bluuebunny/crossref_metadata_2025_split huggingface dataset:
Serious incidents after death: content analysis of incidents reported to a national database
Authors: Yardley Iain E , Carson-Stevens Andrew , Donaldson Liam J 
Published: November 2017

Objectives To describe serious incidents occurring in the management of patient remains after their death. Design Incidents occurring after patient deaths were analysed using content analysis to determine what happened, why it happened and the outcome. Setting The Strategic Executive Information System database of serious incidents requiring investigation occurring in the National Health Service in England. Participants All cases describing an incident that occurred following death, regardless of the age of the patient. Main outcome measures The nature of the incident, the underlying cause or causes of the incident and the outcome of the incident. Results One hundred and thirty-two incidents were analysed; these related to the storage, management or disposal of deceased patient remains. Fifty-four incidents concerned problems with the storage of bodies or body parts. Forty-three incidents concerned problems with the management of bodies, including 25 errors in postmortem examination, or postmortems on the wrong body. Thirty-one incidents related to the disposal of bodies, 25 bodies were released from the mortuary to undertakers in error; of these, nine were buried or cremated by the wrong family. The reported underlying causes were similar to those known to be associated with safety incidents occurring before death and included weaknesses in or failures to follow protocol and procedure, poor communication and informal working practices. Conclusions Serious incidents in the management of deceased patient remains have significant implications for families, hospitals and the health service more broadly. Safe mortuary care may be improved by applying lessons learned from existing patient safety work.
Five-year forward view: lessons from emergency care at the extremes of age
Authors: Minhas JS , Minhas D , Coats T , Banerjee J , Roland D 
Published: November 2017

Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the “answer is not one-size-fits-all”. This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key ‘think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.
Did Winston Churchill suffer a myocardial infarction in the White House at Christmas 1941?
Authors: Vale J Allister , Scadding John W 
Published: November 2017

Summary While staying in the White House over Christmas 1941, Churchill developed chest pain on trying to open a window in his bedroom. Sir Charles Wilson, his personal physician, diagnosed a ‘heart attack’ (myocardial infarction). Wilson, for political and personal reasons, decided not to inform his patient of the diagnosis or obtain assistance from US medical colleagues. On Churchill's return to London, Wilson sought a second opinion from Dr John Parkinson who did not support the diagnosis of coronary thrombosis (myocardial infarction) and reassured Churchill accordingly.
Pericardial effusion following cardiac surgery. A single-center experience
Authors: Nguyen Hien Sinh , Nguyen Hung Doan-Thai , Vu Thang Duc 
Published: November 2017

Background Pericardial effusion is still a common postoperative complication after open heart surgery with cardiopulmonary bypass. Pericardial effusion significantly prolongs the hospital stay and associated costs as well as affecting overall outcomes after open heart surgery in Hanoi Heart Hospital, a tertiary hospital in Vietnam with an annual volume of 1000 patients. This study aimed to investigate the clinical presentation, incidence, and risk factors of postoperative pericardial effusion, which may ensure better prevention of pericardial effusion and improvement in surgical outcomes after open heart surgery. Methods A cross-sectional study was performed on 1127 patients undergoing open heart surgery from January 2015 to December 2015. Results Thirty-six (3.19%) patients developed pericardial effusion. Of these, 16 (44.4%) had cardiac tamponade. Pericardial effusion occurred after valve procedures in 77.8% of cases. Pericardial effusion was detected after discharge in 47.2% of cases at a mean time of 18.1 ± 13.7 days. Univariate logistic regression analysis showed that age > 25 years, body surface area ≥ 1.28 m2, preoperative liver dysfunction, New York Heart Association class III/IV, left ventricular end-diastolic diameter z score ≥ 0.55, and postoperative anticoagulant use were associated with postoperative pericardial effusion. Multivariate logistic regression analysis showed that left ventricular end-diastolic diameter z score ≥ 0.55 was an independent risk factor for postoperative pericardial effusion. Conclusions Routine postoperative echocardiography is necessary to detect postoperative pericardial effusion. Increased left ventricular end-diastolic dimension is an independent predictor of postoperative pericardial effusion.
A systematic review of evidence for older adults’ sedentary behavior and physical activity after hip fracture
Authors: Zusman Enav Z , Dawes Martin G , Edwards Nicola , Ashe Maureen C 
Published: November 2017

Objective: To synthesize evidence on older adults’ sedentary behavior and physical activity during rehabilitation and recovery for hip fracture (1) across the care continuum and (2) from clinical interventions. Design: We conducted a systematic review of peer-reviewed publications using CINAHL, Embase, Ovid MEDLINE, PsycINFO, and SportDiscus (last search: 17 October 2017). Study selection: We included studies that measured sedentary behavior and physical activity of older adults with hip fracture using activity monitors (e.g. accelerometers). We identified literature at Level 1 (title and abstract) and Level 2 (full text), and conducted forward and backward searches. We assessed observational studies’ adherence to reporting guidelines and intervention studies’ risk of bias. Results: We included 14 studies (882 participants). Four studies reported sedentary behavior data, while all studies reported information on physical activity. Settings included hospital, rehabilitation centers, and the community. Nine studies were observational; five were experimental design. Older adults had excessive sedentary time (>10 hours/day) and low physical activity. Participants’ average upright time differed across settings. During hospital stay, it ranged 16–52 minutes/day, while in the community, it ranged 51–261 minutes/day. Data from five interventions reported on physical activity change: two studies increased between 14 and 27 minutes/day. Another study reported participants accumulated 6994 steps/day at the end of the intervention, but for two other interventions, activity was below 5000 steps/day. Conclusion: Based on available evidence, older adults with hip fracture engage in prolonged sedentary behavior and have low levels of physical activity during rehabilitation and recovery.
A Culturally Tailored Intervention for Promoting Breast Cancer Screening Among Women From Faith-Based Communities in Israel: A Randomized Controlled Study
Authors: Freund Anat , Cohen Miri , Azaiza Faisal 
Published: November 2017

Lower rates of screening for early detection of cancer were reported among ethnic minorities and faith-based communities. The purpose of the article is to assess the effect of a culturally based intervention program intended to increase breast cancer screening adherence among two groups in Israel: ultra-Orthodox Jewish and Arab women. Using a randomized controlled study design, 598 participants completed the 3-month follow-up questionnaire regarding adherence to screening and perceived effect of intervention. Results show that having a lower level of religious beliefs and gaining a better understanding of the importance of screenings were significant predictors of performing breast awareness practice (BAP) and undergoing clinical breast examination (CBE) in both groups. We conclude that interventions should be specifically tailored to cultural groups to reduce barriers stemming from unique beliefs and perceptions, which prevent individuals in these groups from undergoing screening. Special efforts should be made to increase CBE among young women.
Effect of pear apple and date fibres incorporation on the physico-chemical, sensory, nutritional characteristics and the acceptability of cereal bars
Authors: Bchir Brahim , Jean-François Thiry , Rabetafika Holy Nadia , Blecker Christophe 
Published: November 2017

Cereal bars are nutritious food composed of several ingredients including dry raw and agglutinative ingredients. The objective of this study was to evaluate the effect of pear apple and date fibres, from cooked fruit co-product, addition on the physico-chemical textural and sensory properties of cereal bars. First, five formulations containing an amount of 10% of co-products and commercial fibre, used as a reference, were elaborated and their physico-chemical composition was determined. Second, to determine the acceptability of consumer, apple fibre co-products were added (6, 10 and 14%). Products were evaluated for their texture using a texturometer and sensory characteristics using an acceptance test. Results showed that physico-chemical composition of cereal bars elaborated with co-products was slightly different compared to those elaborated with commercial fibre. All bars have low water activity levels (∼0.470) and interesting energy (300 kcal/100 g bar). External appearance revealed a darker colour (L*:∼42/a*:∼8/b*:∼20). There were no significant differences (P > 0.05) in texture values (hardness: 40.8 N; cohesiveness: 0.34; springiness: 0.60; chewiness: 8.30 N) between cereal bars prepared with pear co-product and wheat bran. Acceptance test confirms the formulation used for cereals bars and showed that incorporation of 10% of co-product produced cereal bars with the highest acceptability. Sensory characteristics revealed that appearance is the limiting factor for consumer acceptability, essentially for cereal bars containing pear co-product. Apple, pear and date co-products could be used successfully as a food ingredient to develop new formulations of cereal bars.
When one childhood meets another – maternal childhood trauma and offspring child psychopathology: A systematic review
Authors: Plant Dominic T , Pawlby Susan , Pariante Carmine M , Jones Fergal W 
Published: November 2017

Background: Child maltreatment can have a long-term impact on mental health. Less is known about the consequences of child maltreatment on the next generation’s psychological wellbeing. Aim: This systematic review aimed to synthesise the existing empirical literature on the association between a mother’s history of maltreatment in her own childhood and her children’s experiences of psychopathology, and to characterise potential mediating pathways. Method: Electronic database and hand searches yielded 12 studies, with a combined sample size of 45,723 mother–child dyads, which met criteria for inclusion in the review. Results: There was evidence of an overall positive association between a mother’s history of child maltreatment and her child’s experience of emotional and behavioural difficulties across childhood and adolescence. Maternal psychological distress and poorer parenting practices were found to be key mediating pathways of this association. Conclusion: Children of mothers who were exposed to maltreatment in childhood appear to be at an increased risk for psychopathology. Mothers with traumatic childhood experiences should be offered improved access to psychological therapies and parenting programmes to help mitigate the potential impact of child maltreatment on future generations.
A one-year cost–utility analysis of REBOA versus RTACC for non-compressible torso haemorrhage
Authors: Renna Maxwell S , van Zeller Cristiano , Abu-Hijleh Farah , Tong Cherlyn , Gambini Jasmine , Ma Mengyao 
Published: November 2017

Introduction Major trauma is a leading cause of death and disability in young adults, especially from massive non-compressible torso haemorrhage. The standard technique to control distal haemorrhage and maximise central perfusion is resuscitative thoracotomy with aortic cross-clamping (RTACC). More recently, the minimally invasive technique of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to similarly limit distal haemorrhage without the morbidity of thoracotomy; cost–utility studies on this intervention, however, are still lacking. The aim of this study was to perform a one-year cost–utility analysis of REBOA as an intervention for patients with major traumatic non-compressible abdominal haemorrhage, compared to RTACC within the U.K.’s National Health Service. Methods A retrospective analysis of the outcomes following REBOA and RTACC was conducted based on the published literature of survival and complication rates after intervention. Utility was obtained from studies that used the EQ-5D index and from self-conducted surveys. Costs were calculated using 2016/2017 National Health Service tariff data and supplemented from further literature. A cost–utility analysis was then conducted. Results A total of 12 studies for REBOA and 20 studies for RTACC were included. The mean injury severity scores for RTACC and REBOA were 34 and 39, and mean probability of death was 9.7 and 54%, respectively. The incremental cost-effectiveness ratio of REBOA when compared to RTACC was £44,617.44 per quality-adjusted life year. The incremental cost-effectiveness ratio, by exceeding the National Institute for Health and Clinical Effectiveness’s willingness-to-pay threshold of £30,000/quality-adjusted life year, suggests that this intervention is not cost-effective in comparison to RTACC. However, REBOA yielded a 157% improvement in utility with a comparatively small cost increase of 31.5%. Conclusion Although REBOA has not been found to be cost-effective when compared to RTACC, ultimately, clinical experience and expertise should be the main factor in driving the decision over which intervention to prioritise in the emergency context.
A comparison of fluoroscopic exposure and operative time during treatment of displaced supracondylar elbow fractures in children
Authors: Hand Cameron , Bresnahan James J , Hennrikus William L 
Published: November 2017

Background Intraoperative fluoroscopy can potentially expose the surgeon to levels of radiation beyond the recommended limits. This study aimed to assess the intraoperative differences between the fixation of types 2 and 3 supracondylar fractures for fluoroscopy time, operative time, direction of displacement, and potential cumulative risk of radiation to the surgeon. Methods Retrospective chart analysis was used to review 74 consecutive subjects with type 2 or 3 extension supracondylar fractures over a six-year period. Closed reduction and percutaneous pinning with fluoroscopy was used in all cases. Fluoroscopy time and operative time were analyzed based on the fracture type, direction of initial displacement, and the number of K-wires used. Results Type 2 supracondylar fractures require less fluoroscopy (mean: 16.8 s) and are shorter operations (mean: 19.2 min) when compared to type 3 (26.2 s and 25.1 min; p<0.05). The direction of displacement (posteromedial vs. posterolateral) did not influence operative (23.8 vs. 26.5 min) or fluoroscopy times (27.6 vs. 24.9 s; p>0.05). Conclusions Type 3 supracondylar fractures utilize more fluoroscopy time and operative time than type 2 fractures. The direction of displacement did not affect fluoroscopy time or operative time. Surgeons who perform large numbers of closed reduction and percutaneous pinning may be exposed to excess amounts of radiation.
Gut reactions: How the blood–brain barrier connects the microbiome and the brain
Authors: Logsdon Aric F , Erickson Michelle A , Rhea Elizabeth M , Salameh Therese S , Banks William A 
Published: November 2017

A growing body of evidence indicates that the microbiome interacts with the central nervous system (CNS) and can regulate many of its functions. One mechanism for this interaction is at the level of the blood–brain barriers (BBBs). In this minireview, we examine the several ways the microbiome is known to interact with the CNS barriers. Bacteria can directly release factors into the systemic circulation or can translocate into blood. Once in the blood, the microbiome and its factors can alter peripheral immune cells to promote interactions with the BBB and ultimately with other elements of the neurovascular unit. Bacteria and their factors or cytokines and other immune-active substances released from peripheral sites under the influence of the microbiome can cross the BBB, alter BBB integrity, change BBB transport rates, or induce release of neuroimmune substances from the barrier cells. Metabolic products produced by the microbiome, such as short-chain fatty acids, can cross the BBB to affect brain function. Through these and other mechanisms, microbiome–BBB interactions can influence the course of diseases as illustrated by multiple sclerosis.Impact statementThe connection between the gut microbiome and central nervous system (CNS) disease is not fully understood. Host immune systems are influenced by changes to the microbiota and offers new treatment strategies for CNS disease. Preclinical studies provide evidence of changes to the blood–brain barrier when animals are subject to experimental gut infection or when the animals lack a normal gut microbiome. The intestine also contains a barrier, and bacterial factors can translocate to the blood and interact with host immune cells. These metastatic bacterial factors can signal T-cells to become more CNS penetrant, thus providing a novel intervention for treating CNS disease. Studies in humans show the therapeutic effects of T-cell engineering for the treatment of leukemia, so perhaps a similar approach for CNS disease could prove effective. Future research should begin to define the bacterial species that can cause immune cells to differentiate and how these interactions vary amongst CNS disease models.
Utilization of stent grafts in the management of arteriovenous access pseudoaneurysms
Authors: Aurshina Afsha , Hingorani Anil , Marks Natalie , Ascher Enrico 
Published: November 2017

Objective Endovascular stent graft repair for exclusion of pseudoaneurysm is currently being explored to replace open surgical repair as current management. The objective of the study was to evaluate the clinical safety and efficacy of endovascular stent graft intervention in pseudoaneurysms complicating arteriovenous reconstructions in patients on chronic hemodialysis. Methods A retrospective analysis of all pseudoaneurysms treated with stent grafts at our institution over a period of five years was performed. The indications for endovascular intervention included bleeding from the pseudoaneurysm, infection, and significant skin compromise overlying the pseudoaneurysm or combination of the above. The rates of technical success, complication, and primary patency were measured at one-week, one-month, and six-month follow-up. Results A total of 33 endovascular stent graft interventions in 29 patients were performed for the treatment of pseudoaneurysms. The average age of patients was 68 years (range 31–90 years), with 13 female. Diabetes and hypertension were present in 15 and 22 patients, respectively. In eight patients, there was evidence of active infection at the fistula site. The choice of stent grafts include Viabahn ( n = 31), Wallgraft ( n = 1), and i-Cast ( n = 1). The initial technical success rate was 94%. The two failed interventions included occlusion of inflow artery with immediate conversion to open procedure ( n = 1) and incomplete pseudoaneurysm exclusion ( n = 1). Primary patency at one month and six months was 83 and 60%, respectively. An additional balloon angioplasty of outflow tract or central stenosis was performed in 18 cases (54%). The explanation of stent grafts due to persistent or recurrent bacteremia/site infection was required in four out of eight patients. The average time to explanation was 93 days (range 6–204 days). Conclusion The stent graft implantation is a safe, minimally invasive and efficient way to control and manage arteriovenous accesses with pseudoaneurysms. In the presence of infection, this approach may be less durable.
Arterio-biliary fistulas: What to choose as endovascular treatment?
Authors: Stefańczyk Ludomir , Polguj Michał , Szubert Wojciech , Chrząstek Jarosław , Jurałowicz Piotr , Garcarek Jerzy 
Published: November 2017

Objectives Endovascular procedures are the treatment of choice in cases of intrahepatic fistulas. Arterio-biliary fistulas are the rarest and most difficult to treat, due to high risk of infection. Methods Eight cases of persistent hemobilia that developed as a result of arterio-biliary fistulas are presented. Five cases developed as a result of iatrogenic injury, two cases as a result of chronic infection, one case as a consequence of trauma. Results Patients were treated using endovascular embolization or combined endovascular and endoscopic biliary tract revision. The results were monitored after six to seven days and one month after embolization. The embolizations were considered effective in all cases. One patient had four asynchronous fistulas requiring separate treatments sessions. Four patients required a revision of their biliary ducts after embolization and restoration of patency. In one patient, a migration of the coil to biliary ducts occurred. Conclusion Endovascular treatment of arterio-biliary fistulas is safe and effective. The use of embolization with soft and biodegradable materials like histoacrylic glue or thrombin may be the optimal method of treatment in comparison with coils which have a risk of migration or chronic infection.