bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does spatial proximity drive norovirus transmission during outbreaks in hospitals?
Authors: Harris John P , Lopman Ben A , Cooper Ben S , O'Brien Sarah J 
Published: July 2013

ObjectiveTo assess the role of spatial proximity, defined as patients sharing bays, in the spread of norovirus during outbreaks in hospitals.DesignEnhanced surveillance of norovirus outbreaks between November 2009 and November 2011.MethodsData were gathered during 149 outbreaks of norovirus in hospital wards from five hospitals in two major cities in England serving a population of two million. We used the time between the first two cases of each outbreak to estimate the serial interval for norovirus in this setting. This distribution and dates of illness onset were used to calculate epidemic trees for each outbreak. We then used a permutation test to assess whether proximity, for all outbreaks, was more extreme than would be expected by chance under the null hypothesis that proximity was not associated with transmission risk.Results65 outbreaks contained complete data on both onset dates and ward position. We estimated the serial interval to be 1.86 days (95% CI 1.6 to 2.2 days), and with this value found strong evidence to reject the null hypothesis that proximity was not significant (p<0.001). Sensitivity analysis using different values of the serial interval showed that there was evidence to reject the null hypothesis provided the assumed serial interval was less than 2.5 days.ConclusionsOur results provide evidence that patients occupying the same bay as patients with symptomatic norovirus infection are at an increased risk of becoming infected by these patients compared with patients elsewhere in the same ward.
Pregnancy outcomes following maternal exposure to second-generation antipsychotics given with other psychotropic drugs: a cohort study
Authors: Sadowski Alexander , Todorow Michelle , Yazdani Brojeni Parvaneh , Koren Gideon , Nulman Irena 
Published: July 2013

ObjectivesSecond-generation antipsychotics (SGAs), in conjunction with other psychotropic medications, are increasingly used to treat psychiatric disorders in pregnancy. The few available studies investigating the reproductive safety of SGAs did not reach conclusive results, and none have compared monotherapy with polytherapy involving other psychotropic medications.DesignDescriptive cohort study using a prospectively collected database.SettingMotherisk Program, The Hospital for Sick Children, Toronto, Canada.Participants133 women exposed to SGAs and other psychotropic drugs and 133 matched healthy controls were assessed and analysed. Outcomes of mother–child pairs exposed to SGAs in monotherapy (N=37) were compared with those exposed to SGAs with other psychotropic medications (in polytherapy; N=96).Main outcome measuresMaternal, pregnancy, delivery and neonatal outcomes.Results72% of exposed women received SGAs in polytherapy, and 101 women took their medications throughout pregnancy. These women had significantly higher pre-pregnancy weight, experienced more associated comorbidities and instrumental deliveries, and delivered a greater proportion of large for gestational age neonates. There were no differences in maternal weight gain in pregnancy between the exposed and comparison groups and between the monotherapy-exposed and polytherapy-exposed subgroups. The exposed neonates were more likely to be born premature, were admitted more often to the neonatal intensive care unit, presented with poor neonatal adaptation signs and had higher rates of congenital malformations. All the aforementioned neonatal outcomes were found mainly in the polytherapy subgroup.ConclusionsThe use of SGAs in polytherapy was prevalent in the assessed cohort and was associated with adverse pregnancy outcomes for both the mother and the child. In utero exposure to SGA monotherapy appears to be associated with less risk to the fetus. Future research should focus on polytherapy in pregnancy in order to define its reproductive safety and to separate the effects of medication exposure, underlying psychopathology and associated comorbidities.
Mortality and its determinants among patients infected with HIV-1 on antiretroviral therapy in a referral centre in Yaounde, Cameroon: a retrospective cohort study
Authors: Poka-Mayap Virginie , Pefura-Yone Eric Walter , Kengne André Pascal , Kuaban Christopher 
Published: July 2013

ObjectivesMortality has declined in people with HIV infection, subsequent to the improved access to antiretroviral therapy (ART). We assessed the incidence and determinants of mortality among patients with HIV-1 infection who were started on ART in a referral treatment centre for HIV infection in Yaounde, Cameroon.DesignCohort study with baseline assessment between 2007 and 2008, and follow-up during 5 years until June 2012.SettingThe accredited HIV treatment centre of the Yaounde Jamot Hospital in the capital city of Cameroon.ParticipantsPeople living with HIV infection who started ART between 2007 and 2008 at the study centre.Outcome measuresAll-cause mortality over time; accelerated failure time models used to relate baseline characteristics to mortality occurrence during follow-up.ResultsOf the 1444 patients included, 827 (53.7%) were men, and the median age (25–75th centiles) was 38 (31–45) years. The median duration of follow-up was 14.1 (1.1–46.4) months, during which 235 deaths were recorded (cumulative incidence rate: 16.3%), including 208 (88.5%) during the first year of follow-up. Baseline predictors of mortality were male gender (adjusted HR 2.15 (95% CI 1.34 to 3.45)), active tuberculosis (2.35 (1.40 to 3.92)), WHO stages III–IV of the disease (3.63 (1.29 to 10.24)), low weight (1.03 (1.01 to 1.05)/kg), low CD4 count (1.04 (1.01 to 1.07)/10/mm3lower CD4) and low haemoglobin levels (1.12 (1.00 to 1.26)/g/dL lower).ConclusionsMortality rate among patients with HIV is very high within the first year of starting ART in this centre. Early start of the treatment at a less advanced stage of the disease, and favourable levels of CD4 could reduce early mortality, but would have to be tested.
Use of health information technology to reduce diagnostic errors
Authors: El-Kareh Robert , Hasan Omar , Schiff Gordon D 
Published: July 2013

BackgroundHealth information technology (HIT) systems have the potential to reduce delayed, missed or incorrect diagnoses. We describe and classify the current state of diagnostic HIT and identify future research directions.MethodsA multi-pronged literature search was conducted using PubMed, Web of Science, backwards and forwards reference searches and contributions from domain experts. We included HIT systems evaluated in clinical and experimental settings as well as previous reviews, and excluded radiology computer-aided diagnosis, monitor alerts and alarms, and studies focused on disease staging and prognosis. Articles were organised within a conceptual framework of the diagnostic process and areas requiring further investigation were identified.ResultsHIT approaches, tools and algorithms were identified and organised into 10 categories related to those assisting: (1) information gathering; (2) information organisation and display; (3) differential diagnosis generation; (4) weighing of diagnoses; (5) generation of diagnostic plan; (6) access to diagnostic reference information; (7) facilitating follow-up; (8) screening for early detection in asymptomatic patients; (9) collaborative diagnosis; and (10) facilitating diagnostic feedback to clinicians. We found many studies characterising potential interventions, but relatively few evaluating the interventions in actual clinical settings and even fewer demonstrating clinical impact.ConclusionsDiagnostic HIT research is still in its early stages with few demonstrations of measurable clinical impact. Future efforts need to focus on: (1) improving methods and criteria for measurement of the diagnostic process using electronic data; (2) better usability and interfaces in electronic health records; (3) more meaningful incorporation of evidence-based diagnostic protocols within clinical workflows; and (4) systematic feedback of diagnostic performance.
Staying just one step ahead: providing care for patients with motor neurone disease
Authors: McConigley R , Kristjanson L J , Aoun S M , Oldham L , Currow DC , O'Connor M , Holloway K 
Published: July 2013

IntroductionThere is limited information about the experiences and educational needs of health professionals who may be required to provide care for people with Motor Neurone Disease (MND) especially in the later stages of the disease. The aim of this study was to determine the experiences of, and need for, education of these health professionals.MethodsInterviews and focus groups were conducted with 31 health professionals with some experience in providing palliative care for people with MND. Thematic content analysis was used to identify common themes.ResultsA key theme,Just One Step Ahead, emerged, that describes the central capability health professionals identified as necessary to help individuals plan and prepare for disease and lifestyle changes just before they arise. Two subthemes also emerged:Expertise in MNDandBespoke Communication. Expertise in MNDdescribed the required understanding of the disease and the particular individual's version of the disease to allow the health professional to plan, advise, support and anticipate the needs of the person living with MND.Bespoke Communicationwas the facility to tailor care messages sensitively and effectively to the range of people involved in care (patients, family, healthcare team members).ConclusionsCare of people with MND requires up-to-date expertise about the disease and skilled communication abilities to manage complexity and change. Timely and focused education and specialist MND support for care providers are essential to tailored and responsive care and a widely available education programme has been developed to address these needs.
Attitudes and practices regarding resuscitation in emergency departments in Trinidad and Tobago
Authors: Baird Georgia , Sammy Ian , Nunes Paula , Paul Joanne 
Published: July 2013

BackgroundEthical issues with regard to resuscitation are increasingly important. Understanding how emergency physicians deal with these problems is essential for the development of policies for resuscitative care.ObjectivesTo identify the knowledge, opinions and practices of emergency physicians employed full time in public hospitals in Trinidad and Tobago, with respect to cardiopulmonary resuscitation. To compare the differences in responses between physicians in training and those who were not. In addition, to compare these responses with those expressed in a similar study in the USA in 2007.MethodsAll emergency physicians (120) who fulfilled the eligibility criteria for the study were asked to record anonymous responses to survey questions about ethical issues regarding resuscitation.ResultsOf the 98 respondents, most (79.6%) had been practising emergency medicine for ≤5 years and about 38% had had some training in emergency medicine. Most respondents agreed that survival rates for cardiopulmonary resuscitation (CPR) were poor. However, 41.2% of respondents had performed CPR >10 times in the past 3 years despite expected futility. More participants in the US study than in the local study thought that the existence of an advance directive was important in making decisions about CPR and that legal concerns should not, but do, affect CPR decisions in practice.ConclusionsLocal emergency physicians are as affected by legal and ethical CPR issues as are US emergency physicians. Education programmes and policies that deal with these concerns would better assist the emergency physician in dealing with them.
A systematic review of the activity and impact of emergency care practioners in the NHS
Authors: Hill Harry , McMeekin Peter , Price Christopher 
Published: July 2013

BackgroundThe NHS has seen a great expansion in the number of emergency care practitioners (ECPs) working in prehospital, primary and acute care settings since the role was introduced in 2003. This paper updates and expands on two previous reviews of ECP roles by identifying and discussing all empirical studies to date that examined the impact of ECP services in the NHS.ObjectivesTo summarise the national evidence-based literature on the impact of ECPs on healthcare delivery, effectiveness of practice and related health service resource use.MethodsSearches in MEDLINE, EMBASE and CINAHL databases, and two internet search engines (Google and Google Scholar). Identified publications were screened for relevance and quality before a description and synthesis of their findings. No statistical comparison was undertaken.ResultsStudies from the peer-reviewed literature (n=15) and project reports (n=6) were included. Overall, there was evidence that investment in ECP roles is beneficial for the quality of care reported by patients and cost efficiency savings. There was clear support from staff and patients for ECP services, and a number of studies of high methodological quality described care processes (diagnosis, investigations instigated and treatment initiated) provided by ECPs to be equivalent to or better to that provided by practitioners with traditional roles. Prehospital ECPs provided ‘added value’ by treating more patients at the scene thereby reducing unnecessary referral to emergency departments. It was often unclear whether the ECP intervention was part of a larger service change and/or new investment.ConclusionsSuccessful implementation of the ECP role has been described. Further evaluations should consider whether the beneficial impact of the role transfers equally across all operational settings and patient groups, and is not just a reflection of new investment in clinical services.
“Can you send an ambulance please?”: a comparison of callers’ requests for emergency medical dispatch in non-stroke and stroke calls
Authors: Leathley Michael J , Jones Stephanie P , Gibson Josephine M E , Ford Gary A , McAdam Joanna J , Quinn Tom , Watkins Caroline L 
Published: July 2013

BackgroundIdentifying ‘true stroke’ from an emergency medical services (EMS) call is challenging, with over 50% of strokes being misclassified. In a previous study, we examined the relationship between callers’ descriptions of stroke symptoms to the emergency medical dispatcher and the subsequent classification and prioritisation of EMS response. The aim of this subsequent study was to explore further the use of keywords by callers when making emergency calls, comparing stroke and non-stroke calls.MethodsAll non-stroke calls to one EMS dispatch centre between 8 March 2010 and 14 March 2010 were analysed. These were compared with the stroke calls made to one EMS dispatch centre between 1 October 2006 and 30 September 2007. Content analysis was used to explore the problems described by the caller, and findings were compared between non-stroke and stroke calls.Results277 non-stroke calls were identified. Only eight (3%) callers mentioned stroke, 12 (4%) and 11 (4%) mentioned limb weakness and speech problems, respectively, while no caller mentioned more than one classic stroke symptom. This contrasted with 473 stroke calls, where 188 (40%) callers mentioned stroke, 70 (15%) limb weakness and 72 (15%) speech problems, and 14 (3%) mentioned more than one classic stroke symptom.ConclusionsPeople who contact the EMS about non-stroke conditions rarely say stroke, limb weakness, speech problems or facial weakness. These words are more frequently used when people contact the EMS about stroke, although many calls relating to stroke patients do not mention any of these keywords.
Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial
Authors: Jennings Paul A , Cameron Peter , Bernard Stephen , Walker Tony , Jolley Damien , Fitzgerald Mark , Masci Kevin 
Published: July 2013

IntroductionImproved early pain control may affect the longer-term prevalence of persistent pain. In a previous randomised, controlled trial, we found that the administration of ketamine on hospital arrival decreased pain scores to a greater extent than morphine alone in patients with prehospital traumatic pain. In this follow-up study, we sought to determine the prevalence of persistent pain and whether there were differences in patients who received ketamine or morphine.MethodsThis study was a long-term follow-up study of the prehospital, prospective, randomised, controlled, open-label study comparing ketamine with morphine in patients with trauma and a verbal pain score of >5 after 5 mg intravenous morphine. Patients were followed-up by telephone 6–12 months after enrolment, and a questionnaire including the SF-36 (V.2) health-related quality of life survey and the Verbal Numerical Rating Scale for pain was administered.ResultsA total of 97/135 (72%) patients were able to be followed-up 6–12 months after enrolment between July 2008 and July 2010. Overall, 44/97 (45%) participants reported persistent pain related to their injury, with 3/97 (3%) reporting persistent severe pain. The prevalence of persistent pain was the same between study groups (22/50 (44%) for the ketamine group vs 22/47 (46%) for the morphine group). There was no difference in the SF-36 scores between study arms.ConclusionsThere is a high incidence of persistent pain after traumatic injury, even in patients with relatively minor severity of injury. Although decreased pain scores at hospital arrival are achieved with ketamine compared with morphine, this difference does not affect the prevalence of persistent pain or health-related quality of life 6 months after injury. Further larger studies are required to confirm this finding.Trial Registration NumberAustralian and New Zealand Clinical Trials Registry (ACTRN12607000441415).
Clinical significance of E-cadherin, β-catenin, vimentin and S100A4 expression in completely resected squamous cell lung carcinoma
Authors: Zhang Hua , Liu Jun , Yue Dongsheng , Gao Liuwei , Wang Daowei , Zhang Hongdian , Wang Changli 
Published: July 2013

ObjectiveThe aim of this study was to evaluate the prognostic value of E-cadherin, β-catenin, vimentin and S100A4 expression in a cohort of squamous cell lung carcinoma (SqCC) patients.MethodsTumours from 204 patients with surgically resected SqCC were used for the immunohistochemical analyses of E-cadherin, β-catenin, vimentin and S100A4 expression. Correlations between the expression of these markers and clinicopathological parameters were analysed using the χ2test. The prognostic value of these markers was evaluated using univariate Kaplan–Meier survival analyses and multivariate Cox proportional hazards model analyses.ResultsSignificant associations between E-cadherin expression and T stage (p=0.040), histological differentiation (p=0.005), lymph node metastasis (p<0.001), and recurrence (p<0.001) were identified. Decreased β-catenin expression was significantly correlated with T stage (p=0.003) and lymph node metastasis (p=0.010). Vimentin expression was associated with histological differentiation (p=0.017) and lymph node metastasis (p=0.001). Moreover, significant correlations were observed between S100A4 expression and lymph node metastasis (p=0.020) and recurrence (p<0.001). In the univariate analyses, high E-cadherin expression was a positive indicator for overall survival (OS) (p<0.001) and disease-free survival (DFS) (p<0.001), whereas high S100A4 or vimentin expression were negative indicators for OS (p<0.001 and p=0.010, respectively) and DFS (p<0.001 and p=0.006, respectively). In the multivariate analyses, E-cadherin and S100A4 expression were independent prognostic factors for OS (HR 0.697, 95% CI 0.524 to 0.926, p=0.013, and HR 1.508, 95% CI 1.122 to 2.027, p=0.007, respectively) and DFS (HR 0.634, 95% CI 0.471 to 0.852, p=0.003, and HR 1.490, 95% CI 1.101 to 2.015, p=0.010, respectively).ConclusionsEffective analysis of E-cadherin and S100A4 expression may allow for the identification of patients who are at a high risk of recurrence and poor prognosis in SqCC.
Reference intervals for red cell variables and platelet counts in infants at 2, 5 and 13 months of age: a cohort study
Authors: Hinchliffe R F , Bellamy G J , Bell F , Finn A , Vora A J , Lennard L 
Published: July 2013

AimsTo derive reference values for red cell variables and platelet counts from a cohort of infants sampled at precise ages during the first 13 months of life.MethodsBlood counts, reticulocyte counts and zinc protoporphyrin concentrations were obtained from healthy term infants of North European ancestry at 2, 5 and 13 months of age.ResultsMean cell volume (MCV) and mean cell haemoglobin (MCH) values did not differ significantly between 5 and 13 months and MCH concentration was unaffected by age. Values of all other variables at any one age differed significantly from those at the other two. Haemoglobin, mean cell haemoglobin, zinc protoporphyrin and platelet values (95% ranges) at 2 (n=119), 5 (n=97) and 13 months (n=42) were, respectively, 91–125, 101–129 and 105–133 g/L; 28.6–33.1, 24.5–28.7 and 24.3–28.7 pg; 36–116, 25–91 and 27–57 micromol/mol haem; and 216–658, 241–591 and 209–455×109/L. At 2 and 5 months, respectively, 26.9% and 10.8% of subjects had platelet counts >500×109/L. Reticulocyte counts at 2 months and MCV and MCH values at 5 months were significantly higher in girls. In boys, red cell distribution width values were significantly higher at 5 months, and zinc protoporphyrin values at both 2 and 5 months.ConclusionsThese findings indicate the value of obtaining reference data at precise ages during infancy and confirm and extend earlier reports indicating a gender difference in laboratory measures used to assess iron status in early infancy.
Prediction of low birthweight and small for gestational age from symphysis-fundal height mainly in developing countries: a meta-analysis
Authors: Goto Eita 
Published: July 2013

BackgroundA highly sensitive and simple screening procedure is required for early detection of low birthweight and small for gestational age, especially in developing countries.MethodsA meta-analysis was performed to evaluate use of symphysis-fundal height for prediction of low birthweight and small for gestational age. PubMed (MEDLINE) and other databases were used with no limitation on the date of publication (January 2012). The inclusion criteria were moderate-to-high-quality studies, that is, Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) score ≥8, published in English, which provided true and false, positive and negative results for prediction. 2×2 tables were constructed and diagnostic meta-analysis was performed.Results46 studies, which were conducted mostly in hospitals, evaluated the prediction of low birthweight (n=12) or small for gestational age (n=34). Only specificity to predict small for gestational age (0.87) was relatively high. Sensitivity to predict low birthweight (0.72) or small for gestational age (0.58) and specificity to predict low birthweight (0.73) were not sufficiently high. Regardless of predicting low birthweight or small for gestational age, the diagnostic accuracy was moderate (0.7 ≤ area under the curve≤0.9) and informational value was small (but sometimes important; positive and negative likelihood ratios of 2–5 and 0.5–0.2, respectively).ConclusionsThe present meta-analysis suggested that symphysis-fundal height is unsuitable for primary screening of low birthweight or small for gestational age. The results may be overly optimistic due to the inclusion of hospital-based versus community-based studies.