bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors influencing the implementation of the guideline Triage in emergency departments: a qualitative study
Authors: Janssen Maaike AP , van Achterberg Theo , Adriaansen Marian JM , Kampshoff Caroline S , Schalk Donna MJ , Mintjes‐de Groot Joke 
Published: December 2011

Aims and objectives.  The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline.Background.  Guideline dissemination is no guarantee for guideline implementation. In 2004 the guideline Triage in Emergency Departments was disseminated in Dutch hospitals. Guideline revision was scheduled in 2008. Prior to the revision, factors which influenced the implementation of the guideline [2004] were studied to be addressed at the implementation of the revised guideline.Methods.  This is an exploratory study using a qualitative design including: a questionnaire sent to all emergency departments in the Netherlands (n = 108): four focus group interviews, including nurses and ward managers and in‐depth interviews with ward managers and doctors. Based on the results, tailored implementation strategies and activities were suggested which target the identified influencing factors.Results.  Various factors at individual, social context and organisational level were identified as influencing the implementation of the 2004 version of the guideline, namely: level of knowledge; insight and skills; work preferences; motivation and/or commitment; support; informed doctors; preliminary work and arrangements for implementation; description of tasks and responsibilities; workload and resources. Ward managers, nurses and doctors mentioned similar as well as different factors. Consequently, tailored implementation strategies and activities related to education, maintenance of change, motivation and consensus‐building, information, organisation and facilitation were suggested.Conclusion.  Nurses, ward managers and doctors broadly indicated similar influencing factors, although the importance of these factors differed for the different groups. For nurses, resistance and lack of resources are most important, ward managers mentioned culture and doctors the availability of doctors at the emergency department.Relevance to clinical practice.  Insight into the barriers for implementation and tailoring implementation strategies to these barriers improves the implementation.
Do medical certificates of stillbirth provide accurate and useful information regarding the cause of death?
Authors: Cockerill Ruth , Whitworth Melissa K. , Heazell Alexander E. P. 
Published: December 2011

SummaryCockerill R, Whitworth MK, Heazell AEP. Do medical certificates of stillbirth provide accurate and useful information regarding the cause of death? Paediatric and Perinatal Epidemiology 2012; 26: 117–123.Stillbirth affects one in 200 pregnancies in the UK. Understanding the causes of stillbirth is essential to reducing perinatal mortality. Stillbirth certificates represent a potential source of data on perinatal mortality. We aimed to assess whether the information on stillbirth certificates used in the UK is accurate.A retrospective cross‐sectional audit of stillbirth certificates issued in a geographical region of the UK in 2009 was undertaken. Data were recorded from the stillbirth certificate and health records. The cause of death was classified using the ReCoDe system. Two hundred and thirteen stillbirth certificates were issued for stillbirths (feticides for fetal anomaly were excluded). Agreement for the primary factor associated with the stillbirth was fair (Kappa = 0.286). This contrasts with the gestation of stillbirth, which was almost complete agreement (Kappa = 0.883). The majority of stillbirths (58.7%) were classified on the certificate as ‘unknown cause’. A proportion of 9.4% of stillbirths were classified as congenital anomaly and 8.0% as placental abruption. Only 0.5% of stillbirth certificates cited fetal growth restriction as a relevant condition contributing to death. A total of 49.6% of ‘unexplained’ stillbirths were associated with fetal growth restriction on review. Errors were present in 77.9% of certificates, including missing co‐morbidities (55.9%) and the wrong cause of death (40.4%).The cause(s) of death is (are) not recorded accurately on the UK medical certificate of stillbirth, and the majority of certificates contain one or more errors. Training is required to improve understanding of the causes of stillbirth and completion of medical certificates. Data recorded directly from medical certificate of stillbirths are not sufficiently reliable for descriptive studies of causation and epidemiology.
Emergency reversal of pentasaccharide anticoagulants: a systematic review of the literature
Authors: Elmer J. , Wittels K. A. 
Published: December 2011

Objectives: To conduct a systematic review of the literature to answer the question: Has administration of recombinant activated factor VII (rFVIIa) or prothombin complex concentrate (PCC) or activated PCC (aPCC) been demonstrated to be effective in reversing pendasaccharide anticoagulants (PSAs)?Background: Fondaparinux and idraparinux are ultra‐short, synthetic PSAs. Typical anticoagulation reversal with either vitamin K and fresh frozen plasma or protamine sulphate does not reverse PSAs. Mechanistically, it is plausible that rFVIIa, PCC and aPCC may be effective reversal agents for PSAs. However, the available data are limited.Materials/Methods: We conducted a systematic review of MEDLINE, EMBASE, CINAHL and the Cochrane Library without date or language limitations designed to answer the question: Has administration of rFVIIa, PCC or aPCC been demonstrated to be effective in reversing PSAs? The quality of the included studies was assessed based on standard methodologies. Relevant information was synthesised and reported.Results: After an initial literature search, 197 abstracts were identified, of which 14 articles were reviewed in their entirety. Ultimately, five studies were identified that met inclusion and exclusion criteria. Although the literature is limited, the best available data support the use of rFVIIa for serious bleeding in patients anticoagulated with PSAs.Conclusions: Limited data support the use of rFVIIa as a reversal agent for serious bleeding in patients who are anticoagulated with PSAs. The optimal dose, role for concomitant use of platelets or antifibrinolytic agents and exact indications for reversal remain to be determined. Such investigations are urgently needed as use of PSAs increases.
Transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney morcellation: a proof of concept study
Authors: Lima Estevao , Branco Frederico , Parente Joana , Autorino Riccardo , Correia‐Pinto Jorge 
Published: December 2011

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Until now, the transvaginal approach has been the only method of removing larger specimens from the abdominal cavity using natural orifice transluminal endoscopic surgery. There has been no means of extracting larger specimens in men and the means are restricted even in women, particularly in young women.The present study shows that the difficulty of large specimen retrieval can be overcome, irrespective of the diameter of the chosen port, through natural orifices using morcellation.OBJECTIVE
To show, in a porcine model, the feasibility of a complete transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney extraction after morcellation through the same port.
MATERIALS AND METHODS
Transvesical nephrectomy and morcellation were performed in six pigs at Minho University, Braga, Portugal after institutional review board approval.
The transvesical port and the cystotomy were created under the guidance of a ureteroscope, while the remaining steps were done under the guidance of an operating telescope.
Dissection of the renal vessels and kidney was performed using dissection grasping forceps and a vessel sealing system (LigaSure™; Covidien, Mansfield, MA, USA) and morcellation was done using a Piranha™ morcellator (Richard Wolf, Knittlingen, Germany).
RESULTS
There were no complications related to the creation of transvesical access.
The image provided by the telescope was superior to that of the ureteroscope, especially underwater. Morcellation was quick and effective, with the support of a fixing needle through the abdominal wall, designed to fix the kidney, after laceration of a bowel loop occurred in the first experiment.
It was found that technical improvements are needed to ensure safety of NOTES morcellation.
CONCLUSIONS
Kidney morcellation after nephrectomy, using a natural orifice exclusively, is feasible.
Despite technical limitations, this proof of concept study can be regarded as a potential step towards the application of NOTES in urology.
Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single‐site (LESS), laparoscopic and open surgery
Authors: Olweny Ephrem O. , Mir Saad A. , Best Sara L. , Park Samuel K. , Donnally III Chester , Cadeddu Jeffrey A. , Tracy Chad R. 
Published: December 2011

Study Type – Therapy (case series)Level of Evidence  4What's known on the subject? and What does the study add?Studies in other surgical populations have found that scarring is a relatively unimportant preoperative patient consideration when compared with surgical cure and safety, but that younger age was a significant factor influencing preference for ‘scarless’ surgery.The present study corroborates the findings of previous series, among patients who were contemplating kidney surgery.OBJECTIVE
To evaluate patient attitudes towards cosmesis relative to other considerations, before and after undergoing laparoendoscopic single‐site surgery (LESS) vs laparoscopic/robot‐assisted vs open kidney surgery.
METHODS
Participants were provided with a survey querying demographic information, surgical history and importance of scarring relative to other surgical outcomes and considerations.
The relative importance of each outcome was recorded on a nine‐level ranking scale, ranging from 1 (most important) to 9 (least important).
The median scores for each outcome were compared before and after surgery using the Wilcoxon signed‐rank test, and by surgical approach using the Kruskal–Wallis test.
The importance of scarring was further analysed according to age (≤50 vs >50 years), surgical indication (oncological vs non‐oncological), gender, and proportion of patients who had undergone previous abdominal surgery.
RESULTS
A total of 90 patients completed surveys before surgery, of whom 65 (72.2%) also completed surveys after surgery.
‘Surgeon reputation’ and ‘no complications’ were the most important considerations before surgery (median scores 2 and 3, respectively) and after surgery (median scores of 2 for both).
‘Size/number of scars’ was the least important consideration before surgery (median score 8) and the second least important consideration after surgery (median score 7).
The median score for ‘size/number of scars’ was significantly higher for the LESS cohort before surgery (laparoscopic/robot‐assisted vs LESS vs open surgery: 8.5 vs 6 vs 9; P = 0.003), but was nonsignificant after surgery (laparoscopic/robotic vs LESS vs open surgery: 7 vs 6.5 vs 7.5; P = 0.83).
The median score for ‘size/number of scars’ before surgery was significantly higher for younger patients (P = 0.05) and those with non‐oncological surgical indications (P < 0.001), but there was no significant difference in this outcome for these sub‐groups after surgery.
CONCLUSIONS
For most patients contemplating urological surgery, cosmesis is of less concern than surgeon reputation and avoidance of surgical complications.
Cosmesis may be a more important preoperative consideration for younger patients and those with benign conditions, which warrants further investigation.
Autonomic responses to stress in Black versus Caucasian Africans: The SABPA Study
Authors: Reimann Manja , Hamer Mark , Schlaich Markus , Malan Nicolaas T. , Rüdiger Heinz , Ziemssen Tjalf , Malan Leoné 
Published: December 2011

AbstractUnderlying mechanisms of increased pressor responses to stress in Blacks are poorly understood. Cardiovascular regulation of normotensive Black (n = 43) and Caucasian (n = 90) Africans was studied during a cold pressor and color‐word conflict test. Autonomic evaluation was performed by spectral analysis. Higher diastolic pressor and heart rate responses to the cold pressor test were observed in Black compared to Caucasian Africans. Autonomic efferent outflow to stress was comparable between groups. Transient downregulation of baroreflex during stress was evident in Blacks but not in Caucasians. Greater diastolic pressor responses were related to a higher cardiac reactivity, a baroreflex desensitization, and higher stress perception in Black Africans. Thus, increased stress perception may facilitate cardiac and diastolic hyperreactivity, indirectly affecting baroreflex function in Black Africans.
Adult neurogenesis in the short‐lived teleost Nothobranchius furzeri: localization of neurogenic niches, molecular characterization and effects of aging
Authors: Tozzini Eva Terzibasi , Baumgart Mario , Battistoni Giorgia , Cellerino Alessandro 
Published: December 2011

SummaryWe studied adult neurogenesis in the short‐lived annual fish Nothobranchius furzeri and quantified the effects of aging on the mitotic activity of the neuronal progenitors and the expression of glial fibrillary acid protein (GFAP) in the radial glia. The distribution of neurogenic niches is substantially similar to that of zebrafish and adult stem cells generate neurons, which persist in the adult brain. As opposed to zebrafish, however, the N. furzeri genome contains a doublecortin (DCX) gene. Doublecortin is transiently expressed by newly generated neurons in the telencephalon and optic tectum (OT). We also analyzed the expression of the microRNA miR‐9 and miR‐124 and found that they have complementary expression domains: miR‐9 is expressed in the neurogenic niches of the telencephalon and the radial glia of the OT, while miR‐124 is expressed in differentiated neurons. The main finding of this paper is the demonstration of an age‐dependent decay in adult neurogenesis. Using unbiased stereological estimates of cell numbers, we detected an almost fivefold decrease in the number of mitotically active cells in the OT between young and old age. This reduced mitotic activity is paralleled by a reduction in DCX labeling. Finally, we detected a dramatic up‐regulation of GFAP in the radial glia of the aged brain. This up‐regulation is not paralleled by a similar up‐regulation of S100B and Musashi‐1, two other markers of the radial glia. In summary, the brain of N. furzeri replicates two typical hallmarks of mammalian aging: gliosis and reduced adult neurogenesis.
Monitoring of cellular senescence by DNA‐methylation at specific CpG sites
Authors: Koch Carmen M. , Joussen Sylvia , Schellenberg Anne , Lin Qiong , Zenke Martin , Wagner Wolfgang 
Published: December 2011

SummaryReplicative senescence has fundamental implications on cell morphology, proliferation, and differentiation potential. Here, we describe a simple method to track long‐term culture based on continuous DNA‐methylation changes at six specific CpG sites. This epigenetic senescence signature can be used as biomarker for various cell types to predict the state of cellular senescence with regard to the number of passages, population doublings, or days of in vitro culture.
Catheter Dysfunction: The Role of Lock Solutions
Authors: Niyyar Vandana Dua 
Published: December 2011

AbstractVascular access dysfunction is a major cause of morbidity in hemodialysis (HD) patients. An upper extremity autogenous arteriovenous fistula (AVF) that preferentially involves the cephalic vein is the access of choice for HD patients, followed by autogenous AVF utilizing the basilic vein and the use of prosthetic arteriovenous grafts (AVGs). Despite these recommendations, central venous catheter (CVC) use is widespread among both incident and prevalent HD patients. Long‐term use of CVCs for HD is complicated by a high rate of infection and thrombus‐related dysfunction. Catheter locking solutions have been used both prophylactically and therapeutically for catheter thrombosis as well as catheter‐related infections, with varying degrees of success. This review aims to address the different catheter locking solutions, their advantages and disadvantages, and new directions in this field.
Evaluation of Left Ventricular Relaxation in Rotary Blood Pump Recipients Using the Pump Flow Waveform: A Simulation Study
Authors: Moscato Francesco , Granegger Marcus , Naiyanetr Phornphop , Wieselthaler Georg , Schima Heinrich 
Published: December 2011

AbstractIn heart failure, diastolic dysfunction is responsible for about 50% of the cases, with higher prevalence in women and elderly persons and contributing similarly to mortality as systolic dysfunction. Whereas the cardiac systolic diagnostics in ventricular assist device patients from pump parameters have been investigated by several groups, the diastolic behavior has been barely discussed. This study focuses on the determination of ventricular relaxation during early diastole in rotary blood pump (RBP) recipients. In conventional cardiology, relaxation is usually evaluated by the minimum rate and the time constant of left ventricular pressure decrease, dP/dtmin and τP. Two new analogous indices derived from the pump flow waveform were investigated in this study: the minimum rate and the time constant of pump flow decrease, dQ/dtmin and τQ. The correspondence between the indices was investigated in a numerical simulation of the assisted circulation for different ventricular relaxation states (τP ranging from 24 to 68 ms) and two RBP models characterized by linear and nonlinear pressure‐flow characteristics. dQ/dtmin and τQ always correlated with the dP/dtmin and τP, respectively (r > 0.97). These relationships were influenced by the nonlinear pump characteristics during partial support and by the pump speed during full support. To minimize these influences, simulation results suggest the evaluation of dQ/dtmin and τQ at a pump speed that corresponds to the borderline between partial and full support. In conclusion, at least in simulation, relaxation can be derived from pump data. This noninvasively accessible information could contribute to a continuous estimation of the remaining cardiac function and its eventual recovery.
Assessment of Appropriateness of Screening Community‐Dwelling Older People to Prevent Functional Decline
Authors: Drewes Yvonne M. , Gussekloo Jacobijn , van der Meer Victor , Rigter Henk , Dekker Janny H. , Goumans Marleen J. B. M. , Metsemakers Job F. M. , van Overbeek Riki , de Rooij Sophia E. , Schers Henk J. , Schuurmans Marieke J. , Sturmans Ferd , de Vries Kerst , Westendorp Rudi G. J. , Wind Annet W. , Assendelft Willem J. J. 
Published: December 2011

ObjectivesTo identify appropriate screening conditions, stratified according to age and vulnerability, to prevent functional decline in older people.DesignA RAND/University of California at Los Angeles appropriateness method.SettingThe Netherlands.ParticipantsA multidisciplinary panel of 11 experts.MeasurementsThe panelists assessed the appropriateness of screening for 29 conditions mentioned in guidelines from four countries, stratified according to age (60–74, 75–84, ≥85) and health status (general, vital, and vulnerable) and received a literature overview for each condition, including the guidelines and up‐to‐date literature. After an individual rating round, panelists discussed disagreements and performed a second individual rating. The median of the second ratings defined the appropriateness of screening.ResultsThe panel rated screening to be appropriate in three of the 29 conditions, indicating that screening was expected to prevent functional decline. Screening for insufficient physical activity was considered appropriate for all three age and health groups. Screening for cardiovascular risk factors and smoking was considered appropriate for the general and vital population aged 60 to 74. Of the 261 ratings, 63 (24%) were classified as uncertain, of which 42 (67%) concerned the vulnerable population. The panelists considered conditions inappropriate mainly because of lack of an adequate screening tool or lack of evidence of effective interventions for positive screened persons.ConclusionThe expert panel considered screening older people to prevent functional decline appropriate for insufficient physical activity and smoking and cardiovascular risk in specific groups. For other conditions, sufficient evidence does not support screening. Based on their experience, panelists expected benefit from developing tests and interventions, especially for vulnerable older people.
Radiological Correlate of Ocular Flutter in a Case with Paraneoplastic Encephalitis
Authors: Newey Christopher R. , Sarwal Aarti , Wu Guiyun 
Published: December 2011

ABSTRACTWe present an interesting [18F]fluoro‐2‐deoxyglucose positron emission tomography (FDG‐PET) imaging finding in a patient with ocular flutter and cerebellar ataxia as part of anti‐Ma 1/2 antibody‐mediated paraneoplastic syndrome associated with a testicular seminoma. He had a typical anterior mesial temporal hyperintensity on magnetic resonance imaging (MRI) without gadolinium enhancement. In addition, his FDG‐PET images showed increased deep cerebellar and inferior rectus and superior oblique ocular muscles FDG uptake. This case is the first to visualize in vivo the possible underlying neuropathological mechanism of ocular flutter associated with cerebellar nuclei on functional imaging.
Halitology (breath odour: aetiopathogenesis and management)
Authors: Scully C , Greenman J 
Published: December 2011

Oral Diseases (2012) 18, 333–345This article reviews the aetiopathogenesis of halitosis (oral malodour) and management. Halitosis is any disagreeable breath odour. In most patients, the odour originates from the oral cavity. In some patients, it has an extra‐oral aetiology and, in a few, metabolic anomalies are responsible. In other patients complaining of malodour, this is imagined rather than real. Volatile sulphur compounds (VSCs) and other elements appear largely responsible for the malodour. Predisposing factors include poor oral hygiene, hyposalivation, dental appliances, gingival and periodontal disease and mucosal disease. The first step in assessment is objective measurement to determine whether malodour is present. If present, the oral or extra‐oral origin should be determined, because the latter requires medical investigation and support in therapy, as is also the case where the malodour is imagined rather than real. Oral malodour is managed largely by oral health improvement, plus use of one or more of the wide range of antimalodour therapies, and sometimes also with use of a malodour counteractive. Emergent treatments include probiotics and vaccines targeted against causal micro‐organisms or their products.