bluuebunny/crossref_metadata_2025_split huggingface dataset:
In whose words? Struggles and strategies of service providers working with immigrant clients with limited language abilities in the violence against women sector and child protection services
Authors: Alaggia Ramona , Maiter Sarah , Jenney Angelique 
Published: January 2016

AbstractNewcomer and immigrant clients with limited language abilities face communication barriers that can compromise their capacity to make informed decisions about themselves and their children with serious implications for their families. These clients most likely had high proficiency of language in their country of origin but are learning the language of the new host country. Using a phenomenological design to elicit descriptions from and interpret experiences of Canadian‐helping professionals, we conducted four focus groups first with child protection workers, and second with violence against women service providers. Analyses of these data uncovered five themes: (1) enhancing client engagement and self‐agency; (2) advantages and drawbacks in use of interpreters; (3) creative and intensive translation strategies; (4) structural challenges and (5) gender and cultural considerations. Results are organized into an ecological framework in putting forward implications for policy and practice. The over‐arching finding supports that important training and preparation are necessary for service providers to deliver language‐sensitive services. As well, funding levels need to be increased to better match service delivery goals. Newcomer and immigrant clients whose language needs are not adequately met potentially face safety issues and/or fragmentation of their families.
Long‐term prospective cohort study on dental implants: clinical and microbiological parameters
Authors: Tenenbaum Henri , Bogen Omer , Séverac François , Elkaim René , Davideau Jean‐Luc , Huck Olivier 
Published: January 2016

AbstractObjectiveThe aim of the present prospective cohort study is to evaluate clinical and microbiological data of dental implants after at least 8 years of follow‐up.Material and methodsA total of 110 patients and 232 implants were included at baseline and followed during 1 year. Fifty‐two patients and 108 implants could be evaluated at the final examination. Clinical and microbiological data were taken at baseline, 1 year and at least 8 years.ResultsThe mean follow‐up time was 10.8 ± 1.7 years. Plaque index was, respectively, 0.50 ± 0.50 at baseline, 0.50 ± 0.50 at 1 year and 0.33 ± 0.67 at ≥8 years. Gingival index was, respectively, 1.08 ± 0.19 at baseline, 1.01 ± 0.39 at 1 year and 0.22 ± 0.47 at ≥8 years. Sulcular bleeding index was, respectively, 0.17 ± 0.22 at baseline, 0.11 ± 0.33 at 1 year and 0.17 ± 0.22 at ≥8 years. Probing depth was, respectively, 2.67 ± 0.75 at baseline, 3.00 ± 0.83 at 1 year and 2.74 ± 1.00 at ≥8 years. Clinical attachment level was, respectively, 3.75 ± 1.17 at baseline, 4.00 ± 1.06 at 1 year and 4.00 ± 1.17 at ≥8 years. Peri‐implant mucositis was detected around 60.2% of implants in 73.1% of patients, while peri‐implantitis was affecting 12% of implants in 15.4% of patients. Some bacteria species were associated with worsened clinical parameters.ConclusionsAbout 69.4% of implants (75/108) and 67.3% of the patients (35/52) were considered as success in the present prospective cohort study after a mean follow‐up of 10.8 years. Microbial follow‐up may help to identify patients at risk for peri‐implant disease.
Dental implant surgery in patients in treatment by dabigatran
Authors: Gómez‐Moreno Gerardo , Fernández‐Cejas Esther , Aguilar‐Salvatierra Antonio , de Carlos Félix , Delgado‐Ruiz Rafael Arcesio , Calvo‐Guirado José Luis 
Published: January 2016

AbstractObjectivesThe aim of this study was to evaluate the incidence of bleeding complications after dental implant placement in patients in treatment by the oral anticoagulant dabigatran following a specific protocol.Material and methodsSeventy‐one patients were divided into two groups: 29 had been taking dabigatran for over 6 months (150 mg orally every 12 h) before implant surgery (dabigatran group) and a control group consisting of 42 healthy subjects. Patients were treated in an outpatient setting. All subjects received dental implants in different positions, dabigatran group patients 12 h after the last dose of dabigatran. Nonabsorbable sutures were used and patients were given gauzes impregnated with tranexamic acid 5% to bite on for 30–60 min. Dabigatran patients resumed medication 8 h after the procedure, resuming usual dosage (every 12 h) the day after surgery.ResultsTwo dabigatran patients and two control patients presented slight bleeding the day after surgery. Bleeding was managed with gauzes impregnated with tranexamic acid. No statistically significant differences (P = 0.542) were found in relation to bleeding episodes between the groups, with a relative risk of 0.675 based on the pooled groups and a 95% confidence interval of 0.090–5.088.ConclusionsDental implant surgery in patients taking dabigatran can be performed safely providing 12 h have passed since the last dose and local hemostatic measures are applied. Normal dosage can be resumed 8 h after implant surgery.
Social deprivation in patients requiring pelvic exenterative surgery
Authors: Radwan R. W. , Coyne P. E. , Jones H. G. , Evans M. D. , Davies M. , Harris D. A. , Beynon J. 
Published: January 2016

AbstractAimPelvic exenteration is an aggressive operation for locally advanced rectal cancer. Social deprivation has been shown to reduce life expectancy and has been linked to a poorer outcome in patients with colorectal cancer. The aim of this study was to analyse the effect of social deprivation scores on the outcome in these complex patients.MethodA retrospective review of all patients undergoing pelvic exenteration for primary rectal cancer between 2006 and 2014 was performed. Deprivation scores were calculated for all patients using the Welsh Index of Multiple Deprivation. Patients were then grouped into quartiles, from Q1 (most deprived) to Q4 (least deprived). The primary outcome measure was 5‐year survival.ResultsIn all, 120 patients were included (65 female) with a median age of 64 (31–90) years. No differences between quartiles were identified for neoadjuvant therapy (P = 0.687) or type of exenteration (P = 0.690). The median length of stay was significantly higher in the most deprived groups (Q1–Q2; P = 0.023). There was a significant difference in survival between the groups, with lowest 5‐year survival rates (53%) in the most deprived quartile (Q1) (P = 0.015).ConclusionSocial deprivation is significantly associated with postoperative length of stay and survival in patients undergoing pelvic exenteration for primary rectal cancer.
Risk factors associated with portomesenteric venous thrombosis in patients undergoing restorative proctocolectomy for medically refractory ulcerative colitis
Authors: Gu J. , Stocchi L. , Gorgun E. , Remzi F. H. 
Published: January 2016

AbstractAimData on risk factors for portomesenteric venous thrombosis (PMVT) following abdominal surgery for ulcerative colitis (UC) are limited. The aim of this study was to investigate factors associated with PMVT after surgical treatment for UC.MethodPatients who underwent restorative proctocolectomy (RPC) and ileal pouch‐anal anastomosis (IPAA) including diverting ileostomy closure for medically refractory UC were identified from a prospectively maintained database. Patient‐related, disease‐related and treatment‐related variables were collected. Univariable and multivariable analyses were performed to assess factors associated with PMVT.ResultsOf the 521 patients completing surgical treatment for UC between 2006 and 2012, symptomatic PMVT occurred in 36 (7%), which resulted in a significantly increased hospital stay (P < 0.001). Patients developing PMVT were younger (P = 0.014), had a lower preoperative albumin level (P = 0.037) and were more likely to have been taking steroids within 1 month before surgery (P = 0.006). The combined incidence of PMVT was comparable between patients having a three‐stage and two‐stage management (6% vs 8%, P = 0.43), but the relative incidence of PMVT after RPC + IPAA was 8%, significantly higher than the 4% after total abdominal colectomy (TAC) (P = 0.005) and the 2% after subsequent completion proctectomy (CP) + IPAA (P = 0.038). Multivariate analysis confirmed that RPC + IPAA was associated with a significantly greater risk of PMVT than CP + IPAA (OR = 4.9, P = 0.003) or TAC (OR = 3.5, P = 0.011). Preoperative steroid use was an independent factor for PMVT (OR = 5.8, P = 0.006).ConclusionSteroid use 1 month before surgery is associated with an increased risk of PMVT. A staged restorative proctocolectomy does not increase the overall incidence of PMVT.
Intermittent hydrostatic pressure maintains and enhances the chondrogenic differentiation of cartilage progenitor cells cultivated in alginate beads
Authors: Li Yang , Zhou Jianxin , Yang Xiaofei , Jiang Yiqiu , Gui Jianchao 
Published: January 2016

The objective of this study was to explore the effects of intermittent hydrostatic pressure (IHP) on the chondrogenic differentiation of cartilage progenitor cells (CPCs) cultivated in alginate beads.CPCs were isolated from the knee joint cartilage of rabbits, and infrapatellar fat pad‐derived stem cells (FPSCs) and chondrocytes (CCs) were included as the control cell types. Cells embedded in alginate beads were treated withIHPat 5 Mpa and 0.5 Hz for 4 h/day for 1, 2, or 4 weeks. The cells' migratory and proliferative capacities were evaluated using the scratch and Live/Dead assays, respectively. Hematoxylin and eosin staining, safranin O staining, and immunohistochemical staining were performed to determine the effects ofIHPon the synthesis of extracellular matrix (ECM) proteins. Real‐time polymerase chain reaction analysis was performed to measure the expression of genes related to chondrogenesis. The scratch and Live/Dead assays revealed thatIHPsignificantly promoted the migration and proliferation ofFPSCs andCPCs to different extents. The staining experiments showed greater production of cartilageECMcomponents (glycosaminoglycans and collagenII) by cells exposed toIHP, and the gene expression analysis demonstrated thatIHPstimulated the expression of chondrocyte‐related genes. Importantly, these effects ofIHPwere more prominent inCPCs than inFPSCs andCCs. Considering all of our experimental results combined, we conclude thatCPCs demonstrated a stronger chondrogenic differentiation capacity than theFPSCs andCCs under stimulation withIHP. Thus, the use ofCPCs, combined with mechanical stimulation, may represent a valuable strategy for cartilage tissue engineering.
Estimating the impact of better management of glycaemic control in adults with Type 1 and Type 2 diabetes on the number of clinical complications and the associated financial benefit
Authors: Baxter M. , Hudson R. , Mahon J. , Bartlett C. , Samyshkin Y. , Alexiou D. , Hex N. 
Published: January 2016

AbstractAimTo estimate potential cost avoidance through modest and achievable improvements in glycaemic control in adults with Type 1 or Type 2 diabetes mellitus in the UK healthcare system.MethodsThe IMS Core Diabetes Model was used to examine the impact of improved glycaemic control (indicated by reduction in HbA1c level), in a representative cohort of adults with Type 1 or Type 2 diabetes. The cumulative incidence of microvascular and macrovascular complications was modelled across 5‐year periods to a 25‐year time horizon. Complication costs were applied to the data to estimate potential accrued cost avoidance.ResultsSignificant cost avoidance of ~£340 m is apparent in the first 5 years, increasing to ~£5.5bn after 25 years of sustained improvement in control. The overwhelming majority of cost avoidance arises from reductions in microvascular complications. In people with Type 1 diabetes the greatest cost avoidance comes from a reduction in renal disease (74% of cost avoidance), while in people with Type 2 diabetes it is generated by a reduction in foot ulcers, amputations and neuropathy: 57% cost avoidance). Greater cost reduction is accrued more rapidly in people with higher starting HbA1c levels.ConclusionModest improvements in glycaemic control generate significant reductions in the incidence and, therefore, cost of microvascular complications in people with Type 1 or Type 2 diabetes. This study provides clear support for the premise that prioritized and sustained investment in early and better intervention can provide concrete financial benefits in both the short and longer term.
Diabetic ketoacidosis in an adolescent and young adult population in the UK in 2014: a national survey comparison of management in paediatric and adult settings
Authors: Edge J. A. , Nunney I. , Dhatariya K. K. 
Published: January 2016

AbstractAimsTo assess the management of diabetic ketoacidosis in young people, which differs in the UK between paediatric and adult services, and to evaluate outcomes and extent to which national guidelines are used.MethodsA standardized questionnaire was sent to all paediatric and adult diabetes services in England, requesting details of all diabetic ketoacidosis admissions in young people aged > 14 years in paediatric services (‘paediatric’ patients), and in young adults up to the age of 22 years in adult services (‘adult’ patients).ResultsA total of 64 adult patients aged ≤ 22 years (mean age 19.2 years) were reported, of whom seven were aged between 10 and 16 years. A total of 71 paediatric patients were reported [mean (range) age 14.9 (11–18) years]. We found that 85% of paediatric and 69% of adult patients were treated according to national guidelines, 99% of paediatric and 89% of adult patients were treated with 0.9% saline and fixed‐rate insulin infusions and 16% of adult patients received an insulin bolus. Insulin treatment was initiated later in paediatric patients than in adult patients (100 vs 39 min; P < 0.001). In 23% of adult patients and 8.8% of paediatric patients, potassium levels were < 3.5 mmol/l (P < 0.005). The lowest mean potassium levels were 3.8 mmol/l in paediatric and 3.5 mmol/l in adult patients (P < 0.005). Hypoglycaemia occurred in 42.3% of paediatric and 36% of adult patients. Time to resolution was similar in paediatric and adult patients (16.0 vs 18.2 h), as was duration of hospital stay (2.35 vs 2.53 days).ConclusionsYoung people were treated according to national guidelines, but the quality of monitoring was variable in both paediatric and adult settings. The incidence of hypoglycaemia and hypokalaemia was unacceptably high.
Glucose test provenance recording in UK primary care: was that fasted or random?
Authors: McGovern A. P. , Fieldhouse H. , Tippu Z. , Jones S. , Munro N. , de Lusignan S. 
Published: January 2016

AbstractAimsTo describe the proportion of glucose tests with unrecorded provenance in routine primary care data and identify the impact on clinical practice.MethodsA cross‐sectional analysis was conducted of blood glucose measurements from the Royal College of General Practitioner Research and Surveillance Centre database, which includes primary care records from >100 practices across England and Wales. All blood glucose results recorded during 2013 were identified. Tests were grouped by provenance (fasting, oral glucose tolerance test, random, none specified and other). A clinical audit in a single primary care practice was also performed to identify the impact of failing to record glucose provenance on diabetes diagnosis.ResultsA total of 2 137 098 people were included in the cross‐sectional analysis. Of 203 350 recorded glucose measurements the majority (117 893; 58%) did not have any provenance information. The most commonly reported provenance was fasting glucose (75 044; 37%). The distribution of glucose values where provenance was not recorded was most similar to that of fasting samples. The glucose measurements of 256 people with diabetes in the audit practice (size 11 514 people) were analysed. The initial glucose measurement had no provenance information in 164 cases (64.1%). A clinician questioned the provenance of a result in 41 cases (16.0%); of these, 14 (34.1%) required repeating. Lack of provenance led to delays in the diagnosis of diabetes [median (range) 30 (3–614) days].ConclusionsThe recording of glucose provenance in UK primary care could be improved. Failure to record provenance causes unnecessary repeated testing, delayed diagnosis and wasted clinician time.
Safety and efficacy of insulin degludec/insulin aspart with bolus mealtime insulin aspart compared with standard basal–bolus treatment in people with Type 1 diabetes: 1–year results from a randomized clinical trial (BOOST® T1)
Authors: Hirsch I. B. , Franek E. , Mersebach H. , Bardtrum L. , Hermansen K. 
Published: January 2016

AbstractAimsTo evaluate the long‐term safety and efficacy of a simplified basal–bolus regimen of once‐daily insulin degludec/insulin aspart (IDegAsp) with additional IAsp vs. a standard basal–bolus insulin regimen of insulin detemir (IDet) with IAsp in adults with Type 1 diabetes.MethodsThis was an open‐label trial comprising a 26‐week core phase followed by a 26‐week extension phase. Participants were randomized to IDegAsp once daily at the main meal and IAsp at remaining meals (IDegAsp+IAsp), or IDet (once or twice daily) and IAsp at all meals (IDet+IAsp). Insulins were titrated to target plasma glucose of < 5 mmol/l (< 90 mg/dl) at pre‐breakfast (IDegAsp and IDet) and at pre‐meal (IAsp).ResultsAfter 52 weeks, the overall confirmed hypoglycaemia rate was 31.8 episodes/patient‐years of exposure (PYE) with IDegAsp+Asp and 36.7 episodes/PYE with IDet+IAsp, and the rate of nocturnal confirmed hypoglycaemia was significantly lower with IDegAsp+Asp than with IDet+IAsp (3.1 vs. 5.4 episodes/PYE, respectively; P < 0.05). Adverse event rates were comparable between groups. Mean HbA1c decreased from baseline by 0.7% (IDegAsp+IAsp) and 0.6% (IDet+IAsp), achieving 60 or 61 mmol/mol (7.6% or 7.7%, respectively), at Week 52. The mean total daily insulin dose was lower with IDegAsp+IAsp than with IDet+IAsp (ratio: 0.87; 95% CI 0.79–0.95; P = 0.0026).ConclusionsOnce‐daily treatment with IDegAsp and IAsp as bolus insulin for remaining meals was associated with significantly lower risk of nocturnal confirmed hypoglycaemia, improved glycaemic control and showed non‐inferiority compared with IDet+IAsp, the standard of care in Type 1 diabetes.
Insulin degludec/insulin aspart once daily in Type 2 diabetes: a comparison of simple or stepwise titration algorithms (BOOST®: SIMPLE USE)
Authors: Park S. W. , Bebakar W. M. W. , Hernandez P. G. , Macura S. , Hersløv M. L. , de la Rosa R. 
Published: January 2016

AbstractAimsTo compare the efficacy and safety of two titration algorithms for insulin degludec/insulin aspart (IDegAsp) administered once daily with metformin in participants with insulin‐naïve Type 2 diabetes mellitus.MethodsThis open‐label, parallel‐group, 26‐week, multicentre, treat‐to‐target trial, randomly allocated participants (1:1) to two titration arms. The Simple algorithm titrated IDegAsp twice weekly based on a single pre‐breakfast self‐monitored plasma glucose (SMPG) measurement. The Stepwise algorithm titrated IDegAsp once weekly based on the lowest of three consecutive pre‐breakfast SMPG measurements. In both groups, IDegAsp once daily was titrated to pre‐breakfast plasma glucose values of 4.0–5.0 mmol/l. Primary endpoint was change from baseline in HbA1c (%) after 26 weeks.ResultsChange in HbA1c at Week 26 was IDegAspSimple −14.6 mmol/mol (−1.3%) (to 52.4 mmol/mol; 6.9%) and IDegAspStepwise −11.9 mmol/mol (−1.1%) (to 54.7 mmol/mol; 7.2%). The estimated between‐group treatment difference was −1.97 mmol/mol [95% confidence interval (CI) −4.1, 0.2] (−0.2%, 95% CI −0.4, 0.02), confirming the non‐inferiority of IDegAspSimple to IDegAspStepwise (non‐inferiority limit of ≤ 0.4%). Mean reduction in fasting plasma glucose and 8‐point SMPG profiles were similar between groups. Rates of confirmed hypoglycaemia were lower for IDegAspStepwise [2.1 per patient years of exposure (PYE)] vs. IDegAspSimple (3.3 PYE) (estimated rate ratio IDegAspSimple/IDegAspStepwise 1.8; 95% CI 1.1, 2.9). Nocturnal hypoglycaemia rates were similar between groups. No severe hypoglycaemic events were reported.ConclusionsIn participants with insulin‐naïve Type 2 diabetes mellitus, the IDegAspSimple titration algorithm improved HbA1c levels as effectively as a Stepwise titration algorithm. Hypoglycaemia rates were lower in the Stepwise arm.
Association of aerobic fitness level with exercise‐induced hypoglycaemia in Type 1 diabetes
Authors: Al Khalifah R. A. , Suppère C. , Haidar A. , Rabasa‐Lhoret R. , Ladouceur M. , Legault L. 
Published: January 2016

AbstractAimTo determine the impact of physical fitness level on hypoglycaemia risk during exercise in people with Type 1 diabetes.MethodsA total of 44 patients [34 adults (aged 22–70 years) and 10 adolescents (aged 12–18 years)] with Type 1 diabetes, treated with insulin pump therapy, underwent a standardized exercise session. Cardiorespiratory fitness (maximum oxygen uptake) was measured and classified, based on established norms for age and sex, into either poor (< 25th percentile) or good fitness level (> 25th percentile). Plasma glucose levels were measured every 10 min, each patient performed physical activity at 60% maximum oxygen uptake either on a treadmill for 1 h or on a bicycle for 30 min. Frequency of hypoglycaemia (plasma glucose < 4 mmol/l) and decline in plasma glucose levels during exercise were assessed.ResultsIn all, 23 patients had a good exercise fitness level. Hypoglycaemic events occurred in 17/23 patients (74.0%) in the good fitness level group compared with 8/21 patients (38.0%) in the poor fitness level group (P = 0.02). Both groups had similar pre‐exercise plasma glucose levels. The plasma glucose values during exercise in the good fitness level group compared with the poor fitness level group were: plasma glucose nadir 3.9 ± 1.6 vs 5.5 ± 2.4 mmol/l (P = 0.01) and plasma glucose change −4.6 ± 3.4 vs. −2.1 ± 3.1 mmol/l (P = 0.01). The correlation between the plasma glucose nadir and maximum oxygen uptake was r = −0.38 (P = 0.01).ConclusionsPatients with good fitness level seem to be more prone to hypoglycaemia during exercise. This could be the result of better insulin sensitivity and the fact that they tend to exercise at greater work thresholds. These results are a step toward a better understanding of the association between physical fitness and exercise‐induced hypoglycaemia.