bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterisation of vascular changes in different stages of Stargardt disease using double swept-source optical coherence tomography angiography
Authors: Reich Michael , Glatz Andreas , Cakir Bertan , Böhringer Daniel , Lang Stefan , Küchlin Sebastian , Joachimsen Lutz , Lagreze Wolf , Agostini Hansjuergen T , Lange Clemens 
Published: November 2019

ObjectiveTo describe vascular changes in different stages of Stargardt disease (STGD) via double swept-source optical coherence tomography angiography.Methods and analysisProspective, cross-sectional case–control study. Twenty-three patients (45 eyes) with ABCA4 mutations graded according to the Fishman STGD classification and 23 controls (23 eyes) were included. Two independent investigators quantified the foveal avascular zone (FAZ) in the superficial and deep capillary plexus (SCP/DCP) and the areas presenting rarefied flow and complete vascular atrophy in the outer retina to choriocapillaris (ORCC) and choriocapillaris (CC) slab.ResultsThe mean age at first diagnosis of STGD was 24.0 years (range 9–50) and 37.9 years (range 18–74) at the time of examination. Eleven patients were assigned to the Fishman STGD classification stage (S) 1, three to S2, eight to S3 and one to S4. The FAZ in SCP and DCP was increased in all stages compared with controls (p<0.01). Areas with rarefied flow signal and vascular atrophy were detected in the ORCC and the CC layer and grew with increasing stage of disease (p<0.01). The duration of disease correlated with the extent of the enlarged FAZ in the SCP/DCP and with the area of reduced flow in the ORCC and CC layer (p<0.01). Best corrected visual acuity correlated negatively with the extent of the enlarged FAZ in the SCP/DCP (p<0.0001), as well as with enlarged atrophic area in the ORCC and CC layer (p=0.026 and p=0.074).ConclusionsPatients with STGD reveal vascular changes in the retina and CC in all disease stages. The avascular zone in the SCP/DCP and areas with rarefied flow signal in the ORCC/CC increase with the duration and stage of disease, indicating progressive vascular decay most likely secondary to retinal pigment epithelium and neuronal loss. Furthermore, increased vascular damage is associated with decreased vision.
Expediting the management of cauda equina syndrome in the emergency department through clinical pathway design
Authors: Buell Kevin G , Sivasubramaniyam Sujan , Sykes Mark , Zafar Kamran , Bingham Lucy , Mitra Anu 
Published: November 2019

IntroductionCauda equina syndrome (CES) is a neurosurgical emergency. Early diagnosis with MRI and subsequent surgical decompression surgery can prevent permanent neurological dysfunction. Charing Cross Hospital (CXH) is a tertiary neurosurgical referral centre where in the emergency department (ED), current practice mandated a neurosurgery review prior to requesting MRI.HypothesisIt was hypothesised that a new clinical pathway, with better coordination from the ED, radiology and neurosurgical teams could reduce the time of presentation to diagnosis or exclusion of CES.MethodRetrospective case-note analysis of patients presenting with back pain to CXH ED over a 3-month period was performed. The primary outcome was the time interval between the patient’s arrival to the ED and the MRI preliminary report.ResultsThe baseline primary outcome was recorded at 8 hours and 16 min (n=30). A new clinical pathway was designed empowering ED senior decision makers to order MRIs prior to neurosurgical review. Two Plan-Do-Study-Act (PDSA) cycles were performed, each measured over a 2-month period. The first PDSA cycle was performed after the pathway was initially launched (n=17), while the second PDSA cycle measured the effect of staff education and active promotion of the pathway (n=17). MRI was requested earlier, waiting and reporting time for MRI were reduced. The exclusion or diagnosis of CES was reduced to 5 hours and 54 min in PDSA 1 and 5 hours 17 min in PDSA 2, a 29% and 36% reduction (p=0.048 and p=0.012, respectively).ConclusionThe clinical protocol was a cost-neutral and sustainable intervention that effectively reduced the time taken to diagnose or exclude CES and ED waiting times.
Development of a real-time physician–patient communication data collection tool
Authors: Custer Adam , Rein Laura , Nguyen Daniel , Wentworth Karen , Dhamoon Amit 
Published: November 2019

ObjectivesTo design a tool to assess and improve physician communication, provide physicians with personalised feedback in real time, and relate specific communication behaviours to patient experience measures. It was hypothesised that performance of fundamental communication behaviours would correlate with individual patient experience scores as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.DesignProspective observational study.SettingSingle-centre study at a mid-sized academic tertiary medical centre.ParticipantsThirteen hospitalists across 305 patient interactions were assessed in this study. Participants were recruited from three geographically cohorted adult general medicine-teaching teams on two inpatient units. Participants with cognitive impairment or who were unable to speak English were excluded from the study.Main outcome measuresFrequency of performance of 10 fundamental communication behaviours.ResultsThe communication behaviours of 13 hospitalists were assessed by 305 surveys: 146 observations, 106 patient reports and 52 excluded interactions. During rounds, 50% of physicians introduced themselves, 40% explained their role, 44% introduced other members of the team, 59% addressed patients by name, 58% addressed friends/family, 59% attempted to be at eye level, 41% asked permission before performing a physical examination, 40% asked if patients had questions and 20% asked if patients understood the plan of care. Several variables correlated with higher HCAHPS scores; however, addressing patients by name (r=0.60482, p=0.0492) and introducing other members of the team (r=0.87239, p=0.0234) were statistically significant.ConclusionThis study highlights the importance of effective physician–patient communication and presents a unique data collection tool to assess and improve physician communication in real time. This tool can provide physicians with personalised feedback and relate specific communication behaviours to patient experience measures to provide high-quality care and improve the patient experience.
Obstetric care navigation: results of a quality improvement project to provide accompaniment to women for facility-based maternity care in rural Guatemala
Authors: Austad Kirsten , Juarez Michel , Shryer Hannah , Moratoya Cristina , Rohloff Peter 
Published: November 2019

BackgroundMany maternal and perinatal deaths in low-resource settings are preventable. Inadequate access to timely, quality care in maternity facilities drives poor outcomes, especially where women deliver at home with traditional birth attendants (TBA). Yet few solutions exist to support TBA-initiated referrals or address reasons patients frequently refuse facility care, such as disrespectful and abusive treatment. We hypothesised that deploying accompaniers—obstetric care navigators (OCN)—trained to provide integrated patient support would facilitate referrals from TBAs to public hospitals.MethodsThis project built on an existing collaboration with 41 TBAs who serve indigenous Maya villages in Guatemala’s Western Highlands, which provided baseline data for comparison. When TBAs detected pregnancy complications, families were offered OCN referral support. Implementation was guided by bimonthly meetings of the interdisciplinary quality improvement team where the OCN role was iteratively tailored. The primary process outcomes were referral volume, proportion of births receiving facility referral, and referral success rate, which were analysed using statistical process control methods.ResultsOver the 12-month pilot, TBAs attended 847 births. The median referral volume rose from 14 to 27.5, meeting criteria for special cause variation, without a decline in success rate. The proportion of births receiving facility-level care increased from 24±6% to 62±20% after OCN implementation. Hypertensive disorders of pregnancy and prolonged labour were the most common referral indications. The OCN role evolved to include a number of tasks, such as expediting emergency transportation and providing doula-like labour support.ConclusionsOCN accompaniment increased the proportion of births under TBA care that received facility-level obstetric care. Results from this of obstetric care navigation suggest it is a feasible, patient-centred intervention to improve maternity care.
Effects of self-monitoring devices on blood pressure in older adults with hypertension and diabetes: a randomised controlled trial
Authors: Gu Yeqing , Bao Xue , Wang Yanyan , Meng Ge , Wu Hongmei , Zhang Qing , Liu Li , Song Kun , Wang Yaogang , Niu Kaijun 
Published: November 2019

BackgroundHypertension and diabetes frequently coexist, which results in the difficulty of hypertension control in community-dwelling elderly adults who lack effective prevention and control strategies. The aim of this study is to determine whether a combined pedometer and home blood pressure monitoring (HBPM) programme could improve blood pressure (BP) among community-dwelling elderly adults with hypertension and diabetes.MethodsThe trial was a 2×2 factorial randomised clinical trial that recruited 180 community-dwelling elderly people (aged ≥60) with hypertension and diabetes in Tianjin, China. Participants were randomly assigned to control, pedometer, HBPM, and pedometer+HBPM groups. Intervention period was 12 months. The coprimary outcomes of the study were systolic and diastolic BP; the secondary outcomes included the proportion of patients with controlled hypertension. BP was measured twice in the right arm using a mercurial sphygmomanometer. The mean of these two measurements was taken as the BP value.ResultsAt 12 months, compared with the control group, the adjusted differences in least squares mean (95% CI) in systolic and diastolic BP changes for pedometer, HBPM, and pedometer+HBPM groups were −4.2 (–8.4 to 0.1), –2.7 (–6.9 to 1.5) and −8.1 (–12.3 to –3.9) mm Hg (p<0.01); −3.2 (–5.2 to –1.1), −0.1(−2.1 to 1.9) and −3.6 (–5.6 to –1.5) mm Hg (p<0.001), respectively; the adjusted difference in percentage (95% CI) in the controlled hypertension (BP <140/90 mm Hg) for pedometer, HBPM and pedometer+HBPM groups were 7.5 (–12.2 to 27.1), 9.9 (–10.4 to 30.3) and 23.1 (5.0 to 41.1) (p=0.09).ConclusionCombination pedometer and HBPM interventions can significantly decrease BP levels in elderly adults with hypertension and diabetes.Trials Registration numberUMIN000021613.
Collective impact of chronic medical conditions and poverty on perinatal mental illness: population-based cohort study
Authors: Faulkner Mary-Rose , Barker Lucy C. , Vigod Simone N. , Dennis Cindy-Lee , Brown Hilary K 
Published: November 2019

BackgroundChronic medical conditions (CMCs) and poverty commonly co-occur and, while both have been shown to independently increase the risk of perinatal mental illness, their collective impact has not been examined.MethodsThis population-based study included 853 433 Ontario (Canada) women with a singleton live birth and no recent mental healthcare. CMCs were identified using validated algorithms and disease registries, and poverty was ascertained using neighbourhood income quintile. Perinatal mental illness was defined as a healthcare encounter for a mental health or substance use disorder in pregnancy or the first year postpartum. Modified Poisson regression was used to test the independent impacts of CMC and poverty on perinatal mental illness risk, adjusted for covariates, and additive interaction between the two exposures was assessed using the relative excess risk due to interaction (RERI) and synergy index (SI).ResultsCMC and poverty were each independently associated with increased risk of perinatal mental illness (CMC vs no CMC exposure: 19.8% vs 15.6%, adjusted relative risk (aRR) 1.21, 95% CI (CI) 1.20 to 1.23; poverty vs no poverty exposure: 16.7% vs 15.5%, aRR 1.06, 95% CI 1.05 to 1.07). However, measures of additive interaction for the collective impact of both exposures on perinatal mental illness risk were not statistically significant (RERI 0.02, 95% CI −0.01 to 0.06; SI 1.09, 95% CI 0.95 to 1.24).ConclusionCMC and poverty are independent risk factors for perinatal mental illness and should be assessed as part of a comprehensive management programme that includes prevention strategies and effective screening and treatment pathways.
Determinants of aortic growth rate in patients with bicuspid aortic valve by cardiovascular magnetic resonance
Authors: Sophocleous Froso , Berlot Bostjan , Ordonez Maria Victoria , Baquedano Mai , Milano Elena Giulia , De Francesco Viola , Stuart Graham , Caputo Massimo , Bucciarelli-Ducci Chiara , Biglino Giovanni 
Published: November 2019

ObjectivesThis study aimed to identify determinants of aortic growth rate in bicuspid aortic valve (BAV) patients. We hypothesised that (1) BAV patients with repaired coarctation (CoA) exhibit decreased aortic growth rate, (2) moderate/severe re-coarctation (reCoA) results in increased growth rate, (3) patients with right non-coronary (RN) valve cusps fusion pattern exhibit increased aortic growth rate compared with right-left cusps fusion and type 0 valves.MethodsStarting from n=521 BAV patients with cardiovascular magnetic resonance data, we identified n=145 patients with at least two scans for aortic growth analysis. Indexed areas of the sinuses of Valsalva and ascending aorta (AAo) were calculated from cine images in end-systole and end-diastole. Patients were classified based on dilation phenotype, presence of CoA, aortic valve function and BAV morphotype. Comparisons between groups were performed. Linear regression was carried out to identify associations between risk factors and aortic growth rate.ResultsPatients (39±16 years of age, 68% male) had scans 3.7±1.8 years apart; 32 presented with AAo dilation, 18 with aortic root dilation and 32 were overall dilated. Patients with repaired CoA (n=61) showed decreased aortic root growth rate compared with patients without CoA (p≤0.03) regardless of sex or age. ReCoA, aortic stenosis, regurgitation and history of hypertension were not associated with growth rate. RN fusion pattern showed the highest aortic root growth rate and type 0 the smallest (0.30 vs 0.08 cm2/m*year, end-systole, p=0.03).ConclusionsPresence of CoA and cusp fusion morphotype were associated with changes in rate of root dilation in our BAV population.
Improved diagnostic accuracy of pathology with the implementation of a perioperative point-of-care ultrasound service: quality improvement initiative
Authors: Ramsingh Davinder , Runyon Alec , Gatling Jason , Dorotta Ihab , Lauer Ryan , Wailes Dustin , Yang Jaron , Alschuler Matt , Austin Briahnna , Stier Gary , Martin Robert 
Published: November 2019

Introduction
The utility of perioperative point-of-care ultrasound (P-POCUS) is rapidly growing. The successful implementation of a comprehensive P-POCUS curriculum, Focused PeriOperative Risk Evaluation Sonography Involving Gastro-abdominal, Hemodynamic, and Trans-thoracic Ultrasound (FORESIGHT), has been demonstrated. This project sought to further evaluate the utility of P-POCUS with the following aims: (1) to assess the ability to train the FORESIGHT curriculum via a free, open-access, online platform; (2) to launch a P-POCUS clinical service as a quality improvement (QI) initiative; (3) to evaluate the diagnostic accuracy of the P-POCUS examinations to formal diagnostic studies; and (4) to compare the P-POCUS diagnostic accuracy with the diagnostic accuracy of traditional assessment (TA).

Methods
This study was launched as a QI project for the implementation of a P-POCUS service. A group of attending and resident anesthesiologists completed P-POCUS training supported by an online curriculum. After training, a P-POCUS service was launched. The P-POCUS service was available for any perioperative event, and specific triggers were also identified. All examinations were documented on a validated datasheet. The diagnostic accuracy of the two index tests, P-POCUS and TA, were compared with formal diagnostic testing. TA was defined as a combination of the anesthesiologist’s bedside assessment and physical examination. The primary outcome marker was a comparison in the accuracy of new diagnosis detected by P-POCUS service versus the TA performed by the primary anesthesiologist.

Results
A total of 686 P-POCUS examinations were performed with 466 examinations having formal diagnostic studies for comparison. Of these, 92 examinations were detected as having new diagnoses. Performance for detection of a new diagnosis demonstrated a statistically higher sensitivity for the P-POCUS examinations (p<0.0001). Performance comparison of all P-POCUS examinations that were matched to formal diagnostic studies (n=466) also demonstrated a significantly higher sensitivity. These findings were consistent across cardiovascular, pulmonary and abdominal P-POCUS categories (p<0.01). Additionally, multiple pathologies demonstrated complete agreement between the P-POCUS examination and the formal study.

Conclusion
A P-POCUS service can be developed after training facilitated by an online curriculum. P-POCUS examinations can be performed by anesthesiologists with a high degree of accuracy to formal studies, which is superior to TA.
Successful treatment of hypogammaglobulinaemia in a camel calf (Camelus dromedarius) by maternal blood transfusion
Authors: Dabiri Mehran , Agerholm Jorgen S , Talebkhan Garoussi Massoud 
Published: November 2019

A well‐functioning humoral immune response is critical for the immune function of neonatal camel calves. A two‐week‐old dromedary camel (Camelus dromedarius) calf was presented for examination. Leucocytosis and neutrophilia with a mild left shift and toxic changes were present. The plasma total protein (PTP) level was 4.32 g/dl, being consistent with failure of transfer of colostral immunoglobulins. Since commercial camel plasma was not available, whole blood (1 litre) was transferred intravenously from the dam to the calf. This was repeated three days later. The PTP had increased to 6.1 g/dl on the day after the second infusion. Blood transfusion from the dam to a calf with insufficient uptake of immunoglobulins increases the calf’s chance of survival. For veterinarians working in low‐income or rural areas, blood transfusion should be considered an easy and cheap option in cases of insufficient uptake of immunoglobulins to save the life of the calf.
Determining priority welfare issues for cats in the United Kingdom using expert consensus
Authors: Rioja‐Lang Fiona , Bacon Heather , Connor Melanie , Dwyer Cathy Mary 
Published: November 2019

BackgroundCats are the most popular pets in the UK, yet relatively little research has been conducted into the welfare of cats living in a home environment. The purpose of this study was to determine and prioritise welfare issues for cats using a Delphi method.MethodsCat welfare experts (n=14) were asked to identify and rank welfare issues for cats in the UK. An initial list of 118 welfare issues was generated by an anonymous online discussion board of experts and thematic analysis using NVivo. Subsequently experts ranked the list of welfare issues according to severity, duration and prevalence using a 6‐point Likert scale. All issues with a median score of 3 or above (n=43) were included in the second survey to determine agreement on the rankings of issues. Finally, a subsection of experts attended a two‐day workshop to discuss the welfare rankings and determine the final prioritised list of welfare issues.ResultsThe issues considered to be the most severe and/or likely to cause prolonged cat suffering included social behaviour issues, diseases of old age, obesity, owners not seeking veterinary care and poor pain management. The welfare issues perceived to be most prevalent included neglect/hoarding, delayed euthanasia, inherited conformational defects/diseases, social or environmental restriction, and poor pain management.ConclusionsThe outcomes suggested that, although issues such as cat behaviour required further research, owner education was an important factor in improving cat welfare.
One-stage repair of aortic coarctation and cardiac pathology via sternotomy
Authors: Charchyan Eduard R , Stepanenko Anna B , Galeev Nail A , Belov Yuri V 
Published: November 2019

Background Aortic coarctation is a hereditary disease often accompanied by ascending aortic aneurysm and aortic valve disease. We introduce a single-stage surgical treatment option for patients with aortic coarctation, ascending aortic aneurysm, and aortic valve disease, with a comparative analysis of the results. Methods The study included six patients with aortic coarctation, ascending aortic aneurysm, and aortic valve disease. All operations were performed by a full median sternotomy. For a comparative analysis, the patients were divided into two groups: 3 patients underwent ascending-to-descending aortic bypass, and the other 3 underwent surgical aortic coarctation repair. The short- and medium-term postoperative periods were monitored. The mean duration of monitoring was 27 months. Results When comparing the 2 groups, we observed a tendency for improvement in all intraoperative parameters in the 2nd group. There was no mortality in the postoperative hospital period. One (16.7%) patient died of stroke in the medium-term postoperative period. The other 5 patents showed no signs of procedure-related complications. Conclusion We recommend performing a single-stage procedure for surgical treatment of coarctation of the aorta with concomitant aneurysm of the ascending aorta and aortic valve disease. Compared to ascending-to-descending aortic bypass, surgical repair of aortic coarctation is more physiological, feasible via a sternotomy, and tends to improve intraoperative factors.
Do (Australian) jockeys have hot hands?
Authors: Wrathall Robert , Falvey Rod , Rajaguru Gulasekaran 
Published: November 2019

We extend the empirical analysis of hot hands in sports to horse racing, using the winning streaks of a sample of jockeys riding in Australia. Grouping jockeys by strike rate (win percentage), we find evidence of hot hands across almost all strike rates. But considering jockeys individually, only a minority exhibit hot hands. A wagering strategy based on hot hands yields a negative return overall and for most hot hand jockeys, although some do yield a positive return. We conclude that hot hands are present but not ubiquitous and that this is generally recognised in the betting market. JEL Classification: C53, D81, D84