bluuebunny/crossref_metadata_2025_split huggingface dataset:
A quality improvement project to improve the effectiveness and patient-centredness of management of people with mild-to-moderate kidney disease in primary care
Authors: Thomas Nicola , Gallagher Hugh , Jain Neerja 
Published: April 2014

AbstractChronic kidney disease (CKD) stages 3 to 5, affects 6-7% of the adult population and is an important risk factor for both advanced kidney disease and cardiovascular disease. This paper describes a quality improvement project that aimed to establish consistent implementation of best practice in people with stage 3-5 kidney disease who were managed in primary care.The intervention was a Care Bundle for CKD. The bundle included three evidence-based, high impact interventions based on National Institute for Care Excellence (NICE, 2008) guidance, with an additional and novel self-management element.29 GP Practices in England and Wales began the study. They undertook training in clinical management of CKD and in facilitation of self-management, with the self-management content designed and led by patients. Practices were asked to report baseline and then monthly outcome data extracted from practice computer systems. The project team provided implementation and ongoing quality improvement support for participating Practices.Ten Practices dropped out of the study following the training. Data submissions were incomplete in six Practices who continued to apply the care bundle. At the project end, a decision was taken by the study team to perform the final analysis on those thirteen Practices which completed the project and submitted at least six sets of monthly Practice-level outcome data. In these Practices the Care Bundle was applied to under 20% of the registered CKD stage 3 to 5 population in 5 Practices, 20-29% in 3 Practices, 30-49% in 2 Practices and ≥50% in 3 Practices (998 patients in total). Of these, 671 patients (75%) agreed to the self-management component of the intervention.The reliability (at project end) in those who received the Bundle was 100%. The Bundle was applied to an additional 315 patients in the six Practices who completed the project but did not submit regular practice-level monthly data.In the thirteen remaining Practices, the achievement of NICE (2008) blood pressure targets at the start of the project was 74.8% in people with CKD stage 3-5 and no diabetes and 48% in people with CKD stage 3-5 and diabetes. At the project end these figures in the same Practices were 76.7% and 49.2% respectively. These improvements were achieved in spite of Practices increasing their recording of prevalence rate (that is, identifying and recording more patients with CKD on the Practice CKD Register).In conclusion, a care bundle can be implemented in primary care. However, maintaining engagement with primary care health care professionals and maximising exposure to an intervention in patients seen infrequently are significant challenges to generalisation and sustainability.
Unseen but present danger: improving the safe prescribing of anti-embolism stockings (AES)
Authors: Bradley Alison 
Published: April 2014

AbstractA strong evidence base exists supporting thromboprophylaxis for venous thromboembolism (VTE) in surgical patients. Given the ageing population, obesity epidemic, and rise in type 2 diabetes, VTE and peripheral vascular disease (PAD) are likely to become an escalating problem. PAD is a contraindication to the use of anti-embolism stockings (AES). Half of those patients diagnosed with PAD report no symptoms, potentially underestimating its prevalence. Implementation of guidelines for thromboprophylaxis, including the safe prescribing of AES, is therefore imperative.The aims of this project were to establish whether thromboprophylaxis was being prescribed correctly, and appropriately, to all surgical inpatients. This included documented evidence that peripheral pulses had been examined – and, in the case of diabetic patients, that there was documentation of full peripheral neurovascular examination – before AES were prescribed. Data were collected from case notes of all surgical inpatients. Foundation year 1 doctors (FY1s) completed a questionnaire assessing their knowledge of local guidelines. Teaching sessions and posters summarising local guidelines were delivered to FY1s.Appropriate pharmacological prescribing improved from 57.69% to 100%. AES were appropriately prescribed for 65.38% of patients. Post intervention this increased to 79.17%. 0% had documented peripheral neurovascular examination. This increased to 50% post intervention.
Improving the documentation of the daily review of patients in general intensive care
Authors: Zucco Liana , Webb Carly 
Published: April 2014

AbstractFollowing the daily review of patients on the general intensive care unit (GICU), ongoing issues are addressed and a management plan formulated. Within our unit, the documentation of this daily review is freehand and should include all items covered within the local GICU daily review checklist. However, an initial audit of the daily review demonstrated an average completion rate of only 57%, with several aspects of care consistently missed, most notably: eye and mouth care in ventilated patients (44% and 40%, respectively), glucose control (33%), stress ulcer prophylaxis (54%), and inspection and need for peripheral and central lines (24%). The current system relied on doctors learning the requirements for the clerking and remembering to document them all. It is known that there is a low level of reliability in successfully applying proven medical evidence; this is partly explained by dependence on vigilance and hard work by the clinician, and absence of checklists and protocols to reduce the impact of human factors on results. The majority of doctors on the unit believe they consistently record all items of this checklist, highlighting the gap between the ideal that clinicians strive towards and the outcome. An abbreviated daily review checklist was therefore implemented in the form of a laminated bookmark into the medical notes, to act as a reminder of the items that should be considered in the daily review and prompt subsequent documentation. Bookmarks were implemented over two PDSA cycles and medical notes re-audited. Post-intervention, the documentation of the daily review improved to an overall completion rate of >77%, with notable improvements in eye and mouth care in ventilated patients (89%, 95% respectively), glucose control (67%), stress ulcer prophylaxis (100%), and inspection and need for peripheral and central lines (43%). The daily review checklist concisely summarised onto bookmarks were cheap and simple to create, durable and easy to use, and improved the overall documentation of the daily review. The effect of this outcome remains untested.
Efficacy of amitraz plus inactivated parapoxvirus ovis in the treatment of canine generalised demodicosis
Authors: Pekmezci D. , Pekmezci G. Z. , Guzel M. , Cenesiz S. , Gurler A. T. , Gokalp G. 
Published: April 2014

Canine generalised demodicosis (CGD) is a challenging disease to treat effectively. Inactivated parapoxvirus ovis (iPPVO) could help to accelerate treatment with acaricidial therapy by altering the immune response. This study was designed to investigate the effects of treating CGD with amitraz plus iPPVO in terms of clinical outcomes and blood parameters. The study involved 16 dogs ranging in age from eight months to six years and weighing between 10 and 40 kg. Eight dogs were treated with amitraz and eight with amitraz plus iPPVO. Biochemical analysis of whole blood and serum, including serum C reactive protein (CRP) and serum amyloid A (SAA), was performed. Skin scrapings were conducted on days 0, 10, 40, 80 and 120 of treatment, and mite numbers were recorded. Clinical remission was determined according to mite numbers and clinical scores. The difference in mean whole remission days between the amitraz group (104.3 days) and the amitraz+iPPVO group (84.5 days) was statistically significant (P<0.05). Mean clinical scores were also significantly better in the amitraz+iPPVO (5.60) group when compared with the amitraz group (7.65). No adverse reactions were observed in either group. In view of these findings, the use of iPPVO in conjunction with amitraz can be recommended for treating CGD.
Existence of ground state of an electron in the BDF approximation
Authors: Sok Jérémy 
Published: April 2014

The Bogoliubov–Dirac–Fock (BDF) model allows us to describe relativistic electrons interacting with the Dirac sea. It can be seen as a mean-field approximation of Quantum Electrodynamics (QED) where photons are neglected. This paper treats the case of an electron together with the Dirac sea in the absence of any external field. Such a system is described by its one-body density matrix, an infinite rank, self-adjoint operator. The parameters of the model are the coupling constant α > 0 and the ultraviolet cut-off Λ > 0: we consider the subspace of squared integrable functions made of the functions whose Fourier transform vanishes outside the ball B(0, Λ). We prove the existence of minimizers of the BDF energy under the charge constraint of one electron and no external field provided that α, Λ-1 and α log(Λ) are sufficiently small. The interpretation is the following: in this regime the electron creates a polarization in the Dirac vacuum which allows it to bind. We then study the non-relativistic limit of such a system in which the speed of light tends to infinity (or equivalently α tends to zero) with αlog(Λ) fixed: after rescaling and translation the electronic solution tends to a Choquard–Pekar ground state.
Autologous T-cell Therapy for Cytomegalovirus as a Consolidative Treatment for Recurrent Glioblastoma
Authors: Schuessler Andrea , Smith Corey , Beagley Leone , Boyle Glen M. , Rehan Sweera , Matthews Katherine , Jones Linda , Crough Tania , Dasari Vijayendra , Klein Kerenaftali , Smalley Amy , Alexander Hamish , Walker David G. , Khanna Rajiv 
Published: May 2014

Abstract
Glioblastoma multiforme (GBM) is one of the most aggressive human brain malignancies. Even with optimal treatment, median survival is less than 6 months for patients with recurrent GBM. Immune-based therapies have the potential to improve patient outcome by supplementing standard treatment. Expression of human cytomegalovirus (CMV) antigens in GBM tissues provides the unique opportunity to target viral antigens for GBM therapy. Here, we report findings of a formal clinical assessment of safety and potential clinical efficacy of autologous CMV-specific T-cell therapy as a consolidative treatment for recurrent GBM. From a total of 19 patients with recurrent GBM, CMV-specific T cells were successfully expanded from 13 patients (68.4%), 11 of whom received up to four T-cell infusions. Combination therapy based on T-cell infusion and chemotherapy was well tolerated, and we detected only minor adverse events. The overall survival of these patients since first recurrence ranged from 133 to 2,428 days, with a median overall survival of 403 days. Most importantly, 4 of 10 patients that completed the treatment remained progression free during the study period. Furthermore, molecular profiling of CMV-specific T-cell therapy from these patients revealed distinct gene expression signatures, which correlated with their clinical response. Our study suggests that a combination therapy with autologous CMV-specific T cells and chemotherapy is a safe novel treatment option and may offer clinical benefit for patients with recurrent GBM. Cancer Res; 74(13); 3466–76. ©2014 AACR.
Physiological Basis and Long-Term Clinical Outcome of Discordance Between Fractional Flow Reserve and Coronary Flow Velocity Reserve in Coronary Stenoses of Intermediate Severity
Authors: van de Hoef Tim P. , van Lavieren Martijn A. , Damman Peter , Delewi Ronak , Piek Martijn A. , Chamuleau Steven A.J. , Voskuil Michiel , Henriques José P.S. , Koch Karel T. , de Winter Robbert J. , Spaan Jos A.E. , Siebes Maria , Tijssen Jan G.P. , Meuwissen Martijn , Piek Jan J. 
Published: April 2014

Background—
Discordance between fractional flow reserve (FFR) and coronary flow velocity reserve (CFVR) may reflect important coronary pathophysiology but usually remains unnoticed in clinical practice. We evaluated the physiological basis and clinical outcome associated with FFR/CFVR discordance.

Methods and Results—
We studied 157 intermediate coronary stenoses in 157 patients, evaluated by FFR and CFVR between April 1997 and September 2006 in which revascularization was deferred. Long-term follow-up was performed to document the occurrence of major adverse cardiac events: cardiac death, myocardial infarction, or target vessel revascularization. Discordance between FFR and CFVR occurred in 31% and 37% of stenoses at the 0.75, and 0.80 FFR cut-off value, respectively, and was characterized by microvascular resistances during basal and hyperemic conditions. Follow-up duration amounted to 11.7 years (Q1–Q3, 9.9–13.3 years). Compared with concordant normal results of FFR and CFVR, a normal FFR with an abnormal CFVR was associated with significantly increased major adverse cardiac events rate throughout 10 years of follow-up, regardless of the FFR cut-off applied. In contrast, an abnormal FFR with a normal CFVR was associated with equivalent clinical outcome compared with concordant normal results: ≤3 years when FFR <0.75 was depicted abnormal and throughout 10 years of follow-up when FFR ≤0.80 was depicted abnormal.

Conclusions—
Discordance of CFVR with FFR originates from the involvement of the coronary microvasculature. Importantly, the risk for major adverse cardiac events associated with FFR/CFVR discordance is mainly attributable to stenoses where CFVR is abnormal. This emphasizes the requirement of intracoronary flow assessment in addition to coronary pressure for optimal risk stratification in stable coronary artery disease.
Platonic Power and Political Realism
Authors: Wallach John R. 
Published: April 2014

Abstract
Despite often being condemned for having a paradigmatically unrealistic or dangerous conception of power, Plato expends much effort in constructing his distinctive conception of power. In the wake of Socrates’ trial and execution, Plato writes (in Gorgias and Republic I) about conventional (Polus’, Polemarchus’), elitist (Callicles’), and radically unethical (Thrasymachus’) conceptions of power only to ‘refute’ them on behalf of a favoured conception of power allied with justice. Are his arguments as pathetic or wrong-headed as many theorists make them out to be – from Machiavelli to contemporary political realists, from ‘political’ critics of Plato ranging from Popper to Arendt? And if not, has our understanding of power been impoverished? This question has been surprisingly unasked, and it is one I address by asking Plato and his critics: What are the dialectical moves Plato makes in refuting Socrates’s opponents and constructing his own conception of legitimate (i.e., just) power? Exactly how does he interweave his conception of power with a kind of ethics? How does it compare to recent conceptions of political realism and the power-politics/ethics relationship – e.g., after Marx and Foucault? While addressing these questions I also attend to the issue of Plato’s historicity: to what extent do the limits of his language and world affect our reading of Plato and his political critics? Ultimately, I argue that and how Plato’s conception of power and its political dimensions realistically have much to teach us that we have not learned.
Terminal cancer patients’ and their primary caregivers’ attitudes toward hospice/palliative care and their effects on actual utilization: A prospective cohort study
Authors: An Ah Reum , Lee June-Koo , Yun Young Ho , Heo Dae Seog 
Published: April 2014

Background: Previous studies on hospice/palliative care indicated that patients’ socio-demographic factors, disease status, and availability of health-care resources were associated with hospice/palliative care utilization. However, the impact of family caregivers on hospice/palliative care utilization has not been thoroughly investigated. Aim: To evaluate the association between attitudes toward hospice/palliative care of both patients with terminal cancer (defined as progressive, advanced cancer in which the patient will die within months) and their family caregivers and utilization of inpatient hospice/palliative care facilities. Design: A prospective observational cohort study was performed in 12 hospitals in South Korea. Attitude toward hospice/palliative care was assessed immediately after terminal cancer diagnosis. After the patient’s death, caregivers were interviewed whether they utilized hospice/palliative care facilities. Participants: A total of 359 patient–caregiver dyads completed baseline questionnaires. After the patients’ death, 257 caregivers were interviewed. Results: At the baseline questionnaire, 137/359 (38.2%) patients and 185/359 (51.5%) of caregivers preferred hospice/palliative care. Preference for hospice/palliative care was associated with awareness of terminal status among both patients (adjusted odds ratio: 1.87, 95% confidence interval: 1.16–3.03) and caregivers (adjusted odds ratio: 2.14, 95% confidence interval: 1.20–3.81). Religion, metastasis, and poor performance status were also independently associated with patient preference for hospice/palliative care. At the post-bereavement interview, 104/257 (40.5%) caregivers responded that they utilized hospice/palliative care facilities. Caregiver’s preferences for hospice/palliative care were significantly associated with actual utilization (adjusted odds ratio: 2.67, 95% confidence interval: 1.53–4.67). No patient-related factors were associated with hospice/palliative care utilization. Conclusion: Promoting awareness of prognosis and to improve communication between doctors and families is important for facilitating the use of hospice/palliative care.
Effect of individualized exercise during maintenance haemodialysis on exercise capacity and health-related quality of life in patients with uraemia
Authors: Wu Yongyao , He Qiang , Yin Xiaohong , He Qien , Cao Shengsheng , Ying Guanghui 
Published: April 2014

Objective To investigate the effect of individualized exercise on exercise capacity and health-related quality of life (HRQoL) in uraemic patients during maintenance haemodialysis (MHD). Methods Patients receiving MHD were divided randomly into a test group, who underwent recumbent cycling exercise during dialysis, and a control group, who performed simple stretching exercises. The same dialysis protocol was used for all study participants. At study start and after 12 weeks, exercise capacity was measured using tests of physical ability; HRQoL was measured using the kidney disease quality of life score (KDQOL-SF™). Results A total of 65 patients were included in the study: 33 in the control group and 32 in the test group. There were no significant differences in patient characteristics between the two groups at baseline. After 12 weeks, there were significant improvements in exercise capacity and in many of the items of the KDQOL-SF™ in the test group compared with the control group. Conclusion Individualized exercise during MHD significantly improved the exercise capacity and HRQoL for uraemic patients within a short time period, and could therefore be used as a simple, cost-effective therapeutic approach.
The effect of health education in patients with chronic low back pain
Authors: Zhang Yan , Wan Li , Wang Xueqiang 
Published: April 2014

Objective To assess the value of health education (active management and postural hygiene) over and above exercise alone, in patients with chronic low back pain. Methods Adults (aged 18–30 years) with low back pain of ≥3 months’ duration were randomized to undergo a 12-week programme of lumbar strengthening exercise and health education or exercise alone. Pain, disability (Oswestry Disability Index, ODI), static and dynamic muscle endurance, and health-related quality-of-life (short form-36, SF-36) were assessed at baseline and after completion of treatment. Results At the end of the 12-week intervention period, pain, disability, SF-36 physical component and SF-36 mental component were significantly better in the health education group ( n = 25) than in the control group ( n = 24). There were no significant between-group differences in static or dynamic endurance. Conclusion Health education provides additional benefits to exercise alone for improving pain, disability and mental and physical health-related quality-of-life.
Sports and Activity Levels After Open Surgical Treatment of Femoroacetabular Impingement
Authors: Naal Florian D. , Schär Michael , Miozzari Hermes H. , Nötzli Hubert P. 
Published: April 2014

Background: Several studies indicate that professional athletes can successfully return to competition after surgical treatment of femoroacetabular impingement (FAI). However, little is known about sports and activity levels after FAI surgery in the general patient population. Hypothesis/Purpose: The purpose was to determine the sports behavior, satisfaction with sports ability, and activity levels in a consecutive cohort of patients with FAI who were treated by surgical hip dislocation. The hypothesis was that the majority of patients (>75%) would be active in sports at follow-up. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study included 153 patients (mean age, 30.0 years; 40.5% female) with 192 hips treated. Sports behavior and satisfaction were determined at a mean follow-up of 59.4 months with the use of a questionnaire. Activity levels at follow-up were assessed by the Hip Sports Activity Scale (HSAS) and the University of California, Los Angeles (UCLA) activity scale. Results: Of 126 patients who were regularly active in sports before surgery, 107 (85%) were so at follow-up. Nineteen patients (12.4%) stopped participating in regular sports, and 8 (5.2%) commenced with sports after the operation. The most popular activities before surgery were skiing (22%), cycling (22%), jogging (20%), and soccer (13%). At follow-up, most patients were engaged in cycling (23%), fitness/weight training (20%), skiing (18%), and jogging (11%). Of all patients, 75% were satisfied with their sports ability, and 25% were not. Moreover, 60.3% stated that their sports ability had improved after surgery, 20.5% declared no change, and 19.2% were subjectively deteriorated. The mean pain level during sports was rated to be 2.1 according to the visual analog scale. The mean HSAS score was 3.5 (range, 0-8), and the mean UCLA score was 7.7 (range, 3-10); male patients reported significantly higher scores than did female patients on the HSAS (4.1 vs 2.7, respectively) and UCLA scale (8.2 vs 7.0, respectively). Conclusion: The vast majority of patients with FAI who are treated by surgical hip dislocation return to sports activities, and most patients are satisfied with their sports ability at midterm follow-up. Activity levels are significantly higher in male patients, but this does not yield higher satisfaction rates.
Dialogue on Ideal End-of-Life Care for Those With Dementia
Authors: Stewart-Archer Lois A. , Afghani Afrooz , Toye Christine M. , Gomez Frank A. 
Published: April 2014

Purpose: To identify both meanings and perceptions of delivery of end-of-life (EoL) care for the person experiencing dementia. Design/Methods: As part of a larger cross-sectional mixed methods study examining quality of life in dementia, perspectives of EoL care were sought from 136 seniors using open-ended questions administered at interview. Results: Seniors living in various settings identified obligatory requisites of care as time when the finality of death needed to be accepted, comfort was prioritized, family presence was valued, appearance remained important, and solitude or time “to be with God” was stressed. Skilled nursing care, honesty, and engaged family were also necessary. Implications: Understanding EoL preferences of those with dementia is critical for advocacy and service delivery.