bluuebunny/crossref_metadata_2025_split huggingface dataset:
A review of adverse event reporting in Irish surgical specialties
Authors: Breathnach O , Cousins G , Dunne D , Ryan K , Smith D , O'Byrne J 
Published: March 2011

Introduction Reporting of adverse events in medicine is an important concept. It is widely accepted that a key element of any healthcare service is the approach that is adopted towards reporting adverse events. Government legislation and the increased number of patient safety initiatives with widespread discussion within the medical literature marks adverse event reporting as an important topic for analysis. Methods The Clinical Indemnity Scheme (CIS) provides risk advisory services to state authorities in Ireland. This study will focus on 42,094 adverse events reported across all surgical specialties to the CIS via a confidential weblink (STARSWeb) since 2004. The most common features of each adverse event and closed medicolegal claims processed by the CIS were reviewed as part of this study. Results The majority of reported adverse events occur in orthopaedic and general surgery (73% of all cases). Slips/trips/falls are the most common adverse event reported. Doctors report only 4% of the total number of adverse events. The month of October records the highest number of adverse events with the highest frequency of adverse events taking place before 13:00 each day. The most common incident type which resulted in a claim being closed by the CIS was the perioperative/periprocedure incident (50% of all cases). Conclusions The CIS report a significant number of adverse events across a range of surgical specialties. A pattern of adverse events being reported during ‘daylight’ hours gives a clear indication that routine surgical operations and procedures carry with them a risk for injury to the patient. Particular months of the year and time of the day are more likely to be associated with reported adverse events. This pattern of events should be highlighted in an attempt to promote safer surgical practice within hospitals during particular times of the day, month or year.
Legal issues surrounding information sharing
Authors: Hanratty Gerard 
Published: March 2011

The article considers the issues which can arise for the NHS in sharing information, looking at the common occasions when information will be shared and providing a checklist to ensure compliance with the Data Protection Act 1998 and the common law duty of confidentiality. It also considers potential legal proceedings should the DPA or common law duty be breached and looks at how the Information Commissioner has used his increased ability to fine organisations for breaching the DPA. Finally consideration is given to some recent developments, such as the draft Data Sharing Code of Practice which the IC has issued and some supplementary guidance from the DH on confidentiality with regard to public interest disclosures. The conclusion is that now represents an opportune moment for the NHS and other organisations to review their data sharing protocols and ensure they comply with the new Code from the IC and guidance from the DH. Given the fines which the IC has recently imposed, any failure to have a policy on information sharing which is fit for purpose could lead to a significant monetary penalty and damage to reputation.
Predictors of Clinically Significant Drug-Drug Interactions Among Patients Treated with Nonnucleoside Reverse Transcriptase Inhibitor–, Protease Inhibitor–, and Raltegravir-Based Antiretroviral Regimens
Authors: Patel Nimish , Abdelsayed Sandra , Veve Michael , Miller Christopher D 
Published: March 2011

Background: The Department of Health and Human Services (DHHS) HIV treatment guidelines recommend that antiretroviral regimens for treatment-naïve individuals include at least 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus either (1) a nonnucleoside reverse transcriptase inhibitor (NNRTI), (2) a protease inhibitor (PI), or (3) raltegravir, an integrase strand transfer inhibitor. Differences in drug-drug interaction potential may represent an important differentiating feature when choosing between these regimen types. Objective: To identify risk factors for clinically significant drug-drug interactions (CSDDIs) among patients on NNRTI-, PI-, and raltegravir-based antiretroviral regimens; compare CSDDI risks between these regimen types; and develop a clinical prediction tool for antiretroviral CSDDIs Methods: In this cross-sectional study, outpatient medical records from the HIV clinic at Albany Medical Center Hospital were randomly selected to review patients’ current antiretroviral regimens. Patients treated with NNRTI-, PI-, or raltegravir-based regimens were included. Drug therapies were analyzed for interactions using Lexi-Comp drug interaction software. The CSDDIs were defined as either (1) a drug combination that is contraindicated or accompanied by strong precautions per DHHS antiretroviral guidelines or (2) a drug combination that necessitates a medication dose adjustment. Results: Of the 500 patient records screened. 229 were included. Baseline characteristics were similar between regimen groups, with the exception of comorbidities. In multivariate analyses, variables independently associated with CSDDIs were use of >5 non-antiretroviral medications (prevalence ratio [PR] 1.86; 95% CI 1.31 to 2.64: p< 0.001) and regimen type (NNRTI: PR 2.48, PI: PR 4.96, and rallegravir [referent]: PR 1.00; 95% CI 1.79 to 3.44; p < 0.001). Conclusions: Use of >5 non-antiretroviral medications or a non-raltegravir-based antiretroviral regimen increased the risk of a CSDDI. Our findings help clarify drug interaction risks among NNRTI-. PI-, and raltegravir-based regimen types that should be considered when prescribing antiretroviral therapy.
Levels of Adherence Required for Virologic Suppression Among Newer Antiretroviral Medications
Authors: Kobin Allison Beth , Sheth Neha Umesh 
Published: March 2011

Objective: To determine the adherence levels needed for HIV virologic suppression with newer antiretroviral (ARV) medications, including darunavir, etravirine, and raltegravir. Data Sources: Literature searches of PubMed, MEDLINE (1950-October 2010), and Google Scholar were performed using the following hey words in multiple combinations: antiretroviral, HIV, AIDS, adherence, darunavir, raltegravir, and etravirine. A review of the bibliographies of retrieved articles was performed to identify additional references. Study Selection and Data Extraction: All articles in English were identified from the data sources and evaluated. Studies that did not state names of medications or drug classes studied were excluded. Data Synthesis: There are differing levels of adherence needed to maintain virologic suppression, depending on the ARV class used. The adherence level needed for unboosted protease inhibitors (Pls) has been established as greater than 95%, but recent studies have shown that greater than 80% adherence to boosted Pls may be sufficient. Nonnucleoside reverse transcriptase inhibitors (NNRTIs) could require lower adherence rates than boosted Pls; however, study results are varied and NNRTIs carry a potential for developing resistance with nonadherence. Studies assessing the adherence needed for raltegravir have yet to be performed. Conclusions: Studies have shown differing levels of adherence needed among ARV classes of medications. With the advent of boosted Pls and potent medications, the amount of adherence needed has dropped since the 1990s. Although the current data are useful, there are discrepancies in the results due to the methods of adherence measurement. Knowing what adherence levels are needed is valuable in helping to determine the optimal ARV regimen for patients, given their adherence barriers. This knowledge can also help determine which patients require in-depth adherence counseling. Further research with a reliable method of measuring adherence is essential to determine adherence levels needed for newer ARV medications, including darunavir, etravirine, and raltegravir.
Clinical Outcomes of a Collaborative, Home-Based Postdischarge Warfarin Management Service
Authors: Stafford Leanne , Peterson Gregory M , Bereznicki Luke RE , Jackson Shane L , Tienen Ella C van , Angley Manya T , Bajorek Beata V , McLachlan Andrew J , Mullan Judy R , Misan Gary MH , Gaetani Luigi 
Published: March 2011

Background: Warfarin remains a high-risk drug for adverse events, especially following discharge from the hospital. New approaches are needed to minimize the potential for adverse outcomes during this period. Objective: To evaluate the clinical outcomes of a collaborative, home-based postdischarge warfarin management service adapted from the Australian Home Medicines Review (HMR) program. Methods: In a prospective, nonrandomized controlled cohort study, patients discharged from the hospital and newly initiated on or continuing warfarin therapy received either usual care (UC) or a postdischarge service (PDS) of 2 or 3 home visits by a trained, HMR-accredited pharmacist in their first 8 to 10 days postdischarge. The PDS involved point-of-care international normalized ratio (INR) monitoring, warfarin education, and an HMR, in collaboration with the patient's general practitioner and community pharmacist. The primary outcome measure was the combined incidence of major and minor hemorrhagic events in the 90 days postdischarge. Secondary outcome measures included the incidences of thrombotic events, combined hemorrhagic and thombotic events, unplanned and warfarin-related hospital readmissions, death, INR control, and persistence with therapy al 8 and 90 days postdischarge. Results: The PDS (n = 129) was associated with statistically significantly decreased rates of combined major and minor hemorrhagic events to day 90 (5.3% vs 14.7%; p = 0.03) and day 8 (0.9% vs 7.2%; p = 0.01) compared with UC (n = 139). The rate of combined hemorrhagic and thrombotic events to day 90 also decreased (6.4% vs 19.0%; p = 0.008) and persistence with warfarin therapy improved (95.4% vs 83.6%; p = 0.004). No significant differences in readmission and death rates or INR control were demonstrated. Conclusions: This study demonstrated the ability of appropriately trained accredited pharmacists working within the Australian HMR framework to reduce adverse events and improve persistence In patients taking warfarin following hospital discharge. Widespread implementation of such a service has the potential to enhance medication safety along the continuum of care. KEY WORDS: adverse drug events, community pharmacy services, international normalized ratio, patient discharge, warfarin.
Extended-Spectrum β-Lactamase–Producing Bacterial Infections in Adult Solid Organ Transplant Recipients
Authors: Winters Holli A , Parbhoo Rupal K , Schafer Jason J , Goff Debra A 
Published: March 2011

Background: Limited research is available evaluating infections due to extended-spectrum β-lactamase (ESBL)–producing organisms in adult recipients of solid organ transplant (SOT). Objective: To evaluate clinical response and rate of recurrence of ESBL-producing organisms in 20 SOT recipients. Methods: In a retrospective case series, records of adult SOT recipients with an admitting diagnosis of infection and a positive culture for an ESBL-producing organism from January 2003 through August 2006 were reviewed. Results: Twenty patients met inclusion criteria. The median time to infection following transplant was 3.5 years (range 1-23 years). Overall, 85% of the patients received inadequate empiric antibiotic therapy, including ciprofloxacin or piperacillin/tazobactam, to manage their infection. Nineteen patients had clinical resolution; however. 12 patients required at least 1 readmission due to infection recurrence. One patient's death occurred during the study period. The median time to readmission for a recurrence was 41 days (18-455 days). All recurrent infections were caused by the same ESBL-producing pathogen and 10 of 12 (83%) infections occurred at the same site as the initial infection. Among patients with recurrent infections, 75% received inadequate empiric therapy upon readmission. All 12 patients with recurrent infections had successful clinical responses to both initial and recurrent infections. Conclusions: The provision of inadequate empiric therapy for new and recurrent infections due to ESBL-producing pathogens was common in this study population. SOT recipients with a history of infection due to an ESBL-producing organism presenting with a new infection should receive adequate empiric therapy with a carbapenem agent until a definitive diagnosis can be established.
Use of Argatroban as a Procedural and Bridging Anticoagulant in a Patient Undergoing Carotid Endarterectomy with Concomitant Atrial Fibrillation
Authors: Nanda Manisha M , Kauflin Matthew J , Jain Priya G , Yannetta Jacob C 
Published: March 2011

Objective: To describe the use of argatroban as a procedural and bridging anticoagulant in a patient with a previous history of heparin allergy and atrial fibrillation undergoing carotid endarterectomy. Case Summary: A 78-year-old female with a history of heparin-induced thrombocytopenia (HIT) and multiple medical comorbidities, including atrial fibrillation requiring chronic anticoagulation with warfarin, was found to have greater than 70% stenosis of her left carotid artery by standard duplex imaging. Her warfarin therapy was discontinued as an outpatient approximately 48 hours prior to an elective left carotid endarterectomy and she was started on argatroban 2 μg/kg/min for bridging therapy. The endarterectomy was successfully performed while the patient was maintained on a continuous argatroban infusion, The dose was adjusted by 0.25-μg/kg/min intervals to achieve and maintain an activated clotting time of greater than 200 seconds during the procedure. Her postoperative course was unremarkable and she was transitioned back to warfarin and subsequently discharged home. Discussion: HIT poses a challenge for patients in need of vascular surgery, Optimally, one would postpone any surgical Intervention until the heparin antibodies are cleared from circulation, which on average takes about 100 days. In theory, it is safe to reexpose these patients to heparin products upon clearance of the antibody; however, there is scant literature available to show its safety. Current guidelines recommend limiting heparin exposure in any patients with a history of HIT, but the optimal alternative anticoagulant in this setting is unclear. There are several direct thrombin inhibitors available, but argatroban seemed to be a logical choice for our patient, especially in the setting of renal insufficiency, given its favorable pharmacokinetics and ease of monitoring with readily available coagulation tests. To our knowledge, this is the second reported case of the systemic use of argatroban in carotid endarterectomy in a patient with a previous history of HIT. Conclusions: Argatroban may be an effective anticoagulant during carotid endarterectomy in patients with underlying chronic renal disease and a history of HIT. Additional research is needed to determine the ideal anticoagulant in vascular surgery when heparin cannot be utilized.
Sport participation during adolescence and suicide ideation and attempts
Authors: Taliaferro Lindsay A. , Eisenberg Marla E. , Johnson Karen E. , Nelson Toben F. , Neumark-Sztainer Dianne 
Published: March 2011

Abstract

Background: Most research regarding sport participation and suicide risk found protective relationships. However, all studies in this area were based on cross-sectional designs.

Objective: To fill a gap in research by exploring associations between sport involvement and suicide ideation and attempts (suicidality) based on a 5-year longitudinal, population-based study.

Study group: Participants (n=739) completed surveys in middle school and high school.

Methods: Logistic regression analysis compared suicidality during high school across four groups: youth who participated in sport in both middle and high school, youth who participated only in middle school or only in high school, and youth who did not participate in sport during adolescence.

Results: Compared to non-participants, youth involved in sport in both middle and high school had lower odds of suicidal ideation during high school. Youth who discontinued sport after middle school had higher odds of attempting suicide during high school than non-participants.

Conclusions: Remaining involved in sport throughout adolescence can offer mental health benefits. Future research should identify mechanisms that account for protective relationships between involvement in sport throughout adolescence and suicidality, and identify factors that explain deleterious relationships for youth who discontinue sport early in adolescence.
Bullying in middle school: results from a 2008 survey
Authors: Pergolizzi Fabianna , Pergolizzi Joseph , Gan Zoe , Macario Samantha , Pergolizzi Joseph V. , Ewin T.J. , Gan Tong J. 
Published: March 2011

Abstract
A survey conducted in 2008 among 346 American middle school students in several cities determined that 82.7% of respondents found bullying to be a problem of some degree, with 46.0% rating it a “medium”, “bad”, or “very bad” problem. It was found that 89% had witnessed an act of bullying and 49.1% said they had been the victim of a bully. Boys were significantly more likely than girls to say that a victim deserved to be bullied (11.1% vs. 1.3%, p=0.01), whereas girls were significantly more likely than boys to fail to intervene because they did not know what to do (30.3% for girls vs. 11.1%, p<0.01). There was no significant difference in this study between boys and girls in terms of being a bully: 43.6% admitted they had bullied another (46.2% boys, 41.1% girls, p=0.34); however, girls were significantly more likely than boys to bully by excluding others and gossiping about them than by hitting, teasing, or threatening. Cyberbullying, surveyed as a distinct entity, had affected 31.1% of respondents directly, with similar results from 2006 to 2007 surveys. Of those who found conventional bullying a “bad” or “very bad” problem at their schools, numbers fell from 17.3% in 2006–2007 vs. 11.3% in 2008.
Drawing the line in the Edinburgh Postnatal Depression Scale (EPDS): a vital decision
Authors: Lagerberg Dagmar , Magnusson Margaretha , Sundelin Claes 
Published: March 2011

AbstractBackground:The Edinburgh Postnatal Depression Scale (EPDS) is widely used in early child health care. This study examined the appropriateness of the recommended EPDS cut-off score 11/12.Methods: Two main analyses were performed: 1. Associations between EPDS scores and maternal health behaviour, stress, life events, perceived mother-child interaction quality and child behaviour. 2. Screening parameters of the EPDS, i.e., sensitivity, specificity and positive predictive value. EPDS scores were available for 438 mothers and maternal questionnaires for 361 mothers.Results: Already in the EPDS score intervals 6–8 and 9–11, there were notable adversities, according to maternal questionnaires, in stress, perceived quality of mother-child interaction, perceived child difficultness and child problem behaviours. Using maternal questionnaire reports about sadness/distress postpartum as standard, the recommended EPDS cut-off score 11/12 resulted in a very low sensitivity (24%). The cut-off score 6/7 yielded a sensitivity of 61%, a specificity of 82% and a positive predictive value of 61%.Conclusions: In terms of both clinical relevance and screening qualities, an EPDS cut-off score lower than 11/12 seems recommendable.
Text messaging: one step forward for phone companies, one leap backward for adolescence
Authors: LaBode Vanessa 
Published: March 2011

Abstract
The increasing popularity of text messaging has made this mode of communication the preferred interaction portal for teens. Virtually every teenager has a cell phone with an un­limited text messaging plan. Text messaging easily facilitates communication between individuals without much interruption into daily life. After administering a survey to ten early adolescents and ten late adolescents, the effects of this technology are manifested across many developmental characteristics. Communication, responsibility, and relationships all seem to be negatively influenced by the use of text messaging. This pattern is seen in both early and late adolescent groups. Developmentally, different characteristic features categorize early and late adolescence, yet it seems the use of text messaging is propelling early adolescence forward by removing the consequences of awkward face-to-face interactions. This early onset of late adolescence results in having very young teens, 12 and 13 year olds, showing increased interest in romantic relation­ships and sexual exploration. The anxiety and uneasiness felt by early teens about speaking with others has led to deficits in the ability to communicate in social settings, which could prove troublesome later. This study looks at only a few developmental issues associated with text messaging use among teens. It would be relevant and appropriate to study other ways that text messaging affects our youth in addition to exploring the more long-term effects of using this technology.
Menstrual bleeding patterns in adolescents using etonogestrel (ENG) implant
Authors: Deokar Amit M. , Jackson Wendy , Omar Hatim A. 
Published: March 2011

Abstract

Background: Etonogestrel (ENG) implant is an effective method of contraception. The implant is designed to provide contraceptive efficacy for 3 years with a relatively quick return of fertility upon its removal. Menstrual irregularities are not uncommon on long-acting progestins and can often be the factor for discontinuation or removal. A retrospective chart analysis was done on 58 patients who chose to be on the ENG implant. Age ranged from 12 to 24 years. The cycle ranged from 1 to 17 months. The mean length of use of the implant was 10.9 months. Over the 20-month period, 13 ENG implants were removed because of menstrual bleeding problems.

Method: We conducted a chart review of the adolescent patients who received the ENG implant in our adolescent clinic. An analysis was done based on symptoms experienced by patients who were on the ENG implant and their management, which in some cases resulted in its removal.

Setting: The data is presented on adolescent and young adult patients who receive their reproductive care in the Adolescent Medicine Clinic at the University of Kentucky, Lexington, KY, USA.

Conclusions: ENG implant when used correctly and as indicated is extremely effective in providing contraception for up to 3 years. However, menstrual irregularities can be very troublesome and often a reason for its removal. In our experience, 22.4% (13 out of the 58 subjects) had menstrual problems post-insertion that led to its removal. It is crucial for a clinician to inform and be informed about such side effects.
Zur frühen Entwicklung der tschechischen Elegie
Authors: Ibler Reinhard 
Published: March 2011

Abstract
The poetry of Karel Hynek Mácha, the main representative of Czech romanticism, is written in a deeply elegiac mode, thus standing opposite to the literary production of Czech National Revival with its clear tendency to the idyllic model. Mácha’s elegism was, first of all, influenced by German, English, and Polish romanticism, but has its roots also in the poetry of early Czech National Revival. The paper follows the beginnings and early development of Czech elegy from Thám’s and Puchmajer’s almanacs up to František Turinský’s sentimental elegies and Jan Kollár’s endeavours for a national elegy.