bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients’ satisfaction with quality of care in general hospitals in Ebonyi State, Nigeria, using SERVQUAL theory
Authors: Umoke MaryJoy , Umoke Prince Christian Ifeanachor , Nwimo Ignatius O , Nwalieji Chioma Adaora , Onwe Rosemary N , Emmanuel Ifeanyi Nwafor , Samson Olaoluwa Agbaje 
Published: July 2020

Background: Patient satisfaction is an essential parameter in the assessment of quality of care and healthcare facility performance. Objective: To investigate patients’ satisfaction with quality of care in general hospitals in Ebonyi State, South East, Nigeria, using the SERVQUAL. Methods: A cross-sectional descriptive study design was employed on a sample of 400 patients using a 27-item structured open-ended patients’ satisfaction questionnaire with a multi-stage cluster sampling technique. Patients included in the study were those who must have come for an outpatient clinic within the period, be 18 years and above, and those who gave consent to participate. Of 400 questionnaires administered, 396 (99%) were retrieved. SPSS version 20 was used for data analysis. Descriptive statistics, such as frequencies, percentages, mean score ( x), and standard deviation, were employed for interpretation. Results: Out of 396 patients, 156 (39.4%) were male and 240 (60.6%) were females. Most patients were 18–39 years (233 (58.8%)), had secondary education (139 (35.1%)), married (221 (55.8%)), earned <18,000 (170(42.9%)), and were traders (136 (34.3%)). Patients were satisfied with tangibility (2.57 ± 0.99) and reliability (2.84 ± 0.95) and very satisfied with responsiveness (3.06 ± 0.63), assurance (3.07 ± 0.63), and empathy (3.12 ± 0.57). Conclusions: Patients were satisfied with the quality of care. However, satisfaction was highest with empathy and lowest with tangibility. Thus, managers should focus their quality improvement efforts on areas of the neat appearance of health workers, waiting facilities for attendants and patients, and hygienic conditions at the hospital. Also, biannual assessment of patients’ satisfaction should be done and the results generated use judiciously to provide a platform for health sector reform.
Effectiveness of behavioral activation for depression treatment in medical students: Study protocol for a quasi-experimental design
Authors: Domínguez Rodríguez Alejandro , Martinez-Maqueda Gustavo Iván , Arenas Landgrave Paulina , Martínez Luna Sofía Cristina , Ramírez-Martínez Flor Rocío , Salinas Saldivar Jasshel Teresa 
Published: July 2020

Introduction: Depression is a frequent mood disorder among medical students that can lead to multiple negative consequences at individual and social level (such as academic achievement and interpersonal conflicts) as well as patient care performance. Therefore, the need of depression decreasing treatments in medical students is important. This study is designed to evaluate the effectiveness of the Behavioral Activation Treatment for Depression in a sample of Mexican medical students. Methods: This study will be performed under a quasi-experimental design to verify the effectiveness of the Behavioral Activation Treatment for Depression to reduce depressive symptoms in medical students from two public universities in northwestern Mexico. The participants will be assessed with the Center for Epidemiologic Studies Depression Scale, the Depression Anxiety Stress Scales, the Pittsburgh Sleep Quality Index, and the Plutchik Suicide Risk Scale. In addition to the psychometric assessment, there will be an electroencephalogram evaluation using the EMOTIV (v 1.1) device. Results: A pre-post intervention of 10 Behavioral Activation Treatment for Depression sessions will be implemented. The results of the effectiveness of the Behavioral Activation Treatment for Depression will be analyzed in five measures at pre-post intervention and two follow-ups of 3 and 6 months. Conclusions: This study looks for evidence regarding the efficacy and feasibility of the Behavioral Activation Treatment for Depression in a sample of medical students from two public universities in Mexico with high levels of depression along with stress and anxiety.
Principled sentencing for drug supply offences: Revised methamphetamine sentencing guidelines in New Zealand
Authors: Foulds James A , Nutt David 
Published: July 2020

Methamphetamine was reclassified as a Class A drug in New Zealand in 2003. This meant harsher sentences for people convicted of its manufacture, importation or supply. Despite this, the number of convictions for methamphetamine-related offending continued to increase. In 2019, the New Zealand Court of Appeal agreed to review the sentencing of people convicted of methamphetamine offences on the grounds that some sentences were disproportionately severe. This resulted in a guideline judgment which lowered penalties for offences involving small amounts of methamphetamine (up to 5 grams). Community-based sentences replaced imprisonment as the lower bound of the starting point for sentence calculation. The Court of Appeal highlighted that the presence of addiction, mental health problems or social disadvantage should be taken into account as potential mitigating factors in sentencing. The Court accepted that these factors diminished moral culpability and reduced the deterrent impact of prison sentences. In this article we review the law and policy background to the New Zealand Court of Appeal proceedings, and discuss the reasoning behind the Court’s judgment.
The use of 5‐aminosalicylate for patients with Crohn’s disease in a prospective European inception cohort with 5 years follow‐up – an Epi‐IBD study
Authors: Burisch Johan , Bergemalm Daniel , Halfvarson Jonas , Domislovic Viktor , Krznaric Zeljko , Goldis Adrian , Dahlerup Jens F , Oksanen Pia , Collin Pekka , de Castro Luisa , Hernandez Vicent , Turcan Svetlana , Belousova Elena , D’Incà Renata , Sartini Alessandro , Valpiani Daniela , Giannotta Martina , Misra Ravi , Arebi Naila , Duricova Dana , Bortlik Martin , Gatt Kelly , Ellul Pierre , Pedersen Natalia , Kjeldsen Jens , Andersen Karina W , Andersen Vibeke , Katsanos Konstantinos H , Christodoulou Dimitrios K , Sebastian Shaji , Barros Luisa , Magro Fernando , Midjord Jóngerð MM , Nielsen Kári R , Salupere Riina , Kievit Hendrika AL , Kiudelis Gediminas , Kupčinskas Juozas , Fumery Mathurin , Gower‐Rousseau Corinne , Kaimakliotis Ioannis P , Schwartz Doron , Odes Selwyn , Lakatos Laszlo , Lakatos Peter L , Langholz Ebbe , Munkholm Pia ,   for the Epi‐IBD group
Published: July 2020

BackgroundThe lack of scientific evidence regarding the effectiveness of 5‐aminosalicylate in patients with Crohn’s disease is in sharp contrast to its widespread use in clinical practice.AimsThe aim of the study was to investigate the use of 5‐aminosalicylate in patients with Crohn’s disease as well as the disease course of a subgroup of patients who were treated with 5‐aminosalicylate as maintenance monotherapy during the first year of disease.MethodsIn a European community‐based inception cohort, 488 patients with Crohn’s disease were followed from the time of their diagnosis. Information on clinical data, demographics, disease activity, medical therapy and rates of surgery, cancers and deaths was collected prospectively. Patient management was left to the discretion of the treating gastroenterologists.ResultsOverall, 292 (60%) patients with Crohn’s disease received 5‐aminosalicylate period during follow‐up for a median duration of 28 months (interquartile range 6–60). Of these, 78 (16%) patients received 5‐aminosalicylate monotherapy during the first year following diagnosis. Patients who received monotherapy with 5‐aminosalicylate experienced a mild disease course with only nine (12%) who required hospitalization, surgery, or developed stricturing or penetrating disease, and most never needed more intensive therapy. The remaining 214 patients were treated with 5‐aminosalicylate as the first maintenance drug although most eventually needed to step up to other treatments including immunomodulators (75 (35%)), biological therapy (49 (23%)) or surgery (38 (18%)).ConclusionIn this European community‐based inception cohort of unselected Crohn’s disease patients, 5‐aminosalicylate was commonly used. A substantial group of these patients experienced a quiescent disease course without need of additional treatment during follow‐up. Therefore, despite the controversy regarding the efficacy of 5‐aminosalicylate in Crohn’s disease, its use seems to result in a satisfying disease course for both patients and physicians.
Learning Language, Learning Culture: Teaching Language to the Whole Student
Authors: Kim Deoksoon 
Published: July 2020

Purpose: This article develops a conceptualization of language pedagogy that engages the whole student. Instead of teaching language as if it were just a collection of grammar and vocabulary, we need to think about language as extending into many aspects of life and engaging whole people. Design/Approach/Methods: This article builds an original conceptualization of language learning and teaching that imagines language learning as a tool for developing whole people. It brings together research on learning culture through language, together with cultural-historical activity theory (CHAT), to develop a vision for language learning and human development. Findings: When we teach language, we should be helping people participate in ways of life. This goes beyond knowledge of subject matter, and it goes beyond any simple type of well-being. Language learning can immerse students in others’ worlds, and it can foster empathy and understanding across social and political divides. But it can do so only if we base our research and pedagogy on an adequate account of language and culture. Originality/Value: In our rapidly changing, increasingly interconnected contemporary world, we need a more dynamic conception of culture than has typically been used to design language teaching and learning. This article draws on CHAT, especially the ideas of dialogue and critique, to develop an account of language pedagogy that can engage the whole student.
Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up
Authors: Maldonado David R. , Chen Sarah L. , Chen Jeffery W. , Shapira Jacob , Rosinksy Philip J. , Annin Shawn , Lall Ajay C. , Domb Benjamin G. 
Published: July 2020

Background: Labral tears are the most common abnormalities in patients undergoing hip arthroscopic surgery. Appropriate management is crucial, as it has been shown that better overall outcomes can be achieved with labral restoration. Purpose: To report the patient-reported outcomes (PROs) at minimum 2-year follow-up of patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique in the setting of femoroacetabular impingement syndrome (FAIS). Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery for FAIS for labral tear repair using the knotless controlled-tension anatomic technique. Patients were excluded if they had prior hip conditions, prior ipsilateral surgery, Tönnis grade >1, a lateral center-edge angle (LCEA) <25°, or workers’ compensation claims. Preoperative and postoperative scores at minimum 2-year follow-up were recorded for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The proportion of patients who achieved the minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS) for the mHHS, HOS-SSS, and iHOT-12 were also reported. Results: A total of 309 hips were included. The mean patient age was 36.2 years (range, 12.8-75.9 years). The mean preoperative LCEA and alpha angle were 31.9° and 57.1°, respectively. A significant improvement on the mHHS (62.6 ± 15.7 preoperatively vs 86.9 ± 16.2 at 2-year follow-up), NAHS (63.1 ± 16.7 vs 86.1 ± 16.7), and HOS-SSS (39.8 ± 22.0 vs 74.2 ± 27.3) was found ( P < .001 for all). A significant decrease was shown for VAS scores ( P < .001). Also, 78.6% and 82.2% of patients achieved the MCID and PASS for the mHHS, respectively; 60.8% and 69.9% of patients met the MCID and PASS for the HOS-SSS, respectively; and the MCID for the iHOT-12 was met by 77.3% of patients. Conclusion: In the setting of FAIS and labral tears, patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique demonstrated significant improvement in several validated PRO measures, the VAS pain score, and patient satisfaction at a minimum 2 years of follow-up. Based on this evidence, labral tear repair using the knotless controlled-tension anatomic technique seems to be a safe option.
Effect of Trochlear Dysplasia on Commonly Used Radiographic Parameters to Assess Patellar Instability
Authors: Pace J. Lee , Cheng Chris , Joseph Sheeba M. , Solomito Matthew J. 
Published: July 2020

Background: Trochlear dysplasia (TD) is an important anatomic risk factor for patellar instability (PI). Several imaging-based risk factors for PI have been established, but it is unclear what effect TD has on these measurements, and the Dejour method of categorizing TD has been shown to be unreliable. The lateral trochlear inclination (LTI) is a quantifiable measurement of proximal trochlear morphology. Recently, a modified technique for measuring LTI referencing the posterior condylar angle has demonstrated near-perfect reliability and may serve as a new standard for quantifying TD. Purpose/Hypothesis: The purpose of this study was to evaluate how TD, expressed in terms of LTI, affects historically used measures of PI, including the sulcus angle (SA), tibial tuberosity to trochlear groove (TT-TG) distance, lateral patellar inclination (LPI), and Caton-Deschamps (CD) ratio. We hypothesized that lower LTI (ie, more dysplastic trochlea) will correlate with higher SA and TT-TG distances, increased patellar tilt, and more patella alta. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients aged 9 to 18 years treated for PI between January 2014 and August 2017 were queried. On magnetic resonance imaging (MRI), LTI, SA, LPI, and the TT-TG measured at the most proximal (pTT-TG) and distal (dTT-TG) aspects of the fully formed trochlear groove were measured on axial images. CD ratio was measured using sagittal MRI as well as lateral radiographs. All measurements were performed by 2 independent observers. Patients were included if there was a diagnosis of PI that was confirmed with a chart review and if there were appropriate imaging studies to analyze. Results: A total of 65 patients met inclusion criteria for this study. Average pTT-TG distance (15.7 ± 4.5 mm) was not significantly different from dTT-TG distance (15.7 ± 4.2 mm) ( P = .94). LTI had a weak but significant inverse correlation with pTT-TG ( r = –0.40; β = –0.15 mm; P < .001) and SA ( r = –0.43; β = –0.478°; P < .001). There was a moderate and significant inverse correlation of LTI with dTT-TG ( r = –0.593; β = –0.21 mm; P < .001) and with LPI ( r = –0.69; β = –0.54°; P < .001). There was a weak but significant correlation between LTI and the MRI-based CD ratio ( r = 0.279; β = 0.149; P = .005). Radiograph-based CD ratio did not show a significant correlation with LTI ( r = –0.189; P = .135). Conclusion: Smaller (ie, more dysplastic) LTI values correlated significantly with larger TT-TG, SA, LPI, and MRI-based CD ratio measurements. The relationship between SA and LTI is intuitive, but the relationship between LTI and the other analyzed variables suggests that they are dependent variables to TD and may not be consistent independent risk factors for PI. Together, these suggest that TD alters the radiographic interpretation of TT-TG and patellar tilt. The correlation between TD and patellar height is unclear and warrants further investigation.
Stroke care in Italy: An overview of strategies to manage acute stroke in COVID-19 time
Authors: Zedde Marialuisa , Pezzella Francesca Romana , Paciaroni Maurizio , Corea Francesco , Reale Nicoletta , Toni Danilo , Caso Valeria 
Published: July 2020

Purpose To analyse structural and non-structural modifications of acute stroke care pathways undertaken at healthcare institutions across the regions of Italy due to the coronavirus disease 2019 (COVID-19) pandemic. Methods Research on National decrees specific for the pandemic was carried out. The stroke pathways of four Italian regions from North to South, such as Lombardy, Veneto, Lazio and Campania, were analysed before and after the pandemic outbreak. Findings On 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency. Stroke management was affected and required changes, basically resulting in the need to prioritise the ongoing COVID-19 emergency. In the most affected regions, the closure of departments and hospitals led to a complete reorganisation of previously functioning stroke networks. With the closure of several Stroke Units and Stroke Centres, the transportation time to hospital lengthened significantly, especially for the outlying populations. Discussion The COVID-19 pandemic outbreak has been spreading rapidly in Italy and placing an overwhelming burden on healthcare systems. In response to this, political and healthcare decision-makers worked together to develop and implement efforts to sustain the national healthcare system while fighting the pandemic. Stroke care pathways changed during the pandemic and different organisational models were applied in the most affected regions. Conclusions Stroke treatment pathways will need to be redesigned so to guarantee that severe and acute disease patients do not lose their rights to the access and delivery of care during the COVID-19 pandemics.
Comparing First Metatarsophalangeal Joint Flexibility in Hallux Rigidus Patients Pre- and Postcheilectomy Using a Novel Flexibility Device
Authors: Henry Jensen K. , Kraszewski Andrew , Volpert Lauren , Cody Elizabeth , Hillstrom Howard , Ellis Scott J. 
Published: July 2020

Background: Hallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR. Methods: This is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up). Results: Patients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls ( P < .015), postoperative early flexibility was similar to controls ( P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery. Conclusion: Surgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures. Level of Evidence: Level II, prospective comparative study.
Office Examinations–Directed Treatment Paradigms Reduce Travel Burden, Decrease Treatment Cost, and Improve Quality-Adjusted Life-Years for Patients With Exudative Age-Related Macular Degeneration Undergoing Antivascular Endothelial Growth Factor Therapy
Authors: Emerson Geoffrey G. , Thompson John T. , Vo Loi V. , Mason Robert W.H. , Lee Gregory D. , Leder Henry A. 
Published: July 2020

Purpose: In the United States, most intravitreal injections are performed the same day as an office examinations; however, federal agencies and insurance payers suggest these same-day examinations charges are overused and have recommended scrutiny. In this study, we estimate the cost vs benefit to society of same-day office examinations during intravitreal injections for wet age-related macular degeneration (wAMD). Methods: An Excel spreadsheet was used to model different antivascular endothelial growth factor treatment scenarios for wAMD, including automatic treatment, injection series' treat and extend (T&E), and as-needed treatment, with increasing same-day examinations in the order listed. Treatment parameters were estimated using US population statistics, published literature, and Centers for Medicare & Medicaid Services, provider utilization data. Costs and benefits were compared for the 4 treatment scenarios. Results: Although yearly examinations and optical coherence tomography costs were higher for injection series, T&E, and as-needed protocols compared with automatic treatment, our model predicts reduced yearly injection and travel costs for those same treatment scenarios also, saving $2.9 billion (injection series), $7.2 billion (T&E), and $6.1 billion (as-needed) annually for the US population. Same-day injections accounted for 21%, 8%, and 9% of the savings, respectively, because of reduced travel burden. Furthermore, early detection of wAMD in the fellow eye during office examinations allows for a 1.8, 2.1, and 2.5 quality-adjusted life-year benefit, respectively. Conclusions: Office examinations–directed antivascular endothelial growth factor therapy for wAMD reduces travel and treatment expenses and improves screening of the fellow eye, resulting in robust cost savings and quality-adjusted life-year benefit for the US population.