bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of a Modified Glasgow‐Blatchford Score for Risk Stratification of Patients with Suspected Upper Gastrointestinal Bleeding in an Accident and Emergency Department in Hong Kong
Authors: Tsui ATS , Chau CW , Leung JKS 
Published: December 2017

ObjectivesTo validate the use of a modified Glasgow‐Blatchford Score (mGBS) for risk stratification of patients with suspected upper gastrointestinal bleeding (UGIB) in an accident and emergency department in Hong Kong.MethodsThis was a retrospective cohort study of patients who attended the emergency department of the study centre from January 2014 to June 2014 who were subsequently admitted to surgical wards with suspected UGIB. High risk patients were considered to be those who required in‐patient clinical interventions (blood transfusion, therapeutic endoscopy, angiographic embolisation, or surgery). The mGBS was calculated for each patient. The sensitivity, specificity, and area under the receiver‐operating characteristic curve (AUC) of the score were calculated.ResultsA total of 372 patients were included in the study. With an mGBS of 0 (low risk) for detecting the primary outcome, the sensitivity was 99.2% (95% CI, 95.6100%), and the specificity was 25.91 (95% CI 20.6‐31.8%). The negative likelihood ratio was 0.031 (95% CI 0.004‐0.2). The AUC was 0.90 (95% CI 0.87 to 0.93).ConclusionThe modified Glasgow‐Blatchford Score is a clinically useful tool for emergency physician to identify UGIB patients at low‐risk of requiring in‐hospital clinical interventions. (Hong Kong j.emerg.med. 2016;23:3‐11)
Toxicology Training Unit in Emergency Department Reduces Admission to other Specialties and Hospital Length of Stay
Authors: Choi KM , Chan CK , Lau FL 
Published: December 2017

Objective To evaluate the outcome of intoxicated patients presented to Accident and Emergency Department (AED) in Hong Kong with Toxicology Training Unit accreditation and AED without toxicology team. Method A retrospective observational study with data collection from all intoxicated cases reported through Pre-hospital Activated Charcoal Programme, a protocol driven poisoning reporting system, from 1/7/2011 to 30/6/2013 (2 years). Data on basic demographic data (e.g. sex, age), receiving AED, admission rate to other specialty, length of stay in hospital exclude psychiatry ward admission and clinical outcome were collected and analysed. Five AEDs with Toxicology Training Unit (study group) and 7 AEDs without toxicology team (control group) were included. Results A total of 329 intoxicated cases were included in this study. The basic epidemiological data were similar in both groups. There was a significantly lower in hospital admissions in study group (16.9%) than in control group (69.3%; p<0.001) and significant shorter median of hospital stay of 22.1 hours (interquartile range [IQR] 12.8-43.5 hours) in study group compare to 42.7 hours (IQR 20.4-76.1 hours) in control group (p<0.001). Conclusion Our findings show that the establishment of the toxicology training unit can achieve significant reduction in admissions to other specialty and the length of stay in hospital in the management of patients with acute intoxication.
Nurse Performed Ultrasonography in Confirming the Position of Nasogastric Tube in the Emergency Department: A Prospective Single Group Diagnostic Test Study
Authors: Tai PH , Lau WS , Chan PY , Ng SY , Lam YC , Mak HT , Mak YT 
Published: December 2017

Introduction Emergency nurses often encounter patients with nasogastric tube (NGT) dislodgements who require reinsertion. Empirical evidence supporting the use of ultrasonography in verifying the position of NGT in local accident and emergency departments (AED) is scanty. There is also a lack of validation of nurse performed ultrasonography in Hong Kong. With the support from hospitals and medical personnel, a prospective, single group diagnostic test study was conducted to review the possibility of nurse performed ultrasonography in verifying the position of NGT in AED. Methods This study was conducted in the AED of three local hospitals. Investigators with specific ultrasound training performed ultrasonography scans to the subjects in addition to conventional pH test and “whoosh” test. Results were compared with chest or abdominal X-ray for evaluation of accuracies. Results This study confirmed a high sensitivity and specificity of nurse performed ultrasonography in confirming the position of NGT in the AED. The high positive predictive value and positive likelihood ratio supported the confirmation of NGT position by bedside ultrasound. The high specificities and minimal negative likelihood ratios of ultrasonography tests also suggested the application of bedside ultrasound in ruling out patients with misplaced NGTs. Conclusions Nurse performed ultrasonography allows immediate bedside confirmation of the position of NGT in the overcrowded AED. Considered the limitations of conventional methods, nurse performed ultrasonography can be incorporated into daily practice for providing extra evidence for the confirmation of NGT position.
Epidemiology of Paediatric Out-of-Hospital Cardiac Arrest Presented to a Local Emergency Department: A Retrospective Case Series
Authors: Ho YK , Mok YT 
Published: December 2017

ObjectiveTo outline the epidemiology of paediatric out-of-hospital cardiac arrest (OHCA) cases presented to a regional hospital.DesignRetrospective case series.MethodsAttendance records of critical cases aged from 0 to 17 years old from year 2001 to 2014 attending Emergency Department (ED) of Yan Chai Hospital were searched. Demographic data and predictive parameters were analysed for association with outcome.ResultsThere were 40 cases of paediatric OHCA throughout the study period. A total of 21 (52.5%) had witnessed arrest; 27 (67.5%) had cardiac arrest at home. Twenty-eight (70%) of the cardiac arrest were first noted by family members; 8 (20%) received bystander cardiopulmonary resuscitation (CPR). Only 13 (32.5%) cases had return of spontaneous circulation (ROSC) in the ED and were admitted. Seven patients (17.5%) survived to hospital discharge.ConclusionPaediatric OHCA, although a rare occurrence, has a high mortality of 82.5% in our series. Majority of the cases occur at home, and are witnessed. Family members are often the first persons to detect the arrest. Yet the rate of providing bystander CPR is low in Hong Kong.
Impact of a Sepsis Guideline in Emergency Department on Outcome of Patients with Severe Sepsis
Authors: Tse CL , Lui CT , Wong CY , Ong KL , Fung HT , Tang SYH 
Published: December 2017

ObjectiveA dedicated program with guideline to enhance sepsis care was launched in July 2014 in Emergency Department (ED) of two regional hospitals. The study aimed to evaluate the effectiveness of the interventional program for severe sepsis patients, in antibiotic delivery rate and survival outcome.MethodsIt is a before‐and‐after interventional study with data from July to December 2013 and August 2014 to January 2015. A dedicated program for severe sepsis patients was introduced in July 2014. The outcome measures were blood culture rate, antibiotic administration rate in ED and mortality. Kaplan‐Meier analysis and log‐rank test was used for comparison of the survival. Multivariate Cox proportional hazards model was constructed to predict time to mortality adjusted for covariates.Results64 patients were included, 31 patients were in the pre‐intervention group whereas 33 post‐intervention. Both blood culture rate (29% vs 72.7%; p<0.001) and antibiotics administration in ED (38.7% vs 72.7%, p=0.0011) were significantly increased. Survival outcome was significantly improved in patients receiving timely antibiotics in ED (log‐rank test p=0.016). Antibiotics administered in ED had hazard ratio of 0.178 (95% CI 0.053 to 0.595; p=0.005) in the Cox Proportional hazard regression model with adjustment of covariates. Age (adjusted odds ratio 1.06, 95% CI 1.01 to 1.12, p=0.033) and initial hypotension (adjusted odds ratio 0.97, 95% CI 0.95 to 0.99, p=0.005) were significant predictors of mortality.ConclusionA dedicated guideline for severe sepsis management could improve blood culture rate, early antibiotics administration in the emergency department. Patients received early antibiotic had better outcome and survival.
An extended review of couple-centred interventions in dementia: Exploring the what and why — Part B
Authors: Bielsten Therése , Hellström Ingrid 
Published: December 2017

This scoping review is an extended version of a narrative review of couple-centred interventions in dementia shared in part A and the previous publication in this edition. The rationale for expanding study A emerged through the fact that most dyadic interventions have samples consisting of a majority of couples. The exclusion of interventions with samples of mixed relationships in part A therefore contributed to a narrow picture of joint dyadic interventions for couples in which one partner has a dementia. The aim of this second review is to explore the ‘what’ (types of interventions) and the ‘why’ (objectives and outcome measures) of dyadic interventions in which sample consists of a majority of couples/spouses and in which people with dementia and caregivers jointly participate. Method A five-step framework for scoping reviews guided the procedure. Searches were performed in Academic Search Premier, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science. Results Twenty-one studies with various types of psychosocial interventions were included. The main outcome measure for people with dementia was related to cognitive function, respectively caregiver burden and depression for caregivers. Conclusions The findings of this extended review of joint dyadic interventions in dementia are in line with the findings of part A regarding the negative approach of outcomes, lack of a genuine dyadic approach, lack of tailored support, neglect of interpersonal issues and the overlook of the views of people with dementia. This review also recognises that measures of caregiver burden, as well as relationship quality should be considered in samples of mixed relationships due to the different significance of burden and relationship quality for a spouse as opposed to an adult child or friend.
Quality nursing care in dementia specific care units: A scoping review
Authors: Gilbert Julia , Ward Louise , Gwinner Karleen 
Published: December 2017

Background The concept of quality nursing care in a dementia specific unit is perceived as being subject to the interpretation of individuals, nurses and healthcare organisations. As the number of dementia diagnoses increases, understanding what constitutes quality nursing care within dementia specific care units is vital to inform policy makers and healthcare organisations globally. Efforts to identify quality nursing care and improve dementia care within dementia specific care units, may significantly reduce the financial and emotional burden of care-giving and improve the quality of life for individuals living with dementia. This scoping review aimed to examine current literature to gain an understanding of what constitutes quality nursing care in a dementia specific care unit. Design and methods Five electronic databases (CINAHL, MEDLINE, ProQuest, Social Sciences Citation Index and Ovid) were used to search for articles published in English between 2011 and 2016 focusing on a definition of quality nursing care within dementia specific care units. Findings: Twenty journal articles were identified. From these articles, two content themes were identified: Challenges in the provision of quality nursing care in dementia specific care units, and Standardised approach to quality nursing care in a dementia specific care unit. The articles contained the following research designs, controlled pre-test and post-test design ( n = 1), focus group interviews ( n = 1), cross sectional survey ( n = 6), semi structured interviews ( n = 3), narrative review ( n = 1), survey ( n = 2), literature review ( n = 3), systematic review ( n = 1), and prospective longitudinal cohort study ( n = 2). Conclusions The concept of quality nursing care in a dementia specific unit remains subject to the interpretation of individuals, nurses and healthcare organisations, with current literature unable to provide a clear definition. Further research into what constitutes quality nursing care in dementia specific care units is recommended.
Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: The Campania Salute Network
Authors: Mancusi Costantino , Losi Maria A , Izzo Raffaele , Canciello Grazia , Carlino Maria V , Albano Giovanni , De Luca Nicola , Trimarco Bruno , de Simone Giovanni 
Published: December 2017

Background Increased pulse pressure is associated with structural target organ damage, especially in elderly patients, increasing cardiovascular risk. Design In this analysis, we investigated whether high pulse pressure retains a prognostic effect also when common markers of target organ damage are taken into account. Methods We analysed an unselected cohort of treated hypertensive patients from the Campania Salute Network registry ( n = 7336). Participants with available cardiac and carotid ultrasound were required to be free of prevalent cardiovascular disease, with ejection fraction ≥50%, and no more than stage III Chronic Kidney Disease. The median follow-up was 41 months and end-point was occurrence of major cardiovascular events (i.e. fatal and non-fatal stroke or myocardial infarction and sudden death). Based on current guidelines, pulse pressure ≥60 mm Hg was classified as high pulse pressure ( n = 2356), at the time of the initial visit, whereas pulse pressure <60 mm Hg was considered normal ( n = 4980). Results High pulse pressure patients were older, more likely to be women and diabetic, while receiving more antihypertensive medications than normal pulse pressure (all p < 0.0001). High pulse pressure exhibited greater prevalence of left ventricular hypertrophy, and carotid plaque than normal pulse pressure (all p < 0.0001). In Cox regression, high pulse pressure patients had 57% increased hazard of major cardiovascular events, compared to normal pulse pressure (hazard ratio = 1.57; 95% confidence interval: 1.12–2.22, p = 0.01), an effect that was independent of significant prognostic impact of older age, male sex, diabetes, left ventricular hypertrophy, carotid plaque and less prescription of anti-renin–angiotensin system therapy. Conclusions High pulse pressure is a functional marker of target organ damage, predicting cardiovascular events in hypertensive patients, even independently of well-known structural markers of target organ damage.
The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement
Authors: Boody Barrett S. , Hashmi Sohaib Z. , Rosenthal Brett D. , Maslak Joseph P. , McCarthy Michael H. , Patel Alpesh A. , Savage Jason W. , Hsu Wellington K. 
Published: December 2017

Study Design: Prospective randomized study. Objectives: To define the impact of an inexpensive, user-friendly, and reproducible lumbar pedicle screw instrumentation bioskills training module and evaluation protocol. Methods: Participants were randomized to control (n = 9) or intervention (n = 10) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 20-minute bioskills training module while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of pedicle breach and breach anatomic location was measured pre- and posttest in lumbar spine models. Results: The intervention group showed a 30.8% improvement in PPDIS scores, compared with 13.4% for the control group ( P = .01). The intervention group demonstrated statistically significant 66% decrease in breaches ( P = .001) compared with 28% decrease in the control group ( P = .06). Breach identification demonstrated no change in accuracy of the control group (incorrect identification from 32.2% pre- to posttest 35%; P = .71), whereas the intervention group’s improvement was statistically significant (42% pre- to posttest 36.5%; P = .0047). Conclusions: We conclude that a concise lumbar pedicle screw instrumentation bioskills training session can be a useful educational tool to augment clinical education.
Incidence of Osteoporosis-Related Complications Following Posterior Lumbar Fusion
Authors: Bjerke Benjamin T. , Zarrabian Mohammad , Aleem Ilyas S. , Fogelson Jeremy L. , Currier Bradford L. , Freedman Brett A. , Bydon Mohamad , Nassr Ahmad 
Published: December 2017

Study Design: Retrospective review. Objectives: This study investigates the prevalence of adverse postsurgical events, or osteoporosis-related complications (ORCs), following spinal fusion. Methods: Patients undergoing primary posterior thoracolumbar or lumbar fusion by 1 of 2 surgeons practicing at a single institution were analyzed from 2007 to 2014. ORCs were defined in one of the following categories: revision surgery, compression fracture, proximal junctional kyphosis, pseudarthrosis, or failure of instrumentation. Patients with a bone mineral density of the hips and/or spine performed within 1 year of the index procedure were included. Patients were stratified into normal bone density, osteopenia, and osteoporosis using WHO guidelines. Patients were excluded if they were younger than 18 years at the time of surgery, with infection, malignancy, skeletal dysplasia, neuromuscular disorders, concomitant or staged anterior-posterior procedure, or fusion performed because of trauma. Results: Out of 140 patients included, the prevalence of normal bone density was 31.4% (44/140), osteopenia 58.6% (82/140), and osteoporosis 10.0% (14/140). There were no differences between groups for gender, age, body mass index, and interbody device rate. The overall prevalence of ORCs was 32.1% (45/140). By group, there was a prevalence of 22.7% (10/44), 32.9% (27/82), and 50.0% (7/14) for normal bone density, osteopenia, and osteoporosis, respectively. These differences were significantly higher for both the osteopenia and osteoporosis groups. Conclusions: Patients with T scores below −1.0 undergoing posterior lumbar fusion have an increased prevalence of ORCs. Consideration of bone density plays a crucial role in patient selection, medical management, and counseling patient expectations.
Cancer nanomedicine: a review of recent success in drug delivery
Authors: Tran Stephanie , DeGiovanni Peter‐Joseph , Piel Brandon , Rai Prakash 
Published: December 2017

AbstractCancer continues to be one of the most difficult global healthcare problems. Although there is a large library of drugs that can be used in cancer treatment, the problem is selectively killing all the cancer cells while reducing collateral toxicity to healthy cells. There are several biological barriers to effective drug delivery in cancer such as renal, hepatic, or immune clearance. Nanoparticles loaded with drugs can be designed to overcome these biological barriers to improve efficacy while reducing morbidity. Nanomedicine has ushered in a new era for drug delivery by improving the therapeutic indices of the active pharmaceutical ingredients engineered within nanoparticles. First generation nanomedicines have received widespread clinical approval over the past two decades, from Doxil® (liposomal doxorubicin) in 1995 to Onivyde® (liposomal irinotecan) in 2015. This review highlights the biological barriers to effective drug delivery in cancer, emphasizing the need for nanoparticles for improving therapeutic outcomes. A summary of different nanoparticles used for drug delivery applications in cancer are presented. The review summarizes recent successes in cancer nanomedicine in the clinic. The clinical trials of Onivyde leading to its approval in 2015 by the Food and Drug Adminstration are highlighted as a case study in the recent clinical success of nanomedicine against cancer. Next generation nanomedicines need to be better targeted to specifically destroy cancerous tissue, but face several obstacles in their clinical development, including identification of appropriate biomarkers to target, scale‐up of synthesis, and reproducible characterization. These hurdles need to be overcome through multidisciplinary collaborations across academia, pharmaceutical industry, and regulatory agencies in order to achieve the goal of eradicating cancer. This review discusses the current use of clinically approved nanomedicines, the investigation of nanomedicines in clinical trials, and the challenges that may hinder development of the nanomedicines for cancer treatment.
Health Technology Assessment capacity development in low- and middle-income countries: Experiences from the international units of HITAP and NICE
Authors: Tantivess Sripen , Chalkidou Kalipso , Tritasavit Nattha , Teerawattananon Yot 
Published: December 2017

Health Technology Assessment (HTA) is policy research that aims to inform priority setting and resource allocation. HTA is increasingly recognized as a useful policy tool in low- and middle-income countries (LMICs), where there is a substantial need for evidence to guide Universal Health Coverage policies, such as benefit coverage, quality improvement interventions and quality standards, all of which aim at improving the efficiency and equity of the healthcare system. The Health Intervention and Technology Assessment Program (HITAP), Thailand, and the National Institute for Health and Care Excellence (NICE), UK, are national HTA organizations providing technical support to governments in LMICs to build up their priority setting capacity. This paper draws lessons from their capacity building programs in India, Colombia, Myanmar, the Philippines, and Vietnam. Such experiences suggest that it is not only technical capacity, for example analytical techniques for conducting economic evaluation, but also management, coordination and communication capacity that support the generation and use of HTA evidence in the respective settings. The learned lessons may help guide the development of HTA capacity in other LMICs.
LOS CÉSPEDES ESPONTÁNEOS DEL PARQUE J.F. VILLARINO (ZAVALLA–SANTA FE) Y SU BANCO DE SEMILLAS
Authors: Boccanelli Silvia Irene , Alzugaray Claudia , Franceschi Eduardo Andrés 
Published: December 2017

El objetivo de este trabajo fue caracterizar las comunidades herbáceas espontáneas que constituyen los céspedes del parque J.F. Villarino (Provincia de Santa Fe, Argentina) y evaluar la vegetación emergente y el banco de semillas del suelo. Se utilizaron parcelas de inventario de 16 m 2 . Los datos fueron analizados con métodos multivariados. En la vegetación se observaron tres grupos: Grupos 1, 2 y 3 dominados por Cynodon dactylon, Paspalum notatum y Digitaria sanguinalis, respectivamente. En el banco de semillas se reconocieron dos grupos, que se diferenciaron por la importancia relativa de alguna de sus especies. El 62 % de las especies del banco presentó una distribución agregada (Índice de Morisita). La similitud entre la vegetación y el banco fue de 55,7% (Índice de Sörensen). El 47 % de las especies que en la vegetación se destacaron por su constancia y/o abundancia, también se encontraron en el banco, aunque pocas alcanzaron una densidad alta. En ambas situaciones predominaron las especies nativas (80,3 % en céspedes y 61,9 % en el banco del suelo) y perennes (73,8 % y 58,5 % respectivamente). Los resultados señalan la importancia de preservar los céspedes espontáneos, dado que contienen y actúan como refugio de especies nativas del pastizal pampeano extinto en la región.