Miracle-dz/UniFAR-FTUs huggingface dataset:
Incidence and types of canine tumours in Croatia

Neoplastic diseases are among the leading health concerns in medicine. As such, epidemiological studies considering canine tumours are benefi cial in understanding the patterns of tumour occurrence. The aim of this study was to analyze data on the occurrence of canine tumours in Croatia. From 1 January 2006 to 31 December 2009, a total of 1568 tumours were diagnosed after routine biopsy submission or necropsy. The WHO classifi cation was used for designating tumour type. Most tumours (59.1%) were malignant, 35.4% were benign, while the remainder (5.29%) were treated as not specifi ed. Tumours originated from the skin and subcutis (45.73%), mammary gland (21.75%) and genital system (7.97%). The most common specifi c tumour types diagnosed were mammary tubulopapillary carcinoma (7.14%), mast cell tumour (4.91%) and fi brosarcoma (4.91%). Differences in tumour occurrence in dog populations from inland and coastal areas were negligible in all but mammary tumours (20.54% in inland ; 28.63% in coastal areas) and mammary tubulopapillary carcinoma (6.37% in inland ; 11.54% in coastal areas). Using data from the Croatian national registry of vaccinated dogs, the crude incidence of tumours was calculated only for the Zagreb area. Expressed as the number of tumours per 100, 000 dogs per year, the incidence was 1504 for all tumours, 532 for benign and 790 for malignant tumours. The overall frequencies of dominant tumour types and the crude incidence of canine tumours in the Zagreb area are comparable to other investigations.
Multimorbidity in primary care: developing the research agenda.

Multimorbidity - usually deﬁned as the co-existence of two or more long-term conditions in an individual - is the norm rather than the exception in primary care patients 1,2 and will become more prevalent as popula-tions age. 3,1 Multimorbidity cuts across the vertical paradigms in which most health research and policy is envisaged, and carried out, reﬂecting not only specialist interests in particular problems and diseases, but also the tendency of research to focus on easily deﬁned issues. ‘‘Complicated’’ patients with multimorbidity are usually excluded from such research.
Attitudes towards the Development of Wind Farms in Australia

The Australian government is supporting the development of renewable energy technology, such as wind power, in its efforts to reduce green house gases in line with the Kyoto agreement. While wind technology offers many advantages, property owners have voiced opposition to the siting of wind farms due to concerns over changes in neighbourhood aesthetics, noise, loss of bird life, and loss in property values. Such opposition can result in planning permission being declined and a restriction in the ability to meet Kyoto targets. This paper outlines the results of research carried out in Western Australia in 2008 to investigate the attitudes of residents towards the development of a wind farm. The results indicate that the majority of the respondents think of a wind farm in positive terms. The proximity to the wind farm is an important aspect that could determine attitudes with many respondents reporting that they would not want to live 'near' a wind farm, usually stated as between 1-5km. Over a third (38%) of the respondents would pay 1-9% less for their property due to the presence of a wind farm nearby. These results will be of interest to power companies in helping to plan the siting of wind farms.
Unemployment, cigarette smoking, alcohol consumption and body weight in young British men

The relationship of unemployment experienced between the ages of 16 and 33 years with smoking, alcohol consumption and obesity was examined in 2,887 men who were members of the 1958 longitudinal British birth cohort study (NCDS). Cigarette smoking, alcohol consumption, measured as units consumed in the past week and as problem drinking using the CAGE questionnaire and the body mass index (BMI) were measured at age 33 years. Both the amount of unemployment accumulated between the ages of 16 and 33 years and recent unemployment experienced in the year prior to interview at age 33 years were examined. When compared with men who had never been unemployed, the adjusted relative odds amongst men with over three years of accumulated unemployment (after adjustment for possible confounding socioeconomic and behavioural factors measured prior to unemployment) were 2.11 (95% Cl: 1.42-3.12) for smoking, 2.13 (95% Cl: 1.32-3.42) for a low BMI and non-significant for a high BMI; 1.52 (95% Cl: 1.04-2.24) for no alcohol consumed; non-significant for high alcohol consumption, but 2.15 (95% Cl: 1.39-3.33) for problem drinking. Men who had experienced unemployment in the year prior to the interview, compared to those who had not, after adjustment, were significantly more likely to smoke (RO 2.92, 95% Cl: 2.13-4.01), drink heavily (RO 1.73, 95% Cl: 1.18-2.54) and to have a drink problem (RO 2.90, 95% Cl: 1.99-4.21). Unemployment may play a significant part in establishing life-long patterns of hazardous behaviour in young men.
Clinical practice. Should coronary calcium screening be used in cardiovascular prevention strategies?

A 52-year-old man requests a coronary-artery calcium (CAC) scan for assessment of coronary risk factors after seeing an advertisement from a local facility that offers the test. He has no symptoms of cardiac disease, has never smoked, and is not overweight, but he does not exercise regularly. His father, who was a heavy smoker, had a fatal myocardial infarction at 45 years of age. The patient's blood pressure is 130/85 mm Hg. His total cholesterol level is 220 mg per deciliter, and his low-density lipoprotein and high-density lipoprotein cholesterol levels are 160 mg per deciliter and 38 mg per deciliter, respectively. His fasting blood glucose level is 92 mg per deciliter. What would you advise regarding CAC scanning?
Daniel's and Worthingham's muscle testing : techniques of manual examination

Principles of Manual Muscle Testing. Testing the Muscles of the Neck. Testing the Muscles of the Trunk. Testing the Muscles of the Upper Extremity. Testing the Muscles of the Lower Extremity. Testing in Infants and Children. Assessment of Muscles Innervated By Cranial Nerves. Upright Motor Control. Ready Reference Anatomy: Alphabetical List of Muscles, List of Muscles By Region, Skeletal Muscles of the Human Body, Motions and Their Participating Muscles, Cranial and Peripheral Nerves and the Muscles They Innervate, Myotomes. The Motor Nerve Roots and the Muscles They Innervate. Bibliography. Cited References. Index.
Solicitations in GP, nurse and pharmacist prescriber consultations: an observational study.

BACKGROUND The opening solicitation is a key element of the primary care consultation as it enables patients to express their ideas, concerns and expectations that can lead to improved patient outcomes. However, in practice, this may not always occur. With nurses and pharmacists now able to prescribe, this research explored the opening solicitation in a multi-professional context. OBJECTIVE To compare the nature, frequency and response to opening solicitations used in consultations with nurse prescribers (NPs), pharmacist prescribers (PPs) and GPs. METHODS An observational study using audio-recordings of NP, PP and GP patient consultations in 36 primary care practices in southern England. Between 7-13 prescriber-patient consultations were recorded per prescriber. A standardized pro forma based upon previous research was used to assess recordings. RESULTS Five hundred and thirty-three patient consultations (213 GPs, 209 NPs, 111 PPs) were audio-recorded with 51 prescribers. Across the prescribing groups, pharmacists asked fewer opening solicitations, while GPs used more open questions than NPs and PPs. The mean number of patient agenda items was 1.3 with more items in GP consultations. Patients completed their opening agenda in 20% of consultations, which was unaffected by professional seen. Redirection of the patient's agenda occurred at 24 seconds (mean). CONCLUSION All prescribers should be encouraged to use more open questions and ask multiple solicitations throughout the consultation. This is likely to result in greater expression of patients' concerns and improved patient outcomes.
Mycophenolate mofetil for patients with autoimmune hepatitis and overlap syndromes: authors’ reply

SIRS, Garcia-Buey and Moreno-Otero nicely summarise the literature on mycophenolate mofetil (MM) in autoimmune hepatitis (AIH) and overlap syndromes. The Dutch Autoimmune Hepatitis Group (DAHG) shows that second-line MM induces remission in 67% of patients with AIH and intolerance to azathioprine (AZA). In AIH and AZA nonresponse, remission was achieved with MMF in only 13%, and all deaths, liver transplantations and decompensations of cirrhosis occurred in this group. Therefore, in AIH and AZA-nonresponse other options, including liver transplantation, seem more appropriate. This is consistent with the findings of Hennes et al. For all patients with overlap syndromes, MM appears a valuable treatment option. In the DAHG cohort, MM induced remission in 63% and 57%, and response in 15% and 14% after AZA intolerance and nonresponse respectively. Recently, adding MM and budesonide appeared beneficial in primary biliary cirrhosis (PBC) with insufficient response to ursodeoxycholic acid. Further investigations of MM in PBC and overlap seem warranted. As first-line therapy for AIH, one randomised controlled study indicates that budesonide with AZA induces more remission with less side-effects than prednisolone with AZA. However, despite the one prospective cohort with MM as first-line therapy in AIH, and the limitations of earlier studies, most evidence for first-line therapy in AIH still is with AZA and prednisolone. We therefore still consider prednisolone with AZA the first-line treatment in AIH and overlap syndromes until further randomised studies prove otherwise. In case of steroid side-effects, in the absence of cirrhosis, budesonide could be considered, although a prospective maintenance study against prednisolone is still lacking. As second-line therapy in case of AZA-intolerance in AIH, or for all overlap syndrome patients, MM with prednisolone appears useful, but not for AIH with AZA nonresponse. In contrast to AZA, MM is contraindicated in pregnancy.
Social accountability of medical schools and academic primary care training in Latin America: principles but not practice.

BACKGROUND Latin America has one of the highest rates of health disparities in the world and is experiencing a steep increase in its number of medical schools. It is not clear if medical school authorities consider social responsibility, defined as the institutional commitment to contribute to the improvement of community well-being, as a priority and if there are any organizational strategies that could reduce health disparities. OBJECTIVE To study the significance and relevance of social responsibility in the academic training of medical schools in Latin America. METHODS The study combined a qualitative thematic literature review of three databases with a quantitative design based on a sample of nine Latin American and non-Latin American countries. RESULTS The thematic analysis showed high agreement among academic groups on considering medical schools as 'moral agents', part of a 'social contract' and with an institutional responsibility to reduce health disparities mainly through the implementation of strong academic primary care programs. The quantitative analysis showed a significant association between higher development of academic primary care programs and lower level of health disparities by country (P = 0.028). However, the data showed that most Latin American medical schools did not prioritize graduate primary care training. CONCLUSIONS The study shows a discrepancy between the importance given to social responsibility and academic primary care training in Latin America and the practices implemented by medical schools. It highlights the need to refocus medical education policies in the region.
Studies of the symptom abdominal pain--a systematic review and meta-analysis.

BACKGROUND Diagnostic reasoning in primary care patients with abdominal pain is a complex challenge for GPs. To ensure evidence-based decision making for this symptom, GPs need setting-specific knowledge about the prevalence, potential risks for diseases and chance of recovery or risk of undesirable courses of disease. AIM We conducted a systematic review of symptom-evaluating studies on prevalence, aetiology or prognosis of abdominal pain. METHODS We included all studies evaluating the symptom 'abdominal pain' as a reason for consultation in primary care. We included all types of study designs except for qualitative studies. Studies focussed solely on children or settings other than primary care were also excluded. RESULTS We identified 14 studies. Mean consultation prevalence is 2.8% for abdominal pain. In about one-third of patients the underlying cause of abdominal pain cannot be specified. The most common aetiologies are gastroenteritis (7.2-18.7%), irritable bowel disease (2.6-13.2%), urological cause (5.3%) and gastritis (5.2%). About 1 in 10 abdominal pain patients suffers from an acute disease like appendicitis (1.9%), diverticulitis (3.0%), biliary/pancreatic (4.0%) or neoplastic (1.0%) diseases needing immediate therapy. CONCLUSION There is a high prevalence of patients consulting GPs for abdominal pain. The review identified a comparably high rate of acute underlying diseases in need of further investigation or therapy. At the same time, the underlying cause of the complaints often remains unexplained. Further symptom-evaluating studies are necessary, ideally using standardized methodology in order to gain sufficient evidence for developing much-needed guidelines and decision support tools.
Fatores de risco pré-operatórios para mediastinite após cirurgia cardíaca: análise de 2768 pacientes

INTRODUCAO: A esternotomia mediana longitudinal e a via de acesso mais utilizada no tratamento das doencas cardiacas. As infeccoes profundas da ferida operatoria no pos-operatorio das cirurgias cardiovasculares sao uma complicacao seria, com alto custo durante o tratamento. Diferentes estudos tem encontrado fatores de risco para o desenvolvimento de mediastinite e as variaveis pre-operatorias tem tido especial destaque. OBJETIVO: O objetivo deste estudo e identificar fatores de risco pre-operatorios para o desenvolvimento de mediastinite em pacientes submetidos a revascularizacao do miocardio e a substituicao valvar. METODOS: Este estudo observacional representa uma coorte de 2768 pacientes operados consecutivamente. O periodo considerado para analise foi de maio de 2007 a maio de 2009 e nao houve criterios de exclusao. Foi realizada analise univariada e multivariada pelo modelo de regressao logistica das 38 variaveis pre-operatorias eleitas. RESULTADOS: Nesta serie, 35 (1,3%) pacientes evoluiram com mediastinite e 19 (0,7%) com osteomielite associada. A idade media dos pacientes foi de 59,9 ± 13,5 anos e o EuroSCORE de 4,5 ± 3,6. A mortalidade hospitalar foi de 42,8%. Na analise multivariada, foram identificadas tres variaveis como preditoras independentes de mediastinite: balao intra-aortico (OR 5,41, 95% IC [1,83 -16,01], P=0,002), hemodialise (OR 4,87, 95% IC [1,41 - 16,86], P=0,012) e intervencao vascular extracardiaca (OR 4,39, 95% IC [1,64 - 11,76], P=0,003). CONCLUSAO: O presente estudo demonstrou que necessidade do suporte hemodinâmico pre-operatorio com balao intra-aortico, hemodialise e intervencao vascular extracardiaca sao fatores de risco para o desenvolvimento de mediastinite apos cirurgia cardiaca.
Empathy: what does it mean for GPs? A qualitative study.

BACKGROUND Research has highlighted empathy as an important and effective factor in patient-physician communication. GPs have extensive practical experience with empathy. However, little is known about the personal views of GPs regarding the meaning and application of empathy in daily practice. OBJECTIVES To explore GP's experiences and the application of empathy in daily practice and to investigate the practical use of empathy. Facts such as preconditions, barriers and facilitating possibilities are described. METHODS Qualitative interview study; 30 in-depth interviews were performed between June 2012 and January 2013 with a heterogeneous sample of Dutch GPs. Interviews were recorded and transcribed verbatim; content analysis was performed with the help of ATLAS-ti. RESULTS Empathy was seen as an important quality-increasing element during the patient-GP consultation. The application of non-verbal and verbal techniques was described. Attention to cues and references to previous consults were reported separately. Required preconditions were: being physically and mentally fit, feeling no time pressure and having an efficient practice organization. Not feeling connected to the patient and strict medical guidelines and protocols were identified as obstacles. A key consideration was the positive contribution of empathy to job satisfaction. CONCLUSIONS The opinions of GPs in this research can be considered as supplementing and strengthening the findings of previous researches. The GPs in this study discussed, in particular, ideas important to the facilitation of empathy. These included: longer consultations, smaller practices, efficient telephonic triage by practice assistants, using intervision to help reflect on their work and drawing financiers' attention to the effectiveness of empathy.
Cluster randomized trials: evaluating treatments applied to groups.

Sometimes a new treatment is best introduced to an entire group of patients rather than to individual patients. Examples include when the new approach requires procedures be followed by multiple members of a health care team or when the new technique is applied to the environment of care (eg, a method for cleaning a hospital room before it is known which patient will be assigned the room). This avoids confusion that could occur if all caregivers had to keep track of which patients were being treated the old way and which were being treated the newway. One approach to evaluate the efficacy of such treatments— treatments for which the application typically involves changes at the level of the health care practice, hospital unit, or even health care system—is to conduct a cluster randomized trial. In a cluster randomized trial, study participants are randomized in groups or clusters so that all members within a single group are assigned to either the experimental intervention or the control.1,2 This contrasts with the more familiar randomized clinical trial (RCT) in which randomization occurs at the level of the individual participant, and the treatment assigned to one study participant is essentially independent of the treatment assigned to any other. In a cluster randomized trial, the cluster is the unit randomized, whereas in a traditional RCT, the individual study participant is randomized. In both types of trials, however, the outcomes of interest are recorded for each participant individually. Although there are both theoretical and pragmatic reasons for using cluster randomization in a clinical trial, doing so introduces a fundamental challenge to those analyzing and interpreting the results of the trial: study participants from the same cluster (eg, patients treated within the same medical practice or hospital unit) tend to be more similar to each other than participants from different clusters.2 This nearly universal fact violates a common assumption of most statistical tests, namely, that individual observations are independent of each other. To obtain valid results, a cluster randomized trial must be analyzed using statistical methods that account for the greater similarity between individual participants from the same cluster compared with those from different clusters.2-4 In a recent JAMA article, Curley et al5 reported the results of RESTORE, a cluster randomized clinical trial evaluating a nurseimplemented, goal-directed sedation protocol for children with acute respiratory failure receiving mechanical ventilation in the intensive care setting, comparing this approach with usual care. The trial evaluated the primary hypothesis that the intervention group—patients treated in intensive care units (ICUs) using the goal-directed sedation protocol—would have a shorter duration of mechanical ventilation. Thirty-one pediatric ICUs, the “clusters,” were randomized to either implement the goal-directed sedation protocol or continue their usual care practices. Use of theMethod
Acute gastroenteritis hospitalizations among US children following implementation of the rotavirus vaccine.

Acute Gastroenteritis Hospitalizations Among US Children Following Implementation of the Rotavirus Vaccine Routine rotavirus vaccination of US children was implemented in 2006, with 2 or 3 doses recommended before the age of 8 months.1 Previous studies have demonstrated the association of rotavirus vaccine introduction with reductions in health care use during the early postintroduction period or with limited insurance databases.2-4 Because laboratory testing and coding for rotavirus are not routinely performed for patients with diarrhea, we examined both allcause acute gastroenteritis and rotavirus-coded hospitalizations among children younger than 5 years from 2000 through 2012.
Prevalence of spinal pathology in patients presenting for lumbar MRI as referred from general practice.

BACKGROUND The use of magnetic resonance imaging (MRI) as initial imaging for back pain has increased in general practice. However, few data are available on the characteristics of these referred patients. The objective of this study was to describe the baseline characteristics and MRI findings of patients presenting for a lumbar MRI examination as referred by their GP. METHODS Patients presenting for a lumbar MRI examination as referred by their GP were recruited at the MRI Center. The MRI radiology reports were scored for the presence of disc bulging, disc herniation, nerve root compression, spinal stenosis, spondylolisthesis and serious pathologies. Information on patients' characteristics, characteristics of the complaints and red flags were derived from questionnaires. Cross-sectional differences between patients with and without specific MRI findings were analyzed. RESULTS A total of 683 low back pain (LBP) patients were included; mean age was 49.9 (range 19-80) years and 53% was male. Mean back pain severity score was 6.6 (SD 2.0) and 67% of the patients reported having chronic LBP. In total, 374 patients (55%) reported sciatica complaints for at least 6 weeks. Of all MRI reports, 69% mentioned signs of nerve root compression. Serious pathologies were reported in 3% of the patients. In total, 94% of patients had abnormal MRI findings. CONCLUSIONS Almost all patients presenting for a lumbar MRI examination as referred by their GP had abnormal MRI findings. In total, 55% of the patients reported persistent sciatica in which imaging is recommended according to international guidelines.
Short-term Outcomes of Infants Enrolled in Randomized Clinical Trials vs Those Eligible but Not Enrolled.

It is unknown whether participation in a neonatal randomized controlled trial (RCT) is independently associated with differences in outcomes. Our objective was to compare inhospital outcomes between extremely premature infants enrolled in RCTs and those who were eligible but not enrolled in RCTs conducted by the National Institute of Child Health and Human Development Neonatal Research Network (NRN).