bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using mode and maximum values from the Numeric Rating Scale when evaluating postoperative pain management and recovery
Authors: Eriksson Kerstin , Wikström Lotta , Lindblad‐Fridh Marianne , Broström Anders 
Published: September 2012

Aims and objectives.  To (1) examine the clinical applicability of compiled mode and maximum values from the Numeric Rating Scale (NRS) by comparing the correspondence between patient perceptions of pain and pain values from monitoring records, as well as (2) to study the relationship between mode and maximum values and self‐assessed ability for early postoperative recovery.Background.  Documentation of pain remains a problem despite recommendations of quality improvements. To examine the correlation between patient perceptions and documented pain therefore becomes important. Few have studied how pain affects recovery.Design.  A quantitative cross‐sectional design was used in which 157 postoperative patients answered a questionnaire on pain intensity and recovery. A parallel examination of pain in monitoring records was conducted.Results.  A total of 57% had a mode value calculated from records between 0 and 3 on postoperative day 1 and 69% on day 2. A maximum value between 4 and 10 was found in monitoring records for 73% on day 1 and for 67% on day 2. The correspondence between mode value from monitoring records and the patients’ retrospective perceptions was 88% for NRS 0–3 and 92% between maximum value and NRS 4–10. The correlation between documented pain and retrospectively identified pain for mode value of the NRS in all (0–10) was rather weak (r = 0·37), while maximum value had a stronger correlation (r = 0·53).Conclusion.  Mode and maximum values could be used as outcome measures when evaluating postoperative pain. Pain affects recovery negatively, but more research is needed to strengthen the evidence for the use and clarify the link between pain and recovery.Relevance to clinical practice.  International organisations emphasise the importance of improving pain assessment. Mode and maximum values are easy to compile for nurses and can, together with assessments of how experienced pain levels affect postoperative recovery, improve treatment of postoperative pain.
South Asian dietary patterns and their association with risk factors for the metabolic syndrome
Authors: Garduño‐Diaz S. D. , Khokhar S. 
Published: September 2012

AbstractBackgroundCertain dietary patterns have been associated with higher risk of noncommunicable diseases, with South Asians identified as a high‐risk group. The present study aimed to identify the association between dietary patterns and the metabolic syndrome (MS) in South Asians living in the UK.MethodsDietary patterns were derived by principal component analysis from 15 different food groups using an ethnic‐specific food frequency questionnaire. MS risk factors, including obesity and hypertension, were measured, whereas existing conditions of dyslipidaemia and hyperglycaemia were self‐reported. Participants (n = 100) were divided into quartiles based on dietary factor scores and the link between dietary patterns and risk factors was investigated.ResultsThree different patterns were derived, which together explained 46% of the total diet variation; eastern pattern, mixed pattern and western pattern. An inverse correlation was found between the eastern pattern and education P = 0.05). A direct correlation was found between the western pattern and physical activity (P = 0.05) and the overall risk of MS (P = 0.05). Body composition was altered as residence time in the UK increased, with a reduction in muscle mass (29–26%) and an increase in body fat (31–37%). Diagnosis criteria for MS were found in 20% of the participants.ConclusionsDietary acculturation, including a reduction in vegetarianism, an increased intake of caffeinated drinks and altered meal patterns, may be associated with the higher prevalence of MS in migrant South Asians in the UK.
Quality of life in a cohort of patients diagnosed with renal failure in childhood and who received renal transplant
Authors: Tozzi Alberto E. , Mazzotti Eva , Di Ciommo Vincenzo Maria , Dello Strologo Luca , Cuttini Marina 
Published: September 2012

Tozzi AE, Mazzotti E, Di Ciommo VM, Dello Strologo L, Cuttini M. Quality of life in a cohort of patients diagnosed with renal failure in childhood and who received renal transplant.Abstract:  Studies on HRQOL on kidney‐transplanted young adults who had a diagnosis of chronic renal failure (CRF) in the pediatric age are uncommon. We studied HRQOL and its predictors in a sample of young adults with CRF in childhood who underwent a renal transplant. We recruited patients ≥18 yr old with renal transplant. We measured HRQOL by a standardized questionnaire on lifestyle, Short Form‐36 (SF‐36; including a PCS and a MCS; scale: 0–100), the GHQ (for short‐term changes in mental health; scale: 0–36), and the MSPSS (with scales for family, friends, and significant others; scale: 0–100). We assessed the association of potential predictors of HRQOL through multiple linear regression models. We studied 66 patients aged 18–34 yr. The average PCS score was 76.4, and the average MCS score was 73.9. The mean GHQ total score was 14.8, and the total scale MSPSS mean score was 70. Severe comorbidities significantly affected the PCS score. Individuals with severe comorbidities had lower PCS scores.
Meso‐Rex bypass as an alternative technique for portal vein reconstruction at or after liver transplantation in children: Review and perspectives
Authors: de Ville de Goyet Jean , Lo Zupone Cristina , Grimaldi Chiara , D’Ambrosio Giuseppe , Candusso Manila , Torre Giuliano , Monti Lidia 
Published: September 2012

de Ville de Goyet J, Lo Zupone C, Grimaldi C, D’Ambrosio G, Candusso M, Torre G, Monti L. Meso‐Rex bypass as an alternative technique for portal vein reconstruction at or after liver transplantation in children: Review and perspectives.Abstract:  Direct portal revascularization can be achieved by interposing a vascular graft between the SMV and the Rex recessus (left portal vein system): the MRB. To review indications and results of the procedure in the setting of pediatric liver transplantation, reports were selected from the English literature. Previously reported series were updated to analyze long‐term outcome. A new series was added and analyzed as a complementary set of cases. A total of 51 cases were analyzed. With a 96% overall patient survival rate and a 100% long‐term patency rate when the IJV is used for the bypass, MRB achieves a very successful physiologic cure of chronic portal hypertension and restores the portal flow into and through the liver graft. It also has been used successfully for primary revascularization of liver grafts, as well as for managing early acute portal vein thrombosis episodes. The use of this procedure in conjunction with other strategies and techniques might be of interest for transplant surgeons, particularly those caring for children.
Cognitive function in patients with chronic pain treated with opioids: characteristics and associated factors
Authors: KURITA G. P. , DE MATTOS PIMENTA C. A. , BRAGA P. E. , FRICH L. , JØRGENSEN M. M. , NIELSEN P. R. , HØJSTED J. , SJØGREN P. 
Published: September 2012

BackgroundThe paucity of studies regarding cognitive function in patients with chronic pain, and growing evidence regarding the cognitive effects of pain and opioids on cognitive function prompted us to assess cognition via neuropsychological measurement in patients with chronic non‐cancer pain treated with opioids.MethodsIn this cross‐sectional study, 49 patients were assessed by Continuous Reaction Time, Finger Tapping, Digit Span, Trail Making Test‐B and Mini‐mental State Examination tests. Linear regressions were applied.ResultsPatients scored poorly in the Trail Making Test‐B (mean = 107.6 s, SD = 61.0, cut‐off = 91 s); and adequately on all other tests. Several associations among independent variables and cognitive tests were observed. In the multiple regression analyses, the variables associated with statistically significant poor cognitive performance were female sex, higher age, lower annual income, lower schooling, anxiety, depression, tiredness, lower opioid dose, and more than 5 h of sleep the night before assessment (P < 0.05).ConclusionsPatients with chronic pain may have cognitive dysfunction related to some reversible factors, which can be optimized by therapeutic interventions.
The frequency and nature of drug administration error during anaesthesia in a Chinese hospital
Authors: ZHANG Y. , DONG Y. J. , WEBSTER C. S. , DING X. D. , LIU X. Y. , CHEN W. M. , MENG L. X. , WU X. Y. , WANG D. N. 
Published: September 2012

BackgroundThroughout the world, drug administration error remains a known and significant threat to patients undergoing anaesthesia. Estimates of the extent of the problem vary, but few are based on large prospectively collected datasets. Furthermore, little is known about whether differences in work culture are important in error rates.MethodsA prospective incident monitoring study was conducted at a large tertiary hospital in China to estimate the frequency of drug administration error during anaesthesia. Anaesthetists were asked to return a study form anonymously for every anaesthetic, indicating whether or not a drug administration error had occurred, including incident details if affirmative.ResultsFrom 24,380 anaesthetics, 16,496 study forms were returned (67.7% response rate), reporting 179 errors. The frequency (95% confidence interval) of drug administration error was 0.73% (0.63% to 0.85%) based on total study anaesthetics and 1.09% (0.93% to 1.26%) based on total forms returned. The largest categories of error were omissions (27%), incorrect doses (23%) and substitutions (20%). Errors resulted in prolonged stay in recovery for 21 patients, transfer to the ICU for five and one case each of haemorrhagic shock and asthmatic attack. More respondents who were not fully rested reported inattention as a contributing factor to error (21%) than those who were fully rested (7%, P = 0.04).ConclusionOur results are comparable with other international prospective estimates indicating that drug administration error is of concern in China as elsewhere. These results will form a baseline from which to detect the effects of countermeasures.
LMA ProSealTM vs. i‐GelTM in ventilated children: A randomised, crossover study using the size 2 mask
Authors: GASTEIGER L. , BRIMACOMBE J. , OSWALD E. , PERKHOFER D. , TONIN A. , KELLER C. , TIEFENTHALER W. 
Published: September 2012

BackgroundThe Laryngeal Mask Airway (LMA) ProSealTM and the i‐GelTM are two extraglottic devices with either an inflatable cuff or a non‐inflatable cuff.AimWe test the hypothesis that oropharyngeal leak pressure and fiberoptic position of the airway tube differ between the size 2 LMA ProSealTM and the i‐GelTM in non‐paralysed ventilated children.MethodsFifty‐one children aged 1.5–6 years weighing 10–25 kg were studied using a crossover design. Anaesthesia was with remifentanil/propofol mixture. The LMA ProSealTM and the i‐GelTM were inserted into each patient in random order.ResultsOropharyngeal leak pressure for the LMA ProSealTM and the i‐GelTM was similar at 22 (5) and 21 (5) cm H2O, respectively. Fiberoptic position of the airway tube for the LMA ProSealTM and the i‐GelTM was similar, with the vocal cords visible from the distal airway tube in 94% and 96%, respectively.ConclusionWe conclude that oropharyngeal leak pressure and fiberoptic position of the airway tube are similar for the size 2 LMA ProSealTM and i‐GelTM in non‐paralysed ventilated children.
Concomitant medication among persistent opioid users with chronic non‐malignant pain
Authors: MELLBYE A. , SVENDSEN K. , BORCHGREVINK P. C. , SKURTVEIT S. , FREDHEIM O. M. S. 
Published: September 2012

BackgroundRecent guidelines for opioid treatment of chronic non‐malignant pain discourage co‐medication with benzodiazepines and benzodiazepine‐related hypnotics, whereas co‐medication with non‐opioid analgesics and co‐analgesics may offer a beneficial opioid sparing effect, and is recommended. The aim of this study was to describe 1‐year periodic prevalence of co‐medication with benzodiazepines, benzodiazepine‐related hypnotics, non‐opioid analgesics, co‐analgesics and antidepressants in persistent opioid users with chronic non‐malignant pain.MethodsThe study is based on data from the Norwegian Prescription Database, covering all drugs dispensed to outpatients in 2008. Concomitant medication levels were compared between users in two definitions of persistent opioid use, all Norwegian adults dispensed opioids in 2008 and the Norwegian background population.ResultsOf the Norwegian adult population studied, 1.2% met the criteria of persistent opioid use based on prescription pattern and prescription level. Sixty per cent of persistent opioid users were dispensed a benzodiazepine or benzodiazepine‐related hypnotic in amounts indicating regular use, with 15% dispensed a high amount of both classes. Sixty‐two percent of persistent opioid users were dispensed one or more non‐opioid analgesics, 47% an antidepressant and 33% were dispensed an antiepileptic drug.ConclusionApproximately 60% of persistent opioid users also receive benzodiazepines or benzodiazepine‐related hypnotics in amounts indicating regular use. This is in conflict with recent guidelines for the treatment of chronic non‐malignant pain and may indicate that these users are at an increased risk of developing problematic opioid use.
Epidemiology in evolutionary time: the case of Wolbachia horizontal transmission between arthropod host species
Authors: Zug R. , Koehncke A. , Hammerstein P. 
Published: September 2012

AbstractWolbachia are bacterial endosymbionts that manipulate the reproduction of their arthropod hosts. Although theory suggests that infections are frequently lost within host species due to the evolution of resistance, Wolbachia infect a huge number of species worldwide. This apparent paradox suggests that horizontal transmission between host species has been a key factor in shaping the global Wolbachia pandemic. Because Wolbachia infections are thus acquired and lost like any other infection, we use a standard epidemiological model to analyse Wolbachia horizontal transmission dynamics over evolutionary time. Conceptually modifying the model, we apply it not to transmission between individuals but between species. Because, on evolutionary timescales, infections spread frequently between closely related species and occasionally over large phylogenetic distances, we represent the set of host species as a small‐world network that satisfies both requirements. Our model reproduces the effect of basic epidemiological parameters, which demonstrates the validity of our approach. We find that the ratio between transmission rate and recovery rate is crucial for determining the proportion of infected species (incidence) and that, in a given host network, the incidence may still be increasing over evolutionary time. Our results also point to the importance of occasional transmission over long phylogenetic distances for the observed high incidence levels of Wolbachia. In conclusion, we are able to explain why Wolbachia are so abundant among arthropods, although selection for resistance within hosts often leads to infection loss. Furthermore, our unorthodox approach of using epidemiology in evolutionary time can be applied to all symbionts that use horizontal transmission to infect new hosts.
Surgical outcomes of 230 resected hilar cholangiocarcinoma in a single centre
Authors: Song Sun Choon , Choi Dong Wook , Kow Alfred Wei‐Chieh , Choi Seong Ho , Heo Jin Seok , Kim Woo Seok , Kim Min Jung 
Published: September 2012

AbstractsBackgroundLow resectability rate and poor survival outcomes after surgical resection for hilar cholangiocarcinoma are common in most institutions. We retrospectively reviewed the surgical outcomes of hilar cholangiocarcinoma in a tertiary institution focusing on the surgical procedures, radicalities, survival rates and independent prognostic factors.MethodsTwo hundred thirty patients who underwent surgical resection for hilar cholangiocarcinoma between 1995 and 2010 were retrospectively analysed based on the clinical variables, Bismuth‐Corlette types, radicality of operation and survival rates.ResultsThe median overall and disease‐free survival time in the whole cohort were 39.1 and 19.2 months, respectively. Patients with type I or II tumour were more likely to undergo segmental bile duct resection than combined liver resection with lower R0 rates (68.2% and 76.1%, respectively). Liver resection (P < 0.001) and combined caudate lobectomy (P = 0.003) were associated with significantly higher R0 rates. Multivariate analysis showed that lymph node metastasis (P = 0.001), preoperative level of bilirubin above 3.0 mg/dL (P = 0.003) and positive resection margin (P = 0.033) were independent prognostic factors on overall survival.ConclusionLiver resection and combined caudate lobectomy increased curative resection rates in hilar cholangiocarcinoma regardless of Bismuth‐Corlette types. Preoperative biliary drainage should be performed in jaundiced patients to improve perioperative outcome and survival.
Dedicated hip fracture service: implementing a novel model of care
Authors: Sivakumar Brahman Shankar , McDermott Luke Michael , Bell Jack Joseph , Pulle Chrys Ranjeev , Jayamaha Sophie , Ottley Michael Carl 
Published: September 2012

AbstractBackgroundHip fracture is a common clinical problem with historically high morbidity and mortality, and various model of acute and subacute care have been employed. We describe 12‐month results from the first dedicated hip fracture unit in Australia, and compare it with other models of care both locally and internationally.MethodsThis was performed as a prospective uncontrolled study over a 12‐month period. After application of exclusion criteria, a total of 346 patients were yielded. Outcomes measured included performance indicators as well as morbidity and mortality data.ResultsImprovements in performance indicators (adequate preoperative medical assessment, time to surgery, return to premorbid residence, etc.) and morbidity and mortality data (such as pressure sores, infections and in‐hospital death) are noted.ConclusionsEarly results suggest more comprehensive preoperative assessment, shorter times to theatre, reduced post‐operative complications and diminished mortality rates when the principles undermining this unit are instituted.
Outcomes of patients with histologically proven acute acalculous cholecystitis
Authors: Nikfarjam Mehrdad , Manya Kiran , Fink Michael A. , Hadj Andrew K. , Muralidharan Vijayaragavan , Starkey Graham , Jones Robert M. , Christophi Christopher 
Published: September 2012

AbstractBackgroundAcute acalculous cholecystitis (AAC) is traditionally described in the setting of critical illness, where the diagnosis is based on clinical assessment and imaging criteria. Very few studies have assessed the features and outcomes of AAC in patients treated by cholecystectomy.MethodsPatients with histologically confirmed acute cholecystitis treated in a specialized unit in a tertiary hospital between 2005 and 2011 were identified from prospectively maintained database. Retrospective review of data was undertaken and patients with AAC were compared with those patients with acute cholecystitis and confirmed gallstones.ResultsAAC was identified in 35 of 412 (8.5%) patients with acute cholecystitis. These patients were older (69 years versus 61 years; P = 0.004) and were more likely to be febrile (46% versus 21%; P = 0.001) and hypotensive (23% versus 5%; P < 0.001) at initial presentation. There was a higher incidence of chronic obstructive airways disease (COAD) in the AAC group (26% versus 6%; P < 0.001). Other co‐morbidities were similar among the groups. Operative outcomes were similar between the groups. There were no overall differences in postoperative complications between AAC and calculous acute cholecystitis patients (17% versus 16%; P = 0.063). However, the postoperative length of stay was higher in the AAC group (5 days versus 3 days; P = 0.026).ConclusionAAC more commonly occurs in older patients and those with COAD. The operative outcomes and complications of AAC treated by cholecystectomy are similar to cases of acute calculous cholecystitis.
Objective structured assessment of technical skills and checklist scales reliability compared for high stakes assessments
Authors: Gallagher Anthony G. , O'Sullivan Gerald C. , Leonard Gerald , Bunting Brendan P. , McGlade Kieran J. 
Published: September 2012

AbstractBackgroundThe establishment of assessment reliability at the level of the individual trainee is an important attribute of assessment methodologies, particularly for doctors who have been failed. This issue is of particular importance for the process of competence assessment in the USA, UK, Australia and New Zealand.MethodsWe use data from 19 applicants for higher surgical training in 2008 at the Royal College of Surgeons in Ireland to compare: (i) the objective structured assessment of technical skills (OSATS) method; and (ii) a procedure‐specific checklist to assess surgical technical skills in the excision of a sebaceous cyst task by two experienced senior surgeons.ResultsThe overall interrater reliability (IRR) of the OSATS assessment as determined by a correlation coefficient was 0.507 (P < 0.03) and 0.67 with coefficient alpha, considerably below the accepted 0.8 level of IRR. The checklist's overall IRR was 0.89. Individually, only five (26%) of the OSATS assessments reached the 0.8 level of IRR in contrast to 18 (95%) of the checklist assessments.DiscussionWe propose binary procedure‐based assessment checklists as more reliable assessment instruments with more robust reproducibility.
Disruption of raphé serotonergic neural projections to the cortex: a potential pathway contributing to remote loss of brainstem neurons following neonatal hypoxic–ischemic brain injury
Authors: Reinebrant Hanna E. , Wixey Julie A. , Buller Kathryn M. 
Published: September 2012

AbstractNeuronal injury is a key feature of neonatal hypoxic–ischemic (HI) brain injury. However, the mechanisms underpinning neuronal losses, such as in the brainstem, are poorly understood. One possibility is that disrupted neural connections between the cortex and brainstem may compromise the survival of neuronal cell bodies in the brainstem. We investigated whether brainstem raphé serotonergic neurons that project to the cortex are lost after HI. We also tested if neuroinflammation has a role in disrupting brainstem raphé projections. Postnatal day 3 (P3) rats underwent unilateral carotid artery ligation followed by hypoxia (6% oxygen for 30 min). A retrograde tracer, choleratoxin b, was deposited in the motor cortex on P38. On P45 we found that retrogradely labelled neurons in the dorsal raphé dorsal, ventrolateral, interfascicular, caudal and ventral nuclei were lost after P3 HI. All retrogradely labelled neurons in the raphé nuclei were serotonergic. Numbers of retrogradely labelled neurons were also reduced in the ventromedial thalamus and basolateral amygdala. Minocycline treatment (45 mg/kg 2 h post‐HI, 22.5 mg/kg daily P4–P9) attenuated losses of retrogradely labelled neurons in the dorsal raphé ventrolateral, interfascicular and ventral raphé nuclei, and the ventromedial thalamus. These results indicate that raphé neurons projecting to the cortex constitute a population of serotonergic neurons that are lost after P3 HI. Furthermore, neuroinflammation has a role in the disruption of raphé and thalamic neural projections. Future studies investigating the cellular mechanisms of axonal degeneration may reveal new targets for interventions to prevent neuronal losses after neonatal HI.