Miracle-dz/UniFAR-FTUs huggingface dataset:
The Kiwi way: lessons from New Zealand

New Zealand is proud of being the first country to create a universal social security system and free health care in the late 1930s. This reflects the strong socialist tradition of the country, which has been sustained by a scarcity of labour for most of its history. It was the socialist party that introduced deregulation and market reforms in the 1980s. Nationalised industries were privatised, but the health service was untouched until a conservative government introduced market type reforms in 1993. Reforms are modelled on the British system, with a purchaser and provider split, competition for income through contracts, but without primary care purchasing. The area health boards have been abolished and four purchasing regional health authorities set up with populations of around 800000 each. The changes generated much controversy, although it is arguable that the reforms only made more visible the many problems of the health care system that are similar to those faced by Britain. Two unpopular changes were abolishing political boards at area and hospital level and introducing charges for each day of stay in hospital. After a few months the hospital charges were dropped but there is still concern about the lack of local representation and accountability, especially in relation to the large purchasing organisations, which are viewed as remote from the people they are supposed to serve. Partly to make up for lack of local representation, purchasers and other public health …
PHYSICAL AND TOXIC FACTORS IN SHOCK

The word shock as currently used covers essentially the following conditions: 1. Primary shock, characterized by direct reduction of blood pressure and other less precisely defined acute symptoms, attributed to nervous, circulatory or toxic causes. 2. Secondary shock, a more slowly developing condition, of better defined character but of disputed etiology. It has usually been produced experimentally by mechanical, thermal or other trauma of the limbs or of the intestine. Authorities are agreed as to the epochal importance of the physical concept, established by Phemister, 1 Blalock 2 and their collaborators and corroborated by numerous writers (Herbst, 3 Holt and Macdonald, 4 Harkins 5 and his collaborators, Underhill 6 and his collaborators, Roome and Wilson, 7 Aikawa 8 and others) through demonstration of a passage of protein-containing fluid resembling blood plasma into the injured tissues, with consequent increase of corpuscle counts and reduction of volume of the blood. The opposite
Reliability of predictors for screw cutout in intertrochanteric hip fractures.

BACKGROUND Following internal fixation of intertrochanteric hip fractures, tip apex distance, fracture classification, position of the screw in the femoral head, and fracture reduction are known predictors for screw cutout, but the reliability of these measurements is unknown. We investigated the reliability of the tip apex distance measurement, the Cleveland femoral head dividing system, the three-grade classification system of Baumgaertner for fracture reduction, and the AO classification system as predictors for screw cutout. METHODS All patients with an intertrochanteric hip fracture who were managed with either a dynamic hip screw or a gamma nail between January 2007 and June 2010 were evaluated from our hip trauma database. RESULTS The tip apex distance measurement was reliable and patients with device cutout had a significantly higher tip apex distance. The agreement between observers with regard to screw position and fracture reduction was moderately reliable. After adjustment for tip apex distance and screw position, A3 fractures were at more risk of cutout compared with A1 fractures. Poor fracture reduction was significantly related with a higher incidence of cutout in univariate analysis, but not in multivariate analysis. Central-inferior and anterior-inferior positions, after adjustment for tip apex distance and screw position, were significantly protective against cutout. CONCLUSION To decrease probable risks of cutout, the tip apex distance needs to stay small or the screw needs to be placed central-inferiorly or anterior-inferiorly. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Effectiveness of oral contraceptive pills in a large US cohort comparing progestogen and regimen

1. Dinger J, 2. Minh TD, 3. Buttmann N, 4. et al . Obstet Gynecol 2011;117:1–8 [OpenUrl][1][PubMed][2][Web of Science][3] It is not easy to perform informative prospective studies of contraceptive failure. This paper refers to the most recent analysis of data from the International Active Surveillance Study of women taking oral contraceptives, which is a comprehensive 6-monthly follow-up of up to 5 years of pill users in multiple European countries and the USA. The current analysis refers to a … [1]: {openurl}? query=rft.jtitle%253DObstetrics%2B%2526%2BGynecology%26rft.stitle%253DObstet%2BGynecol%26rft.issn%253D0029-7844%26rft.aulast%253DChang%26rft.auinit1%253DR. %2BJ. %26rft.volume%253D117%26rft.issue%253D1%26rft.spage%253D1%26rft.epage%253D2%26rft.atitle%253DDefining%2Brisk%2Bin%2Bwomen%2Bwith%2Bpolycystic%2Bovary%2Bsyndrome%253A%2Ba%2Bneed%2Bfor%2Bconstant%2Bvigilance. %26rft_id%253Dinfo%253Apmid%252F21173638%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref? access_num=21173638&link_type=MED&atom=%2Ffamilyplanning%2F37%2F2%2F96.1. atom [3]: /lookup/external-ref? access_num=000285500800001&link_type=ISI
Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis.

BACKGROUND Total knee arthroplasty is associated with substantial blood loss and the risks of transfusion. Conflicting reports have been published regarding the effectiveness and safety of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty. We performed a meta-analysis to investigate the effectiveness and safety of tranexamic acid in reducing postoperative blood loss in total knee arthroplasty. METHODS A meta-analysis was performed to assess the effectiveness and safety of using tranexamic acid in total knee arthroplasty. Randomized controlled trials that had been published before May 2011 were retrieved, and fifteen studies met the inclusion criteria. The weighted mean difference in blood loss, number of transfusions per patient, prothrombin time, and postoperative activated partial thromboplastin time and the summary odds ratio of transfusion, deep-vein thrombosis, and pulmonary embolism were calculated in the group of patients who received tranexamic acid and the group of patients who received a placebo. RESULTS The amount of blood loss and the number of blood transfusions per patient were significantly less and the proportion of patients who required a blood transfusion was smaller in the tranexamic acid group compared with the placebo group. No significant difference in prothrombin time, activated partial thromboplastin time, deep-vein thrombosis, and pulmonary embolism was detected between the tranexamic acid group and the placebo group. CONCLUSIONS The meta-analysis shows that the use of tranexamic acid for patients undergoing total knee arthroplasty is effective and safe for the reduction of blood loss.
The relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: a prospective randomized trial.

BACKGROUND Antifibrinolytics can reduce intraoperative blood loss. The primary aim of this study was to determine the efficacy of intraoperative tranexamic acid, epsilon-aminocaproic acid, and placebo at reducing perioperative blood loss and the transfusion rate in patients with adolescent idiopathic scoliosis undergoing posterior spinal arthrodesis. METHODS This is a prospective, randomized, double-blind comparison of tranexamic acid, epsilon-aminocaproic acid, and placebo used intraoperatively in patients with adolescent idiopathic scoliosis. One hundred and twenty-five patients with adolescent idiopathic scoliosis were randomly assigned to the tranexamic acid, epsilon-aminocaproic acid, or control groups. Parameters recorded included estimated blood loss, hematocrit, blood product usage, drain output, and total blood losses. The primary outcomes were intraoperative blood loss and postoperative drainage. Secondary outcomes were transfusion requirements and hematocrit changes both intraoperatively and postoperatively. RESULTS One hundred and twenty-five patients (ninety-seven female and twenty-eight male, with a mean age of fifteen years) were randomized to receive tranexamic acid (thirty-six patients), epsilon-aminocaproic acid (forty-two patients), or saline solution (forty-seven patients). The groups were similar at baseline, with one exception: the saline solution group had a higher estimated blood volume at baseline than the tranexamic acid group. Both tranexamic acid and epsilon-aminocaproic acid reduced the estimated blood loss per degree and estimated blood loss per pedicle screw. Epsilon-aminocaproic acid, but not tranexamic acid, reduced estimated blood loss and estimated blood loss per level. Tranexamic acid also reduced total blood losses compared with epsilon-aminocaproic acid or saline solution. In an analysis controlling for level, degree, and number of anchors, tranexamic acid reduced drain output and total blood losses. Tranexamic acid or epsilon-aminocaproic acid had a smaller decrease in hematocrit postoperatively. In an analysis controlling for the mean arterial pressure during surgical exposure, tranexamic acid reduced estimated blood loss and total blood losses. Overall, antifibrinolytics (tranexamic acid or epsilon-aminocaproic acid) reduced estimated blood loss, total blood losses, and the decline in hematocrit postoperatively compared with saline solution. There was no difference among the groups with respect to the transfusion rate, duration of surgery, levels fused, or pedicle screws placed. CONCLUSIONS Tranexamic acid and epsilon-aminocaproic acid reduced operative blood loss but not transfusion rate. Tranexamic acid is more effective at reducing postoperative drainage and total blood losses compared with epsilon-aminocaproic acid. Maintenance of the mean arterial pressure at <75 mm Hg during surgical exposure appears to be critical for maximizing antifibrinolytic benefit. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Fractures in children: epidemiology and activity-specific fracture rates.

BACKGROUND Approximately one-third of pediatric fractures occur during sport or recreational activity. In this paper, we investigate the incidence and causes of pediatric fractures in our region and quantify the fracture rate per exposure time for the most common sport and recreational activities. METHODS We prospectively evaluated all children younger than sixteen years who presented to our institution with a new fracture within a twelve-month period. Exposure time to the most common childhood activities was measured by means of interviewing random parents from the study population. The main outcome measures were the annual fracture incidence in the population and fracture rates per 10,000 hours of exposure to various sports and recreational activities. RESULTS A total of 1403 fractures were included. The overall annual incidence was 180.1 fractures per 10,000 children younger than sixteen years. The distal part of the radius was most often fractured (436 fractures, 31.1%). Snowboarding was associated with the highest activity-specific fracture rate, estimated to be 1.9 (95% confidence interval [CI], 1.16 to 2.60) fractures per 10,000 hours of exposure. In comparison, the fracture rate per 10,000 hours of exposure was 0.79 (CI, 0.42 to 1.09) for handball, 0.44 (CI, 0.35 to 0.52) for soccer, and 0.35 (CI, 0.23 to 0.47) for trampolining. CONCLUSIONS The distal part of the radius is the most common fracture site in childhood. Fracture rates differ between various physical activities. The fracture rate for snowboarding was four times higher compared with that for other common childhood sport and recreational activities in our region.
Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K).

BACKGROUND Approximately one-third of patients undergoing total knee replacement require one to three units of blood postoperatively. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has been successfully used intravenously to stop bleeding after total knee replacement. A topical application is easy to administer, provides a maximum concentration of tranexamic acid at the bleeding site, and is associated with little or no systemic absorption of the tranexamic acid. METHODS A double-blind, randomized controlled trial of 157 patients undergoing unilateral primary cemented total knee replacement investigated the effect of topical (intra-articular) application of tranexamic acid on blood loss. The primary outcome was the blood transfusion rate. Secondary outcomes included the drain blood loss, hemoglobin concentration drop, generic quality of life (EuroQol), Oxford Knee Score, length of stay, a cost analysis, and complications as per the protocol definitions. RESULTS Tranexamic acid reduced the absolute risk of blood transfusion by 15.4% (95% confidence interval [CI], 7.5% to 25.4%; p = 0.001), from 16.7% to 1.3%, and reduced blood loss by 168 mL (95% CI, 80 to 256 mL; p = 0.0003), the length of stay by 1.2 days (95% CI, 0.05 to 2.43 days; p = 0.041), and the cost per episode by £333 (95% CI, £37 to £630; p = 0.028). (In 2008, £1 = 1.6 U.S. dollars.) Oxford Knee Scores and EuroQol EQ-5D scores were similar at three months. CONCLUSIONS Topically applied tranexamic acid was effective in reducing the need for blood transfusion following total knee replacement without important additional adverse effects. LEVEL OF EVIDENCE Therapeutic level I. See Instructions for Authors for a complete description of levels of evidence.
Diagnosis and treatment of cutaneous leishmaniasis

Although traditionally mostly confined to the endemic areas of Latin America, Africa, the Middle East and Central Asia, cutaneous leishmaniasis is increasingly seen in clinical practices in the Northern hemisphere due to the consequences of tourism and armed conflict. It is a group of diseases with a varied spectrum of clinical manifestations, ranging from small, benign cutaneous nodules to disfiguring mucosal tissue destruction. Caused by several Leishmania spp. , cutaneous leishmaniasis is transmitted to human beings and animals by sandflies. Clinical diagnosis is difficult because diseases of other etiologies with a similar clinical spectrum are common in endemic areas. Hence, any clinical suspicion of cutaneous leishmaniasis should be confirmed by parasitological diagnosis. The standard treatment of cutaneous leishmaniasis is still using pentavalent antimonials. Although effective, antimonials can have potentially severe side effects and, ideally, patients should be monitored closely while undergoing t.
Maternal occupational risk factors for oral clefts

with orofacial clefts: aliphatic aldehydes (OR 2.1,95% CI 0.8-5.9) and glycol ethers (OR 1.7,95% CI 0.9-3.3) for cleft lip with or without cleft palate and lead compounds (OR 4.0,95% CI 1.3-12.2), biocides (OR 2.5,95% CI 1.0-6.0), antineoplastic drugs (OR 5.0,95% CI 0.8-34.0), trichloroethylene (OR 6.7,95% CI 0.949.7), and aliphatic acids (OR 6.0,95% CI 1.5-22.8) for cleft palate only. CO~CIUS~O~S Due to the limited number of subjects, these results must be interpreted with caution. However, they point out some chemicals already known or suspected as reproductive toxins. Key terms epidemiology, occupational exposures.
Working together to learn together: learning together to work together

If the object of interprofessional education is to improve the quality of care, continuous quality improvement (CQI) should be an integral part of its methodology. That is the message that rings through these ® ve closely interwoven contributions. For they are not simply about the application of CQI in health and social care, nor about its use as a vehicle for collaborative learning, nor even about its introduction into shared undergraduate practice learning. They are about making CQI the starting point from which to build a new collaborative curriculum across undergraduate professional education. Four years ago, I argued that the time had come to develop a competency-based model for interprofessional education that went beyond attitude and knowledge-based models. This would make it easier to marry up interprofessional and professional education where, as seemed to be increasingly common, the latter was competency-based. It would stand a better chance too of winning the backing of employers who often judged the merits of applications for funding against competency-based outcomes (Barr, 1998). These articles go further. They make the case not only for a competency-based, but also a methods-based model of interprofessional education. Findings from recent research in the UK highlight the need to develop undergraduate curricula that prepare nurses and others to function effectively together in teams (Miller et al., 1999). Finding ways to improve the organisation and delivery of care through teamwork follows (Baker et al., 1995; Irvine, 1998). We need look no further than this issue for the ingredients of the collaborative curriculum. CQI, all ® ve contributions assert, is the basic ingredient, although we must look elsewhere for ways in which students can relate it to the repertoire of instruments for quality assurance and control such as multidisciplinary audit and clinical guidelines (Cluzeau et al., 1995; Humphris & Littlejohn, 1995). CQI needs, we are told, to be put in a community context and to focus upon community health issuesÐ easily said, but not so easily done when undergraduate education is hospital based and community placements short, but see Seifer & Maurana (1998) and other articles in their issue of this Journal. Students need to learn about the complex interplay between systems in which they are interveningÐ daunting when they are preoccupied with learning how to apply the rudiments of their newfound professional skills. In case that is not enough, students, we are told, need also to manage change to understand human motivation, to acquire research skills and to apply professional ethicsÐ all of them demanding, challenging and stretching.
A Retrospective Study of the Risk Factors for Invasive Aspergillosis in Iran

Back ground: Invasive aspergillosis is a well-known complication in immunocompromised patients. Among fungal infections, Invasive Pulmonary Aspergillosis (IPA) is the first cause of death after transplantation, and remains a major complication in curses of leukemia treatment. Despite considerable progress in the management of infections, it remains an important cause of morbidity and mortality, mainly after transplantation. This study was conducted in order to determine the risk factors for Aspergillus infections. Patients and methods: During retrospective investigation of 24 patients with aspergillosis, significant risk factors for invasive aspergillosis have been identified. Diagnosis was confirmed by demonstration of fungi by direct examination of the clinical samples, histopathology and cultures. Results: All patients were immunocompromised or had one or more predisposing factors. Patients with solid organ transplantation, renal transplant recipients and patients with hematologic malignancy or chronic granulomatous disease were at the highest risk for Invasive Pulmonary Aspergillosis (IPA). Fever unresponsive to broad-spectrum antibiotics was the earliest and most common clinical sign in this study. Conclusion: The major advances in the management of invasive fungal infections (IFI) have come from the noticing of the risk factors for the development of IFI, from the development of new biological markers of IFI, and also from well-designed therapeutic trails. However, much remains to be done to decrease the rate of mortality due to IFI in high risk patients. A high degree of knowledge and efforts for an early diagnosis may interfere to improve the poor prognosis.
Antecedentes personales y familiares de los trastornos de la conducta alimentaria

El presente trabajo tuvo por objetivo buscar antecedentes personales y familiares de pacientes con trastornos de conducta alimentaria (anorexia y bulimia nerviosa) de manera de conocer posibles factores de riesgo que permitan al medico pediatra estar alerta y realizar tareas de prevencion para evitar el desarrollo de dichas enfermedades. Se analizaron 39 pacientes con trastornos alimentarios que consultaron en un centro especializado de atencion de adolescentes entre el 26 de octubre de 1995 y el 23 de setiembre de 1999. Se compararon con un grupo control de 39 pacientes que tambien consultaron en la institucion con otros diagnosticos psiquiatricos. Los resultados de ambas poblaciones fueron procesados estadisticamente con la prueba del Chi cuadrado. Se concluyo que la poblacion de pacientes con trastornos de la conducta alimentaria estuvo constituida casi exclusivamente por mujeres entre 12 y 26 anos de edad. Predomino el subtipo bulimia atracon-purga, seguido por la anorexia restrictiva. Las tres cuartas partes presentaban comorbilidad con trastornos del estado de animo y/o trastornos por ansiedad. Dichas pacientes presentaban significativamente mayor cantidad de antecedentes de desordenes alimentarios y anomalias ponderales, tanto en el primer ano de vida como en el resto de la infancia, que el grupo control. Las madres y padres presentaron mayores porcentajes de sobrepeso y preocupacion por el fisico que los del grupo control, aunque las diferencias no fueron significativas. Las madres presentaron mayor porcentaje de sobreproteccion sobre sus hijos que las del grupo control, las diferencias no fueron significativas.
Development and validation of a diabetes knowledge questionnaire

An Australian National Consensus Position on Outcomes and Indicators for Diabetes Education identified knowledge and understanding as the outcomes most directly affected by diabetes education. A subsequent literature review failed to identify a validated, suitable questionnaire for measuring knowledge. Consequently, we aimed to develop a minimum diabetes knowledge questionnaire (DKQ) suitable for people with both type 1 and type 2 diabetes. Content validity was established through literature review, Delphi survey of 52 opinion leaders and a workshop of Australian Diabetes Educators (n ≥300). The resulting instrument was tested for internal consistency on 129 and for reliability on 57 people with type 1 and type 2 diabetes, respectively. The final questionnaire contains: 12 multiple choice questions common to type 1 and type 2 diabetes, e.g. normal blood glucose levels, complications, diet, exercise, selfmonitoring of blood glucose, annual check-ups, support services, and sick-days; two questions for people on oral medication/insulin only; and one question (sick-days) for people with type 1 diabetes only. For the first 12 questions, the internal consistency was good (Cronbach’s α=0.73); with the additional item for type 1 diabetes, the internal consistency was slightly better (α=0.79) as it was with the additional items for people on medication/insulin (α=0.76). No particular item seemed to adversely affect the overall consistency of the questionnaire. Comparing test-retest pilots, total scores showed good reliability with no evidence of change over time (t=1.73; df=56; p The DKQ is now ready to use for evaluating knowledge outcomes of diabetes education.