bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimally Invasive Septal Myectomy for the Treatment of Hypertrophic Obstructive Cardiomyopathy and Intrinsic Mitral Valve Disease
Authors: Gilmanov Daniyar Sh. , Bevilacqua Stefano , Solinas Marco , Ferrarini Matteo , Kallushi Enkel , Santarelli Philippo , Farneti Pier Andrea , Glauber Mattia 
Published: March 2015

Objective Transaortic left ventricular septal myectomy described by Morrow is a classical procedure for the treatment of systolic anterior motion of the mitral apparatus associated with hypertrophic obstructive cardiomyopathy (HOCM). We aimed to review our results of transmitral septal myectomy and mitral valve repair/replacement in patients with intrinsic mitral valve disease associated with HOCM, operated on through a minimally invasive approach. Methods Between 2005 and 2014, 19 patients [7 men (37%); mean (SD) age, 69.4 (14.5) years] were treated with minimally invasive approach for degenerative mitral regurgitation and HOCM. Preoperative peak left ventricular outflow tract (LVOT) gradient was 66 (24) mm Hg. Severe mitral regurgitation was diagnosed in 16 cases (84%). New York Heart Association functional class III to IV heart failure was present in 13 patients (68%). Results Fifteen patients (79%) underwent mitral valve replacement, and four patients (21%) underwent mitral valve repair. Left ventricular outflow tract obstruction was corrected directly in all patients via the mitral valve with septal myectomy/myotomy, avoiding aortotomy in majority of the patients. No significant prolongation of extracorporeal circulation/aortic cross-clamping times was observed ( P = 0.41 and P = 0.67, respectively) when compared with a similar population without HOCM. No iatrogenic ventricular septal defect developed in treated patients. No hospital mortality occurred. Resting LVOT gradient reduced at discharge to 13 (22) mm Hg ( P = 0.025). Conclusions Transmitral left ventricular septal myectomy in patients with degenerative mitral valve disease is quite a simple, feasible, and effective technique and does not require aortotomy in most cases. It can be performed with low early mortality and satisfactory resolution of LVOT obstruction in a minimally invasive setting.
Long-term Patency of Endoscopically Harvested Radial Arteries: From a Randomized Controlled Trial
Authors: Burns Daniel J.P. , Swinamer Stuart A. , Fox Stephanie A. , Romsa Jonathan , Vezina William , Akincioglu Cigdem , Warrington James , Guo Lin-Rui , Chu Michael W.A. , Quantz Mackenzie A. , Novick Richard J. , Kiaii Bob 
Published: March 2015

Objective From 2005 to 2007, 119 patients were enrolled in a prospective randomized controlled trial comparing open and endoscopically harvested radial arteries for coronary artery bypass grafting. The objective of the current study was to compare graft patency between intervention groups at more than 5 years from the initial trial. We hypothesized that endoscopically harvested radial arteries would show equivalent patency to those conventionally harvested. Methods At 5 years or greater from their operation, all consenting patients underwent a single-day anatomic and functional cardiac assessment with coronary computed tomography angiography and sestamibi myocardial perfusion scanning. Medical Outcomes Study 36-Item Short-Form Health Surveys and Seattle Angina Questionnaires were completed to assess the overall quality of life. All patients had received calcium channel blocker therapy for at least 6 months postoperatively. Results The mean (SD) duration of follow-up was 79.2 (8.6) months for all patients. One death occurred within 30 days of coronary artery bypass grafting in each treatment group, and eight additional noncardiac deaths occurred during the study time frame. Of 119 patients, 66 consented to follow-up. Thirty-two had open radial artery harvest, and 34 had endoscopic radial artery harvest. At more than 5 years, there were 28 patent conventionally harvested radial arteries (87.5%) and 31 patent endoscopically harvested radial arteries (91.2%) ( P = 0.705). Measured quality of life was comparable between groups. Conclusions Endoscopic radial artery harvest is safe and effective when compared with open radial artery harvest, with excellent graft patency demonstrated at more than 5 years. Patency results are noninferior in endoscopic radial artery harvest.
Does Paravertebral Blockade Facilitate Immediate Extubation after Totally Endoscopic Robotic Mitral Valve Repair Surgery?
Authors: Neuburger Peter J. , Chacon M. Megan , Luria Brent J. , Manrique-Espinel Ana Maria , Ngai Jennie Y. , Grossi Eugene A. , Loulmet Didier F. 
Published: March 2015

Objective Immediate extubation of select patients in the operating room after cardiac surgery has been shown to be safe and may result in improved hemodynamics and decreased cost perioperatively. The aim of this study was to evaluate whether the addition of paravertebral blockade (PVB) to general anesthesia facilitates extubation in the operating room in patients undergoing totally endoscopic robotic mitral valve repair (TERMR). Methods A review of 65 consecutive patients who underwent TERMR between January 2012 and June 2013 at a single institution was conducted. Patients were divided into two groups, one group that received PVB and general anesthesia and a second group that received general anesthesia alone. The data analyzed included quantities of anesthetic administered during surgery and the location of extubation after surgery. Results A total of 34 patients received PVB and general anesthesia, whereas 31 received general anesthesia alone. The two groups had similar demographic and surgical data. Patients in the PVB and general anesthesia group were more likely to be extubated in the operating room (67.6%, n = 23 vs 41.9%, n = 13, P = 0.048) and required less intraoperative fentanyl (3.41 μg/kg vs 4.90 μg/kg, P = 0.006). There were no adverse perioperative events in either group related to PVB or extubation. Conclusions The addition of PVB to general anesthesia for perioperative pain control facilitated extubation in the operating room in patients undergoing TERMR. Paravertebral blockade allowed for lower intraoperative fentanyl dosing, which may account for the increased incidence of immediate extubation. A detailed prospective study is warranted.
Impacts of Intraoperative Flow on Graft Patency of Sequential and Individual Saphenous Vein Grafts
Authors: Takazawa Akitoshi , Nakajima Hiroyuki , Iguchi Atsushi , Tabata Mimiko , Morita Kozo , Koike Hiroyuki , Uwabe Kazuhiko , Asakura Toshihisa , Niinami Hiroshi 
Published: March 2015

Objective We sought to delineate the predictor of saphenous vein graft (SVG) failure and to evaluate the impact of sequential grafting of SVG on graft flow as the significant predictor of patency. Methods Angiograms and clinical records of 439 patients who underwent coronary artery bypass grafting with aortocoronary SVG were reviewed. Of these, 708 distal anastomoses were created by 480 SVGs. Of 349 patients who underwent isolated coronary artery bypass grafting, operation was performed with an off-pump technique in 347 patients (99%). For 90 patients, a combined procedure on cardiopulmonary bypass was performed. A postoperative angiography was performed in 230 SVGs for clinical reasons. Insufficient flow (IF) was defined as a graft flow of 20 mL/min or less, measured by transit-time Doppler flowmetry during operation. Results In 480 SVGs, 44 (9.2%) presented IF, and 24 SVGs presented partial or total occlusion. Six of the nine failed individual SVG had IF, whereas none of the failed sequential SVG was associated with IF. Univariate and multivariate logistic regression analyses demonstrated that IF ( P = 0.002; odds ratio, 6.63) and sequential grafting ( P = 0.004; odds ratio, 2.51) were significantly correlated with a failure of the SVG. The patency rate of sequential SVG to the most distal target was 78/93 (83.9%), which was significantly lower than 9/139 (93.5%) of the individual SVG ( P = 0.02) and 7/113 (93.8%) of the sequential SVG to proximal targets ( P = 0.02). Conclusions When both targets seem to have sufficient demand, avoidance of sequential grafting would be reasonable. Moreover, the important target should be grafted by individual grafting or sequential proximal anastomosis.
Exposure to Gastric Acid–Suppression Therapy Is Associated With Health Care– and Community‐Associated Clostridium difficile Infection in Children
Authors: Jimenez Jennifer , Drees Marci , Loveridge‐Lenza Beth , Eppes Stephen , del Rosario Fernando 
Published: March 2015

ABSTRACTObjective:The aim of the study was to determine whether gastric acid–suppression therapy is associated with Clostridium difficile infection (CDI) in both inpatient and outpatient pediatric populations.Methods:We conducted a retrospective case‐control study at a 200‐bed academic pediatric hospital and associated outpatient clinics during 2005–2010. We defined cases as children 1 to 18 years of age with a first positive test for C difficile toxin A/B, and matched each case to 2 controls without C difficile. We conducted chart review to elicit selected comorbidities and exposure to gastric acid–suppression therapy and antibiotics in the preceding 3 months of the infection or encounter date. We used bivariate and multivariable logistic regression to evaluate the association between antacid use and CDI, controlling for potential confounders.Results:We identified 138 children with health care– or community‐associated CDIs and 276 controls. The use of any acid suppression therapy was more common in cases compared with controls (34% vs 20%, P = 0.002). When adjusted for demographic variables and comorbidities, gastric acid–suppression therapy remained significantly associated with CDI (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI] 1.0–3.1). Antibiotic use (aOR 1.7, 95% CI 1.1–2.7) and immunosuppressed state were also associated with CDI in our adjusted model (aOR 2.5, 95% CI 1.2–5.2).Conclusions:Gastric acid–suppression therapy was associated with both health care– and community‐associated CDIs in children. Larger pediatric studies are necessary to determine the role of proton pump inhibitors specifically in causing CDI in children.
Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana
Authors: Acheampong Franklin , Tetteh Ashalley Raymond , Anto Berko Panyin 
Published: March 2015

Objectives
This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana.

Methods
This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients’ medication charts, and identified errors were clarified with staff for possible causes.

Results
Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding “lack of drug availability” fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems.

Conclusions
This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.
The Safety Stand-down: A Technique for Improving and Sustaining Hand Hygiene Compliance Among Health Care Personnel
Authors: Cunningham Dennis , Brilli Richard J. , McClead Richard E. , Davis J. Terrance 
Published: March 2015

Objectives
Hand hygiene (HH) is critical to prevent health care–acquired infections. However, compliance by health care workers remains between 30% and 70% at most institutions. Most efforts to improve compliance have proven ineffective. The objective of this study was to determine whether a safety stand-down can improve HH compliance.

Methods
We adapted and borrowed from the military an approach known as a stand-down. A mandatory Hand-Hygiene Leadership Safety Summit was called for all hospital leaders—physicians and nonphysicians. Four days later, a hospital-wide 15-minute–long safety stand-down occurred, during which all nonessential activity was suspended and action plans to improve HH compliance were discussed. All medical sections and hospital departments were required to submit written action plans. After the stand-down, HH compliance monitoring was increased, and noncompliers were required to speak to senior hospital administration.

Results
Compliance increased from less than 65% to greater than 95% (P < 0.001) and has been sustained for 3½ years.

Conclusions
A health care safety stand-down can be an effective method to rapidly change and sustain culture change regarding HH in the inpatient hospital setting.
The unusual gene order in the Echinoderm Hox cluster is related to the embryo and larva symmetries
Authors: Papageorgiou Spyros 
Published: March 2015

AbstractBackgroundHox gene collinearity relates the sequential location of Hox genes in the 3’ to 5’ direction on the chromosome with the linear arrangement of the body elements along the anterior-posterior (A/P) axis of bilaterian embryos. This spatial Hox gene collinearity has been almost universally respected in diverse organisms like worms, insects or vertebrates. It is therefore surprising that the above well established collinearity rule is violated in the case of Echinoderms. No explanation of this violation is apparent. Here a hypothesis is put forward which provides a cue to understand the abnormal serial gene location in the sea urchin disorganized Hox cluster.ResultsBilateral symmetry along the A/P embryo axis is established at the very early stages of ontogeny of the sea urchin. For the subsequent developmental stages, rotational symmetry emerges in the vestibula larva. In analogy to the linear A/P case, the circular topology of modules might be a reflection of the architectural restructuring of the Hox loci where the 3’ and 5’ ends of the Hox cluster approach each other so that a closed contour of the chromatin fiber is formed. At a later stage, the break and opening of the cluster contour at the level of Hox4 combined with the rotational symmetry leads to the observed Hox gene sequence that violates the standard 3’ to 5’ collinearity.ConclusionThe unusual gene series manifests the congruence of Hox gene sequence in the cluster with the circular arrangement of the sea urchin primary podia. Accordingly, the Hox sequence after the break at Hox4 is not a violation but an extension of Hox gene collinearity to animals with rotational symmetry.
Antimicrobial resistance and stewardship
Authors: Birnbaum David 
Published: March 2015

Purpose
– The purpose of this paper is to report on recent developments concerning promotion of initiatives to contain the spread of resistance to antimicrobial drugs.

Design/methodology/approach
– Narrative review.

Findings
– In 2014, an American executive order made combating antimicrobial resistance a national priority. While this and other developments convey a message of growing urgency, the core elements required and challenges ahead are neither new nor unexplored. The quantity and quality of antimicrobial stewardship research over the past decade has added little to what already was known. Suppressing evolution of emerging drug resistance and containing emergence of resistant strains as on-going activities to maintain a balance might be a more realistic statement of the problem than framing it as winning a war. It remains to be seen how well those in the front lines of healthcare epidemiology and infection control shape framing of this problem before American federal and state agencies respond to their presidential directive by relaying marching orders through laws, rules, regulations, financial incentives and penalties. It remains to be seen whether the next decade will be more successful than the last given a more recent emphasis on the strategy of bundling small sets of practical key measures into effect, and the involvement of public health departments in support of antimicrobial stewardship. Unlike a generation ago, it also is clear that international trade and travel make this a global problem. America cannot be expected to resolve emerging drug resistance alone even if containment efforts within its own borders are successful, but like other developed countries it can be expected to have vested self-interests in promoting global solutions to this complex problem.

Originality/value
– This report brings together recent American government policy decisions and insights from two noteworthy interdisciplinary conferences.
Clinical governance: an assessment of New Zealand’s approach and performance
Authors: Gauld Robin , Horsburgh Simon 
Published: March 2015

Purpose
– Clinical governance policy initiatives have been introduced in many countries and health systems. How to assess development is an important question. The purpose of this paper is to describe and reflect upon the approach taken in New Zealand.

Design/methodology/approach
– New Zealand’s clinical governance policy of 2009 and its implementation through its public health care system are outlined. The authors’ assessments, in 2010 and 2012, of this policy are described and key findings summarised.

Findings
– The implementation of the policy was swift, with considerable commitment across the public health care system to this. The quantitative assessments found reasonable developmental progress between 2010 and 2012. Case studies undertaken in 2012 indicated various areas that policy makers should attend to or build upon in order to better support clinical governance development.

Research limitations/implications
– Key lessons from New Zealand’s clinical governance experience, based on the assessments, include the need for: a well-defined definition of clinical governance; resource materials that can be used by those involved in clinical governance development; recognition that clinical governance development is complicated and takes time; and commitment to new leadership and organisational arrangements.

Originality/value
– This paper provides useful lessons for policy makers pursuing clinical governance development, derived from two rounds of assessment in New Zealand.
CGIJreview
Authors: MacVane Phipps Fiona 
Published: March 2015

Purpose– The purpose of this paper is to provide an overview of the content of the current issue ofCGIJ.Design/methodology/approach– The review is prepared by the review editor to highlight key points within each paper.Findings– Enables readers to scan content and select articles of most interest or relevance to their needs.Originality/value–CGIJis the only Emerald health journal providing this service to its readers.
Breaking the circle of blame for sustainable buildings – evidence from Nordic countries
Authors: Andelin Mia , Sarasoja Anna-Liisa , Ventovuori Tomi , Junnila Seppo 
Published: March 2015

Purpose– The study aims to examine how the vicious circle of blame for sustainable buildings can be turned into virtuous loops of adaptation when considering sustainable buildings and what are the drivers for tenants and investors regarding sustainable buildings and gaining insights of investors’ and tenants’ corporate responsibility (CR) actions.Design/methodology/approach– The paper consists of a literature review and two surveys. The literature review concentrates on exploring investors’ and tenants’ CR and sustainability drivers. Empirical evidence was gathered via two specific surveys. The first survey targeted investors, and the second survey targeted tenants to determine the focus areas of sustainability.Findings– The findings of this study indicate that the vicious circle of blame can be turned into one of cooperation with respect to sustainable buildings if the mutual drivers for improving sustainability are linked with investor–tenant collaboration. Based on the survey, the tenants claim that productivity, corporate culture and image are the primary drivers for sustainable buildings, whereas the investors claim that corporate culture and image, tenant demand and marketability are the primary drivers. Both parties mentioned the same sustainability drivers: corporate culture and image and lower operating costs. However, it was found that investors are not communicating their CR actions to public or promoting image and productivity benefits of green buildings to potential tenants.Research limitations/implications– The limitation of this study is the sampling of Nordic countries, as there are indications of different situation in other markets such as the USA.Originality/value– Improving sustainability in the real estate industry is linked to investor–tenant collaboration. In addition to common drivers, both investors and tenants have their own list of benefits and drivers for sustainable buildings. These drivers are linked to each other. Making progress with respect to sustainability in the built environment depends on people in the industry being aware of the importance of and possibilities offered by sustainable buildings, as well as being able and willing to act on this knowledge. Only through partnership can the full potential of the built environment be realised and help deliver an economically, environmentally and socially sustainable future.
An investigation into how corporate real estate in the financial services industry can add value through alignment and methods of performance measurement
Authors: Langford Luke , Haynes Barry 
Published: March 2015

Purpose– The purpose of this study is to evaluate corporate real estate (CRE) performance measurement and how value can be added to the core business.Design/methodology/approach– An analysis is made of the appropriate literature and primary research conducted via interviews with 11 senior professionals from three globally renowned companies, one global financial organisation and two corporate advisory firms.Findings– The findings from this research provide evidence that CRE can be used to add value to the core business, both in the physical and behavioural environment. By aligning aims and objectives with the business, continually conducting portfolio analytics, encompassing size, cost, space, retention and productivity, value can be added, maximising shareholder worth.Research limitations/implications– The main conclusions drawn from this study are that CRE can add value to the business. The role of corporate real estate asset managers (CREAMs) needs to change from the physical environment to the behavioural environment, working to increase productivity, which can have greatest impact on shareholder value.Originality/value– This paper provides evidence to suggest that CRE ’s role is not only to manage property but should be broadened to add value to the organisation by aligning CRE strategy with the corporate strategy. Closer interactions with human resource and information technology are required to enhance productivity, via relationship management, perhaps outsourcing to provide best in industry expertise. CREAMs can shape the future of office space, by demanding carbon neutral properties. This paper recommends that further research should be conducted on the measurement of intangibles, like productivity and corporate social responsibility, and how they can be used to add value and sustainable saves.