bluuebunny/crossref_metadata_2025_split huggingface dataset:
81 A Review of the Referrals to a Daily TIA Service and Subsequent Specialist Diagnosis
Authors: Magee Michael , Vahidassr Djamil 
Published: September 2019

Abstract

Background
Current guidelines highlight the need for all patients experiencing transient ischaemic attacks (TIA) within the previous 7 days to be seen by a specialist service within 24 hours. (RCP National Clinical Guideline for Stroke 2016) Risk stratification tools are no longer recommended.(Lavallee 2007;Wardlaw, 2014) We reviewed the referrals to such a service to assess the proportion of patients who received a diagnosis of TIA and the time taken for assessment.

Methods
We used a retrospective review of 131 patients coded under the daily TIA clinic in 2018 and analysed the clinic letter from the attendance. We assessed the time taken from referral to clinic review and the percentage of patients diagnosed with TIA by the specialist service.

Results
Of 131 patients seen only 33.6% were diagnosed TIA by the stroke specialist team. Other frequently seen diagnoses were migraine (22.9%), presyncope (12.2%), transient global amnesia (4.6%). ‘Other’ diagnoses such as peripheral nerve palsy, cervical root impingement and delirium made up the remainder. Referrals from the emergency department only received TIA diagnosis in 25.3%, GP referrals (34.9%) and eye casualty (83.3%).
The time from referral to review was a mean of 2.45 days. The patients diagnosed with TIA were seen with average of 2.14 days, non TIAs were 2.6 days.

Conclusion
Evidence shows that patients suffering TIA should be seen urgently within 24hrs. The degree of non TIA symptoms being reviewed risks these services being overrun. A review of our service has shown that the average time of referral to review is longer than desired, however only a third of patients seen were felt to have a TIA. Unless there is a change in the standard of referral it will continue to be difficult to see all true TIAs within 24hrs. This will require further education for our colleagues and a more robust triaging system.
86 Haemorrhagic Stroke: What's in a Bleed?
Authors: Noone Imelda , Kate Meagher Mary , Davey Naomi , O'Shea Diarmuid , Cassidy Tim 
Published: September 2019

Abstract

Background
Intracerebral haemorrhage (ICH) accounts for approximately 20% of all strokes and is a leading cause of disability and mortality. The distribution of the ICH(Lobar v Deep) may be explained by the two major aetiologies of ICH, Cerebral Amyloid Angiopathy (CAA) versus hypertensive (HBP) respectively. The aim of our study was to look at outcomes of lobar versus deep ICH stroke patients.

Methods
We analyzed data of all ICH’s admitted in 2018 using SPSS. Demography, classification of haemorrhage, hypertension, atrial fibrillation (AF) and anticoagulation history, pre and post stroke Rankin and subsequent outcome were analyzed.

Results
373 acute strokes were admitted of which 66(18%) were ICH. Mean age was 73yrs (52-93) and 50% were male. On neuroradiology imaging, 40(60%) were lobar and 26(39%) were deep. Lobar haemorrhages were significantly more likely to be older (p = 0.0001) however, there was no significant difference in pre-stroke Rankin. Post stroke the lobar haemorrhages had both a worse outcome from disability (p = 0.005) and mortality (p = 0.0001). 17(26%) patients with a ICH also had AF with 94% were on an oral anticoagulant(OAC).17.5% of the lobar bleeds were on an OAC versus 36% of the deep ICH. Of the lobar bleeds on OAC none died versus 4 of the deep ICH (p = .001). In total, 48(72%) of patients had a history of hypertension, but only 34(51%) were on HBP medication on admission.

Conclusion
There were a greater proportion of patients with lobar versus deep bleeds in our cohort which may be due to the older population in our area. Mortality and disability was far greater in the lobar cohort. None of the lobar bleeds with AF who were on OAC died in contrast to the deep ICH patients. This may suggest that more aggressive hypertensive treatment is required in this subpopulation.
96 Service Priorities for People with Dementia in Ireland: A Mixed Methods Study of Health Care Professionals
Authors: Keogh Fiona , Pierse Tom , O'Shea Eamon 
Published: September 2019

Abstract

Background
Public services for people with dementia living in the community face significant resource constraints. The aims of this study are to identify an optimum mix of services for six dementia case types and to gain a greater understanding of the resource allocation decision making process.

Methods
Irish datasets were used to identify dementia cases types representing 46% of cases in the datasets. Vignettes were prepared for six case types ranging from low to high dependency and needs. Carers, people with dementia and health and social care professionals (HSCPs) took part in mixed methods workshops. Initial findings for the HSCPs are reported here (N=23). HSCP participants firstly quantitatively identified an optimum care package for a set of six vignettes, then qualitatively discussed the needs and individual case factors that were driving service recommendations. The quantitative exercise was repeated with a budget constraint. The sessions finished with a discussion on service and case prioritisation.

Results
When no budget constraint is imposed, participants recommended the use of a wide range of services. Home help, in-home respite and day care services comprised 62% of spending in this scenario. When a budget constraint was imposed, participants focused on essential care and reduced services aimed at prevention, quality of life and carer support. Resources were not redistributed between cases (e.g. from low need to higher need cases) as a similar proportion of the budget was allocated to each of the cases in both scenarios.

Conclusion
People with dementia living in the community and their families have a wide range of health and social care needs. Optimum dementia care packages included a wide range of services to meet these needs. However, a budget constraint resulted in a much narrower range of services with consequent implications in terms of unmet need and a reactive rather than preventive approach to care.
134 Does a Purely Occipital Lobe Stroke Lead to Significant Long Term Disability and Handicap?
Authors: Davey Naomi , McNally Sarah , Donnelly Kerri , Kate Meagher Mary , Noone Imelda , Cassidy Tim 
Published: September 2019

Abstract

Background
Occipital lobe strokes are characterised by a visual field deficit (VFD) and the absence of a motor deficit. A persistent VFD may have significant long-term implications for a patient and their lifestyle. Our aim was to assess the overall impact of these events particularly patients’ ability to return to driving.

Methods
All patients admitted with an acute occipital lobe stroke to a Dublin teaching hospital in 2017 were identified. Case notes were retrospectively reviewed to identify patients’ pre-stroke function, stroke pathology, neurological losses and further vascular events. A follow up phone call was made 18 months after the event to assess if previous drivers had returned to driving and required the installation of formalised home supports after discharge.

Results
In 2017, 37 of 311 stroke patients admitted had a confirmed occipital lobe stroke. 33 of these patients (89.1%) had ischemic events. The median age was 76 (50-93) years old. Twenty-nine patients were able to undergo formal cognitive testing; the median Montreal Cognitive Assessment (MOCA) was 18 (2-29).
15 patients (40.5%) had underlying Atrial Fibrillation with one (6.7%) of this cohort being identified post discharge; 14 (85.7%) of those patients with ischemic strokes were anticoagulated for atrial fibrillation.
The median length of stay was 33.9 days, with a range of 2-391 days.
Further vascular events occurred in 2 (5.8%) of the patients.
A follow up phone call was made to the 15 patients who drove prior to their event. 12 patients (80%) could not resume driving due to persistent VFD. One (7%) of the previous drivers had a home care package installed since discharge.

Conclusion
A persistent VFD results in long term problems including an increased risk of further vascular events, a reduction in overall independence and quality of life following an occipital lobe stroke. This study has led to a business plan for a dedicated hemianopia clinic.
161 Cross Sectional Study of Pharmacological Management of Rheumatoid Arthritis in Patients over the age of 70
Authors: Reddin Catriona , Costello Maria , Lynch Bernadette 
Published: September 2019

Abstract

Background
Rheumatoid arthritis (RA) is a common inflammatory joint disease. It can lead to joint destruction resulting in joint deformity, functional impairment and reduced mobility. With a growing older population, prevalence of RA is increasing and due to the associated morbidity it is essential to prioritise disease control.
Conventional treatment of RA has comprised of disease modifying anti rheumatic drugs (DMARDs) along with analgesia and corticosteroids. Recently, the development of biologics has revolutionised management of inflammatory arthritis. We now strive for tighter control to prevent joint damage and preserve function. However, studies have shown that uptake of biologic medications in the older population has been slower than their younger counterparts. (1)

Methods
Our departmental electronic record system, Cellma, was interrogated for patients aged 70 and over with a diagnosis of RA. Deceased patients were excluded. The current medication list was reviewed using the online rheumatology outpatient system.

Results
A total of 514 patients over the age of 70 were identified with a diagnosis of RA [(67% (n=343) female, 33% (n=171) male)], 24.5% (n=126) were on biologic therapy, 13% (n=68) patients were on a single DMARD in combination with a biologic, 42% (n=217) of patients were on a single conventional DMARD alone and 9.7% (n=50) were on analgesia alone.

Conclusion
The management of RA in the older population poses its own challenges but this should not prohibit the thoughtful use of newer agents. Awareness of the therapeutic potential and associated adverse events is necessary for maximizing therapeutic benefits while minimizing adverse effects from conventional DMARDs and biologic therapies.
162 An Audit of Comprehensive Geriatric Assessment in the Southern Trust Acute Care at Home Service
Authors: McCann Ann , McCaffrey Patricia , Toal Deborah 
Published: September 2019

Abstract

Background
The population is ageing. Acute Care at Home (AC@H) is a consultant led multidisciplinary team, providing acute non-critical care to our older population, preventing hospital admissions and promoting a better quality of life and supporting them to live independently for longer. A recent Cochrane review shows that older people who receive Comprehensive Geriatric Assessment rather than routine medical care after admission to hospital are more likely to be living at home and are less likely to be admitted to a nursing home at up to a year after hospital admission.

Methods
One-hundred patient charts were selected at random who had been under the AC@H team between 2016 and 2018. The nursing and medical assessments were reviewed to assess how well Comprehensive Geriatric Assessment was being carried out. The domains selected for audit are shown in the results table

Results
The domains were assessed appropriately as follows in percentages - Dementia 93%, Delerium 85%, Depression 6%, Falls, 99%, Fractures/Osteoporosis: 27%, Medication/Polypharmacy: 100%, Pain: 91%, Nutrition: 98%, Skin: 93%, Incontinence: 94%, Advanced Care Planning: 39%, Visual Acuity: 7%, Social Support: 99%

Conclusion
Whilst some areas of Comprehensive Geriatric Assessment are achieved adequately, others are not. Our electronic assessment did not include a Geriatric Depression Score. Although pain was frequently assessed, again a score was not always used. Other areas for improvement include visual acuity, fractures and osteoporosis and advanced care planning
The results of this audit have been presented to the team, adjustments have been made to our electronic assessments so that we can record and capture this data better. There will be a reaudit in 6 month’s to evaluate improvement.
Common bacterial infections and their treatment in hospitalized pediatric patients
Authors: Fusco Nicholas M , Nichols Kristen 
Published: September 2019

Abstract

Purpose
Common bacterial infections in pediatric patients that the hospital pharmacist may encounter are reviewed, and guidance on the safe and effective use of antibiotics to treat those infections is provided.

Summary
Pharmacists play a key role in evaluating and creating antibiotic treatment plans for patients with infections. Bacterial infections are a common reason for hospital admission in pediatric patients, and pharmacists working in hospitals may be consulted to provide treatment and monitoring recommendations. It is important for pharmacists to be aware of similarities and differences in adult and pediatric populations with regard to presenting signs and symptoms of bacterial infections, common causative pathogens, and antibiotic selection, dosing, and monitoring. This article reviews current approaches to treatment of common bacterial infections in pediatric patients and also provides general suggestions for antibiotic use.

Conclusion
Pharmacists have an opportunity to positively impact the care of pediatric patients with bacterial infections. Especially at facilities where pediatric patients are not regularly treated, pharmacists can potentially improve care through provision of recommendations for optimal antibiotic selection, dosing, and monitoring.
Select topics in the management of critically ill children
Authors: Hughes Kaitlin , Buenger Lauren 
Published: September 2019

Abstract

Purpose
The purpose of this review article is to discuss considerations for the critically ill child presenting to an emergency department (ED) with pharmacists who have minimal to no pediatric training.

Summary
In 2015, 17% of all children visited an ED, constituting 30 million visits. The majority of these children were treated at community hospitals where pediatric care resources, including a pediatric-trained pharmacist, may be limited. Because of the complex array of ages and disease states, the care of critically ill children in the ED creates many concerns for adult and community hospitals. This article will focus on several common disease states seen in the pediatric ED, including septic shock, trauma, status epilepticus, and diabetic ketoacidosis.

Conclusion
Critically ill children admitted to a community or adult ED provide therapeutic dilemmas and medication safety concerns. A pharmacist with training or experience in pediatrics can have a major impact in patient outcomes in many of the disease states seen in these pediatric patients. This article highlights several key differences between critically ill pediatric and adult patients to better prepare all pharmacists to care for these vulnerable patients.
Behavioral and morphological evidence of an Allen’s × Rufous hummingbird (Selasphorus sasin × S. rufus) hybrid zone in southern Oregon and northern California
Authors: Myers Brian M , Rankin David T , Burns Kevin J , Clark Christopher J 
Published: September 2019

AbstractAllen’s (Selasphorus sasin) and Rufous (S. rufus) hummingbird have long been suspected to hybridize, and potentially form a hybrid zone where their ranges overlap in southern Oregon. Migratory Allen’s Hummingbird (S. s. sasin) breeds along a narrow strip of the California coast up to the Oregon border, while Rufous Hummingbird breeds from southern Oregon to Alaska. Analysis of behavioral and morphological data for 183 males and morphological data from 138 females showed that Allen’s and Rufous hummingbird form a hybrid zone in southern Oregon and northern California. Linear discriminant function analysis and cline analysis of 20 phenotypic characters for males and 9 phenotypic characters for females suggested the center of the coastal transect of this north–south hybrid zone spanned from Bandon, Oregon (Coos County), to Port Orford, Oregon (Curry County). The contact zone extended north into the breeding range of Rufous (into Florence, Lane County, Oregon) and south into the range of Allen’s (into Arcata, Humboldt County, California). Sporadic inland sampling suggested the hybrid zone extended at least 94 km inland from the coast. Behavioral data included courtship displays, which were composed of discrete, modular, behavioral elements. Sexual selection acted on these courtship displays, as behavioral clines related to courtship behaviors were more narrow than morphological clines. Some of the courtship behaviors analyzed included previously undescribed diagnostic behavioral characters for Allen’s and Rufous hummingbird.
Reference intervals for blood-based biochemical analytes of southern Beaufort Sea polar bears
Authors: Fry Tricia L , Friedrichs Kristen R , Atwood Todd C , Duncan Colleen , Simac Kristin , Goldberg Tony 
Published: September 2019

AbstractAccurate reference intervals (RIs) for commonly measured blood-based analytes are essential for health monitoring programmes. Baseline values for a panel of analytes can be used to monitor physiologic and pathophysiologic processes such as organ function, electrolyte balance and protein catabolism. Our reference population includes 651 serum samples from polar bears (Ursus maritimus) from the southern Beaufort Sea (SB) subpopulation sampled in Alaska, USA, between 1983 and 2016. To establish RI for 13 biochemical analytes, we defined specific criteria for characterizing the reference population and relevant subgroups. To account for differences in seasonal life history characteristics, we determined separate RI for the spring and fall seasons, when prey availability and energetic requirements of bears differ. We established RI for five subgroups in spring based on sex, age class and denning status, and three subgroups in fall based on sex and age class in females only. Alkaline phosphatase activities were twice as high in subadult as in adult polar bears in spring (zmales = 4.08, Pmales < 0.001, zfemales = 3.90, Pfemales < 0.001) and did not differ between seasons. Denning females had significantly higher glucose concentrations than non-denning females (z = 4.94, P < 0.001), possibly reflecting differences in energy expenditure during lactation. A total of 10 of the 13 analytes differed significantly between seasons in either males or females; however, the physiologic importance of these differences may be minimal. Establishing these RIs allows for temporal monitoring of polar bear health in the SB and may prove useful for assessing and monitoring additional polar bear subpopulations in a changing Arctic environment.
A rare case of stiff left atrial syndrome caused by both coconut left atrium and vertebral compression: a case report
Authors: Ooka Junichi , Matsumoto Kensuke , Kondo Morihiko , Otomo Toshiyuki 
Published: September 2019

Abstract

Background
Calcification of the left atrium (LA) is a rare condition and can be the result of long-standing rheumatic mitral stenosis or an unusual complication after mitral valve replacement. Cases of massive LA calcification have sometimes been referred to as those with ‘coconut LA’ or ‘porcelain LA’.

Case summary
A 75-year-old woman was referred to our hospital because of chest discomfort and exertional dyspnoea. Doppler echocardiography revealed the presence of elevated filling pressure with significant LA dysfunction. A cardiac catheter examination revealed a quite impressive pulmonary capillary wedge pressure waveform with a steep up-slope and prominent v wave of 43 mmHg (mean: 15 mmHg). Multidetector row computed tomography revealed that LA was sandwiched by dense calcifications along the roof and bottom of the LA, and the posterior wall was compressed by a vertebral body. Integration of these functional and anatomical findings ultimately led to the diagnosis of ‘stiff LA syndrome’.

Discussion
She had a history of tuberculosis but no history of rheumatic fever or cardiac surgery. Thus, it appeared that the tuberculous pericarditis might have led to the calcified LA by long lasting inflammation. In this case, the LA was encased by a dense calcification and compressed by vertebral body from the posterior direction. Therefore, we speculated that the LA pressure could easily elevate even with a slight haemodynamic load in this special case, and thus eventually resulting in decompensated heart failure.
Experimental study on deformation and failure characteristics of discontinuous prefabricated fractured tuff
Authors: Song Yang , Wang Heping , Ren Meng 
Published: September 2019

Abstract
To study more fully the characteristic law of deformation and failure of tuff jointed rock mass of prefabricated parallel discontinuous joint test specimens, the uniaxial compression test was used. The stress–strain curve, peak intensity, deformation parameters, energy characteristics, etc., of the rock test specimens were systematically studied under different combinations of joint dip angle and joint spacing. The research found that: (1) during the failure process of tuff, the peak intensity and elastic modulus followed a U-shaped change pattern and the minimum value was reached when α = 60°; (2) the fracture modes of test specimens with different joint dip angles were different. When α = 30° and 45°, failure characteristics were mixed modes of tensile or tensile shear failure. When α = 60°, failure characteristics were shear. At α = 75°, the failure characteristic was tensile shear failure. (3) The absorbed and dissipated energy of the rock increased nonlinearly at each stage of deformation. (4) We quantified rock energy damage through a correlation between dissipated energy and absorbed energy of the rock in the process of energy evolution, and obtained an evolution of the relationship between the dissipated energy ratio, crack dip angle and crack spacing. Based on different fracture distribution methods and according to the strain equivalence principle, the constitutive equation of the pre-peak rock damage was obtained.
A physical modelling study of the reservoir scale effect on amplitude variation with incidence angle
Authors: Xu Chao , Chen Chunqiang , Deng Jixin , Di Bangrang , Wei Jianxin 
Published: September 2019

Abstract
The 3D pre-stack seismic data from a physical modeling experiment were employed to investigate the effect of reservoir scales on AVO (amplitude variation with offset or incidence angle). Eight cuboid samples simulating cavernous reservoirs with different widths and the same thickness and elastic parameters were set within a 3D model. 3D seismic data acquisition and processing were conducted. To get the AVO responses of the samples with different widths, trough amplitudes corresponding to the sample tops at different incidence angles were extracted from the pre-stack angle gathers. Amplitude calibration for transducer radiation patterns was conducted on the extracted amplitudes at different angles. AVO analysis was conducted to quantitatively demonstrate the effect of sample scales on AVO characteristics. The effect of sample width was weak when the width was less than 60 m, which was 3/5 of the wavelength. When the width was larger than 60 m, both AVO intercept and gradient gradually increased with the sample width. The AVO gradient peaked at 150 m, which was 1.5 times the wavelength. Cross-plot analysis of AVO intercept and gradient showed the samples were aligned in a straight line when the sample width was less than twice the seismic wavelength. The result in this study partially verified the conclusions of reservoir scale effect on AVO responses drawn from previous numerical modelling studies. For a heterogeneous rectangular reservoir, the effect of reservoir scales on AVO responses could potentially be used to quantitatively estimate reservoir scale.