bluuebunny/crossref_metadata_2025_split huggingface dataset:
56 Manipulation and reduction of paediatric forearm fractures using Es-ketamine in a paediatric emergency department – a 5 year study
Authors: Mulvaney Shirley 
Published: November 2017

BackgroundForearm fractures are the most common paediatric injury presenting to A+E.1,2Literature supports safe and effective treatment of these injuries in A+E using a variety of sedation methods, including ketamine.3,4The Paediatric Orthopaedic Trauma Snapshot (POTS) study showed that only 35% of A+Es nationally allow manipulation of these injuries in the department.MethodsA retrospective analysis was undertaken of all patients presenting with fractures of the forearm between January 2012 to December 2016 who were treated with reduction and manipulation in the Alder Hey A+E department using Es-ketamine. Pre and post manipulation radiographs were reviewed, and fracture angulation measured pre and post reduction.ResultsA total of 151 patients were included with an average age of 8.5 years. 3 Salter Harris Type I, 16 Salter Harris Type II, 54 metaphyseal fractures, 44 distal third diaphyseal, 31 middle third diaphyseal and 3 proximal third diaphyseal were noted. 3 patients were lost to follow up after initial post reduction films. 11 patients required operative intervention following initial reduction. At one week follow up a further 5 patients were deemed to be of an unacceptable position requiring definitive operative management. No fractures slipped beyond 1 st week post procedure. A successful reduction, with improvement in lateral angulation, was achieved in 90% (133/148) of patients. The average pre-reduction lateral angulation was 23.7 degrees, post reduction was 4.6 and at final review was 0.3 degrees. At final follow up average 32 days all patients had clinical and radiological union.DiscussionEs-Ketamine has been established as a safe method of sedation in paediatrics. Es-Ketamine allows same day discharge thus improving patient journey and leading to about £63 000 savings annually.ConclusionsWith adequate and appropriate training, the majority of simple radius and ulna fractures can be reduced and definitively treated safely and effectively using Es-ketamine in the emergency department. This technique has significant benefits in terms of resource management and finance whilst maintaining optimum patient care.
57 Support for suddenly bereaved parents in the emergency unit
Authors: Jones Emily , Simpson Steffan 
Published: November 2017

The Paediatric Emergency Unit at the University Hospital of Wales provides care for over 33 000 children per year. There was no provision in place to support suddenly bereaved families. Staff felt that we could improve the services provided to families who’s children sadly died in the unit.The aim was to provide immediate support for the suddenly bereaved families by working in partnership with local Charity 2 Wish Upon a Star. Together we created a Standard Operating Procedure (SOP) that consisted of a checklist and pathway allowing us to refer relatives for immediate physical and emotional support. The pilot ran for 12 months offering support and counselling tailored to each individual family.The bereaving process begins in the emergency department. When a child had died families were given the to Wish Upon a Star memory boxes which contained physical support including two cuddly elephants, one to follow the patient and one for the parent/carer to keep and hand and foot print kits. As well as written booklets giving practical information on the next steps such as post mortems and funerals- these often very difficult questions to ask and answer. And about the charity itself. Once consent was gained by the staff, the families details were shared with the immediate support worker at the charity who would contact them within 24 hours.The initial 12 months trial had 18 paediatric deaths, 17 of which took up the support offered to them. The informal feedback we gained was positive from both staff and families. Our relationship with the charity has enabled us to feedback to the individual nurse involved, thus improving staff well being.Due to the success of this pathway it has been extended to include young adults up to the age of 25 years. The model has also been rolled out across critical care in UHW and is now being used in all emergency department in Wales.This innovative partnership offers immediate support to bereaved families across Wales which has improved care and services provided by the University Health Board.
6 Prognostic value of the glasgow admission prediction score: hospital length of stay, mortality and hospital readmission
Authors: Jones Dominic , Cameron Allan , Mason Suzanne , O’Keeffe Colin , Lowe David 
Published: November 2017

IntroductionAs patient numbers presenting to emergency departments (ED) increase, with their myriad of comorbidities, early hospital admission prediction and demand modelling are crucial both in the ED and beyond. The Glasgow admission prediction score (GAPS) (figure 1)1has already been shown to be accurate in predicting hospital admission from the ED at the point of triage.2As demand on EDs increase, data driven models such as GAPS will become increasingly important for predicting patient course. However, GAPS has not previously been tested beyond the point of admission.Figure 1AimTo assess whether GAPS has the ability to predict hospital length of stay (LOS), six-month mortality and six-month hospital readmission.MethodsSampling was conducted in 2016 at the Sheffield Teaching Hospitals NHS foundation trust ED and the NHS Greater Glasgow and Clyde ED. Data were collected prospectively at the point of triage for all consecutive patients who presented to the ED during sampling times. GAPS was calculated independent of patient clinical management and recorded. Patients were followed up at six months, looking at length of any hospital admission, mortality and hospital readmission. Length of hospital stay, mortality and hospital readmission against GAPS was modelled using survival analysis.ResultsIn total 1420 patients were recruited, 39.6% of these patients were initially admitted to hospital. At six months, 30.6% of patients had been readmitted and 5.6% of patients had died. For those admitted at first presentation, the chance of being discharged at any one time fell by 4.3% (95% confidence interval (CI) 3.2%–5.3%) per GAPS point increase. Figure 2 displays the Kaplan Meier curves for 6 month mortality. Cox regression showed a significant association between GAPS and mortality, with a hazard increase of 9% (95% CI:6.9% to 11.2%) for every point increase on GAPS. Figure 3 displays the Kaplan Meier curves for 6 month hospital readmission.Figure 2DiscussionGAPS is a simple tool which utilises data routinely collected at triage. It is predictive of hospital admission, hospital length of stay, six-month all-cause mortality and six-month hospital readmission. Therefore, GAPS could be employed to aid staff in hospital bed planning, clinical decision making and ED resource allocation and utilisation.Figure 3ReferencesLogan E, et al.Predicating admission at triage. Presented at International Acute Medicine Conference, Edinburgh 2016.Cameron A, et al. A simple tool to predict admission at the time of triage. Emergency Medicine Journal2014.
7 Mass casualty incidents: a review of triage severity planning assumptions
Authors: Hunt Paul 
Published: November 2017

BackgroundRecent events involving a significant number of casualties have emphasised the importance of appropriate preparation for receiving hospitals, especially Emergency Departments, during the initial response phase of a major incident. Development of a mass casualty resilience and response framework in the Northern Trauma Network included a review of existing planning assumptions in order to ensure effective resource allocation, both in local receiving hospitals and system-wide.Existing planning assumptions regarding categorisation by triage level are generally stated as a ratio for P1:P2:P3 of 25%:25%:50% of the total number of injured survivors. This may significantly over-, or underestimate, the number in each level of severity in the case of a large-scale incident.MethodsA pilot literature review was conducted of the available evidence from historical incidents in order to gather data regarding the confirmed number of overall casualties, ‘critical’ cases, admitted cases, and non-urgent or discharged cases. This data was collated and grouped by mechanism in order to calculate an appropriate severity ratio for each incident type.Results12 articles regarding mass casualty incidents from the last two decades were identified covering three main incident types: (1) Mass transportation crash, (2) Building fire, and (3) Bomb and related terrorist attacks and involving a total of 3615 injured casualties. The overall mortality rate was calculated as 12.3%. Table 1 summarises the available patient casualty data from each of the specific incidents reported and calculated proportions of critical (‘P1’), admitted (‘P2’), and non-urgent or ambulatory cases (‘P3’).ConclusionsDespite the heterogeneity of data and range of incident type there is sufficient evidence to suggest that current planning assumptions are incorrect and a more refined model is required. An important finding is the variation in proportion of critical cases depending upon the mechanism. For example, a greater than expected proportion results from incidents involving a building fire whereas the existing model may over-estimate critical caseload in more ‘conventional’ incidents such as a transportation accident or even in terrorism-related incidents.A new model suggesting the proportions of casualties expected by severity categorisation and incident type is shown in table 2. A more detailed investigation is planned to further refine and develop this model.Table 1Table 2
8 Different approaches needed to manage ED demand among different age-groups
Authors: Rimmer Melanie , Ablard Suzanne , O’Keeffe Colin , Mason Suzanne 
Published: November 2017

Background/objectivesA variety of interventions have been proposed to manage rising demand for Emergency and Urgent Care, described by an NHS England review as unsustainable in the long term. However it is unlikely that any suggested approach will be equally suitable for the diverse population of ED users.We aimed to understand the patterns of demand amongst different types of patients attending ED. We also sought to understand the intended and unintended effects of demand management initiatives. Our study combined insights from routine data, a survey of ED patients, and qualitative interviews with ED staff. This paper describes the results of our analysis of the interviews.MethodsWe conducted semi-structured interviews with 25 ED and Urgent Care Centre staff across 7 hospital sites in Yorkshire and Humber between 25 April and 11 July 2016. The interview topic guide asked about 4 broad areas; job role, description of patients and their impact on demand, description of inappropriate attendance, and current/future initiatives to deal with rising demand. Interviews were transcribed verbatim and analysed using framework analysis. We analysed the results to identify groups of patients with different patterns of use of ED services. We also explored ED staff experiences of demand management initiatives, and their suggestions for future initiatives.ResultsAlthough we did not ask specifically about patients’ age, our analysis revealed that ED staff categorised attenders as children and young people, working age people, and older people. These groups had different reasons for attendance, different routes to the ED, different rate of non-urgent attendance, and different issues driving demand. Staff also described variation in the time taken to treat patients of different ages, with the oldest and youngest patients described as requiring the most time.There was no consensus amongst staff about the effectiveness of initiatives for managing demand. A strikingly wide variety of initiatives were mentioned including patient education, co-location of other services with ED (‘ED hubs’), and extending community-based services.ConclusionED staff attribute distinctly different patterns of ED attendance to patients of different age groups, including reasons for attending ED, the route to the ED, and the rate of non-urgent attendance. Given this variation, proposed demand management interventions are likely to impact differently on different age groups, and one solution is unlikely to be optimal for all ages. Therefore a number of different approaches will be needed to manage ED demand among different age groups.
9 Closed chest compressions reduce survival in a model of haemorrhage-induced traumatic cardiac arrest
Authors: Watts Sarah , Smith Jason , Gwyther Robert , Kirkman Emrys 
Published: November 2017

BackgroundClosed chest compressions (CCC) are a key component of resuscitation from medical causes of cardiac arrest, but when haemorrhage, the leading cause of preventable battlefield deaths, is the likely cause there is little evidence to support their use. Resuscitation protocols for traumatic cardiac arrest (TCA) highlight the importance of addressing reversible causes, such as the administration of fluids to treat hypovolaemia. This study evaluated whether CCC were beneficial following haemorrhage-induced TCA and additionally whether resuscitation with blood improved physiological outcomes.MethodsThe study was conducted with the authority of UK Animals (Scientific Procedures) Act 1986 using 39 terminally anesthetised Large White pigs (35 kg, 29–40 kg) instrumented for invasive physiological monitoring. Following instrumentation and baseline measurements, animals underwent tissue injury (captive bolt to the right thigh) and controlled haemorrhage (30% blood volume). Mean arterial blood pressure (MAP) was maintained at 45 mmHg for 60 min, followed by a further controlled haemorrhage to a MAP of 20 mmHg. As arterial blood and pulse pressures spontaneously deteriorated further over a 5 min period, the randomised resuscitation protocol was initiated as follows: CCC (n=6); IV 0.9% saline (Sal n=8); IV autologous whole blood (WB n=8); IV saline +chest compressions (Sal +CCC n=9); and IV whole blood +chest compressions (WB +CCC n=8). 3×10 ml/kg fluid boluses were administered using the Belmont Rapid Infuser (200 ml/min). CCC were performed using the LUCAS II Chest Compression System.Outcome was attainment of return of spontaneous circulation (ROSC) 15 min post-resuscitation. ROSC was categorised by MAP (MAP ≥50 mmHg=ROSC; MAP >20 <50 mmHg=partial ROSC; MAP ≤20 mmHg=dead).Figure 1ResultsOutcome was significantly worse in the group that received CCC compared to WB and Sal groups (6/6 dead versus 0/8 and 0/8 respectively) (p<0.0001).A significantly higher number of animals attained ROSC in WB compared to Sal group (6/8 versus 0/8 ROSC and 2/8 versus 8/8 partial ROSC respectively) (p=0.0069).There were some none significant differences between WB and WB+CCC groups (6/8 versus 5/8 ROSC, 2/8 versus 1/8 partial ROSC and 0/8 versus 2/8 dead respectively) (p=0.4411).No animals attained ROSC in the Sal and Sal+CCC groups however significantly more animals died in the Sal+CCC group (0/8 versus 0/9 ROSC, 8/8 versus 2/9 partial ROSC and 0/8 versus 7/9 dead respectively) (p=0.0023).ConclusionsCCC were associated with increased mortality compared to intravenous fluid resuscitation. Resuscitation with whole blood demonstrated the greatest physiological benefit as demonstrated by highest numbers of animals achieving ROSC.
Neighbourhood characteristics and health outcomes: evaluating the association between socioeconomic status, tobacco store density and health outcomes in Baltimore City
Authors: Galiatsatos Panagis , Kineza Cynthia , Hwang Seungyoun , Pietri Juliana , Brigham Emily , Putcha Nirupama , Rand Cynthia S , McCormack Meredith , Hansel Nadia N 
Published: November 2017

IntroductionSeveral studies suggest that the health of an individual is influenced by the socioeconomic status (SES) of the community in which he or she lives. This analysis seeks to understand the relationship between SES, tobacco store density and health outcomes at the neighbourhood level in a large urban community.MethodsData from the 55 neighbourhoods of Baltimore City were reviewed and parametric tests compared demographics and health outcomes for low-income and high-income neighbourhoods, defined by the 50th percentile in median household income. Summary statistics are expressed as median. Tobacco store density was evaluated as both an outcome and a predictor. Association between tobacco store densities and health outcomes was determined using Moran’s I and spatial regression analyses to account for autocorrelation.ResultsCompared with higher-income neighbourhoods, lower-income neighbourhoods had higher tobacco store densities (30.5 vs 16.5 stores per 10 000 persons, P=0.01), lower life expectancy (68.5 vs 74.9 years, P<0.001) and higher age-adjusted mortality (130.8 vs 102.1 deaths per 10 000 persons, P<0.001), even when controlling for other store densities, median household income, race, education status and age of residents.ConclusionIn Baltimore City, median household income is inversely associated with tobacco store density, indicating poorer neighbourhoods in Baltimore City have greater accessibility to tobacco. Additionally, tobacco store density was linked to lower life expectancy, which underscores the necessity for interventions to reduce tobacco store densities.
Mechanism-informed Repurposing of Minocycline Overcomes Resistance to Topoisomerase Inhibition for Peritoneal Carcinomatosis
Authors: Huang Huang-Chiao , Liu Joyce , Baglo Yan , Rizvi Imran , Anbil Sriram , Pigula Michael , Hasan Tayyaba 
Published: November 2017

Abstract
Mechanism-inspired drug repurposing that augments standard treatments offers a cost-effective and rapid route toward addressing the burgeoning problem of plateauing of effective therapeutics for drug-resistant micrometastases. We show that the antibiotic minocycline, by its ability to minimize DNA repair via reduced expression of tyrosyl-DNA phosphodiesterase-1 (Tdp1), removes a key process attenuating the efficacy of irinotecan, a frequently used chemotherapeutic against metastatic disease. Moreover, minocycline and irinotecan cooperatively mitigate each other's undesired cytokine inductions of VEGF and IL8, respectively, thereby reinforcing the benefits of each modality. These mechanistic interactions result in synergistic enhancement of irinotecan-induced platinum-resistant epithelial ovarian cancer cell death, reduced micrometastases in the omenta and mesentery by &gt;75%, and an extended overall survival by 50% in a late-stage peritoneal carcinomatosis mouse model. Economic incentives and easy translatability make the repurposing of minocycline as a reinforcer of the topoisomerase class of chemotherapeutics extremely valuable and merits further investigations. Mol Cancer Ther; 17(2); 508–20. ©2017 AACR.
Apolipoprotein E e4 Allele Is Associated with Subjective Cognitive Decline: A Meta-Analysis
Authors: Zhang Ting , Liu Shuling , Zhang Yajing  , Guan Yalin  , Wang Xiaodan , Zhao Lei  , Shi Zhihong , Yue Wei , Zhang Ying  , Liu Shuai , Ji Yong 
Published: November 2017

<b><i>Background and Purpose:</i></b> Subjective cognitive decline (SCD) is a condition associated with increased risk of Alzheimer’s disease. This study performs a meta-analysis to estimate the prevalence of the <i>Apolipoprotein E e4</i> (<i>APOE e4</i>) allele in SCD and the association of <i>APOE e4</i> with SCD. <b><i>Methods:</i></b> The MEDLINE, EMBASE, and Cochrane Library databases were searched. Meta-analyses were conducted using STATA 12.0 software. When significant heterogeneity was present (<i>I</i><sup>2</sup> &#x3e;50% and <i>p</i> &#x3c; 0.05), we conducted stratified and meta-regression analyses to explore possible reasons for heterogeneity. <b><i>Results:</i></b> We selected a total of 28 studies that were conducted in Australia, the United States, northern Europe, middle Europe, southern Europe, and Asia. The sample size of the SCD group was 6,044. Thirteen studies included a healthy control group (total control cohort of 3,822), whereas the remaining 15 studies were single-arm studies of SCD groups. The <i>APOE e4</i> allele was associated with SCD (OR 1.12 [1.00–1.25]; <i>p</i> = 0.04). The pooled estimate for <i>APOE e4</i> carrier prevalence was 32% (95% CI 28–35). Due to the significant heterogeneity in prevalence estimates, we performed stratified and meta-regression analyses and found that age and northern European residency were significantly associated with heterogeneity. <b><i>Conclusion:</i></b> The results of this meta-analysis indicate a weak association between <i>APOE e4</i> and SCD. Age and northern European residency are the critical factors that determine heterogeneity in the <i>APOE e4</i>-associated prevalence of SCD.
Reducing Risk by Improving Standards of Intrapartum Fetal Care
Authors: Young Peter , Hamilton Rosie , Hodgett Sheena , Moss Mary , Rigby Claire , Jones Peter , Johanson Richard 
Published: November 2017

Summary Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI) have pointed to a high frequency of suboptimal intrapartum fetal care of a kind that, in the event of an adverse outcome, is hard to defend in court. In an effort to minimize liability, various strategies were applied in a district hospital labour ward—guidelines, cyclical audit, monthly feedback meetings and training sessions in cardiotocography (CTG). The effects of these interventions on quality of care was assessed by use of the CESDI system in all babies born with an Apgar score of 4 or less at 1 min and/or 7 or less at 5 min. 540 babies (4.3%) had low Apgar scores, and neither the percentage nor gestational age differed significantly between audit periods. In the baseline audit, care was judged suboptimal (grade II/III) in 14 (74%) of 19 cases, and in the next four periods it was 23%, 27%, 27% and 32%. In the latest audit period, after further educational interventions, it was 9%. Many of the failures to recognize or act on abnormal events were related to CTG interpretation. After the interventions there was a significant increase in cord blood pH measurement. There were no differences between audit periods in the proportion of babies with cord pH <7.2. These results indicate that substantial improvements in quality of intrapartum care can be achieved by a programme of clinical riskmanagement.
Why do we have Apocrine and Sebaceous Glands?
Authors: Porter Alan M W 
Published: November 2017

Summary The secretions of sebaceous and apocrine glands fulfil an important thermoregulatory role in cold-stressed and heat-stressed hunter-gatherers. In hot conditions the secretions emulsify eccrine sweat and thus encourage the formation of a sweat sheet and discourage the formation and loss of sweat drops from the skin. In colder conditions sebum changes its nature and repels rain from skin and hair.
Design or Accident? The Natural History of Teenage Pregnancy
Authors: Seamark Clare 
Published: November 2017

The UK has the highest rate of teenage pregnancy in Western Europe. A retrospective record-based study was conducted in an East Devon general practice to gain greater understanding of the outcome of first teenage pregnancy and subsequent reproductive history. The comparison group was women who had first conceived between the ages of 25 and 29 years. 149/673 women born between 1968 and 1977 became pregnant when teenagers. Of these, 70 (47%) had the baby, 67 (45%) had a termination and 10 (7%) had a spontaneous miscarriage; 2 others experienced fetal loss. Of the women aged 25-29 at first conception, 127 (92%) had the baby, 6 (4%) had a termination and 5 (4%) had a miscarriage. 40 (27%) of the teenage group went on to have a second teenage pregnancy, including 12 of the 67 who had their first pregnancy terminated. Although teenage pregnancy is often viewed as unplanned and unwanted, the reality is more complex. Among this group, many first pregnancies were desired. Even among those whose first pregnancy was terminated, 18% went on to have a baby while still a teenager.