bluuebunny/crossref_metadata_2025_split huggingface dataset:
55 ‘Mini Sim’ – innovative bite sized simulation teaching in a busy children’s emergency department
Authors: Sunley Rachel , Moloney Karen , Parker Jessica , Arrowsmith Christopher , Brown Kirsty , Wilson Alex 
Published: November 2017

Emergency Medicine requires a highly skilled workforce who are passionate about delivering excellent patient care. Shift patterns linked with the ever increasing numbers of patients who attend Emergency Departments puts strain on educating the workforce and fostering team togetherness.Our objective in devising and instigating the ‘Mini Sim’ programme was to embed regularin-situsimulation training to enhance the learning of all staff within our Emergency Department team, building a highly trained workforce to deliver excellent care within the remit of our busy department. The whole team is involved including junior nurses, senior nurses and all tiers of junior doctors including foundation, general practice and senior ED trainees (including Grid).‘Mini Sim’ takes place on a weekly basis, every Tuesday morning from 0930–1000. This timing is to ensure maximum participation from all staff. The setup is a fifteen minute simulation (one nurse, one junior doctor, one senior doctor) followed by fifteen minutes of debrief. The format includes an assessment of the participants confidence prior to ‘Mini Sim’ in the subject being practiced. This is rated on a numerical scale from 1 (being not confident at all) to 5 (being completely confident). The topics chosen are based on feedback from trainees and nurses on clinical skills they feel under confident in, (e.g., pelvic binder application, rapid sequence induction, sickle cell crisis), clinical incidents which have occurred around the Trust (e.g., seizures and access to benzodiazepines), National Patient Safety Alerts (e.g., phenytoin toxicity), protocols (e.g., abducted child, rapid tranquilisation for the acutely disturbed adolescent) , governance issues (e.g., blocked tracheostomy, resuscitation room rebuild) and competencies linked to RCEM objectives. The ‘Mini Sim’ then takes placein situwithin the ED resus, ED main department or our short stay observation ward which is under the auspices of the Children’s Emergency Department using real equipment and drugs. After the simulation a debrief is held and any additional teaching is carried out to embed learning. Each medical participant is then offered the opportunity to complete a work place based assessment on the ‘Mini Sim’ for their e-portfolio.Figure 1Evaluation of impact of ‘mini sim’The work flow of the department has been unaffected and we have received excellent written feedback from participants about the educational quality of the programme which has also shown improvements in staff confidence in dealing with a variety of emergency situations. We would suggest this model could be used in other departments for similar gain.Figure 2
Inhibition of O-GlcNAcase Sensitizes Apoptosis and Reverses Bortezomib Resistance in Mantle Cell Lymphoma through Modification of Truncated Bid
Authors: Luanpitpong Sudjit , Chanthra Nawin , Janan Montira , Poohadsuan Jirarat , Samart Parinya , U-Pratya Yaowalak , Rojanasakul Yon , Issaragrisil Surapol 
Published: November 2017

Abstract
Aberrant energy metabolism represents a hallmark of cancer and contributes to numerous aggressive behaviors of cancer cells, including cell death and survival. Despite the poor prognosis of mantle cell lymphoma (MCL), due to the inevitable development of drug resistance, metabolic reprograming of MCL cells remains an unexplored area. Posttranslational modification of proteins via O-GlcNAcylation is an ideal sensor for nutritional changes mediated by O-GlcNAc transferase (OGT) and is removed by O-GlcNAcase (OGA). Using various small-molecule inhibitors of OGT and OGA, we found for the first time that O-GlcNAcylation potentiates MCL response to bortezomib. CRISPR interference of MGEA5 (encoding OGA) validated the apoptosis sensitization by O-GlcNAcylation and OGA inhibition. To identify the potential clinical candidates, we tested MCL response to drug-like OGA inhibitor, ketoconazole, and verified that it exerts similar sensitizing effect on bortezomib-induced apoptosis. Investigations into the underlying molecular mechanisms reveal that bortezomib and ketoconazole act in concert to cause the accumulation of truncated Bid (tBid). Not only does ketoconazole potentiate tBid induction, but also increases tBid stability through O-GlcNAcylation that interferes with tBid ubiquitination and proteasomal degradation. Remarkably, ketoconazole strongly enhances bortezomib-induced apoptosis in de novo bortezomib-resistant MCL cells and in patient-derived primary cells with minimal cytotoxic effect on normal peripheral blood mononuclear cells and hepatocytes, suggesting its potential utility as a safe and effective adjuvant for MCL. Together, our findings provide novel evidence that combination of bortezomib and ketoconazole or other OGA inhibitors may present a promising strategy for the treatment of drug-resistant MCL. Mol Cancer Ther; 17(2); 484–96. ©2017 AACR.
Macrophagic “Crown-like Structures” Are Associated with an Increased Risk of Breast Cancer in Benign Breast Disease
Authors: Carter Jodi M. , Hoskin Tanya L. , Pena M. Alvaro , Brahmbhatt Rushin , Winham Stacey J. , Frost Marlene H. , Stallings-Mann Melody , Radisky Derek C. , Knutson Keith L. , Visscher Daniel W. , Degnim Amy C. 
Published: November 2017

Abstract
In breast adipose tissue, macrophages that encircle damaged adipocytes form “crown-like structures of breast” (CLS-B). Although CLS-B have been associated with breast cancer, their role in benign breast disease (BBD) and early carcinogenesis is not understood. We evaluated breast biopsies from three age-matched groups (n = 86 each, mean age 55 years), including normal tissue donors of the Susan G. Komen for the Cure Tissue Bank (KTB), and subjects in the Mayo Clinic Benign Breast Disease Cohort who developed cancer (BBD cases) or did not develop cancer (BBD controls, median follow-up 14 years). Biopsies were classified into histologic categories, and CD68-immunostained tissue sections were evaluated for the frequency and density of CLS-B. Our data demonstrate that CLS-B are associated with BBD: CLS-B–positive samples were significantly less frequent among KTB biopsies (3/86, 3.5%) than BBD controls (16/86 = 18.6%, P = 0.01) and BBD cases (21/86 = 24%, P = 0.002). CLS-B were strongly associated with body mass index (BMI); BMI &lt; 25: 7% CLS-B positive, BMI 25–29: 13%, and BMI ≥ 30: 29% (P = 0.0005). Among BBD biopsies, a high CLS-B count [&gt;5 CLS-B/sample: 10.5% (BBD cases) vs 4.7% (BBD controls), P = 0.007] conferred a breast cancer OR of 6.8 (95% CI, 1.4–32.4), P = 0.02, after adjusting for adipose tissue area (cm2), histologic impression, and BMI. As high CLS-B densities are independently associated with an increased breast cancer risk, they may be a promising histologic marker of breast cancer risk in BBD. Cancer Prev Res; 11(2); 113–9. ©2017 AACR.
Avaliação do controle da asma em crianças e adolescentes do Programa Respirar da cidade de Ipatinga, Minas Gerais, Brasil
Authors: Lage Bruna Almeida , Souza Debora David de , Oliveira Rosimar Freitas , Cardoso Walquíria Carolina Catenacci , Gaspar Lea Rache 
Published: November 2017

Introdução: A asma é uma das principais causas de morbidade na infância, ocasionando grandes prejuízos aos pacientes. O Programa Respirar foi implantado na cidade de Ipatinga, localizada na região do leste mineiro, em abril de 2003 visando ao atendimento às crianças e adolescentes asmáticos com indicação do uso de anti-inflamatório inalado profilático. O objetivo deste estudo foi avaliar o controle da asma dos pacientes inseridos no Programa Respirar. Métodos: estudo longitudinal retrospectivo, com 305 pacientes portadores de asma com indicação de corticoterapia inalatória, com idades entre sete e 19 anos selecionados aleatoriamente no Programa Respirar da cidade em questão, mediante análise de prontuários referentes a janeiro de 2012 a dezembro de 2015. A análise estatística foi realizada utilizando os programas EpiData (3.03) e SPSS (19.0) e para a análise descritiva, tabelas de distribuição de frequência e medidas de tendência central (média) e de variabilidade (desvio padrão, mínimo e máximo). Para a comparação das variáveis clínicas no início e após a entrada no programa, foi aplicado o teste de McNemar no caso de variáveis categóricas e teste T-pareado para as variáveis numéricas. Em todas as análises, foi considerado nível de significância de 5%. Resultados: Quando comparadas as variáveis clínicas antes e depois de três anos de entrada no Programa Respirar, 51% dos pacientes melhoraram a classificação da asma, 60,1% das crianças diminuíram o número de hospitalizações por crise de asma e 86,7% reduziram o número de idas ao pronto-atendimento por crises de asma. Essas diferenças foram estatisticamente significativas (valor de p < 0,001). Conclusão: Os pacientes assistidos pelo Programa Respirar mantêm melhor controle sobre as crises de asma, reduzindo significativamente as hospitalizações e idas ao pronto-socorro por decorrência da doença.
Socio-Semantic Processes in Social Actors Representation: A Case Study of “Ya-Sin”
Authors: Farsi Roghayeh 
Published: November 2017

AbstractThe academic field of Qurʾānic Studies employs a wide range of approaches, each one of which helps to open up a new perspective on the Qurʾānic text. The Holy Book was revealed to guide people; it is thus of relevance to all aspects of people’s lives. This article focuses on the way social actors are represented in one Meccansūra, entitled “Ya-Sin”, and employs a case-study approach to do so. The analysis carried out includes the socio-semantic processes that thesūrauses in order to represent social actors either by behavior (action) or meaning (reflection), and it also analyzes the actors as they are represented in processes such as activation and passivation. The methodology adopted is eclectic and analytic. It is a hybrid of Swales’ move analysis, El-Awa’s identification of shift-markers, and Halliday’s and Van Leeuwen’s theories of social actor representation. This study shows how such an analysis can contribute to understanding the apparently fragmented and non-linear nature of “Ya-Sin”.
Ara⁠ʾaytum: The Exegetical Implications of a Qurʾānic Stance Marker
Authors: Mohamed Emad 
Published: November 2017

AbstractDiscourse markers are lexical items that play the role of conveying the speaker’s attitude towards the topic of conversation. Although discourse markers have this function, they have little semantic content, yet their importance for understanding (oral) discourse can hardly be overestimated. As such, they have been widely studied in English. While the Qurʾān has a number of these discourse markers, none of them seem to have been properly noticed, let alone studied, by Arabic linguists and Qurʾān commentators. This article introduces what I believe to be the most frequent of these in the Qurʾān:araʾaytum(literally: “have you seen?”) in its various morphological manifestations. This article uses concepts from historical linguistics, pragmatics, and corpus linguistics – and in particular lexical co-occurrences – to examine the development of this form from a sense verb that simply means “to see” to a pragmatic attitudinal marker that is semantically vacuous and whose main function is to express the speaker’s dissatisfaction with, resentment at, or disapproval of the topic of conversation. While the analysis provided in this article is mainly linguistic, the findings will affect the way we read the Arabic-Islamic heritage, especially as regards the authenticity of what are known as the Satanic Verses, also known as the episode of the High-Flying Cranes(Qiṣṣat al-ġarānīq).This article also provides suggestions for the translation of this discourse marker.
Surgical Decisions in the Elderly: The Importance of Biological Age
Authors: Farquharson S M , Gupta Ramesh , Heald R J , Moran B J 
Published: November 2017

Summary Surgeons will sometimes advise against an operation because the patient is ‘old and frail’. A simple starring system (one to five), based on performance and lifestyle, has been devised to assess the biological age of elderly patients. 10 consultant surgeons and 10 trainees answered questions about their treatment recommendations for hypothetical patients of standard age and medical history but with various star ratings and surgical conditions. 1000 decisions were available for analysis. The four and five star patients (those leading an independent existence) were recommended 266 interventions, the one and two star patients 55. Trainees were more inclined to intervene than consultants, recommending operations in half the patients rather than one-third. These results indicate that decisions on surgical management are strongly influenced by the patient's star rating or biological age. If the starring method proves reproducible in other patient groups and settings, it could allow better communication on an important factor in clinical decisions.
Critical Appraisal in Clinical Practice: Sometimes Irrelevant, Occasionally Invalid
Authors: Coomarasamy Aravinthan , Latthe Pallavi , Papaioannou Spyros , Publicover Mary , Gee Harry , Khan Khalid S 
Published: November 2017

A core activity of evidence-based practice is the search for and appraisal of evidence on specific clinical issues. Clinicians vary in their competence in this process; we therefore developed a 16-item checklist for quality of content (relevance and validity) and presentation (useability, attribution, currency and contact details). This was applied to a set of 55 consecutive appraisals conducted by clinicians and posted at a web-based medical journal club site. Questions were well formulated in 51/55 (92%) of the appraisals. However, 22% of appraisals missed the most relevant articles to answer the clinical question. Validity of articles was well appraised, with methodological information and data accurately extracted in 84% and accurate conversion to clinically meaningful summary statistics in 87%. The appraisals were presented in a useable way with appropriate and clear bottom-lines stated in 95%. The weakest link in production of good-quality critical appraisals was identification of relevant articles. This should be a focus for evidence-based medicine and critical appraisal skills.
Comparative Audit: The Trouble with Possum
Authors: Bann Simon D , Sarin Sanjeev 
Published: November 2017

The Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) has been proposed for use in comparative audit between surgeons and between hospitals. To assess its feasibility, POSSUM scoring was attempted on admission in all patients under the care of two consultant surgeons over a six-month period. Scores were awarded only if all investigations necessary for POSSUM were performed; investigations unnecessary for effective treatment were not performed. 815 patient discharges were recorded over the six-month period, with 521 patients undergoing operative procedures. Of those undergoing an operation, scores could be allocated in only 155 (30%). Scoring systems such as POSSUM are procedure-based, thereby excluding those who do not undergo an operation. However, most of our operative cases were also excluded. Full POSSUM scoring will often require additional investigations. POSSUM is unlikely to be of use in the wider setting of comparative audit.
Out-of-Hours Palliative Care in the UK: Perspectives from General Practice and Specialist Services
Authors: Munday Daniel , Dale Jeremy , Barnett Mandy 
Published: November 2017

Palliative care within the community requires well coordinated multidisciplinary teamworking, involving both primary and secondary care practitioners. ‘Out-of-hours'periods are a potentially problematic time for delivery of high quality care. We report on two national surveys—one of medical directors of out-of-hours general practitioner cooperatives, the other of medical directors of specialist palliative care units. The aim was to describe general practitioners'and specialists'perspectives on the availability and scope of community nursing and specialist palliative care services. The results point to wide variation in service provision within the community. The two groups differed strikingly in their perceptions, the general practitioners being much less positive than the specialists about the availability of specialist advice and admission to specialist units out of hours. Equitable out-of-hours palliative care services of high quality are unlikely to be achieved without dialogue between primary and secondary care based providers, local needs assessment and adequate resourcing.
Alcohol Abuse: Prevalence and Detection in a General Hospital
Authors: Hearne Ronan , Connolly Anita , Sheehan John 
Published: November 2017

Despite a high prevalence of alcohol-related disabilities and the availability of cost-effective interventions, alcohol abuse and dependence commonly go undetected in hospital inpatients. In a university teaching hospital we compared three well validated screening methods for sensitivity and specificity—the Alcohol Use Disorders Identification Test (AUDIT, with various cut-off scores), CAGE (a four-question screening tool), and a 10-question version of the Michigan Alcoholism Screening Test (BMAST). A subset of patients also completed the DSM IV structured clinical interview for diagnosis. 1133 adult patients were randomly selected from all hospital admissions, with exclusion of day cases and patients too ill to be interviewed. Two-thirds of the patients were interviewed, most of the remainder being unavailable at the time. 30% of the men and 8% of the women met the DSM IV criteria for alcohol abuse or dependence. Sensitivities and specificities of the screening tools were as follows: AUDIT (with cut-off score > 8) 89% and 91%; CAGE 77% and 99%; BMAST 37% and 100%. 255 case records of patients scoring above the cut-off on one or more questionnaires were subsequently reviewed. The admitting team recognized an alcohol problem in only 46, of whom 17 were referred for appropriate follow up. As in previous hospital surveys, alcohol abuse and dependence was not receiving proper attention. The most efficient screening tool was the CAGE questionnaire.
Colonoscopy at a Combined District General Hospital and Specialist Endoscopy Unit: Lessons from 505 Consecutive Examinations
Authors: Thomas-Gibson Siwan , Thapar Catherine , Shah Syed G , Saunders Brian P 
Published: November 2017

Provisional reports from the Intercollegiate British Society of Gastroenterology National Colonoscopy audit show completion rates of 57–77%for the procedure and poor levels of training and supervision. We prospectively audited all aspects of colonoscopy performed at a combined district general hospital and specialist endoscopy unit. Details of referral, examination, endoscopist, complications and follow-up were recorded and patients were sent questionnaires for long-term follow-up. 505 patients (246 male) underwent colonoscopy by 27 different endoscopists. Their median age was 57 years (range 13–92) and 93%were outpatients. 64% patients were symptomatic and 36%were having surveillance or follow-up colonoscopy. The overall caecal intubation rate was 93%, with little difference between surgeons, physicians and experienced trainees (89%, 92%, 94%) and specialist endoscopists (98%). In only one case was an inexperienced trainee (<100 procedures) unsupervised. Pain scores estimated by the endoscopist were well matched with those given by the patient—medians 29 and 26 (maximum 100) respectively. Median satisfaction score was 96 (maximum 100). Polyp pick-up rate was 26.9%and there were 11 new cancers. 16 (3%) minor immediate complications were recorded—5 oversedation, 6 vasovagal attacks, 3 polypectomy haemorrhages and 2 mucosal injuries (neither requiring treatment). 3 patients died within 6 months of follow-up but no death was colonoscopy related. Completion rates in this setting were adequate for all endoscopists studied. Patient satisfaction with the procedure was high and very few immediate or long-term complications were encountered.
Why Do Patients not Keep their Appointments? Prospective Study in a Gastroenterology Outpatient Clinic
Authors: Murdock A , Rodgers C , Lindsay H , Tham T C K 
Published: November 2017

Unkept outpatient appointments are a drain on resources. In a prospective study we asked non-attenders at a gastroenterology clinic why they had missed their appointment. 103 patients missed their appointment (14% of the total invited); 3 had died. The remaining 100 were asked to complete questionnaires, 68 by mail (43 returned) and 32 by telephone (30 successful); the response rate was thus 73%. 49 of the respondents were new patients, 6 of them with urgent referrals. The explanations for non-attendance by the 73 patients were: forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments. The non-attendance rates for different clinics ranged from 10% to 25% (average 14%). A substantial number of non-attenders claimed to have forgotten their appointment or to cancel it. If, as we surmise, this reflects apathy, no strategy to improve attendance is likely to have great impact. Since the non-attendance rate is reasonably constant, it can be taken into account when patients are booked.
Chronic Subdural Haematoma in the Elderly—A North Wales Experience
Authors: Asghar Muhammad , Adhiyaman Vedamurthy , Greenway M W , Bhowmick Bhimal K , Bates A 
Published: November 2017

Chronic subdural haematoma (CSDH) is predominantly a disease of the elderly. Most of the existing data come from studies done several decades ago. We examined the incidence, risk factors, clinical presentation, management and outcome in elderly patients with CSDH by retrospective study of the period 1996–1999 in the three district hospitals of North Wales. 40 cases of CSDH were identified in patients > 65 years, the incidence in this population being 8.2/100000. Falls (57%) and antithrombotic therapy (33%) were the most frequent risk factors. The most common presenting features were altered mental state (52%) and focal neurological deficit (50%). 24 patients (60%) underwent surgical intervention with 4 deaths (17%). In the non-operated group mortality was 7/16 (44%). Most of the deaths in this series were due either to CSDH or to the complications of frailty and poor mobility. Surgery itself was generally successful.
Screening for Sulphonylureas in the Investigation of Hypoglycaemia
Authors: Kwong P Y P , Teale J D 
Published: November 2017

The most important cause of hypoglycaemia in the presence of high insulin and C-peptide concentrations is insulinoma. However, a similar picture arises from use of sulphonylureas, which is sometimes covert. All specimens received in two years by a supraregional assay service laboratory from adults with low glucose and inappropriately high insulin and C-peptide concentrations were tested for sulphonylureas by a radioimmunoassay that employed antibodies to glibenclamide. In sulphonylurea-positive cases a questionnaire was sent to the consultant responsible for the patient, to elicit further information. Samples from 93 adult patients met the criteria, and 34 (37%) of these gave a positive result on screening for sulphonylureas. The consultants provided further information on 31 of the 34, and in 20 the presence of a sulphonylurea was unexpected. In 10 the features were such as to raise the possibility of factitious drug ingestion. A simple screening technique applied to specimens from patients with hyperinsulinaemic hypoglycaemia indicated that, in a substantial proportion of cases, the patient was taking a sulphonylurea.