bluuebunny/crossref_metadata_2025_split huggingface dataset:
A change of culture: reducing blood culture contamination rates in an Emergency Department
Authors: Bentley James , Thakore Shobhan , Muir L , Baird Alastair , Lee Jennifer 
Published: June 2016

Blood cultures are an important investigation to help tailor effective management for patients with severe sepsis. Frequent contaminated samples increase laboratory workload and can delay or cause incorrect changes to patient management. This can prolong patient hospitalisation, increase the risk of harm and increase cost to health boards. Current guidelines advocate a contamination rate of 2–3%. From January 2013 to November 2014 inclusive, the contamination rate was 4.74% in our Emergency Department, responsible for initial management and investigation of over 40 cases of sepsis per month. A Quality Improvement team was created to try to reduce contamination rates to the recommended target.An initial baseline survey of local staff showed good understanding of when to obtain a blood culture but there was variability in the methods and equipment used. A project was then conducted which focused on rationalising and standardising equipment and technique for blood culture sampling along with staff education to support this change. A simple department target of 30 days free from a contaminated blood culture was created which, if achieved, would ensure a contamination rate of less than 3%. This was supported by ongoing surveillance of contamination rates and investigation of contaminated sample cases. We were able to then identify high risk patients and factors which increased the chance of blood culture contamination. This allowed us to formulate solutions to help reduce the risks of contamination. Department achievements and learning points to help prevent further contamination were fed back positively to all staff. This project operated for 12-months and successfully reduced local contamination rates to 2.0%.
Improving admission medication reconciliation compliance using the electronic tool in admitted medical patients
Authors: Taha Haytham , abdulhay dana , Luqman Neama , Ellahham Samer 
Published: June 2016

Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity that is fully occupied most of the time.SKMC senior management has made a commitment to make quality and patient safety a top priority. Our governing body Abu Dhabi Health Services Company has identified medication reconciliation as a critical patient safety measure and key performance indicator (KPI). The medication reconciliation electronic form a computerized decision support tool was introduced to improve medication reconciliation compliance on transition of care at admission, transfer and discharge of patients both in the inpatient and outpatient settings. In order to improve medication reconciliation compliance a multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to enhance compliance with admission medication reconciliation and the outcomes of those interventions.We chose to conduct the pilot study in general medicine as it is the busiest department in the hospital, with an average of 390 patients admitted per month during the study period. The study period was from April 2014 till October 2015 and a total of 8576 patients were evaluated. The lessons learned were disseminated throughout the hospital. Our aim was to improve admission medication reconciliation compliance using the electronic form in order to ensure patient safety and reduce preventable harm in terms of medication errors. Admission medication reconciliation compliance improved in general medicine from 40% to above 85%, and this improvement was sustained for the last four months of the study period.
Improving the management of iron deficiency in ambulatory heart failure patients
Authors: Hayward Carl , Patel Hitesh , Allen Chris , Vazir Ali 
Published: June 2016

Based on clinical trial data patients with heart failure (HF) and evidence of iron deficiency should be offered intravenous (iv) iron with the aim of improving exercise capacity and symptoms. Baseline measurement in outpatient HF clinics demonstrated that only 50% of patients who may be eligible for iv iron were investigated with iron studies. Our aim was to make sure that 90% of the patients attending our heart failure clinics who were symptomatic and had an ejection fraction (EF) ≤45% should have their iron studies checked within the last six months.In an effort to increase the proportion of suitable patients in whom iron studies are requested, we carried out three plan-do-study-act (PDSA) cycles each with a different intervention. These interventions included a presentation of the clinical trial evidence at a HF multidisciplinary meeting, email reminders prior to clinic and stickers in the patient notes (repeated twice). The effect of each intervention was measured with the outcome being the proportion of eligible patients in whom iron studies were documented within the previous 6 months. The interventions increased the number of suitable patients who had iron studies checked, to as high as 100%, however this effect was not sustained. Root cause analysis revealed that clinicians were unenthusiastic to continue performing iron studies due to inefficiency in the process of admitting patients and giving them iv iron. For example median in-hospital stay of seven hours for an infusion that is given over 15 minutes.In an attempt to improve patient and physician satisfaction we piloted an ambulatory outpatient service to deliver iv iron. We demonstrated that this service was feasible and more efficient as less time was required waiting for a bed or spent in hospital and was less costly. In summary we have demonstrated interventions which can increase the identification of patients who would benefit from iv iron and piloted a new time and cost efficient system of administration of iv iron.
Implementation of a Shoulder Soft Tissue Injury Triage Service in a UK NHS Teaching Hospital Improves Time to Surgery for Acute Rotator Cuff Tears.
Authors: Bateman Marcus , Davies-Jones Gareth , Tambe Amol , Clark David I 
Published: June 2016

Shoulder problems account for 2.4% of GP consultations in the United Kingdom and of those 70% are related to the rotator cuff. Many rotator cuff tears are of a degenerate nature but they can occur as a result of trauma in 8% of cases. Evidence suggests that patients with traumatic rotator cuff tears gain a better outcome in terms of pain and function if the tear is repaired early after injury.A specialist shoulder soft tissue injury clinic was set up in a large UK NHS teaching hospital with the primary purpose in the first year to halve the length of time patients with traumatic rotator cuff tears had to wait to consult a specialist and double the number of patients undergoing surgical repair within three months. The secondary purpose was to ensure that the new clinic was utilised to capacity by the end of the first year. The clinic was later expanded to manage patients with acute glenohumeral joint (GHJ) or acromioclavicular joint (ACJ) dislocations and identify those patients requiring surgical stabilisation. The new service involved referral of all patients presenting to the Accident & Emergency department with recent shoulder trauma and either an inability to raise the arm over shoulder height with a normal set of radiographs, or a confirmed GHJ or ACJ dislocation; to a specialist clinic run by an experienced upper limb physiotherapist. Patients were reassessed and referred for further imaging if required. Those patients found to have traumatic rotator cuff tears or structural instability lesions were listed for expedited surgery. The clinic ran alongside a consultant-led fracture clinic giving fast access to surgical decision-making. The service was reviewed after 3, 6, and 12 months and findings compared to a sample of 30 consecutive patients having undergone rotator cuff repair surgery via the previous pathway.144 patients were referred to the clinic in the first year: 62 with rotator cuff symptoms, 38 with GHJ instability, 13 with ACJ instability, and 33 others. 7 missed fractures were identified. 12 patients subsequently underwent rotator cuff repair surgery, 10 GHJ stabilisation, and 1 ACJ stabilisation. Mean referral time to first clinical assessment improved from 37 days to 8 days. For rotator cuff repair: mean referral to surgery time was 86 days compared with 115 days on the old pathway. 58% of patients underwent surgery within 90 days of injury compared with 20% previously.Our new service resulted in surgical repair of traumatic rotator cuff tears 29 days faster than the traditional system with an extra 38% of patients having surgery within 90 days of injury - a benchmark thought to improve outcome. Future work will aim to improve this percentage further and include long term patient follow up of outcome measures after surgery.
Presenting risk information in sexual and reproductive health care
Authors: David Anna L , Akintomide Hannat 
Published: June 2016

ObjectivesPresenting risk information to patients is an important part of clinical encounters. Good risk communication improves patient satisfaction with their care and the decisions they make. In sexual and reproductive healthcare (SRH), women frequently need to make decisions based on their perceived risk. Risk perception can be altered by how actual risk is presented to patients.MethodsDatabases were searched using MeSH terms combined with a keyword search for articles relevant to SRH; the search was limited to English language.ResultsPersonalised risk communication where a risk score is provided, increases knowledge and slightly increases uptake of screening tests. Decision aids improve a patient's knowledge of the options, create realistic expectations of their benefits and harms, reduce difficulty with decision-making, and increase participation in the process. The most effective way to present risks uses a range of structured, tailored presentation styles; interactive formats are best. Framing the information improves patient understanding. Most people understand natural frequencies or event rates better than probability formats with varying denominators. Expressing changes in risk as an absolute risk reduction or relative risk reduction with baseline risk formats improves understanding. Descriptive terms such as ‘low risk’ or ‘high risk’ should be quantified as a frequency rather than a percentage. Using a consistent denominator to portray risk is recommended. Using the ‘number needed to treat’ and visual aids puts benefits or risks into perspective. The duration of risk should be presented.ConclusionPresenting risk information to patients can be optimised using a number of strategies.
Structural optimization and physical properties of TcB3 and MoB3 at high-pressure: First-principles
Authors: Ying Chun , Bai Xiaowan , Du Yungang , Zhao Erjun , Lin Lin , Hou Qingyu 
Published: June 2016

The thermodynamic, mechanical and dynamic properties of TcB3 and MoB3 are systematically investigated at high-pressure by first-principles within density functional theory (DFT). The calculated formation enthalpies are negative for TcB3 with considered structures under the pressure range from 0 to 100 GPa. Triboride hP4-TcB3 (i.e., TcB3 in hP4-OsB3 type structure) has the lowest formation enthalpy of −1.44 eV under ambient condition. The largest shear modulus of 240 GPa and smallest Poisson’s ratio of 0.20 for oP16-TcB3 are comparable to those of 267 GPa and 0.15 for ReB2. The calculated elastic constants show that MB3 (M=Tc and Mo) are mechanically stable at ambient conditions, except for mP8-MoB3. The estimated high hardness of 33.4 and 33.1 GPa for oP16-TcB3 and hP4-TcB3, respectively, are reported for the first time. The calculated lattice parameters for MoB3 are in good agreement with the previously theoretical and experimental studies. Below 13 GPa, hP16-MoB3 and hR24-MoB3 are thermodynamically more favorable than MoB3 in other structures. A pressure-induced phase transition is predicted at 13 GPa from hP16-MoB3 and hR24-MoB3 to hP4-MoB3. Above 13 GPa, hP4-MoB3 becomes the thermodynamically most stable phase among MoB3 in considered structures. All compounds with considered structures are metallic, and the electronic structures of MB3 are governed by a strong hybridization between M-4d and B-2p states. The strong and directional covalent bonding between M-4d and B-2p as well as the strong interlayer interactions of boron layers are correlated to the high hardness of 38.0 and 38.4 GPa for hP16-MoB3 and hR24-MoB3, respectively.
Accumulation of 11C-methionine in the normal pituitary gland on 11C-methionine PET
Authors: Tomura Noriaki , Saginoya Toshiyuiki , Mizuno Yasuaki , Goto Hiromi 
Published: June 2016

Background For pituitary tumors, positron emission tomography (PET) with 11C-methonine (MET) has been reported as feasible to facilitate diagnosis. MET is well-known to accumulate in the normal pituitary glands, but almost no studies have examined the degree of MET accumulation in the normal pituitary gland. Purpose To investigate accumulation of MET in normal pituitary gland on PET/CT. Material and Methods Among patients who underwent PET/CT using MET over the past 7 years, 77 patients who fulfilled our criteria for normal pituitary glands were retrospectively selected. Maximum standardized uptake value (SUVmax) for the pituitary gland was measured. Results SUVmax of MET in the pituitary gland was in the range of 0.9–6.6 (mean ± standard deviation = 2.60 ± 1.04). A negative correlation between SUVmax and patient age (y = −0.032 × + 4.29, n = 77, r = 0.55) was found by linear regression analysis. SUVmax of the pituitary gland did not differ significantly between women and men. Conclusion MET shows strong accumulation in normal pituitary gland. PET/CT would thus be feasible to differentiate between normal and abnormal pituitary glands.
A phase IIb randomized, double-blind, placebo-controlled trial of ubrogepant for the acute treatment of migraine
Authors: Voss Tiffini , Lipton Richard B , Dodick David W , Dupre Nicole , Ge Joy Yang , Bachman Robert , Assaid Christopher , Aurora Sheena K , Michelson David 
Published: June 2016

Aim The aim of this trial was to evaluate the efficacy and tolerability of ubrogepant (MK-1602), a calcitonin gene-related peptide receptor antagonist (CGRP-RA), for the acute treatment of migraine. Methods This double-blind, placebo-controlled study randomized 834 participants to treat one migraine attack with ubrogepant 1 mg, 10 mg, 25 mg, 50 mg, 100 mg, or placebo in a 1:1 ratio. The co-primary endpoints were pain freedom and headache response at two hours. The first primary hypothesis tested the dose-response trend for two-hour pain freedom using a logistic regression model. Subsequent hypotheses tested the effects of each dose on the co-primary endpoints, using a closed sequential testing procedure to control for multiplicity. Results A total of 527 participants received ubrogepant and 113 received placebo. A positive response trend in the proportion of participants achieving two-hour pain freedom was demonstrated ( p < 0.001). Ubrogepant 100 mg was significantly superior to placebo for two-hour pain freedom (25.5% vs 8.9%) but not for two-hour headache response. Per the prespecified multiplicity strategy, this nonsignificant result precluded further formal hypothesis testing, although the 50 mg and 25 mg doses demonstrated nominal significance over placebo for two-hour pain freedom (unadjusted p < 0.05). Overall, adverse events were similar between ubrogepant and placebo. Conclusion This trial supports ubrogepant’s efficacy and provides further evidence that CGRP-RAs are viable options for the acute treatment of migraine.
Health Extension Workers’ Knowledge and Knowledge-Sharing Effectiveness of Optimal Infant and Young Child Feeding Are Associated With Mothers’ Knowledge and Child Stunting in Rural Ethiopia
Authors: Abebe Zeweter , Haki Gulelat Desse , Baye Kaleab 
Published: June 2016

Background: Little is known about how the knowledge and the knowledge-sharing effectiveness (KSE) of health extension workers (HEWs) affect maternal knowledge of optimal infant and young child feeding (IYCF) and their child’s nutritional status. Objective: The objective of this study was to evaluate mothers’ and HEWs’ knowledge of key IYCF practices and to investigate whether mothers’ knowledge and HEWs’ KSE are associated with stunting in young children (aged 12-23 months). Methods: This cross-sectional study used face-to-face interviews to assess the IYCF knowledge of HEWs (n = 96) and mothers of 12- to 23-month-old children (n = 122) in Mecha district, West Gojam, Ethiopia. The association between HEWs’ KSE and children’s length-for-age z scores (LAZ) was investigated. Results: Stunting (50%), underweight (34%), and wasting (10%) were highly prevalent. Less than half (45%) of the mothers had access to nutrition education through the health extension program, but those who had, had better knowledge of IYCF practices and thus lower rates of stunting ( P < .001). However, key IYCF practices were not well understood by the HEWs and this affected their KSE. The gap in KSE was negatively associated with LAZ ( r = −.475, P < .001) and remained significant even after adjusting for maternal height, socioeconomic status, and maternal education ( r = −.423, P = .002). Conclusion: Health extension workers’ KSE is associated with child stunting. Future training of HEWs would benefit from emphasis on not only the content of the IYCF messages but also the process of delivery while increasing their counseling skills.
A cross-sectional survey to assess household sanitation practices associated with uptake of “Clean Team” serviced home toilets in Kumasi, Ghana
Authors: Greenland Katie , de-Witt Huberts Jessica , Wright Richard , Hawkes Lisa , Ekor Cyprian , Biran Adam 
Published: June 2016

“Clean Team” provides serviced, free-standing toilets as a sanitation option in low-income areas of Kumasi, Ghana. A cross-sectional survey was carried out to assess sanitation and hygiene practices in 199 Clean Team households and 201 neighbouring, non-Clean Team households. Adults in non-Clean Team households were no more likely to report unsafe defecation (faeces not contained in a latrine) than their Clean Team neighbours, although their reliance on public toilets may lead to occasional unsafe practices. Children in Clean Team households used the household toilet from a younger age than those in non-Clean Team households, and their faeces were thus more often disposed of safely. Soap and water were more frequently found at the latrine in Clean Team households than in latrine-owning non-Clean Team households. Use of Clean Team toilets is likely to reduce faecal contamination of the environment through safer child defecation and stool disposal practices, and may increase the opportunity for post-defecation handwashing with soap.
Strengthening the Pharmaceutical Supply Chain Management with Information Communication Technology Intervention
Authors: Kokilam Monica Balakrishnan , Joshi Harish G. , Kamath Veena Ganesh 
Published: June 2016

Medicines are major elements of modern healthcare systems and have helped significantly to reduce the burden of deaths and diseases all over the globe. Access to these essential medicines is a major need in order to achieve ‘Good Health to All’. Traditionally, India has been a rural, agrarian economy where the majority of the population still live in villages. The main factors which affect the provision of good healthcare among the rural population are affordability, unavailability and average quality of drugs and other medical supplies. The availability and quality of medicines are substandard when compared to the urban population standards. To promote proper utilization of medicines, there is a need for availability and affordability of quality medicines in the presence of ‘rational drug usage’ ideology among the medical professionals and health workers. They play a vital role in imparting the knowledge of drug information to the patient community which in the long run can help in achieving the goal of health to all. This paper showcases the need and emergence of a pharmaceutical supply chain mechanism in the healthcare industry and how it can prove to be the backbone of the present public healthcare system by enhancing it with information communication technology (ICT) implementation. This paper also discusses the problems and resentment faced with the initial introduction of modernized technology into the current healthcare system.
Digital Dermoscopy Photographs Outperform Handheld Dermoscopy in Melanoma Diagnosis
Authors: Mintsoulis Danielle , Beecker Jennifer 
Published: June 2016

Background: Pigmented lesion clinics (PLCs) that use technology such as digital dermoscopy and total-body photography are thought to confer a clinical advantage for patients at high risk of developing melanoma over general dermatology clinics (GDCs) with regular dermoscopy. Objective: To examine the difference between depths of melanomas diagnosed in a PLC and a GDC. Methods: Medical records from 257 patients at the PLC at The Ottawa Hospital and 441 patients from a GDC were reviewed. Results: Invasive melanoma was less frequent than in situ melanoma at the PLC (7.14% vs 38.27%; P = .02). The average Breslow depth for melanomas at the PLC was also smaller compared with the GDC (0.0371 vs 0.3450 mm; P = .02). Conclusions: The use of digital dermoscopy and total-body photography together in a PLC appears to be an effective way to monitor patients at high risk of melanoma.
Altered intestinal permeability in patients with relapsing–remitting multiple sclerosis: A pilot study
Authors: Buscarinu Maria Chiara , Cerasoli Benedetta , Annibali Viviana , Policano Claudia , Lionetto Luana , Capi Matilde , Mechelli Rosella , Romano Silvia , Fornasiero Arianna , Mattei Gianluca , Piras Eleonora , Angelini Daniela Francesca , Battistini Luca , Simmaco Maurizio , Umeton Renato , Salvetti Marco , Ristori Giovanni 
Published: June 2016

Background: Alterations of intestinal permeability (IP) may contribute to the pathophysiology of immune-mediated diseases. Objective: We investigated the possible association between IP changes and multiple sclerosis (MS). Methods: We studied 22 patients with relapsing–remitting multiple sclerosis (RRMS) and 18 age- and sex-matched healthy donors (HDs), including five twin pairs (one concordant, and four discordant for disease). Measurement of lactulose (L) and mannitol (M; two non-metabolized sugars) levels in urine samples, after an oral load, allowed to quantify gut dysfunction. Results: The proportion of participants with increased IP was significantly higher in patients than in HDs (16/22 (73%) versus 5/18 (28%); p = 0.001). Accordingly, the L/M urinary ratio showed significantly higher values in patients than in controls ( p = 0.0284). Urinary mannitol concentration was significantly lower in patients than in controls ( p = 0.022), suggesting a deficit of absorption from intestinal lumen. Such changes did not appear related to patients’ clinical–radiological features. Conclusion: The relatively high proportion of IP changes in RR-MS patients seems to confirm our work hypothesis and warrants more work to confirm the result on a larger sample, and to understand the implications for related immunological disturbances and intestinal microbiota alterations. Our finding may also have relevance for oral treatments, recently introduced in clinical practice.