bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gamma Probe Localization in the Surgical Treatment of Osteoid Osteoma
Authors: Kettunen J. S. , Mäkelä E. A. , Kauppinen T. A. 
Published: July 2017

Background: Osteoid osteoma is a benign bone tumor typically inducing night pain. It has traditionally been treated with operative excision. An accurate localization and complete removal of the small lesion is difficult resulting in high recurrence rate and reoperations. Aims: The purpose of the present study was to examine the applicability of a handheld gamma probe in the intraoperative localization of an osteoid osteoma. Material and Methods: Five patients were examined and operated for osteoid osteoma. Dose of 740 MBq Technetium 99m was injected 3 hours before operation, and handheld gamma probe was used for the intraoperative detection of the lesion. Results: All patients were relieved their symptoms. A histologically confirmed, complete removal of the lesion was achieved in 4 of 5 patients. No recurrences has been seen in the follow-up of 6 years. Conclusions: The gamma probe is an useful tool in the surgical treatment of osteoid osteoma. The technique is rapid and simple resulting in more accurate excision of the small lesion.
Vaccination Immunotherapy — An Update
Authors: Doehn C. , Jocham D. 
Published: July 2017

Renal cell carcinoma is often regarded as an “immunogenic tumor”. Organ-confined tumors are best treated by operative removal. Adjuvant strategies, however, may improve the outcome after operative therapy. Recently, a phase-III trial using an autologous renal tumor cell vaccine was able to demonstrate a reduction of the risk of progression in patients after radical nephrectomy for renal cell carcinoma larger than 2.5 cm. These results were achieved with minimal side effects. Patients with metastases have a poor prognosis. Thirty years ago autologous tumor cell vaccination resulted in remissions in a small number of patients. Almost all vaccination reports focus on patients with metastatic renal cell carcinoma. These reports differ considerably in their modes of preparation, stimulation, application route and intervals and other relevant parameters. More important, clinical response is limited in most studies. For metastatic renal cell carcinoma none of the various vaccination approaches are being currently investigated in phase-III trials. Ongoing efforts focus on development of more powerful vaccines. This review summarizes vaccination approaches for renal cell carcinomas published in the past 4 years.
Joint Disease Management Ventures in the UK
Authors: Mason Anne , Drummond Michael , Towse Adrian 
Published: July 2017

A postal questionnaire was sent out to individuals in the National Health Service (NHS) and in the pharmaceutical industry known to be involved in joint disease management ventures, details of which were available in the public domain. The questionnaire was designed to uncover information about the roles played by the partners in the venture, the disease areas covered and the use of guidelines. Of the 25 joint disease management questionnaires sent out, 14 responses were received, giving a response rate of 56%. The ventures covered a range of diseases, but concentrated on respiratory and cardiovascular disease. Three of the projects were concerned with sexual health. The pharmaceutical industry acted in an enabling role in all these projects, offering support in the areas of finance, research, and communication and information technology expertise. In no case did a pharmaceutical company both provide and finance care directly. This is the only case known to the authors of an attempt to collate information on joint disease management ventures in the NHS. However, it should be noted that the results presented in this paper cover only one quarter to one half of all the current NHS joint venture activity.
How Much Information is Too Much Information for Patients?
Authors: Scott Alison 
Published: July 2017

An effective pre-operative information-giving strategy is important in day surgery units, where a low pain score is essential for early discharge home. Good post-operative recovery at home is of utmost importance, as it has to be remembered that one-day surgery does not mean one-day recovery. Integrated care pathways (ICPs) have recognised and well documented benefits, and an ICP which includes a patient information strategy was thought likely to benefit staff and patients in the day surgery setting, where it is essential that patients receive timely, appropriate and evidenced-based care and information. The benefits of giving patients pre-operative information are well documented, and a large majority of patients in this study ( n=100) received written pre-operative information prior to their admission to an orthopaedic day surgery ward. However, it was found that 49% ( n = 42) of patients would have preferred more information. The post-operative pain scores of these patients were demonstrably higher than those of patients who were satisfied with the information they received.
An Integrated Care Pathway for the Last Two Days of Life: A Pathway for Implementing a Pathway
Authors: Fowell Andrew , Finlay Ilora , Johnstone Ros , Minto Lindsey 
Published: July 2017

Aim of the Paper: To offer colleagues a method of monitoring the process of implementing an integrated care pathway (ICP) on a local level or, across a wide area. Background: A training pack was developed to assist with the Wales-wide implementation of an ICP for the last two days of life. The training pack includes a workbook, which is structured around seven stages recognised as being essential to the effective implementation of the pathway. The workbook is formatted in the same way as the pathway and as such is complete with a variance sheet. The variance sheet is utilised to record instances when a desired goal is not achieved and the reason why. The workbook represents a ‘Pathway for Implementing a Pathway’, which can be used to monitor the progress of implementation and highlight inhibiting and facilitating factors. Methods: The Wales-wide implementation of the ICP for the last two days of life, utilised the workbook as a pro forma for assessing the progress of implementation. Analysis of the variance sheets from the workbooks permitted the identification of inhibiting and facilitating factors contributing to the successful implementation of the pathway on a local and national level. Findings: Inhibiting factors affecting the implementation of an ICP include: local politics, fear of failure and lack of motivation. Facilitating factors range from, ‘top-down approval’ or gaining management commitment for the pathway, to ‘bottom-up motivation’, which entails enthusing colleagues as to the benefits of implementing the care pathway. Conclusions: The ‘Pathway for Implementing a Pathway’ is a useful tool for implementing an ICP. Although primarily developed to accompany the implementation of an integrated care pathway for the last two days of life, it would be interesting to assess the transferability of the implementation pathway to other clinical areas.
Controlled Evaluation of a Care Pathway for An Acute Episode of Schizophrenia
Authors: Mynors-Wallis L , Rastogi S , Virgo N , Kosky N , Howard A , Brake G 
Published: July 2017

Background: Care pathways have been produced for medical and surgical patients with some evidence that standards of care can be improved. This paper evaluates the use of a care pathway for the treatment of patients with an acute episode of schizophrenia. Aims: The aim of the study was to evaluate the use of a care pathway for the treatment of patients with schizophrenia. Method: A multidisciplinary team drew up and piloted a care pathway for schizophrenia. The final care pathway involved 45 standards for the acute and stabilisation phases of a schizophrenic illness. The pathway was implemented in six adult clinical teams. Outcomes for patients being treated on the care pathway were compared with a control group of patients with schizophrenia being cared for in six teams not implementing the pathway. Results: There were few significant differences in the care received between the two groups. There were no differences in terms of clinical outcome as measured by the Brief Psychiatric Rating Scale, the Clinical Global Impression, or the Camberwell Assessment of Need. There was also no difference in the mean number of inpatient days between the two groups. Conclusion: The care pathway for an acute episode of schizophrenia did not result in significant changes for patients either in terms of care received or in terms of clinical outcome.
An Evaluation of the Quality of Integrated Care Pathway Development in the UK National Health Service
Authors: Croucher Michelle 
Published: July 2017

An integrated care pathway (ICP) is an outline of planned care for a specific patient group. It highlights usual practice that is evidence-based, from which variations occur as health-care professionals use their professional judgement. The objectives of the study were to identify the key elements within an ICP, to formulate a checklist utilizing the ICP key elements, and to evaluate ICPs available from the UK National electronic Library for Health (NeLH) against the checklist. An ICP key elements checklist was produced from a review of ICP literature. In all, 90% of the ICPs evaluated contained a plan of anticipated care along some form of timeline, including processes and outcomes. Also, 70% of the ICPs evaluated did not contain a variance-recording framework. In addition, 70% of the ICPs evaluated did not contain any evidence of evidence-based best practice. This study shows that there is wide variability in the quality of the ICPs being developed in the UK National Health Service (NHS), and that the development of ICPs in many health-care organizations is inadequate. Variability of the ICPs being developed will have a direct impact on the quality of patient care, and improvements in care and service delivery may not be identified, implemented or reviewed. It is recommended that a tool be produced, which would provide a standard framework for NHS staff to follow when developing ICPs.
Evaluation of the Current Knowledge and Awareness of the Integrated Care Pathway Tool in a Local Health Community
Authors: Croucher Michelle 
Published: July 2017

An integrated care pathway (ICP) identifies the patient's anticipated progress and ensures that any activities delivered by health- and social-care professionals are signed off, and that any variation from the intended practice is documented. Analysis of the variances from the ICP allows continuous assessment of process and outcomes against guidelines or standards. The objectives of this study were to establish the current knowledge and awareness of the ICP tool within the local health community, and to find out how it may be improved. A semi-structured questionnaire was sent to 15 representatives at a senior manager or director level in the local health community. A response rate of 67% was achieved. The questionnaire data were examined using ‘content analysis' and ‘constant comparison’ methodology. In all, 80% of the questionnaire respondents did not identify that the variance framework was an essential element of the ICP tool. A high number of questionnaire respondents identified some, but not the majority, of the benefits that the ICP tool can offer. A total of 60% of the respondents identified resources to assist in the development of ICPs. None of the respondents identified the National Electronic Library for Health (NeLH) as a main resource where guidance was available. However, 100% of the respondents stated that it would be beneficial if standardized national guidance were made available to support ICP development. In conclusion, this study demonstrated that there is variability in the current level of knowledge and awareness of the ICP tool. It is therefore recommended that national guidance be produced, which would provide a standard framework for National Health Services staff to follow when developing ICPs. It is also recommended that improved provision and distribution of information on how ICPs can be used can lead to effective quality improvement programmes.
What Happens When There is No Weekend Urology Cover? An Audit and Formation of a New Care Pathway
Authors: Durai R , Subramonian K , Ravi R , Dickinson I K 
Published: July 2017

Objective: An audit was conducted to find out whether there is any unnecessary delay in discharging patients after transurethral resection of the prostate (TURP). Methods: About 94 patients who underwent elective TURP over a period of seven months between April 2002 and October 2002 at Darent Valley Hospital were selected. Details were collected from the case-notes retrospectively. Results: The mean age of patients was 72.71 (range 57–90) and the mean postoperative hospital stay was 4.7 days (range 2–20). In all, 30 patients stayed for less than three days and 64 (68.1%) patients stayed for longer duration. Among these 64, 37 had underlying reasons for their prolonged stay and 27 (42%) had no obvious reason for their delay in discharge. Among these 27 (mean stay − 4.42 days), 16 (59.25%) were operated upon on Friday, eight (29.62%) on Thursday, three (11%) on Wednesday and none were operated upon on Monday. Discussion: Patients undergoing operations on Thursday and Friday stayed longer because of lack of urological cover during the weekend. Complications such as urinary tract infection (UTI) and excess bleeding can be minimized by implementing strict preoperative urine culture, antibiotic prophylaxis and spending a little extra time on haemostasis. If a patient fails his trial without a catheter it should not be removed again during the same admission. An anticoagulation nurse can help to reduce the stay for patients on warfarin. Nurses and junior doctors should be taught about how to reduce postoperative stay after TURP. A new care pathway, which allows nurses to remove the catheter without waiting for instructions, may be useful. A prospective audit is recommended.
Privileging Younger Children's Voices in Research: Use of Drawings and a Co-Construction Process
Authors: Tay-Lim Joanna , Lim Sirene 
Published: July 2017

The growing acknowledgement of the value of listening to children's views and experiences in social research, popularly termed as “listening to their voices,” brings with it methodological consequences. Regarding children as expert informants about their own lives carries with it the simultaneous call for researchers to be experts in developing and employing appropriate strategies that can effectively elicit the insights that children can bring to a research topic. With younger children, the use of participatory methodologies has been foregrounded as the key to unlocking their potential to contribute rich and useful perspectives to inform research into their lives. This article explores the usefulness of employing preschoolers' drawings within the context of a co-construction process to facilitate the children's construction of ideas and reinforce their voices in research. The case is made that the quality of the dialogical engagement is as important as the drawing itself, and both visual images and the verbal exchanges are central to the children's meaning-making process. In the co-construction process, both adult and child are (ideally) equal players and the resulting dialogical process plays a major role in the constitution of the phenomena. The role of the researcher as the co-constructor can be a challenging one because it entails engaging and supporting children's views and the expression of these views. The discussion and illustrations from the first author's research projects contribute to the literature base on positioning preschool children as valid social actors in their communities. We operate through an ethos of empowerment of all participants, and aim for participatory research practice which has at its heart an active involvement in promoting the rights of children as citizens with voice and power. (Pascal & Bertram, 2009, p. 249)
A Modification Of Elson's Test For The Diagnosis Of An Acute Extensor Central Slip Injury
Authors: Schreuders Ton Ar , Soeters Johannes Nm , Hovius Steven Er , Stam Henk J 
Published: July 2017

When testing for an extensor tendon central slip lesion at the proximal interphalangeal (PIP) joint, it is proposed that the affected finger should be compared with the non-injured finger of the other hand. In this modified Elson's test, the injured finger is flexed at about 90° in the PIP joint and pushed against the dorsal side of the midphalanx of the same finger of the non-injured hand. Once in this position, the patient is asked to extend the distal interphalangeal (DIP) joints. The finger with a central slip lesion will be able to extend the distal phalanx more than the non-injured distal phalanx. The difference between the extension at the DIP joint of the injured and non-injured hand is easily observed. Asymmetrical position of the two distal phalanges in an effort to extend the distal phalanges suggests that the central slip is not in continuity. If the two fingers remain in a symmetrical position when trying to extend the distal phalanges, a central slip lesion is highly unlikely.
Early Active Motion Rehabilitation Versus Immobilisation For Thumb Extensor Tendon Repairs: A Review Of Two Case Studies
Authors: Burr Nikki , Pratt Anna L 
Published: July 2017

Following positive outcomes reported in recent literature, early active motion within a static splint is now a recognised rehabilitation regime for finger extensor tendons. This paper discusses the available literature on thumb extensor tendon rehabilitation, and the justification for introducing early motion for this injury. The early active motion regime for the thumb extensor tendon used at our unit is described and compared against the traditional static splint regime. Two case studies are presented to illustrate the problems associated with these regimes and the patient outcomes achieved. Outcomes were analysed utilising Total Active Motion (Kleinert and Verdan 1983), Kapandji's opposition (1992) and White's assessment of tendon repair (1956). Both patients made a full, uncomplicated recovery after their thumb extensor tendon repair, but the patient who followed the Early Active Motion regime regained motion and light function sooner than the patient who underwent four weeks of immobilisation. This enabled an earlier discharge (eight rather that 12 weeks) and less therapy intervention overall. These are all factors that need to be considered when deciding upon which rehabilitation regime to use.
The Use of Incremental Peritoneal Dialysis in a Large Contemporary Peritoneal Dialysis Program
Authors: Ankawi Ghada A. , Woodcock Nancy I. , Jain Arsh K. , Garg Amit X. , Blake Peter G. 
Published: July 2017

Background: The use of an incremental peritoneal dialysis (PD) strategy in a large contemporary patient population has not been described. Objective: We report the use of this strategy in clinical practice, the prescriptions required, and the clearances achieved in a large center which has routinely used this approach for more than 10 years. Design: This is a cross-sectional observational study. Setting: A single large Canadian academic center. Patients: This study collected data on 124 prevalent PD patients at a single Canadian academic center. Methods and Measurements: The proportion of patients who achieve the clearance target on a low clearance or incremental PD prescription; the actual PD prescriptions and consequent total, peritoneal, and renal urea clearances [Kt/V] achieved; and patient and technique survival and peritonitis rate in comparison with national and international reports. Results: Of the 124 prevalent PD patients in this PD unit, 106 (86%) were achieving the Kt/V target, and of these, 54 (44% of all patients) were doing so using incremental PD prescriptions. Fifty of these incremental PD patients were using automated PD (APD) with either no day dwell (68%) or less than 7 days a week treatment (12%) or both (20%). Patient survival in our PD unit was not different from that reported in Canada as a whole. Peritonitis rates were better than internationally recommended standards. Limitations: This is an observational study with no randomized control group. Conclusions: Incremental PD is feasible in a contemporary PD population treated mainly with APD. Almost half of the patients were able to achieve clearance targets while receiving less onerous and less costly low clearance prescriptions. We suggest that incremental PD should be widely used as a cost-effective strategy in PD.
Maternal Factors Associated with Early Childhood Caries in Urban Latino Children
Authors: Tiwari T. , Wilson A.R. , Mulvahill M. , Rai N. , Albino J. 
Published: July 2017

The objective of this investigation was to describe maternal psychosocial, behavioral, and acculturation factors associated with early childhood caries in a sample of urban Latino mother-child dyads. A cross-sectional survey was conducted with 100 mothers whose children (under the age of 6 y) were patients at the Dental Center at Children’s Hospital Colorado in Aurora, Colorado. All children participating in the study received an oral examination to measure decayed, missing, filled, surfaces (dmfs). Participating mothers were given the option to sign the consent form and complete the survey in English or Spanish, according to their preferred language. The survey used demographic, behavioral, knowledge, and several psychosocial variables. Bivariate analysis was conducted with dmfs as a dependent variable. The associations between independent variables and dmfs were modeled using negative binomial regression. Mean ± SD dmfs for the entire sample was about 11 ± 16.85. The mothers who spoke Spanish had children with significantly ( P = 0.046) higher dmfs scores (15.2) compared to mothers who spoke English (7.56). Preference of Spanish language was significantly associated with self-efficacy ( P = 0.0043), oral health knowledge ( P = 0.0024), and 3 subscales of the health belief model: perceived severity ( P = 0.057), perceived barriers ( P = 0.0002), and perceived susceptibility ( P = 0.008). Both in the univariate and the multivariate models, oral health behavior and preferential use of Spanish remained significantly associated with higher dmfs scores. Results of this study demonstrate that maternal oral health behaviors and preferred language are significant factors associated with early childhood caries in urban Latino children. Knowledge Transfer Statement: Results of this study indicate that maternal oral health behaviors and the level of acculturation are significantly associated with caries in urban Latino children. Caries prevention efforts in this population could use this information to tailor oral health messaging according to the level of acculturation in mothers.