bluuebunny/crossref_metadata_2025_split huggingface dataset:
A systematic review of observational pain assessment instruments for use with nonverbal intubated critically ill adult patients in the emergency department: an assessment of their suitability and psychometric properties
Authors: Varndell Wayne , Fry Margaret , Elliott Doug 
Published: September 2016

Aim and objectiveTo examine the psychometric properties and suitability of the available observational pain instruments for potential use with nonverbal critically ill adult patients in the emergency department.BackgroundIn the emergency department, assessing pain in critically ill patients is challenging, especially those unable to communicate the presence of pain. Critically ill patients are commonly unable to verbally communicate pain due to altered oral communication (e.g. endotracheal intubation) and/or diminished consciousness (e.g. sedation, delirium), placing them at great risk of inadequate pain management. Over half of intensive care critically ill intubated patients experience moderate‐to‐severe pain whilst intubated and mechanically ventilated.DesignSystematic review.Data sourcesTheCINAHL,EMBASE,MEDLINE, ProQuest databases, and the Cochrane Library and the National Institute of Clinical Excellence were also searched from their date of inception to April 2016, with no language restrictions applied.Review methodStudies were identified using predetermined inclusion criteria. Data were extracted and summarised and underwent evaluation using published classification of psychometric tests for consistency of interpretation.ResultsTwenty‐six studies evaluating five observational pain assessment instruments that had been used with critically ill intubated patients were identified. All five instruments included behavioural indicators, with two including physiologic indicators. All five instruments have undergone validity and reliability testing involving nonverbal critically ill intubated patients, three were examined for feasibility, and one instrument underwent sensitivity and specificity testing. None have been tested within the emergency department with nonverbal critically ill intubated adult patients.ConclusionThe use of an appropriate and valid observational pain assessment instrument is fundamental to detecting and optimising pain management in nonverbal critically ill intubated patients in the emergency department. Of the observational pain assessment instruments reviewed, the Critical‐Care Pain Observation Tool was identified as most appropriate for testing in a prospective trial in an emergency department setting.
Taking actions to quit chewing betel nuts and starting a new life: taxi drivers’ successful experiences of quitting betel nut chewing
Authors: Yang Tsui‐Yun , Lin Hung‐Ru 
Published: September 2016

Aims and objectivesTo understand taxi drivers’ successful experiences of quitting betel nut chewing.BackgroundPrevious studies verified that betel nut chewing significantly increases the risk of oral cancer. In Taiwan, taxi drivers work for approximately 10–13 hours per day, and 31·7–80% of them choose to chew betel nuts for their invigorating qualities, which enable them to work more hours and receive more income.DesignA qualitative research design was used.MethodsThis study used the grounded theory method with purposive sampling to perform in‐depth interviews with male taxi drivers who had successfully quit betel nut chewing for more than six months.ResultsThe interviewed participants were 25 taxi drivers aged 45–67 who had chewed betel nuts for an average of 30·9 years. A constant comparative analysis of the 25 interviews revealed six categories, namely the first experience of chewing betel nuts, a part of work and life, perceiving the impact of betel nuts, trying to change, acting to quit betel nut chewing and starting a new life.ConclusionsDuring the cessation process, taxi drivers tended to be affected by their addiction to chewing betel nuts and the temptation of friends’ invitations to chew betel nuts. However, their recognition of the physical effects of betel nut chewing and their sense of responsibility and commitment to family were the critical factors affecting their determination to quit betel nut chewing. Their willpower to not to chew betel nuts and the source of their motivation to exercise self‐control also contributed to their success.Relevance to clinical practiceHealthcare personnel should understand the experiences and perceptions of betel nut chewers, strengthen their understanding of the effects of betel nut chewing on physical health during the cessation period and support their self‐efficacy and quitting behaviours with the assistance of significant others.
Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China
Authors: Liu Shuai , Li Chonghui , Shi Zhihong , Wang Xiaodan , Zhou Yuying , Liu Shuling , Liu Jing , Yu Tao , Ji Yong 
Published: September 2016

Aims and objectivesTo evaluate caregiver burden and factors that influence this burden among caregivers and patients with Alzheimer's disease in China.BackgroundLong‐term care can reduce the quality of life for caregivers and result in both mental and physical exhaustion. However, little is known about caregiver burden and associated factors in China.DesignThe study had a quantitative cross‐sectional design.MethodsA total of 309 caregivers and their patients were included in the study. The patients' cognitive, psychological and functional status and their caregivers' burden, sleep quality and mental state were evaluated. Descriptive analyses, single‐factor regression and stepwise factor regression were used to determine the effects of various factors on caregiver burden.ResultsOlder females and spouses still play an important role in providing family care for those with dementia. Most of the caregivers were the sole full‐time caregiver and had little time for themselves. Sleepiness was a common physical problem for caregivers, and some of them had moderate to severe depression and anxiety. A lower functional status of the patient was associated with higher caregiver burden. Poorer physical status compared with before caregiving began, lower life satisfaction, and higher degrees of depression and anxiety were associated with higher caregiver burden.ConclusionDepression, anxiety and sleep problems are the main challenges that are faced by family caregivers of patients with Alzheimer's disease. Caregivers' functional status, lower life satisfaction, depression and anxiety influenced caregiver burden. Caregiver burden was related to the severity of the patient's dementia and the personal factors of the caregivers.Relevance to clinical practiceTo provide information about caregivers' current status while caring for patients with Alzheimer's disease and to understand caregiver burden and its related factors. Professionals who work with Alzheimer's disease should pay more attention to caregiver burden, especially those with mental and physical problems.
Health promotion among older adults in Austria: a qualitative study
Authors: Boggatz Thomas , Meinhart Christoph Matthias 
Published: September 2016

Aims and objectivesTo determine the types of attitudes to health promotion among older Austrians.BackgroundHealth promotion in old age becomes increasingly important in the current period of demographic transition. Interventions are likely to be successful if they take the attitude of older persons into consideration. There may be several types of attitudes to health promotion among older adults.DesignCross‐sectional qualitative study.MethodsSemi‐structured interviews were conducted in a purposive sample consisting of 36 home‐dwelling older persons from local communities in the federal province of Salzburg, Austria. Data were analysed using qualitative content analysis according to Mayring and subsequent construction of types.ResultsThere are three main types of attitudes to health promotion. ‘Health promoters through everyday activities’ considered domestic work and walks to be sufficient in keeping up their health. Fitness‐oriented persons practised sports of some type. Users of complementary methods practised such methods to some degree. These types of attitudes could be further differentiated according to their outcome expectations. In addition to benefits for health, socialising was also an important outcome. Physical decline may reduce a fitness‐oriented attitude, whereas encouragement by others may trigger it.ConclusionOlder adults have various attitudes to health promotion, but these are not immutable.Relevance to clinical practiceHealth promotion programmes that are not restricted to a narrow focus on health but provide the opportunity to socialise may support older adults in maintaining a healthy lifestyle.
Healthcare‐professional patients’ conceptions of being ill and hospitalised – a phenomenographic study
Authors: Prenkert Malin , Carlsson Eva , Svantesson Mia , Anderzén‐Carlsson Agneta 
Published: September 2016

Aims and objectivesTo describe the variation of conceptions of being ill and hospitalised, from the perspective of healthcare‐professional patients.BackgroundPrevious literature focuses on either physicians’ or nurses’ experiences of being a patient, without aiming at determining a variation of ways of understanding that phenomena. Nor have we been able to identify any study reporting other healthcare professionals’ experiences.DesignThis study has an inductive descriptive design.MethodsQualitative interviews with healthcare professionals (n = 16), who had been hospitalised for at least two days. Phenomenographic data analysis was conducted.ResultsThe feelings of security were based on knowledge, insight and trust, and acceptance of the healthcare system. Being exposed and totally dependent due to illness provoked feelings of vulnerability and insecurity. The patients used their knowledge to achieve participation in the care. The more severe they perceived their illness to be, the less they wanted to participate and the more they expressed a need for being allowed to surrender control. The patients’ ideal picture of care was sometimes disrupted, and based on their experience, they criticised care and made suggestions that could contribute to general care improvements.ConclusionsHealthcare‐professional patients have various conceptions of being ill and hospitalised. Based on the general nature of the many needs expressed, we believe that the insights provided in this study can be transferred so as to also be valid for lay patients. Possibly, an overhaul of routines for discharge planning and follow‐up, and adopting a person‐centred approach to care, can resolve some of the identified shortcomings.Relevance to clinical practiceThe results can be used for the purpose of developing knowledge for healthcare professions and for educational purposes.
Genome divergence and diversification within a geographic mosaic of coevolution
Authors: Parchman Thomas L. , Buerkle C. Alex , Soria‐Carrasco Víctor , Benkman Craig W. 
Published: September 2016

AbstractDespite substantial interest in coevolution's role in diversification, examples of coevolution contributing to speciation have been elusive. Here, we build upon past studies that have shown both coevolution between South Hills crossbills and lodgepole pine (Pinus contorta), and high levels of reproductive isolation between South Hills crossbills and other ecotypes in the North American red crossbill (Loxia curvirostra) complex. We used genotyping by sequencing to generate population genomic data and applied phylogenetic and population genetic analyses to characterize the genetic structure within and among nine of the ecotypes. Although genome‐wide divergence was slight between ecotypes (FST = 0.011–0.035), we found evidence of relative genetic differentiation (as measured byFST) between and genetic cohesiveness within many of them. As expected for nomadic and opportunistic breeders, we detected no evidence of isolation by distance. The one sedentary ecotype, the South Hills crossbill, was genetically most distinct because of elevated divergence at a small number of loci rather than pronounced overall genome‐wide divergence. These findings suggest that mechanisms related to recent local coevolution between South Hills crossbills and lodgepole pine (e.g. strong resource‐based density dependence limiting gene flow) have been associated with genome divergence in the face of gene flow. Our results further characterize a striking example of coevolution driving speciation within perhaps as little as 6000 years.
Identification of pneumococcal proteins that are functionally linked to penicillin‐binding protein 2b (PBP2b)
Authors: Straume Daniel , Stamsås Gro Anita , Berg Kari Helene , Salehian Zhian , Håvarstein Leiv Sigve 
Published: September 2016

SummaryThe oval shape of pneumococci results from a combination of septal and lateral peptidoglycan synthesis. The septal cross‐wall is synthesized by the divisome, while the elongasome drives cell elongation by inserting new peptidoglycan into the lateral cell wall. Each of these molecular machines contains penicillin‐binding proteins (PBPs), which catalyze the final stages of peptidoglycan synthesis, plus a number of accessory proteins. Much effort has been made to identify these accessory proteins and determine their function. In the present paper we have used a novel approach to identify members of the pneumococcal elongasome that are functionally closely linked to PBP2b. We discovered that cells depleted in PBP2b, a key component of the elongasome, display several distinct phenotypic traits. We searched for proteins that, when depleted or deleted, display the same phenotypic changes. Four proteins, RodA, MreD, DivIVA and Spr0777, were identified by this approach. Together with PBP2b these proteins are essential for the normal function of the elongasome. Furthermore, our findings suggest that DivIVA, which was previously assigned as a divisomal protein, is required to correctly localize the elongasome at the negatively curved membrane region between the septal and lateral cell wall.
Candida infections in paediatrics: Results from a prospective single‐centre study in a tertiary care children's hospital
Authors: Mesini Alessio , Bandettini Roberto , Caviglia Ilaria , Fioredda Francesca , Amoroso Loredana , Faraci Maura , Mattioli Girolamo , Piaggio Giorgio , Risso Francesco M. , Moscatelli Andrea , Loy Anna , Castagnola Elio 
Published: September 2016

SummaryTo describe the epidemiology of invasive Candida infection in a tertiary care paediatric hospital. Prospective single‐centre survey on all Candida strains isolated from normally sterile fluids and urines in the period 2005‐2015 . A total of 299 ICI were documented in 262 patients. Urinary tract infection represented the most frequent diagnosis (62%), followed by fungaemia (34%) and peritonitis (4%). Fungaemia was most frequent in children with cancer (59%) or in low birth weight neonates (61%), while urinary tract infections were more frequent in patients with urinary tract malformation. C.albicans was the most frequently isolated species (60%) compared with C. non‐albicans, but differences were present according to the site of isolation and underlying conditions. Overall 90‐day mortality was 7%, 13% in fungaemias, 8% in peritonitis and 2% in urinary tract infections. The rates of invasive Candida infection increased during the study period. Invasive Candida infection is diagnosed with increasing frequency in children. Site of isolation and aetiology are frequently related with the presence of underlying, favouring conditions. Mortality was not negligible, especially in the presence of more invasive infections and specific underlying conditions.
Sleep disturbances in irritable bowel syndrome: a systematic review
Authors: Tu Q. , Heitkemper M. M. , Jarrett M. E. , Buchanan D. T. 
Published: September 2016

AbstractBackgroundSleep disturbances are well‐documented among persons with irritable bowel syndrome (IBS). Difficulty in falling asleep, shorter sleep time, frequent arousal and awakenings, or non‐restorative sleep are the most common manifestations. Sleep disturbances are also related to a higher risk of having IBS. Some researchers have provided evidence of a positive association between poorer subjective sleep quality and increased severity and frequency in gastrointestinal (GI) symptoms in those with IBS. However, findings from studies using objective sleep and activity measures, such as polysomnography and actigraphy, are inconclusive.PurposeThis systematic review of the literature between 1990 and 2015 evaluates the evidence of sleep disturbances in adults with IBS and their relationship with GI symptoms.
Analysis of Networks with Missing Data with Application to the National Longitudinal Study of Adolescent Health
Authors: Gile Krista J. , Handcock Mark S. 
Published: September 2016

SummaryIt is common in the analysis of social network data to assume a census of the networked population of interest. Often the observations are subject to partial observation due to a known sampling or unknown missing data mechanism. However, most social network analysis ignores the problem of missing data by including only actors with complete observations. We address the modelling of networks with missing data, developing previous ideas in missing data, network modelling and network sampling. We use several methods including the mean value parameterization to show the quantitative and substantive differences between naive and principled modelling approaches. We also develop goodness-of-fit techniques to understand model fit better. The ideas are motivated by an analysis of a friendship network from the National Longitudinal Study of Adolescent Health.
Arthroscopy of the Dorsal and Plantar Pouches of the Tarsocrural Joint for the Treatment of Osteochondritis Dissecans in the Horse: Clinical Features and Follow‐Up
Authors: James Oliver , Payne Richard , Bathe Andrew , Greet Tim , Wylie Claire 
Published: September 2016

ObjectiveTo describe the clinical details and pathology within the dorsal and plantar pouches of the tarsocrural joint of a population of horses that underwent arthroscopic surgery for tarsocrural osteochondritis dissecans (OCD).Study DesignRetrospective cohort study.AnimalsHorses referred for arthroscopic treatment of tarsocrural OCD between 2005 and 2013 (102 horses; 144 joints).MethodsCase records of all horses that had tarsocrural arthroscopy for OCD at Rossdales Equine Hospital, Newmarket, United Kingdom were included. Cases from 3 ECVS Diplomates were included, 1 of whom routinely examined 70 plantar pouches concurrently with routine dorsal pouch investigation. A structured questionnaire was used to obtain follow‐up data alongside examination of racing records where appropriate. Descriptive data and 95% CI were calculated.ResultsOf the 70 joints that had both dorsal and plantar pouches examined, there was cartilage erosion/degeneration in 22 dorsal pouches (31.4%), cartilage wear lines in 32 plantar pouches (45.7%), and fragments were removed at the time of surgery from 7 plantar pouches (10.0%). Of the plantar pouches with wear lines, 18 (25.7%) had no evidence of cartilage abnormalities (separate from the OCD lesion) within the dorsal pouch. From the 102 horses with available follow‐up, 34 horses (66.7%) achieved their intended use postsurgery.ConclusionRoutine plantar pouch investigation is warranted in cases of tarsocrural OCD to provide further information on the health of the joint and allows for removal of fragments from the plantar pouch that may not have been identified by routine diagnostic radiography.
Frequency of Undetected Glove Perforation and Associated Risk Factors in Equine Surgery
Authors: Elce Yvonne A. , Laverty Sheila , Almeida da Silveira Eduardo , Piat Perrine , Trencart Pierre , Ruzickova Pavlina , Reardon Richard J. M. 
Published: September 2016

ObjectiveTo estimate the frequency of undetected perforations in surgical gloves during equine surgery and to identify risk factors associated with occurrence.Study DesignObservational cohort study.Sample PopulationSurgical gloves—292 pairs.MethodsWater leak tests were performed on gloves after equine surgery to detect perforations. Fifty pairs of unused gloves were also tested. Potential risk factors were recorded. Logistic regression was used to explore associations between putative risk factors and perforation.ResultsNo perforations were detected in the unused gloves. Of 292 pairs of used gloves tested, 80 (27%) had at least one glove perforation per pair. The frequency of perforations was not different between surgery diplomates and residents (P=.69). The length and type of surgery were significantly associated with the likelihood of undetected glove perforation with surgeries longer than 60 minutes approximately 2.5 times more likely to result in glove perforation (P=.005). Surgery classified as soft tissue, orthopedic or exploratory celiotomy was 3 times more likely to result in glove perforation than minimally invasive surgery. The perforations occurred significantly more frequently in the nondominant hand (19%) than the dominant hand (11%) (P=.009).ConclusionThere is a high occurrence of undetected glove perforation in equine surgery. Precautions can be suggested based on this study although further investigation is required to assess whether glove perforations are associated with surgical site infections.
Urgent Implementation in a Hospital Setting of a Strategy To Rule Out Secondary Cases Caused by Imported Extensively Drug-Resistant Mycobacterium tuberculosis Strains at Diagnosis
Authors: Pérez-Lago Laura , Martínez-Lirola Miguel , García Sergio , Herranz Marta , Mokrousov Igor , Comas Iñaki , Martínez-Priego Llúcia , Bouza Emilio , García-de-Viedma Darío 
Published: September 2016

ABSTRACTCurrent migratory movements require new strategies for rapidly tracking the transmission of high-risk importedMycobacterium tuberculosisstrains. Whole-genome sequencing (WGS) enables us to identify single-nucleotide polymorphisms (SNPs) and therefore design PCRs to track specific relevant strains. However, fast implementation of these strategies in the hospital setting is difficult because professionals working in diagnostics, molecular epidemiology, and genomics are generally at separate institutions. In this study, we describe the urgent implementation of a system that integrates genomics and molecular tools in a genuine high-risk epidemiological alert involving 2 independent importations of extensively drug resistant (XDR) and pre-XDR BeijingM. tuberculosisstrains from Russia into Spain. Both cases involved commercial sex workers with long-standing tuberculosis (TB). The system was based on strain-specific PCRs tailored from WGS data that were transferred to the local node that was managing the epidemiological alert. The optimized tests were available for prospective implementation in the local node 33 working days after receiving the primary cultures of the XDR strains and were applied to all 42 new incident cases. An interpretable result was obtained in each case (directly from sputum for 27 stain-positive cases) and corresponded to the amplification profiles for strains other than the targeted pre-XDR and XDR strains, which made it possible to prospectively rule out transmission of these high-risk strains at diagnosis.