bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic indicators of 6-month mortality in elderly people with advanced dementia: A systematic review
Authors: Brown Meghan A , Sampson Elizabeth L , Jones Louise , Barron Anna M 
Published: November 2012

Background: For end-of-life dementia patients, palliative care offers a better quality of life than continued aggressive or burdensome medical interventions. To provide the best care options to dementia sufferers, validated, reliable, sensitive, and accurate prognostic tools to identify end-of-life dementia stages are necessary. Aim: To identify accurate prognosticators of mortality in elderly advanced dementia patients consistently reported in the literature. Design: Systematic literature review. Data sources: PubMed, Embase, and PsycINFO databases were searched up to September 2012. Reference lists of included studies were also searched. Inclusion criteria were studies measuring factors specifically related to 6-month outcome in patients diagnosed with dementia in any residential or health-care setting. Results: Seven studies met the inclusion criteria, five of which were set in the United States and two in Israel. Methodology and prognostic outcomes varied greatly between the studies. All but one study found that Functional Assessment Staging phase 7c, currently widely used to assess hospice admission eligibility in the United States, was not a reliable predictor of 6-month mortality. The most common prognostic variables identified related to nutrition/nourishment, or eating habits, followed by increased risk on dementia severity scales and comorbidities. Conclusions: Although the majority of studies agreed that the Functional Assessment Staging 7c criterion was not a reliable predictor of 6-month mortality, we found a lack of prognosticator concordance across the literature. Further studies are essential to identify reliable, sensitive, and specific prognosticators, which can be applied to the clinical setting and allow increased availability of palliative care to dementia patients.
Hospice experiences and approaches to support and assess family caregivers in managing medications for home hospice patients: A providers survey
Authors: Joyce Brian T , Lau Denys T 
Published: November 2012

Background: Hospice providers need to ensure that informal, unpaid caregivers can safely manage medications to alleviate pain and distressing symptoms in patients near the end of life. Aim: This study characterizes hospice providers’ self-reported experiences and approaches to helping caregivers’ medication management for home hospice patients. Design: Survey with mixed-method analysis. Setting/Participants: Surveys were administered to a convenience sample of 98 hospice providers (74 nurses, 6 physicians, 11 social workers, 7 chaplains) from 5 Chicago-based agencies in the United States. Results: Among respondents, 67% rated ensuring proper medication management as “most important” in hospice care delivery, and 33% reported frequently encountering caregivers with problems managing medications. To assess if caregivers had problems managing medications, two categories of approaches emerged from the data: prospective approaches and retrospective warning signs when a problem occurred (e.g. identifying medication nonadherence after observing a sudden patient health decline). Overall, 42% reported using at least one prospective approach, while 38% reported only retrospective signs. To help caregivers manage medications, three categories of approaches emerged: teaching to increase knowledge, supporting existing or simplifying medication management process, and counseling to overcome attitudinal barriers. Overall, 6% reported approaches from all three categories. About 28% frequently experienced difficulty teaching/supporting caregivers with medication management. As much as 47% believed that they would benefit “to a great extent” from additional resources to help caregivers. Conclusions: Supporting caregivers in medication management is considered important, yet challenging, to hospice providers. Additional resources may be needed to help providers consistently and effectively teach, support, and assess caregivers’ medication management.
A qualitative study: Professionals’ experiences of advance care planning in dementia and palliative care, ‘a good idea in theory but …’
Authors: Robinson Louise , Dickinson Claire , Bamford Claire , Clark Alexa , Hughes Julian , Exley Catherine 
Published: November 2012

Background: Advance care planning comprises discussions about an individual’s wishes for future care while they have capacity. Aim: To explore professionals’ experiences on the implementation of advance care planning in two areas of clinical care, dementia and palliative care. Design: Qualitative study, focus groups and individual interviews. Setting: North East of England. Sample: Ninety-five participants from one Primary Care Trust, two acute National Health Service Hospital Trusts, one Ambulance Trust, one Local Authority and voluntary organisations and the legal sector. Results: Fourteen focus groups and 18 interviews were held with 95 participants. While professionals agreed that advance care planning was a good idea in theory, implementation in practice presented them with significant challenges. The majority expressed uncertainty over the general value of advance care planning, whether current service provision could meet patient wishes, their individual roles and responsibilities and which aspects of advance care planning were legally binding; the array of different advance care planning forms and documentation available added to the confusion. In dementia care, the timing of when to initiate advance care planning discussions was an added challenge. Conclusions: This study has identified the professional, organisational and legal factors that influence advance care planning implementation; professional training should target these specific areas. There is an urgent need for standardisation of advance care planning documentation. Greater clarity is also required on the roles and responsibilities of different professional groups. More complex aspects of advance care planning may be better carried out by those with specialist skills and experience than by generalists caring for a wide range of patient groups with different disease trajectories.
Off-label prescribing in palliative care: A survey of independent prescribers
Authors: Culshaw Joseph , Kendall David , Wilcock Andrew 
Published: November 2012

Background: The ‘off-label’ use of a drug beyond the specifications of its Marketing Authorization is widespread in palliative care.It is legal, but there are implications for prescribers, outlined by regulatory bodies such as the General Medical Council. A previous survey suggested that few doctors in palliative medicine always follow these recommendations. Aim: To obtain a contemporary view of how medical and non-medical independent prescribers adhere to current regulatory guidance. Design: Selected doctor, nurse and all pharmacist members of www.palliativedrugs.com from the United Kingdom were invited to complete an online questionnaire. There were 332 respondents, a response rate of 9% based on number of e-mails delivered. Most worked within an inpatient hospice, although for nurses it was the community; there was a wide range of experience. Results: Few respondents (15%) reported that their services operated a policy on providing information about off-label use. Most (65%) would always make a clear record of the drug prescribed, and this was highest for doctors, with 39%–73% always operating in line with the ‘must do’ aspects of General Medical Council guidance. This proportion was lower for nurse (42%–55%) and pharmacist (0%–30%) responders in part because their guidance is based on the previous, less pragmatic General Medical Council guidance. Examples given for off-label use, together with general comments, provided additional insight into respondents’ practice. Conclusions: Compared to before and to nurse and pharmacist prescribers, doctors appear better able to adhere to their regulatory body guidance. Given that all the independent prescribers in palliative care can prescribe the same drugs, consistent regulatory guidance is required.
Three-Dimensional Evaluation of Cyclic Displacement in Single-Row and Double-Row Rotator Cuff Reconstructions Under Static External Rotation
Authors: Lorbach Olaf , Kieb Matthias , Raber Florian , Busch Lüder C. , Kohn Dieter M. , Pape Dietrich 
Published: November 2012

Background: The double-row suture bridge repair was recently introduced and has demonstrated superior biomechanical results and higher yield load compared with the traditional double-row technique. It therefore seemed reasonable to compare this second generation of double-row constructs to the modified single-row double mattress reconstruction. Hypothesis: The repair technique, initial tear size, and tendon subregion will have a significant effect on 3-dimensional (3D) cyclic displacement under additional static external rotation of a modified single-row compared with a double-row rotator cuff repair. Study Design: Controlled laboratory study. Methods: Rotator cuff tears (small to medium: 25 mm; medium to large: 35 mm) were created in 24 human cadaveric shoulders. Rotator cuff repairs were performed as modified single-row or double-row repairs, and cyclic loading (10-60 N, 10-100 N) was applied under 20° of external rotation. Radiostereometric analysis was used to calculate cyclic displacement in the anteroposterior (x), craniocaudal (y), and mediolateral (z) planes with a focus on the repair constructs and the initial tear size. Moreover, differences in cyclic displacement of the anterior compared with the posterior tendon subregions were calculated. Results: Significantly lower cyclic displacement was seen in small to medium tears for the single-row compared with double-row repair at 60 and 100 N in the x plane ( P = .001) and y plane ( P = .001). The results were similar in medium to large tears at 100 N in the x plane ( P = .004). Comparison of 25-mm versus 35-mm tears did not show any statistically significant differences for the single-row repairs. In the double-row repairs, lower gap formation was found for the 35-mm tears ( P ≤ .05). Comparison of the anterior versus posterior tendon subregions revealed a trend toward higher anterior gap formation, although this was statistically not significant. Conclusion: The tested single-row reconstruction achieved superior results in 3D cyclic displacement to the tested double-row repair. Extension of the initial rupture size did not have a negative effect on the biomechanical results of the tested constructs. Clinical Relevance: Single-row repairs with modified suture configurations provide comparable biomechanical strength to double-row repairs. Furthermore, as increased gap formation in the early postoperative period might lead to failure of the construct, a strong anterior fixation and restricted external rotation protocol might be considered in rotator cuff repairs to avoid this problem.
In vitro evaluation of the L-peptide modified magnetic lipid nanoparticles as targeted magnetic resonance imaging contrast agent for the nasopharyngeal cancer
Authors: Chen Yung-Chu , Min Chia-Na , Wu Han-Chung , Lin Chin-Tarng , Hsieh Wen-Yuan 
Published: November 2012

The purpose of this study was to analyze the encapsulation of superparamagnetic iron oxide nanoparticles (SPION) by the lipid nanoparticle conjugated with the 12-mer peptides (RLLDTNRPLLPY, L-peptide), and the delivery of this complex into living cells. The lipid nanoparticles employed in this work were highly hydrophilic, stable, and contained poly(ethylene-glycol) for conjugation to the bioactive L-peptide. The particle sizes of two different magnetic lipid nanoparticles, L-peptide modified (LML) and non-L-peptide modified (ML), were both around 170 nm with a narrow range of size disparity. The transversal relaxivity, r2, for both LML and ML nanoparticles were found to be significantly higher than the longitudinal relaxivity r1 (r2/r1 > 20). The in vitro tumor cell targeting efficacy of the LML nanoparticles were evaluated and compared to the ML nanoparticles, upon observing cellular uptake of magnetic lipid nanoparticles by the nasopharyngeal carcinoma cells, which express cell surface specific protein for the L-peptide binding revealed. In the Prussian blue staining experiment, cells incubated with LML nanoparticles indicated much higher intracellular iron density than cells incubated with only the ML and SPION nanoparticles. In addition, the MTT assay showed the negligible cell cytotoxicity for LML, ML and SPION nanoparticles. The MR imaging studies demonstrate the better T2-weighted images for the LML-nanoparticle-loaded nasopharyngeal carcinoma cells than the ML- and SPION-loaded cells.
Open Patellar Tendon Debridement for Treatment of Recalcitrant Patellar Tendinopathy
Authors: Gill Thomas J. , Carroll Kaitlin M. , Hariri Sonaz 
Published: November 2012

Background: Patellar tendinopathy can be treated surgically for patients that have failed at least 1 year of nonoperative treatment who continue to have debilitating symptoms. Patellar tendinopathy can cause significant functional deficits, yet little has been reported about the operative treatment of patellar tendinopathy. Hypothesis: A combined arthroscopic and open surgical technique for the treatment of recalcitrant patellar tendinopathy results in an improvement in function and pain at a minimum 2-year follow-up. The purpose of this study was to present the indications, combined surgical technique, rehabilitation protocol, and the 2-year minimum follow-up results of the operative treatment of recalcitrant patellar tendinopathy. Study Design: Retrospective case series. Methods: A retrospective review was performed of all patients who underwent a surgical primary patellar tendon debridement for recalcitrant patellar tendinopathy by a single surgeon between July 1999 and December 2005. Every patient failed at least 1 year of nonoperative treatment. Patients were excluded from the study if they had previous open knee surgery. Validated patient-reported outcome scores were used to assess function and pain levels pre- and postoperatively (Lysholm, International Knee Documentation Committee, Tegner activity, and visual analog pain score). Results: Thirty-four consecutive patients (37 consecutive cases) with mean follow-up 3.8 ± 1.6 years (range, 2-7.6 years) underwent the procedure with no complications. The mean age at surgery was 29 years (range, 14-51 years). Postoperatively, the visual analog score decreased by an mean of 6 points (range, 1 to −10, P < 0.001), and patients were able to return to their preinjury Tegner activity level. When asked if they were satisfied by the overall outcome of their surgery, 28 patients (82%) were completely or mostly satisfied with their surgical outcome on a particular knee; 6 (18%) were somewhat satisfied; and 2 (6%) were dissatisfied. Twenty-seven patients (79%) said they would have the surgery again. Conclusion: The combined arthroscopic and open surgical technique described for chronic recalcitrant patellar tendinopathy successfully reduces knee pain and allows return to preinjury level of activity.
Pulmonary gas transfer in children and adolescents born extremely preterm
Authors: Satrell Emma , Røksund Ola , Thorsen Einar , Halvorsen Thomas 
Published: November 2012

In extremely preterm-born infants, gas exchange takes place in developmentally fetal lungs, disturbing normal acinar growth and differentiation, potentially with long term negative consequences for lung function. The aim was to compare alveolar function in children and adolescents born extremely preterm and at term by measuring diffusing capacity of the lung for carbon monoxide (DLCO). Since this procedure may be challenging for subjects with shortcomings often seen after extremely preterm birth, we also assessed the reproducibility of the method.DLCOandDLCOadjusted for lung volume (KCO) were measured twice within 2 weeks in two population-based cohorts born at gestational age ≤28 weeks or with birth weight ≤1000 g, aged 10.6 years (n = 35) and 17.7 years (n = 46), and in 81 term-born controls individually matched for sex, age and place of birth.Reproducibility ofDLCOmeasurements was in the same range for preterm and term-born children and young adults, and coefficients of variation were below 10% for all subgroups.KCOwas significantly reduced with 7.9% and 7.2% for the oldest and youngest preterm birth cohorts, respectively.Reproducibility ofDLCOin children and young adults born extremely preterm was adequate.DLCOandKCOwere modestly reduced, supporting recent reports suggesting continuing alveolar growth throughout childhood.
Simvastatin inhibits smoke-induced airway epithelial injury: implications for COPD therapy
Authors: Davis Benjamin B. , Zeki Amir A. , Bratt Jennifer M. , Wang Lei , Filosto Simone , Walby William F. , Kenyon Nicholas J. , Goldkorn Tzipora , Schelegle Edward S. , Pinkerton Kent E. 
Published: November 2012

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death. The statin drugs may have therapeutic potential in respiratory diseases such as COPD, but whether they prevent bronchial epithelial injury is unknown. We hypothesised that simvastatin attenuates acute tobacco smoke-induced neutrophilic lung inflammation and airway epithelial injury.Spontaneously hypertensive rats were given simvastatin (20 mg·kg−1i.p.) daily for either 7 days prior to tobacco smoke exposure and during 3 days of smoke exposure, or only during tobacco smoke exposure.Pretreatment with simvastatin prior to and continued throughout smoke exposure reduced the total influx of leukocytes, neutrophils and macrophages into the lung and airways. Simvastatin attenuated tobacco smoke-induced cellular infiltration into lung parenchymal and airway subepithelial and interstitial spaces. 1 week of simvastatin pretreatment almost completely prevented smoke-induced denudation of the airway epithelial layer, while simvastatin given only concurrently with the smoke exposure had no effect.Simvastatin may be a novel adjunctive therapy for smoke-induced lung diseases, such as COPD. Given the need for statin pretreatment there may be a critical process of conditioning that is necessary for statins’ anti-inflammatory effects. Future work is needed to elucidate the mechanisms of this statin protective effect.
Exercise tolerance with helium-hyperoxiaversushyperoxia in hypoxaemic patients with COPD
Authors: Queiroga Fernando , Nunes Marcos , Meda Ethiane , Chiappa Gaspar , Machado Maria Christina , Nery Luiz Eduardo , Neder J. Alberto 
Published: November 2012

The purpose of this study was to investigate whether helium-hyperoxia (HeHOx) would allow greater tolerance to maximal and submaximal exercise compared to hyperoxia (HOx) on isolation in hypoxaemic chronic obstructive pulmonary disease (COPD) patients under long-term oxygen therapy.In a double-blind study, 24 males in the Global Initiative for Chronic Obstructive Lung Disease functional class IV (forced expiratory volume in 1 s 35.2±10.1% predicted and arterial oxygen tension 56.2±7.5 mmHg) were submitted to incremental and constant load cycling at 70–80% peak work rate while breathing HOx (60% nitrogen and 40% oxygen) or HeHOx (60% helium and 40% oxygen).HeHOx improved resting airflow obstruction and lung hyperinflation in all but two patients (p<0.05). Peak work rate and time to exercise intolerance were higher with HeHOx than HOx in 17 (70.8%) out of 24 patients and 14 (66.6%) out of 21 patients, respectively (p<0.05). End-expiratory lung volumes were lower with HeHOx, despite a higher ventilatory response (p<0.05). HeHOx speeded on-exercise oxygen uptake kinetics by ∼30%, especially in more disabled and hyperinflated patients. Fat-free mass was the only independent predictor of higher peak work rate with HeHOx (r2= 0.66, p<0.001); in contrast, none of the resting characteristics or exercise responses were related to improvements in time to exercise intolerance (p>0.05).Helium is a valuable ergogenic aid when added to HOx for most long-term oxygen therapy-dependent patients with advanced COPD.
Effect of oxidative stress on respiratory epithelium from children with Down syndrome
Authors: Bruijn Martijn , Lutter René , Eldering Eric , Bos Albert P. , van Woensel Job B.M. 
Published: November 2012

Children with Down syndrome are at high risk for acute respiratory distress syndrome. In Down syndrome, both regulation of inflammation and apoptosis, important in acute respiratory distress syndrome pathophysiology, are abnormal. This has been linked to an imbalance in free radical scavengers. We investigated the expression of free radical scavengers and the effect of oxidative stress in terms of apoptosis and inflammation in respiratory epithelium from children with Down syndrome compared with control subjects.We cultured primary nasal epithelial cells from Down syndrome children (n=12) and controls (n=17) and exposed them to oxidative stress by supplementing superoxide.First we showed that the expression of the free radical scavengers CuZn-superoxide dismutase was 28% higher (p=0.06), catalase was 36% lower (p=0.04) and glutathione peroxidase was 73% lower (p=0.004) in Down syndrome children compared with controls. We found no significant difference in apoptosis, between Down syndrome and control subjects after exposure to oxidative stress. We also found no significant difference in levels of interleukin (IL)-1β, IL-6, IL-8, vascular endothelial growth factor and granulocyte colony-stimulating factor in primary nasal epithelial cell supernatant after exposure to oxidative stress between Down syndrome and control subjects.We found an imbalance in free radical scavengers in respiratory epithelial cells from children with Down syndrome, but this did not result in increased levels of either apoptosis or inflammation upon exposure to oxidative stress.
Determinants of, and reference equation for, exhaled nitric oxide in the Chinese population
Authors: Ko Fanny W.S. , Leung Ting F. , Wong Gary W.K. , Chu Jojo H.Y. , Sy Hing Y. , Hui David S.C. 
Published: November 2012

Measurement of fractional exhaled nitric oxide concentration (FeNO) has been proposed as a useful biomarker for monitoring and management of airway diseases. Limited information is available regarding reference levels ofFeNOlevels in Chinese adults. This study aimed to investigate the reference equation and determinants ofFeNOin Chinese adults.1093 (577 males) healthy nonsmoking subjects aged 18–90 years were recruited.FeNOwas measured online using a chemiluminescence analyser. Other assessments included spirometry, skin prick tests, total serum IgE levels and eosinophil count in peripheral blood.The geometric meanFeNOwas 32.6 (95% reference interval (RI) 31.4–33.7) ppb for all subjects.FeNOvalues were higher in males than females (geometric mean (95% RI) 38.3 (36.5–40.2) ppbversus27.1 (25.8–28.5) ppb, p<0.0001), and in atopic than nonatopic subjects (34.6 (33.0–36.3) ppbversus29.8 (28.3–31.4) ppb, p<0.0001).FeNOcorrelated with age (r2= 0.23), height (r2= 0.20), IgE level (r2= 0.18) and percentage eosinophil count (r2= 0.18) (all p<0.0001), but not with spirometric parameters. Based on multiple regression modelling, the reference equation ofFeNOvalue was:log(FeNO) = 0.781 + 0.104(sex) + 0.004(age) + 0.084(atopy) + 0.003(height in cm), where for sex 1 = male and 0 = female, age is measured in years, for atopy 1 = atopic and 0 = nonatopic, and height is measured in cm.TheFeNOof Chinese adults is higher than that of the Caucasian population, and is affected by age, sex, height and atopic status. This study provides useful references for the interpretation ofFeNO.