bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intrinsic Molecular Subtypes of Glioma Are Prognostic and Predict Benefit From Adjuvant Procarbazine, Lomustine, and Vincristine Chemotherapy in Combination With Other Prognostic Factors in Anaplastic Oligodendroglial Brain Tumors: A Report From EORTC Study 26951
Authors: Erdem-Eraslan Lale , Gravendeel Lonneke A. , de Rooi Johan , Eilers Paul H.C. , Idbaih Ahmed , Spliet Wim G.M. , den Dunnen Wilfred F.A. , Teepen Johannes L. , Wesseling Pieter , Sillevis Smitt Peter A.E. , Kros Johan M. , Gorlia Thierry , van den Bent Martin J. , French Pim J. 
Published: December 2012

Purpose Intrinsic glioma subtypes (IGSs) are molecularly similar tumors that can be identified based on unsupervised gene expression analysis. Here, we have evaluated the clinical relevance of these subtypes within European Organisation for Research and Treatment of Cancer (EORTC) 26951, a randomized phase III clinical trial investigating adjuvant procarbazine, lomustine, and vincristine (PCV) chemotherapy in anaplastic oligodendroglial tumors. Our study includes gene expression profiles of formalin-fixed, paraffin-embedded (FFPE) clinical trial samples. Patients and Methods Gene expression profiling was performed in 140 samples, 47 fresh frozen samples and 93 FFPE samples, on HU133_Plus_2.0 and HuEx_1.0_st arrays, respectively. Results All previously identified six IGSs are present in EORTC 26951. This confirms that different molecular subtypes are present within a well-defined histologic subtype. Intrinsic subtypes are highly prognostic for overall survival (OS) and progression-free survival (PFS). They are prognostic for PFS independent of clinical (age, performance status, and tumor location), molecular (1p/19q loss of heterozygosity [LOH], IDH1 mutation, and MGMT methylation), and histologic parameters. Combining known molecular (1p/19q LOH, IDH1) prognostic parameters with intrinsic subtypes improves outcome prediction (proportion of explained variation, 30% v 23% for each individual group of factors). Specific genetic changes (IDH1, 1p/19q LOH, and EGFR amplification) segregate into different subtypes. We identified one subtype, IGS-9 (characterized by a high percentage of 1p/19q LOH and IDH1 mutations), that especially benefits from PCV chemotherapy. Median OS in this subtype was 5.5 years after radiotherapy (RT) alone versus 12.8 years after RT/PCV (P = .0349; hazard ratio, 2.18; 95% CI, 1.06 to 4.50). Conclusion Intrinsic subtypes are highly prognostic in EORTC 26951 and improve outcome prediction when combined with other prognostic factors. Tumors assigned to IGS-9 benefit from adjuvant PCV.
Clinical Impact of Immune Microenvironment in Stage I Lung Adenocarcinoma: Tumor Interleukin-12 Receptor β2 (IL-12Rβ2), IL-7R, and Stromal FoxP3/CD3 Ratio Are Independent Predictors of Recurrence
Authors: Suzuki Kei , Kadota Kyuichi , Sima Camelia S. , Nitadori Jun-ichi , Rusch Valerie W. , Travis William D. , Sadelain Michel , Adusumilli Prasad S. 
Published: December 2012

Purpose Mounting evidence suggests that tumor-infiltrating immune cells have prognostic value for patients with solid organ malignancies. Our aim was to investigate the prognostic significance of the immune microenvironment in patients with stage I lung adenocarcinoma (ADC). Patients and Methods Using tissue microarray and immunohistochemistry, we investigated eight types of tumor-infiltrating immune cells in the tumor nest and tumor-associated stroma as well as tumor expression of five cytokines in a uniform cohort of 956 patients with stage I lung ADC (478 each in training and validation cohorts). Results Although a high density of stromal forkhead box P3 (FoxP3) –positive cells was associated with shorter recurrence-free probability (RFP; P = .043), the relative proportion of stromal FoxP3 to CD3 was a stronger predictor of recurrence (5-year RFP, 85% for high v 77% for low ratio; P = .004). High expression of tumor interleukin-12 receptor β2 (IL-12Rβ2) was associated with better outcome (5-year RFP, 90% for high v 80% for low expression; P = .026), whereas high expression of tumor IL-7R was associated with worse outcome (5-year RFP, 76% for high v 86% for low expression; P = .001). In multivariate analysis, these immune markers were independently associated with recurrence. Although IL-7R remained significant for poor overall survival, all the markers remained prognostic for recurrence in patients with stages IA and IB disease as well as for patients with tumors ≤ 2 cm. Conclusion Our investigation confirms the biologic and prognostic significance of the tumor immune microenvironment for patients with stage I lung ADC and provides support for its use to stratify clinical outcome and immunotherapeutic interventions.
Safety for home care: the use of Internet video calls to double-check interventions
Authors: Bradford Natalie , Armfield Nigel R , Young Jeanine , Ehmer Marissa , Smith Anthony C 
Published: December 2012

Summary We investigated the feasibility of using Internet video calls for a double check on medication or other complex interventions being administered in the home. Seven nurses were recruited to the study and received training on using laptop and tablet computers with mobile Internet connections. The devices were taken on scheduled home visits to patient homes and video calls with a second clinician were conducted to double-check various items associated with the clinical care of the patient. Over a 14-month period, 88 video calls were conducted during which a total of 600 checks were completed. The items checked included medication names, doses, segmentations on syringes and details of ventilator settings. The quality of the video call was acceptable on 97% of occasions. On three occasions (3%) it was not possible to establish a connection and the double check was not achieved. On every occasion that the video call was successful ( n = 85), nurses were 100% confident that they were able to carry out the full requirements of a double check. The use of Internet video calls is feasible for double-checking and has the potential to improve patient safety and reduce costs.
A pilot study of the effectiveness of home teleconsultations in paediatric palliative care
Authors: Bradford Natalie , Young Jeanine , Armfield Nigel R , Bensink Mark E , Pedersen Lee-Anne , Herbert Anthony , Smith Anthony C 
Published: December 2012

Summary We conducted a pilot study to investigate the effectiveness of a home telehealth service for paediatric palliative care consultations. Over a 10 week period, 14 of the 17 caregivers approached to be part of the study agreed to participate. Families were allocated, non-randomly, to a control group (usual care) or an intervention group (usual care with the addition of home telehealth consultations). The primary outcome measure was quality-of-life score. Caregivers were surveyed for up to 99 days following recruitment. A descriptive analysis of the quality-of-life data showed no differences between caregivers in the two groups. However, important lessons were learnt regarding factors which influence the success of studies in this population group, and the domains of caregiver quality-of-life that warrant intervention. Palliative care is complex, and multiple interventions and supports are required if care is to be managed at home. Home telehealth consultations are a feasible and acceptable means of facilitating a palliative care consultation which can reduce the burden on families at a distressing time.
Effects of type 2 diabetes behavioural telehealth interventions on glycaemic control and adherence: a systematic review
Authors: Cassimatis Mandy , Kavanagh David J 
Published: December 2012

Summary We reviewed the effect of behavioural telehealth interventions on glycaemic control and diabetes self-management in patients with type 2 diabetes. The databases CINAHL, Medline and psychlNFO were searched in August 2012. Journal articles were selected that had been published in English with a randomized controlled trial design using a usual care comparison group, and in which the primary intervention component was delivered by telehealth. Relevant outcome measures were glycaemic control and one or more of the following diabetes self-care areas: diet, physical activity, blood glucose self-monitoring (BGSM) or medication adherence. Interventions were excluded if they were primarily based on telemonitoring. The search retrieved 1027 articles, from which 49 were selected based on their title and abstract. Fourteen articles (reporting 1 3 studies) met the eligibility criteria for inclusion. Four studies reported significant improvements in glycaemic control. Five of eight studies on dietary adherence reported significant treatment effects, as did five of eight on physical activity, four of nine on blood glucose self-monitoring, and three of eight on medication adherence. Overall, behavioural telehealth interventions show promise in improving the diabetes self-care and glycaemic control of people with type 2 diabetes.
Telehealth opportunities in regional Queensland: a scoping study
Authors: Croll Jasmine , Norton Chrissie J , Gray Leonard C , Bryett Andrew , Smith Anthony C 
Published: December 2012

Summary We carried out a six month scoping study to ascertain current health service needs in the Queensland towns of Dalby, Chinchilla and Miles. The towns have a high proportion of their populations in the dependent age groups of over 65 years of age and less than 14 years of age. This implies a need for ready access to paediatric and geriatric specialist services. The hospitals in the three towns provided a range of health services, but patients still had to be referred to Toowoomba and Brisbane for specialist consultations. All three hospitals had videoconference facilities, but videoconferencing was mainly used for education, administration and training. General practitioners in the three towns did not use telehealth in their practice. The study reinforced the potential for telehealth services in three key domains: regional hospitals, residential aged-care facilities and general practice.
A qualitative study of the careers and professional practices of graduates from an e-health postgraduate programme
Authors: Edirippulige Sisira , Armfield Nigel R , Smith Anthony C 
Published: December 2012

Summary We studied the careers and professional practices of graduates from an e-health postgraduate programme at the University of Queensland (UQ). The information was collected using an online questionnaire distributed to those who graduated from 2005 to 2010. A total of 35 surveys were completed, a response rate of 89%. The majority of respondents ( n = 20, 57%) were male, and most of them ( n = 27, 77%) were aged 30-49 years. Most of the respondents ( n = 19, 54%) had graduated from the Graduate Certificate in E-healthcare programme; 12 had graduated from the Master of E-healthcare and 4 had graduated from the Graduate Diploma programme. The majority of respondents ( n = 29, 83%) perceived that e-health study at UQ helped in their career development. The current occupation of the majority of respondents ( n = 24, 69%) was related to health or medicine, and most ( n = 27, 77%) had worked in an e-health related job since graduating. Overall, the level of satisfaction regarding the learning experience doing e-health study at UQ was high.
Practical experience of telehealth between an Antarctic station and Japan
Authors: Ohno Giichiro , Watanabe Kentaro , Okada Yutaka , Higuchi Kazuo 
Published: December 2012

Summary The Japanese Antarctic Research Expedition (JARE) has had a presence in Antarctica since 1956. The Syowa station is 15,000 km from Japan and evacuation of patients is impossible during the winter months. From 1956 to 2003, a total of 4932 telemedical consultations were undertaken, i.e. every member of the station needed an average of 4 medical consultations each winter. Forty five percent of the consultations were surgical or orthopaedic cases, 23% were for internal medicine and 12% were for dental problems. In the early 1980s, satellite radio-telephony was found to be useful for consultations, but did not have the ability to transmit medical pictures. Email was transmitted by the International Mobile Satellite Organization (INMARSAT) but the connection was only available every 2 hours and the maximum message size was 100 kByte. In 2004, the International Telecommunications Satellite (INTELSAT) system made a connection constantly available, and increased the maximum message size to 10 MByte. Transmission of still and moving pictures became possible. Scheduled consultations are performed monthly. A doctor in Japan can ask the patient questions and perform a proxy examination with the assistance of the Antarctic doctor. Real-time telemedicine is very effective in orthopaedic and surgical cases, skin, eye and dental troubles. Still pictures are more effective for understanding in detail skin and eye problems. Emergency consultations are effective if adequate consulting staff are available.
The role of the champion in telehealth service development: a qualitative analysis
Authors: Wade Victoria , Eliott Jaklin 
Published: December 2012

Summary Telehealth ‘champions’ are enthusiastic individuals who initiate and promote the uptake of telehealth services. Their role and impact was investigated as part of a qualitative study into the uptake and sustainability of telehealth services in Australia. Semi-structured interviews were conducted with 39 individuals who had been involved in the establishment and operations of 37 diverse telehealth services throughout Australia. A grounded theory analysis was carried out. The results indicated that most services were initiated by champions (25 of the 37). The champions appeared to have three main roles: enthusiastic promotion of telehealth, acting as legitimators, and relationship building. Champions were capable of keeping small scale services operating, but the services were vulnerable to cessation when they lost interest or moved on. As long as participation in telehealth remains optional, the role of the champion will be an important factor in continued operations.
Sernbo score predicts survival after intracapsular hip fracture in the elderly
Authors: Dawe EJC , Lindisfarne E , Singh T , McFadyen I , Stott P 
Published: December 2012

Introduction The Sernbo score uses four factors (age, social situation, mobility and mental state) to divide patients into a high-risk and a low-risk group. This study sought to assess the use of the Sernbo score in predicting mortality after an intracapsular hip fracture. Methods A total of 259 patients with displaced intracapsular hip fractures were included in the study. Data from prospectively generated databases provided 22 descriptive variables for each patient. These included operative management, blood tests and co-mobidities. Multivariate analysis was used to identify significant predictors of mortality. Results The mean patient age was 85 years and the mean follow-up duration was 1.5 years. The one-year survival rate was 92% (±0.03) in the low-risk group and 65% (±0.046) in the high-risk group. Four variables predicted mortality: Sernbo score >15 (p=0.0023), blood creatinine (p=0.0026), ASA (American Society of Anaesthesiologists) grade >3 (p=0.0038) and non-operative treatment (p=0.0377). Receiver operating characteristic curve analysis showed the Sernbo score as the only predictor of 30-day mortality (area under curve 0.71 [0.65–0.76]). The score had a sensitivity of 92% and a specificity of 51% for prediction of death at 30 days. Conclusions The Sernbo score identifies patients at high risk of death in the 30 days following injury. This very simple score could be used to direct extra early multidisciplinary input to high-risk patients on admission with an intracapsular hip fracture.
Should prophylactic antibiotics be used routinely in epistaxis patients with nasal packs?
Authors: Biggs TC , Nightingale K , Patel NN , Salib RJ 
Published: December 2012

Introduction The current mainstream practice in otolaryngology departments relating to the use of prophylactic antibiotics in epistaxis patients requiring nasal packing is highly variable. This is due primarily to the lack of any validated guidelines. As such, we introduced a new treatment algorithm resulting in significant reduction of use in the systemic antibiotics, with emphasis instead on the use of topical antibiotics. The results were validated through a complete audit cycle. Methods A total of 57 patients undergoing nasal packing for spontaneous epistaxis were studied. Reaudit occurred after the implementation of new guidelines. Telephone surveys were conducted six weeks after hospital discharge, assessing infective nasal symptoms as well as rebleeding and readmission rates. Results Systemic antibiotic prescribing in anterior nasal packing fell by 58.2% between audit cycles with no statistically significant associated increase in infective nasal symptoms, rebleeding or readmission rates six weeks following hospital discharge. Conclusions Systemic prophylactic antibiotics are unnecessary in the majority of epistaxis patients with nasal packs. The use of topical antibiotics such as Naseptin® may be more appropriate, cheaper and as effective. Implementation of this treatment algorithm will help standardise systemic antibiotic usage in epistaxis patients with nasal packing and should reduce costs associated with unnecessary use of such medication.
The Waterlow score for risk assessment in surgical patients
Authors: Thorn CC , Smith M , Aziz O , Holme TC 
Published: December 2012

Introduction Perioperative scoring systems aim to predict outcome following surgery and are used in preoperative counselling to guide management and to facilitate internal or external audit. The Waterlow score is used prospectively in many UK hospitals to stratify the risk of decubitus ulcer development. The primary aim of this study was to assess the potential value of this existing scoring system in the prediction of mortality and morbidity in a general surgical and vascular cohort. Methods A total of 101 consecutive moderate to high risk emergency and elective surgical patients were identified through a single institution database. The preoperative Waterlow score and outcome data pertaining to that admission were collected. The discriminatory power of the Waterlow score was compared against that of the American Society of Anesthesiologists (ASA) grade and the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). Results The inpatient mortality rate was 17% and the 30-day morbidity rate was 29%. A statistically significant association was demonstrated between the preoperative Waterlow score and inpatient mortality (p<0.0001) and 30-day morbidity (p=0.0002). Using a threshold Waterlow score of 20 to dichotomise risk, accuracies of 0.84 and 0.76 for prediction of mortality and morbidity were demonstrated. In comparison with P-POSSUM, the preoperative Waterlow score performed well on receiver operating characteristic analysis. With respect to mortality, the area under the curve was 0.81 (0.80–0.85) and for morbidity it was 0.72 (0.69–0.76). The ASA grade achieved a similar level of discrimination. Conclusions The Waterlow score is collected routinely by nursing staff in many hospitals and might therefore be an attractive means of predicting postoperative morbidity and mortality. It might also function to stratify perioperative risk for comparison of surgical outcome data. A prospective study comparing these risk prediction scores is required to support these findings.
Role of the faecolith in modern-day appendicitis
Authors: Singh JP , Mariadason JG 
Published: December 2012

Introduction The prevailing view on appendicitis is that the main aetiology is obstruction owing to faecoliths in adults and lymphoid hyperplasia in children. Faecoliths on imaging studies are believed to correlate well with appendicitis. Methods A retrospective chart review was conducted of 1,014 emergency appendicectomy patients between 2001 and 2011. Faecolith prevalence in adult and paediatric appendicectomy specimens with and without perforation was studied. The sensitivity and positive predictive value (PPV) of computed tomography (CT) for identifying faecoliths in the pathology specimen were examined. Results Overall, faecoliths were found in 18.1% (178/986) of appendicitis specimens and 28.6% (8/28) of negative appendicectomies. Faecolith prevalence for positive cases was 29.9% (79/264) in paediatric patients and 13.7% (99/722) in adults (p<0.05). Faecolith prevalence was 39.4% in perforated appendicitis but only 14.6% in non-perforated appendicitis (p<0.05). In adults, faecolith prevalence was 27.5% in perforated appendicitis and 12.0% in non-perforated appendicitis (p<0.05) while in paediatric patients, it was 56.1% in perforated appendicitis and 22.7% in non-perforated appendicitis (p=0.00). Sensitivity and PPV of preoperative CT in identifying faecoliths on pathology were 53.1% (86/162) and 44.8% (86/192) respectively. Conclusions Faecolith prevalence is too low to consider the faecolith the most common cause of non-perforated appendicitis. Faecoliths are more prevalent in paediatric appendicitis than in adult appendicitis. Preoperative CT is an unreliable predictor of faecoliths in pathology specimens.
Audiovisual distraction reduces pain perception during aural microsuction
Authors: Choudhury N , Amer I , Daniels M , Wareing MJ 
Published: December 2012

IntroductionAural microsuction is a common ear, nose and throat procedure used in the outpatient setting. Some patients, however, find it difficult to tolerate owing to discomfort, pain or noise. This study evaluated the effect of audiovisual distraction on patients’ pain perception and overall satisfaction.MethodsA prospective study was conducted for patients attending our aural care clinic requiring aural toileting of bilateral mastoid cavities over a three-month period. All microsuction was performed by a single clinical nurse specialist. Any patients with active infection were excluded. For each patient, during microsuction of one ear, they watched the procedure on a television screen while for the other ear they did not view the procedure. All patients received the same real time explanations during microsuction of both ears. After the procedure, each patient completed a visual analogue scale (VAS) to rate the pain they experienced for each ear, with and without access to the television screen. They also documented their preference and reasons why.ResultsA total of 37 patients were included in the study. The mean pain score for patients viewing the procedure was 2.43 compared with a mean of 3.48 for patients with no television view. This difference in patients’ pain perception was statistically lower in the group who observed the procedure on the television (p=0.003), consistent with the majority of patients reporting a preference to viewing their procedure (65%).ConclusionsAudiovisual distraction significantly lowered patients’ VAS pain scores during aural microsuction. This simple intervention can therefore reduce patients’ perceived pain and help improve acceptance of this procedure.