bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of intraoperative acetabular fracture in primary total hip arthroplasty
Authors: Li Juncheng , Ji Quanbo , Ni Ming , Zheng Qingyuan , Sun Jingyang , Zhang Guoqiang 
Published: June 2020

AbstractBackgroundIntraoperative acetabular fracture(IAF) is a rare complication of primary total hip arthroplasty(THA). The previous reports have lacked a sufficiently large number of subjects to allow for an analysis of the causes and appropriate treatment of this problem.MethodsBetween 2015 to 2018, 4888 primary THA were enrolled. We retrospectively reviewed the records in our Total Joint Registry Database and found that 24 patients (24 hips) had sustained intraoperative acetabular fractures. Twenty-four patients(16 females and 8males)were all treated with a posterolateral approach using uncemented components. Twenty patients(83.3%)underwent supplemental screw fixation, of which 2 patients were treated with steel plate fixation. Two patients’ femoral heads were used as a graft. In 4 patients(16.7%), the acetabular components were judged to be stable despite the fracture and no additional treatment was performed. All patients were evaluated clinically with Harris Hip Scores (HHS) and radiographically with serial X-rays which follow up for a mean period of 34.0 ± 12.6 months. We evaluated the anatomic locations, causes, treatments, and outcome of the fractures to study the treatment method and effect of intraoperative acetabular fracture during operation.ResultsThe fracture rate associated with uncemented components was 0.49%. In 17(70.8%) of these patients, the fracture was noted during the impaction of the real acetabular component. Six patients(25%)with Ankylosing Spondylitis had fractures, 4 in the anterior wall, and 1 in the anterior column, because the patient with hip joint fusion needs a to pre-osteotomy before the dislocation. The HHS score increased from 30.8 ± 9.7 preoperatively to 90.2 ± 4.2 postoperatively. All the latest x-ray showed that the fracture did not move, and there is no translucent line formed in the acetabular cup bone interface.ConclusionIntraoperative acetabular fractures are rare complications of THA, and most commonly occur during the implantation of the acetabular components. It is necessary to prevent the occurrence of fractures as much as possible even if the fractures are found during the operation. It should be noted that patients with ankylosing spondylitis involving hip joints during THA surgery must be careful to prevent IAFs during dislocation and pre-osteotomy.
Evaluation of risk factors for insulin resistance: a cross sectional study among employees at a private university in Lebanon
Authors: Fahed Myriam , Abou Jaoudeh Maya G. , Merhi Samar , Mosleh Jocelyne Matar Bou , Ghadieh Rachelle , Al Hayek Sibelle , El Hayek Fares Jessy E. 
Published: June 2020

Abstract
Background
Worldwide, the prevalence of insulin resistance ranges from 15.5 to 46.5%, among adults. Lebanon reported one of the highest rates reaching 44.6%. The literature suggests an association between dairy product consumption and insulin resistance, however results are inconclusive. To our knowledge, no study examined this association in the Middle Eastern Region. The aim of the study was to investigate the prevalence of insulin resistance among a sample of Lebanese adults, to identify its risk factors depending on gender, and to evaluate the association between insulin resistance and dairy products consumption.

Methods
A cross-sectional study was conducted among employees at Notre Dame University - Louaize. Four questionnaires were administered including a background and International Physical Activity Questionnaire short form questionnaires, food frequency questionnaire and a 24 h recall. Bioelectric Impedance Analysis (BIA) was used to measure percent body fat (PBF). Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was used to quantify insulin resistance. A person with HOMA-IR ≥ 2.5 was considered as insulin resistant. Statistical analyses were performed using the Statistical Package for Social Sciences version 23 for Windows. P < 0.05 was considered statistically significant.

Results
Out of 286 study participants, 38.0% were insulin resistant. Average dairy product intake in the total sample was 2.2 ± 1.0 servings per day. Among males, the odds of having insulin resistance were 3.9 times higher (95%CI 1.4–11.0; p = 0.009) for those having a risky waist circumference compared to those having a healthy waist circumference. Among females, being married (OR: 0.2, 95%CI 0.1–0.5; p = 0.002), PBF (OR: 1.2, 95%CI 1.0–1.3; p = 0.008) and hypertriglyceridemia (OR: 8.7, 95%CI: 2.1–35.9; p = 0.003) were associated with HOMA-IR, after controlling for confounders. Dairy intake was not associated with HOMA-IR neither among males (p = 0.777), nor among females (p = 0.968), after controlling for confounders.

Conclusion
Dairy consumption was not associated with increased insulin resistance. More research focusing on the relationship between dairy intake and insulin resistance is needed, especially in the Arab and Middle-Eastern region. Future studies should examine the effect of different types of dairy products and the effect of different nutrients in dairy products on insulin resistance.
Comparison of indirect markers of insulin resistance in adult patients with Double Diabetes
Authors: Ferreira-Hermosillo Aldo , Ibarra-Salce Raúl , Rodríguez-Malacara Joshua , Molina-Ayala Mario Antonio 
Published: June 2020

Abstract
Background
The presence of insulin resistance (IR) and metabolic syndrome (MS) in patients with type 1 diabetes (T1D) has been called “double diabetes”. This entity increases the risk for development of micro and macrovascular complications and cardiovascular mortality. The gold standard for IR quantification is the hyperinsulinemic euglycemic clamp (HEC) but it is invasive, time-consuming and not available in the majority of the clinical settings. Because of this, some formulas for IR quantification have been proposed. We aimed to compare the utility of those methods for MS detection in patients with T1D.

Methods
We conducted a cross-sectional study in 112 patients with T1D and determined the presence of MS using the Joint Statement Criteria. We calculated the estimated glucose disposal rate (eGDR), estimated insulin sensitivity index (eIS), natural logarithm of glucose disposal rate (lnGDR), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), visceral adipose index (VAI) and waist-to-height ratio (WHtR), and compared among patients with and without MS using Student t-test or Mann-Whitney U test. Receiver Operating Characteristics curves for the different indexes were used to identify the best cut-off points for MS detection.

Results
Thirty three percent of the patients were considered to have MS. The patients with MS had lower eGDR (5.49 [4.37–6.80] vs. 8.93 [8.03–9.94] mg/kg/min), eIS (2.89 [1.54–3.54] vs. 3.51 [2.68–4.68]) and lnGDR (1.69 ± 0.27 vs. 1.95 ± 0.21 mg/kg/min), and higher WHtR (0.55 ± 0.05 vs. 0.50 ± 0.05), VAI (3.4 [1.92–5.70] vs. 1.39 [0.97–1.92]) and TG/HDL-c (3.78 [2.63–5.73] vs. 1.77 [1.18–2.75]) in comparison with patients without MS. The cut-off points of TG-HDL-c > 2.0, eGDR < 7.32 mg/kg/min, lnGDR < 1.8 mg/kg/min, VAI > 1.84, WHtR > 0.52 and eIS < 2.92 had a sensitivity of 86, 85, 82, 77 and 70% respectively, for MS detection. The TG/HDL-c, lnGDR and eIS sensitivity changed depending on sex meanwhile eGDR, WHtR and VAI did not need adjust by sex.

Conclusion
Our data show that an eGDR < 7.32 mg/kg/min have the highest sensitivity and specificity to detect the presence of MS in patients with T1D.
Medical students on long-term rural clinical placements and their perceptions of urban and rural internships: a qualitative study
Authors: Bailey Jannine , Pit Sabrina 
Published: June 2020

Abstract
Background
There is some anecdotal evidence that anxiety about the responsibility of an intern influences rural future intentions. Additionally, research has shown that urban interns have reported that they are worried about being ‘forced’ to work in non-metropolitan hospitals in their first year after graduation. This study sought to explore rural medical students’ perceptions and expectations of a rural internship and how local health services and/or their medical school can prepare them best for a rural intern position.

Methods
Four focus groups were conducted with 62 final-year medical students upon completion of a 12-month rural clinical school placement. Focus groups were audio-recorded and transcribed verbatim for thematic analysis to identify key themes.

Results
Most students have high levels of anxiety around starting work but they acknowledge that this may be exaggerated. They believe that in rural areas they get higher quality supervisory support than in urban hospitals as people know you better, whereas in the city you are more anonymous. However, the level of responsibility placed on rural interns was considered to be a double-edged sword. While rural interns were allowed to do more than be a ‘paper-pusher’ this level of responsibility means they are more accountable. The majority felt that doing your first training years in a metropolitan hospital can be crucial to getting on a training program in your chosen speciality.

Conclusions
There appears to be a relatively high level of anxiety about rural internships amongst final-year medical students. Students need more targeted information around specialisation, particularly around regional training hubs, if we want to achieve higher levels of interns choosing a rural career path.
Risk management-based security evaluation model for telemedicine systems
Authors: Kim Dong-won , Choi Jin-young , Han Keun-hee 
Published: June 2020

AbstractBackgroundInfectious diseases that can cause epidemics, such as COVID-19, SARS-CoV, and MERS-CoV, constitute a major social issue, with healthcare providers fearing secondary, tertiary, and even quaternary infections. To alleviate this problem, telemedicine is increasingly being viewed as an effective means through which patients can be diagnosed and medications prescribed by doctors via untact Thus, concomitant with developments in information and communication technology (ICT), medical institutions have actively analyzed and applied ICT to medical systems to provide optimal medical services. However, with the convergence of these diverse technologies, various risks and security threats have emerged. To protect patients and improve telemedicine quality for patient safety, it is necessary to analyze these risks and security threats comprehensively and institute appropriate countermeasures.MethodsThe security threats likely to be encountered in each of seven telemedicine service areas were analyzed, and related data were collected directly through on-site surveys by a medical institution. Subsequently, an attack tree, the most popular reliability and risk modeling approach for systematically characterizing the potential risks of telemedicine systems, was examined and utilized with the attack occurrence probability and attack success probability as variables to provide a comprehensive risk assessment method.ResultsIn this study, the most popular modelling method, an attack tree, was applied to the telemedicine environment, and the security concerns for telemedicine systems were found to be very large. Risk management and evaluation methods suitable for the telemedicine environment were identified, and their benefits and potential limitations were assessed.ConclusionThis research should be beneficial to security experts who wish to investigate the impacts of cybersecurity threats on remote healthcare and researchers who wish to identify new modeling opportunities to apply security risk modeling techniques.
Nurses’ knowledge of pressure ulcer and its associated factors at Hawassa University comprehensive specialized hospital Hawassa, Ethiopia, 2018
Authors: Muhammed Ezedin Molla , Bifftu Berhanu Boru , Temachu Yemataw Zewdu , Walle Tarkie Abebe 
Published: June 2020

AbstractBackgroundPressure ulcer is largely avoidable, but its prevalence rate increased more than 80% in a 13 years study. Nurses have a great position to advance best practices towards the prevention of pressure ulcers. Therefore they should be knowledgeable of the signs and symptoms of pressure ulcers, and preventive strategies to reduce its incidence, but there is limited evidence on nurses’ knowledge and its associated factors to prevent pressure ulcers in Ethiopia.MethodsA hospital-based cross-sectional study was conducted from March 25 – April 23/ 2018. A total of 356 nurses were selected by stratification with a simple random sampling technique. Pretested structured questionnaire with closed and open-ended questions was used to collect data. Frequency distribution and percentage were computed to describe each variable. Bivariate and multivariable logistic regression with a 95% confidence interval was also carried out to see the effect of each independent variable on the dependent variable and declared statistically significant association withP < 0.05.ResultThe mean knowledge score of nurses was 25.22 out of 41 item questions. Fifty-two point 5 % of nurses score above the mean. Males [AOR = 0.44, 95% CI (0.26–0.73)], working a maximum of eight hours [AOR = 3.57, 95% CI (1.48–8.61), not having training [(AOR = 2.31, 95% CI (1.14–4.61)], Low salary [AOR = 3.47, 95% CI (1.03–11.67)] were significantly associated with inadequate knowledge.ConclusionGenerally a nurse’s knowledge of pressure ulcers was inadequate. Being female, working less than or equal to eight hours, not having the training and low working salary are contributors to a low level of knowledge for pressure ulcers.
Adult patient perspectives on receiving hospital discharge letters: a corpus analysis of patient interviews
Authors: Weetman Katharine , Dale Jeremy , Scott Emma , Schnurr Stephanie 
Published: June 2020

AbstractBackgroundUK government guidelines and initiatives emphasise equity in delivery of care, shared decision-making, and patient-centred care. This includes sharing information with patients as partners in health decisions and empowering them to manage their health effectively. In the UK, general practitioners (GPs) routinely receive hospital discharge letters; while patients receiving copies of such letters is seen as “good practice” and recommended, it is not standardised. The effects and consequences of whether or not this happens remains unclear. The aim of this study (one of three forming the Discharge Communication Study) was to explore patient perspectives on receiving discharge letters and their views on how this could be improved in order to optimise patient experience and outcomes.MethodsSemi-structured interviews were conducted with a diverse sample of 50 patients recruited from 17 GP surgeries within the West Midlands, UK. All participants were adults with a recent episode of general hospital inpatient or outpatient care. Data were audio recorded, transcribed and analysed using mixed methods corpus linguistics techniques.ResultsParticipants reported inconsistent access to discharge letters. Most wanted to receive a copy of their discharge letter although some expressed reservations. Perceived benefits included: increased understanding of their condition and treatment, reduced anxiety, and increased satisfaction. Consequences where participants had not received letters included: letter inaccuracies being overlooked, missed follow up actions, failure to fully remember diagnosis, treatment, or self-management or recommendations, and confusion and anxiety at what occurred and what will happen next. Participants felt the usefulness of receiving copies of letters could be increased by: including a patient information section, avoidance of acronyms, and jargon or technical terms explained with lay language.ConclusionsMost patients value receiving copies of hospital discharge letters, and should be consistently offered them. Patients’ preferences for letter receipt could be logged in their health records. To enable positive outcomes letters should have a clear and accessible format that reflects the priorities and information needs of patients. Patients appear not to be receiving or being offered copies of letters consistently despite UK policies and guidelines supporting this practice; this suggests a need for greater standardisation of practice.
Implementation of the clinical practice guideline for individuals with amputations in Colombia: a qualitative study on perceived barriers and facilitators
Authors: Patiño-Lugo Daniel F. , Pastor Durango María del Pilar , Lugo-Agudelo Luz Helena , Posada Borrero Ana María , Ciro Correa Verónica , Plata Contreras Jesús Alberto , Vera Giraldo Claudia Yaneth , Aguirre-Acevedo Daniel Camilo 
Published: June 2020

Abstract
Background
The issue of lower extremity amputation has been in the Colombian political agenda for its relationship with the armed conflict and antipersonnel mines. In 2015 the Colombian Ministry of Health published a national clinical practice guideline (CPG) for amputee patients. However, there is a need to design implementation strategies that target end-users and the context in which the CPG will be used. This study aims to identify users’ perceptions about the barriers and facilitators for implementing the guideline for the care of amputee patients in a middle-income country such as Colombia.

Methods
Semi-structured interviews were conducted with 38 users, including patients, health workers, and administrative staff of institutions of the health system in Colombia. Individuals were purposively selected to ensure different perspectives, allowing a balance of individual positions.

Results
According to participants’ perceptions, barriers to implementation are classified as individual barriers (characteristics of the amputee patient and professionals), health system barriers (resource availability, timely care, information systems, service costs, and regulatory changes), and barriers related to clinical practice guidelines (utility, methodological rigour, implementation flexibility, and characteristics of the group developing the guidelines).

Conclusions
Our study advances knowledge on the perceived individual and health system barriers and facilitators for the implementation of the CPG for amputee patients in Colombia. Importantly, the governance, financial, and service delivery arrangements of the Colombian health system are determining factors in implementing CPGs. For example, the financial arrangements between the insurance companies and the health care provider institutions were identified as barriers for the implementation of recommendations related to the continuity and opportunity of care of patients with amputations. The design of implementation strategies that successfully address the individual behaviours and the contextual health systems arrangements may significantly impact the health care process for amputee patients in Colombia.
Country of first birth and neonatal outcomes in migrant and Norwegian-born parous women in Norway: a population-based study
Authors: Vik Eline S. , Nilsen Roy M. , Aasheim Vigdis , Small Rhonda , Moster Dag , Schytt Erica 
Published: June 2020

Abstract
Background
This study compares subsequent birth outcomes in migrant women who had already had a child before arriving in Norway with those in migrant women whose first birth occurred in Norway. The aim of this study was to investigate the associations between country of first birth and adverse neonatal outcomes (very preterm birth, moderately preterm birth, post-term birth, small for gestational age, large for gestational age, low Apgar score, stillbirth and neonatal death) in parous migrant and Norwegian-born women.

Methods
National population-based study including second and subsequent singleton births in Norway from 1990 to 2016. Data were retrieved from the Medical Birth Registry of Norway and Statistics Norway. Neonatal outcomes were compared between births to: 1) migrant women with a first birth before immigration to Norway (n = 30,062) versus those with a first birth after immigration (n = 66,006), and 2) Norwegian-born women with a first birth outside Norway (n = 6205) versus those with a first birth in Norway (n = 514,799). Associations were estimated as crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using multiple logistic regression.

Results
Migrant women with a first birth before immigrating to Norway had increased odds of adverse outcomes in subsequent births relative to those with a first birth after immigration: very preterm birth (22–31 gestational weeks; aOR = 1.27; CI 1.09–1.48), moderately preterm birth (32–36 gestational weeks; aOR = 1.10; CI 1.02–1.18), post-term birth (≥42 gestational weeks; aOR = 1.19; CI 1.11–1.27), low Apgar score (< 7 at 5 min; aOR = 1.27; CI 1.16–1.39) and stillbirth (aOR = 1.29; CI 1.05–1.58). Similar results were found in the sample of births to Norwegian-born women.

Conclusions
The increased odds of adverse neonatal outcomes for migrant and Norwegian-born women who had their first births outside Norway should serve as a reminder of the importance of taking a careful obstetric history in these parous women to ensure appropriate care for their subsequent pregnancies and births in Norway.