bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing a ward round checklist to improve patient safety
Authors: Hale Gordon , McNab Duncan 
Published: February 2015

AbstractChecklists have been shown to improve care and reduce morbidity and mortality in the healthcare setting.[1] Their application in safety-critical industries outside of medicine continues to offer a strong argument for their application to medicine.[2] The daily in-patient medical ward round is a complex process and includes multiple potential risks to patient safety. This project aims to evaluate the effectiveness of a ward round review checklist on one general medical ward in a district general hospital in the UK.A baseline audit was performed, examining case-notes for a set of pre-defined outcome measures relevant to patient safety. Compliance with documentation of each outcome measure was assessed prior to the introduction of a ward round checklist. This was followed by a quality improvement project through the use of PDSA cycles, with the aim of introducing and developing a ward round checklist over a nine month period. Following the introduction of a checklist, overall compliance with documentation of each outcome measure improved from 45% to 89%.In conclusion, a quality improvement project involving the introduction of a ward round checklist for daily use has resulted in improved documentation of outcome measures that are relevant to patient safety. Teamwork and leadership skills from clinicians committed to improving patient safety is essential to sustaining improvements in traditional ward round practice.
A novel approach to improving coagulation sample ordering in an emergency department
Authors: Murphy Emma , MacGlone Sile , McGroarty Claire 
Published: February 2015

AbstractDriven by emergency department targets, there is a need for rapid initial assessment and investigations of attendees to the department, and blood tests are often performed before full patient assessment. It has been shown that many investigations ordered in the emergency department are inappropriate. Coagulation samples are acknowledged as one the commonest blood samples requested on admission. We predicted that the majority of the routine coagulation samples performed in our ED department were unnecessary.We aimed to determine if coagulation tests sent from our department were appropriate, develop guidance for appropriate testing and to increase the percentage of appropriate tests to 90%. Criterion based audit was used. All coagulation samples sent from the ED over a one week period were reviewed and the indications for testing compared to guidance developed by consensus with ED consultants.On the first data collection, 66 of 369 (17%) samples were deemed appropriate. Feedback to clinical staff was given at educational meetings and appropriate indications discussed. In collaboration with both senior nursing and medical staff, coagulation screen request bottles were removed from the main clinical area and were only available in the resuscitation area.Following these interventions, 69 of 97 (71%) samples were deemed appropriate and a further intervention is planned to reach our standard.This improvement could lead to a £100,000 saving annually and a cross-site collaborative study is planned to spread these improvements.
Reducing avoidable time delays in immediate medication administration - learning from a failed intervention
Authors: Nagar Sachin , davey nicola 
Published: February 2015

AbstractStat medications are regularly prescribed on hospital wards as part of the ongoing care for patients. Because they are prescribed at variable times that do not coincide with regular nursing drug administration times, they rely on good communication and vigilance on staff to ensure they are administered in a timely manner. Delays in drug administration can lengthen patient recovery times, prolong admission, and can lead to avoidable patient harm and suffering.While working on a geriatrics ward I noticed that there were often significant delays in administration of stat medications which occurred on a regular basis. I therefore investigated this by collecting data over a two week period to assess the situation based on our current practice. After root cause analysis (figure 1), it became clear that communication between staff was a significant factor in delayed administration. A solution was implemented in the form of "ward bay wall charts" to aid documentation and communication of stat medication requirements between nursing and medical staff with the intention to reduce delays by improving communication.After gaining support of medical and nursing staff, a trial was undertaken and a further two weeks of data collected to see the effect of the intervention. The results showed that there was an increase in the median time delay (1 hour 34 minutes to 2 hours 26 minutes, a 55% increase in median time delay) after the implementation of the my intervention, suggesting that it actually made communication worse, creating more delays. Subsequent feedback and analysis showed that this was due to a number of factors that led to worsened communication between staff and therefore an increase in medication delays. Early recognition allowed the intervention to be promptly withdrawn and a re-assessment of the nature of the initial problem.This project highlights the importance of measurement in determining if an intervention actually works and is an improvement on current practice.
Patient handover in orthopaedics, improving safety using Information Technology
Authors: Pearkes Tim 
Published: February 2015

AbstractGood inpatient handover ensures patient safety and continuity of care. An adjunct to this is the patient list which is routinely managed by junior doctors. These lists are routinely created and managed within Microsoft Excel or Word. Following the merger of two orthopaedic departments into a single service in a new hospital, it was felt that a number of safety issues within the handover process needed to be addressed. This quality improvement project addressed these issues through the creation and implementation of a new patient database which spanned the department, allowing trouble free, safe, and comprehensive handover. Feedback demonstrated an improved user experience, greater reliability, continuity within the lists and a subsequent improvement in patient safety.
Changing trends in the UK management of upper GI bleeding: is there evidence of reduced UK training experience?
Authors: Penny H A , Kurien M , Wong E , Ahmed R , Ejenavi E , Lau M , Romaya C , Gohar F , Dear K L , Kapur K , Hoeroldt B , Lobo A J , Sanders D S 
Published: February 2015

ObjectiveThe aim of this study was to evaluate UK trainee experience in endoscopy for acute upper gastrointestinal bleeding (AUGIB).MethodsData was prospectively collected from all patients presenting to South Yorkshire Hospitals with AUGIB from September 2011 to December 2011 and compared with data from 1996. Concurrently, all gastroenterology trainees registered with the British Society of Gastroenterology were invited to respond to a web-based questionnaire regarding their experience in AUGIB management.Results77% (589/766) of the patient cohort underwent endoscopy for AUGIB; 15% (90/589) were performed by trainees. 7.2% (9/125) of the out of hours endoscopy case load was performed by trainees; all were low-risk or medium-risk cases (pre-endoscopy Rockall score ≤4). During the study period, dual therapy was delivered by a trainee on only four occasions. Comparison with the 1996 cohort demonstrated a marked reduction in the number of trainee performed endoscopies (76% vs 15%; p<0.001). Questionnaires were returned by 51% (245/478) of British Society of Gastroenterology trainees. 81% (198/245) thought that <10% of the gastroscopies they had performed involved therapeutic intervention. 23% (57/245) felt they would not be competent in AUGIB endoscopy by completion of specialty training.ConclusionsThis study demonstrates the decline over time in trainee experience in AUGIB endoscopy. It also highlights a lack of trainee exposure to more challenging cases, out of hours endoscopy and therapeutic procedures. Furthermore, trainees are concerned that a level of competency may not be attained during specialty training. We advocate reviewing UK endoscopic training provision for AUGIB to ensure that experienced endoscopists are produced to meet future service needs.
Pre-travel health preparation for malaria prevention among Hong Kong travellers
Authors: Hung Kevin K C , Lin Agatha K Y , Cheng Calvin K Y , Chan Emily Y Y , Graham Colin A 
Published: February 2015

ABSTRACT

Background
Malaria remains a significant cause of travel-related mortality and morbidity. Asians are known to have higher risks because they are less careful in pre-travel health preparations. This study reports on a cohort of travellers to malaria-prone regions examined in a previous study, which explored general levels of pre-travel health preparation.

Objectives
To describe the preparations taken by travellers at Hong Kong International Airport going to destinations with significant malaria risks according to the WHO.

Method
A cross-sectional survey was conducted by personal interviews at the boarding gates of flights in April 2013. The flights were chosen from those to malaria-prone regions (type I or above) from the 2012 WHO International Travel and Health Country List.

Results
403 respondents (75.6% Chinese ethnicity) were travelling to malaria-prone regions. 95.3% were travelling to developing countries including China, Thailand, Malaysia and India. 55.1% of respondents had taken at least one mosquito prevention measure and 8.9% of respondents had malaria chemoprophylaxis. Stepwise multivariate logistic regression analysis showed that female gender (OR=2.21, 95% CI 1.23 to 3.97), residence outside Hong Kong (OR=2.71, 95% CI 1.46 to 5.04) and travel including rural areas (OR=5.67, 95% CI 3.11 to 10.34) were predictors of optimum pre-travel health preparations.

Conclusions
Underestimation of malaria risks was a major barrier to adequate pre-travel health preparations. Targeted health education and information about risk is necessary to improve levels of travel health preparedness.
On The Unitary Cayley Ring Signed Graphs$S_n^\oplus$
Authors: SINHA DEEPA , DHAMA AYUSHI 
Published: February 2015

A Signed graph (or sigraph in short) is an ordered pair S = (G, σ), where G is a graph G = (V, E) and σ : E → {+, −} is a function from the edge set E of G into the set {+, −}. For a positive integer n > 1, the unitary Cayley graph Xnis the graph whose vertex set is Zn, the integers modulo n and if Undenotes set of all units of the ring Zn, then two vertices a, b are adjacent if and only if a − b ∈ Un. In this paper, we have obtained a characterization of balanced and clusterable unitary Cayley ring sigraph [Formula: see text]. Further, we have established a characterization of canonically consistent unitary Cayley ring sigraph [Formula: see text], where n has at most two distinct odd primes factors. Also sign-compatibility has been worked out for the same.
The role of Carclaze tin mine in eighteenth and nineteenth century geotourism
Authors: Bristow Colin 
Published: February 2015

Abstract

Carclaze tin mine was an open pit operation which exploited a massive cassiterite-bearing greisen-bordered quartz-tourmaline vein stockwork, straddling the granite margin near St Austell. It became a ‘must-see’ location for visitors to Cornwall from all over Europe in the late eighteenth and early nineteenth centuries, particularly those interested in the then-fashionable pursuits of geology and mineralogy. Intellectually, the early scientific interest in Carclaze can be seen as part of the Enlightenment, but in the nineteenth century the influence of Romanticism can also be detected. Much of the attraction was due to the openness and accessibility of Carclaze pit, which allowed the geology to be easily appreciated. This resulted in the development of the mine being particularly well documented by a large number of contemporary accounts and illustrations, which has also enabled an early, partly underground, canal to be rediscovered. The earliest account was by the Frenchman M. Jars who visited the pit in 1765; this was followed by accounts by other French geotourists from the early to mid-nineteenth century. The Germans Von Oeynhausen and Von Dechen provided the first geological map and cross-section of the pit in 1829. Accounts by local Cornish authors emphasize that Carclaze was a significant ‘sight’ for visitors. The earliest account of the pit by an English geologist was by Adam
Sedgwick in 1822
; in later publications he speculated on the formation of parallel vein swarms and schorl rock, partly based on his observations in Carclaze Old Tin Pit. De la Beche provided a pen-and-ink sketch of the south face of the pit in 1839. There are also many accounts by non-scientific visitors throughout the nineteenth century and, together with published lithographs, these are particularly helpful in describing and showing the methods of mining. Tin extraction from the Old Tin Pit had practically ceased by the mid-nineteenth century as production switched to china clay from new pits to the north. The historic south face of the Old Tin Pit, as illustrated by De La Beche, has survived into the twenty-first century and has been designated a County Geology Site by the Cornwall Geoconservation Group, although it is now threatened by housing and industrial development proposals.
Exploring the Biomechanical Properties of Brain Malignancies and Their Pathologic Determinants In Vivo with Magnetic Resonance Elastography
Authors: Jamin Yann , Boult Jessica K.R. , Li Jin , Popov Sergey , Garteiser Philippe , Ulloa Jose L. , Cummings Craig , Box Gary , Eccles Suzanne A. , Jones Chris , Waterton John C. , Bamber Jeffrey C. , Sinkus Ralph , Robinson Simon P. 
Published: February 2015

Abstract
Malignant tumors are typically associated with altered rigidity relative to normal host tissue. Magnetic resonance elastography (MRE) enables the noninvasive quantitation of the mechanical properties of deep-seated tissue following application of an external vibrational mechanical stress to that tissue. In this preclinical study, we used MRE to quantify (kPa) the elasticity modulus Gd and viscosity modulus Gl of three intracranially implanted glioma and breast metastatic tumor models. In all these brain tumors, we found a notable softness characterized by lower elasticity and viscosity than normal brain parenchyma, enabling their detection on Gd and Gl parametric maps. The most circumscribed tumor (U-87 MG glioma) was the stiffest, whereas the most infiltrative tumor (MDA-MB-231 metastatic breast carcinoma) was the softest. Tumor cell density and microvessel density correlated significantly and positively with elasticity and viscosity, whereas there was no association with the extent of collagen deposition or myelin fiber entrapment. In conclusion, although malignant tumors tend to exhibit increased rigidity, intracranial tumors presented as remarkably softer than normal brain parenchyma. Our findings reinforce the case for MRE use in diagnosing and staging brain malignancies, based on the association of different tumor phenotypes with different mechanical properties. Cancer Res; 75(7); 1216–24. ©2015 AACR.
Transcriptomic and Protein Expression Analysis Reveals Clinicopathological Significance of Bloom Syndrome Helicase (BLM) in Breast Cancer
Authors: Arora Arvind , Abdel-Fatah Tarek M.A. , Agarwal Devika , Doherty Rachel , Moseley Paul M. , Aleskandarany Mohammed A. , Green Andrew R. , Ball Graham , Alshareeda Alaa T. , Rakha Emad A. , Chan Stephen Y.T. , Ellis Ian O. , Madhusudan Srinivasan 
Published: February 2015

Abstract
Bloom syndrome helicase (BLM) has key roles in homologous recombination repair, telomere maintenance, and DNA replication. Germ-line mutations in the BLM gene causes Bloom syndrome, a rare disorder characterized by premature aging and predisposition to multiple cancers, including breast cancer. The clinicopathologic significance of BLM in sporadic breast cancers is unknown. We investigated BLM mRNA expression in the Molecular Taxonomy of Breast Cancer International Consortium cohort (n = 1,950) and validated in an external dataset of 2,413 tumors. BLM protein level was evaluated in the Nottingham Tenovus series comprising 1,650 breast tumors. BLM mRNA overexpression was significantly associated with high histologic grade, larger tumor size, estrogen receptor–negative (ER−), progesterone receptor–negative (PR−), and triple-negative phenotypes (ps &lt; 0.0001). BLM mRNA overexpression was also linked to aggressive molecular phenotypes, including PAM50.Her2 (P &lt; 0.0001), PAM50.Basal (P &lt; 0.0001), and PAM50.LumB (P &lt; 0.0001) and Genufu subtype (ER+/Her2−/high proliferation; P &lt; 0.0001). PAM50.LumA tumors and Genufu subtype (ER+/Her2−/low proliferation) were more likely to express low levels of BLM mRNA (ps &lt; 0.0001). Integrative molecular clusters (intClust) intClust.1 (P &lt; 0.0001), intClust.5 (P &lt; 0.0001), intClust.9 (P &lt; 0.0001), and intClust.10 (P &lt; 0.0001) were also more likely in tumors with high BLM mRNA expression. BLM mRNA overexpression was associated with poor breast cancer–specific survival (BCSS; ps &lt; 0.000001). At the protein level, altered subcellular localization with high cytoplasmic BLM and low nuclear BLM was linked to aggressive phenotypes. In multivariate analysis, BLM mRNA and BLM protein levels independently influenced BCSS. This is the first and the largest study to provide evidence that BLM is a promising biomarker in breast cancer. Mol Cancer Ther; 14(4); 1057–65. ©2015 AACR.
FGFR-Mediated Reactivation of MAPK Signaling Attenuates Antitumor Effects of Imatinib in Gastrointestinal Stromal Tumors
Authors: Li Fang , Huynh Hung , Li Xiaoyan , Ruddy David A. , Wang Youzhen , Ong Richard , Chow Pierce , Qiu Shumei , Tam Angela , Rakiec Daniel P. , Schlegel Robert , Monahan John E. , Huang Alan 
Published: February 2015

Abstract
Activating mutations in either KIT or PDGFRA are present in approximately 90% of gastrointestinal stromal tumors (GIST). Although treatment with the KIT and PDGFR inhibitor imatinib can control advanced disease in about 80% of GIST patients, the beneficial effect is not durable. Here, we report that ligands from the FGF family reduced the effectiveness of imatinib in GIST cells, and FGF2 and FGFR1 are highly expressed in all primary GIST samples examined. The combination of KIT and FGFR inhibition showed increased growth inhibition in imatinib-sensitive GIST cell lines and improved efficacy in patient-derived GIST xenografts. In addition, inhibition of MAPK signaling by imatinib was not sustained in GIST cells. An ERK rebound occurred through activation of FGF signaling, and was repressed by FGFR1 inhibition. Downregulation of Sprouty proteins played a role in the imatinib-induced feedback activation of FGF signaling in GIST cells.
Significance: We here show that FGFR-mediated reactivation of the MAPK pathway attenuates the antiproliferation effects of imatinib in GISTs. The imatinib-induced ERK rebound can be repressed by the FGFR inhibitor BGJ398, and combined KIT and FGFR inhibition leads to increased efficacy in vitro and in patient-derived xenografts. Cancer Discov; 5(4); 438–51. ©2015 AACR.
This article is highlighted in the In This Issue feature, p. 333
Clinical Acquired Resistance to RAF Inhibitor Combinations in BRAF-Mutant Colorectal Cancer through MAPK Pathway Alterations
Authors: Ahronian Leanne G. , Sennott Erin M. , Van Allen Eliezer M. , Wagle Nikhil , Kwak Eunice L. , Faris Jason E. , Godfrey Jason T. , Nishimura Koki , Lynch Kerry D. , Mermel Craig H. , Lockerman Elizabeth L. , Kalsy Anuj , Gurski Joseph M. , Bahl Samira , Anderka Kristin , Green Lisa M. , Lennon Niall J. , Huynh Tiffany G. , Mino-Kenudson Mari , Getz Gad , Dias-Santagata Dora , Iafrate A. John , Engelman Jeffrey A. , Garraway Levi A. , Corcoran Ryan B. 
Published: February 2015

Abstract
BRAF mutations occur in approximately 10% of colorectal cancers. Although RAF inhibitor monotherapy is highly effective in BRAF-mutant melanoma, response rates in BRAF-mutant colorectal cancer are poor. Recent clinical trials of combined RAF/EGFR or RAF/MEK inhibition have produced improved efficacy, but patients ultimately develop resistance. To identify molecular alterations driving clinical acquired resistance, we performed whole-exome sequencing on paired pretreatment and postprogression tumor biopsies from patients with BRAF-mutant colorectal cancer treated with RAF inhibitor combinations. We identified alterations in MAPK pathway genes in resistant tumors not present in matched pretreatment tumors, including KRAS amplification, BRAF amplification, and a MEK1 mutation. These alterations conferred resistance to RAF/EGFR or RAF/MEK combinations through sustained MAPK pathway activity, but an ERK inhibitor could suppress MAPK activity and overcome resistance. Identification of MAPK pathway reactivating alterations upon clinical acquired resistance underscores the MAPK pathway as a critical target in BRAF-mutant colorectal cancer and suggests therapeutic options to overcome resistance.
Significance: RAF inhibitor combinations represent promising approaches in clinical development for BRAF-mutant colorectal cancer. Initial characterization of clinical acquired resistance mechanisms to these regimens identified several MAPK pathway alterations driving resistance by reactivating MAPK signaling, highlighting the critical dependence of BRAF-mutant colorectal cancers on MAPK signaling and offering potential strategies to overcome resistance. Cancer Discov; 5(4); 358–67. ©2015 AACR.
See related commentary by Meador and Pao, p. 348
This article is highlighted in the In This Issue feature, p. 333
Generation of Mouse Pluripotent Stem Cell–Derived Proliferating Myeloid Cells as an Unlimited Source of Functional Antigen-Presenting Cells
Authors: Zhang Rong , Liu Tian-Yi , Senju Satoru , Haruta Miwa , Hirosawa Narumi , Suzuki Motoharu , Tatsumi Minako , Ueda Norihiro , Maki Hiroyuki , Nakatsuka Ryusuke , Matsuoka Yoshikazu , Sasaki Yutaka , Tsuzuki Shinobu , Nakanishi Hayao , Araki Ryoko , Abe Masumi , Akatsuka Yoshiki , Sakamoto Yasushi , Sonoda Yoshiaki , Nishimura Yasuharu , Kuzushima Kiyotaka , Uemura Yasushi 
Published: February 2015

Abstract
The use of dendritic cells (DC) to prime tumor-associated antigen-specific T-cell responses provides a promising approach to cancer immunotherapy. Embryonic stem cells (ESC) and induced pluripotent stem cells (iPSC) can differentiate into functional DCs, thus providing an unlimited source of DCs. However, the previously established methods of generating practical volumes of DCs from pluripotent stem cells (PSC) require a large number of PSCs at the start of the differentiation culture. In this study, we generated mouse proliferating myeloid cells (pMC) as a source of antigen-presenting cells (APC) using lentivirus-mediated transduction of the c-Myc gene into mouse PSC-derived myeloid cells. The pMCs could propagate almost indefinitely in a cytokine-dependent manner, while retaining their potential to differentiate into functional APCs. After treatment with IL4 plus GM-CSF, the pMCs showed impaired proliferation and differentiated into immature DC-like cells (pMC-DC) expressing low levels of major histocompatibility complex (MHC)-I, MHC-II, CD40, CD80, and CD86. In addition, exposure to maturation stimuli induced the production of TNFα and IL12p70, and enhanced the expression of MHC-II, CD40, and CD86, which is thus suggestive of typical DC maturation. Similar to bone marrow–derived DCs, they stimulated a primary mixed lymphocyte reaction. Furthermore, the in vivo transfer of pMC-DCs pulsed with H-2Kb-restricted OVA257-264 peptide primed OVA-specific cytotoxic T cells and elicited protection in mice against challenge with OVA-expressing melanoma. Overall, myeloid cells exhibiting cytokine-dependent proliferation and DC-like differentiation may be used to address issues associated with the preparation of DCs. Cancer Immunol Res; 3(6); 668–77. ©2015 AACR.