bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing BrightHearts: A Pediatric Biofeedback‐Mediated Relaxation App to Manage Procedural Pain and Anxiety
Authors: Morrow Angela M. , Burton Karen L. O. , Watanabe Melissa M. , Cloyd Benjamin H. , Khut George P. 
Published: October 2017

AbstractObjectiveThe objective of this study was to develop a child‐friendly biofeedback‐mediated relaxation device called BrightHearts.MethodsQualitative data were collected at a tertiary pediatric hospital to inform an iterative design process. Clinicians participated in expert group interviews to identify practical considerations that would facilitate the use of BrightHearts during procedures and provide feedback on prototype designs. Children 7 to 18 years of age participated in interactive exhibitions of the prototypes and were interviewed about their experiences using BrightHearts.ResultsTwenty‐four clinicians participated in 6 group interviews. Thirty‐nine children participated in interactive exhibitions, and 21 were interviewed. Clinicians placed high value on the following factors in the management of procedural pain: providing children with an element of control, the use of relaxation techniques, and the use of portable electronic devices such as iPads. They highlighted the need for BrightHearts to be cost effective, portable, and capable of engaging children's interest. They confirmed the utility of developing a biofeedback‐assisted relaxation device for children. Based on the factors identified by clinicians, BrightHearts was developed as an iPad application (app) paired with a wireless heart rate monitor. The BrightHearts heart rate biofeedback app displays digital geometric artwork that responds to changes in heart rate. Children 7 to 17 years of age understood the concept of biofeedback and operated the app by slowing their heart rates.ConclusionThe BrightHearts app can be used to teach children biofeedback‐assisted relaxation. Ongoing studies are evaluating its efficacy for the management of procedural pain in children.
Insidious: The relationship patients have with their eating disorders and its impact on symptoms, duration of illness, and self‐image
Authors: Forsén Mantilla Emma , Clinton David , Birgegård Andreas 
Published: October 2017

ObjectivesIn published clinical and autobiographical accounts of eating disorders, patients often describe their disorder in personified ways, that is, relating to the disorder as if it were an entity, and treatment often involves techniques of externalization. By encouraging patients to think about their eating disorder as a relationship, this study aimed to examine how young female patients experience their eating disorder as acting towards them, how they react in response, and whether these interactions are associated with symptoms, illness duration, and self‐image.DesignStructural Analysis of Social Behavior (SASB) was used to operationalize how patients experience the actions of their eating disorder and their own reactions to the disorder.MethodThe relationship between patients (N = 150) and their eating disorders was examined with respect to symptoms, duration of illness, and self‐image. Patients were also compared on their tendency to react with affiliation in relation to their disorder.ResultsPatients’ responses on the SASB indicated that they tended to conceptualize their eating disorders as blaming and controlling, and they themselves as sulking and submitting in response. Greater experience of the eating disorder as being controlling was associated with higher levels of symptomatology. Patients reacting with more negative affiliation towards their disorder were less symptomatic.ConclusionsWhen encouraging patients to think about their eating disorder as a relationship, comprehensible relationship patterns between patients and their eating disorders emerged. The idea that this alleged relationship may resemble a real‐life relationship could have theoretical implications, and its exploration may be of interest in treatment.Practitioner points

Patients were able to conceptualize their eating disorder as a significant other to whom they relate when encouraged to do so.

Patients tended to experience their disorder as controlling and domineering.

Exploring the hypothetical patient–eating disorder relationship may prove helpful in understanding dysfunctional relational patterns.

Helping patients to rebel against their eating disorder could potentially aid in symptom reduction.
Urinary excretion of sphingomyelinase phosphodiesterase acid‐like 3b in children with intractable nephrotic syndrome
Authors: Watanabe Shojiro , Tsugawa Koji , Tsuruga Kazushi , Imaizumi Tadaatsu , Tanaka Hiroshi 
Published: October 2017

AbstractRituximab (RTX), a specific antibody to human CD20, has been successfully used to treat intractable nephrotic syndrome (NS). Recent studies have suggested a direct effect of RTX on podocytes by targeting sphingomyelinase phosphodiesterase acid‐like 3b (SMPDL‐3b). Thus, we examined the urinary excretion of SMPDL‐3b as well as its immunoreactivity in biopsy specimens from children with intractable NS. Urine samples from six patients (five with minimal‐change NS and one with focal segmental glomerulosclerosis) and from four healthy adults were examined. Glomerular immunoreactivity and urinary excretion of SMPDL3b in proteinuric NS patients decreased compared with controls. Interestingly, urine samples obtained from the same patients at the remission stage after RTX treatment showed an increase in urinary SMPDL‐3b excretion compared with the proteinuric stage. Urinary excretion level of SMPDL‐3b could thus be used to predict the clinical efficacy of RTX treatment in NS patients.
Herpes zoster meningitis in immunocompetent children: Two case reports and a literature review
Authors: Itoh Naohiro , Motokura Kouji , Kumakura Akira , Hata Daisuke , Hata Atsuko 
Published: October 2017

AbstractWe encountered two cases of Herpes zoster (HZ) meningitis, a rarely occurring complication of HZ, in previously healthy children. One patient treated with i.v. acyclovir (ACV, 31 mg/kg/day) did not recover. His symptoms were relieved somewhat by increased ACV dosage, but it caused transient renal dysfunction. Another patient treated with i.v. ACV (30 mg/kg/day) recovered. Treatment for HZ meningitis in immunocompetent children has not been established. In a literature review, 80% of 20 patients were treated with the usual dose of ACV 15–30 mg/kg/day. The present cases suggest that a high dosage of ACV up to 60 mg/kg/day should be considered (while monitoring for side‐effects) unless symptoms improve. In the review, one of every three vaccine‐strain Varicella zoster virus (VZV) cases was severe, whereas the present cases resulted from wild type. Further investigations must examine different clinical characteristics of HZ meningitis caused by wild‐type and vaccine‐strain VZV.
Pediatric resident perceptions of shift work in ward rotations
Authors: Nomura Osamu , Mishina Hiroki , Jasti Harish , Sakai Hirokazu , Ishiguro Akira 
Published: October 2017

AbstractAlthough the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross‐sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty‐one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education.
Effect of cesarean section on relapse of childhood idiopathic nephrotic syndrome
Authors: Kimata Takahisa , Kino Jiro , Yamanouchi Sohsaku , Suruda Chikushi , Tsuji Shoji , Kaneko Kazunari 
Published: October 2017

AbstractIn parallel with the increase in the prevalence of childhood chronic diseases, the rate of cesarean delivery has risen during the past decades. This study tested the hypothesis that children delivered by cesarean section (CS) have a higher risk of relapse of idiopathic nephrotic syndrome (INS). Fifty‐six children with INS were categorized into three groups. Group A consisted of patients with INS who had no relapses after the onset of INS; group B consisted of patients with INS who had infrequent relapse; and group C consisted of patients with INS who had frequent relapse. The number of enrolled patients in groups A, B, and C was 10, 14, and 32, respectively. The ratio of neonates delivered via CS was significantly higher in group C (37.5%, P < 0.001) than in groups A (0%) and B (7.1%). This study shows that CS is associated with an increased risk of relapse of childhood INS.
Immunochromatography test for rapid diagnosis of Mycoplasma pneumoniae infection
Authors: Onari Shigeru , Okada Takashige , Okada Takafumi , Okano Syuko , Kakuta Osamu , Kutsuma Hirokazu , Kobayashi Masaaki , Kondo Yasuo , Sakaguchi Naoya , Tajima Takeshi , Nagao Masayoshi , Nakayama Eiichi , Niimi Ryo , Nishimura Syuichi , Higashidate Yoshihito , Hikita Toshiyuki , Meguro Hidenori , Mori Toshihiko , Yoto Yuko , Tsutsumi Hiroyuki 
Published: October 2017

AbstractThe sensitivity and specificity of a new rapid Mycoplasma pneumoniae antigen immunochromatography (IC) test, DK‐MP‐001, were determined using particle agglutination (PA) antibody response and loop‐mediated isothermal amplification (LAMP) gene detection as the gold standard. Of 165 patients, 59 were diagnosed with M. pneumoniae infection based on a ≥fourfold rise of serum PA antibody during the course of the illness. Of the first visit swabs, 60 were positive for M. pneumoniae on LAMP, and 49 were positive for M. pneumoniae antigen on IC test. Compared with PA antibody and LAMP, the sensitivity/specificity of the IC test were 81.4% (48/59) and 99.1% (105/106); and 81.7% (49/60) and 100% (105/105), respectively. IC test detected antigen in pharyngeal swabs more sensitively than in nasal swabs for the same subjects (P < 0.05). The IC test performs well enough to be used with pharyngeal swabs at the first examination.
Concentration effect of prostaglandin E2 on the growth factor expression and cell proliferation in bovine endometrial explants and their kinetic characteristics
Authors: Zhang S , Mao W , Li Q , Gao R , Zhang Y , Gao L , Fu C , Wu J , Deng Y , Shen Y , Li T , Liu B , Cao J 
Published: October 2017

ContentsBovine endometrium undergoes various physiological and histological changes that are necessary for blastocyst implantation during oestrous cycle. From pro‐oestrus to late‐oestrus, endometrium thickens gradually for implantation preparation and exhibits remarkable capacity for self‐repair after uterine lining shedding while implantation does not occur. The prostaglandin E2 (PGE2) secretion pattern is synchronized with endometrial growth during oestrous cycles in bovine endometrium; however, limited information is available regarding the association between PGE2 secretion and endometrial growth. In this study, the concentration (10−9 to 10−5 M) and time effect (2–36 hr) of PGE2 treatment on a series of growth factors are essential for endometrial growth including connective tissue growth factor (CTGF), fibroblast growth factor‐2 (FGF‐2), interleukin‐8 (IL‐8), transforming growth factor‐β1 (TGF‐β1), matrix metalloproteinase‐2 (MMP‐2), and vascular endothelial growth factor A (VEGFA) mRNA and protein expression, and proliferation of epithelial and fibroblast cells was investigated in bovine endometrial explants in vitro. The results indicated that PGE2 at concentration about 10−7 to 10−5 M could up‐regulate CTGF, FGF‐2, IL‐8, MMP‐2, TGF‐β1, VEGFA mRNA and protein expression, and could induce the proliferation of epithelial and fibroblast cells and reduce the proapoptotic factor (caspase‐3) expression in bovine endometrial explants in vitro. These results collectively improved the possibility of PGE2 functions in endometrial growth during oestrous cycles.
Proteomic profiling of follicle fluids after superstimulation in one‐month‐old lambs
Authors: Wu Y , Lin J , Han B , Wang L , Chen Y , Liu M , Huang J 
Published: October 2017

ContentsFollicular fluid (FF) accumulates in the antrum of the ovarian follicle. In addition, FF provides the microenvironment for oocyte development, oocyte maturation and competence, which are acquired during follicular development. Superstimulatory treatment of 1‐month‐old lambs can achieve synchronous development of numerous growing follicles. However, these growing follicles are unable to completely mature and ovulate. Furthermore, the oocytes exhibit lower competence compared with those of ewes. In this study, we utilized an isobaric tag for relative and absolute quantification (iTRAQ)‐based proteomics analysis and compare protein composition between pre‐pubertal and adult superstimulated follicle FF in sheep. In total, 243 differentially expressed proteins were identified, including 155 downregulated and 88 upregulated between lamb and ewe. Gene ontology (GO) and KEGG pathway analysis indicated that the differentially expressed proteins are involved in signal transduction, anatomical structure development, stress response, metabolic pathways, and the complement and coagulation cascades. Many of the proteins known to affect follicle development were observed in lower abundance in FF of lamb (e.g. ADAMTS9, CD14, CTNNB1, FST, GCLC, HSPG2, IGFBP2, IGFBP6, INHBA, PRL, PAPPA, POSTN, PRDX1, SERPINA1, SOD3, STC1, VEGFC, etc.). However, a higher abundance was observed for proteasome proteins. Inadequate amounts of these proteins in FF may be lead to the unique characteristics of follicular development in lamb. These differentially expressed proteins illuminate the age‐dependent changes in protein expression in the follicle microenvironment.
Exogenous factors matter when interpreting the results of an impact evaluation: a case study of rainfall and child health programme intervention in Rwanda
Authors: Mukabutera Assumpta , Thomson Dana R. , Hedt‐Gauthier Bethany L. , Atwood Sidney , Basinga Paulin , Nyirazinyoye Laetitia , Savage Kevin P. , Habimana Marcellin , Murray Megan 
Published: October 2017

AbstractObjectivePublic health interventions are often implemented at large scale, and their evaluation seems to be difficult because they are usually multiple and their pathways to effect are complex and subject to modification by contextual factors. We assessed whether controlling for rainfall‐related variables altered estimates of the efficacy of a health programme in rural Rwanda and have a quantifiable effect on an intervention evaluation outcomes.MethodsWe conducted a retrospective quasi‐experimental study using previously collected cross‐sectional data from the 2005 and 2010 Rwanda Demographic and Health Surveys (DHS), 2010 DHS oversampled data, monthly rainfall data collected from meteorological stations over the same period, and modelled output of long‐term rainfall averages, soil moisture, and rain water run‐off. Difference‐in‐difference models were used.ResultsRainfall factors confounded the PIH intervention impact evaluation. When we adjusted our estimates of programme effect by controlling for a variety of rainfall variables, several effectiveness estimates changed by 10% or more. The analyses that did not adjust for rainfall‐related variables underestimated the intervention effect on the prevalence of ARI by 14.3%, fever by 52.4% and stunting by 10.2%. Conversely, the unadjusted analysis overestimated the intervention's effect on diarrhoea by 56.5% and wasting by 80%.ConclusionRainfall‐related patterns have a quantifiable effect on programme evaluation results and highlighted the importance and complexity of controlling for contextual factors in quasi‐experimental design evaluations.
Validity and feasibility of the wound‐QoL questionnaire on health‐related quality of life in chronic wounds
Authors: Augustin Matthias , Conde Montero Elena , Zander Nicole , Baade Katrin , Herberger Katharina , Debus E. Sebastian , Diener Holger , Neubert Thomas , Blome Christine 
Published: October 2017

AbstractChronic wounds have a major socioeconomic impact due to their frequency, chronicity, and societal costs. Patients experience substantial quality of life (QoL) impairments. The use of questionnaires for a continuous assessment of QoL and resulting interventions to improve the situation of the individual are an important cornerstone of a guideline‐based wound care. The aim of this study was to investigate the validity of the Wound‐QoL questionnaire. Patients with chronic wounds from two different centers were included in the prospective study. All patients completed the Wound‐QoL and two other QoL questionnaires (European Quality of Life‐5 Dimensions, EQ‐5D, and Freiburg Life Quality Assessment for wounds, FLQA‐wk) at baseline and at two more time points (4 and 8 weeks, respectively). Wound status was defined with an anchor question. Two hundred and twenty‐seven patients (48.5% women) participated in the study. Mean age was 66.9 years (range 17–96, median 69.5). Indications were venous leg ulcers (40.1%), pyoderma gangraenosum (14.1%), diabetic or ischemic foot ulcers (5.3%), pressure ulcers (2.6%), and other etiologies (30.0%). The Wound‐QoL showed good internal consistency, with high Cronbach's alpha in all the subscales and in the global scale in all time points (>0.8). Convergent validity was satisfactory since there were significantly (p ≤ 0.001) good correlations with the EQ‐5D (range = 0.5–0.7) and FLQA‐wk global score (r > 0.8) at every time point. Responsiveness was high, too. The Wound‐QoL is a simple, valid tool for the longitudinal assessment of QoL in patients with chronic wounds. This questionnaire is suitable for use in clinical trials, quality of care studies and clinical routine.
Effectiveness of a multi-component quality improvement intervention on rates of hyperglycaemia
Authors: Franco Thérèse , Aaronson Barry , Brown Laurel , Blackmore Craig , Rupp Stephen , Lee Grace 
Published: October 2017

PurposeTo evaluate the effectiveness of a multifaceted, hospital-wide glycaemic control quality improvement programme.MethodsThe quality improvement intervention comprised three components, derived through root cause analysis: standardising and simplifying care (including evidence-based order sets), increasing visibility (through provider access to clinical data and direct feedback) and educational outreach (directed at the entire institution). Effectiveness was determined at a single urban acute care hospital through time-series analysis with statistical process control charts. Primary outcomes included rate of hyperglycaemia and rate of hypoglycaemia.ResultsThe study included 70 992 hospital admissions for 50 404 patients, with 3 35 645 patient days. The hyperglycaemia ratio decreased 25.2% from 14.1% to 10.5% (95% CI 3.3 to 3.9 percentage points, p<0.001). The ratio of patient days with highly elevated blood glucose (>299 mg/dL) decreased 31.8% from 4.8% to 3.3% (95% CI 1.4 to 1.7 percentage points, p<0.001). Hypoglycaemia ratio decreased from 5.2% to 4.6% (95% CI 0.27 to 0.89 percentage points, p<0.001) in patients with diabetes, but increased in patients without diabetes from 1.2% to 1.7% (95% CI 0.46 to 0.70 percentage points, p<0.001).ConclusionsWe demonstrate improved hospital-wide glycaemic control after a multifaceted quality improvement intervention in the context of strong institutional commitment, national mentorship and Lean management
Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms
Authors: Cuttler Sasha J , Barr-Walker Jill , Cuttler Lauren 
Published: October 2017

BackgroundInpatient falls and subsequent injuries are among the most common hospital-acquired conditions with few effective prevention methods.ObjectiveTo evaluate the effectiveness of patient education videos and fall prevention visual signalling icons when added to bed exit alarms in improving acutely hospitalised medical-surgical inpatient fall and injury rates.DesignPerformance improvement study with historic control.SettingFour medical-surgical units in one US public acute care hospital.Study participantsAdult medical-surgical inpatients units.InterventionsA 4 min video was shown to patients by trained volunteers. Icons of individual patient risk factors and interventions were placed at patients’ bedsides. Beds with integrated three-mode sensitivity exit alarms were activated for confused patients at risk of falling.Main outcome measuresThe main outcome measure is the incident rate per 1000 patient days (PDs) for patient falls, falls with any injury and falls with serious injury. The incident rate ratio (IRR) for each measure compared January 2009–September 2010 (baseline) with the follow-up period of January 2015–December 2015 (intervention).ResultsFalls decreased 20% from 4.78 to 3.80 per 1000 PDs (IRR 0.80, 95% CI 0.66 to 0.96); falls with any injury decreased 40% from 1.01 to 0.61 per 1000 PDs (IRR 0.60, 95% CI 0.38 to 0.94); and falls with serious injury 85% from 0.159 to 0.023 per 1000 PDs (IRR 0.15, 95% CI 0.01 to 0.85). Icons were not fully implemented.ConclusionThe first known significant reduction of falls, falls with injury and falls with serious injury among medical-surgical inpatients was achieved. Patient education and continued use of bed exit alarms were associated with large decreases in injury. Icons require further testing. Multicentre randomised controlled trials are needed to confirm the effectiveness of icons and video interventions and exit alarms.
Poor cough flow in acute stroke patients is associated with reduced functional residual capacity and low cough inspired volume
Authors: Ward Katie , Rao Prashant , Reilly Charles C , Rafferty Gerrard Francis , Polkey Michael I , Kalra Lalit , Moxham John 
Published: October 2017

IntroductionEach year 7 million people die of stroke worldwide; most deaths are caused by chest infections. Patients with acute stroke have impaired voluntary cough flow, associated with increased risk of chest infections. Reduced functional residual capacity (FRC) could lead to impaired cough flow. We therefore compared FRC in acute hemiparetic stroke patients and controls and explored its relationship with volume inspired before cough and voluntary cough peak flow.Methods21 patients within 2 weeks of first-ever middle cerebral artery territory (MCA) infarct (mean (SD) age 68 (11) years, 10 females) and 30 controls (58 (11) years, 15 females) underwent FRC and voluntary cough testing (cough inspired volume and peak flow) while semirecumbent. FRC was expressed as % predicted; cough inspired volume was expressed as % predicted VC and cough peak flow as % predicted PEF. A clinician scored stroke severity using the National Institutes of Health Stroke Scale (NIHSS).ResultsPatients’ reclined FRC, voluntary cough peak flowand cough inspired volume were reduced compared with controls (p<0.01 for all): patients’ median (IQR) FRC 76 (67–90) % predicted, mean (SD) cough inspired volume 64 (20) % predicted and mean (SD) peak cough flow 61 (32) % predicted despite them having only mild stroke-related impairments: median NIHSS score 4 (IQR 2–6). Univariate linear regression analyses showed FRC predicted cough inspired volume (adjusted R2=0.45) and cough inspired volume predicted cough flow (adjusted R2=0.56); p<0.01 for both. Sitting patients upright increased their FRC by median 0.210 L.ConclusionsFRC and cough inspired volume in the reclined position are significantly reduced in acute hemiparetic stroke patients with mild impairments; both factors are associated with poor voluntary cough peak flow.