bluuebunny/crossref_metadata_2025_split huggingface dataset:
Revisit of Typical Counterclockwise Atrial Flutter Wave in the ECG: Electroanatomic Studies on the Determinants of the Morphology
Authors: SASAKI KENICHI , SASAKI SHINGO , KIMURA MASAOMI , OWADA SHINGEN , HORIUCHI DAISUKE , ITOH TAIHEI , ISHIDA YUJI , OKUMURA KEN 
Published: April 2013

BackgroundCavotricuspid isthmus‐dependent counterclockwise atrial flutter (typical AFL) is characterized by negative saw‐tooth morphology flutter wave (F‐wave) in the inferior leads, which is classified as type 1 with purely negative F‐wave without positive terminal deflection (PTD), type 2 with small PTD, and type 3 with broad PTD. The determinants of these morphological differences remain to be elucidated.Methods and ResultsOf 72 patients (58 males, 65 ± 13 years) with typical AFL, 19 were classified as type 1 and 53 as types 2 and 3. We created an electroanatomic map of the right atrium (RA) during AFL and determined which RA site activation corresponded to which F‐wave component by analyzing the activation map. It was revealed that F‐wave component from the nadir to terminal deflection point coincided with the cranio‐caudal activation of the RA free wall (RAFW) in all types. The bipolar voltage map showed that type 1 had the greater extent of low voltage (<0.5 mV) area (LVA) in RAFW (39 ± 24%) than types 2 and 3 (4 ± 3%) (P < 0.0001), explaining the absence of PTD in type 1. In types 2 and 3, F‐wave amplitude determining the PTD magnitude was highly correlated with the longitudinal distance between two points on RAFW corresponding to the nadir and peak of F‐wave (r = 0.73, P < 0.0001).ConclusionsTerminal positivity and amplitude of F‐wave in typical AFL are primarily related to the RAFW activity: negatively by the extent of LVA and positively by the longitudinal vector of activation.
Spontaneous Dissociated Firing from the Pulmonary Veins during Ablation of Paroxysmal Atrial Fibrillation: Implications and Impact on Arrhythmia‐Free Survival
Authors: HUSSEIN AYMAN A. , OZAKI ASUKA , MARTIN DAVID O. , BHARGAVA MANDEEP , BARANOWSKI BRYAN , DRESING THOMAS , CALLAHAN THOMAS , KANJ MOHAMED , TCHOU PATRICK , NATALE ANDREA , LINDSAY BRUCE D. , SALIBA WALID I. , WAZNI OUSSAMA M. 
Published: April 2013

BackgroundFollowing pulmonary vein isolation (PVI) for the treatment of paroxysmal atrial fibrillation (AF), spontaneous dissociated firing (DiFi) from the isolated veins may be observed. Little is known about the significance and prognostic implications of this phenomenon. We sought to determine the relationship between DiFi and ablation outcomes.MethodsThe study population consisted of 156 paroxysmal AF patients who underwent first time PVI and were found to have spontaneous DiFi from the pulmonary veins (PVs). Their outcomes were compared to a population of 156 propensity‐matched controls from our prospectively maintained AF ablation data registry.ResultsDiFi was most frequently observed from the right superior PV and occurred in 89 patients (57.1%). After 24 months of follow‐up, patients with DiFi had better success rates compared to those with silent veins after isolation (88.5% vs 75%, P = 0.002). The overall distribution of types of recurrent arrhythmia was similar between DiFi patients and their matched controls (P = NS). During repeat ablations, DiFi patients were less likely to have PV conduction recovery (60% vs 93.3%, P = 0.02). Importantly, none of the veins with DiFi during index procedures was found to have conduction recovery.ConclusionIn patients with paroxysmal AF undergoing ablation, DiFi from the PVs after their isolation was associated with improved ablation outcomes. It is possible that DiFi is an indicator of successful durable isolation of the PVs. The findings suggest that confirmation of exit block may be warranted to improve AF ablation outcomes.
Fitness in Naturally Occurring and Restored Populations of a Grassland Plant Lychnis flos‐cuculi in a Swiss Agricultural Landscape
Authors: Aavik Tsipe , Bosshard Daniel , Edwards Peter J. , Holderegger Rolf , Billeter Regula 
Published: April 2013

AbstractWildflower seed mixtures are widely used for restoration of grasslands. However, the genetic and fitness consequences of using seed mixes have not been fully evaluated. Here, we studied the role of genetic diversity, origin (commercial regional seed mixtures, natural populations), and environmental conditions for the fitness of a grassland species Lychnis flos‐cuculi. First, we examined the relationship between genetic diversity, environmental parameters, and fitness in sown and natural populations of this species in a Swiss agricultural landscape. Second, we established an experiment in the study area and in an experimental garden to study the implications of local adaptation for plant fitness. Third, to examine the response of plants to different soil properties, we conducted an experiment in climate chambers, where we grew plants from sown and natural populations of L. flos‐cuculi as well as from seed suppliers on soils with different nutrient and moisture content. We detected no significant effect of genetic diversity on the fitness of sown and natural populations. There was no clear indication that plants from natural populations were better adapted to local environment than plants from sown populations or seed suppliers. However, plants of natural origin invested more into generative reproduction than plants from sown populations or seed suppliers. Furthermore, in the climate chamber, plants originating from natural populations tended to flower earlier. Our results indicate that using nonlocal seeds for habitat recreation may influence restoration success even if the seeds originate from the same seed zone as the restored site.
Initiation of antiretroviral therapy in HIV‐infected tuberculosis patients in rural Kenya: an observational study
Authors: Stockdale Alexander J. , Nkuranga Joseph , Török M. Estée , Faragher Brian , Lalloo David G. 
Published: April 2013

AbstractObjectiveTo provide information on the effect of timing of antiretroviral therapy (ART) initiation on outcomes of TB infection in real‐life, non‐clinical trial, rural settings in sub‐Saharan Africa.MethodsWe conducted an observational cohort study of all HIV‐infected TB patients presenting to a rural hospital in Kenya between 2005 and 2009. We analysed the association between timing of initiation of ART and mortality, using a Cox regression survival analysis, adjusted for measured confounders.ResultsA total of 404 antiretroviral‐naïve HIV/TB coinfected patients were included in the study. Initiation of ART during the first 8 weeks of TB treatment (early group) was not associated with changes in mortality at 1 year compared with initiation of ART after 8 weeks (late group) [Hazard Ratio (HR) = 0.74 (Confidence Interval (CI), 0.33–1.64, P = 0.46]. In patients with baseline CD4 counts ≤50 cells/μl, there was a significant reduction in mortality in the early group compared with the late group (HR = 0.20; 95% CI, 0.042–0.99; P = 0.049). In patients with a CD4 count >50 cells/μl, there was no significant difference between early and late groups (HR 1.79; 95% CI, 0.64–5.03; P = 0.27).ConclusionsWe found that in HIV/TB coinfected patients in rural Kenya, early ART initiation (within 8 weeks) was associated with reduced mortality in those with CD4 counts ≤50 cells/μl. In patients with CD4 counts >50 cells/μl, there was no association seen between timing of ART and mortality.
A Novel Adenovirus Species Associated with an Acute Respiratory Outbreak in a Baboon Colony and Evidence of Coincident Human Infection
Authors: Chiu Charles Y. , Yagi Shigeo , Lu Xiaoyan , Yu Guixia , Chen Eunice C. , Liu Maria , Dick Edward J. , Carey Kenneth D. , Erdman Dean D. , Leland Michelle M. , Patterson Jean L. 
Published: April 2013

ABSTRACT
Adenoviruses (AdVs) are DNA viruses that infect many vertebrate hosts, including humans and nonhuman primates. Here we identify a novel AdV species, provisionally named “simian adenovirus C (SAdV-C),” associated with a 1997 outbreak of acute respiratory illness in captive baboons (4 of 9) at a primate research facility in Texas. None of the six AdVs recovered from baboons (BaAdVs) during the outbreak, including the two baboons who died from pneumonia, were typeable. Since clinical samples from the two fatal cases were not available, whole-genome sequencing of nasal isolates from one sick baboon and three asymptomatic baboons during the outbreak was performed. Three AdVs were members of species SAdV-C (BaAdV-2 and BaAdV-4 were genetically identical, and BaAdV-3), while one (BaAdV-1) was a member of the recently described SAdV-B species. BaAdV-3 was the only AdV among the 4 isolated from a sick baboon, and thus was deemed to be the cause of the outbreak. Significant divergence (<58% amino acid identity) was found in one of the fiber proteins of BaAdV-3 relative to BaAdV-2 and -4, suggesting that BaAdV-3 may be a rare SAdV-C recombinant. Neutralizing antibodies to the other 3 AdVs, but not BaAdV-3, were detected in healthy baboons from 1996 to 2003 and staff personnel from 1997. These results implicate a novel adenovirus species (SAdV-C) in an acute respiratory outbreak in a baboon colony and underscore the potential for cross-species transmission of AdVs between humans and nonhuman primates.

IMPORTANCE
Adenoviruses (AdVs) are DNA viruses that infect many animals, including humans and monkeys. In 1997, an outbreak of acute respiratory illness from AdVs occurred in a baboon colony in Texas. Here we use whole-genome sequencing and antibody testing to investigate new AdVs in baboons (BaAdVs) during the outbreak, one of which, BaAdV-3, came from a sick animal. By sequence analysis, BaAdV-3 may be a recombinant strain that arose from a related BaAdV found in baboons nearby in the colony (who were not sick) and yet another unknown AdV. We also found antibodies to these new BaAdVs in baboons and staff personnel at the facility. Taken together, our findings of a new AdV species as the cause of an acute respiratory outbreak in a baboon colony underscore the ongoing threat from emerging viruses that may carry the potential for cross-species transmission between monkeys and humans.
FULFILLING THE END OF LIFE WISH OF AN AWAKE CRITICALLY ILL PATIENT PRIOR TO WITHDRAWAL OF ORGAN SUPPORT
Authors: Philpot S , Johns S 
Published: April 2013

BackgroundA high proportion of hospital deaths occur in Intensive Care. Most of these patients are unable to communicate immediately prior to their death due to illness, sedation, intubation and mechanical ventilation.AimTo describe how we were able to fulfil the dying wish of an ICU patient to spend an afternoon at home with family, despite ongoing requirement for intensive organ supports. We describe the positive impact of the visit on the patient, her family, and staff.MethodA 58-year-old lady spent over 4 months in our Intensive Care Unit following a bilateral lung transplant which was complicated by respiratory and renal failure. She was dependent upon mechanical ventilation and continuous renal replacement therapy, but was able to fully communicate her wishes. A decision was made to withdraw cardio-respiratory and renal support on the grounds of futility of ongoing active management.Results/DiscussionThe patient was safely transported. During the visit, she commented to her family that she was at peace, and ready to die, something that she had not previously felt. This provided closure for the patient and her family, and significantly helped her family come to terms with her impending withdrawal of respiratory support. She was transported back to the Intensive Care Unit after her home visit, and died the following day after withdrawal of respiratory support.ConclusionExtra-ordinary measures taken to fulfil the dying wishes of our patient were able to significantly improve the dying experience for her and her family.
IS IT APPROPRIATE TO INITIATE PALLIATIVE CARE IN A PAEDIATRIC INTENSIVE CARE UNIT (PICU)?
Authors: Crowe L , Herbert A , Mattke A 
Published: April 2013

BackgroundPaediatric Palliative care is being redefined as medical technology and advancements can at times ‘make death an option’. Children with life limiting conditions can now be on palliative care for years making the boundaries for limitations challenging. The team at the Mater Children's PICU work closely with the Paediatric Palliative Care Service and are a major source of early referrals for children with complex and life limiting conditions.AimReview the referral process for children to the Queensland paediatric palliative care service from PICU.MethodsUsing our electronic chart system we identified 54 patients who had been referred to the palliative care service since 2008. Using thematic analysis we reviewed who initiated discussions, what patient descriptors were associated with referral, common themes and outcomes.ResultsThe majority of children referred had complex medical needs. PICU referral to Palliative Care introduced a greater focus on quality of life and the concept of limiting aggressive care.DiscussionPICU is often viewed as an acute medical environment and not one where palliation discussions for complex long term patients occur. However we found that due to the critical nature of PICU it is often time for a holistic review of the medical history; child and family goals and a focus on quality of life.ConclusionThe PICU team have extensive experience in talking about end of life issues and are ideally placed to work with the Palliative Care Service to initiate referrals, enhance management of subsequent crises and maximise quality of life in PICU and on discharge.
TELEPHONIC ADVANCE CARE PLANNING FACILITATED BY HEALTH PLAN CASE MANAGERS
Authors: Boettcher I , Turner R 
Published: April 2013

BackgroundPriority Health Case Managers (CMs) work telephonically with frail patients that have multiple co-morbidities. CMs have lacked facilitation skills for Advance Care Planning (ACP) discussions in this vulnerable population. Following a 6-month pilot of telephonic ACP (TACP) in the Medicare population, TACP was implemented for the entire Medicare CM staff.AimTo engage identified patients in First Steps© and Last Steps© TACP.MethodsCMs were trained and certified by Respecting Choices© to facilitate ACP discussions telephonically with both First Steps© and Last Steps© protocols. CMs identified appropriate patients using hospitalisation and emergency room utilisation data, severity of illness and diagnostic criteria. The primary goal was to complete both the ACP discussion and document for each protocol on identified patients. CMs also attempted to schedule facilitated conversations with the health care advocate present.ResultsIn one calendar year, 155 patients were identified for TACP using established criteria. 59% indicated they had an existing document identifying preferences for medical care. 35% declined TACP. Last Steps© discussions occurred in 15% of the patients. TACP resulted in eight new or updated documents.DiscussionFollowing TACP implementation to the Medicare CM team and evaluation of the results, processes and methods were instituted to increase engagement and completion of discussions and documents. These included enhancements to the electronic assessment and ongoing support of the CM team to increase engagement of patient and advocate.ConclusionDissemination of the project to the entire Medicare CM team demonstrates opportunities and lessons learned for facilitated TACP discussions.
THE PRACTICALITIES OF CROSS BOUNDARY WORKING IN RESPECT OF ACP FOR CARE HOME WITH NURSING RESIDENTS
Authors: Thorn M , Bloomer C 
Published: April 2013

BackgroundWithin a care home with nursing reviewing the use of ACP to prevent inappropriate hospital admissions at end of life and the use of ACP to prevent delayed discharge from a General Hospital back to the care home.Review of admission data from a care home to general hospital and on the number of admissions resulting in hospital deaths compared to care home deaths during the last 2 years.AimTo highlight the importance of ACP, relationships with the hospital discharge team and community multi-disciplinary teams and how it successfully prevents inappropriate delayed discharges back to the care home setting.MethodWe reviewed hospital admissions over the last 2 years, including who had an ACP, the interactions between the care home with the hospital, the length of hospital stay, and an audit of the feedback received from relatives and residents.Also looking at more recent work providing ‘step up’ and ‘step down’ beds to support a local district general hospital and how having an ACP in place benefits patients.ResultsThis review is on-going (will be completed by end of March 2013) but early results suggest that where an ACP is in place the resident returns to the care home more quickly and both resident and family are more satisfied with the episode of care.DiscussionChallenges in the practicalities such as extracting information from different teams of professionals involved in the resident's care. The importance of building positive relationships with hospital wards and discharge teams.Ensuring correct documentation re ACP goes into hospital with resident.ConclusionThe benefits of developing good cross boundary relationships with hospital teams and the importance of ACP helping prevent delayed discharges.
LOW FOOD INTAKE IN OLDER PEOPLE WITH DEMENTIA
Authors: Rajaram S , Chua H C 
Published: April 2013

AimThe aim of the study was to investigate the risk factors associated with older people in acute care setting for developing low food intake.BackgroundEating difficulties among patients with dementia have been identified in Western countries and they progress when dementia advances. Previous studies have indicated that low food intake and weight loss is not a result of people with dementia not willing to eat independently.DesignThe study consisted of nurses observing meal time observations. Observation was done for 3 days during lunch and dinner time.Methods17 participants were selected from patients with dementia from 2 geriatric units in an acute care hospital. Data was collected using the Barthel index, Mini Mental State Examination (MMSE) and Edinburgh Feeding Evaluation in Dementia (EdFED)ResultsThe prevalence of low food intake at meals in patients with dementia in the acute care unit was about 10%. Eating difficulty, no feeding assistance, moderate dependence, few family visits, being female and older were six independent factors associated with low food intake.ConclusionNurses needed to assess the patients feeding ability to continue to self feed. To supervise the feeding of the patients with moderate dependency and appropriate verbal or physical assistance at meal times is recommended.Relevance to clinical practice: Strategies to encourage families to visit their older relatives in acute care units is encouraged and recommended.
DIAGNOSING DYING: WHEN WE MISS THE BOAT
Authors: Corke Charlie 
Published: April 2013

As good as Advance Care Planning (by both doctors and patients) may become we will still be confronted by the acutely deteriorating patient who will die without treatment—but might well have their death miserably prolonged by treatment. These decisions confront us on a daily basis.Good medicine requires doctors to assist patients to make good decisions (a decision ie, right for that patient at that time).This requires skills that are rarely taught but can be learned.The decision making process in a high risk situation (death vs suffering) is complex.The decision-making process requires two important components:an understanding of the natural history of the disease that the patient has (without undue optimism)an understanding of the person themselves (their values, wishes and fears).Balancing the person (with their values, wishes and fears) with the medical situation that they find themselves in often reveals a clear treatment choice.The thought process can help both the patient and the doctor arrive at a ‘good’ answer—and hopefully informs a shared decision.The ‘When Enough-is-Enough’ course teaches this concept in a straightforward way that empowers junior doctors to explore their patient's values.The concept is not new: In the early 1900s the great physician, Sir William Osler stated:“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”His words are more pertinent today than ever.
SPECIALIST PALLIATIVE CARE SERVICE RESPONSIBILITY TO SUPPORT PRIMARY CARE PROVIDERS IN CARE PLANNING AND END OF LIFE CARE: A REVIEW
Authors: Cole M 
Published: April 2013

BackgroundFollowing a gradual but consistent increase in requests from within Castlemaine Health, a review of service provision by the Community Palliative Care Service (CPCS) was undertaken to determine a sustainable level of support to Primary Care Services.AimAlthough this is a small rural service, the CPCS should provide support to primary care services during an episode of a person's care. This includes promotion of a palliative approach across all care settings and to the community in general.MethodsData for the previous 2 years was reviewed to identify episodes of shared care or consultation to primary care providers; Key stakeholders interviewed and responses grouped into themes of need/support; Education provided and evaluated; Stakeholder review to determine perceived benefit.ResultsThe number of shared care or ‘consultation’ episodes was not reflected in the data due to limited reporting fields and inconsistency of data entry. Stakeholders agreed that palliative care occurs across all settings but recognition by primary care staff continues to be low. There was a perceived need to increase staff confidence in abilities, recognising transition of care (phases) and reviewing Advance Care Plans. Two education programmes were provided with 47 staff attending. On 10 point scale there was a shift of +2/+2.2 respectively in knowledge of after education.DiscussionAccess to Palliative Care Staff on a regular basis increases staff confidence within Primary Care Services.ConclusionIncreased support and direct promotion of the Palliative Care Service is beneficial for assessment and care planning across Primary Care Services.
ETHICAL ISSUES FOR JAPANESE NURSES IN END-OF-LIFE CARE: FROM ANALYSIS OF THE ANGUISH OF NURSES IN AN ACUTE WARD
Authors: Kiyama M , Morishita N , Tajima H 
Published: April 2013

BackgroundIn Japan, many clinical nurses experience ethical dilemmas in daily nursing practice that cannot be resolved easily. Nurses feel strong regret in particular in cases in which the patient is at the end of life. Accordingly, based on one end-of-life case we elucidated the aspects of the patient's condition and the thoughts and disorientation of the nurses.AimTo consider ethical issues for clinical nurses in end-of-life care.MethodsWe surveyed seven nurses on the nursing team involved in this case, through group interviews. The interviews concerned topics including nursing policies and plans, the content of conferences, and the dilemmas nurses experienced.ResultsThrough data analysis, we identified 63 codes, 25 subcategories, and six core categories. While admitted, the patient constantly used the nurse-call for various reasons. She made particularly many calls during the postoperative acute stage and the postoperative recovery stage. In the postoperative acute stage, the nurses anticipated a danger when hearing the nurse-call, immediately answered the call, and went to her room to take appropriate action. However, during the postoperative recovery stage, the nurses were not aware of her sense of anxiety and were confused by the patient's frequent nurse-calls, even during recovery.DiscussionGaps developed between the patient's thoughts and the ethical assumptions of nurses in end-of-life care. This gap was due to differences in each other's goals.ConclusionThis study will support promotion, from the nurse's point of view, of the provision of medical care that satisfies patients, which has not advanced smoothly in Japan.