bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of proximal femoral fractures 2011
Authors:   Membership of the Working Party, Griffiths R , Alper J , Beckingsale A , Goldhill D , Heyburn G , Holloway J , Leaper E , Parker M , Ridgway S , White S , Wiese M , Wilson I 
Published: December 2011

Summary 1. There should be protocol‐driven, fast‐track admission of patients with hip fractures through the emergency department. 2. Patients with hip fractures require multidisciplinary care, led by orthogeriatricians. 3. Surgery is the best analgesic for hip fractures. 4. Surgical repair of hip fractures should occur within 48 hours of hospital admission. 5. Surgery and anaesthesia must be undertaken by appropriately experienced surgeons and anaesthetists. 6. There must be high‐quality communication between clinicians and allied health professionals. 7. Early mobilisation is a key part of the management of patients with hip fractures. 8. Pre‐operative management should include consideration of planning for discharge from hospital. 9. Measures should be taken to prevent secondary falls.10. Continuous audit and targeted research is required in order to inform and improve the management of patients with hip  fracture.
The ratio of glycated albumin to glycated haemoglobin correlates with insulin secretory function
Authors: Kim Daham , Kim Kwang J. , Huh Ji H. , Lee Byung‐Wan , Kang Eun S. , Cha Bong S. , Lee Hyun C. 
Published: December 2011

SummaryObjective  Although glycated haemoglobin (A1c) levels are similar among patients with type 2 diabetes, the glycated albumin (GA)/A1c ratio varies considerably. On the basis of the hypothesis that endogenous insulin secretion might be correlated with the GA/A1c ratio, we investigated whether insulin secretory function or insulin resistance has different effects on the GA/A1c ratio in patients with type 2 diabetes using the standardized liquid meal test.Design  A clinical, retrospective study.Patients and measurements  A total of 758 patients with type 2 diabetes ingested a standardized liquid meal (i.e. 500 kcal, 17·5 g fat, 68·5 g carbohydrate and 17·5 g protein). The subjects were divided into two groups: those with GA/A1c ratio <2·5 (n = 414) and those with GA/A1c ratio ≥2·5 (n = 344). We compared the A1c and GA levels, and the GA/A1c ratio and evaluated the relationships between the glycaemic indices and other parameters. Effects of β‐cell function [homeostasis model assessment (HOMA‐β), insulinogenic index (IGI)] and insulin resistance (HOMA‐IR) on the GA/A1c ratio were also examined.Results  The GA/A1c ratio was significantly correlated with HOMA‐β, IGI and body mass index (BMI) but not with HOMA‐IR. Furthermore, after adjusting for age, gender, BMI, haemoglobin and albumin levels, the GA/A1c ratio was still inversely correlated with both HOMA‐β and IGI.Conclusions  The GA/A1c ratio is significantly correlated with insulin secretory function but not with insulin resistance.
Pressure ulcers in older hospitalised patients and its impact on length of stay: a retrospective observational study
Authors: Theisen Silke , Drabik Anna , Stock Stephanie 
Published: December 2011

Objective.  To examine the effect of pressure ulcers in older patients on the length of stay in hospital.Background.  Previous research on this topic did not focus solely on older people. A growing number of older people require hospital admission.Design.  A retrospective observational study.Methods.  Data of 3198 patients age 75 years and older were included. The setting was a 1350‐bed German University Hospital. Data were drawn from quality indicator data recorded by nurses. The independent effect of pressure ulcers was analysed using a multivariate Poisson–Regression model.Results.  Of the participants, 7·1% had an ulcer during their hospitalisation. 87·3% were classified as categories I and II. Mean age was 81·6 years for all patients and 83·2 years for pressure ulcer patients. Pressure ulcer patients had a longer overall hospital stay (19·0 vs. 9·9 days) and a higher excess length of stay (2·6 vs. 0·3 days). Pressure ulcers had a statistically significant effect (p = 0·0011) on the increase in length of stay. The impact of hospital acquired pressure ulcers on length of stay was more pronounced compared to those ulcers being present on admission. The pressure ulcer category was not significant.Conclusions.  Pressure ulcers during hospitalisation are an independent and significant predictor of a prolonged inpatient stay for elderly patients. This study indicates that besides complications and co‐morbidities social factors, as well as the hospital’s internal processes of patient care, also can play a significant role.Relevance to clinical practice.  To evaluate the distinct role of hospital acquired pressure ulcers further research is needed. The elderly patients in this study were a heterogeneous group. The implementation of clinical and nursing processes for both the ‘fit’ and the ‘sick’ geriatric patients is an important challenge.
Nurse‐led education and counselling to enhance adherence to phosphate binders
Authors: Van Camp Yoleen P , Huybrechts Sofie A , Van Rompaey Bart , Elseviers Monique M 
Published: December 2011

Aims and objectives.  To investigate whether nurse‐led education and counselling enhance phosphate binder adherence in chronic dialysis patients.Background.  One in two chronic dialysis patients experiences difficulties in adhering to phosphate binders. The reasons for non‐adherence are multifactorial and accordingly require a multifaceted strategy. To date, investigations have been confined primarily to single interventions to promote adherence. This study examines the effect of a multifaceted approach.Design.  The design was interventional.Method.  Adherence to phosphate binders was blindly and electronically monitored for 17 consecutive weeks with the Medication Event Monitoring System (MEMS®). After four weeks baseline monitoring, the effects of the intervention were studied for an additional 13 weeks. In week 5, the study nurse gave all 41 participating patients education on phosphate binders. Thereafter, the study nurse gave bi‐weekly personalised counselling to enhance adherence to phosphate binders. The evolution of adherence over time was assessed and compared with historical control data. Secondary outcome variables included serum values of phosphate, calcium and parathyroid hormone and phosphate binder knowledge.Results.  In week 1, mean adherence was 83% in this study (intervention group), compared with 86% in the historical control group. In the intervention group, mean adherence increased from 83–94% after 13 weeks. By contrast, in the historical control group, mean adherence declined from 86–76%. In the intervention group, serum phosphate values decreased from 4·9–4·3 mg/dl and phosphate binder knowledge increased from a mean score of 53–75%.Conclusions.  Combining education and continuous counselling holds promise in enhancing phosphate binder adherence. Large‐scaled and long‐term field studies are indicated to determine which nurse‐led practices lead to an integral and sustained medication adherence management.Relevance to clinical practice.  Nursing strategies to scale up adherence should at least include educating patients and regularly reinforcing adherence behaviour.
Actualistic snapshot of the early Oligocene Alps: the Alps–Apennines knot disentangled
Authors: Malusà Marco G. , Garzanti Eduardo 
Published: December 2011

Terra Nova, 24, 1–6, 2012AbstractThe geological framework of eastern Papua New Guinea allows us to obtain direct insight into how the Alpine region might have looked like during its earliest stages of tectonic growth, and to shed light on the spatial and temporal relationships between subduction and formation of relief before tightening of the Alps–Apennines junction. In both Alpine and Papuan cases, exhumation of high‐pressure rocks was not associated with any significant erosion, but took place while adjacent sedimentary basins were virtually starved of orogenic sediments and largely characterized by slow accumulation of deep‐water mudrocks and limestones. The subduction and exhumation stages were thus well distinct and separated in time from the genesis of topographic relief, which did not take place until many millions years later.
XIAO is involved in the control of organ size by contributing to the regulation of signaling and homeostasis of brassinosteroids and cell cycling in rice
Authors: Jiang Yunhe , Bao Liang , Jeong So‐Yoon , Kim Seong‐Ki , Xu Caiguo , Li Xianghua , Zhang Qifa 
Published: December 2011

SummaryOrgan size is determined by cell number and size, and involves two fundamental processes: cell proliferation and cell expansion. Although several plant hormones are known to play critical roles in shaping organ size by regulating the cell cycle, it is not known whether brassinosteroids (BRs) are also involved in regulating cell division. Here we identified a rice T‐DNA insertion mutant for organ size, referred to as xiao, that displays dwarfism and erect leaves, typical BR‐related phenotypes, together with reduced seed setting. XIAO is predicted to encode an LRR kinase. The small stature of the xiao mutant resulted from reduced organ sizes due to decreased cell numbers resulting from reduced cell division rate, as supported by the observed co‐expression of XIAO with a number of genes involved in cell cycling. The xiao mutant displayed a tissue‐specific enhanced BR response and greatly reduced BR contents at the whole‐plant level. These results indicated that XIAO is a regulator of BR signaling and cell division. Thus, XIAO may provide a possible connection between BRs and cell‐cycle regulation in controlling organ growth.
Low dose intrathecal morphine effects on post‐hysterectomy pain: a randomized placebo‐controlled study
Authors: HEIN A. , RÖSBLAD P. , GILLIS‐HAEGERSTRAND C. , SCHEDVINS K. , JAKOBSSON J. , DAHLGREN G. 
Published: December 2011

BackgroundSpinal anesthesia with different doses of intrathecal morphine has been shown to relieve post‐operative pain. We studied in a prospective randomized, double‐blind fashion the effects of morphine 0, 100, 200, or 300 μg added to intrathecal bupivacaine on first post‐operative 24 h patient‐controlled analgesia morphine (PCA‐morphine) consumption after abdominal hysterectomy under general anesthesia.MethodsOne hundred and forty‐four American Society of Anesthesiologists I‐II women were assigned to receive spinal anesthesia with 12 mg of hyperbaric bupivacaine combined with 100, 200, and 300 μg morphine or saline before standardized general anesthesia was induced. Low transverse incision abdominal hysterectomy was performed. Post‐operative outcome measures were recorded at 1, 2, 4, 6, 12, and 24 h. Primary outcome was 24 h PCA‐morphine. Secondary outcomes were pain by visual analogue scale (0–10), nausea, pruritus, sedation, and respiratory depression.ResultsIntrathecal morphine reduced accumulated 24 h post‐operative morphine consumption. Morphine 100 μg significantly reduced morphine consumption vs. placebo at 0–6 h, 6–12 h, and for the entire 0–24 h time interval post‐operation. Morphine 200 μg further significantly reduced morphine consumption vs. morphine 100 μg at 0–6 h and for the entire 0–24 h post‐operation. There was no further reduction of morphine consumption seen with morphine 300 μg. No serious side effects were seen. Emesis was similar in all groups, and pruritus was experienced only in the morphine groups.ConclusionIntrathecal morphine supplementation to bupivacaine reduces first 24 h PCA‐morphine consumption after abdominal hysterectomy under general anesthesia, and we found no benefit from increasing the dose over 200 μg.
Role of renal medullary oxidative and/or carbonyl stress in salt‐sensitive hypertension and diabetes
Authors: Mori Takefumi , Ogawa Susumu , Cowely Allen W , Ito Sadayoshi 
Published: December 2011

Summary1. Salt‐sensitive hypertension is commonly associated with diabetes, obesity and chronic kidney disease. The present review focuses on renal mechanisms involved in the development of this type of hypertension.2. The renal medullary circulation plays an important role in the development of salt‐sensitive hypertension. In vivo animal studies have demonstrated that the balance between nitric oxide (NO) and reactive oxygen species (ROS) in the renal medulla is an important element of salt‐sensitive hypertension. The medullary thick ascending limb (mTAL) in the outer medulla is an important source of NO and ROS production and we have explored the mechanisms that stimulate their production, as well as the effects of NO superoxide and hydrogen peroxide on mTAL tubular sodium reabsorption and the regulation of medullary blood flow.3. Angiotensin II‐stimulated NO produced in the mTAL is able to diffuse from the renal mTAL to the surrounding vasa recta capillaries, providing a mechanism by which to increase medullary blood flow and counteract the direct vasoconstrictor effects of angiotensin II. Enhanced oxidative stress attenuates NO diffusion in this region.4. Carbonyl stress, like oxidative stress, can also play an important role in the pathogenesis of chronic kidney disease, such as insulin resistance, salt‐sensitive hypertension and renal vascular complications.5. Despite the large number of studies undertaken in this area, there is as yet no drug available that directly targets renal ROS. Oxidative and/or carbonyl stress may be the next target of drug discovery to protect against salt‐sensitive hypertension and associated end‐organ damage.
Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta‐analysis of short‐term outcome
Authors: Trastulli S. , Farinella E. , Cirocchi R. , Cavaliere D. , Avenia N. , Sciannameo F. , Gullà N. , Noya G. , Boselli C. 
Published: December 2011

AbstractAim  The study aimed to compare robotic rectal resection with laparoscopic rectal resection for cancer. Robotic surgery has been used successfully in many branches of surgery but there is little evidence in the literature on its use in rectal cancer.Methods  We performed a systematic review of the available literature in order to evaluate the feasibility, safety and effectiveness of robotic versus laparoscopic surgery for rectal cancer. We compared robotic and laparoscopic surgery with respect to twelve end‐points including operative and recovery outcomes, early postoperative mortality and morbidity, and oncological parameters. A subgroup analysis of patients undergoing full‐robotic or robot‐assisted rectal resection and robotic total mesorectal excision was carried out. All aspects of Cochrane Handbook for systematic reviews and Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) statement were followed to conduct this systematic review. Comprehensive electronic search strategies were developed using the following electronic databases: PubMed, EMBASE, OVID, Medline, Cochrane Database of Systematic Reviews, EBM reviews and CINAHL. Randomized and nonrandomized clinical trials comparing robotic and laparoscopic resection for rectal cancer were included. No language or publication status restrictions were imposed. A data‐extraction sheet was developed based on the data extraction template of the Cochrane Group. The statistical analysis was performed using the odd ratio (OR) for categorical variables and the weighted mean difference (WMD) for continuous variables.Results  Eight non randomized studies were identified that included 854 patients in total, 344 (40.2%) in the robotic group and 510 (59.7%) in the laparoscopic group. Meta‐analysis suggested that the conversion rate to open surgery in the robotic group was significantly lower than that with laparoscopic surgery (OR = 0.26, 95% CI: 0.12–0.57, P = 0.0007). There were no significant differences in operation time, length of hospital stay, time to resume regular diet, postoperative morbidity and mortality, and the oncological accuracy of resection.Conclusion  Robotic surgery for rectal cancer has a lower conversion rate and a similar operative time compared with laparoscopic surgery, with no difference in recovery, oncological and postoperative outcomes.
Safer urethral catheters: how study of catheter balloon pressure and force can guide design
Authors: Wu Alex K. , Blaschko Sarah D. , Garcia Maurice , McAninch Jack W. , Aaronson David S. 
Published: December 2011

What's known on the subject? and What does the study add?The urethal catheter is a ubiquitous device that has not been modified or improved for safety in the last 20 years, although it can be associated with significant patient harm. This study utilizes force and pressure measurements of the urethral catheter in order to aid in future safety modifications.OBJECTIVES
To better define urethral catheter balloon pressures and extraction forces during traumatic placement and removal of urethral catheters.
To help guide design for safer urethral catheters.
MATERIALS AND METHODS
Measurements of balloon pressure were made upon filling within the urethra vs the bladder.
Extraction forces were measured upon removal of a catheter with a filled balloon from the bladder.
Models for the bladder and urethra included an ex vivo model (funnel, ‘bladder’, attached to a 30 F tube, ‘urethra’) and fresh human male cadavers.
The mean (sem) balloon pressures and extraction forces were calculated.
RESULTS
In the ex vivo model, the mean (sem) pressures upon filling the balloon with 10 mL were on average three‐times higher within the ex vivo‘urethra’ (177 [6] kPa) vs ‘bladder’ (59 [2] kPa) across multiple catheter types.
In the human cadaver, the mean balloon pressure was 1.9‐times higher within the urethra (139 [11] kPa) vs bladder (68 [4] kPa).
Balloon pressure increased non‐linearly during intraurethral filling of both models, resulting in either balloon rupture (silicone catheters) or ‘ballooning’ of the neck of the balloon filling port (latex catheters).
Removal of a filled balloon per the ex vivo model ‘urethra’ and cadaveric urethra, similarly required increasing force with greater balloon fill volumes (e.g. 9.34 [0.44] N for 5 mL vs 41.37 [8.01] N for 10 mL balloon volume).
CONCLUSIONS
Iatrogenic complications from improper urethral catheter use is common.
Catheter balloon pressures and manual extraction forces associated with urethral injury are significantly greater than those found with normal use.
The differences in pressure and force may be incorporated into a safer urethral catheter design, which may significantly reduce iatrogenic urethral injury associated with catheterization.
Does the transrectal ultrasound probe influence prostate cancer detection in patients undergoing an extended prostate biopsy scheme? Results of a large retrospective study
Authors: Raber Marco , Scattoni Vincenzo , Gallina Andrea , Freschi Massimo , De Almeyda Eduardo Pedroso , Girolamo Valerio Di , Montorsi Francesco , Rigatti Patrizio 
Published: December 2011

Study Type – Diagnostic (exploratory cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?The influence of transrectal probe system, end‐fire and side‐fire, has not been studied in detail. Using a sextant biopsy template it has been demonstrated a difference between end‐fire and side‐fire modes in 4–10 ng/mL PSA interval population. No studies evaluated the results in extended biopsy templates before.This study adds the knowledge that end‐fire and side‐fire transrectal probe, which are the two probe systems to perform transrectal prostate biopsy, have similar results in terms of prostate cancer detection rate and can be indifferently employed in extended prostate biopsy templates used in daily practice.OBJECTIVE
To compare the prostate cancer detection rate and tolerance profile between a transrectal biopsy made with a ‘side fire’ (SF) and an ‘end fire’ (EF) ultrasound probe.
PATIENTS AND METHODS
We selected patients undergoing first biopsy and re‐biopsy of the prostate with a 14‐ and 18‐core template using EF and SF transrectal probes, respectively.
We compared the cancer detection rate between the two probes on first biopsy and re‐biopsy and gauged patient tolerance using a visual analogue scale (VAS).
RESULTS
A total of 1705 patients were included in the first biopsy group, while 487 were in the re‐biopsy group.
The overall detection rate of first biopsy was 37.2%; the overall detection rate of re‐biopsy was 10.1%.
No significant difference was found between the two probes in the first biopsy and re‐biopsy sets (38% vs 36.5%, P= 0.55; 10.8% vs 9.3%, P= 0.7).
The lack of any significant association between the type of probe used and prostate cancer detection was confirmed by univariable and multivariable analyses in both the first biopsy and re‐biopsy sets after accounting for prostate‐specific antigen values, per cent free prostate‐specific antigen, digital rectal examination, and prostate and transition zone volumes.
The patient tolerance profile of the SF group was significantly better than that of the EF group (mean VAS 1.78 ± 2.01 vs 1.45 ± 2.21; P= 0.02).
CONCLUSION
The prostate cancer detection rate does not depend on the type of probe used. However, the SF transrectal probe is associated with a better patient tolerance profile.
Estimated morbidity and mortality in adolescents and young adults diagnosed with Type 2 diabetes mellitus
Authors: Rhodes E. T. , Prosser L. A. , Hoerger T. J. , Lieu T. , Ludwig D. S. , Laffel L. M. 
Published: December 2011

Diabet. Med. 29, 453–463 (2012)AbstractAims  To estimate remaining life expectancy (RLE), quality‐adjusted life expectancy (QALE), causes of death and lifetime cumulative incidence of microvascular/macrovascular complications of diabetes for youths diagnosed with Type 2 diabetes.Methods  A Markov‐like computer model simulated the life course for a hypothetical cohort of adolescents/young adults in the USA, aged 15–24 years, newly diagnosed with Type 2 diabetes following either conventional or intensive treatment based on the UK Prospective Diabetes Study. Outcomes included RLE, discounted QALE in quality‐adjusted life years (QALYs), cumulative incidence of microvascular/macrovascular complications and causes of death.Results  Compared with a mean RLE of 58.6 years for a 20‐year‐old in the USA without diabetes, conventional treatment produced an average RLE of 43.09 years and 22.44 discounted QALYs. Intensive treatment afforded an incremental 0.98 years and 0.44 discounted QALYs. Intensive treatment led to lower lifetime cumulative incidence of all microvascular complications and lower mortality from microvascular complications (e.g. end‐stage renal disease (ESRD) death 19.4% vs. 25.2%). Approximately 5% with both treatments had ESRD within 25 years. Lifetime cumulative incidence of coronary heart disease (CHD) increased with longer RLE and greater severity of CHD risk factors. Incorporating disutility (loss in health‐related quality of life) of intensive treatment resulted in net loss of QALYs.Conclusions  Adolescents/young adults with Type 2 diabetes lose approximately 15 years from average RLE and may experience severe, chronic complications of Type 2 diabetes by their 40s. The net clinical benefit of intensive treatment may be sensitive to preferences for treatment. A comprehensive management plan that includes early and aggressive control of cardiovascular risk factors is likely needed to reduce lifetime risk of CHD.