bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronically homeless persons’ participation in an advance directive intervention: A cohort study
Authors: Leung Alexander K , Nayyar Dhruv , Sachdeva Manisha , Song John , Hwang Stephen W 
Published: March 2015

Background: Chronically homeless individuals have high rates of hospitalization and death, and they may benefit from the completion of advance directives. Aim: To determine the rate of advance directive completion using a counselor-guided intervention, identify characteristics associated with advance directive completion, and describe end-of-life care preferences in a group of chronically homeless individuals. Design: Participants completed a survey and were offered an opportunity to complete an advance directive with a trained counselor. Participants: A total of 205 residents of a shelter in Canada for homeless men (89.1% of those approached) participated from April to June 2013. Results: Duration of homelessness was ⩾12 months in 72.8% of participants, and 103 participants (50.2%) chose to complete an advance directive. Socio-demographic characteristics, health status, and health care use were not associated with completion of an advance directive. Participants were more likely to complete an advance directive if they reported thinking about death on a daily basis, believed that thinking about their friends and family was important, or reported knowing their wishes for end-of-life care but not having told anyone about these wishes. Among individuals who completed an advance directive, 61.2% named a substitute decision maker, and 94.1% expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest if there was a chance of returning to their current state of health. Conclusion: A counselor-guided intervention can achieve a high rate of advance directive completion among chronically homeless persons. Most participants expressed a preference to receive cardiopulmonary resuscitation in the event of a cardiorespiratory arrest.
Experiences of burden, needs, rewards and resilience in family caregivers of people living with Motor Neurone Disease/Amyotrophic Lateral Sclerosis: A secondary thematic analysis of qualitative interviews
Authors: Weisser Fabia B , Bristowe Katherine , Jackson Diana 
Published: March 2015

Background: Family caregivers of people with Motor Neurone Disease/Amyotrophic Lateral Sclerosis, an incurable, mostly rapidly fatal neurodegenerative disease, face many challenges. Although there is considerable research on caregiver burden in Motor Neurone Disease/Amyotrophic Lateral Sclerosis, there is less knowledge of the positive aspects of caring. Objective: To explore the experiences of family caregivers of people with Motor Neurone Disease/Amyotrophic Lateral Sclerosis, specifically the relationship between positive and negative experiences of caring, and to identify possible ways to better support these caregivers. Methods: Secondary thematic analysis of 24 semi-structured qualitative interviews conducted longitudinally with 10 family caregivers. Interviews explored rewarding and unrewarding aspects of caring. Results: Themes emerged around burden, needs, rewards and resilience. Resilience included getting active, retaining perspective and living for the moment. Burden was multifaceted, including social burden, responsibility, advocacy, ambivalence, guilt and struggling with acceptance. Rewards included being helped and ‘ticking along’. Needs were multifaceted, including social, practical and psychological needs. The four main themes were interrelated. A model of coping was developed, integrating resilience (active/positive), burden (active/negative), needs (passive/negative) and reward (passive/positive). Conclusion: Burden, resilience, needs and rewards are interrelated. Caregivers’ ability to cope with caring for a person with Motor Neurone Disease/Amyotrophic Lateral Sclerosis oscillates between positive and negative aspects of caring, being at times active, at times passive. Clinical implications: Coping is a non-linear process, oscillating between different states of mind. The proposed model could enable clinicians to better understand the caregiver experience, help family caregivers foster resilience and identify rewards, and develop appropriate individualised caregiver support plans.
The role of distress intolerance for panic and nicotine withdrawal symptoms during a biological challenge
Authors: Farris Samantha G , Zvolensky Michael J , Otto Michael W , Leyro Teresa M 
Published: March 2015

Background: Distress intolerance is linked to the maintenance of panic disorder and cigarette smoking, and may underlie both problems. Method: Smokers ( n = 54; 40.7% panic disorder) were recruited for an experimental study; half were randomly assigned to 12-hour nicotine deprivation and half smoked as usual. The current investigation consisted of secondary, exploratory analyses from this larger experimental study. Four distress intolerance indices were examined as predictors of anxious responding to an emotional elicitation task (10% carbon dioxide (CO2)-enriched air challenge); anxious responding was in turn examined as a predictor of post-challenge panic and nicotine withdrawal symptoms. Results: The Distress Tolerance Scale (DTS) was significantly negatively associated with anxious responding to the challenge ( β = −0.41, p = 0.017). The DTS was negatively associated with post-challenge increases nicotine withdrawal symptoms indirectly through the effect of anxious responding to the challenge (b = −0.485, CI95% (–1.095, –0.033)). This same indirect effect was found for post-challenge severity of panic symptoms (b = −0.515, CI95% (–0.888, –0.208)). The DTS was directly predictive of post-challenge increases nicotine withdrawal symptoms, in the opposite direction ( β = 0.37, p = 0.009), but not panic symptom severity. Conclusions: Anxious responding in response to stressful experiences may explain the impact of perceived distress intolerance on panic and nicotine withdrawal symptom expression.
Characteristics of airborne micro-organisms in a neurological intensive care unit: Results from China
Authors: Yu Yao , Yin Sufeng , Kuan Yi , Xu Yingjun , Gao Xuguang 
Published: March 2015

Objective To describe the characteristics of airborne micro-organisms in the environment in a Chinese neurological intensive care unit (NICU). Methods This prospective study monitored the air environment in two wards (large and small) of an NICU in a tertiary hospital in China for 12 months, using an LWC-1 centrifugal air sampler. Airborne micro-organisms were identified using standard microbiology techniques. Results The mean ± SD number of airborne bacteria was significantly higher in the large ward than in the small ward (200 ± 51 colony-forming units [CFU]/m3 versus 110 ± 40 CFU/m3, respectively). In the large ward only, the mean number of airborne bacteria in the autumn was significantly higher than in any of the other three seasons. A total of 279 airborne micro-organisms were identified (large ward: 195; small ward: 84). There was no significant difference in the type and distribution of airborne micro-organisms between the large and small wards. The majority of airborne micro-organisms were Gram-positive cocci in both wards. Conclusion These findings suggest that the number of airborne micro-organisms was related to the number of patients on the NICU ward.
Mild Cognitive Impairment Subtypes in Older People With Depressive Symptoms
Authors: Jayaweera Hirosha K. , Hickie Ian B. , Duffy Shantel L. , Hermens Daniel F. , Mowszowski Loren , Diamond Keri , Terpening Zoe , Paradise Matthew , Lewis Simon J. G. , Lagopoulos Jim , Naismith Sharon L. 
Published: March 2015

Aims: To examine the rates and clinical characteristics of mild cognitive impairment (MCI) in older people with depressive symptoms and to determine the relative contribution of hippocampal volume and MCI to memory change. Method: One hundred and fifty-two participants with lifetime Major Depression and remitted or mild symptoms and 28 healthy controls underwent psychiatric and neuropsychological assessments. Magnetic resonance imaging was also conducted in a subset of the patients (n = 81) and healthy controls (n = 18). Results: MCI was diagnosed in 75.7% of the patients and was associated with increasing age, medical burden, vascular risk factors, later age of depression onset and smaller hippocampi. Multiple regression showed that both hippocampal volume and MCI diagnosis mediate memory performance in depression. Conclusions: MCI occurs in older adults with a history of depression and is not simply due to symptom severity. Memory change is linked to underlying hippocampal atrophy in this patient group.
Ultrasonic vibration–assisted electric discharge machining: A research review
Authors: Khatri Bharat C , Rathod Pravin , Valaki Janak B 
Published: March 2015

Ultrasound waves are directly being used in many of the industrial applications including material removal for generating profiles on material surfaces. Trend has been shifted to use ultrasonic sound waves or ultrasonic vibrations as assisting media to enhance process performance. Electric discharge machining is one such industrial application for material removal, where ultrasonic vibrations have been introduced as assisting media for improving process performance. Ultrasonic vibrations were mainly employed in electric discharge machining process for improved debris evacuation from the sparking gap to increase process efficiency. It also resulted in stable and consistent sparking sequences by minimizing adverse arcing phenomenon in electric discharge machining. Since its introduction, technology of ultrasonic assistance in electric discharge machining has gone through considerable changes and penetrated to various variants of the electric discharge machining process mainly die sinking electric discharge machining, wire cut electric discharge machining and micro electric discharge machining. This article presents a research review for applications of ultrasonic vibrations for electric discharge machining process. The review has been carried out in terms of modes of applying ultrasonic vibrations, effect on performance parameters, process modelling and optimization and application for difficult-to-cut advanced materials. Based on the review of present status of the ultrasonic-assisted electric discharge machining, future research needs have been identified to strengthen the capacity and capabilities of the electric discharge machining process.
Ankle Arthroscopy Simulation Improves Basic Skills, Anatomic Recognition, and Proficiency During Diagnostic Examination of Residents in Training
Authors: Martin Kevin D. , Patterson David , Phisitkul Phinit , Cameron Kenneth L. , Femino John , Amendola Annunziato 
Published: March 2015

Background: The purpose of this study was to determine whether low-fidelity arthroscopic simulation training improves basic ankle arthroscopy performance and efficiency among orthopedic trainees. Methods: Twenty-nine orthopedic surgery trainees with varying levels of experience in ankle arthroscopy were randomized into either simulation or standard practice groups. At baseline testing, all participants performed simulator-based testing and a cadaveric diagnostic ankle arthroscopy with video recording. The simulation group subsequently received 4 one-on-one, 15-minute simulation training sessions over a 4-month period, while the standard practice group received no additional simulation training or exposure. After intervention, both groups were reevaluated with simulator testing and a second recorded cadaveric diagnostic ankle arthroscopy. Two blinded, independent experts evaluated each randomized arthroscopic performance using the 15-point checklist, Arthroscopic Surgery Skill Evaluation Tool (ASSET), and total elapsed time, and all outcome measures were compared within and between groups. Results: Baseline arthroscopic experience, simulator task performance measures, and ASSET scores were equivalent between the simulation and standard practice groups. After completion of training, the simulation group outscored the control group in total ASSET score (34.9 vs 19.6; P < .001) and checklist score (14.5 vs 8.4; P < .001) and achieved nearly expert ASSET Safety scores (4.7 vs 2.9; P < .001) on the simulator model. Cadaver testing also demonstrated significant improvements in total ASSET score (28.8 vs 16.8; P < .001), checklist score (12.6 vs 7.1; P < .001), and ASSET Safety score (3.9 vs 2.6; P < .001). Conclusion: These results demonstrate that low-fidelity ankle arthroscopy simulation training can improve basic surgical skills, efficiency of movement, and anatomic recognition. The results suggest greater patient safety during ankle arthroscopy following simulation training. Level of Evidence: Level I, prospective comparative study.
Comparison of local reactions to oxaliplatin infusions by peripheral versus central venous administration
Authors: To Yue-yun , Sutcliffe Kimberly J , Hoen Helena M , Swaney Ramona A , Nicholls Justin D , Crocenzi Todd S 
Published: March 2015

Purpose Oxaliplatin, a platinum-type alkylator, is not classified as a vesicant but can cause local reactions when infused by peripheral vein. Providence Cancer Center, like other institutions, deferred the venous administration method to clinical judgment incorporating patient preference. Patient experience was evaluated for oxaliplatin-related local reactions by peripheral or central venous administration. Methods A retrospective review of the electronic medical record was performed of the period of January 2011 to March 2013 to identify patients who received oxaliplatin. Included were 59 patients who were given the option of either peripheral or central venous drug administration. The two patient groups (peripheral vein vs. central vein administration) were compared in terms of frequency and type of local reactions (redness/discoloration, swelling, numbness/cold, or pain/discomfort). Results Nineteen (63.3%) of the patients in the peripheral vein group experienced some type of local reaction compared to none in the central vein group ( p < .0001). Pain was the most common local reaction, occurring in 17 (56.7%) patients in the peripheral group. Despite the occurrence of a local reaction, the majority of patients did not alter their initial choice of infusion method. Conclusion This is the first published report to characterize and quantify a single institution's experience with oxaliplatin-related local reactions. A significantly greater number of local reactions, particularly pain, occurred with the administration of oxaliplatin peripherally vs. centrally. This analysis impacted our institution's best practice for oxaliplatin infusions.
A cohort study following up on a randomised controlled trial of a telemedicine application in COPD patients
Authors: Dyrvig Anne-Kirstine , Gerke Oke , Kidholm Kristian , Vondeling Hindrik 
Published: March 2015

Introduction The studies that constitute the knowledge base of evidence based medicine represent only 5%–50% of patients seen in routine clinical practice. Therefore, whether the available evidence applies to the implementation of a particular service often remains unclear. Chronic obstructive pulmonary disease (COPD) is no exception. Methods In this article, the effects of implementing a telemedicine intervention for COPD patients were analysed using data collected before, during, and after a randomised controlled trial (RCT). More specifically, regression techniques using robust variance estimators were used to analyse whether the use of telemedicine, patient age, and gender could explain the risk of readmission, length of hospital admission, and death during a five-year observation period. Results Increased risk of readmission was significantly related to both use of telemedicine and increased age in three sub-periods of the study, whereas women showed a more pronounced risk of readmission than men only during and after the RCT period. The number of days admitted to hospital was higher for patients using telemedicine and being of older age. Risk of death during the observation period was decreased for patients using telemedicine and for female patients and increased for elderly patients. No interaction between intervention and time period was observed. Statistically significant relationships were identified between use of telemedicine and risk of readmission, days admitted to hospital, and death. Discussion Research on effect modification in telemedicine is essential in designing future implementation of interventions as it cannot be taken for granted that effectiveness follows from efficacy.
Internet-based questionnaire to self-assess autonomy and obtain a life-at-home services enforcement plan: a retrospective validation study
Authors: Koskas P , Scemama E , Wolfowicz B 
Published: March 2015

Background In France, a specially-designed care plan for the elderly is generally based on an interdisciplinary, complex and time-consuming process. The health system assigns care throughout the social and health care services using multiple providers and sites. Objective The free website www.jesuisautonome.fr offers senior citizens and their families an opportunity to assess their own independence at home using a questionnaire in order to obtain a personal, life-at-home, enforcement plan. We aim to examine the correlation between the specially-designed care plan obtained by the usual assessment method and through self-evaluation via the website. Methods Community-dwelling subjects, consulting for the first time from December 2012 to July 2014, were under consideration. Patients were assessed using the Comprehensive Geriatric Assessment (CGA) and also independently during the first consultation; patients and their caregivers were then asked to fill out the questionnaire on the website. The two methods were compared using the Bland-Altman analysis for quantitative values and Kappa values for qualitative values. Results 73 patients completed the study. Correlation was excellent between parameters that did not include error due to risk to the patient (assistance with bathing and dressing, a nurse for drug distribution, measure of legal protection). Correlation was good with housekeeper hours that involved a financial cost to state social services and families. The GIR (Iso Ressource Groupe), which in France serves as a reference to determine social disability of the elderly, was similar. Conclusion Our study confirms the potential of the website www.jesuisautonome.fr . to improve the delivery of health and social care services.
Mortality of acute mesenteric ischemia remains unchanged despite significant increase in utilization of endovascular techniques
Authors: Eslami Mohammad H , Rybin Denis , Doros Gheorghe , McPhee James T , Farber Alik 
Published: March 2015

Introduction In this study, we evaluated if increase in utilization of endovascular surgery has affected in-hospital mortality rates among patients with acute mesenteric ischemia. Methods The National Inpatient Sample (2003–2011) was queried for acute mesenteric ischemia using ICD-9 code for acute mesenteric ischemia (557.1). This cohort was divided into patients treated with open vascular surgery (open vascular group) and by endovascular therapies (endovascular group) based on the ICD-9CM procedure codes. Multivariable logistic regression was used to determine temporal trend for mortality while adjusting for confounding variables. Results There was 1.45-fold increase in utilization of endovascular techniques in this study. In-hospital mortality rate, total median charges and length of stay were significantly lower among the endovascular group than the open vascular group despite having significantly higher Elixhauser comorbidities index (3 ± 0.1 vs. 2.7 ± 0.1, p = .003). Over the course of the study period, there was no change in the overall mortality rate despite higher endovascular utilization. Factors associated with increased mortality included age, open surgical repair (Odds ratio: 1.45, 95% Confidence Interval: 1.10–1.91, p = .016) and bowel resection Odds ratio: 2.88, 95% Confidence Interval: 2.01–4.12). Conclusion The mortality rate for acute mesenteric ischemia remains unchanged throughout this contemporary study. Open surgical intervention, bowel resection and age were associated with increased mortality. Endovascular group patients had better survival despite higher morbidity indices.
Investigation of two week wait referred haematuria patients in the UK: A national survey
Authors: Hughes Kaylie E , Drake Tamsin , Hamm Rebecca 
Published: March 2015

Aim: To analyse current UK practice for investigation of patients with visible haematuria (VH) or non-visible haematuria (NVH) who meet referral criteria according to National Institute of Clinical Excellence referral guidelines for suspected cancer. Patients and methods: Questionnaires were sent to 131 trusts. Data collected included demographics, conformity with NICE improving outcomes in urological cancer guidelines, standard first line investigations into VH and NVH and criteria for second line investigations. Results: Seventy-two trusts (55%) responded from 15 deaneries including 48 cancer centres. Almost two-thirds (63.9%) provide a one-stop service. First line investigations into VH varied considerably: 82% of trusts undertake urine tests (cytology 43.0%); three-quarters perform blood tests (prostate-specific antigen 54.2%); all conduct varying radiological imaging of the upper tracts; 95.8% of patients had flexible cystoscopy. Forty per cent of trusts’ first line investigations differ for NVH. Triple phase computed tomography-urogram is not routinely undertaken. Of the trusts, 55.5% perform second line investigations for VH and 55.5% for recurrent VH including computed tomography-urogram or retrograde studies; 20.5% perform non-contrast helical computed tomography scan of the kidneys, ureters and bladder or urine cytology for NVH if the history is indicative. Conclusion: Across trusts, there are wide variations in the regimes for investigation of haematuria. Development of an evidence based guideline to standardise practice across the National Health Service for haematuria referrals is required to abolish the postcode lottery system.