bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review
Authors: Gorton Hayley C , Webb Roger T , Kapur Navneet , Ashcroft Darren M 
Published: January 2016

ObjectivesTo establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations.DesignSystematic review.MethodsFour databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case–control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included.Outcome measuresThe outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study.ResultsOf 11 792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity.ConclusionsWhether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses.
Prevalence of dry eye disease in visual display terminal workers: a systematic review and meta-analysis
Authors: Courtin Romain , Pereira Bruno , Naughton Geraldine , Chamoux Alain , Chiambaretta Frédéric , Lanhers Charlotte , Dutheil Frédéric 
Published: January 2016

ObjectiveTo evaluate the prevalence and risk factors of dry eye disease (DED) in workers using visual display terminals (VDT).DesignSystematic review and meta-analysis.Data sourcesWe searched PubMed, Cochrane Library, Embase and Science Direct databases for studies reporting DED prevalence in VDT workers.Results16 of the 9049 identified studies were included, with a total of 11 365 VDT workers. Despite a global DED prevalence of 49.5% (95% CI 47.5 to 50.6), ranging from 9.5% to 87.5%, important heterogeneity (I2=98.8%, p<0.0001) was observed. Variable diagnosis criteria used within studies were: questionnaires on symptoms, tear film anomalies and corneoconjunctival epithelial damage. Some studies combined criteria to define DED. Heterogeneous prevalence was associated with stratifications on symptoms (I2=98.7%, p<0.0001), tears (I2=98.5%, p<0.0001) and epithelial damage (I2=96.0%, p<0.0001). Stratification of studies with two criteria adjusted the prevalence to 54.0% (95% CI 52.1 to 55.9), whereas studies using three criteria resulted in a prevalence of 11.6% (95% CI 10.5 to 12.9). According to the literature, prevalence of DED was more frequent in females than in males and increased with age.ConclusionsOwing to the disparity of the diagnosis criteria studied to define DED, the global prevalence of 49.5% lacked reliability because of the important heterogeneity. We highlight the necessity of implementing common DED diagnostic criteria to allow a more reliable estimation in order to develop the appropriate preventive occupational actions.
Improving the inspection and manual cleaning of dental instruments in a dental hospital
Authors: Campbell Louise , Barton Aisling , Boyle Rachael , Tully Vicki 
Published: January 2016

AbstractWithin the dental hospital setting, it is a frequent occurrence to find residual cement contaminating instruments in a newly opened kit having undergone the decontamination cycle. Any instrument found to be contaminated then cannot be used, as the area underneath the cement is not sterile. This in itself has several repercussions. These include: cross-contamination, since there is a chance that the cement will be removed and the contaminated instrument used; cost, as each new kit that will be opened due to contaminated instruments will incur decontamination costs; and finally time, which most importantly has an impact on patient experience. Our baseline data recording focussed on finding out the severity of the problem, which instruments were most affected, and how this affected patient treatment, using a questionnaire. Within the paediatric department, 27% of examination kits contained a contaminated instrument, almost one third of all kits used. This quality improvement project utilized a poster and team huddle discussions to raise awareness of the problem and successfully reduced the number of contaminated instrument kits to 7% over a period of four weeks.
Reduction of referral to assessment time for an older adults community mental health team
Authors: Sin Fai Lam Chun Chiang 
Published: January 2016

AbstractAnecdotal evidence suggested that waiting times within the older adults community mental health team (OA CMHT) had been increasing over time. An assessment and evaluation was indicated to ensure best quality care was provided for patients.A comparison was made between waiting times in January to December 2011 compared with August 2013 to July 2014. In 2011 the mean number of days until initial assessment from the point of referral was 12 days for routine cases, and 3.6 days for urgent cases. The re-audit showed the number of days increased to 15.89 days for routine cases, and 9.81 days for urgent cases.Contributory factors were reviewed, and it was felt that to address this problem, a duty worker role was necessary. The role of the duty worker was divided into triaging and allocating work. The triaging process was to ensure all urgent cases were highlighted early and acted upon.The duty worker’s role was also to gather sufficient information from the referrer, to reduce the risks of inadequate knowledge delaying assessment. In addition, the allocating process required the duty worker to designate a clinician in charge of the case upon receipt of referral. This ensured that clinicians were able to offer the earliest possible appointment slot for the initial assessment, and thus reduce waiting times.Following implementation, findings from September 2014 to February 2015 showed an improvement in average waiting times, as well as an improvement in the percentage of assessments reviewed within previously set standards. For routine reviews, the mean time until assessment was 10.68 days. For urgent reviews, the mean time until initial assessment was 6.8 days. However, it was noted that majority of urgent reviews were still not being reviewed in time.The outcomes of this study demonstrated an improvement of both waiting times, and percentage of patients being seen within set standards following a single intervention. In the current climate of cost efficiency savings, it is important for services to continue to find ways to streamline and improve upon current practices, to ensure the best outcome for patients.
Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic
Authors: Maqbool Talha , Raju Sneha , In Eunji 
Published: January 2016

AbstractGulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center.A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21”×32” patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests.The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic. These endpoints were achieved by incorporating patient friendly signage, as well as improving patient flow directors.
Analgesia in hip fractures. Do fascia-iliac blocks make any difference?
Authors: Callear Jacqueline , Shah Ku 
Published: January 2016

AbstractDespite recent national advances in the care for the hip fracture patient, significant morbidity and mortality persists. Some of this morbidity is attributable to the analgesia provided in the hospital setting. The National Institute of Health and Care Excellence and the Association of Anaesthetists of Great Britain and Ireland recommend the use of simple oral analgesia including opioids, with fascia-iliac blocks (FIB) used as an adjunct. Literature review reveals a paucity of evidence on this.The aim of this project was to evaluate the proportion of patients receiving a fascia-iliac block prior to operative intervention. A secondary aim was to evaluate the efficacy of these blocks through analysis of pre and post-operative opioid usage, post-operative delirium, time to bowel opening, and naloxone use.Patients who received a fascia-iliac block received significantly less post-operative and total analgesia (p=0.04, p=0.03), had lower rates of delirium (p=0.03) and those patients which were discharged directly home had a shorter inpatient stay (p=0.03). No patients who received a fascia-iliac block (FIB) needed naloxone to reverse opioid toxicity, whilst two without fascia-iliac block did. The results of the project eventually led to the introduction of a hip fracture care pathway which incorporates a single shot fascia-iliac block for all patients who are eligible. Within a two year study period, compliance with fascia-iliac blocks improved from 54% to 90%.Our experience shows a great improvement in compliance with fascia-iliac blocks in the pre-operative period. This work has also underpinned the introduction of a new hip fracture care pathway ultimately to better patient care and outcomes.
Should we cluster patients or symptoms? The myth of symptom clusters based on ‘depression, insomnia, pain’ and ‘depression, fatigue, pain’
Authors: Aktas Aynur , Walsh Declan , Hauser Katherine , Rybicki Lisa 
Published: January 2016

Context‘Depression, fatigue, pain’ (DFP) and ‘depression, insomnia, pain’ (DIP) symptom clusters (SCs) have been proposed in cancer. These symptoms are common and co-occur, that is, they constitute clusters of patients rather than symptoms.ObjectivesThe following research questions were addressed: (1) What is the frequency of co-occurrence of two symptom groups (DFP and DIP) in advanced cancer? (2) What is the degree of symptom item association within each symptom group? (3) Were either of these symptom trios associated with prognosis?MethodsWe reanalysed a symptom data set of 1000 patients with advanced cancer. We identified the frequency of co-occurrence of two symptom groups: DFP and DIP, using both prevalence and severity data. The symptom associations were tested by χ2and Spearman correlations. We also determined whether either of these symptom trios were associated with a major biological outcome, that is, survival by time-to-event analyses.Results(1) Although DFP and DIP co-occured in about a quarter of the population, they were not SCs, but rather patient clusters. (2) Many persons had only one symptom from any symptom pair, and correlation coefficients were low for all symptom pairs. (3) Neither DFP nor DIP were associated with survival.ConclusionsNeither DFP nor DIP symptom item combinations constituted a specific cancer SC contrary to prior reports. DFP co-occurred in 27% and DIP in only 20%. Additionally, these symptom combinations were not associated with a biological outcome, that is, poor prognosis. Patient subgroups identified by shared symptom experiences alone do not identify SCs.
Systematic review of risk prediction models for falls after stroke
Authors: Walsh Mary E , Horgan N Frances , Walsh Cathal D , Galvin Rose 
Published: January 2016

BackgroundFalls are a significant cause of morbidity after stroke. The aim of this review was to identify, critically appraise and summarise risk prediction models for the occurrence of falling after stroke.MethodsA systematic literature search was conducted in December 2014 and repeated in June 2015. Studies that used multivariable analysis to build risk prediction models for falls early after stroke were included. 2 reviewers independently assessed methodological quality. Data relating to model calibration, discrimination (C-statistic) and clinical utility (sensitivity and specificity) were extracted. A narrative review of models was conducted. PROSPERO reference: CRD42014015612.ResultsThe 12 included articles presented 18 risk prediction models. 7 studies predicted falls among inpatients only and 5 recorded falls in the community. Methodological quality was variable. A C-statistic was reported for 7 models and values ranged from 0.62 to 0.87. Models for use in the inpatient setting most frequently included measures of hemi-inattention, while those predicting community events included falls (or near-falls) history and balance measures most commonly. Only 2 studies reported any form of validation, and none presented a validated model with acceptable performance.ConclusionsA number of falls-risk prediction models have been developed for use in the acute and subacute stages of stroke. Future research should focus on validating and improving existing models, with reference to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines to ensure quality reporting and expedite clinical implementation.
A multicentre, randomised, controlled, open-label pilot study on the feasibility of discontinuation of adalimumab in established patients with rheumatoid arthritis in stable clinical remission
Authors: Chatzidionysiou Katerina , Turesson Carl , Teleman Annika , Knight Ann , Lindqvist Elisabet , Larsson Per , Cöster Lars , Forslind Kristina , van Vollenhoven Ronald , Heimbürger Mikael 
Published: January 2016

ObjectivesTreatment with tumour necrosis factor (TNF) blockers, once started as therapy for rheumatoid arthritis (RA), is usually continued indefinitely. The aim of this trial was to assess the possibility of discontinuing treatment with adalimumab (ADA) while maintaining remission in patients with RA with established disease in stable remission on combination therapy with ADA and methotrexate (MTX).MethodsIn a randomised, controlled, open-label pilot study of patients with RA in stable remission treated with ADA+MTX, patients were randomised in a 1:1 ratio to continue with ADA plus MTX (arm AM) or MTX monotherapy (arm M) for 52 weeks. Flare was defined as Disease Activity Score (DAS28) ≥2.6 or a change in DAS28 (ΔDAS28) of >1.2 from baseline at any time. Patients in arm M with a flare restarted ADA. The primary end point was the proportion of patients in remission at week 28.Results31 patients were enrolled in the study and randomised to arm AM (n=16) or arm M (n=15). At 28 weeks, 15/16 patients (94%) and 5/15 patients (33%) in arms AM and M, respectively, were in remission (p=0.001). During the first 28 weeks, 50% (8/16) in the AM arm and 80% (12/15) in the M arm had a flare (p=0.08). The number of patients in the AM and M arms with ≥1 ΔDAS28 >1.2 during the first 28 weeks was 1/16 (6%) and 8/15 (53%), respectively (p=0.005).ConclusionsIn this study, remission was rarely maintained in patients with long-standing disease who discontinued ADA. Discontinuation may be feasible in only a minority of patients with established RA in stable clinical remission.Trial registration numberNCT00808509.
Bone Morphogenic Protein 4-Smad–Induced Upregulation of Platelet-Derived Growth Factor AA Impairs Endothelial Function
Authors: Hu Weining , Zhang Yang , Wang Li , Lau Chi Wai , Xu Jian , Luo Jiang-Yun , Gou Lingshan , Yao Xiaoqiang , Chen Zhen-Yu , Ma Ronald Ching Wan , Tian Xiao Yu , Huang Yu 
Published: January 2016

Objective—
Bone morphogenic protein 4 (BMP4) is an important mediator of endothelial dysfunction in cardio-metabolic diseases, whereas platelet-derived growth factors (PDGFs) are major angiogenic and proinflammatory mediator, although the functional link between these 2 factors is unknown. The present study investigated whether PDGF mediates BMP4-induced endothelial dysfunction in diabetes mellitus.

Approach and Results—

We generated Ad-Bmp4 to overexpress Bmp4 and Ad-Pdgfa-shRNA to knockdown Pdgfa in mice through tail intravenous injection. SMAD4-shRNA lentivirus, SMAD1-shRNA, and SMAD5 shRNA adenovirus were used for knockdown in human and mouse endothelial cells. We found that PDGF-AA impaired endothelium-dependent vasodilation in aortas and mesenteric resistance arteries. BMP4 upregulated PDGF-AA in human and mouse endothelial cells, which was abolished by BMP4 antagonist noggin or knockdown of SMAD1/5 or SMAD4. BMP4-impared relaxation in mouse aorta was also ameliorated by PDGF-AA neutralizing antibody. Tail injection of Ad-Pdgfa-shRNA ameliorates endothelial dysfunction induced by Bmp4 overexpression (Ad-Bmp4) in vivo. Serum PDGF-AA was elevated in both diabetic patients and diabetic
db/db
mice compared with nondiabetic controls. Pdgfa-shRNA or Bmp4-shRNA adenovirus reduced serum PDGF-AA concentration in
db/db
mice. PDGF-AA neutralizing antibody or tail injection with Pdgfa-shRNA adenovirus improved endothelial function in aortas and mesenteric resistance arteries from
db/db
mice. The effect of PDGF-AA on endothelial function in mouse aorta was also inhibited by Ad-Pdgfra-shRNA to inhibit PDGFRα.

Conclusions—
The present study provides novel evidences to show that PDGF-AA impairs endothelium-dependent vasodilation and PDGF-AA mediates BMP4-induced adverse effect on endothelial cell function through SMAD1/5- and SMAD4-dependent mechanisms. Inhibition of PGDF-AA ameliorates vascular dysfunction in diabetic mice.
Time Series Construction of Summer Surface Temperatures for Alabama, 1883–2014, and Comparisons with Tropospheric Temperature and Climate Model Simulations
Authors: Christy John R. , McNider Richard T. 
Published: January 2016

AbstractThree time series of average summer [June–August (JJA)] daily maximum temperature (TMax) are developed for three interior regions of Alabama from stations with varying periods of record and unknown inhomogeneities. The time frame is 1883–2014. Inhomogeneities for each station’s time series are determined from pairwise comparisons with no use of station metadata other than location. The time series for the three adjoining regions are constructed separately and are then combined as a whole assuming trends over 132 yr will have little spatial variation either intraregionally or interregionally for these spatial scales. Varying the parameters of the construction methodology creates 333 time series with a central trend value based on the largest group of stations of −0.07°C decade−1 with a best-guess estimate of measurement uncertainty from −0.12° to −0.02°C decade−1. This best-guess result is insignificantly different (0.01°C decade−1) from a similar regional calculation using NOAA’s divisional dataset based on daily data from the Global Historical Climatology Network (nClimDiv) beginning in 1895. Summer TMax is a better proxy, when compared with daily minimum temperature and thus daily average temperature, for the deeper tropospheric temperature (where the enhanced greenhouse signal is maximized) as a result of afternoon convective mixing. Thus, TMax more closely represents a critical climate parameter: atmospheric heat content. Comparison between JJA TMax and deep tropospheric temperature anomalies indicates modest agreement (r2 = 0.51) for interior Alabama while agreement for the conterminous United States as given by TMax from the nClimDiv dataset is much better (r2 = 0.86). Seventy-seven CMIP5 climate model runs are examined for Alabama and indicate no skill at replicating long-term temperature and precipitation changes since 1895.
Simulating the Mutual Forcing of Anomalous High Southern Latitude Atmospheric Circulation by El Niño Flavors and the Southern Annular Mode*
Authors: Wilson Aaron B. , Bromwich David H. , Hines Keith M. 
Published: January 2016

Abstract
Numerical simulations using the National Center for Atmospheric Research Community Atmosphere Model (CAM) are conducted based on tropical forcing of El Niño flavors. Though these events occur on a continuum, two general types are simulated based on sea surface temperature anomalies located in the central (CP) or eastern (EP) tropical Pacific. The goal is to assess whether CAM adequately represents the transient eddy dynamics associated with each of these El Niño flavors under different southern annular mode (SAM) regimes. CAM captures well the wide spatial and temporal variability associated with the SAM but only accurately simulates the impacts on atmospheric circulation in the high southern latitudes when the observed SAM phase is matched by the model. Composites of in-phase (El Niño–SAM−) and out-of-phase (El Niño–SAM+) events confirm a seasonal preference for in-phase (out of phase) events during December–February (DJF) [June–August (JJA)]. Modeled in-phase events for both EP (during DJF) and CP (during JJA) conditions support observations of anomalous equatorward momentum flux on the equatorward side of the eddy-driven jet, shifting this jet equatorward and consistent with the low phase of the SAM. Out-of-phase composites show that the El Niño–associated teleconnection to the high southern latitudes is strongly modulated by the SAM, as a strong eddy-driven jet is well maintained by high-latitude transient eddy convergence despite the tropical forcing. A regional perspective confirms that this interaction takes place primarily over the Pacific Ocean, with high-latitude circulation variability being a product of both tropical and high-latitude forcing.