bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving antimicrobial prescribing practice for sore throat symptoms in a general practice setting
Authors: Razai Mohammad , Hussain Kamal 
Published: April 2017

Acute sore throat is a common presentation in primary care settings. We aimed to improve our compliance with national antibiotic guidelines for sore throat symptoms to 90% in 3 months' time period. The national guidelines are based on Centor criteria. A retrospective audit of 102 patient records with sore throat symptoms presenting between 1 January to 30 December 2015 showed that over 50% were given antibiotics. Those who were prescribed antibiotics, 27% did not meet NICE criteria and 85% of patients were given immediate antibiotic prescription. Centor criteria was documented in just 2% of cases. Compliance with correct antibiotic course length was 15%. Antibiotic choice and dose was correct in 94% and 92% of cases respectively. Antibiotic frequency was correctly prescribed in 100% of patients.We introduced interventions that included oral and poster presentations to multidisciplinary team, dissemination of guidelines through internal e-mail and systemic changes to GP electronic patient record system EMIS. This involved creating an automated sore throat template and information page. On re-auditing of 71 patients, after two PDSA cycles, compliance with NICE criteria was 87% with a significant reduction in immediate prescribing (66%). Centor criteria documentation was 42%. Correct antibiotic course length was prescribed in over 30% of cases. Other antibiotic regimen parameters (choice, dose and frequency) were correct in 100% of cases.The initial results demonstrated that significant changes were needed. In particular, reducing the amount of antibiotics prescribed by increasing compliance with NICE criteria and ensuring all parameters of antibiotic prescription were correct. We showed that significant sustainable improvement is achievable through carefully devised automated systemic changes that provides critical information in readily accessible format, and does not solely rely on prescribers' knowledge and initiative. The outcome of these interventions are a decrease in immediate antibiotic prescription, significant increase in Centor criteria documentation and an increase in compliance with the correct course length of antibiotics. All these measures would contribute to reduction in antimicrobial resistance and improvement in patient care in the community. Future work must focus on improving compliance with correct antibiotic course length.
Reducing returns to theatre for neck of femur fracture patients
Authors: Graham Selina , Dahill Mark , Robinson Derek 
Published: April 2017

The Royal United Hospital, Bath, admits approximately 550 patients with neck of femur fractures per year. The risks from returning to theatre for this patient group are often life-threatening. Post-operative wound ooze was noted to cause a significant rate of return to theatre, with increased lengths of stay and patient morbidity.A wound closure protocol was agreed by the consultant body. This information was disseminated by email and teaching sessions to all members of the multidisciplinary team, including surgeons, theatre staff and ortho-geriatricians. The plan-do-study-act model for improvement was used to reduce rates of returns to theatre for wound ooze. Interventions included cyclical teaching during each trainee rotation, updated inductions, posters, email reminders and scrub team involvement to open the protocol sutures unprompted.The primary outcome measure was returns to theatre for wound complications. Baseline data showed 4 returns to theatre over a two month period (4.40% of patients). Length of stay for each patient affected by wound ooze was also compared to the departmental mean. In the 6 month intervention period there was one return to theatre (0.36% of patients). The observed reduction saved the department an estimated £13,831 in length of stay alone.The standardisation of wound closure protocol, with continued reinforcement to all members of the multidisciplinary team, improves patient outcome in this group. Mobilising a group of clinicians across a variety of specialities, with one common goal, is highly effective for patients, improves multidisciplinary working and reduces cost.
Left atrial strain predicts recurrence of atrial arrhythmias after catheter ablation of persistent atrial fibrillation
Authors: Parwani Abdul Shokor , Morris Daniel-Armando , Blaschke Florian , Huemer Martin , Pieske Burkert , Haverkamp Wilhelm , Boldt Leif-Hendrik 
Published: April 2017

IntroductionSuccess rates of catheter ablation (CA) of persistent atrial fibrillation (AF) are very variable. Identifying patients in whom sinus rhythm maintenance cannot be achieved after CA is a critical issue.Methods2D speckle-tracking echocardiography was performed before the first CA procedure in consecutive patients with persistent AF. Left atrial (LA) strain was correlated with recurrence of atrial arrhythmias during the follow-up period of 15 months after one CA procedure with or without antiarrhythmic drugs (primary endpoint). In a secondary analysis, recurrences after two CA procedures were analysed.Results102 patients were included. Patients with recurrence of atrial arrhythmias after one CA procedure (n=55) had significantly lower LA strain than those without recurrence (LA strain 9.7±2.4% vs 16.2±3.0%; p<0.001). Recurrence rate was significantly higher in patients with LA strain <10% than in those with LA strain between 10% and 14.5% and >14.5% (97.7%, 42.1% and 10.3%, respectively; p<0.001). In Cox regression analysis including age, comorbidities, left ventricular dysfunction and LA enlargement, low LA strain (<10%) was the strongest factor associated with recurrence of AF (HR 6.4 (2.4–16.9), p<0.001). Even after inclusion of a second CA procedure, LA strain <10% maintained a high predictive value for recurrence of atrial arrhythmias (86.4% (95% CI 73.3% to 93.6%)).ConclusionIn patients with persistent AF, LA strain imaging could be very useful to select those patients who have a high risk of not benefiting from CA.
Liver stiffness assessed by Fibrosis-4 index predicts mortality in patients with heart failure
Authors: Sato Yu , Yoshihisa Akiomi , Kanno Yuki , Watanabe Shunsuke , Yokokawa Tetsuro , Abe Satoshi , Misaka Tomofumi , Sato Takamasa , Suzuki Satoshi , Oikawa Masayoshi , Kobayashi Atsushi , Yamaki Takayoshi , Kunii Hiroyuki , Nakazato Kazuhiko , Saitoh Shu-ichi , Takeishi Yasuchika 
Published: April 2017

ObjectiveLiver dysfunction due to heart failure (HF) is known as congestive hepatopathy. It has recently been reported that liver stiffness assessed by transient elastography reflects increased central venous pressure. The Fibrosis-4 (FIB4) index (age (years) × aspartate aminotransferase (IU/L)/platelet count (109/L) × square root of alanine aminotransferase (IU/L)) is expected to be useful for evaluating liver stiffness in patients with non-alcoholic fatty liver disease. We aimed to investigate the impact of the FIB4 index on HF prognosis, with consideration for liver fibrosis markers and underlying cardiac function.MethodsConsecutive 1058 patients with HF who were admitted to our hospital were divided into three groups based on their FIB4 index: first (FIB4 index <1.72, n=353), second (1.72≤FIB4 index <3.01, n=353) and third tertiles (3.01≤FIB4 index, n=352). We prospectively followed for all-cause mortality.ResultsDuring the follow-up period (mean 1047 days), 246 deaths occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from the first to third groups (12.2%, 21.0% and 36.6%, p<0.01). In the Cox proportional hazard analysis, FIB4 index was an independent predictor of all-cause mortality in patients with HF (p<0.05). In comparisons of laboratory and echocardiographic findings, the third tertile had higher levels of type IV collagen 7S, procollagen type III peptide, hyaluronic acid, left atrial volume, mitral valve E/e’, inferior vena cava diameter and right atrial end systolic area (p<0.01, respectively).ConclusionThe FIB4 index, a marker of liver stiffness, is associated with higher all-cause mortality in patients with HF.
Association of HLA-DQB1 polymorphisms with rheumatoid arthritis: a meta-analysis
Authors: Wu Jun , Li Jun , Li Si , Zhang Tian-Ping , Li Lian-Ju , Lv Tian-Tian , Pan Hai-Feng , Ye Dong-Qing 
Published: April 2017

ABSTRACTAimStudies investigating the association between HLA-DQB1 alleles and rheumatoid arthritis (RA) have reported conflicting results. The purpose of this study was to evaluate whether DQB1 alleles confer susceptibility to RA.DesignA comprehensive literature search up to May 2016 was conducted to identify case-control studies on the association of HLA-DQB1 alleles with RA. Pooled ORs with 95% CIs were used to assess the strength of association.SettingThe literature indicates that HLA-DQB1 is associated with susceptibility to RA.Main outcome measuresFrequencies of HLA-DQB1 alleles and phenotype in RA patients and healthy controls.ResultsFifteen studies with 1250 cases and 1621 controls were included in this meta-analysis. DQB1 alleles were associated with RA susceptibility. The frequencies of DQB1*06 were lower in RA (p-value for comparability=0.007, OR 0.726,95% CI 0.576 to 0.916; p=0.004, OR 0.611,95% CI 0.438 to 0.852). The frequencies of DQB1*02 were lower in RA (p=0.044, OR 0.731,95% CI 0.597 to 0.895). A higher frequency of DQB1*04 was observed in RA (p=0.023, OR 1.604,95% CI 1.067 to 2.410).ConclusionsThis meta-analysis demonstrates that DQB1*02 and DQB1*06 may be negatively associated with RA. Conversely, DQB1*04 may confer susceptibility to RA.
A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry
Authors: Alsaad Ali A , Alman Carly R , Thompson Kristine M , Park Shin H , Monteau Rebecca E , Maniaci Michael J 
Published: April 2017

ABSTRACTBackgroundAlarm fatigue (AF) is a distressing factor for staff and patients in the hospital. Using cardiac telemetry (CT) without clinical indications can create unnecessary alarms, and increase AF and cost of healthcare. We sought to reduce AF and cost associated with CT monitoring.MethodsAfter implementing a new protocol for CT placement, data were collected on telemetry orders, alarms and bed cost for 13 weeks from 1 January 2015 through 31 March 2015. We also retrospectively collected data on the same variables for the 13 weeks prior to the intervention. A survey was administered to nurses to assess past and present perceptions of AF. Interventions included protocol creation and education for participants.ResultsAt baseline, 77% of patients were monitored with CT. A total of 145 (31%) order discrepancies were discovered during data collection, of which 72% had no indication for CT, so CT was discontinued. The other 28% had indications, so orders were placed. A total of 8336 alarms were recorded during 4 weeks of data collection, of which 333 (4%) were classified as true actionable alarms. Postintervention data showed 67% CT assignment with 10% reduction in CT usage, with no increase in mortality (p&lt;0.001 and &gt;0.05, respectively). A 42% cost reduction was achieved after adjusting the patient status. Nurses reported 27% perceived reduction in AF. One-year follow-up revealed that 69% of patients were being monitored by CT, and the rate of order discrepancies due to lack of indication was 9%.ConclusionAll hospital units may benefit from the protocols created during this study. If applied appropriately, these protocols can lead to reduced AF and cost per episode of care.
Designing for Transformative Play
Authors: Back Jon , Segura Elena Márquez , Waern Annika 
Published: April 2017

Numerous studies have foregrounded how play is only partially shaped by the artifacts that their designers design. The play activity can change the structures framing it, turning players into co-designers through the mere act of playing.
This article contributes to our understanding of how we can design for play taking into account that play has this transformative power. We describe four ways that players can engage with framing structures, which we classify in terms of whether players conform to explore, transgress, or (re)create them. Through the examples of three case studies, we illustrate how this model has been useful in design: as an analytical tool for deconstructing player behavior, to articulate design goals and support specific design choices, and for shaping the design process.
Gas6 Promotes Inflammatory (CCR2
hi
CX3CR1
lo
) Monocyte Recruitment in Venous Thrombosis
Authors: Laurance Sandrine , Bertin François-René , Ebrahimian Talin , Kassim Yusra , Rys Ryan N. , Lehoux Stéphanie , Lemarié Catherine A. , Blostein Mark D. 
Published: April 2017

Objective—
Coagulation and inflammation are inter-related. Gas6 (growth arrest–specific 6) promotes venous thrombosis and participates to inflammation through endothelial-innate immune cell interactions. Innate immune cells can provide the initiating stimulus for venous thrombus development. We hypothesize that Gas6 promotes monocyte recruitment during venous thrombosis.

Approach and Results—

Deep venous thrombosis was induced in wild-type and Gas6-deficient (−/−) mice using 5% FeCl
3
and flow reduction in the inferior vena cava. Total monocyte depletion was achieved by injection of clodronate before deep venous thrombosis. Inflammatory monocytes were depleted using an anti–C-C chemokine receptor type 2 (CCR2) antibody. Similarly, injection of an anti–chemokine ligand 2 (CCL2) antibody induced CCL2 depletion. Flow cytometry and immunofluorescence were used to characterize the monocytes recruited to the thrombus. In vivo, absence of Gas6 was associated with a reduction of monocyte recruitment in both deep venous thrombosis models. Global monocyte depletion by clodronate leads to smaller thrombi in wild-type mice. Compared with wild type, the thrombi from Gas6
−/−
mice contain less inflammatory (CCR2
hi
CX
3
CR1
lo
) monocytes, consistent with a Gas6-dependent recruitment of this monocyte subset. Correspondingly, selective depletion of CCR2
hi
CX
3
CR1
lo
monocytes reduced the formation of venous thrombi in wild-type mice demonstrating a predominant role of the inflammatory monocytes in thrombosis. In vitro, the expression of both CCR2 and CCL2 were Gas6 dependent in monocytes and endothelial cells, respectively, impacting monocyte migration. Moreover, Gas6-dependent CCL2 expression and monocyte migration were mediated via JNK (c-Jun N-terminal kinase).

Conclusions—

This study demonstrates that Gas6 specifically promotes the recruitment of inflammatory CCR2
hi
CX
3
CR1
lo
monocytes through the regulation of both CCR2 and CCL2 during deep venous thrombosis.
True Anemia―Red Blood Cell Volume Deficit―in Heart Failure
Authors: Montero David , Lundby Carsten , Ruschitzka Frank , Flammer Andreas J. 
Published: April 2017

Background—
Anemia in heart failure (HF) is commonly diagnosed according to hemoglobin concentration [Hb], hence may be the result of hemodilution or true red blood cell volume (RBCV) deficit. Whether true (nonhemodilutional) anemia in HF can or cannot be generally inferred by [Hb] measurements and clinical correlates remains unclear. The purpose of this study was to systematically review the literature and investigate the status and correlates of RBCV in patients with HF.

Methods and Results—

MEDLINE, Scopus, and Web of Science were searched since their inceptions until April 2016 for articles directly reporting or allowing the calculation of intravascular volumes (RBCV, plasma volume) in patients with HF according to the International Council for Standardization in Hematology. Eighteen studies were included after systematic review, comprising a total of 368 patients with HF (limits for mean age=49–80 years, sex=0%–92% females, left ventricular ejection fraction=26%–61%). Mean RBCV was reduced (limits=67%–88% of normal) in all studies including HF patients with anemia (low [Hb]) (7 studies, n=127), whereas only 2 of 10 studies in nonanemic patients with HF presented lower than normal mean RBCV (90% and 96%). In metaregression analyses, RBCV was positively associated with [Hb] (
B
=6.10, SE=1.44) and negatively associated with age (
B
=−1.14, SE=0.23), % females (
B
=−0.38, SE=0.04), left ventricular ejection fraction (
B
=−0.81, SE=0.20), and body mass index (
B
=−3.55, SE=0.46;
P
<0.001).

Conclusions—
Presence or absence of true anemia in patients with HF as determined by RBCV status mainly concurs with diagnosis based on [Hb] and presents negative relationships with age, female sex, left ventricular ejection fraction, and body mass index.
Bilirubin Decreases Macrophage Cholesterol Efflux and ATP‐Binding Cassette Transporter A1 Protein Expression
Authors: Wang Dongdong , Tosevska Anela , Heiß Elke H. , Ladurner Angela , Mölzer Christine , Wallner Marlies , Bulmer Andrew , Wagner Karl‐Heinz , Dirsch Verena M. , Atanasov Atanas G. 
Published: April 2017

Background
Mild but chronically elevated circulating unconjugated bilirubin is associated with reduced total and low‐density lipoprotein cholesterol concentration, which is associated with reduced cardiovascular disease risk. We aimed to investigate whether unconjugated bilirubin influences macrophage cholesterol efflux, as a potential mechanism for the altered circulating lipoprotein concentrations observed in hyperbilirubinemic individuals.

Methods and Results

Cholesterol efflux from
THP
‐1 macrophages was assessed using plasma obtained from normo‐ and hyperbilirubinemic (Gilbert syndrome) humans (n=60 per group) or (heterozygote/homozygote Gunn) rats (n=20 per group) as an acceptor. Hyperbilirubinemic plasma from patients with Gilbert syndrome and Gunn rats induced significantly reduced cholesterol efflux compared with normobilirubinemic plasma. Unconjugated bilirubin (3–17.1 μmol/L) exogenously added to plasma‐ or apolipoprotein A1–supplemented media also decreased macrophage cholesterol efflux in a concentration‐ and time‐dependent manner. We also showed reduced protein expression of the
ATP
‐binding cassette transporter A1 (
ABCA
1), a transmembrane cholesterol transporter involved in apolipoprotein A1–mediated cholesterol efflux, in
THP
‐1 macrophages treated with unconjugated bilirubin and in peripheral blood mononuclear cells obtained from hyperbilirubinemic individuals. Furthermore, we demonstrated that bilirubin accelerates the degradation rate of the
ABCA
1 protein in
THP
‐1 macrophages.

Conclusions

Cholesterol efflux from
THP
‐1 macrophages is decreased in the presence of plasma obtained from humans and rats with mild hyperbilirubinemia. A direct effect of unconjugated bilirubin on cholesterol efflux was demonstrated and is associated with decreased
ABCA
1 protein expression. These data improve our knowledge concerning bilirubin's impact on cholesterol transport and represent an important advancement in our understanding of bilirubin's role in cardiovascular disease.
CHA
2
DS
2
-VASc Score (Congestive Heart Failure, Hypertension, Age ≥75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65–74, Female) for Stroke in Asian Patients With Atrial Fibrillation
Authors: Kim Tae-Hoon , Yang Pil-Sung , Uhm Jae-Sun , Kim Jong-Youn , Pak Hui-Nam , Lee Moon-Hyoung , Joung Boyoung , Lip Gregory Y.H. 
Published: April 2017

Background and Purpose—

The CHA
2
DS
2
-VASc stroke score (congestive heart failure, hypertension, age ≥75 (doubled), diabetes mellitus, prior stroke or transient ischemic attack (doubled), vascular disease, age 65–74, female) is used in most guidelines for risk stratification in atrial fibrillation (AF), but most data for this score have been derived in Western populations. Ethnic differences in stroke risk may be present. Our objective was to investigate risk factors for stroke in AF and application of the CHA
2
DS
2
-VASc score in an Asian AF population from Korea.

Methods—
A total of 5855 oral anticoagulant–naive nonvalvular AF patients aged ≥20 years were enrolled from Korea National Health Insurance Service Sample cohort from 2002 to 2008 and were followed up until December 2013.

Results—

The incidence rates (per 100 person-years) of ischemic stroke were 3.32 in the total population, being 0.23 in low-risk (CHA
2
DS
2
-VASc score 0 [male] or 1 [female]) and 4.59 in high-risk patients (CHA
2
DS
2
-VASc ≥2). Incidence rates of ischemic stroke or the composite thromboembolism end point showed a clear increase with increasing CHA
2
DS
2
-VASc score. On multivariable analysis, significant associations between CHA
2
DS
2
-VASc risk factors and ischemic stroke were observed; however, the significance of vascular disease or diabetes mellitus was attenuated after multivariate adjustment, and female sex (hazard ratio, 0.73; 95% confidence interval, 0.64–0.84) had a lower risk of ischemic stroke than males. Patients who were categorized as low risk consistently had an event rate <1% per year.

Conclusions—

The performance of CHA
2
DS
2
-VASc score in Asians is comparable with that in Western populations. The score shows good performance in defining the truly-low-risk AF patients for stroke/thromboembolism.
Navigating the Cultural Divide: Islam, Gender, and the Integration of Somali Immigrants
Authors: al-Huraibi Nahla 
Published: April 2017

This article explores gender notions and practices among American-Somalis in Columbus, Ohio. Theorists have disputed whether original or new culture should influence immigrants’ evolving identities. Interviews with thirty-eight immigrants revealed a more decisive third mode of discourse that seems to transcend the two cultural ends—namely, Islam. Participants invoke Islam to justify adopting new gender arrangements demanded by new circumstances. In other cases they cite Islam to legitimize severing ties with customs perceived as unsavory in the original culture.
This middle way between homogenizing assimilation and compartmentalizing pluralism is based on economic pressures and on rediscovering/rereading Islamic texts, emancipated from older interpretations. Doing so, participants distance themselves from aspects of the original culture while reframing cherished elements of the new culture as “Islamic”. For them, Islam facilitates transcultural integration, enabling hybrid identities and behavioral patterns to coexist, and creating dynamic, novel, and genuinely cross-civilizational representations of “modern” community and agency.