bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using a blended e-learning model to provide accessible infection prevention and control training for NHS staff: The NHSU/TVU/Intuition approach
Authors: Pratt R.J. , Pellowe C.M. , Shelley J. , Adams J. , Loveday H.P. , King D. , Jones S.R.L.J. 
Published: September 2007

ver the past two decades, healthcare-associated infections (HCAI) have emerged as a significant threat to high quality health care. The technological advances made in the treatment of many diseases and disorders are being undermined by the transmission of infections within healthcare settings, especially the emergence of antimicrobial resistant strains of Staphylococcus aureus and enterococci that are now endemic in some healthcare environments. The financial and personal costs of HCAI in terms of the economic consequences to the National Health Service (NHS) and the physical, social and psychological costs to patients and their relatives have increased both government and public awareness of the risks associated with healthcare interventions and in particular the consequences of HCAI. The risk of acquiring HCAI continues to attract intense media interest. Reports of dirty hospitals and stories of healthcare workers failing to observe even the most rudimentary hygiene and other infection prevention and control measures are causing profound anxiety among service users. The public is fast losing confidence in the NHS to safely care for them and this dissatisfaction has propelled HCAI to the top of an increasingly urgent political healthcare agenda. The Department of Health (DH) has focused a number of initiatives on combating HCAI, including the development of national evidence-based infection prevention and control guidelines for acute and primary care settings (Pratt et al, 2001; Pellowe et al, 2003), a research programme to identify a range of effective strategies for combating antimicrobial resistance and more recently setting out a strategy for reducing HCAI and improving environmental hygiene in healthcare settings (DH, 2002; DH, 2004). DH strategy emphasises the importance of ensuring that infection prevention and control training is included in the induction programme for all NHS staff, both clinical and nonclinical, including agency and locum staff, and that this training becomes part of their continuing personal development plans. Professor Christine Beasley, the chief nursing officer at the DH has since taken responsibility for actualising many aspects of this strategy, especially ensuring that the required training is made available for all 1.3 million NHS staff by the end of 2005. Providing that training became the responsibility of the NHS University (NHSU), which commissioned the Richard Wells Research Centre at Thames Valley University London (TVU) along with their Dublin-based educational development partner, Intuition Publishing Ltd, to develop an appropriate and accessible state-of-the-art blended e-learning training programme. In this article, we describe how we designed and structured the programme so that it can be used as an essential tool in orientation/induction, staff development and in-service education programmes for all NHS staff.
Re-emerging infections Part 5: Vaccine-preventable diseases
Authors: Mayon-White R. 
Published: September 2007

ne question asked by those who doubt the efficacy of vaccination is whether improvements in general health could explain the reduction in incidence and severity of diseases like measles and whooping cough. This doubt is countered by those who advocate vaccination by pointing to the experience that these diseases can, and will, re-emerge with fatal cases if vaccination levels fall. Measles is one of the best examples of this debate. Whooping cough gives a historical perspective to the debate on vaccine efficacy, while outbreaks of mumps are topical. Diphtheria, poliomyelitis and Haemophilus influenzae type B (Hib) are give further examples of how important surveillance is to ensure that vaccines are used to best effect.
The evidence base and infection risks from flowers in the clinical setting
Authors: Gould D. , Chudleigh J. , Gammon J. , Ben Salem R. 
Published: September 2007

he need for evidence-based practice in health care is now well accepted. Best practice is likely to change over time with the emergence of new research evidence and may be influenced by other factors, such as acceptability to the general public. Controlled clinical trials supply the most robust evidence, but in the field of infection control trials are often difficult to conduct because of expense (large sample sizes are usually necessary) and ethical constraints. Infection control guidance is frequently based on less robust research evidence and common sense. Occasionally new practices become part of clinical routines despite the lack of supporting evidence. Banning flowers from general hospital wards falls into this category. Although the water in which flowers stand can become a reservoir of potentially pathogenic bacteria, there is no evidence that they have ever caused hospital-acquired infection and simple precautions can be taken to reduce potential risks. Banning flowers from general wards is not popular with the public and is unnecessary according to the evidence available.
Double-blind peer reviewed paper Problem-based learning — a case for infection control
Authors: Cole M. 
Published: September 2007

odern health care requires a workforce that is capable of exploring complex issues, articulate,M and has the capacity to develop problem-solving strategies based on reflective decision-making. The importance of education in the prevention of health care-associated infection is well documented, however measuring the effectiveness of infection control educational programmes has been problematic with insufficient programmes and unsatisfactory levels of compliance being reported. Nursing has traditionally favoured didactic approaches to teaching that suffer from theory overload and treat learners as empty vessels waiting to be filled with knowledge. Infection control nurses should consider innovative student-centred approaches such as problem-based learning (PBL) that recognises learners as cognitive beings, with a frame of reference constructed from a lifetime of experience. In PBL a problem or trigger is encountered in the learning process and serves as a focus for the application of problem-solving or reasoning skills. Clinically relevant material can translate problem solving into the learner's experiential language, enhance intrinsic motivation and assist them to become more adaptable and self-directed. As content experts, ICNs are well positioned to produce material grounded in reality, which will stimulate the students and guide them towards their learning outcomes. An example of a problem-based case study is included.
An investigation of the microbiological contamination of ultrasound equipment
Authors: Sykes A. , Appleby M. , Perry J. , Gould K. 
Published: September 2007

ltrasound equipment comes into direct contact with patients and practitioners during scanning procedures, enabling it to be a potential vehicle for the spread of nosocomial infections. A study was undertaken to determine the extent of contamination on this equipment and therefore the efficacy of the present decontamination guidelines. Five ultrasound machines were sampled over a period of three months. Three used for non-invasive procedures and two for invasive procedures. The equipment was sampled from the probe, probe holder, keyboard and gel. The results revealed that 64.5% of the total samples were contaminated with environmental organisms, 7.7% with potential pathogens and 27.8% were no growth. The most significant contamination was found on the non-invasive equipment, probably due to the lower level of decontamination practices designated for this equipment. Following the study, comprehensive decontamination guidelines for all ultrasound equipment were devised and distributed to all ultrasound departments, and staff were educated on the need for improved decontamination regimes.
Infection control policies and procedures for meticillin-resistant Staphylococcus aureus in care homes for older people in Northern Ireland: a questionnaire study
Authors: Tunney MM , Hughes CM , Magee J. 
Published: September 2007

ackground: Limited information is available regarding the role of infection control in the prevention of infection in nursing and residential care homes. Objectives: To determine what infection control policies and procedures are in place in care homes for older people in Northern Ireland. Methods: Anonymous postal questionnaire survey of all 410 nursing and residential homes in Northern Ireland that provide care to residents over the age of 65. Results: A total of 318 (78%) questionnaires were returned. Visits from infection control nurses from health boards or community trusts were infrequent, with only 23% of homes receiving such a visit. Nearly all homes (99.7%) had a policy on infection control, with 72.4% and 84.3% of homes having a policy on the admission and care of residents with meticillin-resistant Staphylococcus aureus (MRSA) respectively. Of those respondents that had a policy on admission of persons with MRSA, only a small percentage (9.2%) would not admit residents with MRSA. Only 11% of respondents believed that MRSA was a problem in their particular home, but at least 30% agreed that there was a problem with MRSA in care homes. A desire was expressed for more information and support, with 75% of respondents agreeing that more information should be provided to homes on MRSA. Conclusions: There is a clear need for additional infection control advice to be available to care homes and for the development of uniform policies and an infection control audit tool. The audit tool could then be used to ensure that the appropriate policies and standards are in place within care homes and that these standards are met on an ongoing basis.
Comparison of detergent-based cleaning, disinfectant-based cleaning, and detergent-based cleaning after enhanced domestic staff training within a source isolation facility
Authors: Patel S.S. , Pevalin D.J. , Prosser R. , Couchman A. 
Published: September 2007

Source isolation facilities should be adequately cleaned to minimise the risk of cross-infection via the environment and fomites. The aim of this study was to compare the effectiveness of cleaning with detergent, cleaning with detergent followed by sodium hypochlorite and cleaning with detergent after enhanced training for domestic staff within isolation facilities in a district general hospital in southern England. Frequent `hand touch' sites in two isolation rooms were sampled, using contact plates. A total of 567 plates were collected. Bacterial total viable counts (TVCs) and environmental meticillin-resistant Staphylococcus aureus (MRSA) were used as surrogate markers to compare the efficacy of the cleaning methods. The results indicate that cleaning with water and detergent followed by sodium hypochlorite achieved significantly lower TVCs for most sampling sites, but only significantly lower environmental MRSA detections from a minority of sample sites. No one method of cleaning consistently eliminated MRSA from the environment. These results provide some preliminary evidence for the use of detergent and hypochlorite cleaning within source isolation facilities.
Three-dimensional computed tomography imaging in an animal model of emphysema
Authors: Froese A. R. , Ask K. , Labiris R. , Farncombe T. , Warburton D. , Inman M. D. , Gauldie J. , Kolb M. 
Published: September 2007

Emphysema is a major health problem and novel drugs are needed. Animal disease models are pivotal in their development, but the validity and sensitivity of current tools for the evaluation of drug efficacy is limited. The usefulness of micro computed tomography (CT) as an innovative tool to assess emphysema in a mouse model was investigated.Serial CT scans were performed in bi-weekly intervals in Smad3 knockout (KO) mice, which spontaneously develop airspace enlargement. Lung density was quantified in two- and three-dimensional images and correlated to mean linear intercept and lung compliance.CT scans of Smad3 KO lungs revealed a significant decrease in lung density at age 8 weeks and a further progression at age 14 weeks with respect to age-matched wild-type (WT) animals. Emphysema could be reliably assessed with both the two- and three-dimensional approach, but the three-dimensional approach was superior, due to normalisation to lung volumes and less variability. Lung compliance by week 14 was 0.053±0.005 and 0.034±0.002% of maximum volume·cmH2O−1for KO and WT mice, respectively, reflecting significant physiologically relevant emphysema.Small animal computed tomography imaging and density quantification in a reconstructed three-dimensional image is a useful tool for quantifying emphysematous changes in an animal disease model. It adds significant information to conventional assessment.
Demographic characteristics of patients with extrapulmonary tuberculosis in Germany
Authors: Forssbohm M. , Zwahlen M. , Loddenkemper R. , Rieder H. L. 
Published: September 2007

The aim of the present study was to determine the demographics of patients with extrapulmonary tuberculosis in Germany.Data on 26,302 tuberculosis cases from a national survey carried out during the period 1996–2000 were analysed.The crude proportion of tuberculosis patients with extrapulmonary manifestations was 21.6%. Extrapulmonary tuberculosis was most likely among females, children aged <15 yrs and persons originating from Africa and Asia. Females tended to be more likely to have any form of extrapulmonary tuberculosis than males, except pleural tuberculosis. The strength of this association was strongest in the age range 25–64 yrs and less pronounced amongst the oldest patients. Children were particularly prone to the development of lymphatic and meningeal tuberculosis, whereas the likelihood of genitourinary tuberculosis increased with increasing age. Asian and African patients were generally more likely than persons from other areas to have lymphatic, osteoarticular, meningeal and miliary tuberculosis.The analysis shows important differences, by age, sex and origin, in the likelihood of a tuberculosis patient presenting with extrapulmonary tuberculosis. Since the relative contribution of the foreign-born to tuberculosis in low-prevalence countries is rising, extrapulmonary tuberculosis must be taken into account more often in the differential diagnostic work-up of these patients, particularly among those originating from Asia and Africa.
A USA-based registry for pulmonary arterial hypertension: 1982–2006
Authors: Thenappan T. , Shah S. J. , Rich S. , Gomberg-Maitland M. 
Published: September 2007

The aim of this study was to define the epidemiology of World Health Organization (WHO) Group I pulmonary arterial hypertension (PAH) in a large referral centre in the USA.The Pulmonary Hypertension Connection registry, initiated in 2004, evaluated all patients in a single USA practice from 1982–2006. For comparison, the authors divided the group by incidentversusprevalent cohorts, aetiology and by treatment era.In total, 578 patients (77% female) aged 48±14 yrs were entered. Of these, 80% had class III or IV symptoms. Over time, connective tissue disease-associated PAH increased, while referrals for HIV remained low. One-third of patients were referred on calcium channel blocker therapy even though only 4.6% had an acute response to vasodilator challenge. When compared by treatment era, there were no differences in the severity of PAH. However, survival had improved over time, with a 1-yr survival of 85% in the incident cohort.In the USA, pulmonary arterial hypertension patients are still referred to tertiary centres too late. Referral of connective tissue disease is increasing, while referral of HIV remains low. Inappropriate calcium channel blocker treatment is common. Survival rates have increased but remain low suggesting that prognosis is improving but PAH is still a progressive, fatal disease.
Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?
Authors: Otero R. , Trujillo-Santos J. , Cayuela A. , Rodríguez C. , Barron M. , Martín J. J. , Monreal M. 
Published: September 2007

Patients with acute pulmonary embolism (PE) presenting with haemodynamic instability have the worst prognosis. However, what is understood by haemodynamic instability has not been clearly defined.The Registro Informatizado de la Enfermedad Tromboembólica (RIETE) is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute deep vein thrombosis or PE. The present authors compared the predictive value of a systolic blood pressure (SBP) value of <100 mmHg and <90 mmHg and the shock index (cardiac frequency divided by SBP) on 30-day mortality in consecutive patients with PE.As of May 2006, 6,599 patients with PE were enrolled in the study. Of these, 417 (6.3%) died within 30 days: 153 of the initial PE, 29 of recurrent PE and 235 due to other causes. Of the 417 individuals who died, 127 (30%) had a positive shock index, 60 (14%) had SBP <100 mmHg and 33 (7.9%) had SBP <90 mmHg. On multivariate analysis any of the three parameters were independently associated with an increased mortality. The shock index had a higher sensitivity (30.5versus14.4 and 7.9% for SBP <100 mmHg and <90 mmHg, respectively) but lower specificity (86.3versus93.0 and 96.6).All three measures of haemodynamic instability are independent predictors of 30-day mortality. However, while the shock index had the highest sensitivity, a systolic blood pressure value <90 mmHg had the highest specificity.
Expression and role of EGFR ligands induced in airway cells by PM2.5and its components
Authors: Rumelhard M. , Ramgolam K. , Hamel R. , Marano F. , Baeza-Squiban A. 
Published: September 2007

The aim of the current study was to establish the epidermal growth factor receptor (EGFR) ligand expression profile in human airway epithelial cells exposed to either particulate matter (PM) with an aerodynamic diameter <2.5 μm (PM2.5) or its components and the involvement of EGFR ligands in PM2.5-provoked airway inflammation.EGFR ligand mRNA and protein expression were studied in a human bronchial epithelial cell line and normal nasal cells exposed to noncytotoxic concentrations of PM2.5or its components. The autocrine role of EGFR ligands in airway epithelial cell pro-inflammation was determined by adding conditioned media from PM2.5-treated cells to fresh cells and measuring the secretion of granulocyte-macrophage colony-stimulating factor (GM-CSF), a pro-inflammatory biomarker.PM2.5increased amphiregulin, transforming growth factor-α and heparin-binding EGF-like growth factor mRNA expression and protein secretion, with a slight contribution of aqueous metallic compounds and a strong participation of organic components putatively attributed to PM polyaromatic hydrocarbon content. PM2.5-induced EGFR ligands were involved in cellular GM-CSF release.The current study revealed upregulation of several epidermal growth factor receptor ligands by airway epithelial cells exposed to particulate matter with an aerodynamic diameter <2.5 μm and their contribution to bronchial epithelial cell granulocyte-macrophage colony-stimulating factor secretion by an autocrine action, suggesting that these ligands could elicit and sustain the particulate matter-induced airway pro-inflammatory response and contribute to bronchial remodelling.
Value of cancer antigen 125 for diagnosis of pleural endometriosis in females with recurrent pneumothorax
Authors: Bagan P. , Berna P. , Assouad J. , Hupertan V. , Le Pimpec Barthes F. , Riquet M. 
Published: September 2007

The thorax is the most frequent extrapelvic location of endometriosis. Thoracic endometriosis is probably responsible for the high rate of recurrent pneumothoraces in females. The goal of the present prospective study was to assess the value of cancer antigen (CA)125 measurement in the detection of endometriosis in order to further enable early and adequate treatment of catamenial pneumothorax.Between January 2004 and March 2006, 31 females (mean age 32 yrs) underwent pneumothorax surgery. The control group comprised 17 males (mean age 27 yrs), who underwent videothoracoscopic pleural abrasion. Serum CA125 was measured around a menstrual period in females and before surgery in males.Videothoracoscopically diagnosed endometriosis occurred in 29% of females. The CA125 concentration was significantly higher in females with endometriosis compared to disease-free females (76.1versus16 U·mL−1). The mean value in males was similar to that observed in disease-free females.The frequency of thoracic endometriosis-related pneumothorax corresponds to, on average, a third of females presenting with recurrent pneumothorax. Early detection can be achieved with serum cancer antigen 125 measurement and may be helpful in indicating videothoracoscopic surgery.
Chronic bronchitis sub-phenotype within COPD: inflammation in sputum and biopsies
Authors: Snoeck-Stroband J. B. , Lapperre T. S. , Gosman M. M. E. , Boezen H. M. , Timens W. , ten Hacken N. H. T. , Sont J. K. , Sterk P. J. , Hiemstra P. S. 
Published: September 2007

The presence of chronic bronchitis predicts a more rapid decline of forced expiratory volume in one second (FEV1) in patients with chronic obstructive pulmonary disease (COPD). The hallmark of COPD is airway inflammation. It was hypothesised that COPD patients with chronic bronchitis are characterised by a distinct inflammatory cell profile, as measured in bronchial biopsies and sputum.From 114 COPD patients (male/female ratio 99/15, mean±sdage 62±8 yrs, current smoking 63%, post-bronchodilator FEV163±9% predicted, no steroids), with and without chronic bronchitis, inflammatory cell counts in bronchial biopsies and induced sputum were measured. Analysis was carried out by logistic regression.COPD patients with chronic bronchitis had lower eosinophil counts in biopsies and higher percentages of sputum eosinophils than patients without those symptoms, which remained after adjustment for smoking and sex. Patients with chronic bronchitis also showed higher percentages of macrophages and lower percentages of neutrophils in sputum, which could be explained by differences in smoking and sex.It was concluded that chronic bronchitis reflects an inflammatory sub-phenotype among patients with chronic obstructive pulmonary disease. The present results indicate a preferential distribution of eosinophils towards the airway lumen in patients with chronic bronchitis. This may have implications for anti-inflammatory treatment of chronic obstructive pulmonary disease patients with chronic bronchitis.