bluuebunny/crossref_metadata_2025_split huggingface dataset:
Workplace bullying in the UK NHS: a questionnaire and interview study on prevalence, impact and barriers to reporting
Authors: Carter Madeline , Thompson Neill , Crampton Paul , Morrow Gill , Burford Bryan , Gray Christopher , Illing Jan 
Published: June 2016

ObjectivesTo examine the prevalence and impact of bullying behaviours between staff in the National Health Service (NHS) workplace, and to explore the barriers to reporting bullying.DesignCross-sectional questionnaire and semi-structured interview.Setting7 NHS trusts in the North East of England.Participants2950 NHS staff, of whom 43 took part in a telephone interview.Main outcome measuresPrevalence of bullying was measured by the revised Negative Acts Questionnaire (NAQ-R) and the impact of bullying was measured using indicators of psychological distress (General Health Questionnaire, GHQ-12), intentions to leave work, job satisfaction and self-reported sickness absence. Barriers to reporting bullying and sources of bullying were also examined.ResultsOverall, 20% of staff reported having been bullied by other staff to some degree and 43% reported having witnessed bullying in the last 6 months. Male staff and staff with disabilities reported higher levels of bullying. There were no overall differences due to ethnicity, but some differences were detected on several negative behaviours. Bullying and witnessing bullying were associated with lower levels of psychological health and job satisfaction, and higher levels of intention to leave work. Managers were the most common source of bullying. Main barriers to reporting bullying were the perception that nothing would change, not wanting to be seen as a trouble-maker, the seniority of the bully and uncertainty over how policies would be implemented and bullying cases managed. Data from qualitative interviews supported these findings and identified workload pressures and organisational culture as factors contributing to workplace bullying.ConclusionsBullying is a persistent problem in healthcare organisations which has significant negative outcomes for individuals and organisations.
Criminality and suicide: a longitudinal Swedish cohort study
Authors: Stenbacka M , Romelsjö A , Jokinen J 
Published: June 2016

ObjectivesThis study aimed to investigate whether violent and non-violent offending were related to elevated risk of suicide. We also investigated whether the risk was higher among those with repeated offences and how experiences of substance misuse and suicide attempt modified the relationship.DesignA nationwide prospective cohort study.SettingA register study of 48 834 conscripted men in 1969/1970 in Sweden followed up during a 35-year period in official registers.ParticipantsA birth cohort of 48 834 men who were mandatory conscripted for military service in 1969/70 at the age of 18–20 years. Possible confounders were retrieved from psychological assessments at conscription and the cohort was linked to mortality and hospitalisation and crime records from 1970 onwards. Estimates of suicide risks were calculated as HR with 95% CIs using Cox proportional regression analyses with adjustment for potential confounding by family, psychological and behavioural factors including substance use and psychiatric disorders.ResultsOf the total cohort, 2671 (5.5%) persons died during the follow-up period. Of these, 615 (23%) persons died due to suicide. Non-violent criminality was evident for 29% and violent criminality for 4.7% of all the participants. In the crude model, the violent offenders had nearly five times higher risk (HR=4.69, 3.56 to 6.19) to die from suicide and non-violent criminals had about two times higher risk (HR=2.08, 1.72 to 2.52). In the fully adjusted model, the HRs were still significant for suicide in the non-violent group.ConclusionsExperiences of violent or non-violent criminality were associated with increased risk of suicide. Comorbidity with alcohol and substance use and psychiatric disorders modified the risk, but the suicide risk remained significantly elevated for non-violent criminals. It is crucial to identify offenders and especially repeated offenders who also suffer from alcohol or substance misuse and psychiatric illness in clinical settings in order to prevent suicide.
Risk assessment and prophylaxis of venous thromboembolism in surgical inpatients: improving adherence to national guidelines
Authors: Johnson Oscar , Kumar Shankar 
Published: June 2016

AbstractIn Europe, venous thromboembolism (VTE) is the third most common cause of vascular death after myocardial infarction and stroke. It is especially common during and after hospitalisation for surgery and acute medical illness though many other risk factors have now been identified. VTE is often preventable with judicious use of preventative measures in the form of thromboprophylaxis and mechanical antiembolism stockings. In 2014, a study was undertaken across all surgical wards at a teaching hospital in London to assess compliance to national guidelines for VTE risk assessment and subsequent institution of protective measures.The initial results demonstrated that performance could be improved in terms of meeting the national target of assessing 95% of surgical inpatients for risk of VTE at admission, prescribing anti-embolism stockings, ensuring that they are correctly worn, and reassessing patients 24 hours later. Utilising a multidisciplinary team approach, simple interventions were put in place such as e-mail reminders, posters, and senior input during ward rounds. Three subsequent measurements demonstrated that sustained improvement was achieved with the national guideline of 95% VTE risk assessment met. Improved performance was noted across all parameters considered, highlighting that simple intervention with all team members involved can improve patient safety and care.
Improving medical handover at the weekend: a quality improvement project
Authors: Michael Emma , Patel Chandni 
Published: June 2016

AbstractIn recent years medical handover has been identified as an increasingly important area for hospitals to improve upon, in light of the changes in shift patterns for doctors. Significant changes to weekday handover had recently been successfully introduced at Broomfield hospital. Weekend handover remained a concern, with an electronic and paper system being used simultaneously.Our objectives were to introduce a new electronic handover system for weekend handover at Broomfield Hospital and improve the organisation of the weekend handover meeting to promote patient safety.Doctors involved in weekend handover were surveyed using a questionnaire, to establish insufficiencies in the weekend handover process; where both the electronic ExtraMed system and paper were being used inconsistently. A new weekend handover system was introduced together with a new user-friendly electronic handover database, addressing the identified difficulties in the current system. These changes met the medical handover guidelines set by the Royal College of Physicians. Three months after the launch of the new system, doctors were re-surveyed using a modified questionnaire to assess the impact our changes had made.Before changes were implemented only 12% of doctors surveyed used the electronic system for weekend. Eighty-nine percent found sorting through jobs time consuming and 67% were handed jobs to them meant for a different grade of doctor. Only 41% were aware who to hand weekend discharges to. Subjective assessment of safety was 3.18 out of 5. The electronic system was felt to be time consuming and complicated.After execution of the new weekend handover process, 100% of doctors reported using the electronic system for weekend handover. Only 47% of doctors felt sorting through jobs was time consuming and 89% of doctors were aware who to handover weekend discharges to. Subjective assessment of the safety of weekend handover improved to 3.84 out of 5. Informal interviews on the ward revealed a high degree of satisfaction with the new weekend handover system. In conclusion we found that a structured, well organised weekend handover meeting together with an effective electronic handover system improves the quality of medical weekend handover.
Improving access to clinical guidance: redevelopment of a junior doctor intranet page
Authors: Walkden Graham , Millwood Sinead , Cavanagh Andrew 
Published: June 2016

AbstractJunior doctors frequently rely on electronic access to clinical guidelines to inform assessment and management, particularly whilst on-call and occasionally during emergencies. Difficulties in locating and accessing up to date guidance from different hospital intranet sites can lead to delays or errors in patient management. We used a focus group and email feedback to redesign an intranet site for junior doctors which logically organised the documents which doctors said they needed access to in one readily accessible location. A quality improvement project was carried out over six months, testing two iterations of the new junior doctors' intranet site before a third version was launched and evaluated. Their performance was measured by the number of mouse clicks and the time required for doctors to find a representative subset of five guidelines, and revisions were made at each cycle based on feedback from doctors and stakeholders. Cumulatively, we demonstrated a decrease in the total number of clicks required to access the sample of guidelines from 18 to 12 clicks, a corresponding decrease in the time required to access the sample of guidelines from 130 seconds to 22 seconds, and an increase in user satisfaction. We maintained one-click access to emergency guidance. In conclusion, we have developed and implemented an electronic resource for junior doctors which provides more immediate access to both emergency and non-emergency clinical guidance. To ensure the resource remains up to date, it will be maintained by Foundation Programme representatives at our hospital on a rolling basis.
Improving the productivity and efficiency of vascular surgery and radiology multidisciplinary meetings
Authors: Dobson Gary , Neeson Declan 
Published: June 2016

AbstractMultidisciplinary team meetings are recognized as an important factor in driving quality of care. The Vascular Society of Great Britain and Northern Ireland recommend that all aspects of vascular surgery are suitable for discussion at multidisciplinary team (MDT) meetings, including carotid, peripheral, and aortic disease.The juniors doctors were tasked with preparing the patient list in our unit. This had become time consuming and somewhat unrewarding. The methods of preparation and information required on the patient list were reviewed.It was felt that typing a clinical summary for each patient on the list was the most time consuming factor. This was removed and patients were instead simply categorized into subgroups such as aneurysms, critical limb ischemia, and others.The information removed was substituted with the use on an electronic care record during the meeting to answer questions regarding comorbidities and previous interventions.Time spent preparing the meeting by the junior doctors was recorded before and after cycles of intervention. Prior to intervention this was found be a mean of 140 minutes (2.3 hours), and improved to a mean of 45 minutes (0.45 hours) with consequent cycles.The overall proportion of patients receiving definitive outcomes in each meeting after changes were implemented increased from 35 to 55%. This was not a primary outcome, but an unintended consequence of careful consideration of each cycle.In conclusion, the changes implemented have allowed junior doctors to spend more of their time with other activities such as the outpatient department (OPD) and theatre during their vascular surgery rotation. The proportion of cases discussed has increased due to more focused discussions during the MDT meeting, resulting in improved patient care. All stakeholders gave a largely positive reaction to the changes implemented.
Does the CHA2DS2-Vasc score predict procedural and short-term outcomes in patients undergoing transcatheter aortic valve implantation?
Authors: Hamid Tahir , Choudhury Tawfiq R , Anderson Simon G , Hashmi Izhar , Chowdhary Saqib , Hesketh Roberts David , Fraser Douglas G , Hasan Ragheb , Mahadevan Vaikom S , Levy Richard 
Published: June 2016

BackgroundTranscatheter aortic valve implantation (TAVI) is associated with periprocedural and postprocedural morbidity and mortality. Currently, there is a paucity of risk stratification models for potential TAVI candidates. We employed the CHA2DS2-Vasc score to quantify the risk of 30-day mortality and morbidity in patients undergoing TAVI.Methods and resultsA retrospective analysis of registry data for consecutive patients undergoing TAVI at 3 tertiary centres in Northwest England between 2008 and 2013. The CHA2DS2-Vasc score and its modification—the R2CHA2DS2-Vasc score, which includes pre-existing renal impairment and pre-existing conduction abnormality (right bundle branch block/left bundle branch block, RBBB/LBBB)—were calculated for all patients. A total of 313 patients with a mean age of 80 (79.1–80.8) years underwent TAVI. The implanted devices were either the CoreValve or the Edwards-SAPIEN prosthesis. The 30-day mortality was 14.3% in those with a CHA2DS2-Vasc score ≥6, whereas it was only 6.2% in those with a score <6 (p=0.04). Using the R2-CHA2DS2-Vasc score, the difference was more pronounced with a 30-day mortality of 22.6% in those patients with an R2-CHA2DS2-Vasc score ≥7 compared to 6.0% in those with a R2-CHA2DS2-Vasc score <7 (p=0.001). In multivariable Cox regression analyses, there was a significant and independent relationship between the CHA2DS2-Vasc score (hazard ratio (HR)= 2.71, (1.01 to 7.31); p<0.05) and the modified R2CHA2DS2-Vasc score (HR=4.27 (1.51 to 12.07); p=0.006) with 30-day mortality.ConclusionsOur study demonstrates the potential use of the CHA2DS2-Vasc or the R2CHA2DS2-Vasc score to quantify the risk of mortality in patients undergoing TAVI. This could have significant implications in terms of clinical as well as patients’ decision-making.
A propensity matched comparison of return to work and quality of life after stenting or coronary artery bypass surgery
Authors: Maznyczka Annette M , Howard James P , Banning Amerjeet S , Gershlick Anthony H 
Published: June 2016

ObjectivesWe sought to determine (1) return to work (RTW) rates, (2) long-term employment (>12 months postprocedure), (3) time taken to RTW, and (4) quality of life (QoL), in patients treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).MethodsQuestionnaires regarding RTW were sent to 689 PCI and 169 CABG patients who underwent PCI or CABG at University Hospitals of Leicester Trust, UK, from May 2012 to May 2013. QoL was also measured using the European QoL 5-dimensions questionnaire (EQ-5D). Responses from patients employed preprocedure were analysed using multivariate logistic regression. Propensity score-matching was further used to compare similar patient populations receiving PCI or CABG.ResultsThe response rate was 38% (235 PCI and 88 CABG patients). 241 respondents (75%) were employed preprocedure. Of these 162 (93%) PCI and 51 (77%) CABG patients returned to work, whereas 147 (85%) PCI and 41 (62%) CABG patients were still employed at >12 months postprocedure. After propensity analysis, there was no significant difference between PCI and CABG patients in RTW, long-term employment, nor QoL. The median time taken to RTW was 6 weeks after PCI and 13 weeks after CABG (p=0.001). The effect remained significant after multivariate analysis (p=0.001) and propensity analysis (p=0.001).ConclusionsIn this first propensity score-matched study comparing RTW and QoL after PCI or CABG strict propensity matching indicates that RTW or QoL, is similar for PCI or CABG, albeit the number of matched pairs was small. There are differences, however, in delay in RTW.
Patterns of ST segment resolution after guidewire passage and thrombus aspiration in primary percutaneous coronary intervention (PPCI) for acute myocardial infarction
Authors: Russhard Paul , Al Janabi Firas , Parker Michael , Clesham Gerald J 
Published: June 2016

BackgroundST segment elevation allows the rapid identification of patients with acute myocardial infarction who benefit from emergency reperfusion. Primary percutaneous coronary intervention (PPCI) has emerged as the preferred perfusion strategy for patients presenting with ST segment elevation myocardial infarction (STEMI).Methods and resultsWe studied the effects of the simple passage of an angioplasty guidewire followed by mechanical thrombus aspiration on the ST segment displacement in 289 patients presenting with acute STEMI. Simple guidewire passage led to a statistically significant fall in the mean ST elevation from 5.9 to 4.9 mm (p<0.001), but the mean ST displacement after subsequent mechanical thrombus aspiration was 4.8 mm, not statistically significantly different from guidewire passage. When compared with simple guidewire passage, thrombus aspiration resulted in more patients achieving more than 50% ST resolution (21.8% vs 15.2%, p=0.009), but a higher proportion had a worsening of ST elevation compared to baseline (19.7% vs 13.5%, p=0.041).ConclusionsMechanical thrombus aspiration in acute STEMI did not improve the mean ST resolution compared with simple guidewire passage. Thrombus aspiration increased the proportion achieving 50% resolution but also increased the proportion who had a worsening of ST elevation. These data may help explain some of the uncertainties surrounding the routine use of thrombus aspiration in STEMI and potentially supports the use of ‘time to angioplasty guidewire passage’ as one of the ways to judge the promptness of PPCI services.
SIMULATION OF SOLID–LIQUID SUSPENSION AND SCALE-UP OF AGAROSE GEL ACTIVATION REACTOR
Authors: ZHOU XUELING , LIU YIFAN , YU WEN , CHENG SHAOJIE , YIN JIANZHONG 
Published: June 2016

Agarose gel activation reaction, which is of great importance in preparing the carrier of the column packing material for blood purification, would be significantly influenced by the configuration and parameter of reactor. In order to optimize the structure design of the reactor and operating parameters of the process, the characteristics of suspension system composed of agarose gel, NaOH, water, 3-allyl bromide, and activated alumina were simulated numerically utilizing an Eulerian multiphase flow model and multi-reference frame (MRF) approach. The effect of impeller configuration was studied with three typical impellers, including Rushton disk turbine (DT), pitched blade downflow turbine (PBTD45), and pitched blade upflow turbine (PBTU45). The results showed that the optimum solid suspension was obtained using PBTD45 impeller with a diameter of 100[Formula: see text]mm and critical suspension speed of 570[Formula: see text]rpm in a 20[Formula: see text]L stirred reactor. In addition, the critical suspension speeds using the three impellers were calculated and the errors were all within the engineering allowance. Finally, the feasibility of scale-up design for agarose gel activation reactor was preliminarily discussed. The results would be useful to the optimization and scale-up of relevant reactor design.
Palynological calibration of Devonian events at near-polar palaeolatitudes in the Falkland Islands, South Atlantic
Authors: Marshall J. E. A. 
Published: June 2016

Abstract

In the Devonian, the Falkland Islands were part of the high-latitude Cape Basin. West Falkland palynological assemblages are at a low thermal maturity level but also very low in diversity and dominated by simple spores with rare chitinozoans and acritarchs. The South Harbour Member contains rare verrucate and sculptured trilete spores, and is early Lochkovian. The Fish Creek Member palynofloras are late Lochkovian. The best correlative datum is the transgressive Fox Bay Formation where the palynological assemblage includes
Ramochitina magnifica
and is equivalent to the Sequence B transgression in Brazil (dated as late Pragian–earliest Emsian). The early Eifelian upper Fox Bay Formation spore assemblage is comparable to the Sequence C transgression in Brazil and the ?Choteč Event. The facies and position of the base Port Philomel Formation prasinophyte-rich black shale suggests the late Eifelian transgression (Kačák Event). Above this level is the inception of
Geminospora lemurata
(base Givetian). The upper Port Stanley Formation contains a late (but not latest) Famennian assemblage. Comparisons with both South Africa and South America indicate a number of correlative transgressive and regressive events that match to Euramerica. These correlations are at a continental scale and confirm eustatic control of these Devonian events.
SNP rs16906252C&gt;T Is an Expression and Methylation Quantitative Trait Locus Associated with an Increased Risk of Developing MGMT-Methylated Colorectal Cancer
Authors: Kuroiwa-Trzmielina Joice , Wang Fan , Rapkins Robert W. , Ward Robyn L. , Buchanan Daniel D. , Win Aung Ko , Clendenning Mark , Rosty Christophe , Southey Melissa C. , Winship Ingrid M. , Hopper John L. , Jenkins Mark A. , Olivier Jake , Hawkins Nicholas J. , Hitchins Megan P. 
Published: June 2016

Abstract
Purpose: Methylation of the MGMT promoter is the major cause of O6-methylguanine methyltransferase deficiency in cancer and has been associated with the T variant of the promoter enhancer SNP rs16906252C&gt;T. We sought evidence for an association between the rs16906252C&gt;T genotype and increased risk of developing a subtype of colorectal cancer featuring MGMT methylation, mediated by genotype-dependent epigenetic silencing within normal tissues.
Experimental Design: By applying a molecular pathologic epidemiology case–control study design, associations between rs16906252C&gt;T and risk for colorectal cancer overall, and colorectal cancer stratified by MGMT methylation status, were estimated using multinomial logistic regression in two independent retrospective series of colorectal cancer cases and controls. The test sample comprised 1,054 colorectal cancer cases and 451 controls from Sydney, Australia. The validation sample comprised 612 colorectal cancer cases and 245 controls from the Australasian Colon Cancer Family Registry (ACCFR). To determine whether rs16906252C&gt;T was linked to a constitutively altered epigenetic state, quantitative allelic expression and methylation analyses were performed in normal tissues.
Results: An association between rs16906252C&gt;T and increased risk of developing MGMT-methylated colorectal cancer in the Sydney sample was observed [OR, 3.3; 95% confidence interval (CI), 2.0–5.3; P &lt; 0.0001], which was replicated in the ACCFR sample (OR, 4.0; 95% CI, 2.4–6.8; P &lt; 0.0001). The T allele demonstrated about 2.5-fold reduced transcription in normal colorectal mucosa from cases and controls and was selectively methylated in a minority of normal cells, indicating that rs16906252C&gt;T represents an expression and methylation quantitative trait locus.
Conclusions: We provide evidence that rs16906252C&gt;T is associated with elevated risk for MGMT-methylated colorectal cancer, likely mediated by constitutive epigenetic repression of the T allele. Clin Cancer Res; 22(24); 6266–77. ©2016 AACR.