bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mild traumatic brain injury: Improving quality of care in the paediatric emergency department setting
Authors: Sharpe Sarah , Kool Bridget , Shepherd Michael , Dalziel Stuart , Ameratunga Shanthi 
Published: April 2011

Aim:  Traumatic brain injury (TBI) in childhood can impose a significant threat to life and longer‐term disability. This study investigated the extent to which the documentation of key indicators of healthcare quality in the emergency department (ED) setting was consistent with clinical guidelines for the management of children with mild TBI (MTBI).Methods:  The clinical records of a random sample of 60 children (stratified by ethnicity and age group), who were seen and discharged from a large metropolitan paediatric hospital ED following a head injury, were systematically reviewed to examine the processes of care and follow‐up.Results:  Based on the documentation in clinical records, processes designed to identify and manage potentially life‐threatening acute complications (e.g. computed tomography scanning to identify intracranial haemorrhage) were consistent with best practice standards. However gaps existed between current and best practice for some aspects of care that could minimise risks of longer‐term disability from MTBI. For example, relevant clinical criteria were well documented, but this information did not appear to be applied systematically to identify and to follow up children with definite or possible MTBI.Conclusion:  The apparent absence of a systematic approach to the diagnosis and follow‐up of MTBI in children presenting to ED suggests a missed opportunity to minimise the risk of disability following these injuries. Greater attention to an integrated care pathway that improves the identification, documentation, and follow‐up of children with MTBI presenting to ED is required.
Detection of microorganisms in exhaled breath condensate during acute exacerbations of COPD
Authors: ZAKHARKINA TETYANA , KOCZULLA A.‐REMBERT , MARDANOVA OLGA , HATTESOHL AKIRA , BALS ROBERT 
Published: April 2011

ABSTRACTBackground and objective:  One hallmark of COPD is colonization and infection of the lung. Acute exacerbations of COPD (AECOPD) are acute deteriorations of the chronic disease and are associated with a change of the pulmonary microbial balance. The collection of exhaled breath condensate (EBC) can be used to non‐invasively determine markers of lung disease. The aim of the present study was to compare the results of assays based on the detection of microbial nucleic acids from EBC and from spontaneous sputum in patients with AECOPD.Methods:  EBC and sputa of 29 adults with AECOPD were obtained. Isolated DNA or RNA were used as starting material for the PCR assays to detect Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae, influenza viruses (AH 1, AH 3) and respiratory syncytial virus.Results:  Bacterial or viral nucleic acids were identified in 14 EBC and 21 sputa from 29 patients. Results from EBC did not correlate well with those from sputum. Viral and S. pneumoniae nucleic acids were detected only in sputum, whereas L. pneumophila DNA was only found in EBC. In three EBC and 10 sputa nucleic acids of more than one microorganism was detected.Conclusions:  Bacterial nucleic acids can be identified in EBC of COPD patients with exacerbations. The results obtained from EBC and sputum did not correlate well.
Simple clinical score is associated with mortality and length of stay of acute general medical admissions to an Australian hospital
Authors: Li J. Y. Z. , Yong T. Y. , Hakendorf P. , Roberts S. , O'Brien L. , Sharma Y. , Ben‐Tovim D. , Thompson C. H. 
Published: April 2011

AbstractBackground:  In a rural Irish hospital, a simple clinical score (SCS) determined at the time of admission enabled stratification of acute general medical admissions into five categories that were associated incrementally with patients' immediate and 30‐day mortality. The aim of this study was to examine the representative performance of this SCS in predicting the outcomes of general medical admissions to an Australian teaching hospital.Methods:  A retrospective chart review was undertaken of a representative sample from 480 admissions in 2007 to an urban university teaching hospital in Australia. The SCS was calculated and related to that patient's outcome in terms of mortality, length of stay, nursing home placement on discharge, the occurrence of medical emergency team call and intensive care unit transfer. These data were compared, where possible, with the outcomes reported in the Irish hospital.Results:  Four hundred and seventeen complete sets of data allowed calculation of the SCS. There were significant linear correlations of the SCS (divided into quintiles) and patients' in‐hospital and 30‐day mortality, their length of stay and their discharge to a nursing home. There was no association of the SCS and the patients' readmission rate, intensive care unit transfer rate or likelihood of a medical emergency team call. The significant trends replicated those from the Irish hospital.Conclusion:  The SCS can predict significant outcomes for general medical admissions in an Australian hospital despite obvious differences to the hospital of its derivation. A wider study of Australasian hospitals and the performance of the SCS as a predictor of general medical admission outcomes is underway.
The association between time to disposition plan in the emergency department and in‐hospital mortality of general medical patients
Authors: Mitra B. , Cameron P. A. , Archer P. , Bailey M. , Pielage P. , Mele G. , Smit D. V. , Newnham H. 
Published: April 2011

AbstractBackground:  A perceived risk of time‐limited emergency department (ED) assessment of patients is inadequate workup leading to inappropriate disposition. The aim of this study was to examine the association of time to disposition plan (TDP) on ED length of stay (LOS) and correlate this to mortality.Methods:  A retrospective review of data collected from ED information systems at three hospitals was conducted between June 2008 and October 2009. Included patients were admitted to a general medical unit. Patients were excluded if admitted to intensive care, coronary care, a cardiac monitored bed or required surgery in first 24 h or had an expected LOS of <48 h. Multivariate regression analysis was used to identify independent associations with mortality.Results:  A total of 10 107 patient episodes was analysed, of which 6768 patients (67.0%) had an ED LOS of ≥8 h. There was significant effect modification by ED LOS in the association of TDP and mortality. In the setting of longer ED LOS, a TDP of <4 h was associated with significantly higher mortality (OR 1.57, 95% CI: 1.28–1.92, P < 0.001), corrected for age, gender and triage category. This association was not significant when ED LOS was <8 h (OR 0.88, 95% CI: 0.60–1.27, P= 0.49).Conclusions:  In the setting of prolonged ED LOS, completing ED assessment and management within 4 h of presentation was associated with significantly higher mortality. Further prospective studies are required to understand the relationship between rapid decision making in the ED and patient safety.
Strategies for improving the quality of care in psoriasis with the use of treatment goals – a report on an implementation meeting
Authors: Mrowietz U , Kragballe K , Nast A , Reich K 
Published: April 2011

AbstractTargeted treatment, early intervention and the use of treatment goals is a new approach in medicine that has been implemented across several disciplines (e.g. diabetes, pulmonary arterial hypertension and rheumatoid arthritis) over the last 5–10 years. As in other chronic diseases, well‐defined treatment goals may be helpful in guiding physicians in their care of patients with psoriasis, thereby obviating poor outcomes. Individual treatment goals were recently developed for the first time in psoriasis by a European Consensus group of experts from 19 European countries to supplement guidelines and promote the consistent use of available therapies to improve patient care. Goal‐oriented therapy involves treating according to a treatment algorithm, regularly monitoring therapeutic response and prompt modification of therapy if goals are not met. In the absence of hard outcomes in psoriasis (e.g. biomarkers or biomedical predictors of clinical response), the European Consensus group based their treatment goals on changes in Psoriasis Area Severity Index and Dermatology Life Quality Index scores. Further evidence generation is important to determine whether surrogate markers for disease progression (e.g. co‐morbidities) or predictors of clinical response can be identified for psoriasis. Furthermore, psoriasis may have a potential cumulative effect on the life course of patients, the understanding of which is likely to provide the rationale for earlier treatment strategies in psoriasis. For the work of the European Consensus group to have an impact on clinical care, transmission of treatment goals into guidelines, along with implementation of treatment goals at both the regional and national level is needed. Thus, dermatology experts from Europe, the Middle East, Australia and Canada gathered in Frankfurt, 2010, for a 1.5 day educational meeting run by the Progressive Psoriasis Initiative to discuss how treatment goals in psoriasis might best be implemented in clinical practice. The meeting conclusions are presented here.
Presence‐only versus presence–absence data in species composition determinant analyses
Authors: Kent Rafi , Carmel Yohay 
Published: April 2011

AbstractAim  Studying relationships between species and their physical environment requires species distribution data, ideally based on presence–absence (P–A) data derived from surveys. Such data are limited in their spatial extent. Presence‐only (P‐O) data are considered inappropriate for such analyses. Our aim was to evaluate whether such data may be used when considering a multitude of species over a large spatial extent, in order to analyse the relationships between environmental factors and species composition.Location  The study was conducted in virtual space. However, geographic origin of the data used is the contiguous USA.Methods  We created distribution maps for 50 virtual species based on actual environmental conditions in the study. Sampling locations were based on true observations from the Global Biodiversity Information Facility. We produced P–A data by selecting ∼1000 random locations and recorded the presence/absence of all species. We produced two P‐O data sets. Full P‐O set was produced by sampling the species in locations of true occurrences of species. Partial P‐O was a subset of full P‐O data set matching the size of the P–A data set. For each data set, we recorded the environmental variables at the same locations. We used CCA to evaluate the amount of variance in species composition explained by each variable. We evaluated the bias in the data set by calculating the deviation of average values of the environmental variables in sampled locations compared to the entire area.Results  P–A and P‐O data sets were similar in terms of the amount of variance explained by the different environmental variables. We found sizable environmental and spatial bias in the P‐O data set, compared to the entire study area.Main conclusions  Our results suggest that although P‐O data from collections contain bias, the multitude of species, and thus the relatively large amount of information in the data, allow the use of P‐O data for analysing environmental determinants of species composition.
Adaptive gait changes in older people due to lens magnification
Authors: Chapman Graham J , Scally Andy J , Elliott David B 
Published: April 2011

Citation information: Chapman GJ, Scally AJ & Elliott DB. Adaptive gait changes in older people due to lens magnification. Ophthalmic Physiol Opt 2011, 31, 311–317 doi: 10.1111/j.1475‐1313.2010.00807.xAbstractPurpose:  Intervention trials that reduce visual impairment in older adults have not produced the expected improvements in reducing falls rate. We hypothesised that this may be caused by adaptation problems in older adults due to changes in magnification provided by new spectacles and cataract surgery. This study assessed the effects of ocular magnification on adaptive gait in young and older adults.Methods:  Adaptive gait was measured in 10 young (mean age 22.3 ± 4.6 years) and 10 older adults (mean age 74.2 ± 4.3 years) with the participants’ habitual refractive correction (0%) and with size lenses producing ocular magnification of ±1%, ±2%, ±3%, and ±5%. Adaptive gait parameters were measured when participants approached and stepped up onto a raised surface.Results:  Adaptive gait changes in the young and older age groups were similar. Increasing amounts of magnification (+1% to +5%) led to an increased distance of the feet from the raised surface, increased vertical toe clearance and reduced distance of the lead heel position on the raised surface (p < 0.0001). Increasing amounts of minification (−1% to −5%) led to the opposite of these changes (p < 0.0001). Adaptation to ocular magnification did not occur in the short term in young or older adults.Conclusion:  The observed adaptive gait changes were driven by the magnification changes provided by the size lenses. The raised surface appeared closer and larger with magnification and further away and smaller with minification and gait was adjusted accordingly. Magnification may explain the mobility problems some older adults have with updated spectacles and after cataract surgery.
An exploratory study of visual search performance in glaucoma
Authors: Smith Nicholas D , Crabb David P , Garway‐Heath David F 
Published: April 2011

Citation information: Smith ND, Crabb DP & Garway‐Heath DF. An exploratory study of visual search performance in glaucoma. Ophthalmic Physiol Opt 2011, 31, 225–232. doi: 10.1111/j.1475‐1313.2011.00836.xAbstractPurpose:  Visual search plays an integral role in many daily activities. This study aimed to determine whether patients with glaucoma are slower than visually healthy age‐matched individuals when searching for items in computer displayed images.Methods:  Forty participants were recruited for the study: 20 patients with a clinical diagnosis of glaucoma and 20 age‐similar visually healthy control subjects. All participants had visual acuity of 6/12 or better. Participants were presented with 20 images with Landolt C symbols and 15 photographic images of everyday scenes on a computer. The time taken by each participant to locate a specified item in each image was recorded. Average search times were calculated across participants and compared between groups.Results:  All the patients had visual field defects in both eyes. On average, the patients also differed from control subjects by binocular contrast sensitivity measurements (p = 0.01) and visual acuity (p = 0.003). The patients (mean age = 67 years, S.D.: 10 years) and controls (mean age: 67 years, S.D.: 11 years) were age similar (p = 0.40). The median search time for patients finding target items in photographs of everyday scenes was 15.2 s (interquartile range 9.4–20.6 s) and this was significantly slower than the median time (10.0 s; interquartile range 7.2–10.3 s) taken by the controls (p = 0.007). There was no statistical evidence for a difference in median search times between groups in the Landolt C search task (p = 0.24).Conclusion:  Some individuals with glaucomatous visual field defects in both eyes find it especially difficult to locate objects in photographs of everyday scenes when compared to visually healthy individuals of a similar age.
Circulating apoptotic and necrotic cell death markers in patients with acute liver injury
Authors: Craig Darren G. N. , Lee Patricia , Pryde Elizabeth A. , Masterton Gail S. , Hayes Peter C. , Simpson Kenneth J. 
Published: April 2011

AbstractBackground: The host response to cell death underpins the immune activation that follows acute liver injury, and measurement of circulating cell death markers could therefore aid prognostication following paracetamol overdose. Nucleosomes, formed during apoptosis, can complex with high‐mobility group box 1 (HMGB1) protein and may play a pathogenic role in liver injury.Aims: To explore the levels and prognostic significance of nucleosomes, HMGB1, and other cell death markers following acute liver injury.Methods: Levels of plasma nucleosomes, HMGB1, caspase‐cleaved cytokeratin‐18 (M30) and total cytokeratin‐18 (M65) were measured by immunoassay, in a cohort of 33 patients with paracetamol‐ and non‐paracetamol‐induced acute liver injury.Results: Admission nucleosome levels in paracetamol overdose patients were significantly higher than in chronic liver disease and healthy control subjects, but were similar in paracetamol and non‐paracetamol patients (P=0.11). Nucleosome levels were not associated with death or requirement for liver transplantation, fulfillment of poor prognostic criteria or organ failure in paracetamol patients. Nucleosome levels correlated with levels of HMGB1 (r=0.500, P=0.009), alanine aminotransferase (r=0.410, P=0.038) and M65 (r=0.709, P<0.001), but not with M30 (r=0.309, P=0.124). None of the cell death markers analysed improved prognostication in paracetamol patients beyond the King's College criteria.Conclusions: Plasma nucleosomes are significantly elevated following acute liver injury. Neither apoptotic nor necrotic cell death markers accurately predict survival following paracetamol‐induced hepatotoxicity, suggesting that the extent and type of cell death play a limited role in determining outcome.
Four new species of Scythrididae (Lepidoptera: Gelechioidea) from Irano–Turanian area, with notes on taxonomy and distribution
Authors: PASSERIN D'ENTRÈVES Pietro , ROGGERO Angela 
Published: April 2011

AbstractFour new scythridid species are described: Scythris kabulella sp. nov. and S. claudiae sp. nov. from Afghanistan, S. alborzensis sp. nov. from Iran and S. bifasciella sp. nov. from Iran and Turkey. Scythris kabulella is closely related to S. bagdadiella Amsel, 1949 and is assigned to the S. bagdadiella species group because of its genital features. Scythris claudiae is also assigned to Scythris pascuella species group due to its genital features. At present, S. alborzensis and S. bifasciella could not be assigned to any known species group.
Hepatitis B and residual risk of infection in English and Welsh blood donors, 1996 through 2008
Authors: Brant Lisa J. , Reynolds Claire , Byrne Lisa , Davison Katy L. 
Published: April 2011

BACKGROUND: Globally, of all infections that donations are tested for, hepatitis B has the highest residual risk of transfusion transmission, despite donor selection criteria and advances in testing. Every blood donation in England and Wales is tested for hepatitis B surface antigen. Knowledge of infections being detected can inform donor selection and testing strategies.STUDY DESIGN AND METHODS: Data on donation testing and infections detected are collated by the NHS Blood and Transplant and Health Protection Agency Epidemiology Unit. Infected donors are classified as having acute or chronic hepatitis B virus (HBV) by a clinician; their demographic characteristics were described. The prevalence (by acute or chronic HBV status, ethnicity, and geography) and incidence of infection were calculated between 1996 and 2008. The residual risk was calculated for four periods using a modification of the incidence and window period model; the effects of modifying variables were investigated.RESULTS: Most infections (1047/1155) detected were chronic and seen in new donors. People with acute infections were more likely to be white and/or born in Western Europe. Prevalence was highest in donors from minority ethnic communities and in London. Incidence in repeat donors has halved in recent years. The estimated frequency of an infectious donation being missed was 1.37 per million donations (2006‐2008), the lowest since surveillance began or three per year.CONCLUSION: Many HBV infections in England and Wales were detected among new donors, who had chronic infection and were born overseas. The residual risk of infection declined over the 13 study years, but is still higher for HBV than other viral infections for which testing is undertaken.
The appropriateness of red blood cell use and the extent of overtransfusion: right decision? Right amount?
Authors: Barr Paul J. , Donnelly Michael , Cardwell Chris R. , Parker Michael , Morris Kieran , Bailie Karen E.M. 
Published: April 2011

BACKGROUND: Shrinkage of the donor pool coupled with an increasing demand for blood presents a major challenge to maintaining an adequate blood supply. Consequently it has become even more important to reduce inappropriate blood use, including decisions about when and how much blood to prescribe. This study aimed to ascertain the levels of inappropriate practice and factors associated with it.STUDY DESIGN AND METHODS: The medical records of a randomly selected sample of hospital patients in Northern Ireland who received a red blood cell transfusion during 2005 (n = 1474) were reviewed, and inappropriate transfusion and overtransfusion criteria were applied. Logistic regression models were used to identify factors associated with inappropriate practice and overtransfusion.RESULTS: In this study 23% of transfusions were considered inappropriate, occurring most commonly where the lowest hemoglobin (Hb) threshold for transfusion applied. Younger patients, those undergoing surgery, and those with lower comorbidity and higher Hb values were most likely to have an inappropriate transfusion. Among patients appropriately transfused, 19% were overtransfused. Females and those of lower weight (<65 kg) were most likely to be overtransfused.CONCLUSION: While the choice of criteria used to judge decisions will influence the absolute level of inappropriate or overtransfusion reported, our findings suggest that a significant minority of clinicians are either unaware of or are reluctant to accept lower transfusion thresholds. To improve further improve transfusion practice we suggest that barriers to the implementation of recommended transfusion thresholds should be examined and guidance on an appropriate posttransfusion Hb level developed.