bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are medical students trained in cross‐cover?
Authors: Heidemann Lauren A , Fitzgerald James T , Hartley Sarah 
Published: June 2018

SummaryObjectivesTo examine the current state of cross‐cover education in undergraduate medical education and intern perceived readiness to provide cross‐cover.MethodsAn electronic survey was distributed to 126 incoming interns in surgery, internal medicine, family medicine and paediatrics residencies at a single academic centre. Information regarding prior cross‐cover training, experience, confidence, and responses to a sample cross‐cover case were obtained.ResultsThe survey response rate was 69.8% (88 of 126), which included both partial and complete responses. Fifty‐seven interns out of 85 (67.1%) had no formal training and 51 (60.0%) had no experience performing cross‐cover. They reported feeling unprepared to provide cross‐cover, with an average score of 1.8 on a 5‐point Likert scale (1, not at all confident; 5, extremely confident). Interns had more confidence in performing cross‐cover tasks if they had prior direct cross‐cover experience (p = 0.001), and were the least confident in performing the initial evaluation and management of urgent issues (Likert score = 1.6).
Scores on the sample case were correlated with the amount of prior experience with patients (p = 0.06). Only 77.7% of interns indicated that they would notify their senior resident in two urgent scenarios. Those who reported higher confidence in knowing when to ask for help were more likely to appropriately notify their senior colleague (p = 0.005).We identified gaps in cross‐cover training and in the preparedness of incoming internsConclusionsWe identified gaps in cross‐cover training and in the preparedness of incoming interns. This has important implications for the first day of residency, when interns are often asked to perform cross‐coverage, yet feel unprepared to do so and express the greatest concern in urgent cross‐cover scenarios. Addressing this curricular gap is crucial in assuring safe cross‐cover care.
Do HIV treatment eligibility expansions crowd out the sickest? Evidence from rural South Africa
Authors: Kluberg Sheryl A. , Fox Matthew P. , LaValley Michael , Pillay Deenan , Bärnighausen Till , Bor Jacob 
Published: June 2018

AbstractObjectiveThe 2015 WHO recommendation to initiate all HIV patients on antiretroviral therapy (ART) at diagnosis could potentially overextend health systems and crowd out sicker patients, mitigating the policy's impact. We evaluate whether South Africa's prior eligibility expansion from CD4 ≤ 200 to CD4 ≤ 350 cells/μl reduced ART uptake in the sickest patients.MethodsUsing data on all patients presenting to the Hlabisa HIV Treatment and Care Programme in KwaZulu‐Natal from April 2010 to June 2012 (n = 13 809), we assessed the impact of the August 2011 eligibility expansion on the number of patients seeking care, number initiating ART and time from HIV diagnosis to ART initiation among patients always eligible (CD4 0–200), newly eligible (CD4 201–350) and not yet eligible by CD4 count (>350). We used interrupted time series methods to control for long‐run trends and isolate the effect of the policy.ResultsExpanding ART eligibility led to an increased number of patients initiating ART per month [+95.5; 95% CI (−1.3; 192.3)]. Newly eligible patients (CD4 201–350) initiated treatment 47% faster than before (95% CI 19%; 82%), while the sickest patients (CD4 ≤ 200) saw no decline in the monthly number of patients initiating treatment or the rate of treatment uptake.ConclusionThe Hlabisa programme successfully extended ART to patients with CD4 ≤ 350 cells/μl, while ensuring that the sickest patients did not experience delays in ART initiation. Treatment programmes must be vigilant to maintain quality of care for the sickest as countries move to treat all patients irrespective of CD4 count.
First detection of Leishmania donovani in sand flies from Cameroon and its epidemiological implications
Authors: Tateng Aimé Ngouateu , Kirstein Oscar David , Ngouateu Omer Bébé , Krüger Andreas , von Stebut Esther , Maurer Marcus , Payne Vincent Khan , Warburg Alon , Dondji Blaise 
Published: June 2018

SummaryObjectivesA sound knowledge of the vector‐host‐parasite transmission dynamics is a prerequisite for adequate control measures of vector‐borne diseases. To achieve this, an entomological investigation was conducted in the cutaneous leishmaniasis (CL) endemic focus of Mokolo District, northern Cameroon to identify the insect vector(s) of the disease.MethodsPhlebotomine sand flies were collected in and around Mokolo using New Standard CDC Miniature Light Traps. Individual sand flies were used for morphological species identification, and the remainder of the body for DNA analysis. Sand flies were demonstrated to harbour Leishmania spp. parasites using ITS1 PCR. Mitochondrial vertebrate‐specific Cytochrome b ‐PCR was used to identify blood meals ingested by female sand flies. PCR amplicons were sequenced for Leishmania and blood sources discrimination.ResultsThis study revealed the presence of Leishmania donovani complex DNA (n = 1) in Phlebotomus duboscqi and of lizard‐borne Leishmania tarentolae‐like DNA (n = 3) in Sergentomyia spp. in 79 sand fly specimens from Mokolo district.ConclusionsThe causative agent of CL could not be detected in potential vectors. Instead, we found evidence for visceral leishmaniasis (VL) parasites in Phlebotomus duboscqi as well as enzootic reptile parasites in the Mokolo area. We recommend that an epidemiological survey be carried out in the area to evaluate the prevalence and eventually describe the clinical manifestations of VL in the human population. Political instability in neighbouring countries and the resulting refugee migration are likely explanations for the emergence of VL in Mokolo.
Persistent reticulocytosis in a case of poodle macrocytosis
Authors: Boyd Susan P. , Best Matthew P. 
Published: June 2018

AbstractA healthy 14‐year‐old, male neutered, Miniature Poodle was found to have a persistent erythrocyte macrocytosis and reticulocytosis with a normal and stable HCT. The hematologic features of macrocytosis, increased Howell‐Jolly bodies, and metarubricytosis, in the absence of anemia or other cytopenias, combined with the cytologic evidence of bone marrow erythroid dysplasia, including megaloblastosis, binuclearity, increased mitotic activity, and nuclear fragmentation, are consistent with previous reports of congenital dyserythropoiesis termed poodle macrocytosis. We speculate that the additional presence of persistent reticulocytosis in the absence of an identifiable stimulus for accelerated erythropoiesis may represent a phenotypic variation of this inherited condition, and the morphologic abnormalities of the dyserythropoiesis are described.
Tolerance to a haemorrhagic challenge during heat stress is improved with inspiratory resistance breathing
Authors: Huang Mu , Brothers R. Matthew , Ganio Matthew S. , Lucas Rebekah A. I. , Cramer Matthew N. , Moralez Gilbert , Convertino Victor A. , Crandall Craig G. 
Published: June 2018

New Findings
What is the central question of this study?
Does inspiratory resistance breathing improve tolerance to simulated haemorrhage in individuals with elevated internal temperatures?

What is the main finding and its importance?
The main finding of this study is that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress. These findings demonstrate a scenario in which exploitation of the respiratory pump can ameliorate serious conditions related to systemic hypotension.

AbstractHeat exposure impairs human blood pressure control and markedly reduces tolerance to a simulated haemorrhagic challenge. Inspiratory resistance breathing enhances blood pressure control and improves tolerance during simulated haemorrhage in normothermic individuals. However, it is unknown whether similar improvements occur with this manoeuvre in heat stress conditions. In this study, we tested the hypothesis that inspiratory resistance breathing improves tolerance to simulated haemorrhage in individuals with elevated internal temperatures. On two separate days, eight subjects performed a simulated haemorrhage challenge [lower‐body negative pressure (LBNP)] to presyncope after an increase in internal temperature of 1.3 ± 0.1°C. During one trial, subjects breathed through an inspiratory impedance device set at 0 cmH2O of resistance (Sham), whereas on a subsequent day the device was set at −7 cmH2O of resistance (ITD). Tolerance was quantified as the cumulative stress index. Subjects were more tolerant to the LBNP challenge during the ITD protocol, as indicated by a > 30% larger cumulative stress index (Sham, 520 ± 306 mmHg min; ITD, 682 ± 324 mmHg min; P < 0.01). These data indicate that inspiratory resistance breathing modestly improves tolerance to a simulated progressive haemorrhagic challenge during heat stress.
Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial
Authors: Daniels Lisa , Taylor Rachael W , Williams Sheila M , Gibson Rosalind S , Fleming Elizabeth A , Wheeler Benjamin J , Taylor Barry J , Haszard Jillian J , Heath Anne-Louise M 
Published: June 2018

ObjectiveTo determine the iron intake and status of infants following a version of baby-led weaning (BLW) modified to prevent iron deficiency (Baby-Led Introduction to SolidS; BLISS) compared with those of infants following traditional spoon-feeding.Design, participants and interventionThis randomised controlled trial included 206 participants assigned to control (n=101) or BLISS (n=105) groups. Both groups received standard midwifery and ‘Well Child’ care. BLISS participants received eight additional visits (from before birth to 9 months) providing education and support on the BLISS approach to complementary feeding (ie, BLW modified to increase iron intake). The primary outcome of the BLISS study (growth) has been previously reported. This paper reports the key prespecified secondary outcomes, iron intake and iron status.Outcome measuresIntake of iron and key absorption modifiers were assessed using weighed 3-day diet records at 7 and 12 months. A venipuncture blood sample was collected at 12 months to determine plasma ferritin, haemoglobin, soluble transferrin receptor, C-reactive protein and α1-acid glycoprotein concentrations; and body iron was calculated.ResultsDifferences in median dietary iron intakes between the control and BLISS groups were not significant at 7 (difference 0.6 mg/day; 95% CI −1.0 to 2.3) or 12 (−0.1 mg/day; −1.6 to 1.4) months of age. Similarly, there were no significant differences in plasma ferritin concentration (difference −2.6 µg/L; 95% CI −10.9 to 5.8), body iron (0.04 mg/kg; −1.1 to 1.2) or the prevalence of depleted iron stores, early functional iron deficiency or iron deficiency anaemia (all p≥0.65) at 12 months of age.ConclusionsA baby-led approach to complementary feeding does not appear to increase the risk of iron deficiency in infants when their parents are given advice to offer ‘high-iron’ foods with each meal.Trial registration numberACTRN12612001133820; Pre-results.
Health system costs of potentially inappropriate prescribing in Ontario, Canada: a protocol for a population-based cohort study
Authors: Black Cody D , Thavorn Kednapa , Coyle Douglas , Smith Glenys , Bjerre Lise M 
Published: June 2018

IntroductionAdverse drug events (ADEs) are common in older persons and contribute significantly to emergency department visits, hospitalisations and mortality. ADEs are often due to potentially inappropriate prescriptions (PIP) or potentially inappropriate omissions (PIO), and are avoidable if inappropriate prescriptions or omissions are identified and prevented. Identifying PIP/PIO at the population level through the application of PIP/PIO assessment tools to health administrative data can provide a unique opportunity to assess the economic burden of PIP/PIO on the healthcare system beyond medication costs which is yet to be done. The objective of this study is to assess the economic burden associated with PIP/PIO and to estimate the incremental costs associated with distinct PIP/PIO in the province of Ontario.Methods and analysisWe will conduct a retrospective cohort study using Ontario’s health administrative databases. Eligible patients aged 66 years and older who were prescribed at least one medication between 1 April 2003 and 31 March 2014 (approximately 2.4 million patients) will be included. Population attributable fraction methodology will be used to assess the overall burden of PIP in Ontario, while regression analyses will be used to estimate the incremental costs of having specific PIP criteria and aid in prioritising targets for intervention.Ethics and disseminationThis study was approved by the Institutional Review Board at Sunnybrook Health Sciences Centre, Toronto, Canada. Dissemination will occur via publication, presentation at national and international conferences, and knowledge exchange with various stakeholders.
Economic cost of substandard and falsified human medicines and cosmetics with banned ingredients in Tanzania from 2005 to 2015: a retrospective review of data from the regulatory authority
Authors: Mori Amani Thomas , Meena Estella , Kaale Eliangiringa A 
Published: June 2018

ObjectiveTo estimate the economic cost of substandard and falsified human medicines and cosmetics with banned ingredients in Tanzania from 2005 to 2015.DesignA retrospective review of data.SettingTanzania Food and Drugs Authority and premises dealing with importations and distributions of pharmaceuticals.Eligibility criteriaConfiscation reports of substandard human medicines, falsified human medicines and cosmetics with banned ingredients.Primary and secondary outcome measuresQuantities and costs of pharmaceutical products, costs of transportation, storage, court cases and disposal of products.ResultsThe economic cost of substandard and falsified human medicines and cosmetics with banned ingredients was estimated at US$16.2 million, that is, value of substandard medicines US$13.7 million (84.4%), falsified medicines US$0.1 million (1%), cosmetics with banned ingredients US$1.3 million (8%) and other/operational costs US$1.1 million (6.6%). Some of the identified substandard and falsified human medicines include commonly used antibiotics such as phenoxymethylpenicillin, amoxicillin, cloxacillin and co-trimoxazole; antimalarials such quinine, sulfadoxine–pyrimethamine, sulfamethoxypyrazine–pyrimethamine and artemether–lumefantrine; antiretroviral drugs; antipyretics and vitamins among others.ConclusionThe economic cost of substandard and falsified human medicines and cosmetics with banned ingredients represent a relatively large loss of scarce resources for a poor country like Tanzania. We believe that the observed increase in the quantities and the economic cost of these products over time could partly be due to the improvement in the regulatory capacity in terms of human resources, infrastructure and frequency of inspections.
Characteristics and the average 30-day and 6-month clinical outcomes of patients hospitalised with coronary artery disease in a poor South-East Asian setting: the first cohort from Makassar Cardiac Center, Indonesia
Authors: Qanitha Andriany , Uiterwaal Cuno S P M , Henriques Jose P S , Alkatiri Abdul Hakim , Mappangara Idar , Mappahya Ali Aspar , Patellongi Ilhamjaya , de Mol Bastianus A J M 
Published: June 2018

ObjectiveTo provide a detailed description of characteristics at hospital admission and clinical outcomes at 30-day and 6-month follow-up in patients hospitalised with coronary artery disease (CAD) in a poor South-East Asian setting.DesignProspective observational cohort study.SettingFrom February 2013 to December 2014, in Makassar Cardiac Center, Indonesia.Participants477 patients with CAD (acute coronary syndrome and stable CAD).Outcome measuresAll-cause mortality and major adverse cardiovascular events (MACE).ResultsOut of 477 patients with CAD, the proportion of young age (<60 years) was 53.9% and 72.7% were male. At admission, 44.2% of patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), 38.6% with diagnosis or signs of heart failure and 75.1% had previous hypertension. Out of 211 patients with STEMI, only 4.7% had been treated with primary percutaneous coronary intervention (PCI) and 6.2% received thrombolysis. The time lapse from symptom onset to hospital admission was 26.8 (IQR 10.0–48.0) hours, and 19.1% of all patients had undergone either PCI or coronary artery bypass graft. The survival rate at 6 months was 78.9%. The rates of all-cause mortality at 30 days and 6 months were 13.4% and 7.3%, respectively; the rate of composite MACE at 30 days was 26.2% and 18.0% at 6 months.ConclusionsPatients with CAD from a poor South-East Asian setting present themselves with predominantly unstable conditions of premature CAD. These patients show relatively severe illness, have significant time delay from symptom onset to admission or intervention, and most do not receive the guidelines-recommended treatment. Awareness of symptoms, prompt initial management of acute CVD, well-established infrastructures and resources both in primary and secondary hospital for CVD should be improved to reduce the high rates of 30-day and 6-month mortality and adverse outcomes in this population.
Factors influencing early and late readmissions in Australian hospitalised patients and investigating role of admission nutrition status as a predictor of hospital readmissions: a cohort study
Authors: Sharma Yogesh , Miller Michelle , Kaambwa Billingsley , Shahi Rashmi , Hakendorf Paul , Horwood Chris , Thompson Campbell 
Published: June 2018

ObjectivesLimited studies have identified predictors of early and late hospital readmissions in Australian healthcare settings. Some of these predictors may be modifiable through targeted interventions. A recent study has identified malnutrition as a predictor of readmissions in older patients but this has not been verified in a larger population. This study investigated what predictors are associated with early and late readmissions and determined whether nutrition status during index hospitalisation can be used as a modifiable predictor of unplanned hospital readmissions.DesignA retrospective cohort study.SettingTwo tertiary-level hospitals in Australia.ParticipantsAll medical admissions ≥18 years over a period of 1 year.OutcomesPrimary objective was to determine predictors of early (0–7 days) and late (8–180 days) readmissions. Secondary objective was to determine whether nutrition status as determined by malnutrition universal screening tool (MUST) can be used to predict readmissions.ResultsThere were 11 750 (44.8%) readmissions within 6 months, with 2897 (11%) early and 8853 (33.8%) late readmissions. MUST was completed in 16.2% patients and prevalence of malnutrition during index admission was 31%. Malnourished patients had a higher risk of both early (OR 1.39, 95% CI 1.12 to 1.73) and late readmissions (OR 1.23, 95% CI 1.06 to 128). Weekend discharges were less likely to be associated with both early (OR 0.81, 95% CI 0.74 to 0.91) and late readmissions (OR 0.91, 95% CI 0.84 to 0.97). Indigenous Australians had a higher risk of early readmissions while those living alone had a higher risk of late readmissions. Patients ≥80 years had a lower risk of early readmissions while admission to intensive care unit was associated with a lower risk of late readmissions.ConclusionsMalnutrition is a strong predictor of unplanned readmissions while weekend discharges are less likely to be associated with readmissions. Targeted nutrition intervention may prevent unplanned hospital readmissions.Trial registrationANZCTRN 12617001362381; Results.
Retirement ages of senior UK doctors: national surveys of the medical graduates of 1974 and 1977
Authors: Smith Fay , Goldacre Michael J , Lambert Trevor W 
Published: June 2018

ObjectiveTo report on retirement ages of two cohorts of senior doctors in the latter stages of their careers.DesignQuestionnaires sent in 2014 to all medical graduates of 1974 and 1977.SettingUK.Participants3695 UK medical graduates.Main outcome measuresRetirement status by age at the time of the survey and age at retirement if retired. Planned retirement ages and retirement plans if not retired.ResultsOf contactable doctors, 85% responded. 43.7% of all responding doctors had fully retired, 25.9% had ‘retired and returned’ for some medical work, 18.3% had not retired and were working full-time in medicine, 10.7% had not retired and were working part-time in medicine and 1.4% were either doing non-medical work or did not give details of their employment status. The average actual retirement age (including those who had retired but subsequently returned) was 59.6 years (men 59.9, women 58.9). Psychiatrists (58.3) and general practitioners (GPs) (59.5) retired at a slightly younger age than radiologists (60.4), surgeons (60.1) and hospital specialists (60.0). More GPs (54%) than surgeons (26%) or hospital medical specialists (34%) were fully retired, and there were substantial variations in retirement rates in other specialties. Sixty-three per cent of women GPs were fully retired.ConclusionsGender and specialty differences in retirement ages were apparent and are worthy of qualitative study to establish underlying reasons in those specialties where earlier retirement is more common. There is a general societal expectation that people will retire at increasingly elderly ages; but the doctors in this national study retired relatively young.