bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the concept of “caring cultures”
Authors: Gillin Nicola , Taylor Ruth , Walker Susan 
Published: April 2017

Aims and objectivesTo critically examine the conceptual, methodological and validity issues with the “caring cultures” construct.BackgroundPost the Francis Report, “caring cultures” and alternative terminology such as “culture/s of care/caring/compassionate care” have gained prominence in the literature, especially within a UK policy context. However, in order to understand the value these “caring cultures” hold in terms of clinical practice, the concept itself first needs to be understood.DesignA discussion and critical examination of the concept of “caring cultures” and associated terminology.MethodsGrey literature, database, library and reference list searches were conducted.ResultsIt is implied that “caring cultures” influence patient care. However, evidence which verifies this assertion is limited. In this article, the concept of “caring cultures” is deconstructed and its validity explored. An alternative to “caring cultures” is proposed in terms of research, whereby the concept of culture is instead explored in detail, on a microsystem level, using appropriate methodology.ConclusionThe concept of “caring cultures”, although attractive in terms of its apparent simplicity, is not considered the most useful nor appropriate phrases in terms of advancing research. Instead, research which examines the established concept of “culture” in relation to outcomes such as patient care, doing so with an appropriate methodology, is viewed as a more suitable alternative.Relevance to clinical practiceClarifying concepts and terminology relating to “caring cultures” is essential for research to progress and the impact of culture on clinical practice to be better understood.
How is continuity of care experienced by people living with chronic kidney disease?
Authors: Brand Sarah , Pollock Kristian 
Published: April 2017

Aims and objectivesTo explore patients’ perceptions of continuity of care within a hospital‐based specialist service.BackgroundPatient journeys through health care are becoming increasingly complex. For patients with chronic conditions, the longevity of their illness and common multiple co‐morbidities make this complexity more pronounced. Continuity of care is most challenging to provide for these patients. A multifaceted model of continuity is widely accepted, but despite this, much literature focuses exclusively on relational aspects. In addition, the majority of the literature has focused on primary and family care settings whilst continuity within specialist and hospital care has not been widely researched.DesignA qualitative descriptive design was used.MethodsThirteen semi‐structured interviews with patients accessing services as at a Renal and Transplant Unit at a UK hospital were conducted in 2014. Data were analysed thematically to identify commonality as well as diversity amongst participants.ResultsFive themes of time, being known, knowledge, knowing the system and responsibility were identified within patient experiences of continuity. The multidisciplinary team was more important in relational continuity than literature has previously suggested. Patients’ expectations in relation to continuity were notably different in their interactions with hospital‐based services in comparison with community and family‐based care.ConclusionsPatients accessing specialist care services may perceive continuity differently to those receiving care in the community. Generic guidance concerned with patient experience outcomes may be difficult to implement in practice.Relevance to clinical practiceNurses and the wider healthcare team play a fundamental role within the provision of continuity, even in predominantly medically led specialist services. The differences between primary and secondary care in terms of patient expectation and experience should be recognised to ensure effective models of care are implemented which both meet patient expectations and improve their experience of care.
The effects of awareness and count duration on adult respiratory rate measurements: An experimental study
Authors: Hill Andrew , Kelly Eliza , Horswill Mark S , Watson Marcus O 
Published: April 2017

Aims and objectivesTo investigate whether awareness of manual respiratory rate monitoring affects respiratory rate in adults, and whether count duration influences respiratory rate estimates.BackgroundNursing textbooks typically suggest that the patient should ideally be unaware of respiratory rate observations; however, there is little published evidence of the effect of awareness on respiratory rate, and none specific to manual measurement. In addition, recommendations about the length of the respiratory rate count vary from text to text, and the relevant empirical evidence is scant, inconsistent and subject to substantial methodological limitations.DesignExperimental study withawareness of respiration monitoring(aware,unaware; randomised between‐subjects) andcount duration(60 s, 30 s, 15 s; within‐subjects) as the independent variables. Respiratory rate (breaths/minute) was the dependent variable.MethodsEighty‐two adult volunteers were randomly assigned toawareandunawareconditions. In the baseline block, no live monitoring occurred. In the subsequent experimental block, the researcher informedawareparticipants that their respiratory rate would be counted, and did so. Respirations were captured throughout via video recording, and counted by blind raters viewing 60‐, 30‐ and 15‐s extracts. The data were collected in 2015.ResultsThere was no baseline difference between the groups. During the experimental block, the respiratory rates of participants in theawarecondition were an average of 2.13 breaths/minute lower compared tounawareparticipants. Reducing the count duration from 1 min to 15 s caused respiratory rate to be underestimated by an average of 2.19 breaths/minute (and 0.95 breaths/minute for 30‐s counts). The awareness effect did not depend on count duration.ConclusionsAwareness of monitoring appears to reduce respiratory rate, and shorter monitoring durations yield systematically lower respiratory rate estimates.Relevance to clinical practiceWhen interpreting and acting upon respiratory rate data, clinicians should consider the potential influence of these factors, including cumulative effects.
“I am still passionate despite the challenges”: Nurses navigating the care for refugees
Authors: Ogunsiji Olayide , Ng Chok Harrison , Mashingaidze Gladys , Wilkes Lesley 
Published: April 2017

Aims and objectivesTo report the challenges faced by the nursing workforce in refugee health.BackgroundNurses are in the forefront of care provision for refugees who are recognised as one of the most vulnerable population groups in the world. The number of refugees in Australia is increasing, and more nurses are needed as care providers. Research on the challenges faced by refugee health nurses is sparse.DesignQualitative research methodology was used to study the experience of refugee health nurses. Using a descriptive qualitative research approach, a better understanding of the ongoing challenges of caring for refugees is presented.MethodSemi‐structured interview with a convenience sample of registered nurses who worked in New South Wales refugee health services was conducted and digitally recorded in 2013. Responses were transcribed verbatim and analysed for themes.ResultsSix refugee health nurses who have been working in New South Wales refugee health services between 1–8 years participated in this study. A thematic analysis of the data led to three main themes: caring for clients with challenging needs; challenges in the course of caring for refugees; and passion in caring for refugees. Participants reported what it means to be refugee health nurses, they explored their roles and emphasised the need to understand refugee health issues.ConclusionsThis study provides more insight into the unique experiences nurses have when caring for refugees. More debriefing opportunities and resources may reduce the challenges of caring.Relevance to clinical practiceThe refugee health nurses’ stories support the need for further role refinement for nurses caring for refugees in the community, rural areas and health clinics. This is essential in promoting their well‐being and that of the vulnerable population they are caring for.
Experiences of nurses with the care of patients with dementia in acute hospitals: A secondary analysis
Authors: Pinkert Christiane , Faul Eva , Saxer Susi , Burgstaller Melanie , Kamleitner Doris , Mayer Hanna 
Published: April 2017

Aims and objectivesTo describe nurses’ experiences in caring for people with dementia in acute hospital settings.BackgroundRecent research suggests that nurses’ experience in caring for people with dementia in acute hospitals is characterised by frustration, overall job dissatisfaction and feelings of powerlessness and guilt. Despite a growing body of knowledge concerning the care of people with dementia in acute care settings, it remains unclear how nurses in acute hospitals provide care for people with dementia and what general conditions characterise the nursing care provided to these patients.DesignA qualitative secondary analysis was conducted.MethodsData were collected using audio‐recorded focus group discussions with nurses in Germany and Austria. Overall, 12 focus group discussions, which were part of two larger research projects in Germany and Austria, were expanded into a qualitative secondary analysis (a content analysis).ResultsThe findings show that nurses face great uncertainty in caring for people with dementia in acute hospital settings and that each nurse reacts in different ways to address this uncertainty. The results also underline that, even for nurses who provide some form of person‐centred care, the hospital environment imposes several contextual constraints.ConclusionsHospitals must minimise constraints to give every nurse the chance to perform person‐centred care. Furthermore, it is important to sensitise nurses and give them sufficient training and education to enable them to care for people with dementia.Relevance to clinical practiceThe results may contribute to a better understanding of the factors that support or constrain person‐centred nursing care for people with dementia in acute hospitals.
Role of sialyl 6‐sulfo Lewis X in antitumor immunity against oral squamous cell carcinoma
Authors: Yoshida Hisato , Hoshino Hitomi , Imamura Yoshiaki , Yoshimura Hitoshi , Sano Kazuo , Kobayashi Motohiro 
Published: April 2017

BackgroundTumor‐infiltrating lymphocytes (TILs) reportedly play a pivotal role in antitumor immunity against oral squamous cell carcinoma (OSCC); however, mechanisms governing TIL recruitment to OSCC tissues remain to be clarified. This study was undertaken to assess a potential association between TILs and high endothelial venule (HEV)‐like vessels that express sialyl 6‐sulfo Lewis X (LeX).MethodsOSCC tissue sections (n=41) were subjected to immunohistochemistry for sialyl 6‐sulfo LeX and CD34 to allow quantitation of HEV‐like vessels. Triple immunohistochemistry for sialyl 6‐sulfo LeX and either CD3 and CD20 or CD4 and CD8 was conducted to determine which lymphocyte subset is more closely associated with HEV‐like vessels.ResultsHEV‐like vessels expressing sialyl 6‐sulfo LeX were detected in 27 of 41 (65.9%) OSCC cases, and these vessels were more frequently found in early disease (T1/T2 stages) compared with advanced (T3/T4) stages. The number of T cells attached to the inner surface of these HEV‐like vessels was significantly greater than that of B cells, while the number of CD4+ helper T cells and CD8+ cytotoxic T cells did not differ significantly. Interestingly, sialyl 6‐sulfo LeX was also expressed on the membrane of a fraction of OSCC cells, and CD8+ cytotoxic T cells were almost exclusively found attached to these carcinoma cells.ConclusionsSialyl 6‐sulfo LeX is displayed not only on HEV‐like vessels but also on OSCC cells and may potentially function in antitumor immunity against OSCC.
Dissecting Cellulitis of the Scalp with Excellent Response to Isotretinoin
Authors: Marquis Kaitlin , Christensen Laura‐Catherine , Rajpara Anand 
Published: April 2017

AbstractAn 18‐year‐old man presented for evaluation of a 1‐year history of painful nodules on the scalp with associated hair loss. Physical examination revealed multiple confluent, fluctuant, boggy nodules on the scalp with overlying alopecic patches. Based on these findings, a diagnosis of dissecting cellulitis of the scalp was made and the patient was successfully treated with oral isotretinoin therapy.
Garlic Dermatitis on the Neck of an Infant Treated for Nasal Congestion
Authors: Esfahani Amin , Chamlin Sarah L. 
Published: April 2017

AbstractThe health benefits of garlic (Allium sativum) as a naturopathic remedy have been well documented, but topical application of garlic has been linked to allergic and irritant contact dermatitis. We present a case of severe irritant contact dermatitis due to application of a fresh garlic necklace to the neck of infant for treatment of nasal congestion.
Distinct Roles of Th17 and Th1 Cells in Inflammatory Responses Associated with the Presentation of Paucibacillary Leprosy and Leprosy Reactions
Authors: Santos M. B. , de Oliveira D. T. , Cazzaniga R. A. , Varjão C. S. , dos Santos P. L. , Santos M. L. B. , Correia C. B. , Faria D. R. , Simon M. do V. , Silva J. S. , Dutra W. O. , Reed S. G. , Duthie M. S. , de Almeida R. P. , de Jesus A. R. 
Published: April 2017

AbstractIt is well established that helper T cell responses influence resistance or susceptibility to Mycobacterium leprae infection, but the role of more recently described helper T cell subsets in determining severity is less clear. To investigate the involvement of Th17 cells in the pathogenesis of leprosy, we determined the immune profile with variant presentations of leprosy. Firstly, IL‐17A, IFN‐γ and IL‐10 were evaluated in conjunction with CD4+ T cell staining by confocal microscopy of lesion biopsies from tuberculoid (TT) and lepromatous leprosy (LL) patients. Secondly, inflammatory cytokines were measured by multiplex assay of serum samples from Multibacillary (MB, n = 28) and Paucibacillary (PB, n = 23) patients and household contacts (HHC, n = 23). Patients with leprosy were also evaluated for leprosy reaction occurrence: LR+ (n = 8) and LR‐ (n = 20). Finally, peripheral blood mononuclear cells were analysed by flow cytometry used to determine the phenotype of cytokine‐producing cells. Lesions from TT patients were found to have more CD4+IL‐17A+ cells than those from LL patients. Higher concentrations of IL‐17A and IL‐1β were observed in serum from PB than MB patients. The highest serum IFN‐γ concentrations were, however, detected in sera from MB patients that developed leprosy reactions (MB LR+). Together, these results indicate that Th1 cells were associated with both the PB presentation and also with leprosy reactions. In contrast, Th17 cells were associated with an effective inflammatory response that is present in the PB forms but were not predictive of leprosy reactions in MB patients.
Estimation of density and abundance of the blue land crab, Cardisoma guanhumi Latreille, 1828, in the Imburana peninsula, northern Brazil
Authors: Mendes Luciana Do N. , Cruz Raul 
Published: April 2017

The blue land crab (Cardisoma guanhumi Latreille, 1828) supports extensive small-scale artisanal fisheries in the tropical western Atlantic, including Brazil. Land surveys were conducted on a peninsula in a northeastern Brazilian estuary in 2014-2015 in order to evaluate density and abundance. The study area (26 700 m2) was dividied into three subareas with a total of 30 sampling points. In all, 529 burrows were registered of which 71.7% were open (indicating activity), 22.1% were closed (indicating moulting) and 6.2% were empty (fishermen catch). Burrow diameter ranged from 12 to 174 mm (mean: 62.05 ± 3.01 mm; 95% confidence interval). The highly significant correlation between mean burrow diameter and mean carapace length (n = 7; R2 = 0.8968, ) shows that one is a good proxy for the other. The estimated total population size in the study area was 10 362 individuals, with a mean density of 0.39 individuals/m2 (stock of 7347 kg).
Rule-based calculation and simulation design of elevator traffic systems for high-rise office buildings
Authors: Al-Sharif Lutfi , Al Sukkar Ghazi , Hakouz Asma' , Al-Shamayleh Nama' A 
Published: April 2017

Elevator traffic system design has been traditionally based on rules of thumb and the designer’s judgement and expertise. This is especially true for high-rise buildings. This paper attempts to develop a systematic methodology for the design of high-rise buildings, by the use of rational rules. In order to ensure clarity and consistency, it defines the terms sector, zone and stack. A sector is a group of floors that are served by one or more elevators in a journey and are not necessarily fixed and are not necessarily contiguous. A zone is a group of contiguous floors that are served by a group of elevators and are fixed in hardware. When a number of zones are grouped together they form a stack, which is effectively a building within a larger building that is served by a main lobby or by a sky lobby. The systematic methodology is built around the use of rational rules. Rational rules differ from rules of thumbs in a number of ways, and these are discussed in the paper. Six rational rules are presented and used in the design of high-rise buildings. The rules are triggered by the checking of a number of design parameters such as the waiting time and the transit time, as well as the core area used up and the number of elevators in the group. A simulator for incoming traffic and a single entrance is used in order to obtain the parameters for a design and then to trigger the rational rules. Five case studies on the design of various buildings are presented in order to illustrate the use of the six rules. In addition, feedback from the industry experts is reviewed in a dedicated section. Practical application: This paper presents a set of six rules for the design of elevator traffic systems for high-rise buildings. Armed with calculation and simulation tools, the designer can follow the six rules in a systematic procedure in order to arrive at a compliant elevator traffic design for high-rise buildings.
Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis
Authors: Feng Ji-Feng , Wang Xiao-Xia , Lu Yan-Yan , Pang Deng-ge , Peng Wei , Mo Jian-lan 
Published: April 2017

Background Dexmedetomidine (DEX), an α2-adrenergic receptor agonist, produces ideal sedation and early postoperative recovery for premedication in paediatric surgery, reducing preoperative anxiety and facilitating smooth induction of anaesthesia. We performed a meta-analysis to compare the effects of DEX and midazolam (MDZ) in paediatric anaesthesia with sevoflurane. Methods PubMed, Ovid, Web of Science, and Public Health Management Corporation were searched through December 2016 for randomized controlled trials (RCTs) that compared DEX and MDZ in children undergoing sevoflurane anaesthesia. The risk ratio (RR) with 95% incidence interval (95%CI) was used for dichotomous variables. Results Twelve RCTs involving 422 patients in the DEX group and 448 patients in the MDZ group were included. Patients in the DEX group had a significantly lower incidence of unsatisfactory sedation (RR [95%CI] = 0.71 [0.57–0.89]), unsatisfactory parental separation (RR [95%CI] = 0.56 [0.35–0.87]), and rescue analgesia (RR [95%CI] = 0.52 [0.35–0.77]) than patients in the MDZ group. However, both groups had a similar incidence of unsatisfactory mask acceptance, emergence agitation, and postoperative nausea and vomiting. Conclusion Compared with MDZ, DEX is beneficial in paediatric anaesthesia with sevoflurane because of its lower incidence of unsatisfactory sedation, parental separation, and rescue analgesia.
Macro- and microstructural alterations of the subcortical structures in episodic cluster headache
Authors: Király András , Szabó Nikoletta , Párdutz Árpád , Tóth Eszter , Tajti János , Csete Gergő , Faragó Péter , Bodnár Péter , Szok Délia , Tuka Bernadett , Pálinkás Éva , Ertsey Csaba , Vécsei László , Kincses Zsigmond Tamás 
Published: April 2017

Background Previous functional and structural imaging studies have revealed that subcortical structures play a key a role in pain processing. The recurring painful episodes might trigger maladaptive plasticity or alternatively degenerative processes that might be detected by MRI as changes in size or microstructure. In the current investigation, we aimed to identify the macro- and microstructural alterations of the subcortical structures in episodic cluster headache. Methods High-resolution T1-weighted and diffusion-weighted MRI images with 60 gradient directions were acquired from 22 patients with cluster headache and 94 healthy controls. Surface-based segmentation analysis was used to measure the volume of the subcortical nuclei, and mean diffusion parameters (fractional anisotropy, mean, radial and axial diffusivity) were determined for these structures. In order to understand whether the size and diffusion parameters could be investigated in a headache lateralised manner, first the asymmetry of the size and diffusion parameters of the subcortical structures was analysed. Volumes and diffusion parameters were compared between groups and correlated with the cumulative number of headache days. To account for the different size of the patient and control group, a bootstrap approach was used to investigate the stability of the findings. Results A significant lateralisation of the size (caudate, putamen and thalamus) and the diffusion parameters of the subcortical structures were found in normal controls. In cluster headache patients, the mean fractional anisotropy of the right amygdalae, the mean axial and mean diffusivity of the right caudate nucleus and the radial diffusivity of the right pallidum were higher. The mean anisotropy of the right pallidum was lower in patients. Conclusion The analysis of the pathology in the subcortical structures in episodic cluster headache reveals important features of the disease, which might allow a deeper insight into the pathomechanism of the pain processing in this headache condition.