bluuebunny/crossref_metadata_2025_split huggingface dataset:
No-Suicide Contracts to Prevent Suicidal Behavior in Inpatient Psychiatric Settings
Authors: Drew Barbara L. 
Published: January 2017

BACKGROUND: Many individuals who are hospitalized on psychiatric units are at high risk of suicide. Among the strategies commonly recommended for suicide prevention is the negotiation of a no-suicide or no-harm contract. In spite of the conventional acceptance of no-suicide contracts, there is little research about this intervention. OBJECTIVE: To describe the use of no-suicide contracts in inpatient settings including the frequency of their use, the circumstances under which they are negotiated and the form of contracts. STUDY DESIGN: Descriptive survey. RESULTS: No-suicide contracts were used by 79% (n = 66) of the hospitals (N = 84). Contracts were generally negotiated after suicidal ideation was expressed (83% [n = 54] of those hospitals that use contracts), after self-harm (79%,n = 51), or after a patient who made a suicidal gesture or attempt was admitted (65%/, n = 42). In all but one hos- pital, nurses negotiated contracts with patients. Contracts were usually verbal (74%/,n = 48) or handwritten (72%,n = 47) rather than preprinted (15%,n = 10). Fifty-three percent of the respondents estimated more than 10 incidents of suicidal behavior by inpatients per year. CONCLUSIONS: Suicidal behaviors occurred in hospital settings at a rate that is clinically significant. No-suicide contracting is a common nursing practice in psychiatric inpatient settings in Ohio. Contracts are not indiscriminately used but are negotiated when high suicide risk is assessed.
Quality Assurance in Postgraduate Medical Education: Implications for Dermatology Residency Training Programs
Authors: Day Isaiah , Lin Andrew 
Published: January 2017

Background: In the past few years, quality assurance has become an increasingly important part of medical education for both Canadian and American training programs. Since this emphasis on quality assurance in residency programs is recent, most faculty members involved in teaching residents in dermatology training programs would not themselves have had experience with quality assurance. As a result, satisfying this requirement may be a challenge. Objectives: In this article, we review published reports in which various residency training programs have satisfied this requirement and propose projects in which dermatology residency training programs may satisfy quality assurance requirements. Methods: Using the key words residency, training, project, quality, assurance, improvement, medical errors, and safety, a literature search was conducted of English-language articles published after January 1990. Results/Conclusions: There are many innovative and effective ways program directors in dermatology training programs should be able to develop projects that improve patient care, enhance resident education, and fulfill accreditation requirements.
Demographic and Tumor Characteristics of Patients Diagnosed with Nonmelanoma Skin Cancer: 13-Year Retrospective Study
Authors: Mistry Nisha , Abanto Zenaida , Bajdik Chris , Rivers Jason K. 
Published: January 2017

Background: The incidence of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) is increasing worldwide; however, this varies by region. To date, there are limited data about trends of nonmelanoma skin cancer (NMSC) in Canada. Objective: To determine the demographic and tumor characteristic changes in patients diagnosed with BCC and SCC from 1993 to 2005 in a dermatology practice in Vancouver, British Columbia. Method: A retrospective chart review was conducted on patients with biopsy-confirmed NMSC between 1993 and 2005. Demographic and tumor characteristics were documented for the first two incident BCCs and SCCs per patient, and a descriptive data analysis was undertaken. Results: A total of 1,177 NMSCs were identified from 885 patient charts. The number of BCCs increased from 1993 to 2003 and then decreased until 2005. BCCs and SCCs were generally diagnosed in older people (60+ years); however, an important group of younger patients (20–39 years) was also diagnosed with BCCs. BCCs and SCCs were most commonly seen on the head and neck, but the leg was a common location for SCC in women. Conclusion: NMSC is prevalent in British Columbia. These results highlight the fact that NMSC can affect individuals younger than 40 years old. Prevention strategies are warranted to reduce the burden of NMSC in British Columbia.
Intracranial Spread of Merkel Cell Carcinoma to the Cerebellopontine Angle
Authors: Seaman Brian , Brem Steven , Fromm Allison , Staller Aileen , Mccardle Timothy , Jain Surbhi 
Published: January 2017

Background: Merkel cell carcinoma (MCC) is a rare, highly malignant, and aggressive dermal neuroendocrine neoplasm that rarely metastasizes to the central nervous system. Objective: To review the current literature regarding treatment of neurometastatic MCC. Methods: A case of a 78-year-old male with intracranial extra-axial metastatic MCC involving the left cerebellopontine angle is presented. Results: A retrosigmoid craniectomy was performed with complete resection of the metastatic focus. Adjuvant treatment included whole-brain radation therapy followed by etoposide and carboplatin chemotherapy. Seven months postoperatively, the patient was free of metastatic disease. Conclusion: Surgical resection should be performed when feasible to prevent local recurrence. This may be followed by early adjuvant fractionated whole-brain radiotherapy and systemic chemotherapy; however, no clinical trials have been performed to demonstrate a survival benefit.
T-Cell Lymphoma/Sézary Syndrome in a Liver Transplant Recipient
Authors: Ajroush Nojoud Al , Sheikh Khadija Rafique , Kadry Razan , Almutawa Abdulmonem , Alfadley Abdullah 
Published: January 2017

Background: Cutaneous T-cell lymphoma is a rare subtype of posttransplantation lymphoproliferative disease, with only 29 cases reported in the literature to date, the majority of which are post-renal transplantation. Only a few were reported after pancreas, heart, and bone marrow transplantation. There have been no reports of cutaneous T-cell lymphoma following liver transplantation to date. Objective: We report a case of a 76-year-old male who developed generalized eczematous eruption 13 years after a liver transplantation. Investigations showed that it was Epstein-Barr virus-negative, CD3-positive, and CD4-positive cutaneous T-cell lymphoma with Sézary cells in the blood. Conclusion: This shows that cutaneous T-cell lymphoma/Sézary syndrome can also develop after liver transplantation. To our knowledge, there are no similar reports in the English literature.
Getting Evidence into Clinical Practice: An Organisational Behaviour Perspective
Authors: Ferlie Ewan , Fitzgerald Louise , Wood Martin 
Published: January 2017

Objectives: To study the relationship between research evidence and clinical behaviour change in the UK National Health Service (NHS) in the period 1995–1997 by examining the ‘careers' of change issues designed to reshape clinical practice, the impact of such change efforts, and the factors shaping change outcomes. Methods: Comparative case study methods were used. Four clinical change issues were studied using semi-structured interviews ( n=119) and documentary analysis in one English NHS region. For each issue, there was an overview semi-structured interview survey of the issue at regional level, followed by an intensive analysis of its impact at local level on the practice of specific clinical groups. Results: There was a weak relationship between the evidence base and its diffusion. The diffusion and take-up of scientific evidence were shown to be socially constructed. Different forms of evidence were differentially accepted by individuals and groups. Specific organisational and social factors affected this pattern of impact. The general management hierarchy of the NHS played a very limited role in enabling evidence-based clinical change. Conclusions: The implementation of evidence-based medicine is a complex and contested process. The results of this study confirm a professional dominance model of clinical behaviour change and identify tacit expert knowledge as a key power resource in shaping the way research evidence influences clinical practice.
How Do General Practitioners Choose Their Practice? Preferences for Practice and Job Characteristics
Authors: Gosden Toby , Bowler Isobel , Sutton Matthew 
Published: January 2017

Objectives: To investigate the strength of preferences for practice and job characteristics among recently appointed general practitioners (GPs) in south-east England. Methods: Conjoint analysis based on a postal questionnaire survey of all 293 GPs who joined a new practice between April 1997 and March 1998 in London, Essex and Hertfordshire. GPs were presented with descriptions of practices in pairs, which varied systematically for key characteristics, and asked to indicate their preferred practice in each pair. Results: The response rate was 58.7%. The most important influence on GPs' choice of practice was aversion to location in an area of high deprivation. They were more likely to choose a practice that: had an extended primary health care team; offered opportunities to develop outside interests; and offered them higher income, shorter working hours and smaller list sizes. The model generated estimates of the strength of these preferences. For example, GPs would require additional income of just over £5000 per annum to work in an area with a high proportion of deprived patients. Conclusions: Potential policy interventions to attract GPs to under-served areas include increasing their level of remuneration, providing opportunities to develop outside interests and ensuring that practices have a primary health care team.
Conditions for Which Onset or Hospital Admission is Potentially Preventable by Timely and Effective Ambulatory Care
Authors: Sanderson Colin , Dixon Jennifer 
Published: January 2017

Objectives: To identify, using a consensus development process, a list of common conditions likely to be ambulatory care sensitive (ACS); i.e. conditions for which practicable improvements in access to timely and effective ambulatory care in the English National Health Service would either reduce the incidence of the condition or avoid substantial proportions of current hospital admissions. Methods: Three panels of clinicians each reviewed about a third of an initial list of 174 conditions commonly recorded as hospital discharge diagnoses for residents of the North West Thames Region. For each condition, panellists estimated the proportion of cases currently admitted to hospital for which, given timely and effective ambulatory care: onset of disease could have been prevented; admission for existing disease could have been prevented; admission, once indicated, should take place within 48 hours. After an introductory meeting to discuss and clarify the task, panel members completed three rounds of a questionnaire, with postal feedback between each round, and a second meeting to discuss interim results before the final round. Seventeen general practitioners (GPs) and 17 hospital specialists working in the region comprised the panels. Results: The panels considered that for 30 of the 174 conditions at least 70% of admissions to hospital could be avoided, either by prevention of disease onset or timely and effective ambulatory care, though predominantly through the latter. For each of a further 66 conditions, 50–69% of admissions could be prevented. Within-panel agreement between hospital specialists and GPs was generally good, although the GPs tended to give slightly higher scores for avoidability of admissions than the specialists. There was marked convergence of scores in succeeding rounds. Conclusions: Although a consensus-based list of ACS conditions cannot be definitive, the clear view of the panels was that the scope for avoiding admission through better ambulatory care is very substantial.
Is Hospital Performance Related to Expenditure on Management?
Authors: Street Andrew , Carr-Hill Roy , Posnett John 
Published: January 2017

Objectives: Reducing the costs of management appears an easy target for those seeking to generate savings or to promote better spending in the National Health Service (NHS). However, an assessment of the appropriate amount of spending on management requires an evaluation of how much management contributes to organizational performance. Methods: Using routinely available NHS acute hospital data, an econometric analysis was undertaken to test the hypothesis that there is a relationship between the proportion of a hospital's income spent on management and the performance of the hospital measured along three dimensions: the achievement of financial targets; performance against waiting time standards defined in the Patient's Charter; and costs of service provision. Results: No general relationship was found between management costs and hospital performance. However, there was some evidence of a quadratic relationship between management spending and the amount of operating surplus generated and performance against the three-month waiting time standard for an inpatient admission specified in the Patient's Charter. These results suggest that performance returns reach an optimum when management expenditure is around 5–6% of hospital income. Conclusions: The evidence is not yet strong enough to draw a general conclusion that management costs in NHS acute hospitals are too high or that an undiscriminating reduction in management costs would have no detrimental effects on hospital performance. However, the findings should prompt managers to identify ways in which their activities are productive and how these can be measured, and what distinguishes effective from ineffective management.
Point of Care Testing in the Accident and Emergency Department: A Cost Analysis and Exploration of Financial Incentives to use the Technology within the Hospital
Authors: Kendall Jason M. , Bevan Gwyn , Clancy Michael J. 
Published: January 2017

Objectives: To compare the costs of current arrangements for testing emergency blood samples from patients attending an accident and emergency (A&E) department in a large teaching hospital in England with point of care testing (POCT). Methods: Estimates were made of the fixed and variable costs of two options: a supplemental option, in which POCT was introduced to A&E only; and a replacement option, in which POCT was introduced to A&E and the intensive therapy unit (ITU), thereby entirely replacing an existing process. Results: For the supplemental option, current arrangements cost £68 466 in total per year; average costs per test were £5.53 (venous in the central laboratory) and £3.60 (arterial on the ITU). Introducing POCT would increase total hospital costs by £35 929, and average costs per test would be £5.32 (venous) and £4.28 (arterial). For the replacement option, current arrangements cost £132 630 in total, and average cost per test (for all tests) was £4.06. Introducing POCT would make hospital savings ranging from £8332 to £20 000, and average cost per test would be £3.78. Conclusions: Introducing POCT results in lower average costs per test. The supplemental option will result in significantly increased costs to the hospital. The replacement option can lead to significant savings. The internal cross-charging arrangements between departments that exist in this hospital may mean that supplemental implementation of POCT could be potentially ‘profitable’ for the A&E department, but would result in higher expenditure for the hospital as a whole.
Systematic Reviews and Meta-Analysis: A Structured Review of the Methodological Literature
Authors: Sutton Alexander J. , Jones David R. , Abrams Keith R. , Sheldon Trevor A. , Song Fujian 
Published: January 2017

Objective: To systematically review methods for systematic review/meta-analysis in order to identify the different methodological and statistical methods that have been proposed. A summary of the main findings is presented here, with emphasis given to health services research topics. Methods: A thorough systematic search for methodological papers was carried out using a variety of methods, including the use of electronic databases. Approximately 1000 potentially relevant references were identified, a number of them from education, psychology and sociology. Results: After briefly reviewing the procedural methods required to carry out a review, and the basic statistical methods used to combine study estimates, less established methods are discussed. These include methods for dealing with publication bias, meta-regression, meta-analysis of individual patient data, the synthesis of nonrandomized evidence alone and in combination with randomized studies, Bayesian modelling and economic evaluation through meta-analysis. Recommendations for meta-analytical practice are given; these are either distilled from previous guidelines, or constructed where there appears to be a broad consensus across the literature. Conclusions: It is hoped that this review will provide a consistent and comprehensive, but concise, description of the methods available for synthesizing evidence, that it will promote better quality reviews of the results of health services research and identify specific areas which require methodological development.
Albumin Induced Hypercoagulability Does Not Reduce Blood Loss in Patients Undergoing Total HIP Arthroplasty
Authors: Niemi T. T. , Silvanto M. , Rosenberg P. H. 
Published: January 2017

Background and Aims: Albumin may enhance and hydroxyethyl starch (HES) may impair haemostasis. While the effects are also dependent on haemodilution we minimized it by early structured transfusion therapy, and compared albumin and HES regarding blood loss and coagulation parameters in hip arthroplasty patients. Material and Methods: 101 patients undergoing primary hip arthroplasty received in random order 4% albumin (n = 48) or HES (average Mw 120 kDa/molar substitution ratio 0.7, n = 53). The administration of colloid, red blood cell (RBC), fresh frozen plasma and platetet concentrates begun after a 6–8 %, 12–16 %, 60 % and 100 % blood loss of the patient's calculated blood volume respectively. Explanatory risk factors for blood loss were modelled by regression analysis. Results and Conclusions: Administration of albumin or HES 1200 ml (500–2000 and 500–1800) [median (range) respectively] did not affect blood loss. The vWF antigen was higher in the albumin group (p = 0.04) postoperatively. Haematocrit value, platelet count, bleeding time, prothrombin time value, activated thromboplastin time, FV activity and fibrinogen concentration were comparable between the groups. Long operation time was associated with great blood loss (p < 0.001). In hip arthroplasty patients with near normal levels of haematocrit albumin enhanced coagulation without altering blood loss.
No Long-Term Effects of Ultrasound Therapy on Bioabsorbable Screw-Fixed Lateral Malleolar Fracture
Authors: Handolin L. , Kiljunen V. , Arnala I. , Kiuru M. J. , Pajarinen J. , Partio E. K. , Rokkanen P. 
Published: January 2017

Background and Aims: The present study was initiated to evaluate the long-term effects of low-intensity ultrasound therapy on bioabsorbable screw-fixed lateral malleolar fractures, which has not been studied earlier. Patients and Methods: The study design was prospective, randomized, double-blinded, and placebo-controlled. Sixteen dislocated lateral malleolar fractures were fixed with one bioabsorbable self-reinforced poly-L-lactide screw. The patients used an ultrasound device 20 minutes daily for six weeks without knowing it was active (eight patients) or inactive (eight patients). The follow-up time was 18 months. The radiological bone morphology was assessed by multidetector computed tomography (MDCT) scans, the bone mineral density by dual-energy X-ray absorptiometry scans, and the clinical outcome by Olerud-Molander scoring and clinical examination of the ankle. Results: The MDCT scans revealed that all fractures were fully healed, and no differences were observed in radiological bone morphology at the fracture site. The bone mineral density of the fractured lateral malleolus tended to increase slightly during the 18-month follow-up, the increase being symmetrical in both groups. No differences were observed in the clinical outcome or Olerud-Molander scores. Conclusions: The six-week low-intensity ultrasound therapy had no effect on radiological bone morphology, bone mineral density or clinical outcome in bioabsorbable screw-fixed lateral malleolar fractures 18 months after the injury.
Intestinal Microdialysis — Applicability, Reproducibility and Local Tissue Response in a Pig Model
Authors: Emmertsen K. J. , Wara P. , Soerensen F. B. , Stolle L. B. 
Published: January 2017

Background and Aims: Microdialysis has been applied to the intestinal wall for the purpose of monitoring local ischemia. The aim of this study was to investigate the applicability, reproducibility and local response to microdialysis in the intestinal wall. Materials and Methods: In 12 pigs two microdialysis probes were inserted into the ileal wall, one in the peritoneal cavity and one in the psoas muscle. Relative recovery was measured for all probes by the no net flux method. Metabolic measurements of glucose, lactate and glycerol were performed over six hours. The ileal wall segments containing the probes were processed for histological examination. Results: Large intra- and inter-group differences in the relative recovery were found between all locations. Absolute values of metabolites showed no significant changes during the study period. The lactate in blood was 25–30% of the intra-tissue values. A severe inflammatory reaction was seen in the ileal wall around all probes. Conclusion: Measurement of the relative recovery is essential for valid measurements of metabolites when using microdialysis. The inflammatory reaction around the probe in the intestinal wall is likely to affect metabolism and measurements hereof. Therefore intestinal wall microdialysis seems confined to experimental research, and future studies should consider the intra-peritoneal approach.
Sigmoidostomy-Related Parastomal Hernia
Authors: Wik T.-A. , Hjorthaug J. O. B. , Johannessen H.-O. , Johnson E. 
Published: January 2017

Background and Aims: The aim was to examine prevalence and treatment of parastomal hernias in patients with sigmoidostomy. Materials and Methods: In 2009, the medical records of 447 consecutive patients operated with a sigmoidostomy from January 1999 to December 2008 were retrospectiely reviewed. 119 dead patients (26.6%) were excluded because of short follow up (n = 59) and insufficient clinical data (n = 60). 328 patients (73.4%) were followed-up, of whom 210 (64%) alive patients also were scrutinized for presence of parastomal hernia by phone interview. In 2010, 92 out of 153 alive patients (60.1%) without known parastomal hernia also underwent targeted clinical examination in the ambulatory unit. Results and Conclusion: Follow up from stoma operation in 328 patients was median 20 (range 1–129) months. 319 patients had an end sigmoidostomy and nine patients had a loop sigmoidostomy. Time to parastomal hernia in 66 patients (20.1%) was median 9 (1–54) months. Fourty four patients (66.7%) reported no symptoms, eight (12.1%) had mild discomfort, six (9.1%) leakage, six (9.1%) pain, and two (3%) episodes of intestinal obstruction. Eleven (16.7%) had a hernia operation, eight with onlay mesh repair complicated with bowel perforation and ventral hernia in one patient. Three with mesh repair (37.5%) developed recurrent parastomal hernia, of whom one had tissue repair and a second recurrence 6 months later. The only patient with initial tissue repair had a recurrent hernia successfully treated with mesh repair. Two patients had their stoma uneventfully reversed. Parastomal hernia rate, mainly treated with mesh repair, was fairly low in this heterogenous patient series.