bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Medical Futility Experience of Nurses in Caring for Critically Ill Patients
Authors: Hsu Ming-Yi , Su Shu-Fen , Chiang Lien-Ying , Shih Sou-Jen , Chen Yu-Chen 
Published: October 2017

ABSTRACT

Background:
Medical futility is a key bioethical concern. In Taiwan, policymakers tend to provide care standards and evaluation guidelines for critically ill and terminal patients whose treatment is medically futile. However, the current status of medical futility for critically ill patients is inadequate, and no consensus currently exists on the definition of medical futility.

Purpose:
The aim of this study was to understand the medical futility experiences of intensive care nurses.

Methods:
This qualitative research adopted a phenomenological perspective and was conducted in a medical center and a regional hospital in Central Taiwan. Eight nurses with at least 1 year of nursing tenure who were serving in the intensive care unit were recruited. Purposive and snowball sampling methods were used to conduct one-on-one in-depth interviews. Each of the tape-recorded interviews was transcribed before data analysis.

Results:
The research results found four themes, including (a) definitions of medical futility and types of patients, (b) considerations of medical futility, (c) the occurrence of medical futility, and (d) nurses’ responses to medical futility. The participants indicated that medical futility refers to the point at which the continued provision of treatment does not evidently ease the disease condition of a patient or improve his or her quality of life or when life-sustaining treatment is provided to patients to facilitate the process of death.

Conclusions:
This study revealed that the major challenge in clinical cases of medical futility is for physicians, nurses, and patients to communicate effectively together during times of rapid and unanticipated change in patient condition. Thus, events of medical futility may be preventable. Past cases of medical futility involving critically ill patients may serve as references for guiding clinical care, education, and related policy formulation.
Perceptions of Diabetes Self-Care Management Among Older Singaporeans With Type 2 Diabetes: A Qualitative Study
Authors: TAN Cherry Chay Lee , CHENG Karis Kin Fong , SUM Chee Fang , SHEW Jasmine Sew Hong , HOLYDARD Eleanor , WANG Wenru 
Published: October 2017

ABSTRACT

Background:
Given the global shift in aging populations and the associated increasing prevalence of diabetes, it is critical to explore new approaches in diabetic self-care management. In Singapore, what has been overlooked to date is an in-depth, contextually based examination of the needs, expectations, and barriers faced in self-care management by older adults with Type 2 diabetes.

Purpose:
This study aimed to explore the experiences of older Singaporeans with Type 2 diabetes in diabetes self-care management to understand their perceived needs, expectations, and barriers associated with their diabetes self-care management.

Methods:
A descriptive qualitative approach using focus group discussions was adopted. Purposive sampling was used to recruit older adults with Type 2 diabetes from Singapore’s three main ethnic groups, namely, Chinese, Malay, and Indian, through the diabetes centers of two hospitals. Four focus groups, including two groups of Chinese, one group of Malays, and one group of Indians, were conducted. Thematic analysis was used to analyze the data set for emerging themes that relate to the experiences of participants with diabetes self-care management.

Results:
The four major themes related to the experiences of participants with diabetes self-care management that emerged were as follows: (a) “Diabetes is genetic, destined, and not serious; complication, let it come”; (b) “Diabetes self-care is difficult”; (c) “I don’t know diabetes”; and (d) “Doctor and nurses are important facilitators of self-care management.”

Conclusions/Implications for Practice:
Findings have important implications in Singapore as well as in other Asian countries where populations are also aging and diabetes prevalence is increasing. The findings provide new culturally focused insights for clinical patient education within the Southeast Asian context to improve diabetes self-care management of older adults.
Information Reception and Expectations Among Hospitalized Elderly Patients in Taiwan: A Pilot Study
Authors: CHEN Kai-Li , CHANG Chia-Ming , CHEN Ching-Huey , HUANG Mei-Chih 
Published: October 2017

ABSTRACT

Background:
Communicating with patients, especially geriatric patients, is a challenge for medical professionals. Medical message receiving and expectations among hospitalized elderly patients have not been studied.

Purpose:
The aim of this study was to explore medical message receiving and expectations concerning medical information among hospitalized elderly patients in Taiwan.

Methods:
A descriptive study design was used. Convenience sampling was applied, and the research was conducted in a geriatric ward in a medical center in southern Taiwan. Patients were recruited who were 65 years or older and capable of verbal communication. Data were collected using a self-developed semistructured questionnaire. For each participant, data were collected in one regular ward round. The messages of the physician were recorded. During the first and fourth hours after the ward round, the researcher collected the medical messages that were conveyed by the physician in the ward round and that could be repeated by the patients. Open-ended questions were used to collect data about patient expectations of medical messages during the first hour after the ward round. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis.

Results:
Thirty patients participated in this study. All of the participants remembered the visit of the physician. Seventeen participants (56.6%), however, could not repeat the messages, and the total message repetition rate was 17.8% at the first hour after the ward round. By the fourth hour, the message repetition rate fell to 8.9%. Furthermore, three participants (10%) reported messages incorrectly. Participants reported the importance and necessity of physicians conveying medical messages. “Desire to know the reasons for discomfort” and “discharge date” were the messages most expected by the participants.

Conclusions:
This study suggests that most hospitalized elderly patients cannot repeat medical messages that are conveyed by their physicians. Written materials and the involvement of principal caregivers in the medical informing process may be necessary. Besides, before providing medical information, medical professionals should be cognizant of the key concerns of their patients.
Analysis of the citation of articles published in the European Journal of Emergency Medicine since its foundation
Authors: Fernández-Guerrero Inés M. , Martín-Sánchez Francisco J. , Burillo-Putze Guillermo , Graham Collin A. , Miró Òscar 
Published: October 2017

Objectives
The aim of this study was to evaluate the evolution of the citation of articles from the European Journal of Emergency Medicine (EJEM) from 1994 (EJEM foundation) to 2015 and identify highly cited articles and their principal characteristics and determine a possible correlation between the citations counted in different databases.

Materials and methods
We obtained the articles published in EJEM from 1994 to 2015 in ISI-WoS (main source) and Scopus, Google Scholar, and Medline databases (accessory sources). The citations were quantified and their annual evolution and the bibliometric indices derived (impact factor and SCImago Journal Rank) were evaluated. We identified and analyzed the highly cited EJEM articles and evaluated the possible correlation between the citations counted for these articles in the databases.

Results
Overall, 1705 EJEM articles were cited 9422 times in 8122 different articles. The evolution of the global citation, impact factor, and SCImago Journal Rank from 1994 to 2015 increased significantly. The h-index of EJEM was 30, and 31 articles were considered highly cited (≥30 citations), 16.1% of them being clinical trials. By subjects, 22.5% corresponded to cardiology, 19.3% to emergency department management, and 12.9% to pediatrics; by countries, 81% were from Europe, with Belgian authors publishing four (12.9%) highly cited articles, and French, Spanish, British, and Swedish authors having three (9.7%) each. Two studies in the EJEM achieved the definition of ‘citation classics’ (more than 100 citations). The number of citations in all the databases, except Medline, showed statistically significant correlations.

Conclusion
Citation of EJEM articles has progressively increased and EJEM bibliometric indicators have improved; most highly cited articles are mainly by European authors.
Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes
Authors: Nobel Lisa , Jesdale William M. , Tjia Jennifer , Waring Molly E. , Parish David C. , Ash Arlene S. , Kiefe Catarina I. , Allison Jeroan J. 
Published: October 2017

Objective:
To explore the influence of contextual factors on health-related quality of life (HRQoL), which is sometimes used as an indicator of quality of care, we examined the association of neighborhood socioeconomic status (NSES) and trajectories of HRQoL after hospitalization for acute coronary syndromes (ACS).

Methods:
We studied 1481 patients hospitalized with acute coronary syndromes in Massachusetts and Georgia querying HRQoL via the mental and physical components of the 36-item short-form health survey (SF-36) (MCS and PCS) and the physical limitations and angina-related HRQoL subscales of the Seattle Angina Questionnaire (SAQ) during hospitalization and at 1-, 3-, and 6-month postdischarge. We categorized participants by tertiles of the neighborhood deprivation index (a residence-census tract-based measure) to examine the association of NSES with trajectories of HRQoL after adjusting for individual socioeconomic status (SES) and clinical characteristics.

Results:
Participants had mean age 61.3 (SD, 11.4) years; 33% were female; 76%, non-Hispanic white; 11.2% had household income below the federal poverty level. During 6 months postdischarge, living in lower NSES neighborhoods was associated with lower mean PCS scores (1.5 points for intermediate NSES; 1.8 for low) and SAQ scores (2.4 and 4.2 points) versus living in high NSES neighborhoods. NSES was more consequential for patients with lower individual SES. Individuals living below the federal poverty level had lower average MCS and SAQ physical scores (3.7 and 7.7 points, respectively) than those above.

Conclusions:
Neighborhood deprivation was associated with worse health status. Using HRQoL to assess quality of care without accounting for individual SES and NSES may unfairly penalize safety-net hospitals.
Pathogenesis of Neisseria gonorrhoeae in the female reproductive tract: neutrophilic host response, sustained infection, and clinical sequelae
Authors: Stevens Jacqueline S. , Criss Alison K. 
Published: October 2017

Purpose of review
Gonorrhea is a major global health concern, caused by the bacterium Neisseria gonorrhoeae. The main clinical feature of acute gonorrhea is neutrophilic influx that is unable to clear infection. Women of reproductive age are predominantly at risk for serious sequelae of gonorrhea, including pelvic inflammatory disease, ectopic pregnancy, and infertility. This review will highlight how neutrophils are recruited to the female reproductive tract (FRT) in response to N. gonorrhoeae, how N. gonorrhoeae resists killing by neutrophils, and the connection between neutrophilic inflammation and cellular damage.

Recent findings
Epithelial cells and immune cells of the FRT recognize and respond to N. gonorrhoeae lipid A and heptose bisphosphate of lipooligosaccharide, porin, lipoproteins, and peptidoglycan fragments. N. gonorrhoeae skews the resulting immune response toward a neutrophilic, Th17-like response. N. gonorrhoeae has multiple, nonredundant mechanisms to survive inside neutrophils and in neutrophil extracellular traps. Infection that ascends to the upper FRT induces the further release of inflammatory cytokines and matrix metalloproteinases, which cause epithelial damage.

Summary

N. gonorrhoeae is remarkable in its ability to recruit neutrophils, yet survive in their midst. New models being developed for FRT infection with N. gonorrhoeae will be useful to reveal the mechanisms underlying these observations.
Early Evidence of the Effectiveness of the Human Papillomavirus Vaccination Program Against Anogenital Warts in Manitoba, Canada: A Registry Cohort Study
Authors: Willows Karla , Bozat-Emre Songul , Righolt Christiaan H. , Kliewer Erich V. , Mahmud Salaheddin M. 
Published: October 2017

Background
We assessed the effectiveness of the quadrivalent human papillomavirus vaccine (qHPV) vaccination program in Manitoba, Canada, in reducing incident anogenital warts (AGWs) and to what extent effectiveness depends on age at vaccination and number of doses.

Methods
Female participants 9 years or older who received the qHPV in Manitoba between September 2006 and March 2013 (n = 31,464) through the publicly funded school-based program and a high-risk catch-up program were included. They were matched on age and area of residence to unvaccinated female participants. Information on incident AGWs was obtained from provincial administrative databases using validated algorithms. Using stratified Cox regression models, we estimate hazard ratios (HRs) for the association between qHPV and AGWs.

Results
For female participants vaccinated at age 18 years or younger, receipt of qHPV was associated with a 40% reduction in AGW risk (HR, 0.6; 95% confidence interval [CI], 0.4–0.8). Further adjustment for socioeconomic and medical history did not alter this estimate. For women vaccinated at age 19 years or older, we saw an increase in AGW incidence, especially among those who were sexually active (HR, 2.8; 95% CI, 2.1–3.7). Among female participants vaccinated at age 18 years or younger, risk of AGWs was lowest among those who received 3 doses, corresponding to a vaccine effectiveness of 56% (95% CI, 30%–70%). For women vaccinated at older age, risk of AGWs remained increased regardless of the number of doses.

Conclusions
Women vaccinated at an older (≥19 years) age may be less protected against AGWs, particularly if sexually active before vaccine administration. Further efforts should be targeted at increasing vaccine uptake among preadolescents before the initiation of sexual activity.
Gastric Drainage in the Treatment of Near-Fatal Food-Induced Anaphylaxis
Authors: Lazar Isaac , Cavari Yuval , Levitas Aviva , Mandolla Amarilia B. , Broides Arnon 
Published: October 2017

Abstract
Anaphylaxis should be treated with early administration of intramuscular Adrenalin; however, fatalities may still occur even with this therapy. We report a patient with near-fatal anaphylaxis due to milk whose symptoms persisted and were resistant to any therapeutic attempt; however, the patient had a prompt resolution of the anaphylaxis shortly after a nasogastric tube placement with gastric drainage, suggesting that this procedure ended the ongoing absorption of additional allergen from the gastrointestinal tract. We suggest that nasogastric drainage of gastric contents should be considered as part of the therapy in severe food-induced anaphylaxis.
Clinical Decision Rule to Identify Orbital Wall Fracture Among Children
Authors: Paek So Hyun , Jung Jin Hee , Kwak Young Ho , Kim Do Kyun , Lee Jin Hee , Jung Jae Yun , Oh Sohee 
Published: October 2017

Objectives
Head and face injuries are leading causes of emergency department visits in children. There is yet no clinical decision rule on face CT such as pediatric head CT rules. The goal was to develop and validate a clinical decision rule for identifying orbital wall fractures in children with periorbital trauma in the emergency department.

Methods
This was a retrospective derivation and validation study. Children younger than 18 years who underwent orbit CT after periorbital trauma were included between January 2011 and December 2013 in 3 emergency centers. Among 16 candidate clinical variables, 13 clinical signs and symptoms were selected as clinical predictors. For the fracture model, these clinical predictors were analyzed by 3-fold cross-validation. Diagnostic performance was assessed using the area under the receiver operating characteristic (AUROC) curve in both cohorts.

Results
Four variables (orbital rim tenderness, periorbital ecchymosis, painful extraocular movement, and nausea/vomiting) had the best predictive model with the highest AUROC value. The AUROC values for fracture prediction were 0.793 (95% confidence interval, 0.741–0.844) and 0.809 (95% confidence interval, 0.742–0.877) in the derivation cohort and validation cohort, respectively. The sensitivity and negative predictive values were 96.4% and 93.4%, respectively, in the derivation cohort, and 97.8% and 98.1%, respectively, in the validation cohort. The sum of these scores ranged from 0 to 4. Patients with a sum of scores of 1 or higher showed significantly increased risk for fracture.

Conclusions
The 4-variable predictive model can be useful for finding clinically important orbital wall fractures in children.
The Peculiar Case of a Large Right Lower Quadrant Solitary Fibrous Tumor With Vasculature Arising from the Splenic Artery and Vein
Authors: Lukaszewicz Andrew Jeremy , Hayes Harold , Maunglay Mary , Muhar Raman , Gerasymchuk Grygori , Menon Shameem 
Published: October 2017

Abstract
We present the interesting case of a patient with peritoneal solitary fibrous tumor (SFT). The patient initially presented with right lower quadrant pain. Computed tomography findings revealed the presence of a large mass near the cecum, with both arterial and venous blood supply arising directly from the splenic artery and vein. The patient ultimately underwent surgical excision of the mass, and pathological examination was consistent with benign SFT. Not only is the location of our patient's tumor exceedingly rare, but also, to our knowledge, it is the first reported case of SFT with such a unique vascular supply.
Cancer Yield of Incidental Breast Lesions Detected on Chest Computed Tomography
Authors: Healey Terrance T. , Agarwal Saurabh , Patel Ronak , Ratanaprasatporn Lisa , Ratanaprasatporn Linda , Lourenco Ana P. 
Published: October 2017

Objective
This study aimed to determine the cancer yield for abnormal breast findings initially identified on chest computed tomography (CT).

Materials and Methods
This institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study retrospectively reviewed reports of 41,217 consecutive chest CT examinations done from January 1, 2006, to December 31, 2011, to identify those with breast findings noted in the impression of the report. Examinations done for staging of newly diagnosed breast cancer were excluded. The electronic medical record was searched for any subsequent breast imaging and any corresponding pathology results. Cancer yield was calculated.

Results
A total of 258 chest CT examinations with abnormal breast findings were identified in 218 unique patients. Average patient age was 65.6 years (range, 30–100 years). There were 207 women and 11 men. Of these, 75 patients had follow-up breast imaging in our system. One hundred forty-three patients did not have follow-up in our system and were excluded for purposes of cancer detection rate calculation. Thirteen of 75 patients were found to have lesions that were malignant: infiltrating ductal carcinoma (8), invasive lobular carcinoma (2), lymphoma (2), and intracystic papillary cancer with atypical features (1). Four of 75 patients underwent further workup and were found to have lesions that were benign: fibroadenoma (3) and benign fibrocystic change (1). The remainder of the 58 of 75 patients had dedicated breast imaging that was classified as either Breast Imaging Reporting and Data System score 1 or 2, and no further workup was performed. Cancer yield from CT findings was 17.3%.

Conclusions
Abnormal CT findings in the breast warrant additional evaluation with dedicated breast imaging to evaluate for a possible underlying malignancy. Cancer yield from CT findings in this study was 17.3%.
Heavily Calcified Coronary Arteries
Authors: De Santis Domenico , Jin Kwang Nam , Schoepf U. Joseph , Grant Katharine L. , De Cecco Carlo N. , Nance John W. , Vogl Thomas J. , Laghi Andrea , Albrecht Moritz H. 
Published: October 2017

Objectives
The aim of this study was to evaluate a prototype dual-energy computed tomography calcium subtraction algorithm and its impact on luminal visualization in patients with heavily calcified coronary arteries.

Materials and Methods
Twenty-nine patients (62% male; mean age, 64 ± 7 years) who had undergone dual-energy coronary computed tomography angiography were retrospectively included in this institutional review board–approved, Health Insurance Portability and Accountability Act–compliant study. Linearly blended (M_0.6) and calcium-subtracted images were reconstructed. Two independent observers assessed luminal visualization of the coronary arteries in a segment-based analysis, subjective image quality, and diagnostic confidence using 5-point Likert scales. Contrast-to-noise ratios for both data sets were calculated. Wilcoxon testing and Cohen's κ were used for statistical comparisons.

Results
Calcium-subtracted image series showed improved lumen visualization of the coronary arteries (P = 0.008), with excellent interreader agreement (mean score, 3.3; κ = 0.82), compared with M_0.6 series (mean score, 2.9; κ = 0.77). The calcium subtraction algorithm improved diagnostic confidence compared with the M_0.6 reconstructions (mean scores, 4.0 and 3.1, respectively; all P ≤ 0.002). The image quality analysis showed no significant differences between calcium-subtracted and M_0.6 data sets (subjectively: mean scores, 4.1 and 4.2, respectively, P = 0.442; objectively: mean contrast-to-noise ratio, 37.0 and 38.2, respectively, P = 0.733).

Conclusions
A prototype algorithm for calcium subtraction improves coronary lumen visualization and diagnostic confidence in patients with heavy coronary calcifications without differences in conventional subjective and objective measures of image quality.