bluuebunny/crossref_metadata_2025_split huggingface dataset:
From tokenism to empowerment: progressing patient and public involvement in healthcare improvement
Authors: Ocloo Josephine , Matthews Rachel 
Published: June 2016

BackgroundThere have been repeated calls to better involve patients and the public and to place them at the centre of healthcare. Serious clinical and service failings in the UK and internationally increase the urgency and importance of addressing this problem. Despite this supportive policy context, progress to achieve greater involvement is patchy and slow and often concentrated at the lowest levels of involvement.MethodsA selective narrative literature search was guided by the authors’ broad expertise, covering a range of disciplines across health and social care, policy and research. Published systematic literature reviews were used to identify relevant authors and publications. Google and hand searches of journal articles and reference lists and reports augmented identification of recent evidence.ResultsPatients and the wider public can be involved at most stages of healthcare, and this can have a number of benefits. Uncertainty persists about why and how to do involvement well and evaluate its impact, how to involve and support a diversity of individuals, and in ways that allow them to work in partnership to genuinely influence decision-making. This exposes patient and public involvement (PPI) to criticisms of exclusivity and tokenism.ConclusionsCurrent models of PPI are too narrow, and few organisations mention empowerment or address equality and diversity in their involvement strategies. These aspects of involvement should receive greater attention, as well as the adoption of models and frameworks that enable power and decision-making to be shared more equitably with patients and the public in designing, planning and co-producing healthcare.
Exploratory study into the effect of abdominal mass loading on airways resistance and ventilatory failure
Authors: Dattani Raj S , Swerner Casey B , Stradling John R , Manuel Ari RG 
Published: June 2016

ObjectiveWe hypothesised that the airway resistance during tidal breathing would correlate with a particular pattern of increasing obesity, particularly when supine, and would differ between participants with and without ventilatory failure.MethodsIn our cross-sectional cohort study, 72 morbidly obese patients (40 males, 32 females, mean body mass index (BMI) 47.2) had measurements of both airways resistance (by impulse oscillometry (IOS)) and adiposity (by dual-energy X-ray absorptiometry (DXA)).ResultsAll measures of airways resistance increased in the supine position: total airways resistance (R5) +37% (p<0.0005); large airways resistance (R20) +29% (p<0.0005); and small airways resistance (R5–R20) +52% (p<0.0005). BMI was correlated with seated R5, seated R5–R20, supine R5 and supine R5–R20 (r=0.33 p<0.006, r=0.32 p<0.004, r=0.30 p<0.02 and r=0.36 p<0.04, respectively). Visceral adipose tissue mass was correlated with supine R5–20 (r=0.46 p<0.05). Supine measures of total airways resistance (R5) and large airways resistance (R20) differed between those with and without ventilatory failure, as did mean weight and BMI.ConclusionsOur study identifies a potentially detrimental effect of the supine posture on tidal breathing airways resistance in obese patients. This change is correlated most with visceral adipose tissue mass and the small airways. We were able to demonstrate that supine increases in airways resistance during tidal breathing, within obese patients, are different between those with and without ventilatory failure.Trial registration numberNCT01380418; pre-results.
Pharmacovigilance in hospice/palliative care: the net immediate and short-term effects of dexamethasone for anorexia
Authors: Hatano Yutaka , Moroni Matteo , Wilcock Andrew , Quinn Stephen , Csikós Ágnes , Allan Simon G , Agar Meera , Clark Katherine , Clayton Josephine M , Currow David C 
Published: June 2016

ObjectivesLoss of appetite is prevalent in palliative care and distressing for patients and families. Therapies include corticosteroids or progestogens. This study explores the net effect of dexamethasone on anorexia.MethodsProspective data were collected when dexamethasone was started for anorexia as part of routine care. The National Cancer Institute's Common Toxicity Criteria for Adverse Events (NCICTCAE) Likert scales assessed severity of anorexia and immediate and short-term harms at 2 time points: baseline and 7 days.ResultsThis study (41 sites, 8 countries) collected data (July 2013 to July 2014) from 114 patients (mean age 71 (SD 11), 96% with cancer). Median Australian-modified Karnofsky Performance Scale was 50% (range 20–70). Mean baseline NCICTCAE anorexia score was 2.7 (SD 0.6; median 3). 6 patients died by day 7. Of 108 evaluable patients, 74 (68.5%; 95% CI 59.0% to 76.7%) reported ≥1 reduction anorexia scores by day 7, of whom 30 were 0. Mean dexamethasone dose on day 7 was 4.1 mg/day (SD 3.4; median 4; range 0–46 mg). 24 patients reported ≥1 harms (32.4% CI 22.6% to 44.1%; insomnia n=10, depression n=7, euphoria n=7 and hyperglycaemia n=7). Of 24 patients with no benefit, 10 reported ≥1 harms.ConclusionsThis study shows positive and negative effects of 7 days of dexamethasone as an appetite stimulant in patients with advanced life-limiting illnesses. Identifying clinicodemographic characteristics of people most at risk of harms with no benefit is a crucial next step. Longer term follow-up will help to understand longer term and cumulative harms.
Man or machine? An experimental study of prehospital emergency amputation
Authors: Leech Caroline , Porter Keith 
Published: June 2016

ObjectivePrehospital emergency amputation is a rare procedure, which may be necessary to free a time-critical patient from entrapment. This study aimed to evaluate four techniques of cadaveric lower limb prehospital emergency amputation.MethodA guillotine amputation of the distal femur was undertaken in fresh frozen self-donated cadavers. A prehospital doctor conducted a surgical amputation with Gigli saw or hacksaw for bone cuts and firefighters carried out the procedure using the reciprocating saw and Holmatro device. The primary outcome measures were time to full amputation and the number of attempts required. The secondary outcomes were observed quality of skin cut, soft tissue cut and CT assessment of the proximal bone. Observers also noted the potential risks to the rescuer or patient during the procedure.ResultsAll techniques completed amputation within 91 s. The reciprocating saw was the quickest technique (22 s) but there was significant blood spattering and continuation of the cut to the surface under the leg. The Holmatro device took less than a minute. The quality of the proximal femur was acceptable with all methods, but 5 cm more proximal soft tissue damage was made by the Holmatro device.ConclusionsEmergency prehospital guillotine amputation of the distal femur can effectively be performed using scalpel and paramedic shears with bone cuts by the Gigli saw or fire service hacksaw. The reciprocating saw could be used to cut bone if no other equipment was available but carried some risks. The Holmatro cutting device is a viable option for a life-threatening entrapment where only firefighters can safely access the patient, but would not be a recommended primary technique for medical staff.
Ectopic crypt foci in conventional and serrated colorectal polyps
Authors: Väyrynen Sara A , Väyrynen Juha P , Klintrup Kai , Mäkelä Jyrki , Tuomisto Anne , Mäkinen Markus J 
Published: June 2016

AimsDespite almost pathognomonic status of ectopic crypt foci (ECF) in the diagnosis of traditional serrated adenoma (TSA), there are few systematic studies on their prevalence in other types of colon polyps or in adenomas adjacent to colorectal cancer (CRC).MethodsWe calculated ECF in all the polyps (n=922) removed in the colonoscopy in Oulu University Hospital in 2001. Moreover, to study ECF in precursor lesions next to CRCs, we re-examined a previously described cohort of 148 CRCs.ResultsECF were seen in 53 (5.7%) polyps representing 28 (6.5%) tubular adenomas (TAs), 14 (53.8%) tubulovillous adenomas (TVAs), 2 (100.0%) villous adenomas (VAs) and 9 (100.0%) TSAs. In all TSAs and VAs, the density of ECF was higher than in TVAs and TAs. An adjacent precursor lesion was recognised in 28 of 148 (18.9%) CRCs. Twenty-four (85.7%) of these contained ECF.ConclusionsECF can most frequently be observed in TSAs but also in many TVAs, VAs and TAs, reflecting a histological overlap between serrated and conventional polyps. Especially, precursor lesions adjacent to CRC frequently contain ECF.
‘It's not the form; it's the process’: a phenomenological study on the use of creative professional development workshops to improve teamwork and communication skills
Authors: Acai Anita , McQueen Sydney A , Fahim Christine , Wagner Natalie , McKinnon Victoria , Boston Jody , Maxwell Colina , Sonnadara Ranil R 
Published: June 2016

IntroductionPast research has demonstrated the positive effects of visual and performing arts on health professionals' observational acuity and associated diagnostic skills, well-being and professional identity. However, to date, the use of arts for the development of non-technical skills, such as teamwork and communication, has not been studied thoroughly.MethodsIn partnership with a community print and media arts organisation, Centre[3], we used a phenomenological approach to explore front-line mental health and social service workers' experiences with a creative professional development workshop based on the visual and performing arts. Through preworkshop and postworkshop interviews with participants and postworkshop interviews with their managers, we sought to examine how participants' perceptions of the workshop compared with their preworkshop expectations, specific impacts of the workshop with respect to participants' teamwork and communication skills and changes in their perceptions regarding the use of the arts in professional development.ResultsOur workshops were successful in enhancing teamwork skills among participants and showed promise in the development of communication skills, though observable changes in workplace communication could not be confirmed. The workshop facilitated teamwork and collegiality between colleagues, creating a more enjoyable and accepting work environment. The workshops also helped participants identify the strengths and weaknesses of their communication skills, made them more comfortable with different communication styles and provided them with strategies to enhance their communication skills.ConclusionsParticipation in the arts can be beneficial for the development of interpersonal skills such as teamwork and communication among health professionals.
Verification and feedback for medical students: an observational study during general practice rotations
Authors: Bösner Stefan , Roth Lisa Marie , Duncan Gertrude Florence , Donner-Banzhoff Norbert 
Published: June 2016

ABSTRACTPurpose of the studyA general practice and family medicine rotation is mandatory as part of undergraduate medical education. However, little is known about the student-teacher interaction in this specific setting of ambulatory teaching. In this study we analysed how frequently preceptors verified students’ history taking and clinical examination skills and how often they gave feedback. The type of feedback given was also categorised.MethodsFrom April to December 2012, 410 individual patient consultations were observed in 12 teaching practices associated with the Philipps University Marburg, Germany. Material was collected using structured field-note forms and videotaping. Descriptive data analysis was performed. Informed, written consent was provided by all participants.ResultsWe analysed 410 consultations which lasted 14.8 min on average. In 130 (31.7%) consultations students took the patient’s medical history; 124 (95.4%) of these were verified by the general practitioner (GP). Physical examination was performed by students in 202 (49.3%) of consultations; 169 (81.9%) of these were verified by the GP. Feedback occurred in 132 (32.2%) of the 410 patient consultations. Feedback was mostly non-specific and positive (68.9%), and occurred during consultation with the patient present. Specific, negative feedback also occurred relatively frequently (29.5%). Specific, positive and non-specific, negative responses were rarely given.ConclusionsGPs should give feedback more frequently and when doing so, focus on specific feedback. GPs should be further instructed in different feedback techniques.
Cardiac arrest leadership: in need of resuscitation?
Authors: Robinson Philip S , Shall Emma , Rakhit Roby 
Published: June 2016

Abstract

Background
Leadership skills directly correlate with the quality of technical performance of cardiopulmonary resuscitation (CPR) and clinical outcomes. Despite an improved focus on non-technical skills in CPR training, the leadership of cardiac arrests is often variable.

Aims
To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs.

Methods
Cross-sectional survey of 102 members of a cardiac arrest team at an Acute Hospital Trust in the UK with 892 inpatient beds. Responses sought from doctors, nurses and healthcare assistants to 12 rated statements and 4 dichotomous questions.

Results
Of 102 responses, 81 (79%) were from doctors and 21 (21%) from nurses. Among specialist registrars 90% agreed or strongly agreed that there was clear leadership at all arrests compared with between 28% and 49% of nurses and junior doctors respectively. Routine omission of key leadership tasks was reported by as many as 80% of junior doctors and 50% of nurses. Almost half of respondents reported non-adherence with Advanced Life Support (ALS) guidelines. Among junior members of the team, 36% felt confident to lead an arrest and 75% would welcome further dedicated cardiac arrest leadership training.

Conclusions
Leadership training is integrated into the ALS (Resus Council, UK) qualification. However, this paper found that in spite of this training; standards of leadership are variable. The findings suggest a pressing need for further dedicated cardiac arrest leadership training with a focus on improving key leadership tasks such as role assignment, team briefing and debriefing.
Dual NAMPT and BTK Targeting Leads to Synergistic Killing of Waldenström Macroglobulinemia Cells Regardless of MYD88 and CXCR4 Somatic Mutation Status
Authors: Cea Michele , Cagnetta Antonia , Acharya Chirag , Acharya Prakrati , Tai Yu-Tzu , Yang Cao , Lovera Davide , Soncini Debora , Miglino Maurizio , Fraternali-Orcioni Giulio , Mastracci Luca , Nencioni Alessio , Montecucco Fabrizio , Monacelli Fiammetta , Ballestrero Alberto , Hideshima Teru , Chauhan Dharminder , Gobbi Marco , Lemoli Roberto M. , Munshi Nikhil , Treon Steven P. , Anderson Kenneth C. 
Published: June 2016

Abstract
Purpose: Nicotinamide phosphoribosyltransferase (Nampt) regulates intracellular NAD+ pool and is highly expressed in a number of malignancies. FK866, a selective inhibitor of Nampt, depletes intracellular NAD+ levels, thereby blocking cellular metabolism and triggering sensitization to other drugs and cell death. Here we characterized the antitumor effects of Nampt inhibition in Waldenström macroglobulinemia.
Experimental Design: We investigated Nampt role in MW cells using both mRNA and protein expression analyses. We have also used loss-of-function approaches to investigate the growth and survival effects of Nampt on MW cells and further tested the anti-MW activity of dual Nampt and BTK inhibition in vitro and in vivo.
Results: We found that Waldenström macroglobulinemia cells exhibit high levels of Nampt compared with normal B cells. Loss of function studies suggested a potential oncogenic role of Nampt in Waldenström macroglobulinemia cells, and BTK-inhibitor ibrutinib and FK866 resulted in a significant and synergistic anti-Waldenström macroglobulinemia cell death, regardless of MYD88 and CXCR4 mutational status. Cell death was associated with: (i) activation of caspase-3, PARP and downregulation of Mcl-1, (ii) enhanced intracellular ATP and NAD+ depletion, (iii) inhibition of NF-κB signaling, and (iv) inhibition of multiple prosurvival signaling pathways. In a murine xenograft Waldenström macroglobulinemia model, low-dose combination FK866 and ibrutinib is well tolerated, significantly inhibits tumor growth, and prolongs host survival.
Conclusions: Our results show intracellular NAD+ level as crucial for proliferation and survival of Waldenström macroglobulinemia cells, and provides the mechanistic preclinical rationale for targeting Nampt, either alone or with Ibrutinib, to overcome drug resistance and improve patient outcome in Waldenström macroglobulinemia. Clin Cancer Res; 22(24); 6099–109. ©2016 AACR.
A Minimal DNA Methylation Signature in Oral Tongue Squamous Cell Carcinoma Links Altered Methylation with Tumor Attributes
Authors: Krishnan Neeraja M. , Dhas Kunal , Nair Jayalakshmi , Palve Vinayak , Bagwan Jamir , Siddappa Gangotri , Suresh Amritha , Kekatpure Vikram D. , Kuriakose Moni Abraham , Panda Binay 
Published: June 2016

Abstract
Oral tongue squamous cell carcinomas (OTSCC) are a homogenous group of aggressive tumors in the head and neck region that spread early to lymph nodes and have a higher incidence of regional failure. In addition, there is a rising incidence of oral tongue cancer in younger populations. Studies on functional DNA methylation changes linked with altered gene expression are critical for understanding the mechanisms underlying tumor development and metastasis. Such studies also provide important insight into biomarkers linked with viral infection, tumor metastasis, and patient survival in OTSCC. Therefore, we performed genome-wide methylation analysis of tumors (N = 52) and correlated altered methylation with differential gene expression. The minimal tumor-specific DNA 5-methylcytosine signature identified genes near 16 different differentially methylated regions, which were validated using genomic data from The Cancer Genome Atlas cohort. In our cohort, hypermethylation of MIR10B was significantly associated with the differential expression of its target genes NR4A3 and BCL2L11 (P = 0.0125 and P = 0.014, respectively), which was inversely correlated with disease-free survival (P = 9E−15 and P = 2E−15, respectively) in patients. Finally, differential methylation in FUT3, TRIM5, TSPAN7, MAP3K8, RPS6KA2, SLC9A9, and NPAS3 genes was found to be predictive of certain clinical and epidemiologic parameters.
Implications: This study reveals a functional minimal methylation profile in oral tongue tumors with associated risk habits, clinical, and epidemiologic outcomes. In addition, NR4A3 downregulation and correlation with patient survival suggests a potential target for therapeutic intervention in oral tongue tumors. Data from the current study are deposited in the NCBI Geo database (accession number GSE75540). Mol Cancer Res; 14(9); 805–19. ©2016 AACR.
Athens QRS Score as a Predictor of Coronary Artery Disease in Patients With Chest Pain and Normal Exercise Stress Test
Authors: Alvi Raza , Sklyar Eduard , Gorski Robert , Atoui Moustapha , Afshar Maryam , Bella Jonathan N. 
Published: June 2016

Background

The diagnostic value of the Athens
QRS
score to detect obstructive coronary artery disease
CAD
in patients with otherwise normal exercise stress test remains unclear.

Methods and Results

We analyzed 458 patients who underwent exercise stress test with or without myocardial perfusion imaging within 2 months of coronary angiography from 2008 to 2011. Patients (n=173) with abnormal stress test based on
ST
segment criteria were excluded. The Athens
QRS
score ≤5 was defined as abnormal. In our study cohort, 285 patients met the inclusion criteria and were divided into 2 groups: low Athens
QRS
score (
LQRS
, n=56), with
QRS
score ≤5 and normal Athens
QRS
score normal Athens
QRS
score, n=229), with
QRS
score >5. The presence of single‐vessel and multivessel obstructive
CAD
was higher in
LQRS
than in normal Athens
QRS
score patients (47% versus 7.5% and 30% versus 3.8%, respectively, all
P
<0.001). Logistic regression analysis showed that the likelihood of
CAD
was strongly and independently associated with
LQRS
(odds ratio=36.81, 95%
CI
: 10.77–120.47), diabetes (odds ratio=6.49, 95%
CI
: 2.41–17.49), lower maximum heart rate (odds ratio=0.92, 95%
CI
: 0.88–0.95, all
P
<0.001), and older age (odds ratio=1.93,
CI
: 1.88–1.97,
P
=0.002).

Conclusions

In a clinical cohort of patients with chest pain and normal exercise stress test,
LQRS
score is a strong independent predictor of presence of
CAD
.
LQRS
patients have a 6‐fold higher prevalence of
CAD
and may warrant further evaluation even with reassuring exercise stress test.
Increasing Trend of Pan Evaporation over the Semiarid Loess Plateau under a Warming Climate
Authors: Zhang Qiang , Wang Wenyu , Wang Sheng , Zhang Liang 
Published: June 2016

AbstractIn most parts of the world, pan evaporation decreases with increased air temperature rather than increases, which is known as the “evaporation paradox.” The semiarid Loess Plateau, which is sensitive to global climate change and ecological variations, has a unique warming and drying climate. The authors of this study consider whether pan evaporation shows the same decreasing trend in this unique environment. Meteorological observations of the typical semiarid Dingxi in the Loess Plateau from 1960 to 2010 were used to analyze the variation in pan evaporation and its responses to climatic factors. It was found that the pan evaporation has increased considerably over the past 50 yr, which does not support the evaporation paradox proposed in previous studies. A multifactor model developed to simulate the independent impacts of climate factors on pan evaporation indicated that the temperature, humidity, wind speed, and low cloud cover variations contributed to pan evaporation by 46.18%, 25.90%, 2.48%, and 25.44%, respectively. The increased temperature, decreased relative humidity, and decreased low cloud cover all caused an increase in pan evaporation, unlike many parts of the world where increased low cloud cover offsets the effects of increased temperature and decreased relative humidity on pan evaporation. This may explain why the evaporation paradox occurs. If all relevant factors affecting pan evaporation are considered, it is possible the paradox will not occur. Thus in warm and drying regions, the increased pan evaporation will lead to increasingly arid conditions, which may exacerbate drought and flood disaster occurrences worldwide.