bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding surgical care delivery in Sub-Saharan Africa: a cross-sectional analysis of surgical volume, operations, and financing at a tertiary referral hospital in rural Tanzania
Authors: Rajaguru Praveen Paul , Jusabani Mubashir Alavi , Massawe Honest , Temu Rogers , Sheth Neil Perry 
Published: October 2019

Abstract

Background
Access to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.

Methods
The 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed.

Results
In 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients).

Conclusion
While surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.
The multifaceted impact of anxiety and depression on patients with rheumatoid arthritis
Authors: Peterson Steve , Piercy James , Blackburn Stuart , Sullivan Emma , Karyekar Chetan S. , Li Nan 
Published: October 2019

Abstract

Background
The prevalence of mood disturbances such as anxiety and depression is greater in rheumatoid arthritis (RA) patients than in the general population. Given this association, the primary aim of this study was to assess the incremental impact of anxiety or depression on patients with RA from the United States of America (USA) and Europe, independent of the impact of the underlying RA disease.

Methods
Rheumatologists (n = 408) from the USA and 5 European countries completed patient record forms for a predetermined number of RA patients who consulted consecutively during the study period; these patients completed patient-reported questionnaires. Descriptive statistics and multivariate regression were used to investigate the relationship between anxiety and depression with treatment and economic outcomes in RA patients.

Results
Of 1015 physician and patient pairs who completed all relevant questionnaire sections, 390 (38.4%) patients self-reported anxiety or depression, while 180 (17.7%) patients were reported to have anxiety or depression by their physicians. Controlling for age, gender, body mass index and clinical factors (flaring and severity), multiple regression analyses suggested that patients with anxiety or depression more often experienced treatment dissatisfaction (odds ratio [OR] 2.28; P < .001), had greater impairment in work (coefficient [β] = 11.82; P = .001) and usual activity (β = 14.73; P < .001), greater disability (β = .35; P < .001), and more often reported unemployment (OR 1.74; P = .001). Multinomial logistic regression revealed discordance between physician and patient satisfaction with treatment. For patients reporting anxiety or depression, physicians were more often satisfied with achievement of current disease control than patients (relative risk ratio 2.19; P = .002).

Conclusion
Concomitant anxiety or depression was associated with a significant incremental impact on the health-related quality of life and economic aspects of life of patients with RA. In light of observed differences between physician recognition of patient anxiety and/or depression versus patient reporting of anxiety and/or depression symptoms, further research is warranted to develop optimal screening and management of depression and anxiety in patients with RA.
Improved CNS Control of Childhood Acute Lymphoblastic Leukemia Without Cranial Irradiation: St Jude Total Therapy Study 16
Authors: Jeha Sima , Pei Deqing , Choi John , Cheng Cheng , Sandlund John T. , Coustan-Smith Elaine , Campana Dario , Inaba Hiroto , Rubnitz Jeffrey E. , Ribeiro Raul C. , Gruber Tanja A. , Raimondi Susana C. , Khan Raja B. , Yang Jun J. , Mullighan Charles G. , Downing James R. , Evans William E. , Relling Mary V. , Pui Ching-Hon 
Published: October 2019

PURPOSE Despite contemporary treatment, up to 10% of children with acute lymphoblastic leukemia still experience relapse. We evaluated whether a higher dosage of PEG-asparaginase and early intensification of triple intrathecal therapy would improve systemic and CNS control. PATIENTS AND METHODS Between 2007 and 2017, 598 consecutive patients age 0 to 18 years received risk-directed chemotherapy without prophylactic cranial irradiation in the St Jude Total Therapy Study 16. Patients were randomly assigned to receive PEG-asparaginase 3,500 U/m2 versus the conventional 2,500 U/m2. Patients presenting features that were associated with increased risk of CNS relapse received two extra doses of intrathecal therapy during the first 2 weeks of remission induction. RESULTS The 5-year event-free survival and overall survival rates for the 598 patients were 88.2% (95% CI, 84.9% to 91.5%) and 94.1% (95% CI, 91.7% to 96.5%), respectively. Cumulative risk of any—isolated or combined—CNS relapse was 1.5% (95% CI, 0.5% to 2.5%). Higher doses of PEG-asparaginase did not affect treatment outcome. T-cell phenotype was the only independent risk factor for any CNS relapse (hazard ratio, 5.15; 95% CI, 1.3 to 20.6; P = . 021). Among 359 patients with features that were associated with increased risk for CNS relapse, the 5-year rate of any CNS relapse was significantly lower than that among 248 patients with the same features treated in the previous Total Therapy Study 15 (1.8% [95% CI, 0.4% to 3.3%] v 5.7% [95% CI, 2.8% to 8.6%]; P = .008). There were no significant differences in the cumulative risk of seizure or infection during induction between patients who did or did not receive the two extra doses of intrathecal treatment. CONCLUSION Higher doses of PEG-asparaginase failed to improve outcome, but additional intrathecal therapy during early induction seemed to contribute to improved CNS control without excessive toxicity for high-risk patients.
African School of Pediatric Oncology Initiative: Implementation of a Pediatric Oncology Diploma Program to Address Critical Workforce Shortages in French-Speaking Africa
Authors: Hessissen Laila , Patte Catherine , Martelli Helene , Coze Carole , Howard Scott C. , Kili Amina , Gagnepain-Lacheteau Anne , Harif Mhamed 
Published: October 2019

PURPOSE In 2012, the French African Pediatric Oncology Group established the African School of Pediatric Oncology (EAOP), a training program supported by the Sanofi Espoir Foundation’s My Child Matters program. As part of the EAOP, the pediatric oncology training diploma is a 1-year intensive training program. We present this training and certification program as a model for subspecialty training for low- and middle-income countries. METHODS A 14-member committee of multidisciplinary experts finalized a curriculum patterned on the French model Diplôme Inter-Universitaire d’Oncologie Pédiatrique. The program trained per year 15 to 25 physician participants committed to returning to their home country to work at their parent institutions. Training included didactic lectures, both in person and online; an onsite practicum; and a research project. Evaluation included participant evaluation and feedback on the effectiveness and quality of training. RESULTS The first cohort began in October 2014, and by January 2019, 72 participants from three cohorts had been trained. Of the first 72 trainees from 19 French-speaking African countries, 55 (76%) graduated and returned to their countries of origin. Four new pediatric oncology units have been established in Niger, Benin, Central African Republic, and Gabon by the graduates. Sixty-six participants registered on the e-learning platform and continue their education through the EAOP Web site. CONCLUSION This training model rapidly increased the pool of qualified pediatric oncology professionals in French-speaking countries of Africa. It is feasible and scalable but requires sustained funding and ongoing mentoring of graduates to maximize its impact.
Children and young people's experiences of living with developmental coordination disorder/dyspraxia: study protocol for a qualitative evidence synthesis
Authors: O'Dea Áine , Coote Susan , Robinson Katie 
Published: October 2019

Children with developmental coordination disorder (DCD) face significant challenges to deal with everyday activities due to underlying motor proficiency difficulties. These challenges affect children and young people’s participation; that is, involvement in daily life situations. In the past, limited consideration was given to personal experience of events, relationships and everyday life in children and young people with DCD; as a result, understanding what it is like to live with DCD is not well conceptualised in the literature. There is a pressing need to synthesise the findings of discrete qualitative studies to advance the conceptual understanding of living with DCD, to inform health service delivery and the development and implementation of complex interventions. This study aims to systematically review and synthesise qualitative literature regarding children and young people’s experiences and views of everyday life and living with DCD. The method of qualitative evidence synthesis that will be followed in this review is a meta-ethnography. The eMERGe and PRISMA reporting guidelines will be used in the development, design and reporting of this review. Nine databases will be searched; Academic Search Complete, AMED, CINAHL, MEDLINE, PsychArticles, PsychInfo, EMBASE, SPORTDiscus, and Web of Science. Two independent reviewers will use the Joanna Briggs Institute Checklist to appraise all included papers. The findings of this meta-ethnography will endeavour to inform future research, policy and practice. In particular, the results will help to inform the design of future complex interventions to meet the needs of children and young people with DCD. Dissemination will involve the publication of the results in a peer-reviewed journal. Increasingly researchers and policymakers are calling for services to be informed by the perspective and voice of children with DCD; therefore, a policy brief will be published so that the findings are widely available. Registration: PROSPERO registration number CRD42019129178; registered on 09 July 2019.
Use of Social Media as a Virtual Community and Support Group by Left Ventricular Assist Device (LVAD) Patients
Authors: Boling Brian , Hart Amanda , Okoli Chizimuzo T. C. , Halcomb Tamra , El-Mallakh Peggy 
Published: October 2019

Background
Left ventricular assist device (LVAD) patients may benefit from participating in a social support group; however, several factors may limit the availability of these communities. Alternatively, online social support communities may be more accessible for LVAD patients. No studies have examined patterns and reasons for health-related social media use among people with LVADs
Methods
An online survey of patients actively participating in LVAD social media groups was conducted using both multiple choice and open-ended questions.
Results
Thirty-nine participants (65% male) completed the survey. Participants’ reasons for weekly engagement in online communities were to seek (69.2%) and offer (66.7%) advice, seek (43.6%) and share (71.8%) coping strategies, seek help (48.7%) or help others (64.1%) solve LVAD problems, and offer general social/emotional support (74.4%). Negative aspects from involvement in a virtual community included an excessive focus on fear/negativity (26.3%) and confusing or misleading information (21%). Most felt supported (100%) from involvement in the virtual community and believed that the information/advice received was helpful (94.6%) and accurate (100%). A significant minority (41.7%) reported that it was easier to get medical advice from Facebook groups than from their health care providers.
Conclusions
LVAD patients use social media to exchange information/advice, share coping strategies, and work with others to solve LVAD problems. Benefits to participating in these groups exist; however, the degree to which they are utilized for medical advice, instead of consulting a health care professional, highlights the importance of a trusting relationship between practitioners and LVAD patients.
Development and Pilot-Testing of a Patient Decision Aid for Left Ventricular Assist Device Placement
Authors: Kostick Kristin , Delgado Estevan D. , Wilhelms Lidija A. , Bruce Courtenay R. , Estep Jerry D. , Loebe Matthias , Minard Charles , Blumenthal-Barby Jennifer S. 
Published: October 2019

Background
Studies indicate suboptimal patient understanding of the capabilities, lifestyle implications, and risks of LVAD therapy. This paper describes the development methodology and pilot-testing of a decision aid for Left Ventricular Assist Device (LVAD) placement, combining traditional needs-assessment with a novel user- centered approach.
Methods and Results
We developed the decision aid in line with the Ottawa Decision Support Framework (ODSF) and the International Patient Decision Aids Standards (IPDAS) for ensuring quality, patient-centered content. Structured interviews were conducted with patients, caregivers, candidates for LVAD treatment, and expert clinicians (n=71) to generate content based on patient values and decisional needs, and providers’ perspectives on knowledge needs for informed consent. The aid was alpha tested through cognitive interviews (n=5) and acceptability tested with LVAD patients (n=10), candidates (n=10), and clinicians (n=13). Patients, caregivers and clinicians reported they would recommend the aid to patients considering treatment options for heart failure. Patients and caregivers agreed that the decision aid is a balanced tool presenting risks and benefits of LVAD treatment and generating discussion about aspects of heart failure treatment that matter most to patients.

Conclusion
We identified gaps in knowledge about heart failure treatment options, including diagnosis, decision-making, surgery, post-operative maintenance and lifestyle changes. Challenges included presenting risks and benefits for informed decision making without frightening patients and circumventing reflection, and balancing an emphasis on LVAD with other alternative treatment options like comfort- directed palliative and supportive care.
Tolerability of Intermittent Hemodialysis in a Cohort of Patients with Left Ventricular Assist Device
Authors: Areephanthu Christopher , El-Husseini Amr , George Bennet , McAbee Jessica , Sawaya B. Peter 
Published: October 2019

Background
The use of left ventricular assist device (LVAD) has emerged as a popular treatment for patients with advanced heart failure. It is not uncommon for these patients to suffer from renal failure requiring renal replacement therapy. The purpose of this study is to assess hemodynamic parameters and ability to complete the prescribed hemodialysis session in a series of patients who underwent numerous dialysis treatments.
Methods
Nine patients with Heart Mate II LVAD received 170 intermittent inpatient hemodialysis treatments between January 1, 2010 and December 31, 2012. Assessment included vital signs, ultrafiltrate removed, hemodialysis duration, symptoms, early terminations (ET), and adverse events during each hemodialysis session.
Results
The mean age was 53 ± 18 with a range of 26-83 years, with a male predominance (7/9). Indication for LVAD was as destination therapy (DT) in the majority of patients (6/9). Nine patients who received a total of 170 hemodialysis sessions with a mean prescribed and achieved: ultrafiltration (liters) 1.98 ± 1.5 and 1.90 ± 1.6; hemodialysis duration (hours) 3.12 ± 0.3 and 2.86 ± 0.9, respectively. Early termination was experienced in 11 sessions (6.5%). Causes of ET were hypotension in 72.7%, other causes were equally distributed between clotted extra-corporeal circuits, nausea & vomiting and LVAD alarm (9.1% in each). Serious arrhythmias were not observed in any of the hemodialysis treatments. Six out of nine patients (66.7%) recovered kidney function and became dialysis independent.

Conclusion
In a hospital setting, patients with LVAD can often tolerate and complete the prescribed hemodialysis treatment.
Does Left Ventricular Assist Device Implantation Affect Driving Patterns in Patients With End-Stage Heart Failure?
Authors: Pinninti Mamatha , Sauld Christina , Thohan Vinay , Cheema Omar , Hastings T. Edward , Crouch John , Downey Frank , Sulemanjee Nasir Z. 
Published: October 2019

Background
In 2012, the Canadian Society of Cardiology indicated that patients supported with left ventricular assist device (LVAD) may drive a private vehicle 2 months after implantation, provided they are deemed clinically stable. Objective evidence supporting this recommendation is limited. We sought to compare data regarding driving habits in our patients following LVAD implantation.
Methods
A standard questionnaire addressing driving patterns before and after LVAD implantation was sent to all living patients who had received an LVAD between January 2010 and January 2014. Ninety-four of 124 patients responded (average age 58 years, 69.2% men, 77.7% bridge to transplant).
Results
Prior to LVAD, all were living at home, 33% were employed, and 93% were driving. Sixty-nine percent indicated they drove after LVAD implantation; they were younger (56 vs 62 years, p=0.02) and had providers recommendation (p=0.004). Four of seven patients who had not driven before started driving (p
Conclusions
Most patients returned to driving after LVAD implantation. A minority had LVAD-associated alarms that were easily addressed. We suggest inclusion of driving habits in registries to provide clarity on the safety of driving while being supported with LVAD.
Limit Configurations of Schrödinger Systems Versus Optimal Partition for the Principal Eigenvalue of Elliptic Systems
Authors: Luo Haijun , Zhang Zhitao 
Published: October 2019

Abstract
We study a Schrödinger system of four equations with linear coupling functions and nonlinear couplings, including the case that the corresponding elliptic operators are indefinite. For any given nonlinear coupling

β
>
0

{\beta>0}

, we first use minimizing sequences on a normalized set to obtain a minimizer, which implies the existence of positive solutions for some linear coupling constants

μ
β

,

ν
β

{\mu_{\beta},\nu_{\beta}}

by Lagrange multiplier rules. Then, as

β
→
∞

{\beta\to\infty}

, we prove that the limit configurations to the competing system are segregated in two groups, develop a variant of Almgren’s monotonicity formula to reveal the Lipschitz continuity of the limit profiles and establish a kind of local Pohozaev identity to obtain the extremality conditions. Finally, we study the relation between the limit profiles and the optimal partition for principal eigenvalue of the elliptic system and obtain an optimal partition for principal eigenvalues of elliptic systems.
Soccer Injuries in Children and Adolescents
Authors: Watson Andrew , Mjaanes Jeffrey M. ,   COUNCIL ON SPORTS MEDICINE AND FITNESS, LaBella Cynthia R. , Brooks M. Alison , Canty Greg , Diamond Alex B. , Hennrikus William , Logan Kelsey , Moffatt Kody , Nemeth Blaise A. , Pengel K. Brooke , Peterson Andrew R. , Stricker Paul R. 
Published: October 2019

This Clinical Report was reaffirmed July 11, 2023.Participation in youth soccer in the United States continues to increase steadily, with a greater percentage of preadolescent participants than perhaps any other youth sport. Despite the wide-ranging health benefits of participation in organized sports, injuries occur and represent a threat to the health and performance of young athletes. Youth soccer has a greater reported injury rate than many other contact sports, and recent studies suggest that injury rates are increasing. Large increases in the incidence of concussions in youth soccer have been reported, and anterior cruciate ligament injuries remain a significant problem in this sport, particularly among female athletes. Considerable new research has identified a number of modifiable risk factors for lower-extremity injuries and concussion, and several prevention programs have been identified to reduce the risk of injury. Rule enforcement and fair play also serve an important role in reducing the risk of injury among youth soccer participants. This report provides an updated review of the relevant literature as well as recommendations to promote the safe participation of children and adolescents in soccer.
Ki mit tud? – A betegátadásról. Egy magyar és lengyel mintán végzett tudásfelmérés tapasztalatai
Authors: Lám Judit , Safadi Heléna , Pitás Eszter , Belicza Éva 
Published: October 2019

Abstract: Introduction: The most common reason for the adverse events in healthcare is communication. Due to the development of health technologies and the increasing specialization of care, more and more healthcare professionals are involved in the treatment of patients, resulting in an increasingly important role and risk for patient handover. Aim: To present the current state of knowledge of patient handover through the results of an international project. Method: Self-developed, anonymous questionnaires with single and multiple choice questions were used to investigate handover knowledge among healthcare workers in 3 Hungarian and 3 Polish hospitals. The frequency of responses was analyzed according to their correctness. The factors that can influence the knowledge were studied using a regression model in the Hungarian sample. Results: The questionnaire was completed by 63% of the 2963 employees who received the questionnaires. In the two countries, there was no significant difference in the proportion of correct responses. Nearly half of the responders (49.4%–45.7%) gave the right answers to the question about the definition of patient handover. The lowest rate of correct answers (14.4%–11.1%) was given to elements of patient handover techniques. The difficulty of the questions also showed a similar pattern. Conclusion: Based on the results, it can be concluded that knowledge of handover needs to be improved in both countries. Although healthcare providers have some knowledge about handover, it cannot be considered accurate and complete. It is important to promote the knowledge and practice of handover together for the safety of patients and healthcare providers. Orv Hetil. 2019; 160(44): 1735–1743.