bluuebunny/crossref_metadata_2025_split huggingface dataset:
Informed decision-making with and for people with dementia: Developing and pilot testing an education program for legal representatives (PRODECIDE)
Authors: Lühnen Julia , Mühlhauser Ingrid , Richter Tanja 
Published: December 2017

Background People living with dementia are often appointed a legal representative, to support and protect their ethical and legal rights to informed healthcare decisions. However, legal representatives usually have no qualifications in healthcare. Objective The aim of this study was to explore decision-making processes with participation of legal representatives and, resulting from this, to develop and pilot test an education program for legal representatives in Germany. Methods We conducted interviews with legal representatives and senior citizens about decision-making processes in healthcare, with special focus on percutaneous endoscopic gastrostomy, physical restraints, and prescription of antipsychotics for people with dementia. We generated a curriculum based on systematic literature searches and the results of these interviews. We tested the education program for comprehensibility, feasibility, usability, and acceptance. Results Personal interviews with voluntary ( n = 12) and professional ( n = 12) representatives, and senior citizens ( n = 14) were conducted. Preferences, attitudes, and wishes regarding percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics, and the process of decision-making, were heterogeneous. A structural approach is lacking. The education program proxy-decison-making (PRODECIDE) comprises four modules: (A) decision-making processes and methods; (B–D) evidence-based knowledge about percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics. We conducted eight trainings with 47 legal representatives. PRODECIDE was well accepted. Comprehensibility of contents and materials was rated high. The program seems feasible for implementation. Conclusion PRODECIDE seems suitable to improve the decision-making processes of legal representatives in Germany. Implementation will be appropriate if efficacy is proven; a randomized controlled trial is currently underway.
Effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being, and cardiovascular risk reduction among patients with coronary heart disease: A systematic review and meta-analysis
Authors: Liu Ting , Chan Aileen WK , Liu Yun Hong , Taylor-Piliae Ruth E 
Published: December 2017

Introduction: Tai Chi is an attractive exercise to improve cardiovascular health. This review aimed to synthesize articles written both in Chinese and in English to evaluate the effects of Tai Chi-based cardiac rehabilitation on aerobic endurance, psychosocial well-being and cardiovascular diseases risk reduction for coronary heart diseases patients. Methods: PRISMA guidelines were used to search major health databases to identify randomized controlled trials or non-randomized controlled clinical trials that evaluated Tai Chi intervention compared with active or non-active control groups in coronary heart disease patients. When suitable, data were pooled using a random-effects meta-analysis model. Results: Thirteen studies met the inclusion criteria. Tai Chi groups showed a large and significant improvement in aerobic endurance compared with both active and non-active control interventions (standard mean difference (SMD) 1.12; 95% confidence interval (CI): 0.58–1.66; p <0.001). Tai Chi groups also showed a significantly lower level of anxiety (SMD=9.28; CI: 17.46–1.10; p=0.03) and depression (SMD=9.42; CI: 13.59–5.26; p <0.001), and significantly better quality of life (SMD=0.73; 95% CI: 0.39–1.08; p <0.001) compared with non-active control groups. Conclusion: Significant effects of Tai Chi have been found in improving aerobic endurance and psychosocial well-being among coronary heart disease patients. Tai Chi could be a cost-effective and safe exercise option in cardiac rehabilitation. However, the effect of Tai Chi on cardiovascular disease risk reduction has not been amply investigated among coronary heart disease patients. Caution is also warranted in view of a small number of studies for this meta-analysis and potential heterogeneity in differences in the varied designs of Tai Chi intervention.
Role of microRNA in the detection, progression, and intervention of acute kidney injury
Authors: Zou Yan-Fang , Zhang Wen 
Published: December 2017

Acute kidney injury, characterized by sharply decreased renal function, is a common and important complication in hospitalized patients. The pathological mechanism of acute kidney injury is mainly related to immune activation and inflammation. Given the high morbidity and mortality rates of hospitalized patients with acute kidney injury, the identification of biomarkers useful for assessing risk, making an early diagnosis, evaluating the prognosis, and classifying the injury severity is urgently needed. Furthermore, investigation into the development of acute kidney injury and potential therapeutic targets is required. While microRNA was first discovered in Caenorhabditis elegans, Gary Ruvkun’s laboratory identified the first microRNA target gene. Together, these two important findings confirmed the existence of a novel post-transcriptional gene regulatory mechanism. Considering that serum creatinine tests often fail in the early detection of AKI, testing for microRNAs as early diagnostic biomarkers has shown great potential. Numerous studies have identified microRNAs that can serve as biomarkers for the detection of acute kidney injury. In addition, as microRNAs can control the expression of multiple proteins through hundreds or thousands of targets influencing multiple signaling pathways, the number of studies on the functions of microRNAs in AKI progression is increasing. Here, we mainly focus on research into microRNAs as biomarkers and explorations of their functions in acute kidney injury. Impact statement Firstly, we have discussed the potential advantages and limitations of miRNA as biomarkers. Secondly, we have summarized the role of miRNA in the progress of AKI. Finally, we have made a vision of miRNA’s potential and advantages as therapeutic target intervention AKI.
‘Time to clean’: A systematic review and observational study on the time required to clean items of reusable communal patient care equipment
Authors: Scott David , Kane Hayley , Rankin Annette 
Published: December 2017

Background: Concerns have been raised over poor standards of hospital cleanliness and insufficient time for staff to clean reusable communal patient care equipment. These items may then act as vectors for the transmission of nosocomial pathogens between hospital patients. Aim: To evaluate the impact of cleaning duration on nosocomial infection rates and estimate the time required to clean care equipment in accordance with national specifications (i.e. a ‘time to clean’). Methods: A systematic review of the published literature on cleaning times and an observational study in which nine healthcare workers cleaned seven items of care equipment while the duration of time taken to clean each item was measured. Results: A limited volume of low-quality evidence indicates that increased cleaning times in hospitals can reduce the incidence of healthcare-associated infections (HCAIs). The mean ‘time to clean’ for care equipment ranged from 166.3 s (95% confidence interval [CI] = 117.8–214.7) for a bed frame to 29.0 s (95% CI = 13.4–44.6) for a blood pressure cuff. Discussion: ‘Time to clean’ estimates for care equipment provide an indication of how much protected time is necessary to ensure acceptable standards of cleanliness. Clinical trials are needed to further evaluate the impact of increased cleaning times on nosocomial infection rates.
Knowledge, perceptions and practices of healthcare workers regarding the use of respiratory protection equipment at Iran hospitals
Authors: Honarbakhsh Marzieh , Jahangiri Mehdi , Ghaem Haleh 
Published: December 2017

Background: Using appropriate respiratory protection equipment (RPE) is very important to protect healthcare workers (HCWs) against respiratory hazards. The aim of this study was to identify the level of knowledge, perceptions and practices of HCWs on using RPE. Methods: This cross-sectional study was conducted with 284 employees of educational hospitals affiliated to Shiraz University of Medical Sciences. The study’s instrument was a self-made questionnaire that comprised four components: demographic inquiries and questions designed to assess the knowledge, perceptions and practice of HCWs regarding RPE. Collected data were analysed using SPSS software version 21. Results: Average scores of knowledge, perceptions and practice of HCWs on using RPE were 66.50% ± 11.93%, 80.32% ± 10.05% and 70.12% ± 20.51%, respectively. A significant association was observed between knowledge and age, job experience, history of using respirator, marital status and risk of respiratory hazards in the workplace and perceptions with age and education and practice with education. Conclusion: Studied HCWs had positive perceptions and moderate level of knowledge and practice about the use of RPE. Full implementation of respiratory protection program in the hospitals would be helpful to improve the knowledge, perceptions and practices of HCWs regarding RPE.
Quality improvement collaborative: A novel approach to improve infection prevention and control. Perceptions of lead infection prevention nurses who participated
Authors: Adams Debra , Hine Victoria , Bucior Helen , Foster Wendy , Mukombe Nyarayi , Ryan Jane , Smirthwaite Sandra , Winfield Jodie 
Published: December 2017

Background: In response to the ongoing infection prevention (IP) challenges in England, a 90-day quality improvement (QI) collaborative programme was developed. The paper discusses the approach, benefits, challenges and evaluation of the programme. Objective: The objective of the collaborative was to develop new approaches to enable sustainable and effective IP. Methodology: Six trusts in the region participated in the collaborative. Each defined their bespoke IP focus. There was no expectation that statistically significant measurable improvements would be identified during the short time frame. The experiences of the participants were sought both during the programme to facilitate its constant review and at the end of the programme to evaluate its effectiveness. The feedback focused on achievements, barriers to change and benefits of participating in a QI collaborative. To measure the potential success of the projects, participants completed the Model for Understanding Success in Quality framework. (MUSIQ; Kaplan et al., 2012). Results: Since each trusts IP focus was bespoke commonalities of success were not evaluated. Participants identified a positive outcome from their QI interventions. The MUSIQ score identified the projects had the potential for success. Discussion: The feedback from the participants demonstrated that it is worthy of further development.
Vessel Health and Preservation Framework: Use of the outcome logic model for evaluation
Authors: Burnett Emma , Hallam Carole , Curran Evonne T , Weston Valya 
Published: December 2017

Background: Vascular access is an important part of many patient care management plans, but has unwanted risks. A working group led by the Infection Prevention Society (IPS) produced a Vessel Health and Preservation (VHP) Framework. Based on current evidence, a framework was developed for frontline staff to assess and select the best vascular access device to meet the individual patient’s needs and to preserve veins for future use. Methods: Using the Outcome Logic Model, we conducted an evaluation of the short- and medium-term outcomes with regards to the impact and success of the VHP Framework. Results: This evaluation found that many respondents were aware of the framework and were using it in a range of different ways. Participants saw the framework as being most beneficial to help decisions on device choice and peripheral vein assessment. However, the framework has not fully reached its intended audience. Discussion: Many positive outcomes were reported as a result of using the VHP Framework including improving clinical practice as it relates to the VHP elements. However, further work is required to find the tools to extend the reach of the framework and assist healthcare teams to be able to fully implement it within their clinical settings.
Self-Reported Fear Predicts Functional Performance and Second ACL Injury After ACL Reconstruction and Return to Sport: A Pilot Study
Authors: Paterno Mark V. , Flynn Kaitlyn , Thomas Staci , Schmitt Laura C. 
Published: December 2017

Background: Outcomes after anterior cruciate ligament reconstruction (ACLR) are highly variable. Previous studies have failed to report the relationship between fear, objective measures of function, and reinjury rates. The purpose of this study was to determine whether fear was related to functional performance measures and risk of second ACL injury after ACLR and return to sport (RTS). Hypothesis: Fear will be associated with performance on functional testing and second ACL injury rate. Study Design: Prospective cohort study. Level of Evidence: Level 2. Methods: A total of 40 patients cleared to RTS after ACLR completed the Tampa Scale of Kinesiophobia (TSK-11), hop testing, and quadriceps strength testing, bilaterally. Patients were tracked for 12 months after RTS to identify the incidence of second ACL injury. Chi-square analyses determined whether patients with high fear (TSK-11, ≥17) were more likely to have lower levels of activity, greater asymmetry on functional testing, and higher reinjury rates. Results: Patients with greater fear on the TSK-11 (≥17) at RTS were 4 times (odds ratio [OR], 3.73; 95% CI, 0.98-14.23) more likely to report lower levels of activity, 7 times (OR, 7.1; 95% CI, 1.5-33.0) more likely to have a hop limb symmetry lower than 95%, and 6 times (OR, 6.0; 95% CI, 1.3-27.8) more likely to have quadriceps strength symmetry lower than 90%. Patients who went on to suffer an ipsilateral second ACL injury had a greater TSK-11 score at the time of RTS (mean, 19.8 ± 4.0) than those who did not suffer a second ACL injury (mean, 16.4 ± 3.6) ( P = 0.03). Patients with a TSK-11 score of 19 or greater at the time of RTS were 13 times (relative risk, 13.0; 95% CI, 2.1-81.0) more likely to suffer a second ACL tear within 24 months after RTS. Conclusion: Patients with greater self-reported fear were less active, presented with lower single-leg hop performance and isometric quadriceps strength, and had an increased risk of suffering a second ACL injury in the 24 months after RTS. Clinical Relevance: Self-reported fear of movement/reinjury after ACLR at the time of RTS may be an important measure to incorporate into discharge criteria prior to release to return to pivoting and cutting sports after ACLR.
Early Clinically Relevant Improvement in Quality of Life and Clinical Outcomes 1 Year Postsurgery in Patients with Knee and Hip Joint Arthroplasties
Authors: Neuprez Audrey , Neuprez Arnaud H. , Kaux Jean-François , Kurth William , Daniel Christophe , Thirion Thierry , Huskin Jean-Pierre , Gillet Philippe , Bruyère Olivier , Reginster Jean-Yves 
Published: December 2017

Objective To measure and identify the determinants of the outcomes after hip/knee arthroplasty (HA/KA) in patients with osteoarthritis during the first postsurgical year. Design In this prospective observational study, we evaluated the preoperative and postoperative (3, 6, and 12 months) outcomes of 626 patients who underwent HA (346 with median age 65 years, 59% female) or KA (280 with median age 66.5 years, 54% female) between 2008 and 2013. Generic and specific tools were used to measure health-related quality of life (HRQoL) and utility. Good outcome was defined as an improvement in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) greater than or equal to the minimal important difference (MID). Regressions were performed to evaluate the relationship between preoperative and postoperative measures and evolution of WOMAC/good outcome. Results We observed an almost systematic improvement of all parameters for up to 12 months, but especially at the 3-month follow-up. The low number of comorbidities and the absence of postoperative complications were the common determinants of improvement of WOMAC total score after 12 months. Other parameters (background of the joint, preoperative function and length of hospital stay in KA group; place of discharge in HA group) affected the evolution of WOMAC scores. 87.09% of HA and 73.06% of KA patients experienced a good outcome. A small number of comorbidities, a worse preoperative function, a shortened hospital stay (KA only), and an absence of early postoperative complications (HA only) significantly predicted a good outcome. Conclusions Intermediate HRQoL following HA or KA improved quickly from preoperative levels for all instruments. More than 70% of patients achieved a good outcome defined as improved pain, stiffness and disability and the predictors are slightly close.
Optimization of Extracellular Matrix Synthesis and Accumulation by Human Articular Chondrocytes in 3-Dimensional Construct with Repetitive Hydrostatic Pressure
Authors: Ogura Takahiro , Tsuchiya Akihiro , Minas Tom , Mizuno Shuichi 
Published: December 2017

Objective The effects of hydrostatic pressure (HP) on the matrix synthesis by human articular chondrocytes have been reported elsewhere. In order to optimize the production of extracellular matrix, we aimed to clarify the effects of repetitive HP on metabolic function by human articular chondrocytes. Design The human articular chondrocytes were expanded and embedded within a collagen gel/sponge scaffold. We incubated these constructs with and without HP followed by atmospheric pressure (AP) and repeated the second HP followed by AP over 14 days. Genomic, biochemical, and histological evaluation were performed to compare the effects of each regimen on the constructs. Results The gene expressions of collagen type II and aggrecan core protein were significantly upregulated with repetitive HP regimens compared with a single HP or AP by 14 days ( P < 0.01 or 0.05). Matrix metalloptoteinase-13 (MMP-13) in AP was upregulated significantly compared to other HP regimens at day 14 ( P < 0.01). No significant difference was observed in tissue inhibitor of metalloproteinases-II. Immunohistology demonstrated that application of HP (both repetitive and single) promoted the accumulation of specific extracellular matrix and reduced a MMP-13. A single regimen of HP followed by AP significantly increased the amount of sulfated glycosaminoglycan than that of the AP, whereas repetitive HP remained similar level of that of the AP. Conclusions Repetitive HP had a greater effect on anabolic activity by chondrocytes than a single HP regimen, which will be advantageous for producing a matrix-rich cell construct.
Protective role of FKBP51 in calcium entry‐induced endothelial barrier disruption
Authors: Hamilton Caleb L. , Kadeba Pierre I. , Vasauskas Audrey A. , Solodushko Viktoriya , McClinton Anna K. , Alexeyev Mikhail , Scammell Jonathan G. , Cioffi Donna L. 
Published: December 2017

Pulmonary artery endothelial cells (PAECs) express a cation current, ISOC (store‐operated calcium entry current), which when activated permits calcium entry leading to inter‐endothelial cell gap formation. The large molecular weight immunophilin FKBP51 inhibits ISOC but not other calcium entry pathways in PAECs. However, it is unknown whether FKBP51‐mediated inhibition of ISOC is sufficient to protect the endothelial barrier from calcium entry‐induced disruption. The major objective of this study was to determine whether FKBP51‐mediated inhibition of ISOC leads to decreased calcium entry‐induced inter‐endothelial gap formation and thus preservation of the endothelial barrier. Here, we measured the effects of thapsigargin‐induced ISOC on the endothelial barrier in control and FKBP51 overexpressing PAECs. FKBP51 overexpression decreased actin stress fiber and inter‐endothelial cell gap formation in addition to attenuating the decrease in resistance observed with control cells using electric cell‐substrate impedance sensing. Finally, the thapsigargin‐induced increase in dextran flux was abolished in FKBP51 overexpressing PAECs. We then measured endothelial permeability in perfused lungs of FKBP51 knockout (FKBP51–/–) mice and observed increased calcium entry‐induced permeability compared to wild‐type mice. To begin to dissect the mechanism underlying the FKBP51‐mediated inhibition of ISOC, a second goal of this study was to determine the role of the microtubule network. We observed that FKBP51 overexpressing PAECs exhibited increased microtubule polymerization that is critical for inhibition of ISOC by FKBP51. Overall, we have identified FKBP51 as a novel regulator of endothelial barrier integrity, and these findings are significant as they reveal a protective mechanism for endothelium against calcium entry‐induced disruption.
Exposure reporting disparity in Gulf War Registry–related clinical assessments
Authors: Metzger-Smith Valerie , Lei Karen , Javors Jennifer , Golshan Shahrokh , Leung Albert 
Published: December 2017

Objectives: The Gulf War Registry monitors related health conditions of veterans returning from the Persian Gulf Region. Enrollment consists of two phases: Phase I—veterans meet with their local VA Environmental Health Coordinator and complete the self-reported Gulf War Phase I Worksheet (VA Form 10-9009A). Phase II involves a physical exam, medical history review, and laboratory test analysis conducted by a licensed physician. The providers’ documentations are frequently referred for exposure assessment and benefit claim. We conducted an initial comparison assessment to ascertain any potential disparity in exposure reporting between the applicants in Phase I and the providers in Phase II. Methods: With institutional human subject committee approval, a list of veterans with a Gulf War Registry electronic medical note from the VA San Diego Healthcare System (2013–2015) was obtained. Comparing Phase I with Phase II reports allows three distinct reporting group combinations for each of the 21 exposure categories. Group I: both the patients and the healthcare personnel provided the same report for the respective exposure. Group II: healthcare personnel but not the patients reported the exposure. Group III: only the patients but not the healthcare personnel reported the exposure. Results: A total of 178 (of 367) subjects had both the medical note from the healthcare provider and a physical copy of their Phase I Worksheet available, and therefore were eligible to be included in the overall one-way and subsequent pair-wise chi-square analyses. The results indicate that Group I reporting pattern had a significantly (p < 0.01) lower prevalence in nine exposure categories compared to Group III. Conclusion: The findings suggest that the medical documentation from the healthcare providers does not consistently and accurately reflect the patients’ report in near 50% (9/21) of assessed exposure categories. Potential remedies addressing this exposure reporting disparity, such as a standardized template or electronic upload, are further discussed.