bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do ward round stickers improve surgical ward round? A quality improvement project in a high-volume general surgery department
Authors: Ng Jimmy , Abdelhadi Ahmed , Waterland Peter , Swallow Jonathan , Nicol Deborah , Pandey Steve , Zilvetti Miguel , Karim Ahmed 
Published: July 2018

IntroductionIncreasing pressure and limitations on the NHS necessitate simple and effective ways for maintaining standards of patient care. This quality improvement project aims to design and implement user-friendly and clear ward round stickers as an adjunct to surgical ward rounds to evidence standardised care.Project design and strategyBaseline performance was measured against the recommended standards by the Royal College of Physicians, General Medical Council and a study performed at the Imperial College London. A total of 16 items were studied. All members of staff in surgery department were informed that an audit on ward round entries would be implemented but exact dates and times were not revealed. In the first cycle, ward round sticker was implemented and results collected across three random days for use and non-use of sticker. Feedback was collected through the use of questionnaires. In the second cycle, the ward round sticker was redesigned based on feedback and results collected for use and non-use of sticker.ResultsBaseline performance noted in 109 ward round entries showed that checking of drug chart, intravenous fluid chart, analgesia, antiemetic, enoxaparin, thromboembolic deterrents ranged from 0% to 6%. With the introduction of ward round stickers in both cycles, there was noticeable improvement from baseline in all items; in ward round entries where stickers were not used, performance was similar to baseline.ConclusionThis quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards. Constant efforts need to be made to promote compliance and sustainability. Commitment from all levels of staff are paramount in ensuring standardised patient care without overlooking basic aspects.
Connecting perspectives on quality and safety: patient-level linkage of incident, adverse event and complaint data
Authors: de Vos Marit S , Hamming Jaap F , Chua-Hendriks Jolanda J C , Marang-van de Mheen Perla J 
Published: July 2018

Background and objectiveIncident, adverse event (AE) and complaint data are typically used separately, but may be related at the patient level with one event triggering a cascade of events, ultimately resulting in a complaint. This study examined relations between incidents, AEs and complaints that co-occurred in admissions.MethodsIndependently and routinely collected incident, AE and complaint data were retrospectively linked for surgical admissions in an academic centre (2008–2014). Two investigators reviewed whether incidents/AEs in admissions were clinically related and in what sequence (incident preceding vs following AE). Likelihood of occurrence of AEs and AE cascades (ie, ≥3 AEs) was studied using logistic regression analyses.ResultsComplaints were filed for 33 (0.1%) of 26 383 admissions. Complaints filed by patients with incidents and/or AEs (n=13) mostly addressed quality/safety problems, whereas other complaints mostly addressed relationship problems. Incidents and AEs co-occurred in 730 (2.8%) admissions, which seemed clinically related in 34% of these cases. Incidents with related AEs preceded as well as followed AEs (56.6%/44.4%). Patients with incidents were at greater risk of AEs than patients without incidents, even for seemingly unrelated AEs (OR 1.4; 95% CI 1.3 to 1.6). Risk of AE cascades was greater when patients with AEs also had incidents, regardless of whether these seemed related (unrelated: OR 2.0; 95% CI 1.6 to 2.5; related: OR 5.7; 95% CI 4.3 to 7.4) or whether incidents preceded or followed AEs in these admissions (53% vs 52%, P>0.05).ConclusionsPatient-level linkage of incident, AE and complaint data can reveal relations between events that otherwise remain obscured, such as incidents that trigger as well as follow AEs, introducing event cascades, regardless of whether clinical relations seem present.
Conflict resolution in anaesthesia: systematic review
Authors: Almghairbi Dalal Salem , Marufu Takawira C , Moppett Iain K 
Published: July 2018

BackgroundConflict is a significant and recurrent problem in most modern healthcare systems. Given its ubiquity, effective techniques to manage or resolve conflict safely are required.ObjectiveThis review focuses on conflict resolution interventions for improvement of patient safety through understanding and applying/teaching conflict resolution skills that critically depend on communication and improvement of staff members’ ability to voice their concerns.MethodsWe used the Population-Intervention-Comparator-Outcome model to outline our methodology. Relevant English language sources for both published and unpublished papers up to February 2018 were sourced across five electronic databases: the Cochrane Library, EMBASE, MEDLINE, SCOPUS and Web of Science.ResultsAfter removal of duplicates, 1485 studies were screened. Six articles met the inclusion criteria with a total sample size of 286 healthcare worker participants. Three training programmes were identified among the included studies: (A) crisis resource management training; (B) the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) training; and (C) the two-challenge rule (a component of TeamSTEPPS), and two studies manipulating wider team behaviours. Outcomes reported included participant reaction and observer rating of conflict resolution, speaking up or advocacy-inquiry behaviours. Study results were inconsistent in showing benefits of interventions.ConclusionThe evidence for training to improve conflict resolution in the clinical environment is sparse. Novel methods that seek to influence wider team behaviours may complement traditional interventions directed at individuals.
Development of a new clinical decision rule for cervical CT to detect cervical spine injury in patients with head or neck trauma
Authors: Inagaki Takeshi , Kimura Akio , Makishi Go , Tanaka Shigeru , Tanaka Noriko 
Published: July 2018

ObjectivePrevious cervical spine imaging decision rules have been based on positive findings on plain X-ray and are limited by lack of specificity, age restrictions and complicated algorithms. We previously derived and validated a clinical decision rule (Rule 1) for detecting cervical spine injury (CSI) on CT in a single-centre study. This recommended CT for patients with (1) GCS score <14, (2) GCS 14–15 and posterior cervical tenderness or neurological deficit, (3) age ≥60 years and fall down stairs, or (4) age <60 and injured in a motorcycle collision or fallen from height. This study assessed the accuracy and reliability of this rule and refined the rule.MethodsWe conducted a prospective, dual-centre study at two Japanese EDs between August 2012 and March 2014. Patients with head or neck injury ≥16 years of age were included. Clinical data were collected from medical records. Imaging was at the discretion of the treating physician. CSI was diagnosed as a fracture or dislocation seen on CT; patients who were not imaged were followed for 14 days. We analysed the sensitivity and specificity of Rule 1 and refined it post hoc using recursive partitioning.Results1192 patients were enrolled. 927 completed follow-up. Of these, 584 (63.0%) underwent CT imaging and 38 had CSI. Sensitivity and specificity of Rule 1 were 92.1% (95% CI 79.2% to 97.3%) and 58.6% (95% CI 55.4% to 61.9%). A second rule (Rule 2) was derived recommending CT for those with any of the following: GCS <14, cervical tenderness, neurological deficit or mechanism of injury (fall down stairs, motorcycle collision or fall from height) without age limits. Sensitivity and specificity were 100% (95% CI 90.8% to 100%) and 51.9% (95% CI 48.6% to 55.2%), respectively.ConclusionsOur initial CT decision rule had lower sensitivity than in our initial validation study. A refined decision rule based on GCS, neck tenderness, neurological deficit and mechanism of injury showed excellent sensitivity with a small loss of specificity. Rule 2 will now need validation in an independent cohort.
Transcranial magnetic stimulation predicts cognitive decline in patients with Alzheimer’s disease
Authors: Motta Caterina , Di Lorenzo Francesco , Ponzo Viviana , Pellicciari Maria Concetta , Bonnì Sonia , Picazio Silvia , Mercuri Nicola Biagio , Caltagirone Carlo , Martorana Alessandro , Koch Giacomo 
Published: July 2018

ObjectiveTo determine the ability of transcranial magnetic stimulation (TMS) in detecting synaptic impairment in patients with Alzheimer’s disease (AD) and predicting cognitive decline since the early phases of the disease.MethodsWe used TMS-based parameters to evaluate long-term potentiation (LTP)-like cortical plasticity and cholinergic activity as measured by short afferent inhibition (SAI) in 60 newly diagnosed patients with AD and 30 healthy age-matched subjects (HS). Receiver operating characteristic (ROC) curves were used to assess TMS ability in discriminating patients with AD from HS. Regression analyses examined the association between TMS-based parameters and cognitive decline. Multivariable regression model revealed the best parameters able to predict disease progression.ResultsArea under the ROC curve was 0.90 for LTP-like cortical plasticity, indicating an excellent accuracy of this parameter in detecting AD pathology. In contrast, area under the curve was only 0.64 for SAI, indicating a poor diagnostic accuracy. Notably, LTP-like cortical plasticity was a significant predictor of disease progression (p=0.02), while no other neurophysiological, neuropsychological and demographic parameters were associated with cognitive decline. Multivariable analysis then promoted LTP-like cortical plasticity as the best significant predictor of cognitive decline (p=0.01). Finally, LTP-like cortical plasticity was found to be strongly associated with the probability of rapid cognitive decline (delta Mini-Mental State Examination score ≤−4 points at 18 months) (p=0.04); patients with AD with lower LTP-like cortical plasticity values showed faster disease progression.ConclusionsTMS-based assessment of LTP-like cortical plasticity could be a viable biomarker to assess synaptic impairment and predict subsequent cognitive decline progression in patients with ADs.
Late functional improvement after lacunar stroke: a population-based study
Authors: Ganesh Aravind , Gutnikov Sergei A , Rothwell Peter Malcolm ,   for the Oxford Vascular Study
Published: July 2018

BackgroundRecovery in function after stroke involves neuroplasticity and adaptation to impairments. Few studies have examined differences in late functional improvement beyond 3 months among stroke subtypes, although interventions for late restorative therapies are often studied in lacunar stroke. Therefore, we compared rates of functional improvement beyond 3 months in patients with lacunar versus non-lacunar strokes.MethodsIn a prospective, population-based cohort of 3-month ischaemic stroke survivors (Oxford Vascular Study; 2002–2014), we examined changes in functional status (modified Rankin Scale (mRS), Rivermead Mobility Index (RMI), Barthel Index (BI)) in patients with lacunar versus non-lacunar strokes from 3 to 60 months poststroke, stratifying by age. We used logistic regression adjusted for age, sex and baseline disability to compare functional improvement (≥1 mRS grades, ≥1 RMI points and/or ≥2 BI points), particularly from 3 to 12 months.ResultsAmong 1425 3-month survivors, 234 patients with lacunar stroke did not differ from others in 3-month outcome (adjusted OR (aOR) for 3-month mRS >2 adjusted for age/sex/National Institutes of Health Stroke Scale score/prestroke disability: 1.14, 95% CI 0.75 to 1.74, p=0.55), but were more likely to demonstrate further improvement between 3 months and 1 year (aOR (mRS) adjusted for age/sex/3-month mRS: 1.64, 1.17 to 2.31, p=0.004). The results were similar on restricting analyses to patients with 3-month mRS 2–4 and excluding recurrent events (aOR (mRS): 2.28, 1.34 to 3.86, p=0.002), or examining BI and RMI (aOR (RMI) adjusted for age/sex/3-month RMI: 1.78, 1.20 to 2.64, p=0.004).ConclusionPatients with lacunar strokes have significant potential for late functional improvement from 3 to 12 months, which should motivate patients and clinicians to maximise late improvements in routine practice. However, since late recovery is common, intervention studies enrolling patients with lacunar strokes should be randomised and controlled.
Age at onset of genetic (E200K) and sporadic Creutzfeldt-Jakob diseases is modulated by the CYP4X1 gene
Authors: Poleggi Anna , van der Lee Sven , Capellari Sabina , Puopolo Maria , Ladogana Anna , De Pascali Eleonora , Lia Debora , Formato Alessia , Bartoletti-Stella Anna , Parchi Piero , van Duijn Cornelia , Pocchiari Maurizio 
Published: July 2018

ObjectivesThe Glu to Lys change at codon 200 (E200K) of the PRNP gene is the most frequent mutation associated to genetic Creutzfeldt-Jakob disease (CJD) and the only one responsible for geographical clusters. Patients carrying this mutation develop disease at different ages and show variable clinical phenotypes that are not affected by the methione/valine polymorphism at codon 129 of the PRNP gene suggesting the influence of other factors. The objective of this study is to look for genes other than PRNP that might be responsible of this variability.MethodsWe searched for other genes by performing genome-wide analyses (GWA) on 19 patients with genetic CJD and 18 healthy subjects carrying the E200K mutation of PRNP and belonging to the Calabrian cluster in Italy. We then validate this result in 32 patients with E200K CJD from non-cluster areas and 259 patients with sporadic CJD referred to the Italian CJD national registry.Results and conclusionsWe identified two single nucleotide polymorphisms on the CYP4X1 gene locus as candidate disease modifiers in patients with E200K CJD of the cluster area and confirmed this finding in 32 patients with E200K CJD from non-cluster areas and 259 patients with sporadic CJD. Our results indicate that the CYP4X1 gene modulates the onset of disease in patients with E200K genetic and sporadic CJD. This finding improves our understanding on the pathogenesis of CJD, suggests new targets for developing novel therapeutic strategies and might be useful for the stratification of patients in future preventive treatment trials.
Association between benzene and congenital anomalies in Oklahoma, 1997–2009
Authors: Janitz Amanda E , Dao Hanh Dung , Campbell Janis E , Stoner Julie A , Peck Jennifer D 
Published: July 2018

ObjectivesAlthough the most common cause of death in infants, little is known about the aetiology of congenital anomalies. Recent studies have increasingly focused on environmental exposures, including benzene. While benzene is known to affect the central nervous system, the effects on the developing fetus are unclear.MethodsWe conducted a retrospective cohort study to evaluate the association between ambient benzene exposure and the prevalence of congenital anomalies among 628 121 singleton births in Oklahoma from 1997 to 2009. We obtained benzene from the Environmental Protection Agency’s 2005 National-Scale Air Toxics Assessment for the census tract of the birth residence. We used modified Poisson regression with robust SEs to calculate prevalence proportion ratios (PPRs) and 95% CIs between quartiles of benzene exposure and critical congenital heart defects (CCHDs), neural tube defects (NTDs) and oral clefts adjusted for maternal education and tobacco use.ResultsMedian benzene exposure concentration in Oklahoma was 0.57 µg/m3. We observed no association between benzene exposure and oral clefts, CCHDs or NTDs. When specific anomalies were examined, we observed an increased prevalence of cleft lip among those exposed to the second quartile of benzene compared with the first (PPR 1.50, 95% CI 1.05 to 2.13), though no association with higher levels of exposure.ConclusionsOur findings do not provide support for an increased prevalence of anomalies in areas more highly exposed to benzene. Future studies would benefit from pooling data from multiple states to increase statistical power and precision in studies of air pollutants and specific anomalies.
Association between night-shift work, sleep quality and metabolic syndrome
Authors: Lim Yin Cheng , Hoe Victor C W , Darus Azlan , Bhoo-Pathy Nirmala 
Published: July 2018

ObjectivesOccupational factors, particularly night-shift work, are attracting growing interest as a possible determinant of metabolic syndrome (MetS). This study aimed to determine the association between night-shift work and MetS, and assess whether sleep quality is a mediating factor.MethodsA cross-sectional study was conducted among Malaysian manufacturing workers, aged 40–65 years old. They completed a self-administered questionnaire on sociodemographics, lifestyle and family history, and the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Waist circumference, blood pressure, fasting blood sugar, triglycerides and high-density lipoprotein levels were measured. Baron and Kenny’s method, Sobel test and multiple mediation models with bootstrapping were used to determine whether the PSQI global score or its components mediated the association between night-shift work and MetS.ResultsOf the 494 participants, 177 (36%) worked night shift and 51% were men. The prevalence of MetS was 37%. Night-shift work was independently associated with a twofold increase in the risk of MetS (adjusted OR: 1.92, 95% CI 1.24 to 2.97). However, the association between night-shift work and MetS did not appear to be modified by sex. Night-shift workers also reported significantly poorer sleep quality, longer sleep latency, shorter sleep duration, sleep disturbances and daytime dysfunction. Robust mediation analysis nonetheless showed that neither PSQI global score nor its components mediated the association between night-shift work and MetS.ConclusionEarly screening and management of MetS and the development of programmes to improve sleep quality should be carried out among night-shift workers. Future research should investigate other modifiable mediators linking night-shift work and MetS.
Contribution of obstructive sleep apnoea to arterial stiffness: a meta-analysis using individual patient data
Authors: Joyeux-Faure Marie , Tamisier Renaud , Borel Jean-Christian , Millasseau Sandrine , Galerneau Louis-Marie , Destors Marie , Bailly Sébastien , Pepin Jean Louis 
Published: July 2018

BackgroundArterial stiffness, measured by pulse wave velocity (PWV), is a strong independent predictor of late cardiovascular events and mortality. It is recognised that obstructive sleep apnoea (OSA) is associated with cardiovascular comorbidities and mortality. Although previous meta-analyses concluded that PWV is elevated in OSA, we feel that an individual patient data analysis from nine relatively homogeneous studies could help answer: to what extent does OSA drive arterial stiffness?MethodsIndividual data from well-characterised patients referred for suspicion of OSA, included in nine studies in which carotid–femoral PWV was measured using a Complior device, were merged for an individual patient data meta-analysis.Results893 subjects were included (age: 56±11 (mean±SD), 72% men, 84% with confirmed OSA). Body Mass Index varied from 15 to 81 kg/m2 (30±7 kg/m2). PWV ranged from 5.3 to 20.5 m/s (10.4±2.3 m/s). In univariate analysis, log(PWV) was strongly related to age, gender, systolic blood pressure, presence of type 2 diabetes (all p<0.01) as well as to dyslipidaemia (p=0.03) and an Epworth Sleepiness Scale score ≥9 (p=0.04), whereas it was not related to obesity (p=0.54), a severe Apnoea–Hypopnoea Index (p=0.14), mean nocturnal saturation (p=0.33) or sleep time with oxygen saturation below 90% (p=0.47). In multivariable analysis, PWV was independently associated with age, systolic blood pressure and diabetes (all p<0.01), whereas severe OSA was not significantly associated with PWV.ConclusionOur individual patient meta-analysis showed that elevated arterial stiffness in patients with OSA is driven by conventional cardiovascular risk factors rather than apnoea parameters.
A Novel Inhibitor Targets Both Wnt Signaling and ATM/p53 in Colorectal Cancer
Authors: Cheng Jiongjia , Dwyer Mary , Okolotowicz Karl J. , Mercola Mark , Cashman John R. 
Published: July 2018

Abstract
For 2017, the estimated lifetime risk of developing colorectal cancer was 1 in 22. Even though preventative colonoscopy screening and standard-of-care surgery, radiation, and chemotherapy have decreased the death rate from colorectal cancer, new therapies are needed for metastatic colorectal cancer. Here, we developed a novel small molecule, compound 2, that inhibited proliferation and viability of human colorectal cancer cells (HCT-116, DLD-1, SW480, and 10.1). Compound 2 inhibited cell migration, invasion, and epithelial–mesenchymal transition processes and potently increased cell apoptosis in human colorectal cancer cells. Compound 2 also modulated mitotic stress signaling, leading to both inhibition of Wnt responsiveness and stabilization and activation of p53 to cause cell-cycle arrest. In mouse xenografts, treatment with compound 2 (20 mg/kg/day, i.p.) induced cell death and inhibited tumor growth more than four-fold compared with vehicle at day 34. Neither acute cytotoxicity nor toxicity in animals (up to 1,000 mg/kg, i.p.) were observed for compound 2. To our knowledge, compound 2 is the first reported potent small molecule that inhibits Wnt/β-catenin signaling, activates p53 signaling regardless of p53 mutation status, and binds microtubules without detectable toxicity. Thus, compound 2 offers a novel mechanism of action and a new strategy to treat colorectal cancer.
Significance: These findings identify a potent small molecule that may be therapeutically useful for colon cancer that works by inhibiting Wnt/β-catenin signaling, activating p53, and binding microtubules without detectable toxicity. Cancer Res; 78(17); 5072–83. ©2018 AACR.
Sudden Bilateral Hearing Loss, Tinnitus, and Vertigo as Presenting Symptoms of Chronic Myeloid Leukemia
Authors: Cass Nathan D. , Gubbels Samuel P. , Portnuff Cory D. F. 
Published: July 2018

Objectives: The objective was to describe a unique case of sudden bilateral hearing loss, tinnitus, and vertigo presenting as the first symptoms of chronic myeloid leukemia (CML). Methods: A patient case is discussed along with a review of associated literature. Results: A patient presented with sudden onset hearing loss, tinnitus, and vertigo, and was diagnosed with CML with an initial white blood cell (WBC) count of 555 000 per microliter. The proposed etiology of otologic symptoms is hyperleukocytosis. Serial audiograms showed minimal improvement in hearing despite reduction of WBC. Conclusion: In cases of bilateral, sudden onset sensorineural hearing loss, evaluation for systemic causes of otologic symptoms, including CML, should be considered.