bluuebunny/crossref_metadata_2025_split huggingface dataset:
Food insecurity among Dutch food bank recipients: a cross-sectional study
Authors: Neter Judith E , Dijkstra S Coosje , Visser Marjolein , Brouwer Ingeborg A 
Published: May 2014

ObjectiveTo determine the prevalence of (very) low food security among Dutch food bank recipients, and to identify potential demographic, lifestyle and nutrition-related factors associated with (very) low food security.Setting11 of 135 Dutch food banks were selected throughout the Netherlands.Participants251 Dutch food bank recipients participated in the study (93 men and 158 women). Inclusion criteria for participation were: (1) at least 18 years of age, (2) sufficiently fluent in Dutch to participate in oral and written interviews, (3) recipient of a Dutch food bank for at least 1 month and (4) collect own food parcel at the food bank. A single member per household was included.Primary outcomeLevel of food security.ResultsThe prevalence of food insecurity was 72.9% (N=183), of which 40.4% (N=74) reported very low food security. Of the very low food secure participants, 56.8% (N=42) reported they were ever hungry but did not eat because they could not afford enough food in the previous 3 months. Adjusted multinomial logistic regression analyses showed that households without children were less likely to experience low food security (OR 0.39 (95% CI 0.18 to 0.88)) and men (OR 0.24 (95% CI 0.11 to 0.51)) were less likely to experience very low food security, while low-educated recipients (OR 5.05 (95% CI 1.37 to 18.61)) were more likely to experience very low food security. Furthermore, recipients with high satisfaction with overall food intake (OR 0.46 (95% CI 0.27 to 0.78)), high perceived healthiness of overall food intake (OR 0.34 (95% CI 0.19 to 0.62)) or high self-efficacy of eating healthy (OR 0.62 (95% CI 0.40 to 0.96)) were less likely to experience very low food security.ConclusionsOur study showed high prevalence rates of food insecurity among Dutch food bank recipients, and identified subgroups at increased risk of food insecurity. More research is urgently needed on the underlying determinants of food insecurity and the effectiveness of food assistance by food banks.
Living with pulmonary hypertension: unique insights from an international ethnographic study
Authors: Kingman Martha , Hinzmann Barbara , Sweet Oliver , Vachiéry Jean-Luc 
Published: May 2014

ObjectivesTo better understand the patient's perspective of pulmonary hypertension (PH), including the impact of living with PH, disease management and treatment.DesignThis qualitative ethnographic study collected observational video footage, supplemented by field notes and patient diaries to assess the impact of PH on the patient's life.SettingPatients were observed and filmed in their home for up to 6 h, capturing the environment, interactions and activities of everyday life.ParticipantsPatients with pulmonary arterial hypertension (PAH) or chronic thromboembolic PH who were receiving PAH-specific medication were recruited through healthcare professionals (HCPs) and patient associations in seven countries across four continents. Sampling was purposive and subgroup analysis was not intended.ResultsOverall, 39 patients with PH were enrolled. Many patients had a poor understanding of PH and found their ‘invisible’ disease difficult to explain to others. An important finding was the secrecy surrounding PH. Feelings of insecurity and isolation were regularly reported, and many patients admitted to hiding their symptoms. The marked improvement in symptoms after therapy initiation made assessment of disease progression more difficult as patients compared their quality of life (QoL) against pretreatment levels. Extensive planning and adherence to daily routines were required in patients’ everyday life.ConclusionsEthnography was used for the first time, in several countries, to evaluate the patient's perception of living with PH. This approach revealed key findings that would not typically be uncovered using other qualitative techniques, including the secrecy surrounding PH, the difficulties in describing the disease and the challenges in assessing disease progression. A more tailored dissemination of information from HCPs and development of a simple and understandable PH definition may be beneficial in alleviating the secrecy reported by patients. A greater appreciation of how patients perceive their disease and QoL has the potential to improve PH management.
‘Saying it without words’: a qualitative study of oncology staff's experiences with speaking up about safety concerns
Authors: Schwappach D L B , Gehring K 
Published: May 2014

ObjectivesTo explore the experiences of oncology staff with communicating safety concerns and to examine situational factors and motivations surrounding the decision whether and how to speak up using semistructured interviews.Setting7 oncology departments of six hospitals in Switzerland.ParticipantsDiverse sample of 32 experienced oncology healthcare professionals.ResultsNurses and doctors commonly experience situations which raise their concerns and require questioning, clarifying and correcting. Participants often used non-verbal communication to signal safety concerns. Speaking-up behaviour was strongly related to a clinical safety issue. Most episodes of ‘silence’ were connected to hygiene, isolation and invasive procedures. In contrast, there seemed to exist a strong culture to communicate questions, doubts and concerns relating to medication. Nearly all interviewees were concerned with ‘how’ to say it and in particular those of lower hierarchical status reflected on deliberate ‘voicing tactics’.ConclusionsOur results indicate a widely accepted culture to discuss any concerns relating to medication safety while other issues are more difficult to voice. Clinicians devote considerable efforts to evaluate the situation and sensitively decide whether and how to speak up. Our results can serve as a starting point to develop a shared understanding of risks and appropriate communication of safety concerns among staff in oncology.
A simple measure to improve the rates of thromboprophylaxis prescription post surgical fixation of neck of femur fractures in a district general hospital
Authors: Sinha Pranab , Najefi Ali-Asgar , Hambidge John 
Published: May 2014

AbstractNeck of femur (NOF) fractures are a major public health concern because of the ageing population and higher incidence of fragility fractures. NOF fractures are associated with high mortality and morbidity rates, and there is a high risk of venous thromboembolism (VTE) after hip fractures (Ref 1). Therefore thromboprophylaxis is vital. Current NICE guidelines advocate 28 – 35 days of thromboprophylaxis after NOF fractures (Ref 1, 2).It came to our attention that patients post NOF fixation were getting variable prescriptions in regards to their thromboprophylaxis. Therefore a retrospective study on prescription of thromboprophylaxis was conducted from October 2012 to February 2013 within the trauma and orthopaedics department at Queens Hospital, Romford.Data was collected on all NOF fractures from electronic discharge summaries. Basic descriptive statistics were used to analysis the data. There were 110 cases of NOF fractures during this period. 100 patients were included since two were discounted as they were already on long term anticoagulants and eight patients died in hospital. No thromboprophylaxis was prescribed for 15 patients (15%). Three patients (3%) were prescribed less than 28 days (mean 14 days, range (14 – 14 days)). 69 patients (69%) received 28 - 35 days of thromprophylaxis, whilst five patients (5%) received more than 35 days (mean 42 days, range 40 – 42 days).Formal departmental teaching and presentation of the findings was given after the initial study and a small label with the message, ‘POST NOF #: 28-35 days Enoxaparin’, was attached to the back of all the junior doctor work phones. After the intervention, data was collected from the period of 7th of January to 7th of February 2013. The second study showed that 50 patients were admitted with NOF fractures in this time period. Four patients died in hospital and three patients were discounted as they were on Warfarin. Two patients were not prescribed thromboprophylaxis (5%). 34 (79%) patients received 28 - 35 days, whereas seven patients (16%) received 42 days of thromboprophylaxis.The older patients with multiple co-morbidities and reduced mobility are at high risk of developing thromboembolism post NOF fixation. Our initial study identified inadequate prescription of thromboprophylaxis post NOF fractures. After introduction of simple measures such as the reminder label attached to phones, our repeat study found that there was improvement in prescription rates. Our study highlights that simple measures can increase awareness and improve patient safety.
Impact of the Marie Curie Cancer Care Delivering Choice Programme in Somerset and North Somerset on place of death and hospital usage: a retrospective cohort study
Authors: Purdy Sarah , Lasseter Gemma , Griffin Thomas , Wye Lesley 
Published: May 2014

ObjectivesThe Marie Curie Cancer Care Delivering Choice Programme (DCP) aims to help palliative patients be cared for in their place of choice. In this study, new palliative care services delivered in two counties in England included end-of-life care coordination centres, an out-of-hours telephone line and discharge in-reach nurses. The study aimed to investigate the impact of DCP on place of death and hospital usage (emergency department (ED) and admissions).MethodsRetrospective cohort of all eligible palliative patients who died over a 6-month period in two counties (n=3594). Participants were those who died of conditions considered to be eligible for end-of-life care, as defined by the Public Health England National End of Life Care Intelligence Network. The sample included people who did and did not access DCP services. DCP service, hospital admission and ED use data, demographic and death data were collected on all eligible participants. Data were analysed using descriptive statistics and logistic regression.ResultsAfter adjusting for potential confounders, those using Delivering Choice were at least 30% less likely to die in hospital or have an emergency hospital admission or ED visit in the last 30 or 7 days of life than those who did not.ConclusionsRecipients of DCP services were less likely to die in or use hospital services. Those considering new ways of providing end-of-life care could explore the possibility of adopting similar services and evaluating the outcomes from patient, carer and system perspectives.
ABG needle study: a randomised control study comparing 23G versus 25G needle success and pain scores
Authors: Yee Kenny , Shetty Amith L , Lai Kevin 
Published: May 2014

ObjectiveTo determine whether a narrower gauge needle used in ABG sampling is associated with lower pain scores and complication rates without increasing the level of difficulty of the procedure.MethodsWe performed a prospective single-blinded randomised control study of patients from a tertiary-level emergency department in Sydney who required an ABG analysis over the period of June 2010–July 2012. Patients were randomised to either a 23G or 25G needle and the primary outcome that included pain experienced by these patient were recorded as pain scores on a 10 cm hatched visual analogue scale. The difficulty scores and complications were also noted from the operator.ResultsData for 119 consenting eligible patients were included in the analysis. 63 patients were allocated to the 23G needle group and 56 to the 25G needle group. The mean pain score was 3.5 (SD=2.7) for the 23G group and 3.4 (SD=2.7) for the 25G group with a mean difference between the pain scores of 0.1 (95% CI −0.9 to 1.1, p=0.83). The 23G and 25G mean difficulty score was 3.4 (SD=2.6) and 4.3 (SD=2.4), respectively, with a mean difference of 0.9 (95% CI −0.03 to 1.7, p=0.06). 21.6% of patient in the 23G needle group experienced some complication with regard to the sampling in the form of haematoma, tenderness or paraesthesia in comparison to 5.4% of patients in the 25G needle group (p=0.03).ConclusionsThere was no significant difference in pain scores experienced by patients undertaking ABG sampling with either a 23G or 25G needle.Trial registration numberACTRN12609000957291.
Risk communication in the hyperacute setting of stroke thrombolysis: an interview study of clinicians
Authors: Lie M L S , Murtagh M J , Burges Watson D , Jenkings K N , Mackintosh J , Ford G A , Thomson R G 
Published: May 2014

ObjectiveCommunicating treatment risks and benefits to patients and their carers is central to clinical practice in modern healthcare. We investigated the challenges of risk communication by clinicians offering thrombolytic therapy for hyperacute stroke where treatment must be administered rapidly to maximise benefit.MethodSemistructured interviews with 13 clinicians from three acute stroke units involved in decision making and/or information provision about thrombolysis. We report on clinicians’ accounts of communicating risks and benefits to patients and carers. Framework analysis was employed.ResultsWe identified the major challenges facing clinicians in communicating risk in this context that is, disease complexity, patients’ capacity and time constraints, and communicating quality of life after stroke. We found significant variation in the data on risks and benefits that clinicians provide, and ways these were communicated to patients. Clinicians’ communication strategies varied and included practices such as: a phased approach to communicating information, being responsive to the patient and family and documenting information they gave to patients.ConclusionsRisk communication about thrombolysis involves complex uncertainties. We elucidate the challenges of effective risk communication in a hyperacute setting and identify the issues regarding variation in risk communication and the use of less effective formats for the communication of numerical risks and benefits. The paper identifies good practice, such as the phased transfer of information over the care pathway, and ways in which clinicians might be supported to overcome challenges. This includes standardised risk and benefit information alongside appropriate personalisation of risk communication.Effective risk communication in emergency settings requires presentation of high-quality data which is amenable to tailoring to individual patients’ circumstances. It necessitates clinical skills development supported by personalised risk communication tools.
Crash fatality and vehicle incompatibility in collisions between cars and light trucks or vans
Authors: Ossiander Eric M , Koepsell Thomas D , McKnight Barbara 
Published: May 2014

BackgroundIn crashes between a car and a light truck or van (LTV), car occupants are more likely to be killed than LTV occupants. The extent this is due to the greater harm imposed by LTVs on cars or the greater protection they offer their own occupants is not known.MethodsWe conducted a case-control study of collisions between two passenger vehicles in the USA during 1990–2008. Cases were all decedents in fatal crashes (N=157 684); one control was selected from each crash in a national probability sample of crashes (N=379 458).ResultsAdjusted for the type of vehicle they were riding in and other confounders, occupants of vehicles colliding with any type of LTVs (categorised as compact sport utility vehicles (SUV), full-size SUVs, minivans, full-size vans, compact pickups and full-size pickups) were at higher risk of death compared with occupants colliding with cars. Adjusted for the type of vehicle they crashed with and other confounders, occupants of LTVs in a collision with any vehicle were at lower risk of death compared with car occupants. Compared with a crash between two cars, the overall RR of death in a crash between any of the other 27 different combinations of vehicle types was 1.0 or greater, except for crashes between two full-size pickups, where the RR of death was 0.9.ConclusionsAlthough LTVs protect their own occupants better than cars do, LTVs are associated with an excess total risk of death in crashes with cars or other LTVs.
Estimated GFR. Comparison of five algorithms:implications for drug dosing
Authors: Kallner Anders 
Published: May 2014

Aims‘Clearance’ is an accepted surrogate for glomerular filtration rate (GFR) that describes the relation between the serum/plasma concentration of a substance, for example, creatinine, and its urinary excretion rate. On a population level the GFR can be estimated from the creatinine concentration by regression analysis. Such estimates inevitably increase the uncertainty compared with the measured quantity, for example, creatinine. Reliable estimates of GFR (eGFR) are crucial for proper administration of drugs with small therapeutic ‘windows’ and require a transformation of ‘normalised’ GFR to ‘individual’ GFR using the individual's anthropometric data. By simulation we compare some common algorithms and discuss their feasibility for drug dosing.MethodsWe compared four algorithms fornormalisedeGFR and one forindividualeGFR in a Caucasian man defined by age and simulated the outcome of different S-Creatinine concentrations. Normalised and individual eGFR were interconverted using published anthropometric data of a national average man.ResultsDifferences between results by the algorithms for eGFR were less than the uncertainty within the diagnostically important interval. Three of the four algorithms were non-continuous at extreme S-Creatinine concentrations. Normalised eGFR values, converted to individual eGFR resulted in an underestimation of 5–40% compared with that by Cockcroft-Gault.ConclusionsThe use of algorithms will increase the uncertainty of results. The difference between different algorithms is small. A global staging recommendation is in jeopardy due to the large interindividual biological variation. Dosage of critical drugs, based on conversion of normalised eGFR, may lead to an underdosage compared with the dosage estimated by Cockroft-Gault.
Republished: Paget’s disease of bone: clinical review and update
Authors: Bolland Mark J , Cundy Tim 
Published: May 2014

Abstract
Paget’s disease (PD) is a focal disorder of bone remodelling that occurs commonly in older people. In this article, we review clinical aspects of PD with an emphasis on recent findings. The epidemiology of PD appears to be changing rapidly, with several groups in different parts of the world reporting a marked reduction in the prevalence and incidence of PD, as well as in the severity of disease seen by clinicians. These findings seem most likely to be caused by changes in exposure to unknown environmental factors that have a role in the development of PD. However, genetic factors are also important. Mutations in SQSTM1 occur in 25–50% of familial PD. Genotype–phenotype relationships are present, as PD develops at an earlier age and is more extensive and severe in those with SQSTM1 mutations, and these findings are more pronounced in those with truncating mutations. However, the prevalence of PD in adults with SQSTM1 mutations is uncertain, and it is not known how such mutations might cause PD. Ultimately, if the cause of PD is determined, it seems likely that it will include both genetic and environmental factors. Lastly, clinical trials have shown that potent bisphosphonates are highly effective treatments for active PD, and reduce pain, improve quality of life, normalise bone turnover and heal lytic lesions on radiographs. They can also induce sustained remission that persists for many years.
Comparison of depopulation and S19‐RB51 vaccination strategies for control of bovine brucellosis in high prevalence areas
Authors: Saez J. L. , Sanz C. , Durán M. , García P. , Fernandez F. , Minguez O. , Carbajo L. , Mardones F. , Perez A. , Gonzalez S. , Dominguez L. , Alvarez J. 
Published: May 2014

RB51 vaccination can minimise the diagnostic problems associated with S19 vaccination of adult cattle, but its use for bovine brucellosis (BB) control remains controversial. Here, the evolution of BB prevalence in five high prevalence areas in Spain subjected to different control measures is described: herd depopulation of infected herds (I–III) or mass vaccination with RB51 and S19‐RB51 vaccination of replacement heifers (IV–V). Annual data from the eradication campaigns were analysed at the special incidence area (SIA) level and the time to obtain herd prevalence levels of <1 per cent (‘controlled status’) was obtained at the local veterinary unit (LVU) level and compared using Cox's proportional hazard model. A higher annual rate of decrease in herd prevalence was observed in the SIAs subjected to vaccination (46.9%, 95% CI 43.5% to 50.0%) compared with those managed using stamping out (14.9%, 95% CI 9.6% to 19.9%). No significant differences in the time to achieve controlled status were observed between the stamping‐out and vaccination strategies used at the LVU level, with median times of 60 (stamping‐out LVUs) and 63 (vaccination LVUs) months. These results suggest that RB51 mass vaccination, in combination with the S19‐RB51 vaccination of replacement heifers and strict implementation of other eradication measures, may provide results at least comparable with those resulting from a herd depopulation based strategy.
Phenobarbitone‐induced haematological abnormalities in idiopathic epileptic dogs: prevalence, risk factors, clinical presentation and outcome
Authors: Bersan E. , Volk H. A. , Ros C. , Risio L. De 
Published: May 2014

The aim of this retrospective study was to assess prevalence, risk factors, clinical presentation and outcome of phenobarbitone induced haematological abnormalities (PBIHA) in dogs. The medical records of two veterinary referral institutions were searched for dogs diagnosed with idiopathic epilepsy and treated with PB as monotherapy or polytherapy between March 2003 and September 2010. Sixteen dogs had PBIHA; the median age at diagnosis was 69.5 months. Phenobarbitone was administered at a median dose of 3 mg/kg twice a day for a median period of 100.5 days and the median serum phenobarbitone level was 19 μg/ml. Two dogs had neutropenia, three had anaemia and thrombocytopenia, two had anaemia and neutropenia; the remaining nine had pancytopenia. All dogs were referred for non‐specific clinical signs. Phenobarbitone was discontinued after diagnosis, and the median time to resolution of PBIHA was 17 days. The prevalence and risk factors for PBIHA were evaluated from a questionnaire survey of referring practices to obtain more detailed follow‐up on cases diagnosed with idiopathic epilepsy. The prevalence rate of PBIHA was 4.2%, and the condition occurred in dogs treated with standard therapeutic doses often within the first three months after starting treatment. Serial haematological evaluations should be therefore considered from the beginning of phenobarbitone therapy to allow early diagnosis and treatment of PBIHA.