bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beyond the hospital infection control guidelines: a qualitative study using positive deviance to characterize gray areas and to achieve efficacy and clarity in the prevention of healthcare-associated infections
Authors: Gesser-Edelsburg Anat , Cohen Ricky , Halavi Adva Mir , Zemach Mina , van Heerden Peter Vernon , Sviri Sigal , Benenson Shmuel , Trahtemberg Uriel , Orenbuch-Harroch Efrat , Lowenstein Lior , Shteinberg Dan , Salmon Asher , Moses Allon 
Published: October 2018

Abstract
Background
The literature is replete with attempts to design and promote customized guidelines to reduce infections during the care continuum. Paradoxically, these efforts sometimes result in gray areas where many staff members are unaware of what is required of them, which then leads to confusion, frustration, and uncertainty.
We coined the phrase “gray areas” in this context to encompass the variety of situations on the care continuum that are not addressed in the accepted guidelines, and where staff members are unsure of how to proceed.
The purpose of the present study was to characterize the gray areas that were reported by staff and to identify the practices of Positive Deviance (PD) individuals. We define to PD individuals as people who independently develop creative solutions to solve problems not identified by the majority in their community.

Methods
A qualitative constructivist research methodology was used that included personal interviews, observations and video recordings of identified PD practices to enhance infection control. The study was conducted January through March 2018, in two Intensive Care Units (ICU) units at Hadassah Hospital, Jerusalem, Israel. Personal interviews were conducted with 82 staff members from the General ICU (GICU) and Medical ICU (MICU).

Results
The study confirmed that guidelines cannot cover all the different situations that arise during the care continuum and can paradoxically result in the increased spread of hospital infections. Our study found there are numerous individuals who independently develop and implement solutions for gray areas. The creative and practical solutions of PD individuals can address the barriers and difficulties on the care continuum that were encountered by the staff in their communities. For example, inserting a central venous line is a complex practice in the general guidelines, while the PDs provided clear situation-specific solutions not covered in the guidelines.

Conclusions
The recommendations of the present study are to encourage hospital personnel to create their own solutions for various situations on the care continuum, and to disseminate them within their units to achieve a bottom up change, in lieu of investing in new or specific written guidelines.
Health-Related Quality of Life in Patients Treated With Antiretroviral Therapy Only Versus Chemotherapy and Antiretroviral Therapy for HIV-Associated Kaposi Sarcoma: A Randomized Control Trial
Authors: Shaik Fahmida , Uldrick Thomas S. , Esterhuizen Tonya , Mosam Anisa 
Published: October 2018

Purpose In sub-Saharan Africa, Kaposi sarcoma (KS) is the most common HIV-associated cancer. KS causes substantial morbidity, and treatment goals should emphasize quality of life (QOL). Antiretroviral therapy (ART) is indicated, and early chemotherapy significantly improves tumor regression. The effect of ART alone or with chemotherapy on QOL in treatment-naïve South Africans with HIV-associated KS was assessed. Methods KAART (Kaposi Sarcoma AIDS Anti-Retroviral Therapy) is a randomized, controlled, open-label trial of ART versus ART plus chemotherapy. Crossover between arms was allowed for patients with progressive disease. Eighty-nine percent of patients had advanced tumor burden. Within KAART, QOL measured by European Organization for Research and Treatment of Cancer-QLQ-C30 questionnaire evaluated functional and symptom domains and global QOL. Intragroup changes between baseline and month 12 (Wilcoxon rank sign test), changes between the arms (Mann-Whitney test), and the relationship between responses, determined by AIDS Clinical Trial Group criteria and QOL measures (Kruskal-Wallis test), were evaluated. P values < .01 were considered significant. Results QOL information was available for 111 of 112 patients. Significant improvements over 12 months were seen in global health status and functional scales (emotional, cognitive, and social scales; not physical and role function). Most symptom scales (fatigue, pain, dyspnea, insomnia, appetite, diarrhea, and constipation) also showed significant improvement. There were no statistically significant changes between arms in intention-to-treat analysis. Patients showing a response to the tumor (complete or partial) reported significantly increased global QOL ( P < .001), pain relief, and improved role functioning. Adherence, adverse events, HIV viral load, and CD4 count did not correlate with global QOL. Conclusion African patients with HIV-associated KS derive a significant benefit in QOL from ART and tumor regression.
Financial Toxicity in Adults With Cancer: Adverse Outcomes and Noncompliance
Authors: Knight Thomas G. , Deal Allison M. , Dusetzina Stacie B. , Muss Hyman B. , Choi Seul Ki , Bensen Jeannette T. , Williams Grant R. 
Published: October 2018

Purpose: Because of the escalating cost of cancer care coupled with high insurance deductibles, premiums, and uninsured populations, patients with cancer are affected by treatment-related financial harm, known as financial toxicity. The purpose of this study was to describe individuals reporting financial toxicity and to identify rates of and reasons for affordability-related treatment noncompliance. Methods: From May 2010 to November 2015, adult patients (age ≥ 18 years) with cancer were identified from a Health Registry/Cancer Survivorship Cohort. Financial toxicity was defined as agreement with the phrase “You have to pay for more medical care than you can afford” from the Patient Satisfaction Questionnaire-18. Logistic regression and Fisher exact tests were used to compare groups. Results: Of 1,988 participants, 524 (26%) reported financial toxicity. Patients reporting financial toxicity were more likely age 65 years or younger, female, nonwhite, non-English speaking, not married, less educated, and to have received a diagnosis more recently (all P < .001). Participants with financial toxicity were more likely to report noncompliance with medication, owing to inability to afford prescription drugs (relative risk [RR], 3.55; 95% CI, 2.53 to 4.98), and reported forgoing mental health care (RR, 3.89; 95% CI, 2.04 to 7.45), doctor’s visits (RR, 2.98; 95% CI, 1.97 to 4.51), and medical tests (RR, 2.54; 95% CI, 1.49 to 4.34). The most endorsed reasons for delayed care were not having insurance coverage and being unable to afford household expenses. Conclusion: More than 25% of adults with cancer reported financial toxicity that was associated with an increased risk for medical noncompliance. Financial toxicity remains a major issue in cancer care, and efforts are needed to ensure patients experiencing high levels of financial toxicity are able to access recommended care.
Long-term strategies in patients with unprovoked venous thromboembolism
Authors: Prandoni P. 
Published: October 2018

SummaryOnce anticoagulation is stopped, the risk of recurrent venous thromboembolism (VTE) over years approaches 40 % of all patients with a first episode of VTE. The risk is twice as high in patients with unprovoked VTE than in those with minor (either transient or persistent) risk factors of thrombosis. Although the latest international guidelines suggest indefinite anticoagulation for most patients with a first episode of unprovoked VTE, strategies that incorporate the assessment of residual vein thrombosis and D-dimer have the potential to identify a substantial proportion of subjects in whom anticoagulation can be safely discontinued. For those patients in whom anticoagulation cannot be discontinued, new opportunities are offered by the availability of low-dose anti-Xa compounds, which have been found to possess an extremely favorable benefit/risk profile.
EHIT after thermoablation
Authors: Leo M. , Romano R. , Di Mitri R. 
Published: October 2018

SummaryAim: After 10 years of experience, we evaluated the incidence and management of endothermal heat-induced-thrombosis (EHIT), i.e. saphenous vein thrombosis following endothermic treatment of saphenous vein re-flux.Methods: From 2006 to 2016 data were retrospectively collected on 840 patients undergoing saphenous vein treatment by laser and radiofrequency technique. All patients were treated with tumescent local anaesthesia in an ambulatory setting to promote early mobilization. Class II compression stockings and heparin were recommended for 5 days post-operatively.Results: EHIT was observed in 15 patients from a total of 992 saphenous veins which were evaluated (1,5 %). 14 patients treated by EVLA had EHIT 1, one patient by RFA had EHIT 2, complicated by pulmonary embolism. All EHIT patients were treated by low weight molecular heparin. 980 nm laser and bare-tip fibres had been used in EVLA-EHIT patients. EHIT was not observed in patients treated by 1470 nm laser and radial fibres.Conclusions: Latest generation technology, the ambulatory setting and local anaesthesia probably contributed to the low incidence of EHIT reported. Further studies are necessary for a better acquaintance of these complications and to facilitate the development of specific guidelines.
Operative Therapie einer ausgedehnten iliofemoralen Thrombose
Authors: Keitou A. Z. 
Published: October 2018

ZusammenfassungDie konservative Therapie der tiefen Bein-/ Beckenvenenthrombose (TVT) ist mit einem hohen Risiko für die Entwicklung eines post-thrombotischen Syndroms korreliert. Solche Folgeschäden an den tiefen Venen können nur durch invasive Maßnahmen vermieden werden. Dies kann durch Rekanalisation der verschlossenen Venen und Wiederherstellung der Funktion des Klappenapparates mit chirurgischen, fibrinolytischen und interventionellen Methoden erreicht werden.
Adipositas-assoziierte Lymphödeme – unterschätzt und unterbehandelt
Authors: Bertsch T. 
Published: October 2018

ZusammenfassungDer weltweite Anstieg der Adipositasprävalenz – die WHO spricht bereits von einer Adipositasepidemie – hat auch eine dramatische Veränderung innerhalb der Lymphologie zur Folge. Während „klassisch sekundäre” Lymphödeme nach onkologischen Operationen aufgrund verbesserter OP-Techniken abnehmen, steigt die Zahl von Patienten mit Lymphödemen, die Adipositas-assoziiert, sind exponentiell an. Dieser Wandel im lymphologischen Patientengut wird aktuell noch weitgehend unterschätzt – häufig auch negiert. So ist dieses Thema sowohl auf wissenschaftlichen Kongressen als auch in der Fachliteratur, wenn überhaupt nur marginal repräsentiert. Im klinischen Umgang dominiert vor allem Hilflosigkeit gegenüber diesen Patienten. Dabei ist der pathophysiologische Zusammenhang zwischen Adipositas und Lymphödem inzwischen gut belegt. Adipositas kann Lymphödeme verursachen bzw. bestehende Lymphödeme verschlechtern. Therapiekonzepte, die isoliert das Lymphödem fokussieren, die Adipositas aber als wesentliche Ursache ignorieren, sind daher nicht zielführend. Ebenso kontraproduktiv ist ein therapeutischer Ansatz, der Adipositas mittels Diäten bzw. durch kommerzielle Gewichtsreduktionsprogramme behandelt. Diäten und Gewichtsreduktionsprogramme haben im Langzeitverlauf bisher nur eines bewiesen – dass sie scheitern. In der Földiklinik werden adipöse Patienten mit Lymphödemen (auch mit Lipödemen) im Rahmen eines multimodalen Adipositasprogramm behandelt. In diesem Programm werden u. a. internistische, psychologische, ggf. auch adipositaschirurgische und plastisch-chirurgische Therapieoptionen angewandt; die Betreuung der Patienten ist langfristig angelegt. Entgegen Vermutungen ist die Therapie von Patienten mit Adipositas-assoziierten Lymphödemen meist sehr dankbar, dankbar weil Patienten nicht nur eine essenzielle Verbesserung ihres Lymphödemes erfahren, dankbar auch, weil viele Patienten durch die im Rahmen eines adipositaschirurgischen Eingriffes erfolgte Gewichtsreduktion wieder in ein normales, weitgehend gesundes Leben zurückkehren.
Adipositas und chronische Inflammation bei phlebologischen und lymphologischen Erkrankungen
Authors: Faerber G. 
Published: October 2018

ZusammenfassungDie Prävalenz der Adipositas ist in den letzten 15 Jahren weiter stark angestiegen. Dabei fällt besonders die deutliche Zunahme der morbiden Adipositas auf, die wiederum bei den Älteren besonders ausgeprägt ist. Da mit dem Alter auch venöse Thromboembolien, chronisch venöse Insuffizienz und sekundäre Lymphödeme zunehmen, steigt die Zahl der Patienten mit venösen oder lymphatischen Erkrankungen, die gleichzeitig schwer adipös und häufig multimorbide sind, überproportional an. Die Adipositas, vor allem die viszerale, verschlechtert alle Ödemerkrankungen, erhöht das Risiko für thromboembolische Erkrankungen und postthrombotisches Syndrom und kann alleinige Ursache sein für die Adipositas-assoziierte funktionelle Veneninsuffizienz ohne Nachweis von Obstruktion oder Reflux. Das Adipositasassoziierte Lymphödem stellt inzwischen den größten Anteil unter den sekundären Lymphödemen. Mehr als 50 Prozent der Lipödempatientinnen sind adipös, die bei ihnen im Verlauf zu beobachtenden sekundären Lymphödeme in der Regel Folge der Adipositas, nicht des Lipödems. Die Symptomatik wird bei allen Krankheitsbildern durch Gewichtsreduktion gebessert. Neben mechanischen Faktoren wie der Erhöhung des intraabdominalen und intertriginösen Drucks, der wiederum zu einer venösen Drucksteigerung in den Beingefäßen führt, sind es vor allem die durch die Zunahme des viszeralen Fettgewebes verursachten metabolischen, chronisch inflammatorischen und prothrombotischen Prozesse, die für diese Zusammenhänge verantwortlich sind, erkennbar an niedrigen Spiegeln von Adiponektin und hohen von Leptin, Insulin, intaktem Proinsulin, PAI-1 sowie proinflammatorischen Zytokinen (Il-6, Il-8, TNF-α). Therapeutische Maßnahmen müssen also in erster Linie auf die Reduktion der viszeralen Adipositas und damit der Hyperinsulinämie bzw. der Insulinresistenz sowie auf die Bekämpfung der chronischen Entzündung abzielen.
Varizenchirurgie bei Adipositas
Authors: Donath M. , Buhr J. K. , Bruning G. 
Published: October 2018

ZusammenfassungDie operative Sanierung der Varikosis stellt bei korrektem intraoperativen Management auch bei adipösen Patienten eine hervorragende Therapieoption dar. Bei der operativen Sanierung der Vena saphena parva und der Seitenastvarikosis ist das Körpergewicht vernachlässigbar, die operative Therapie der Vena saphena magna muss jedoch gewichtsadaptiert geplant und angepasst werden: Der operative Zugang sollte oberhalb der Leistenbeuge und ausreichend groß gewählt werden, die Stumpfligatur mit nicht resorbierbarem Nahtmaterial doppelt ligiert und das Stumpfendothel koaguliert werden. Crossenrezidive stellen insbesondere bei adipösen Patienten sowohl nach operativer Sanierung der Varikosis, als auch nach endovenösen Therapieverfahren eine operative Herausforderung dar. Die Komplikationsrate bei operativer Sanierung ist sehr niedrig. Die Infektionsrate liegt bei adipösen Patienten nur marginal oberhalb derer von Patienten mit einem BMI < 30. Eine Risikoeinschätzung von endovenösen Therapien bei adipösen Patienten steht aktuell aus. Es besteht allerdings eine höhere Rezidivneigung bei größerlumigen Gefäßen.
Use of Stimulan absorbable calcium sulphate beads in revision lower limb arthroplasty
Authors: Kallala R. , Harris W. Edwin , Ibrahim M. , Dipane M. , McPherson E. 
Published: October 2018

Aims Calcium sulphate has traditionally been used as a filler of dead space arising during surgery. Various complications have been described following the use of Stimulan bio-absorbable calcium sulphate beads. This study is a prospective observational study to assess the safety profile of these beads when used in revision arthroplasty, comparing the complication rates with those reported in the literature. Methods A total of 755 patients who underwent 456 revision total knee arthroplasties (TKA) and 299 revision total hip arthroplasties (THA), with a mean follow-up of 35 months (0 to 78) were included in the study. Results A total of 32 patients (4.2%) had wound drainage, and this was higher with higher bead volumes and in McPherson grade C patients. There was also a significantly higher bead volume in the 41 patients who developed hypercalcaemia, two of which were symptomatic (p < 0.0001). A total of 13 patients (1.7%) had heterotopic ossification (HO). There was no statistically significant relationship between the development of HO and bead volume (p > 0.05). Conclusion The strength of this study lies in the large number of patients and the detailed data collection, making it the most comprehensive report available in the literature on the use of calcium sulphate-based bone substitutes. Cite this article: R. Kallala, W. Edwin Harris, M. Ibrahim, M. Dipane, E. McPherson. Use of Stimulan absorbable calcium sulphate beads in revision lower limb arthroplasty: Safety profile and complication rates. Bone Joint Res 2018;7:570–579. DOI: 10.1302/2046-3758.710.BJR-2017-0319.R1.
The acute Charcot foot in diabetics
Authors: Yousaf Sohail , Dawe Edward J.C. , Saleh Alan , Gill Ian R. , Wee Alex 
Published: October 2018

Acute Charcot foot is a diagnostic challenge. The exact pathophysiology is not fully understood. Acute Charcot foot is often present with a history of trauma or cellulitis which does not respond to antibiotics. The condition is best managed within a multidisciplinary team. The mainstay of the treatment is mechanical off-loading and total contact casting. Surgery is reserved for select cases. Cite this article: EFORT Open Rev 2018;3:568-573. DOI: 10.1302/2058-5241.3.180003
A Produção Acadêmica Sobre Redes Sociais Virtuais no Brasil: Análise dos Artigos Publicados em Eventos entre 2006 e 2015
Authors: Visentini Monize Sâmara , Chagas Fernanda Bard , Bobsin Debora 
Published: October 2018

Este artigo realiza um levantamento bibliográfico do período compreendido entre 2006 e 2015 de pesquisas na área de administração no que tange as redes sociais virtuais. Foram analisados 89 artigos publicados no Encontro da ANPAD (EnANPAD), no Encontro da Administração da Informação (ENADI), no Encontro da Divisão de Marketing da ANPAD (EMA), no Encontro Nacional da Engenharia da Produção (ENEGEP), nos Seminários em Administração (SemeAD) e também no International Conference on Management of Technology and Information Systems (CONTECSI). Os resultados indicaram predominância de estudos empíricos e qualitativos, com preponderância de pesquisas descritivas, destacando investigações através de survey e estudos de caso. Dentre as redes sociais estudadas, o Facebook aparece como a mais explorada. Outro ponto identificado é que boa parte dos artigos selecionados teve alguma teoria, ou modelo, como base metodológica, sendo que houve maior incidência de uso desses modelos e teorias pelos autores dos eventos EnANPAD, SemeAD e Contecsi.
Rupture, repression, repetition: The Algerian War of Independence in the present
Authors: Hartley Daniel , Ivey Beatrice 
Published: October 2018

Abstract
What are the legacies of the Algerian War of Independence in the present? More specifically, how do the Algerian War of Independence and its subsequent memorializations force us to reconceptualize historical temporality itself (of which the ‘legacy’ is but one variation)? The following introduction to this special issue provides an overarching framework for multiple answers to these questions. The first half of the introduction focuses on the philosophical and conceptual afterlives of the Algerian War in contemporary French critical thought. In doing so, it attempts to delineate the significant political import of historical temporality as such, setting out a basic problematic to which the articles that follow can be seen variously to respond. In the second part of the introduction, the general cultural and historical legacies of the Algerian War of Independence, and the ‘mnemonic forms’ (Erll 2011) of rupture, repression and repetition that mediate them, come into focus: the ‘rupture’ from a colonial past, the Freudian ‘repression’ of traumatic history, and the ostensible ‘repetition’ of violence in the present. In general, the introduction hopes to open a dialogue with works conducted on these ‘forms’, scrutinizing the effects they have had on the various re-imaginings of the war and its transnational legacies, yet without foreclosing other forms this history may take.
The influence of French colonial humanism on the study of late antiquity: Braudel, Marrou, Brown
Authors: Hunt Thomas E. 
Published: October 2018

Abstract
Late antiquity is a sub-discipline of history. It is also a particular way of representing the time and space of the past. Studies in late antiquity tend to focus on the culture and society of the late Roman world. This article argues that this way of imagining time and space and people derives from francophone debates about colonial governance that were current in the 1920s and 1930s. This colonial humanism provided the context for two francophone authors whose work heavily influenced the formation of late antiquity: Fernand Braudel and Henri Marrou. This article shows how Braudel and Marrou were influenced by colonial humanism and how this influence shaped the formation of late antiquity. Historiographical accounts of the study of late antiquity have noted a recurring preoccupation with modernity. This article argues that late antiquity is modern to the extent that it is dependent on the colony for its constitution.
Regulation and co-regulation of product placement for OTT SVODs: The case of Netflix
Authors: Dagnino Gloria 
Published: October 2018

Abstract
Commercial communications constitute one of the policy areas where differences between traditional broadcasting media and over-the-top (OTT) subscription video on-demand services (SVODs) emerge more dramatically. This article focuses on the exemplary case of global market leader Netflix to examine how this US-born company has been adjusting to EU regulation on product placement (PP) identification. Moreover, the article presents and discusses some of the criticisms that were raised with regard to Netflix’s supposed violation of the ban on the placement of tobacco products. The article argues that Netflix still fails to adequately disclose PP to its viewers. The article also advances a proposal for co-regulation on these matters, in light of the upcoming revised version of the EU Audiovisual Media Services Directive (AVMSD). An effective regulation of PP in OTT SVOD programmes is essential because watching Internet-based television is ever more a mainstream habit, particularly among young demographics, and because PP is a key revenue source for ad-free services like Netflix.
Locating New Literary Practices in Indian Digital Spaces
Authors: T Shanmugapriya , Menon Nirmala 
Published: October 2018

In this essay, we locate and explore new literary practices and expressions in Indian digital spaces such as SMS novel and social media narratives: poetry, flash fiction, twitterfiction which are not considered as electronic literature in India. The integration of technology and creativity is not a novel phenomenon in Indian literature where one can find the narrative tradition of ancient Indian literature which includes poetical words, paintings, and music, for instance, Pattachitra, Ragamala paintings and Chitra Kavi. Similarly, new literary practices and expressions in the digital environment include literary artefacts such as interfaces, images, audio and videos. These works serve as a gateway to exciting electronic literature in India.