bluuebunny/crossref_metadata_2025 huggingface dataset:
Case Series of Topical and Orally Administered β-Glucan for the Treatment of Diabetic Wounds: Clinical Study
Authors: Karaaslan Onder , Kankaya Yuksel , Sungur Nezih , Kocer Ugur , Cuzdart Suat Sedat , Sahin Belma , Uysal Afsin
Published: January 2017

Background:

Chronic, nonhealing wounds, foot ulcers, and lower extremity amputations are among the most problematic complications associated with diabetes mellitus. Standard care for diabetes-related chronic ulcers has included treatment of infection, weight off-loading, aggressive surgical débridement, and maintenance of a moist wound environment with frequent dressing changes.

Objective:

Yeast glucan is a particular high-molecular-weight polymer of β-(1,3)-glycosidic linkages of glycopyranose. We report our observations about the effectiveness of topically and orally administrated β-(1,3)-glucan for the treatment of chronic diabetic wounds and compare them to the literature results previously reported for similar wounds.

Materials and Methods:

Twenty-two patients with nonhealing ulcers associated with diabetes were included in this study. β-Glucan was given both orally and topically for the treatment of nonhealing ulcers. Macroscopic changes and surface areas of diabetic ulcers were recorded, and complete healing times were noted for each patient.

Results:

A rapid decrease in size and healthy granulation were significantly observed in most patients. The duration of complete healing averaged 10.8 weeks (range 6–20 weeks). No adverse events were observed in the treatment period. The complete healing time was shorter than the results previously reported in the literature.

Conclusions:

Our observations support the view that application of glucan hastens epithelialization and wound closure, so topically and orally administered β-(1,3)-glucan therapy can help reverse some of the deficits in impaired healing diseases such as diabetes mellitus.
Topical 5% Imiquimod in the Treatment of Lentigo Maligna
Authors: Wong Jessica G. , Toole Jack W.P. , Demers Alain A. , Musto Grace , Wiseman Marni C.
Published: January 2017

Background:

Standard treatment for lentigo maligna (LM) is surgical excision with 5 to 10 mm margins. This can be cosmetically disfiguring. Imiquimod locally induces Toll-like receptors to release cytokines that destroy neoplastic melanocytes.

Objective:

The off-label use of topical 5% imiquimod cream may provide an alternative to surgery. This study reviews the use of imiquimod to treat LM.

Methods:

A 5-year retrospective and prospective chart analysis was conducted. Pretreatment biopsies confirmed the diagnosis. Treatment was individualized for each patient. Posttreatment biopsies and dermoscopy determined clearance of LM.

Results:

Twenty-seven patients were reviewed. There were 20 responders (74.1%) and 7 failures. The mean tumor size (area of an ellipse) was 6.69 cm2, and the mean treatment duration was 17.68 weeks. Neither the size of the tumor ( p = .86) nor treatment duration ( p = .18) was related to resolution of the lesion.

Conclusion:

Imiquimod is an effective treatment for LM that provides patients with a cosmetically favorable outcome when standard surgery is not an option.
Successful Treatment of Plantar Warts with Very Diluted Bleomycin Using a Translesional Multipuncture Technique: Pilot Prospective Study
Authors: Alghamdi Khalid M. , Khurram Huma
Published: January 2017

Background:

Plantar warts are common and often painful. Treatment of plantar warts is difficult and requires multiple treatments. Several clinical trials have proven the efficacy of bleomycin, but relatively high concentrations have been required and considerable side effects have been experienced.

Objective:

To evaluate the efficacy and safety of low-concentration (0.1 U/mL) bleomycin using a translesional injection technique for the treatment of plantar warts.

Methods:

The study included 23 patients with single or multiple plantar warts. Very low-concentration bleomycin was injected into a single wart or the largest plantar wart in the case of multiple lesions. Injections were performed at 4-week intervals until resolution of the warts or development of side effects. The translesional multipuncture technique was used.

Results:

Thirteen patients were male (56.5%), and the mean age was 27.7 years. The results revealed complete clearance of warts in 17 of 23 (74%) patients, partial response in 1 (4.3%) patient, and no response in 3 (13%) patients. Recurrence was observed in 2 patients at 3 months of follow-up. Among those two, one patient showed complete clearance after the second injection at 6 months of follow-up. All patients were followed for 6 months after the initial treatment. No significant long-term adverse effects were noted. Only three patients (13%) had localized moderate pain for 2 to 3 days after the injection.

Conclusion:

Translesional injection by very low-concentration (0.1 U/mL) bleomycin appears to be a simple, effective, and safe treatment modality for plantar warts.
Sample Size Calculations for Cluster Randomised Trials
Authors: Campbell Marion , Grimshaw Jeremy , Steen Nick ,   Changing Professional Practice in Europe Group (EU BIOMED II Concerted Action)
Published: January 2017

Objectives:

Cluster randomised trials, in which groups of individuals are randomised, are increasingly being used in the health field. Adopting a clustered approach has implications for the design of such trials, and sample size calculations need to be inflated to accommodate for the clustering effect. Reliable estimates of intracluster correlation coefficients (ICCs) are required for robust sample size calculations to be made; however, little empirical evidence is available on their likely size, and on factors which influence their magnitude. The aim of this study was to generate empirical estimates of ICCs and to explore factors which may affect their magnitude.

Methods:

Empirical estimates of ICCs were calculated for both process variables and patient outcomes from a number of datasets of primary and secondary care implementation studies.

Results:

Estimates of ICCs varied according to setting and type of outcome. Estimates of ICCs for process variables were higher than those for patient outcomes, and estimates derived from secondary care were higher than those from primary care. ICCs for process variables in primary care were of the order of 0.05–0.15, whilst those in secondary care were of the order of 0.3. Estimates for patient outcomes in primary care were generally lower than 0.05.

Conclusions:

Adopting cluster randomisation has implications for the design, size and analysis of clinical trials. This study gives an insight into the potential size of ICCs in primary and secondary care, and provides a practical guide to researchers to aid the planning of future studies in this area.
Near-Patient Tests in Primary Care: Setting the Standards for Evaluation
Authors: Delaney Brendan , Wilson Sue , Fitzmaurice David , Hydel Chris , Hobbs Richard
Published: January 2017

Near-patient tests (NPT) are an area of rapid technological advance that may enhance the quality of care given by primary care physicians by enabling more accurate diagnosis or more reliable monitoring of therapy. Unfortunately, many new diagnostic technologies prove disappointing in practice, either because of limitations of the technology or because of a failure to address setting-specific issues that were not apparent during their evaluation.

A recent systematic review of NPT in primary care has highlighted the methodological weaknesses of most published evaluations. There is a need for a formal statement of the criteria by which to judge the quality of evaluations in this field. In a similar fashion to Wilson and Junger's criteria for screening, seven questions need to be addressed. These cover the performance, reliability and acceptability of the test, its impact on decision-making, comparison with existing practice, cost-effectiveness of the test and integration with the practitioner's knowledge base.

Evaluations of NPTs should therefore address the following methodological issues: demonstration of the need for the NPT, definition of the appropriate reference standard, calculation of sample size based on modelling of the decision problem and defining acceptable limits to the likelihood ratio, avoidance of verification bias, selection bias and treatment paradox, testing for the presence of spectrum bias, reporting the sensitivity of the results to changes in setting or prevalence or disease and calculating cost-effectiveness.
Predicting Place of Discharge from Hospital for Patients with a Stroke or Hip Fracture on Admission
Authors: Bond John , Gregson Barbara , Lecouturier Monica Smith Jan , Rousseau Nikki , Rodgers Helen
Published: January 2017

Objectives:

To determine the predictive power of patient and service characteristics on place of discharge following hospital admission for an acute stroke and for hip fracture.

Methods:

Prospective cohort of 440 acute stroke and 572 hip fracture patients aged 65 years or over admitted from home to six district general hospitals and associated community hospitals, three in the North and three in the South of England.

Results:

Age, marital status, living arrangements, mental health status at admission, pre-admission self-rated disability, pre-admission use of home-care services, post-admission staff assessments of functional dependency as measured by Barthel Index and of confusion as measured by the modified Crichton Royal Behavioural Rating Scale and nursing staffs' expectation of place of discharge are all significantly related to place of discharge for stroke and hip fracture participants. Logistic regression correctly predicted discharge destination for 87% of stroke patients from data available at time of admission and 83% of hip fracture patients. Of the 30% of stroke patients discharged to an institution, the model correctly predicted 73%. However, of the 19% of hip fracture patients discharged to an institution, only 28% were correctly predicted.

Conclusions:

Data about older patients admitted to hospital with an acute condition should be routinely collected by hospital staff to inform clinical management and to permit risk-adjusted audit.
Evaluation of the Impact of a Technology Appraisal Process in England: The South and West Development and Evaluation Committee
Authors: Dixon Simon , Coleman Pat , Nicholl Jon , Brennan Alan , Touch Sandra
Published: January 2017

Objectives:

To examine the influence of the English National Health Service (NHS) South and West (S&W) region Development and Evaluation Committee (DEC) technology appraisal reports on purchasing and clinical decisions in the S&W and elsewhere in the NHS, and to estimate the cost of the DEC process.

Methods:

Two postal questionnaires examining issues of awareness, influence and quality of the DEC reports were sent to samples of clinical and managerial health service staff in S&W NHS region, the North West NHS region, and three other randomly selected health authorities elsewhere. Supplementary telephone interviews were undertaken with a subsample of staff. Trends in utilisation before and after the publication of four S&W DEC reports were examined using routine health service data.

Results:

Survey response rates ranged between 73% and 85%. Within health authorities in the S&W, agreement about the impact of the DEC in informing policy and purchasing decisions was consistently high, although responses from clinicians were more equivocal. In the topic areas examined, the impact of the DEC reports could not be separated from wider influences on practice. The cost of each DEC report is estimated to have been £24 659.

Conclusions:

Health service staff perceived that the S&W DEC process had had an impact on policy decisions and clinical practice locally; however, any actual impact on practice could not be identified with routine data. The approach used in this study would be valuable in evaluating the impact of the English NHS National Institute for Clinical Excellence.
Different Regional Organisational Models and the Quality of Health Care: The Case of Coronary Artery Bypass Graft Surgery
Authors: Nobilio Lucia , Ugolini Cristina
Published: January 2017

Objectives:

The Italian regions of Emilia-Romagna and Lombardy within the Italian National Health Service provide an opportunity to see if two different approaches to the organisation of care – one more hierarchical and planned, the other more competitive and market-like – influence its quality through examining the relationship between the number of coronary artery bypass grafts (CABGs) and the rate of in-hospital mortality using administrative data for the period 1996–1998.

Methods:

Descriptive statistics and logistic regression models were used.

Results:

The volume–outcome relation was statistically significant in both regions (odds ratio 0.71, P < 0.0001). Although CABG performance in Emilia-Romagna was slightly poorer than in Lombardy (OR 1.22, P < 0.05), the potential advantage in terms of the reduced risk of death for patients treated at high-volume versus low-volume hospitals was significantly greater. In Emilia-Romagna, the average performance advantage of high-volume units was more substantial in the case of private accredited hospitals than public hospitals (OR = 0.50, P < 0.0001 versus OR = 0.64, P < 0.0001). In Lombardy, the performance advantage of concentrating CABG procedures was greater in private research hospitals (OR = 0.67, P < 0.0001), whereas results were not statistically significant for the other types of hospital, indicating a good level of performance in both public and private hospitals even at low volumes. This also partially explained the lower mortality rate observed in that region.

Conclusions:

The degree of hierarchical regionalisation versus market-like arrangements characterising the two systems produced contrasting effects in terms of the quality of CABG surgery. Lombardy's more competitive environment appeared to achieve better performance in terms of a slightly lower probability of adverse outcomes, in a system with no formal assessment of population need and very high per capita revascularisation rates. To improve performance in the more hierarchical system adopted in Emilia-Romagna would require considerable effort to increase CABG surgery in low-volume cardiac units, and to sharpen performance incentives.
The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making
Authors: Dowie Jack
Published: January 2017

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use?

The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one.

The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.
Establishing Patient Preferences for Blood Transfusion Support: An Application of Conjoint Analysis
Authors: van der Pol Marjon , Cairns John
Published: January 2017

Objective:

To develop a method of determining the relative importance of waiting time and location of care for patients with haematological disorders requiring red cell transfusion. Such information is particularly relevant when evaluating interventions that affect patient well-being (e.g. by changing waiting time and location) but do not affect health outcomes.

Methods:

Conjoint analysis is used to assess the relative importance of waiting time and location with respect to pre-transfusion testing and red cell transfusion. Compensation is also included as an attribute in order to estimate the monetary value of changes in waiting time and location.

Results:

Waiting time and location are important attributes in the provision of pre-transfusion testing and red cell transfusion. Compensation is not an important attribute. On average patients are willing to wait an additional 45 minutes in order to have pre-transfusion testing in their own home and an additional 35 minutes in order to receive red cell transfusions in their preferred location.

Conclusion:

The relative importance of waiting time and location of care was established. However, it was not possible to assign monetary values since compensation was not an important attribute for these respondents. The paper highlights the scope for using conjoint analysis to analyse the non-health benefits that may result from changes in the delivery of care.
Health Policy in Transition: Terminal Care and Site of Death in Japan
Authors: Babazono Akira , Weiner Janet , Hamada Hirohisa , Tsuda Toshihide , Mina Yoshio , Hillman Alan L.
Published: January 2017

Objectives:

In Japan, hospitals have replaced homes as the predominant site of death, especially for the elderly. Site of death is a reliable indicator of where older people receive care before they die. We conducted a population-based study to identify the factors that determine site of death in a typical rural area in Japan.

Methods:

Study subjects were residents of Kawakami town, aged 70 years or older, who died during 1981 and 1990. Death certificates provided information on age, gender, cause of death, duration of illness before death, family members, family occupation, and site of death.

Results:

Among 455 subjects, 52.7% died at home, while 47.3% died in hospital. Multiple logistic regression analyses indicated that subjects with cancer were 6.1 times more likely to die in hospitals than those with other diseases. Subjects who died in their seventies were 2.3 times more likely to die in hospital than older subjects. Members of non-farming families were 1.7 times more likely to die in hospital than members of farming families. Gender, duration of illness, and the presence of spouse or children in the household were not significantly related to site of death according to multivariate analyses, although trends did exist.

Conclusion:

This case study illustrates the importance of developing geriatric care systems in Japan, utilizing alternatives to hospitals, such as nursing homes and formal home care. This is particularly true for patients with cancer. As the older population rapidly increases in Japan, the need for alternatives in geriatric care grows more critical.
The SF-36 Physical and Mental Health Summary Measures: An Example of How to Interpret Scores
Authors: Jenkinson Crispin
Published: January 2017

Objectives:

To provide normative data, in the form of percentile scores from a community sample, for the Physical Component and Mental Health Component Summary scores derived from the SF-36, and to provide an example of how to interpret scores on these measures, comparing normative results with data from a clinical sample.

Method:

Normative data were gained from a postal survey using a questionnaire, containing the SF-36 and a number of other items concerned with lifestyles and illness. The questionnaire was sent to 13 042 randomly selected subjects between the ages of 18 and 64 years, drawn from Family Health Services Authority computerised registers for four English counties. The clinical sample comprised 84 patients aged 18–64 years diagnosed with obstructive sleep apnoea (OSA) who were asked to take part in the study. The Physical Component Summary (PCS) score and Mental Health Component Summary (MCS) score gained from the SF-36 health status measure were the outcome measures.

Results:

The community survey achieved a response rate of 72% (n = 9332). All 84 patients in the age range 18–64 years approached to take part in the OSA study agreed to do so; complete data were available for 60 patients. Results indicated that, prior to treatment, 75% of OSA patients' scores on the PCS/MCS were less than the standardised mean score of 50 and fell in the lowest 34% of scores in the general population. However, after treatment, over 50% of patients scored above the standardised mean score on both the PCS and MCS and more closely mirrored the distribution of the normative sample.

Conclusion:

The data provided here should enable a more meaningful presentation of data than is generally provided in research papers presenting SF-36 summary scores.
Extrapolation of Cost-Effectiveness Information to Local Settings
Authors: Bryan Stirling , Brown Jackie
Published: January 2017

Providers and purchasers of health care are increasingly looking to the results of economic evaluations for guidance when making their decisions. In this paper the authors argue that there are dangers involved in the naive and unthinking use of published cost-effectiveness information outside the setting in which the information was generated. In considering whether the results of a published study are likely to be relevant locally, decision-makers are encouraged to assess whether the values of the key parameters reported in the published study apply locally. The possible sources of variation are described: unit cost differences; differences in the prevalence, incidence or natural history of disease; and differences in the comparators. In situations where the only source of variation is that local unit costs are different, local values can be substituted in the published analysis and local cost-effectiveness results estimated. Where the other sources of variation exist, the decision-maker is required to make an assumption about the nature of the interaction between the sources of variation and the values of the cost-effectiveness parameters. Using an example, the authors argue that local threshold analysis can aid decision-making where the policy change being considered has a high probability either of increasing effectiveness or reducing costs. Without local reanalysis, there is a danger that local policy changes in line with the recommendations of published studies will promote inefficiency. Re-analysis in the local setting is, however, reliant on authors of economic evaluations being explicit about their methods and the comparators used in their analyses.
Advice Provided in British Community Pharmacies: What People Want and What They Get
Authors: Hassell Karen , Noyce Peter , Rogers Anne , Harris Jennifer , Wilkinson Jane
Published: January 2017

Objectives:

This study explored advice-giving behaviour in community pharmacies in order to understand the nature and process of pharmaceutical consultations and consumers' views of the advice-giving role.

Method:

An ethnographic research strategy was used, combining patient interviews with non-participant observation of interactions between consumers and pharmacy staff. One week was spent in each of 10 pharmacies.

Results:

The study demonstrated that the advice given in a community pharmacy is almost wholly focused on product recommendation and use. Advice-giving varies according to whether consultations concern prescription or non-prescription medicines. When the latter are involved, advice-giving is mostly consumer-led. Consumers' major ‘need’ for pharmacy services appears to be for information about the effectiveness of products they buy, whilst pharmacists and pharmacy assistants concentrate on providing advice on the safety of medicines.

Conclusion:

The notion of pharmacists as general health advisors does not appear to be shared by the public and may be at odds with how the public view and use pharmacies. Protocols to guide staff may be improved by including the consumer perspective. Most consumers have previous experience of their ailments and use pharmacies as one of several resources available to them to treat their minor illness, having made their own diagnosis and assessment before entering the pharmacy. The scope for giving new advice is therefore limited. The broader role of community pharmacies merits further attention.
Simulation Applied to Health Services: Opportunities for Applying the System Dynamics Approach
Authors: Taylor Kathryn , Lane David
Published: January 2017

The aim of this essay is to raise awareness and broaden understanding within the health services community of the system dynamics (SD) simulation approach to policy analysis. The application of simulation in health services is reviewed. A comparison is made between the SD and traditional simulation approaches and is illustrated by considering reductions in waiting times for coronary heart disease treatment. Traditionally, simulation studies have tended to focus on the analysis of localized decisions and therefore on problems orientated towards individual patients. Although these methods are extremely powerful and effective, there is scope for an alternative modelling approach which is based on a more holistic perspective; SD is one such approach. It can assist in the design of robust policies by supporting debate on how the underlying structure might influence the evolutionary behaviour of a system. Using this method we can consider the time variation both of tangibles, such as waiting times and health care costs, and intangibles, such as patient anxiety and the effects of various pressures on purchasing decisions. We propose that SD holds great potential in assisting policy formation in health care.
What Determines Geographical Variation in Rates of Acceptance onto Renal Replacement Therapy in England?
Authors: Roderick Paul , Clements Steve , Stone Nicole , Martin David , Diamond Ian
Published: January 2017

Objective:

To determine the independent effects of need and supply factors on the known geographical variation in acceptance rates onto renal replacement therapy (RRT) in England.

Methods:

Data were obtained from all renal units in England on the characteristics of all cases aged 16 years and over, resident in England, who were accepted onto RRT in 1991 and 1992. Of these, 5715 (94.5%) had a valid postcode that could be matched to a census ward. Multilevel modelling using Poisson regression was used. The number of acceptances in each census ward within age bands 16–34, 35–64 and 65+ was the dependent variable. Independent effects modelled were: (1) individual factors (age, sex); (2) census ward need factors — ethnicity (expressed as the percentage of the ward population that was Asian or African-Caribbean), socio-economic deprivation — and supply factors — ‘access’ to the nearest renal unit using crowfly and road travel time and distance, and services available to each ward expressed as number of haemodialysis stations per 100 000 catchment population of the nearest renal unit; (3) district health authority level effects.

Results:

Age was a major determinant of acceptance, with a 7-fold higher rate in males aged over 64 years compared with younger men. Acceptance rates were lower in females, with a negative age-sex interaction in females aged over 64 years. The percentage of both Asian and African-Caribbean populations per ward was a highly significant positive determinant. Deprivation was also a significant determinant, best represented by a customised index. There was an inverse relation of acceptance with distance, especially road travel time. Other supply side variables had a significant effect though there was no independent district effect. There was some variation in the strength of these relationships by type of area (Greater London, urban and non-urban).

Conclusions:

Need and supply factors influence service use as expressed as acceptance onto RRT. Pressure to expand RRT services needs to be aimed at areas with large minority ethnic populations and those living far from existing units.
Geographic Variations in Hospital Discharge Rates and Discretionary Hospital Use
Authors: Porell Frank
Published: January 2017

Objectives:

While past research has shown that there is greater geographic variability in hospital discharge rates for medical conditions where there is less agreement about proper treatment, there is little empirical evidence to support the corollary that high hospital use in a community is primarily the result of a greater volume of such discretionary hospitalizations. This study assesses the contribution of discretionary hospitalizations to higher overall rates of hospital use in communities.

Methods:

Hospital discharge files and Medicare eligibility files were used to estimate adjusted rates of hospital discharge, days of care and adjusted mortality for a sample of 761 geographic communities in four states in the USA. Diagnostic information was used to classify hospitalizations into low, moderate and high discretion categories. Correlation and multiple regression analysis methods were used to test for systematic relationships between a community's overall rate of hospital use and discretion-level mix of hospitalizations.

Results:

Although about half of the variance in overall rates of hospital use among communities was found to be related to the discretion-level mix of hospital discharges, only a small portion of the explained variance could be attributed specifically to community differences in the prevalence of high discretion hospitalizations.

Conclusions:

High overall rates of hospital use in communities were not found to be largely the result of high discretion hospital use.
The Phenomenology of Architecture
Authors: Tamari Tomoko
Published: January 2017

This piece focuses on the work of Juhani Pallasmaa who introduces phenomenological aspects of kinesthetic and multisensory perception of the human body into architecture theory. He argues that hand-drawing is a vital spatial and haptic exercise in facilitating architectural design. Through this process, architecture can emerge as the very ‘material’ existence of human embodied ‘immaterial’ emotion, feelings and wisdom. Hence, for Pallasmaa, architecture can be seen as an artistic practice, which entails multisensory and embodied thought in order to establish the sense of being in the world.
Corporation tax as a problem of MNC organisational circuits: The case for unitary taxation
Authors: Morgan Jamie
Published: January 2017

Research Highlights and Abstract

Contextualises and clarifies the case for unitary taxation In so doing sets out the structural and institutional constraints of the current system of taxation for multinational corporations (separate entity status and the arms length principle) Explores the limits and potentials of current policy initiatives that are shaping the ongoing response to issues of taxation for multinational corporations (from the Organisation for Economic Co-operation and Development (OECD), within the UK and the EC)

The tax practices of multinational corporations have become a matter of significant public and political concern. The underlying issues are rooted in the capacity of multinational corporations (MNCs) to construct organisational circuits that shift where sales, revenue and profit are reported. This capacity in turn becomes a focus because of the way MNCs are treated as a series of separate entities, subject to the arm’s length principle. This has become a classic example of a system whose current form and consequences were not foreseen when the original principles were set out. The continued existence of that system owes more to specific interests and inertia than it does to the absence of a viable alternative. Unitary taxation based on formula apportionment clearly resolves the underlying issues and unitary taxation may well ultimately emerge as a new generalised basis for corporate taxation. However, for it to do so, the problems of the current system and the advantages of the alternative need to be more clearly understood within academia, business and on a societal basis. This paper is a contribution to such an understanding.
Current Augmentation Fixation Techniques for the Osteoporotic Patient
Authors: Moroni A. , Hoang-Kim A. , Lio V. , Giannini S.
Published: January 2017

Osteoporosis is defined as the deterioration of microarchitecture and overall poor bone quality, which represents a risk of implant fixation failure when patients with osteoporosis are surgically treated. Fragility fractures in elderly patients, typically at the hip, spine and wrist, should be assessed by the orthopaedic surgeon prior to surgery in order to select the most appropriate technique necessary to overcome failures and other complications associated with reduced osteofixation. In this review, advanced methods of augmenting implant fixation in osteoporotic bone are described including polymethylmethacrylate (PMMA), bone grafts, calcium phosphate implants, calcium phosphate cements, calcium phosphate coatings, modified implants and pharmaceutical augmentation concepts. The indication for these techniques should be based on the quantitative assessment of the osteoporotic quality of bone evaluated by dual energy X-ray absorptiometry (DXA).
An Update on Fluid Resuscitation
Authors: Alam H. B.
Published: January 2017

Hemorrhagic shock is the leading cause of death in civilian and military trauma. Effective hemorrhage control and better resuscitation strategies have the potential of saving lives. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. It is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. It is important to recognize that unlike numerous other variables, resuscitation is completely under our control. We decide who, when and how should get resuscitated. This paper summarizes data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids on cellular injury, and how these relate to clinical practice. In addition, some novel resuscitation strategies are described that may become clinically available in the near future.
Laparoscopic Floppy Nissen Fundoplication for Gastro-Oesophageal Reflux Disease is Feasible as a Day-Case Procedure
Authors: Victorzon M. , Tolonen P. , Vuorialho T.
Published: January 2017

Background/Aims:

We launched aprospective study to assess the feasibility of day-case laparoscopic fundoplication for gastro-oesophageal reflux disease in March 2003. The specific aims were to assess safety, acceptability and patient satisfaction.

Methods:

The inclusion criteria were American Society of Anaesthesiologists grade I-II surgical risk, body mass index < 35, and adult company at home (less than 50 km travel) or at patient hotel (more than 50 km travel). Patients were informed about the surgical procedure, the expected postoperative course, and the possible postoperative problems and complications. Surgery was performed under general anaesthesia with proposal-infusion, fentanyl, rocuronium and sevoflurane with air + oxygen. All patients received parenteral propacetamol, NSAID, local anaesthetics and metoclopramide, as pre-emptive analgesia before awakening. A total 360° floppy Nissen fundoplication was performed in all patients.

Results:

Twenty-eight patients were included. There was one conversion to open surgery. All the other patients were discharged as planned and there were no readmissions. No intra- or postoperative complications occurred. Postoperative pain, nausea, fatigue and dysphagia were moderate. At interview the morning following the operation three patients reported they would rather have stayed over night at the hospital. However, all patients were ready for a similar procedure as day-case surgery again, if offered. At follow-up 26/28 (< 92.9%) patients were satisfied with the day-case treatment, one patient had no preference. All patients would recommend this operation as day-case surgery for a family member or friend.

Conclusion:

Laparoscopic day-case surgery for gastro-oesophageal reflux disease appears to be safe and well tolerated by the patients.
A Comparison of the Haemodynamic Effects of 4% Succinylated Gelatin, 6% Hydroxyethyl Starch (200/0.5) and 4% Human Albumin after Cardiac Surgery
Authors: Kuitunen A. , Suojaranta-Ylinen R. , Kukkonen S. , Niemi T.
Published: January 2017

Background and Aims:

The goal for volume replacement therapy is to maintain stable haemodynamics after cardiac surgery. We hypothesized that a short term infusion of hydroxyethyl starch results in better haemodynamic response than an infusion of lower molecular weight gelatin.

Material and Methods:

45 patients received a predetermined fixed dose of 15 ml kg−1 of either 4% succinylated gelatin (GEL) or 6% hydroxyethyl starch (HES) or 4% human albumin (HA) after cardiac surgery.

Results and Conclusions:

Pulmonary capillary wedge pressure was more increased in GEL and HES groups [mean (SD) 153% (54) and 168% (57) of pre-infusion value] than in HA group [122% (23)] (P = 0.031) after completion of infusion, but no differences in cardiac index (CI) and stroke volume index (SVI) were observed. At 2 and 18 hours after end of study infusions SVI was more increased in HES [143% (38) and 148% (41) of pre-infusion values] and HA [143% (35) and 163% (42) of pre-infusion values] groups than in GEL [116% (23) and 125% (30)] group (P = 0.047 at 2 hours and P = 0.033 at 18 hours). In early postoperative phase after cardiac surgery, HES and HA infusions improve haemodynamics more and longer period than GEL infusion.
An Open Access Technique to Create Pneumoperitoneum in Laparoscopic Surgery
Authors: Moberg A.-C. , Petersson U. , Montgomery A.
Published: January 2017

Background:

An open access technique might reduce severe vascular and visceral injuries. An open access technique through the umbilical cicatrix tube has been developed as a routine method with the goal to be easy, safe and used by all surgeons in patients without a previous midline incision.

Aim:

To evaluate the open technique in a prospective study in 100 consecutive laparoscopic operations regarding time for entrance, surgeons experience and BMI of the patients.

Methods:

A midline incision from the linea alba up into the inverted umbilicus was performed in the cicatrix tube and the peritoneum was penetrated allowing air to flow into the abdominal cavity followed by a blunt trocar insertion.

Results:

Time for access was median 93 seconds. Entrance time in patients with BMI > 30 (n = 18) was 100 sec and with BMI < 30 it was 90 sec (p = 0,71). The median time for consultants was 88 sec and for residents 120 sec (p = 0,003). No gas leakage was seen. Prolonged time for access was seen in three patients; two equipment failures and one obese patent.

Conclusion:

The open access technique is applicable in all patients without a former midline incision. It is fast, easy to learn with very few associated problems.
Complications Associated with Pulmonary Artery Catheters: A Comprehensive Clinical Review
Authors: Evans D. C. , Doraiswamy V. A. , Prosciak M. P. , Silviera M. , Seamon M. J. , Funes V. Rodriguez , Cipolla J. , Wang C. F. , Kavuturu S. , Torigian D. A. , Cook C. H. , Lindsey D. E. , Steinberg S. M. , Stawicki S. P.
Published: January 2017

Care for the critically ill patient requires maintenance of adequate tissue perfusion/oxygenation. Continuous hemodynamic monitoring is frequently utilized to achieve these objectives. Pulmonary artery catheters (PAC) allow measurement of hemodynamic variables that cannot be measured reliably or continuously by less invasive means. Inherent to every medical intervention are risks associated with that intervention. This review categorizes complications associated with the PAC into four broad groups — Complications of central venous access; complications related to PAC insertion and manipulation; complications associated with short- or long-term presence of the PAC in the cardiovascular system; and errors resulting from incorrect interpretation/use of PAC-derived data. We will discuss each of these four broad categories, followed by in-depth descriptions of the most common and most serious individual complications.
Anterior Mid-Tibial Stress Fractures. Results of Surgical Treatment
Authors: Liimatainen E. , Sarimo J. , Hulkko A. , Ranne J. , Heikkilä J. , Orava S.
Published: January 2017

Background and Aims:

An anterior mid-tibial stress fracture is an uncommon, but possibly career threatening condition for an athlete. We wanted to evaluate the results of the surgical treatment of this notorious stress fracture and compare two different surgical methods.

Material and Methods:

Forty-nine anterior mid-tibial stress fractures were treated surgically in 45 patients during the years 1985–2005. All the patients were athletes, mainly runners. The mean age of the patients was 26 years. Thirty-four of the fractures occurred in men and 15 in women. The first method of treatment (anteromedial and lateral drilling) was used in 20 operations and the second method (laminofixation) in 29 operations.

Results:

Good results were achieved with drilling in only 50% of the operations, where as with laminofixation good results were achieved in 93% of operations. This difference was statistically significant (p = .002). Healing of the stress fracture after laminofixation occurred in less than 6 months. The length of the plate used in the laminofixation had no effect on the end result.

Conclusions:

An anterior mid-tibial stress fracture may often lead to delayed union or non-union in vigorously training athletes. Surgical treatment with laminofixation proved to be superior to tibial fracture site drilling.
The Impacts of Internal Migration on Child Victimization in China: A Meta-Analysis
Authors: Chen Qiqi , Sun Xiaoyue , Xie Qianwen , Li Jia , Chan Ko Ling
Published: January 2017

Objective:

A 100 million children in China are affected by internal migration, a result of the growing demand for human labor due to economic growth. Whether moving to urban cities with their parents or being left behind in rural areas, these children are vulnerable to victimization. The meta-analysis presented in this study is the first to synthesize the rates of victimization among children affected by internal migration.

Method:

Studies providing data published before May 2016 on the prevalence of child victimization among 105,415 Chinese subjects aged 0–17 years were identified through eight English and Chinese databases. Two reviewers independently extracted data to generate summary effect sizes using a random effects meta-analytic model. A priori subgroup and sensitivity analyses were performed to evaluate heterogeneity and bias in these studies.

Results:

Our meta-analysis of 31 studies showed that children affected by internal migration, both migrant children and left-behind children, are at a higher risk of victimization in comparison to their unaffected counterparts (odds ratio [ OR] = 1.492, p < .01), especially in their vulnerability to unintentional injuries ( OR = 1.683, p < .01) and neglect ( OR = 1.398, p < .01). These children are at a higher risk of being unintentionally injured from the ages of 6 to 11 years ( OR = 1.644, p < .01). The highest victimization rate observed in this study was found in the central districts of China ( OR = 1.599, p < .01).

Conclusion:

This study reveals the high prevalence of victimization among both migrant children and left-behind children. The increasing number of children affected by internal migration deserves continuous academic and policy attention.
An Overview of the Integrative Research Review
Authors: Russell Cynthia L.
Published: January 2017

The integrative literature review has many benefits to the scholarly reviewer, including evaluating the strength of the scientific evidence, identifying gaps in current research, identifying the need for future research, bridging between related areas of work, identifying central issues in an area, generating a research question, identifying a theoretical or conceptual framework, and exploring which research methods have been used successfully. The 5-stage integrative review process includes (1) problem formulation, (2) data collection or literature search, (3) evaluation of data, (4) data analysis, and (5) interpretation and presentation of results. Maintaining scientific integrity while conducting an integrative research review involves careful consideration to threats to validity. Strategies to overcome these threats are reviewed. The integrative review methodology must involve detailed and thoughtful work, the outcome of which can be a significant contribution to a particular body of knowledge and, consequently, to practice and research.
Effect of Donor Selection on the Early Outcome of Heart Transplant Recipients
Authors: Michaelides Alexia , Koen Willie
Published: January 2017

Recipients receiving heart transplants from 83 donors from 1995 to 2002 were analyzed to evaluate the effect of various donor factors on recipient outcomes. The 83 donors (13 women and 70 men; 2–51 years old) had cold ischemic times ranging between 55 and 287 minutes. Donor age, cause of death, inotropic support, and cold ischemic times of the hearts were compared to 1-year left ventricular ejection fraction, permanent pacemaker dependency, 30-day mortality, and 1-year survival in the recipients. Donors receiving low-dose inotropic support resulted in recipients with permanent pacemaker dependency in 14.8%, and 30-day mortality and 1-year survival rates of 7.4% and 70.3%, respectively. Donors not receiving inotropic support resulted in recipients with permanent pacemaker dependency in 3.5%, and 30-day mortality and 1-year survival of 3.5% and 83.9%, respectively. Cold ischemic times less than or equal to 120 minutes showed 30-day mortality and 1-year survival rates of 0% and 90.9%, respectively. Cold ischemic times equal to or more than 121 minutes showed 30-day mortality and 1-year survival rates of 8% and 76%, respectively. Increased donor age ( P=.22) and cold ischemic time showed an increase in mortality without affecting mean ejection fraction in survivors. Use of inotropic support in donors ( P=.95) showed an increase in mortality without affecting mean ejection fraction in survivors.
Intestinal Transplantation: The Evaluation Process
Authors: Robinson Jill I. , Spencer Rachel W.
Published: January 2017

After 4 decades of development, the American Gastroenterological Association in a medical position statement recently declared intestinal transplantation to be an acceptable therapy for patients suffering from intestinal failure. Improvements in surgical technique, immunosuppression, and treatment of rejection and infection have contributed to this advancement. Early referral and candidate selection have also been cited as key components to a successful transplantation. The evaluation period, including the referral process, is the cornerstone for this success. The purpose of this article is to present a detailed definition and analysis of the evaluation process. Criteria for listing with the United Network for Organ Sharing will also be discussed.