. We performed subgroup analyses of the primary outcome (modified Rankin Scale score 0–2 at 90 days) using forest plots of treatment effects.ResultsOverall, 372 patients with M2 occlusion (n=184 EVT; n=188, medical treatment) were evaluated. The EVT group had a higher baseline National Institutes of Health Stroke Scale score (median (IQR), 15 [9–19] vs 10 [5–16]) and earlier onset to hospital door time (110 [50–258] vs 150 [60–343] min) than the medical treatment group. After adjustment, EVT was significantly associated with higher odds of primary outcome (adjusted OR=2.09; 95% CI 1.26 to 3.47) and lower odds of mortality at 90 days (adjusted OR= 0.27; 95% CI 0.08 to 0.93). After PSM analyses (184 patients were 1:1 matched with each group), EVT was effective and safe relative to medical treatment. Effects favoring EVT were present in several subgroups of interest.ConclusionIn patients with M2 occlusion, our registry suggests that EVT is effective and safe.
Testing bioresorbable stent feasibility in a rat aneurysm model
Authors: Grüter Basil Erwin , Täschler Dominik , Strange Fabio , Rey Jeannine , von Gunten Michael , Grandgirard Denis , Leib Stephen L , Remonda Luca , Widmer Hans Rudolf , Nevzati Edin , Fandino Javier , Marbacher Serge , Coluccia Daniel 
Published: March 2019

BackgroundAdvances in stent-assisted coiling have incrementally expanded endovascular treatment options for complex cerebral aneurysms. After successful coil consolidation and aneurysm occlusion, endovascular scaffolds are no longer needed. Thus, bioresorbable stents that disappear after aneurysm healing could avoid future risks of in-stent thrombosis and the need for lifelong antiplatelet therapy.ObjectiveTo assess the applicability and compatibility of a bioresorbable magnesium- alloy stent (brMAS) for assisted coiling.MethodsSaccular sidewall aneurysms were created in 84 male Wistar rats and treated with brMAS alone, brMAS + aspirin, or brMAS + coils + aspirin. Control groups included no treatment (natural course), solely aspirin treatment, or conventional cobalt–chromium stent + coils + aspirin treatment. After 1 and 4 weeks, aneurysm specimens were harvested and macroscopically, histologically, and molecularly examined for healing, parent artery perfusion status, and inflammatory reactions. Stent degradation was monitored for up to 6 months with micro-computed and optical coherence tomography.ResultsAneurysms treated with brMAS showed advanced healing, neointima formation, and subsequent stent degradation. Additional administration of aspirin sustained aneurysm healing while reducing stent-induced intraluminal and periadventitial inflammatory responses. No negative interaction was detected between platinum coils and brMAS. Progressive brMAS degradation was confirmed.ConclusionsbrMAS induced appropriate healing in this sidewall aneurysm model. The concept of using bioresorbable materials to promote complete aneurysm healing and subsequent stent degradation seems promising. These results should encourage further device refinements and clinical evaluation of this treatment strategy for cerebrovascular aneurysms.