bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraocular and periocular lymphoma in dogs and cats: a retrospective review of 21 cases (2001–2012)
Authors: Ota‐Kuroki Juri , Ragsdale John M. , Bawa Bhupinder , Wakamatsu Nobuko , Kuroki Keiichi 
Published: October 2013

AbstractObjectiveTo immunologically phenotype and histologically classify canine and feline intraocular and periocular lymphomas.MethodsThe databases of four veterinary medical diagnostic laboratories were searched to identify cases of intraocular or periocular lymphoma in dogs and cats between 2001 and 2012. Hematoxylin and eosin (H&E) stained slides were reviewed for confirmation and classification of lymphoma, and immunohistochemistry for CD3 (T‐cell marker) and CD79a and/or CD20 (B‐cell markers) was examined to determine the lineage of the neoplastic lymphocytes.ResultsSix canine and 15 feline cases of ocular lymphoma were identified. In the canine cases, there were three intraocular and three periocular lymphomas where two intraocular and one periocular lymphomas were B‐cell, one of each intraocular and periocular lymphomas were T‐cell and one periocular lymphoma was nonreactive with CD3, CD79a or CD20. In the feline cases, there were six intraocular and nine periocular lymphomas where five intraocular and six periocular lymphomas were B‐cell, and one intraocular and three periocular lymphomas were T‐cell. Only one canine case had concurrent generalized lymphadenopathy, only one canine conjunctival lymphoma had simultaneous cutaneous lymphoma, and only one feline case had bilateral ocular involvement when they were diagnosed.ConclusionCanine and feline intraocular and periocular lymphomas are often of B‐cell phenotype. Although in general terms lymphoma is not considered a primary tumor when it occurs in or adjacent to the globe, these tumors frequently first become evident in the globe and/or periocular area. An accurate early diagnostic approach is crucial for the patient's quality of life because B‐cell lymphomas are generally more amenable to chemotherapy than T‐cell lymphomas.
Distichiasis in a ferret (Mustela putorius furo)
Authors: Verboven Chantal A.P.M. , Djajadiningrat‐Laanen Sylvia C. , Kitslaar Willem‐Jan P. , Grinwis Guy C.M. , Schoemaker Nico J. , Boevé Michael H. 
Published: October 2013

AbstractA 4‐year‐old intact male ferret was presented to the Ophthalmology Service of the Department of Clinical Sciences of Companion Animals of Utrecht University with chronic blepharospasm, epiphora, and conjunctivitis of the right eye. Examination of the eye revealed mild conjunctivitis and three hairs protruding from the openings of meibomian glands in the upper eyelid, providing the clinical diagnosis of distichiasis. The distichia were removed by transconjunctival unipolar electrocautery. Recovery was uneventful, but the original signs recurred 10 weeks after surgery. Ophthalmic examination revealed another distichia at a different location in the same eyelid and it was removed by full‐thickness wedge excision. Histopathological examination failed to reveal the exact origin of the distichia. To our knowledge, this is the first reported case of distichiasis in a ferret.
Evaluation of accelerated collagen cross‐linking for the treatment of melting keratitis in ten cats
Authors: Famose Frank 
Published: October 2013

AbstractObjectivesMelting keratitis is a serious condition presenting a high risk of permanent blindness and is caused by infectious or noninfectious factors. In humans, the clinical efficacy of collagen cross‐linking (CXL) has been described in the treatment of refractory infectious keratitis by arresting keratomalacia. The aim of this study was to evaluate the efficacy of acceleratedCXLfor the treatment of melting keratitis in cats.Animals studiedTen cats were treated for unilateral melting keratitis by acceleratedCXL.ProcedureCorneas were irradiated byUVA(370 nm) at 30 mW/cm² irradiance for 3 min after soaking with 0.1% riboflavin in 20% dextran for 30 min (D1). Follow‐up was conducted 3, 7, 14, and 30 days after treatment.ResultsPain improvement was noted for all cases atD4 examination. Epithelial healing was observed atD8 for 9 of 10 cases and atD15 for 1 of 10 cases. Resolution of cellular infiltration was observed for all cases atD8 examination. The corneal vascularization was reduced for 9 of 10 cats byD31. AtD31, all cases presented a variable degree of corneal fibrosis, but all eyes had visual function. No recurrent infection was observed.ConclusionAcceleratedCXLappears to be a valuable option for the treatment of melting keratitis in cats. All the cases have reached a satisfactory outcome despite the individual differences in the conditions prior to theCXLtreatment and the variable presence of infectious agents.
Optimising the production of energy from coblended food waste and biosolids using batch reactor studies
Authors: Siddiqui Zuhaib , Horan Nigel. J , Sahito Abdul R , Abdulkadir Jamila , Memon Sheeraz A 
Published: October 2013

AbstractEnergy production from a coblended mixture of biosolids and food waste was optimised for hydrogen and methane production. Four different blends were prepared by varying the carbohydrate : protein (carb : pro) ratios. The biosolids contained a low carbohydrate fraction and so was not suitable for hydrogen production when used alone. However coblending this waste with a carbohydrate‐enriched food waste produced a greater hydrogen yield, making this option viable. Batch studies showed that the optimised mix had a biosolids concentration of 25.7% (w/w). The largest hydrogen yield of 198.5 mL/gVSremoved was observed when the carb : pro was 2.78, and this was threefold higher than the other carb : pro ratios evaluated in this study. The digestate recovered after hydrogen recovery had a C : N of 17.5, which is in the ideal range for methane production. The biochemical methane potential test showed a methane yield of 239 mL/gVSremoved, and the total volatile solids destruction following two‐phase hydrogen and methane production was 93%.
Reducing time spent by junior doctors on call performing routine tasks at weekends
Authors: Ibrahim Wadah , Lin Simeng 
Published: October 2013

AbstractAt the Northern General Hospital, there are sixteen medical wards, spread over approximately half a mile. Weekend care for inpatients on these wards is provided by a team of four junior doctors, of different levels of training. We undertook a quality improvement project to reduce the amount of time junior doctors spent performing routine tasks at weekends. This may increase their available time for direct patient care.The study was performed over a period of nine weeks on two medical wards - Diabetes & Endocrine (W1) and Care of the Elderly Rehabilitation (W2). We monitored the bleeps received by the covering junior doctors during the weekend daytime shifts from the two study wards. We noted that a proportion of bleeps were routine tasks that could have been performed during weekday working hours. We also noted that W2 recorded fewer bleeps than W1 ward. This seemed to be because W2 batched junior doctors' jobs together. Firstly, we attempted to reduce the amount of routine work left undone each weekend. We provided a poster to remind Junior Doctors to complete such work during the week. Secondly, on W1 we replicated the job-batching system already in place on W2. A Doctors' Book was introduced in which nursing staff recorded the tasks that needed doing. This saved them from having to bleep the doctor repeatedly. The two changes resulted in a reduction in the number of bleeps generated by each ward and the number of visits required by the Junior Doctors to W1.Simple changes can reduce the amount of time junior doctors spend performing routine work at weekends. We implemented two such changes and achieved a reduction in the number of bleeps experienced by junior doctors and the number of times they had to return to one ward.
Acute Kidney Injury: It’s as easy as ABCDE
Authors: Forde Caroline , McCaughan Jennifer , Leonard Niall 
Published: October 2013

AbstractAcute kidney injury (AKI) is a common, serious problem which has been found to be poorly managed. Early recognition and action is critical in potentially slowing or reversing its course and facilitating timely referral to specialist services. In this quality improvement project, multidisciplinary education sessions and a simple 'ABCDE' checklist to aid AKI management were introduced in a district general hospital. The incidence of AKI (defined as 26umol/l rise in creatinine), its recognition and management were measured hospital wide. AKI recognition was improved by educating the entire multidisciplinary team to identify three key early warning signs: a rise in serum creatinine, urine output of <500mls in 24 hours and systolic blood pressure of <90mmHg. The 'ABCDE' checklist (Address drugs, Boost blood pressure, Calculate fluid balance, Dip urine, Exclude obstruction) was introduced to prompt AKI management. A four week educational programme was delivered, initially on a pilot ward, to doctors, nurses, nursing assistants and pharmacists. AKI recognition and implementation of the 'ABCDE' checklist were measured. Prior to project introduction 16% of patients developed AKI, but were recognised within 24 hours in only 31% of cases, with 80% of 'ABCDE' steps implemented in only 20%. Following multidisciplinary education, AKI recognition improved to 100%, with 80% of 'ABCDE' steps implemented in 67% of cases. These results were replicated when the project was rolled out across the surgical directorate (120 beds) and in the 40 bed medical admission unit. Prevention and treatment of AKI should be a core competency of all clinical staff. Educating and empowering the multidisciplinary team to implement simple interventions improves standards and should be the foundation of strategies targeting AKI. Through this study significant improvements have been demonstrated in AKI recognition and management, positively impacting on patient safety, quality of care and patients' and staff experience.
Improving Medication Reconciliation on the Surgical Wards of a District General Hospital
Authors: Hughes Erika , Hegarty Paul , Mahon Andrew 
Published: October 2013

AbstractDuring a routine audit it was noted that the surgical wards were consistently underperforming in their rate of medicines reconciliation in comparison to other specialities. The process of medication reconciliation is usually performed by junior doctors during the admission process and can be a complex task which is usually undertaken in the midst of several other jobs. The aim of this project was to review this process and identify methods of improving patient safety. This led to the design of a surgical admissions proforma which incorporated a 'medications on admission' section, to be used for reconciliation. Over a six month period from its introduction into a pilot ward it was noted to improve medication reconciliation from 60% to 85%. The benefits were discussed with members of the trust and a standardised version of the admissions proforma has since been rolled out to all hospitals within the trust.
Competence in confirming correct placement of nasogastric feeding tubes amongst FY1 doctors
Authors: Lee Sindy , Mason Eleanor 
Published: October 2013

AbstractFoundation year one (FY1) doctors are required to confirm correct placement of nasogastric (NG) feeding tubes on chest radiography on a regular basis. Many FY1s do not receive formal training during medical school or during the FY1 year. Multiple incidents of harm to patients, including death, resulting from incorrect placement of an NG feeding tube have been reported to the National Patient Safety Agency (NPSA) since 2005. Our audit assessed the confidence and knowledge of FY1 doctors in correctly confirming NG placement using a qualitative questionnaire. The results showed that both confidence and knowledge on the topic were remarkably poor. Our intervention consisted of a teaching session to the FY1 cohort, which included information on NPSA guidelines for identifying correct NG placement. A post-teaching questionnaire was attained from the same group of FY1s. Confidence and knowledge of the criteria had significantly improved. We concluded that there is clearly a need for teaching on this subject at an undergraduate and post-graduate level. The interactive peer-led style of our teaching session was shown to be highly effective. The addition of handouts and posters in the clinical workplace acted as helpful reminders for junior doctors to use at the point of need. Our project has highlighted a gap in training which poses a serious potential risk to patient safety. We have created a simple solution which, if adopted on a local and national scale, will facilitate a reduction in avoidable harm to patients.
The Effect of ‘On-Line’ POCT on Patient waiting times in an Accident and Emergency Department
Authors: Gilkar Ashfaq , Fink Richard , Eardley Philip , Barron Catriona 
Published: October 2013

AbstractThis POCT (point of care testing) team was constructed at the start of 2012 to implement the POCT project aiming to define and test the hypothesis that interfacing POCT devices to a clinical electronic order communications system reduces patient waiting times in an NHS Accident and Emergency Department (A&E). The devices selected for evaluation initially comprised the Sysmex XS 1000i haematology analyser and the Abbott i-Stat chemistry analyser.The POCT devices were interfaced to a server (Midlynx) which in turn was connected via the hospital internal network, to the ICE system (Integrated Clinical Environment). Test orders entered on the ICE system produced a bar code label read by the individual POCT devices. Once required tests were assayed, the results were transmitted back to the ICE system, where they could be viewed by users across the hospital site. The quality of POCT analytical performance was assessed by running quality control checks as recommended by the manufacturers and by exchanging samples daily with the clinical laboratory. The I-Stat (a Chemistry analyser manufactured by 'Abbott plc') was also tested against material obtained from a national external quality assurance scheme (NEQAS).The time taken to produce POCT tests was calculated as the time elapsed (TE) between requesting tests, and the time at which completed results were returned to the ICE system. Patient waiting times were derived from the patient administration system (Symphony) used in the A&E department. To assess the true effect of POCT on patient waiting times the analysis was confined to cases associated with POCT tests only (n = 217). A control population (n=229) was randomly selected from the clinical laboratory database. The time interval between requesting a test and receiving the results for the POCT tests was 23 minutes and for the laboratory tests, 60 minutes. The patient waiting times (time of discharge â time of arrival) was 167 minutes for the POCT group and 208 for the clinical laboratory group, a difference of 31 minutes. The project confirmed that interfaced (on-line) POCT has many advantages with respect to the quality and safety of data management. The benefits include reliable identification of the requesting clinician and patient and the assurance that the right result is allocated to the right patient. The study also showed that the quality of results produced by the POCT devices met the requirements of the clinical environment.
Professional Support, London: the professional development unit supporting practitioner well-being, refreshment, remediation and revalidation
Authors: Whiteman Julia , Morris Penny , Halpern Helen 
Published: October 2013

AbstractLondon's Professional Support Unit (PSU) was launched in April 2012 at a time when changes and financial pressures across the health service were placing considerable demand on the medical and dental workforce. At the same time the infrastructure to support medical revalidation was established. The PSU provides developmental support to clinicians across London in all career grades and specialities, to sustain and restore them to contribute effectively to health service delivery across the capital. The costs of medical training are high. Maintaining doctors at work has to be cost effective. Clinicians in multicultural London require diverse resources, as increasing numbers have trained abroad.The PSU offers a holistic, tailor-made approach to professional and personal development with a range of resources and approaches. It provides proven high quality educational interventions, creating a linked and integrated service, providing clinicians with new opportunities. Access is by self-referral with resources targeted at those going through transitions in their professional lives, as well as those who have specific developmental needs.A collaborative approach across the PSU and its education and governance communities ensured the provision of personal support to over 1300 clinicians in its first year, together with interdisciplinary group learning opportunities. Online materials were created to assist individuals, workplace groups and a broad network of support and expertise. To maximise the effectiveness of the service, learning events were also held for those working within the PSU.In commending the PSU and its positive impact, the General Medical Council has recommended the model be shared nationally. At the same time the Londonâs three Local Education Training Boards have recommended that the PSU expand to encompass a more diverse range of professional groups. Our challenge is how to extend such flexible, responsive and values-based support across the workforce, given stringent financial pressures.
Successful implementation of strategies to transform Emergency Department transfusion practice.
Authors: Reed Matthew J , Kelly Sarah-Louise , Beckwith Hannah , Innes Catherine J , Manson Lynn 
Published: October 2013

AbstractBlood component transfusion is an important and lifesaving Emergency Department (ED) procedure. It is not however risk-free and careful consideration of its clinical benefit for each individual patient is therefore essential. In 2008, we audited the patterns of blood component usage in 2007 within our ED. This work revealed that whilst 3209 units of blood component were ordered only 39.5% were transfused, and 9.5% were unaccounted for. This was the first and only published detailed look at ED blood transfusion practices. We had to address our poor traceability (i.e. unaccounted for units), our high blood usage, and our ordering of units which were then not transfused as this can lead to wastage. Firstly, better links between the ED and the Scottish National Blood Transfusion Service (SNBTS) were established. A set of improvement measures were then implemented including better ED medical and nursing staff education, monthly traceability reports sent to the ED clinical management teams, the introduction of an ED transfusion guideline, moving our blood fridge into the resuscitation room, having a named ED transfusion consultant and ED transfusion link nurse, ED consultant representation on the Hospital Transfusion Group and finally increasing awareness of ED emergency transfusion with a rotational thromboelastometry (ROTEM) research programme. In 2012, we re-audited our practice looking at our blood component usage in 2011. There was a 64% reduction in blood component ordering (3209 vs. 1034 units), a 39% reduction in blood component transfusion (1131 vs. 687 units), a 68% increase in the proportion of ordered units that were transfused and a 96% reduction in unaccounted units (289 vs. 9 units) between 2007 and 2011. In attempting to cost the savings resulting from our changes we showed that SNBTS spent £306,437 less in 2011 compared to 2007 on handling and issuing ED transfusion requests. Our improvements are immediately generalizable across the UK and the potential savings to the NHS are enormous.
Oxfordshire Childrens Diabetes - The Primary Schools Intervention Programme
Authors: Pal Rani , Edge Julie 
Published: October 2013

AbstractPoorly controlled diabetes adversely affects a child's education, with concentration difficulties, alterations in mood, behaviour and fatigue associated with high or low blood glucose levels. Between years 2004-6 we started all toddlers and children on intensive insulin regimens (multiple dose injection or pump) making it imperative that they received support during the school day. This required close monitoring of blood glucose levels and counting carbohydrate intake to adjust rapid-acting insulin dose or pump bolus at every meal. We report our experience of formulating a sustainable structure of support in primary schools based on trained volunteers who partake in the daily 'Individualised Care Plan (ICP)'.After overcoming multiple barriers, an acceptable system was negotiated with our Primary Care Trust (PCT) and Local Education Authority (LEA). In 2009, the PCT confirmed 3 years funding for a Paediatric Diabetes specialist nurse (PDSN) for schools. In 2010, the first full school year with agreed protocols was in place. By July 2012, our nurses had trained a total of 342 volunteers who provide care for 132 children.The Oxfordshire Schools Intervention Programme ensures that legal obligations are met. A risk assessment allows the LEA to provide indemnity to their school staff to give injections and do blood tests, after training and competency sign-off by a PDSN. Parents, volunteers and PDSN jointly agree a comprehensive 'ICP' and utilise a hand-held communication record book. Diabetes control improved (age 4-11 years cohort from 2004 onwards: Mean (SD) HbA1c in 2001-4 = 8.38 (1.09)%; in 2005-8 = 7.74 (0.81)%; in 2009-12 = 7.58 (0.69)%; ANOVA p<0.001). This requires 500-1000 hours of DSN time to train/retrain/problem-solve annually (approximately 5-10days per month). The cost-benefits are discussed. We advocate that our programme supports each child's ICP, use of intensive insulin regimes in school-day and reassures parents that schools can deliver this safely.