bluuebunny/crossref_metadata_2025_split huggingface dataset:
A serial qualitative interview study of infant feeding experiences: idealism meets realism
Authors: Hoddinott Pat , Craig Leone C A , Britten Jane , McInnes Rhona M 
Published: March 2012

ObjectiveTo investigate the infant feeding experiences of women and their significant others from pregnancy until 6 months after birth to establish what would make a difference.DesignQualitative serial interview study.SettingTwo health boards in Scotland.Participants72 of 541 invited pregnant women volunteered. 220 interviews approximately every 4 weeks with 36 women, 26 partners, eight maternal mothers, one sister and two health professionals took place.ResultsThe overarching theme was a clash between overt or covert infant feeding idealism and the reality experienced. This is manifest as pivotal points where families perceive that the only solution that will restore family well-being is to stop breast feeding or introduce solids. Immediate family well-being is the overriding goal rather than theoretical longer term health benefits. Feeding education is perceived as unrealistic, overly technical and rules based which can undermine women's confidence. Unanimously families would prefer the balance to shift away from antenatal theory towards more help immediately after birth and at 3–4 months when solids are being considered. Family-orientated interactive discussions are valued above breastfeeding-centred checklist style encounters.ConclusionsAdopting idealistic global policy goals like exclusive breast feeding until 6 months as individual goals for women is unhelpful. More achievable incremental goals are recommended. Using a proactive family-centred narrative approach to feeding care might enable pivotal points to be anticipated and resolved. More attention to the diverse values, meanings and emotions around infant feeding within families could help to reconcile health ideals with reality.
Study protocol: a cross-sectional survey of seasonal affective disorder in Danish populations with and without severe visual impairments: Table 1
Authors: Madsen Helle Østergaard , Dam Henrik , Hageman Ida 
Published: March 2012

IntroductionPeople with seasonal affective disorder (SAD) experience recurrent seasonal fluctuations in energy, mood and appetite. Retinal light exposure is suggested to play an important role in the pathogenesis and treatment of SAD. The aim of the study is to determine the prevalence of SAD in persons with severe visual impairments or blindness and to compare the results to a control group without visual impairments. Moreover, the authors wish to investigate whether SAD is correlated to the degree of impairment or to the diagnosis.Methods and analysis2781 persons with visual impairments ranging from total blindness to Snellen visual acuity 6/60 receive information letter and questionnaire by post. Completed questionnaires can be returned by post, email or telephone. For each respondent, all eye-related diagnoses will be obtained from national registries. Normally sighted and demographically matched control respondents will be contacted in a similar manner the subsequent winter season. The Seasonal Pattern Assessment Questionnaire rates seasonal variation within the six items: sleep, appetite, social activity, mood, energy and body weight. The Seasonal Pattern Assessment Questionnaire yields a Global Seasonal Score and a prevalence of SAD. Outcomes from the two groups will be compared. Moreover, outcomes from subgroups of the visually impaired population will be compared.Ethics and disseminationThe study is approved by the Danish Data Protection Agency. Results will be published in a relevant scientific journal and be communicated to respondents and relevant institutions through cooperation with the Danish Association of the Blind.
Do some trusts deliver a consistently better experience for patients? An analysis of patient experience across acute care surveys in English NHS trusts
Authors: Raleigh Veena S , Frosini Francesca , Sizmur Steve , Graham Chris 
Published: March 2012

IntroductionData were used from inpatient, outpatient and accident and emergency surveys in acute trusts in England to examine consistency in patient-reported experience across services, and factors associated with systematic variations in performance.MethodsStandardised mean scores for six domains of patient experience were constructed for each survey for 145 non-specialist acute trusts. Hierarchical cluster analysis was used to investigate whether and how trust performance clusters. Multilevel regression analysis was used to determine trust characteristics associated with performance.ResultsCluster analysis identified three groups: trusts that performed consistently above (30 trusts) or below (six trusts) average, and those with mixed performance. All the poor performing trusts were in London, none were foundation trusts or teaching hospitals, and they had the highest mean deprivation score and the lowest proportion of white inpatients and response rates. Foundation and teaching status, and the proportion of white inpatients, were positively associated with performance; deprivation and response rates showed less consistent positive associations. No regional effects were apparent after adjusting for independent variables.ConclusionThe results have significant implications for quality improvement in the NHS. The finding that some NHS providers consistently perform better than others suggests that there are system-wide determinants of patient experience and the potential for learning from innovators. However, there is room for improvement overall. Given the large samples of these surveys, the messages could also have relevance for healthcare systems elsewhere.
Identifying patients with advanced illness for needs assessment and care planning: SPICT in practice
Authors: Boyd Kirsty , Highet Gill , Crawford Debbie , Duthie Fiona , Murray Scott 
Published: March 2012

BackgroundSystematic identification of patients with advanced illnesses is central to UK end-of-life policies. Recognising a limited prognosis fosters decision-making about future care but probabilistic predictions such as the ‘surprise question’ tend to be overoptimistic. Even in cancer, complex mathematical models are only 60% accurate and open to confounders. The 2009 Supportive and Palliative Indicators Tool (SPICT) used clinical indicators derived from a review of prognostic tools to identify patients likely to have advanced illness and unmet supportive and palliative care needs for assessment.AimsTo pilot the SPICT tool in the renal, liver, cardiac and respiratory wards of a large teaching hospital and assess its utility in an acute hospital setting.MethodsEach ward team developed a customised checklist containing the SPICT clinical indicators. All unplanned admissions to each ward over 2 months were screened and followed up for 3 months to record re-admissions; hospital bed days; time, cause and place of death. The Charleson index of co-morbidities was calculated for comparison.FindingsThe indicators were evaluated and refined by successive teams. Multi-morbidity predicted a limited prognosis, re-admission risk and complex needs but should take account of disease severity. Most, but not all those who died, had a poor performance status (PS). Patients may spend more time bed-bound when hospitalised so usual status at home is important as an acute deterioration might be reversible. Repeated hospital admissions are well documented but increased community care needs are not always apparent initially.ConclusionsThe SPICT performs as well as the Charleson index in identifying patients with a limited prognosis and complex needs. The revised version contains fewer, clearly identifiable indicators that provide a rationale for reviewing care goals with patients and planning care; such as hospital admission, poorly controlled symptoms, increasing dependency and robust descriptors for common illnesses.
Rapid discharge at end of life-shared experience from an acute trust
Authors: Montgomery Emma , Whitfield Andrea 
Published: March 2012

BackgroundAs part of the drive to reduce patients dying in hospital a rapid discharge at end of life task and finish group with multi-agency participation was established in 2010 in a large district general hospital in North West England. The aim of the group was to set up seamless pathways of care for patients at end of life who choose not to die in hospital.MethodThe group met monthly and identified barriers to discharge. These included lack of identification of end of life and consequent lack of discussion with patients and their relatives, limited use of Liverpool Care Pathway, difficulty in accessing equipment and care provision, limited communication with primary care, delays in obtaining medication and transport. These were compounded by delays in obtaining continuing care funding. Solutions to these barriers will be described.ResultsFrom April 2010 to March 2011, 92 patients were discharged from hospital to their own home or to a nursing home depending on their preference. Seventy-four (deemed to have a prognosis of less than 4 weeks) were discharged within 24 h. The remaining 18 were felt to have a prognosis of hours to days and were discharged within 4 h. All received continuing care funding and were supported to die in their preferred place of care. Feedback from patients and relatives has been positive.ConclusionThe authors have demonstrated that it is possible to meet patients and relatives wishes for preferred place of care at end of life through the use of our rapid discharge pathway. The first year highlighted the need to ensure that all patients are discharged with appropriate supplies of as-required medication for symptom control to prevent crises at home. We have recently launched a printed version of the Pathway with documentation to support multi-agency working and will be auditing its use.
A national survey of the management of implantable cardioverter defibrillators in specialist palliative care settings
Authors: Beattie James , Butler Jane , MacCallum Annie , Fuller Alice , Johnson Miriam 
Published: March 2012

BackgroundImplantable cardioverter defibrillators (ICDs), used alone, or sometimes combined with pacemaker-based cardiac resynchronisation therapy, are increasingly inserted to treat those with heart failure (HF) at risk of lethal arrhythmias. Device activity may discomfort dying patients and induce dilemmas for recipients, families and professional carers at the end of life.MethodsOver a 4 week period between February and March 2011, we undertook a web based retrospective survey of ICD management over the preceding 12 months by specialist palliative care (SPC) services across England, Wales and Northern Ireland.ResultsOf 95 respondents, 65% were hospice based, 13% were from SPC units in acute trusts, and 22% were from SPC teams working in a variety of care settings without SPC beds. Of the clinical cohort cared for by these SPC professionals, 5.5% were said to have HF either as a primary or secondary diagnosis. 93% of these services accepted patients with ICDs and 55% had treated such individuals over the relevant period. Half used explicit device-related admission documentation but only 26% had a site specific or regional deactivation policy in place. 42 patients were estimated to have required defibrillator deactivation and in >75% of cases, this required the patient to attend an external device clinic or be visited by a member of the cardiology team or industry representative. Importantly, 44% of SPC teams had no access to a magnet for emergency ICD deactivation and only 32% provided staff training in this intervention.ConclusionThe results of this national survey demonstrate inconsistency in ICD management by SPC teams, with gaps in service which may adversely affect end of life care. SPC units need to develop robust policies to document and manage ICDs prospectively, with staff education and ready access to the necessary expertise and equipment.
Development and evaluation of a decision support tool for ambulance workers
Authors: Munday Daniel , Gakhal Sandeep , Cole Robert , Bronner Rosanna , Clerici Joanne , Cooke Matthew W 
Published: March 2012

AimsRecently completed research demonstrated that ambulance crews had received little training in managing terminally ill patients and showed marked variation in what they consider to be a valid DNAR or what they would accept as an advance care plan indicating that a patient would not want to be admitted to hospital. This research informed the development of an end of life care online education package. However, as it might be difficult for crews to call to mind such learning in an emergency situation, we also developed and are currently evaluating a decision support tool to assist ambulance crews in managing terminally ill patients.MethodsEnd of life vignettes were presented to 21 ambulance clinicians in order to inform the development of the tool. A multidisciplinary expert group subsequently designed the tool. Suggestions for modification were made by two focus groups of ambulance clinicians. 60 ambulance clinicians have been trained to use the tool and currently involved in a survey to evaluate the effectiveness of the tool in practice.ResultsData from the vignettes provided further confirmation of the lack of consistency among ambulance crews in their approach to decision making at the end of life, despite working in the same ambulance trust with standard policies and procedures. There was strong evidence that their decision-making is particularly risk averse leading to the likelihood that terminally ill patients would be admitted to hospital or have cardiopulmonary resuscitation following a cardiac arrest. Participants in the focus and education groups reported that the tool appeared to be helpful and appropriate. The tool is being currently tested and results from this evaluation will be available for presentation.ConclusionLack of consistency in how ambulance crews deal with end of life situations highlights the importance of a decision support tool. Sponsor: NHS West Midlands.
Management of oesophageal coins in children
Authors: Nafousi O , Pertwee Richard , Roland Damian , Acheson Jonathan 
Published: March 2012

ObjectiveIs a watch and wait approach safe in asymptomatic patients presenting to the emergency department with a confirmed oesophageal coin on x-ray?MethodsA retrospective case note review for children <16 years attending with a confirmed oesophageal coin on x-ray over a 7-year period (1 January 2004 to 31 December 2010).Results89% (33/37) of coins in asymptomatic patients, who were conservatively managed, had passed spontaneously on repeat chest x-ray up to 18 h later. No patient who was discharged with a middle or lower oesophageal coin required a GA and no child who was treated conservatively developed any complications.ConclusionIn the UK asymptomatic children, with no history of tracheal or oesophageal disease and a confirmed oesophageal coin on x-ray should undergo a period of observation up to 18 h. This can be safely undertaken at home, followed by a repeat x-ray in the emergency department.
A Phase I Dose–Escalation Study of Regorafenib (BAY 73–4506), an Inhibitor of Oncogenic, Angiogenic, and Stromal Kinases, in Patients with Advanced Solid Tumors
Authors: Mross Klaus , Frost Annette , Steinbild Simone , Hedbom Susanne , Büchert Martin , Fasol Ulrike , Unger Clemens , Krätzschmar Jörn , Heinig Roland , Boix Oliver , Christensen Olaf 
Published: March 2012

Abstract
Purpose: Regorafenib is a novel oral multikinase inhibitor of angiogenic (VEGFR1-3, TIE2), stromal (PDGFR-β, FGFR), and oncogenic kinases (KIT, RET, and RAF). This first-in-man, phase I dose–escalation study assessed the safety, pharmacokinetic, pharmacodynamic, and efficacy profiles of regorafenib in patients with advanced solid tumors.
Patients and Methods: Patients aged 18 years or older with advanced solid tumors refractory to standard treatment were recruited. Regorafenib was administered orally for 21 days on/seven days off in repeating cycles, until discontinuation due to toxicity or tumor progression. Adverse events (AE) were assessed using National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. Pharmacokinetic profiles were measured after a single dose and on day 21. Pharmacodynamic and efficacy evaluations included tumor perfusion assessment using dynamic contrast-enhanced MRI, plasma cytokines, and tumor response using RECIST (v1.0).
Results: Fifty-three patients were enrolled into eight cohorts at dose levels from 10 to 220 mg daily. The recommended dose for future studies was determined to be 160 mg daily, with a treatment schedule of 21 days on/seven days off in repeating 28-day cycles. The most common drug-related grade 3 or 4 AEs were dermatologic AEs (hand–foot skin reaction, rash), hypertension, and diarrhea. Pharmacokinetic analysis revealed a similar exposure at steady state for the parent compound and two pharmacologically active metabolites. Tumor perfusion and plasma cytokine analysis showed biologic activity of regorafenib. Three of 47 evaluable patients achieved a partial response (renal cell carcinoma, colorectal carcinoma, and osteosarcoma).
Conclusion: Regorafenib showed an acceptable safety profile and preliminary evidence of antitumor activity in patients with solid tumors. Clin Cancer Res; 18(9); 2658–67. ©2012 AACR.
BAFF Receptor Deficiency Reduces the Development of Atherosclerosis in Mice—Brief Report
Authors: Sage Andrew P. , Tsiantoulas Dimitrios , Baker Lauren , Harrison James , Masters Leanne , Murphy Deirdre , Loinard Celine , Binder Christoph J. , Mallat Ziad 
Published: March 2012

Objective—
The goal of this study was to assess the role of B-cell activating factor (BAFF) receptor in ­B-­cell regulation of atherosclerosis.

Methods and Results—

Male LDL ­receptor-­deficient mice (
Ldlr
−/−
) were lethally irradiated and reconstituted with either wild type or BAFF receptor (BAFF-R)–deficient bone marrow. After 4 weeks of recovery, mice were put on a ­high-­fat diet for 6 or 8 weeks. ­BAFF-­R deficiency in bone marrow cells led to a marked reduction of conventional mature B2 cells but did not affect the B1a cell subtype. This was associated with a significant reduction of dendritic cell activation and ­T-­cell proliferation along with a reduction of IgG antibodies against ­malondialdehyde-­modified low-density lipoprotein. In contrast, serum IgM type antibodies were preserved. Interestingly, ­BAFF-­R deficiency was associated with a significant reduction in atherosclerotic lesion development and reduced numbers of plaque T cells. Selective ­BAFF-­R deficiency on B cells led to a similar reduction in lesion size and ­T-­cell infiltration but in contrast did not affect dendritic cell activation.

Conclusion—
BAFF-­R deficiency in mice selectively alters mature B2 ­cell-­dependent cellular and humoral immune responses and limits the development of atherosclerosis.
Correlation Between Signal-Averaged ECG and the Histologic Evaluation of the Myocardial Substrate in Right Ventricular Outflow Tract Arrhythmias
Authors: Santangeli Pasquale , Pieroni Maurizio , Russo Antonio Dello , Casella Michela , Pelargonio Gemma , Biase Luigi Di , Macchione Andrea , Burkhardt J. David , Bellocci Fulvio , Santarelli Pietro , Tondo Claudio , Natale Andrea 
Published: March 2012

Background—
The differential diagnosis between idiopathic and cardiomyopathy-related right ventricular outflow tract (RVOT) ventricular arrhythmias (VAs) is crucial. Signal-averaged ECG (SAECG) abnormalities are frequent in cardiomyopathy-related RVOT-VAs, although their pathophysiologic basis and diagnostic value in this setting are undefined. We tested the association between SAECG and the myocardial substrate underlying RVOT-VAs.

Methods and Results—

Twenty-four consecutive patients (median age, 50 years [42–59]; 12 men) with RVOT-VAs (10 with frequent [>1000/24 hours] premature ventricular contractions, 14 with ventricular tachycardias) underwent SAECG with 40-Hz filtering and electroanatomic mapping (EAM) with EAM-guided biopsy for characterization of the RVOT-VAs substrate. A filtered averaged QRS (fQRS) was obtained and analyzed for fQRS duration, low amplitude signal duration <40 mV (LAS40), and root-mean-square voltage in the last 40 ms of the QRS (RMS40). Standard definition of EAM scar was used. EAM-guided biopsy diagnosed ARVC in 11 (46%), myocarditis in 8 (33%), and idiopathic RVOT-VAs in 5 (21%) patients. Patients with cardiomyopathy-related RVOT-VAs had ≥1 EAM scar (median, 2 [1–2]; all with RVOT scar). EAM of patients with idiopathic RVOT-VAs was normal. Patients with cardiomyopathy-related RVOT-VAs had significantly longer fQRS (106 ms [92–132] versus 83 ms [82–84],
P
=0.01) and LAS40 (39 ms [36–51] versus 19 ms [18–21],
P
=0.02), and lower RMS40 (18 µV [9–26] versus 33 µV [32–33],
P
=0.04). A significant linear correlation was found between the extension (cm2) of the RVOT scar and all 3 SAECG parameters (rs=0.76,
P
<0.001 for the fQRSd; rs=0.73,
P
<0.001 for the LAS40; and rs=−0.72,
P
<0.001 for the RMS40). Using the established 2 of 3 criteria (ie, late potentials), SAECG diagnosed cardiomyopathy-related RVOT-VAs with high positive (100%) but low negative (38%) predictive values and missed 7 of 9 (78%) patients with RVOT scar <8 cm
2
.

Conclusions—
In patients with RVOT-VAs, abnormal SAECG parameters reflect the presence of extensive cardiomyopathic involvement of the RVOT. However, a negative SAECG does not reliably rule out cardiomyopathy-related RVOT-VAs in the presence of a small RVOT scar.
Apolipoprotein-E Controls Adenosine Triphosphate-Binding Cassette Transporters ABCB1 and ABCC1 on Cerebral Microvessels After Methamphetamine Intoxication
Authors: ElAli Ayman , Urrutia Andrés , Rubio-Araiz Ana , Hernandez-Jimenez Macarena , Colado Maria I. , Doeppner Thorsten R. , Hermann Dirk M. 
Published: March 2012

Background and Purpose—
Methamphetamine is a powerful addictive, which has been associated with ischemic stroke and brain hemorrhage in humans. Whether and how methamphetamine influences the expression of tight junctions and adenosine triphosphate-binding cassette transporters, which have previously been shown to be regulated by apolipoprotein-E (ApoE) under conditions of brain ischemia, was unknown.

Methods—
C57BL/6J mice received intraperitoneal injections of methamphetamine (3 times 4 mg/kg separated by 3 hours) either alone or in combination with the ApoE receptor-2 inhibitor receptor-associated protein (40 μg/kg) or the inducible nitric oxide synthase inhibitor 1400W (5 mg/kg). Animals were euthanized 3 or 24 hours after methamphetamine exposure. Tissue responses were evaluated with Western blots, immunoprecipitation, and immunohistochemistry using total brain and cerebral microvessel extracts.

Results—
Methamphetamine induced a transient activation of stress kinases c-Jun N-terminal kinase 1/2 and p38 in the brain parenchyma and increased intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 expression on cerebral microvessels without inducing loss of tight junction proteins and without inducing IgG extravasation. Methamphetamine transiently increased the expression of the luminal adenosine triphosphate-binding cassette transporter ABCB1 on cerebral microvessels and reduced the expression of the abluminal transporter ABCC1. Elevated expression of ApoE was noted in the brain parenchyma by methamphetamine, activating ApoE receptor-2 on brain capillaries, deactivating c-Jun N-terminal kinase 1/2 and c-Jun, and regulating ABCB1 and ABCC1 expression. Indeed, ApoE receptor-2 and inducible nitric oxide synthase inhibition prevented the ABCB1 and ABCC1 expression changes.

Conclusions—
Acute exposure to methamphetamine at doses comparable to those consumed in drug addiction does not induce tight junction breakdown but differentially regulates adenosine triphosphate-binding cassette transporters through the ApoE/ApoE receptor-2/c-Jun N-terminal kinase 1/2 pathway.