bluuebunny/crossref_metadata_2025_split huggingface dataset:
Magnetic resonance imaging-directed transperineal limited-mapping prostatic biopsies to diagnose prostate cancer: a Scottish experience
Authors: Mukherjee Ankur , Morton Simon , Fraser Sioban , Salmond Jonathan , Baxter Grant , Leung Hing Y 
Published: October 2014

Background Transperineal prostatic biopsy is firmly established as an important tool in the diagnosis of prostate cancer. The benefit of additional imaging (magnetic resonance imaging) to target biopsy remains to be fully addressed. Methods Using a cohort of consecutive patients undergoing transperineal template mapping biopsies, we studied positive biopsies in the context of magnetic resonance imaging findings and examined the accuracy of magnetic resonance imaging in predicting the location of transperineal template mapping biopsies-detected prostate cancer. Results Forty-four patients (mean age: 65 years, range 53–78) underwent transperineal template mapping biopsies. Thirty-four patients had 1–2 and 10 patients had ≥3 previous transrectal ultrasound scan-guided biopsies. The mean prostate-specific antigen was 15 ng/mL (range 2.5–79 ng/mL). High-grade prostatic intraepithelial neoplasia was found in 12 (27%) patients and prostate cancer with Gleason <7, 7 and >7 in 13, 10 and 8 patients, respectively. Suspicious lesions on magnetic resonance imaging scans were scored from 1 to 5. In 28 patients, magnetic resonance imaging detected lesions with score ≥3. Magnetic resonance imaging correctly localised transperineal template mapping biopsies-detected prostate cancer in a hemi-gland approach, particularly in a right to left manner (79% positive prediction rate), but not in a quadrant approach (33% positive prediction rate). Conclusion Our findings support the notion of magnetic resonance imaging-based selection of patients for transperineal template mapping biopsies and that lesions revealed by magnetic resonance imaging are likely useful for targeted biopsies.
Early Trophic Enteral Nutrition Is Associated With Improved Outcomes in Mechanically Ventilated Patients With Septic Shock
Authors: Patel Jayshil J. , Kozeniecki Michelle , Biesboer Annie , Peppard William , Ray Ananda S. , Thomas Seth , Jacobs Elizabeth R. , Nanchal Rahul , Kumar Gagan 
Published: October 2014

Purpose: Current guidelines provide weak recommendations for starting enteral nutrition (EN) in patients with septic shock (on vasopressor support). Outcomes of patients receiving EN in septic shock on vasopressor support have not been well studied. We hypothesize that early trophic EN in mechanically ventilated patients with septic shock is associated with improved outcomes. Methods: Single-center retrospective study of mechanically ventilated patients admitted with septic shock to identify patients receiving (1) no EN, (2) <600 kcal/d within 48 hours, and (3) ≥600 kcal/d within 48 hours. Outcomes studied included in-hospital mortality, length of intensive care unit stay (LOS), duration of mechanical ventilation (DOMV), and complications of feeding intolerance. Results: Sixty-six patients were identified. In all, 15 received no EN, 37 received <600 kcal/d, and 14 received ≥600 kcal/d EN daily. Median LOS was 12, 5, and 13 days, respectively. The LOS was lower in patients receiving <600 kcal/d when compared to either no EN ( P < .001) or those receiving ≥600 kcal/d ( P < .001). Median DOMV was lower in patients receiving <600 kcal/d (median 3, P < .001) as compared to no EN (median 7, P < .001) or those receiving ≥600 kcal/d (median 7.5, P < .001). Mortality was not different. There were no significant complications among groups. Conclusion: In patients with septic shock, those receiving <600 kcal/d EN within 48 hours had lower DOMV and LOS when compared to those who did not receive EN or those who received ≥600 kcal/d. These observations provide strong justification for prospective evaluation of the effect of early trophic EN in patients with septic shock.
Validation of the Hospital Ethical Climate Survey for older people care
Authors: Suhonen Riitta , Stolt Minna , Katajisto Jouko , Charalambous Andreas , Olson Linda L 
Published: October 2014

Background: The exploration of the ethical climate in the care settings for older people is highlighted in the literature, and it has been associated with various aspects of clinical practice and nurses’ jobs. However, ethical climate is seldom studied in the older people care context. Valid, reliable, feasible measures are needed for the measurement of ethical climate. Objectives: This study aimed to test the reliability, validity, and sensitivity of the Hospital Ethical Climate Survey in healthcare settings for older people. Design: A non-experimental cross-sectional study design was employed, and a survey using questionnaires, including the Hospital Ethical Climate Survey was used for data collection. Data were analyzed using descriptive statistics, inferential statistics, and multivariable methods. Participants and research context: Survey data were collected from a sample of nurses working in the care settings for older people in Finland (N = 1513, n = 874, response rate = 58%) in 2011. Ethical considerations: This study was conducted according to good scientific inquiry guidelines, and ethical approval was obtained from the university ethics committee. Results: The mean score for the Hospital Ethical Climate Survey total was 3.85 (standard deviation = 0.56). Cronbach’s alpha was 0.92. Principal component analysis provided evidence for factorial validity. LISREL provided evidence for construct validity based on goodness-of-fit statistics. Pearson’s correlations of 0.68–0.90 were found between the sub-scales and the Hospital Ethical Climate Survey. Discussion: The Hospital Ethical Climate Survey was found able to reveal discrimination across care settings and proved to be a valid and reliable tool for measuring ethical climate in care settings for older people and sensitive enough to reveal variations across various clinical settings. Conclusion: The Finnish version of the Hospital Ethical Climate Survey, used mainly in the hospital settings previously, proved to be a valid instrument to be used in the care settings for older people. Further studies are due to analyze the factor structure and some items of the Hospital Ethical Climate Survey.
Sustaining hope as a moral competency in the context of aggressive care
Authors: Peter Elizabeth , Mohammed Shan , Simmonds Anne 
Published: October 2014

Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to capture how competencies may reflect an adaptation to a less than ideal work environment. Research design: A critical qualitative approach was used. Participants: Fifteen graduate nursing students from various practice areas participated. Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings.
Cardiac, ventilatory, and metabolic adjustments in chronic obstructive pulmonary disease patients during the performance of Glittre activities of daily living test
Authors: Tufanin Andréa , Souza Gerson Fonseca , Tisi Guilherme Rocha , Tufik Sergio , de Mello Marco Túlio , Nascimento Oliver A , Jardim José R 
Published: October 2014

Functional status and quality of life are measures of the chronic obstructive pulmonary disease (COPD) patient’s health status and can demonstrate the impact of the disease on the patient’s ability to perform activities of daily living (ADLs). The Glittre-ADL test was developed to evaluate the functional status of COPD patients and their ability to perform activities of daily life. The objective of this study was to evaluate the cardiac, respiratory, and metabolic adjustments and reproducibility of the Glittre ADL test performed by COPD patients. Twenty-two mild to severe COPD patients (forced expiratory volume in 1 second (FEV1): 56.6 ± 19.9% predicted; mean age: 66.3 ± 9.18 years old) were enrolled in this study. Metabolic (oxygen uptake (VO2), carbon dioxide production (VCO2), pulmonary ventilation (VE)/VCO2, and VE/VO2), ventilatory (tidal volume, respiratory rate, and VE), and cardiovascular (pulse oxygen saturation, VO2/heart rate (HR), and HR) variables, lower limbs fatigue, and dyspnea (Borg score) after each lap of two Glittre ADL test were analyzed. All metabolic, ventilatory, and cardiac variables increased their values up to the third lap and remained stable (plateau) until the end of the test (five laps; multivariate analysis); there was no difference among the time spent to complete each of the five laps in each test and between tests (total time of second test: 4 minutes and 3 seconds); the second test was 17.8 seconds (6.6%) shorter than the first one (NS). All variables were highly reproducible in the two tests (NS). At the end of the test, patients reached 87.7% of the VO2 max, 81% of VE peak, and 88.5% of the HR peak obtained from an incremental maximal test on a treadmill. The Glittre ADL test is easy for COPD patients to perform and is a highly reproducible test in COPD patients with mild to severe stages of the disease. In addition, our results suggest that it is possible to demonstrate the patient’s functional capacity with a single test of only three laps, making it faster and easier to apply and less stressful for some patients.
Usability and Training Differences Between Two Personal Insulin Pumps
Authors: Schaeffer Noel E. , Parks Linda J. , Verhoef Erik T. , Bailey Timothy S. , Schorr Alan B. , Davis Trent , Halford Jean , Sulik Becky 
Published: October 2014

Background: The purpose of this study was to determine if there were usability and training differences between the Medtronic MiniMed Paradigm Revel™ Insulin Pump and the Tandem Diabetes Care t:slim® Insulin Pump during use by representative users, performing representative tasks, in a simulated use environment. Methods: This study utilized a between-subjects experimental design with a total of 72 participants from 5 sites across the United States. Study participants were randomized to either the Revel pump group or the t:slim Pump group. Participants were 18 years of age or older and managed their diabetes using multiple daily insulin injections. Dependent variables included training time, training satisfaction, time on task, task failures, System Usability Scale (SUS) ratings, perceived task difficulty, and a pump survey that measured different aspects of the pumps and training sessions. Results: There was a statistically significant difference in training times and error rates between the t:slim and Revel groups. The training time difference represented a 27% reduction in time to train on the t:slim versus the Revel pump. There was a 65% reduction in participants’ use error rates between the t:slim and the Revel group. The t:slim Pump had statistically significant training and usability advantages over the Revel pump. Conclusions: The reduction in training time may have been a result of an optimized information architecture, an intuitive navigational layout, and an easy-to-read screen. The reduction in use errors with the t:slim may have been a result of dynamic error handling and active confirmation screens, which may have prevented programming errors.
Retrograde stapling of a free cervical jejunal interposition graft: a technical innovation and case report
Authors: Hackl Christina , Popp Felix C , Ehehalt Katharina , Dendl Lena-Marie , Benseler Volker , Renner Philipp , Loss Martin , Dolderer Jurgen , Prantl Lukas , Kühnel Thomas , Schlitt Hans J , Dahlke Marc H 
Published: October 2014

Abstract

Background
Free jejunal interposition is a useful technique for reconstruction of the cervical esophagus. However, the distal anastomosis between the graft and the remaining thoracic esophagus or a gastric conduit can be technically challenging when located very low in the thoracic aperture. We here describe a modified technique for retrograde stapling of a jejunal graft to a failed gastric conduit using a circular stapler on a delivery system.

Case presentation
A 56 year-old patient had been referred for esophageal squamous cell carcinoma at 20 cm from the incisors. On day 8 after thoracoabdominal esophagectomy with gastric pull-up, an anastomotic leakage was diagnosed. A proximal-release stent was successfully placed by gastroscopy and the patient was discharged. Two weeks later, an esophagotracheal fistula occurred proximal to the esophageal stent. Cervical esophagostomy was performed with cranial closure of the gastric conduit, which was left in situ within the right hemithorax. Three months later, reconstruction was performed using a free jejunal interposition. The anvil of a circular stapler (Orvil®, Covidien) was placed transabdominally through an endoscopic rendez-vous procedure into the gastric conduit. A free jejunal graft was retrogradely stapled to the proximal end of the conduit. Microvascular anastomoses were performed subsequently. The proximal anastomosis of the conduit was completed manually after reperfusion.

Conclusions
This modified technique allows stapling of a jejunal interposition graft located deep in the thoracic aperture and is therefore a useful method that may help to avoid reconstruction by colonic pull-up and thoracotomy.
Gastrointestinal comorbidities associated with atrial fibrillation
Authors: Laliberté François , Moore Yuliya , Dea Katherine , LaMori Joyce C , Mody Samir H , Jones JaCinda L , Arledge Michele D , Damaraju C V , Schein Jeff R , Lefebvre Patrick 
Published: October 2014

Abstract
This observational study was conducted to describe the risk of gastrointestinal (GI) events among patients with atrial fibrillation (AF). We analyzed Thomson Reuters MarketScan® data from 2005 to 2009. Subjects aged ≥18 years with ≥ 1 AF diagnosis were selected. GI events were identified from claims with a primary or secondary diagnosis code for any GI condition. The risk of GI events was assessed using cumulative incidence (new GI events/patients with AF without GI condition at baseline) and incidence rates (IRs), calculated as the number of patients with new GI events divided by patient-years of observation. In addition, the CHADS2 score was evaluated at baseline to determine the patient’s risk of stroke. A total of 557,123 AF patients were identified. The mean (median) AF patient age was 68.2 years (70); 45% were female. The cumulative incidences of any GI event and dyspepsia were 40% and 19%, respectively. The corresponding IRs were 38.8 and 14.7 events per 100 patient–years. IRs of any GI events for female and male patients were 43.6 and 35.5; for patients in the age groups <65, 65–74, 75–84, and ≥85 years, IRs were 32.3, 38.9, 44.6, and 52.7; for patients with a CHADS2 score of 0, 1–2, 3–4, and 5–6, IRs were 30.3, 41.6, 56.9, and 74.5, respectively. In this large claims database, 40% of AF patients experienced a GI event, predominantly dyspepsia. Physicians should take age and comorbidities into consideration when managing AF patients.
Biomarkers in biological fluids for dementia with Lewy bodies
Authors: Schade Sebastian , Mollenhauer Brit 
Published: October 2014

AbstractDementia with Lewy bodies (DLB) has become the second most common neurodegenerative dementia due to demographic ageing. Differential diagnosis is still troublesome especially in early stages of the disease, since there is a great clinical and neuropathological overlap primarily with Alzheimer's disease and Parkinson's disease. Therefore, more specific biomarkers, not only for scientific reasons but also for clinical therapeutic decision-making, are urgently needed. In this review, we summarize the knowledge on fluid biomarkers for DLB, derived predominantly from cerebrospinal fluid. We discuss the value of well-defined markers (β-amyloid, (phosphorylated) tau, ±-synuclein) as well as some promising ‘upcoming' substances, which still have to be further evaluated.
Clinical outcome and cost of treatment and care for neonates less than 1000 grams admitted to Vali-e ASR Hospital
Authors: Dalili Hosein , Fallahi Mohaddese , Moradi Saeid , Nayeri Fatemeh , Shariat Mamak , Rashidian Arash 
Published: October 2014

AbstractBackgroundThe aim of this study is to estimate the cost of care and treatment for extremely low birth weight (ELBW) neonates admitted to a teaching and referral hospital. This cost estimation project can help health policy makers and planners make decisions and develop plans for perinatal service staging programs and better management of NICUs (Neonatal Intensive Care Units).MethodsThis cohort study performed on 50 extremely low birth weight neonates (w???1000gr) born in Vali-e Asr Hospital, Tehran-Iran in the period of March 2012 to September 2013. This teaching and referral hospital had 15 NICU beds as well as an active neonatal growth and development follow-up clinic with a pediatric neurodevelopment specialist during the period of the study. Cases would undergo initial developmental visits and preventative measures immediately after being admitted to the ward. Also after discharge, they were followed up monthly for six months and then every two months, during first year of life.ResultsOveralls, 23 newborns -46% of ELBW and 40% of total neonatal mortality rate (that amounted 55) died during hospital stay. Beside hospitalization, the major part of expenses was related to medication and medical supplies. All neonates needing rehabilitation underwent this type of intervention for one year. The mean cost of rehabilitation in neonates with no insurance coverage was 6700 US Dollars per year, which is reduced by half (3350 US Dollars) when covered by insurance.ConclusionMedication, medical supplies and equipment cost was significantly high. This is especially due to the fact that the present types of insurances do not cover such expenses very well, forcing parents to pay themselves. Insurance systems are expected to take this issue into immediate account.
Ancient Topics in Napoleon’s Proclamations to the army
Authors: Fulińska Agnieszka 
Published: October 2014

Ancient Topics in Napoleon’s Proclamations to the army
The present paper analyses the ancient topics and elements of rhetoric in Napoleon Bonaparte’s proclamations to the army, as they come down to our times in his correspondence and memoirs. The main focus is on the exhortations issued during the early campaigns in Italy and Egypt, since they employ this kind of imagery to the greatest extent. The aim of the paper is to show that the content of these short proclamations, which had obvious propagandistic meaning, was deeply rooted in the Classical education, as well as in the French republican imagery, and also art and literature of the period, all together which shaped the early years of the prospective Emperor.
Metaphorical Picture of Tiberius in Tacitus’s Annals
Authors: Migdał Justyna 
Published: October 2014

Metaphorical Picture of Tiberius in Tacitus’s Annals
The paper discusses the way of presenting Tiberius in Tacitus’ Annals; it concentrates on the analysis of diction and metaphors (Tiberius as a snake, the metaphors of clothing, of siege and of fire). Possible analogies with Vergilian metaphors of the fall of Troy are also taken into account.
Ipsaque morte peior est mortis locus: The underworld in Seneca’s Hercules furens
Authors: Stróżyński Mateusz 
Published: October 2014

Ipsaque morte peior est mortis locus: The underworld in Seneca’s Hercules furens
The present paper analyses the episode of Hercules’ journey to the underworld in Seneca’s Hercules furens. The starting point is the contemporary psychoanalysis school of object relations; the research method combines psychoanalytic interpretive methods with a philological text analysis. The underworld passage, showing Hercules’ weakness and superbia, can be treated as the key to understanding the entire play.
Myoid Gonadal Stromal Tumor
Authors: Kao Chia-Sui , Ulbright Thomas M. 
Published: October 2014

Abstract

Objectives:
To report three new cases of testicular myoid gonadal stromal tumor to better characterize its features.

Methods:
The clinicopathologic findings (including follow-up) were evaluated and a review of the literature was performed.

Results:
The patients were 38, 43, and 59 years old, and tumor sizes were 1.2, 1.3, and 3.2 cm. All were unilateral, well circumscribed, adjacent to the rete testis, and composed exclusively of spindled cells with elongated nuclei and occasional nuclear grooves arranged in fascicles with admixed variably ectatic blood vessels. Nucleoli were inconspicuous, and the cytoplasm was scant, ill-defined, and pale/lightly eosinophilic. No sex cord component was present. Mitotic figures ranged from zero to five per 10 high-power fields. Significant atypia, lymphovascular invasion, and necrosis were absent. All were consistently positive for smooth muscle actin, S100 protein, FOXL2, and steroidogenic factor 1 but negative for h-caldesmon, calretinin, and SOX9. Inhibin and calponin were focally positive. All patients were alive and well at 5, 31, and 58 months postorchiectomy. Combining our cases with those previously reported (n = 6) shows that this neoplasm occurs mostly in younger men (mean, 37 years), and all follow-up thus far (mean, 25 months) has been benign.

Conclusions:
Myoid gonadal stromal tumors are small (&lt;4 cm) indolent testicular tumors distinctly different from other sex cord–stromal tumors and are adequately managed by orchiectomy.
Cardiac troponin assays: a review of quantitative point-of-care devices and their efficacy in the diagnosis of myocardial infarction
Authors: Amundson Beret E. , Apple Fred S. 
Published: October 2014

AbstractCardiac troponin (cTn) I and T are released from myocardial cells following necrosis, i.e., cell death. An accurate measure of cTn concentrations in a patient’s blood following ischemia/chest pain can enable providers to determine whether or not a myocardial infarction (MI) has occurred. Point-of-care (POC) devices that measure blood cTn concentrations in under 30 min may help to significantly reduce hospital costs by managing and triaging patients out of the emergency department as quickly as possible. The use of POC devices that measure cTnI and cTnT with a coefficient of variation (CV) ≤20% at the 99th percentile upper reference limit (URL) limits both false positive and negative results and provides clinically acceptable findings to assist in appropriate diagnoses. This article reviews nine POC devices that measure cTn in terms of their clinical sensitivity and specificity, analytical imprecision, sample type and preparation, and each assay’s principle of analysis.