bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting adherence to therapy in rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis: a large cross-sectional study
Authors: Smolen Josef S , Gladman Dafna , McNeil H Patrick , Mease Philip J , Sieper Joachim , Hojnik Maja , Nurwakagari Pascal , Weinman John 
Published: January 2019

ObjectiveThis analysis explored the association of treatment adherence with beliefs about medication, patient demographic and disease characteristics and medication types in rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS) to develop adherence prediction models.MethodsThe population was a subset from ALIGN, a multicountry, cross-sectional, self-administered survey study in adult patients (n=7328) with six immune-mediated inflammatory diseases who were routinely receiving systemic therapy. Instruments included Beliefs about Medicines Questionnaire (BMQ) and 4-item Morisky Medication Adherence Scale (MMAS-4©), which was used to define adherence.ResultsA total of 3390 rheumatological patients were analysed (RA, n=1943; PsA, n=635; AS, n=812). Based on the strongest significant associations, the adherence prediction models included type of treatment, age, race (RA and AS) or disease duration (PsA) and medication beliefs (RA and PsA, BMQ-GeneralHarmscore; AS, BMQ-SpecificConcernsscore). The models had cross-validated areas under the receiver operating characteristic curve of 0.637 (RA), 0.641 (PsA) and 0.724 (AS). Predicted probabilities of full adherence (MMAS-4©=4) ranged from 5% to 96%. Adherence was highest for tumour necrosis factor inhibitors versus other treatments, older patients and those with low treatment harm beliefs or concerns. Adherence was higher in white patients with RA and AS and in patients with PsA with duration of disease <9 years.ConclusionsFor the first time, simple medication adherence prediction models for patients with RA, PsA and AS are available, which may help identify patients at high risk of non-adherence to systemic therapies.Trial registration numberACTRN12612000977875.
Still ‘skiing their own race’ on New Public Management implementation? Patient choice and policy change in the Finnish and Swedish health-care systems
Authors: Smith Christopher J. , Rauhut Daniel 
Published: January 2019

This article applies an agenda-setting approach to the impact of New Public Management on health-care reform in Sweden and Finland (1993–2016). A system-level view of agenda setting and New Public Management implementation is used to order the historical data derived from literature reviews of each health reform process. New Public Management is viewed as a hybrid concept rooted in the search for efficiency gains and cost containment but, here, generating system preservation and system change strategies, characterised as ‘public competition’ and ‘choice and marketisation’. Sweden and Finland are viewed as ‘pragmatic modernisers’ in the public management literature. Health-care system reform in each country was based on similar problems and similar policy ‘solutions’, and was promoted by similar actors, while the implementation of choice and marketisation again saw windows of opportunity open in a similar manner in each. Policy divergence nevertheless occurred. We identify three key reasons for this, relating to the site and pervasiveness of conflict, the impact of party systems, and administrative openness to outside ideas. Sweden’s conflictual politics produced stalemate while consensual Finland produced radical policy change. Point for practitioners • Finland and Sweden wanted to modernise rather than overturn the traditional welfare settlement with New Public Management implementation. • Similar policy problems emerged and similar solutions were forwarded, often by similar actors and for similar reasons. • In both countries, powerful centre-right government correlates with the promotion of fundamental ‘choice and marketisation’ policies. • National differences in New Public Management implementation remain.
The depth of anaesthesia associated with the administration of isoflurane 2.5% during cardiopulmonary bypass
Authors: Alston R Peter , Connelly Michael , MacKenzie Christopher , Just George , Homer Natalie 
Published: January 2019

Background: Administering isoflurane 2.5% into the oxygenator during cardiopulmonary bypass results in no patient movement. However, doing so may result in an excessive depth of anaesthesia particularly, when hypothermia is induced. Bispectral index and arterial blood and oxygenator exhaust concentrations of volatile anaesthetics should be related to depth of anaesthesia. The primary aim of this study was to measure the depth of anaesthesia using bispectral index, resulting from administering isoflurane 2.5% into the oxygenator during cardiopulmonary bypass, and secondary aims were to examine the relationships between blood and oxygenator exhaust isoflurane concentrations and bispectral index. Methods: Arterial and mixed-venous blood samples were aspirated at three time points during cardiopulmonary bypass and measured for isoflurane concentration using mass spectrometry. Simultaneously, oxygenator exhaust isoflurane concentration, nasopharyngeal temperature and bispectral index were recorded. Results: When averaged across the three time points, all patients had a bispectral index score below 40 (binomial test, p < 0.001). There were no significant correlations between bispectral index score and arterial or mixed-venous blood isoflurane concentrations (r = –0.082, p = 0.715; r = –0.036, p = 0.874) and oxygenator exhaust gas concentration of isoflurane (r = –0.369, p = 0.091). Conclusion: When 2.5% isoflurane was administered into the sweep gas supply to the oxygenator during cardiopulmonary bypass, all patients experienced a bispectral index score less than 40 and no significant relationship was found between either arterial or mixed-venous blood or oxygenator exhaust concentrations of isoflurane and bispectral index.
The Effect of Adjunctive Fresh Frozen Plasma Administration on Coagulation Parameters and Survival in a Canine Model of Antivenom-treated Brown Snake Envenoming
Authors: Jelinek G. A. , Smith A. , Lynch D. , Celenza A. , Irving I. , Michalopoulos N. , Erber W. , Joske D. J. L. 
Published: January 2019

This study aimed to assess the effects of dugite envenoming on blood coagulation and platelet count in a canine model, and the efficacy of fresh frozen plasma (FFP) in reversing the clotting disorder after both adequate and inadequate venom neutralization. Following initial dosing and administration studies, an intravenous venom dose of 1μg/kg was administered to eleven dogs. This was followed 30 minutes later by antivenom in either adequate or inadequate doses. A further 30 minutes later, the animals were given either two units of their own FFP or saline. Fibrinogen, aPTT and platelet levels were monitored for eight hours. Of the six study dogs given antivenom plus FFP, two died at around 60 to 90 minutes post envenoming, at the end of the FFP infusions, and all but one of the survivors had persistent afibrinogenaemia. Of the five study dogs given antivenom and no FFP, all but one had return of detectable fibrinogen at eight hours after envenoming. The platelet count fell in all animals with recovery independent of antivenom dose, administration of FFP, or regeneration of fibrinogen. Post mortem examinations of dogs that died during dosage and administration studies showed massive intracardiac clots. We conclude that early death from Brown Snake envenoming may be due to massive intravascular clotting. FFP administration was associated with persistent afibrinogenaemia regardless of antivenom dose. In the absence of any evidence for its efficacy, this study suggests that the role of FFP after Brown Snake envenoming should be reconsidered.
Dose-related Effect of Propofol on Pancreatic Enzymes and Triglyceride Levels in Patients Undergoing Non-abdominal Surgery
Authors: Pradeep K. , Wig J. , Panda N. B. , Prasad R. 
Published: January 2019

Various case reports have indicated a possible relationship between propofol and pancreatitis. However, it is not clear whether this relationship (if any) is dose-related or idiosyncratic. Therefore, a prospective study was conducted to evaluate the effect of different doses of propofol on postoperative pancreatic enzymes and serum triglyceride levels. One hundred and fifty patients, aged 18 to 60 years, belonging to ASA physical status I and II, undergoing non-abdominal surgery were divided into three groups. Anaesthesia was induced with propofol 2 to 2.5 mg/kg in all groups. It was maintained with isoflurane in group I, propofol infusion <5 mg/kg/h in group II and propofol infusion ≥5 mg/kg/h in group III. All three groups also received nitrous oxide in oxygen for maintenance of anaesthesia. Serum amylase, lipase and triglyceride were estimated before propofol administration and at 24 and 72 hours postoperatively. The mean values of serum amylase, lipase and triglyceride remained within the normal range in the three groups. These values did not differ significantly in between the groups even despite the significantly different doses of propofol in the three groups (P <0.001). None of the patients in the three groups developed any feature suggestive of acute pancreatitis in the postoperative period. These findings indicate that propofol administration at recommended doses does not produce dose-related increases in pancreatic enzyme and triglyceride levels in ASA physical status I and II patients.
Users' Opinions on Intensive Care Unit Alarms — a Survey of German Intensive Care Units
Authors: Siebig S. , Sieben W. , Kollmann F. , Imhoff M. , Bruennler T. , Rockmann F. , Gather U. , Wrede C. E. 
Published: January 2019

Monitoring of physiologic parameters in critically ill patients is associated with an enormous number of alarms, leading to reduced clinical value with high sensitivity but low specificity. To evaluate opinions of intensive care unit (ICU) staff on current monitoring we conducted a survey of German ICUs. Furthermore, the survey aimed to assess requirements and requests for future alarm systems. The survey was conducted between May 2006 and June 2007 on a randomised sample of German ICUs. Questionnaires with 24 partly closed-ended partly open-ended questions were posted. Of 915 letters, 274 (30%) from 185 contacted ICUs were returned and evaluated. One hundred and sixty physicians, the majority (52%) working in a department of anaesthesiology, and 114 nurses returned the survey. Most responders (87%) estimated that less than 50% of current alarms result in clinical consequences (52% estimated less than 25%). We suggested trend alarms, smoothing of signals to reduce artefacts, generation of new combined alarms and integrative monitoring of different alarm systems as improvements of current ICU alarm systems, all of which were agreed to by the majority. Free text commentaries focused on the need for reducing alarms caused by artefacts and called for improvement of the monitor-user interfaces. Our survey demonstrates the dissatisfaction of clinical staff with the current alarm systems regarding alarm frequency and specificity in German ICUs, thereby confirming data raised in single institutions. ICU staff's acceptance for new alarm algorithms like signal extraction or detection of trends as a basis for smart monitoring appealed to the majority of users.
Survey of Airway Skills of Surgeons in Western Australia
Authors: Riley R. H. , Strang T. , Rao S. 
Published: January 2019

Our objective was to survey all consultant surgeons, including obstetricians/gynaecologists, in the State of Western Australia to assess their experience with, and readiness to assist anaesthetists with a difficult or failed airway. Survey questionnaires were mailed to all surgeons registered in Western Australia (n=445). A total of 238 responses (53%) were received, mostly from general surgeons, obstetrician/gynaecologists and orthopaedic surgeons. Forty percent had provided non-surgical assistance with a difficult airway and 60% had assisted with a surgical airway. All ear, nose and throat surgeons who responded to the survey had assisted with an emergency surgical airway and 47 surgeons reported having performed six or more surgical airways. However, 26% of respondents had never performed a surgical airway and 37% did not feel confident in performing an urgent surgical airway. Seven percent of respondents reported witnessing a failed airway that resulted in death or neurological damage. Seventy percent of respondents had undergone formal training in tracheostomy and 26% had advanced trauma life support or early management of severe trauma training. These findings indicate that surgeons in Western Australia perform surgical airways infrequently and only occasionally assist anaesthetists with difficult airway management. However, some surgeons lack confidence and training in surgical airway management. Because anaesthetists cannot always rely on their surgical colleagues to provide a surgical airway during a crisis, we recommend that anaesthetists discuss airway management with their surgical colleagues for all patients with identified difficult airways and that anaesthesia training should include surgical airway management.
The Prevention of Second Anaphylactoid Reactions to Anaesthetic Drugs
Authors: Fisher M. McD. 
Published: January 2019

Fourteen patients who had second reactions to anaesthetic drugs are described. These reactions occurred for various reasons: attributing the initial reaction to the wrong drug, failure to appreciate the possibility of cross sensitivity, and failure to investigate the reaction and explain the reaction fully to the patient. With adequate investigation, communication and avoidance of drugs responsible, use of pretreatment and alternative techniques, the risk of second reactions should be reduced.
Changes of Body Temperature and Heat in Cardiac Surgical Patients
Authors: Shanks Colin A. , Wade Leonard D. , Meyer Ronald , Wilkinson Carolyn J. 
Published: January 2019

Changes in body temperature were assessed in ten adult patients undergoing surgery involving cardiopulmonary bypass (CPB) and induced hypothermia. Intraoperatively, in comparable time intervals before CPB and after rewarming, the patients lost body heat. Between the time of induction of anaesthesia and CPB, the temperature of blood in the pulmonary artery fell 1.46 (SD 0.28°C); between CPB and the end of surgery the fall was 1.55 (SD 0.86°C). The extent of spontaneous hypothermia did not correlate with the amount of subcutaneous fat. Hypothermia was induced to obtain a stable deep body temperature of 27.2 (SD 1.3)°C, when mean skin temperature averaged 2°C higher. The CPB machine returned approximately 2000 kJ of heat in the rewarming period, to produce pulmonary artery and mean skin temperatures of 37.1 (SD 0.7)°C and 31.4 (SD 2.1)°C respectively. Intraoperative deep body temperatures demonstrated the expected exponential relationship with metabolic rate. Postoperatively, increase in metabolic rate was associated with rising deep body and skin temperatures. Low resistance to the flow of heat toward the skin surface was demonstrated by low postoperative values for thermal insulation, which may indicate good peripheral perfusion seen during continuing vasodilator therapy.
A Simple Method of Bronchoalveolar Lavage
Authors: Schindler M. B. , Cox P. N. 
Published: January 2019

Twenty-eight ventilated paediatric intensive care patients, mean age 4.1 ± 4 years, who had had a simple method of non-bronchoscopic bronchoalveolar lavage (NB-BAL) performed were reviewed. The NB-BAL technique involved blindly wedging a 5 or 8F infant feeding catheter endobronchially and lavaging one millilitre per kg saline using a syringe. Adequate samples were collected in 87% of the NB-BAL specimens. In two of the four inadequate specimens, Pneumocystis carinii was still able to be identified. Additional information not obtained from the tracheal aspirate culture was seen in 71% of the NB-BAL samples. One-third of the patients also had a bronchoscopic BAL or a lung biopsy performed and the culture results were all identical to those obtained from NB-BAL. No significant complications were seen. Oxygenation and ventilation were not altered by the technique. We conclude that NB-BAL performed using a syringe and infant feeding catheter is a simple and cheap method that produces good alveolar samples in the majority of cases.
Auditory Recall and Response to Command during Recovery from Propofol Anaesthesia
Authors: Williams M. L. , Sleigh J. W. 
Published: January 2019

Most studies of awareness under general anaesthesia use the ability to respond to a verbal command as the primary measure of consciousness. The aim of this pilot study was to discover whether it was possible for subjects recovering from a propofol general anaesthetic to experience conscious awareness without the capability of responding to verbal command. Ten healthy volunteers received an intravenous propofol infusion (1500 mg/hr) until they were no longer conscious. The infusion was then stopped and they were given verbal commands interspersed with random numbers from a recorded tape until they were able to respond appropriately. Seven of the subjects were able to remember numbers corresponding to times 10 to 40 seconds before they responded to verbal command. In none of these subjects was there recall of the number 30 minutes later. We concluded that there is an ability to have conscious awareness of auditory input without necessarily being able to demonstrate this by responding to verbal command.
Le spectacle de la douleur dans l’expérience : une étude dans les stades de rugby
Authors: Dubreuil Clément , Dion Delphine 
Published: January 2019

Résumé Cette recherche s’attache à comprendre comment le spectacle de la douleur contribue à l’expérience des spectateurs. Reposant sur une approche abductive et une collecte de données mixte et longitudinale de trois ans dans les stades, ce travail identifie quatre fonctions du spectacle de la douleur, en détaille les modalités et la progressivité. Cette recherche sur les matchs de rugby contribue à la littérature sur l’expérience et sur la douleur. Premièrement, elle approfondit la compréhension de l’ambivalence des expériences. Elle montre que les dimensions négatives de l’expérience sont valorisées par un système moral et normatif. Deuxièmement, cette recherche contribue à approfondir les connaissances sur l’attrait de la douleur, en montrant son association à un contenu symbolique. Troisièmement, elle introduit le concept de domestication de la violence face à la douleur. Le spectacle de rugby s’inscrit dans une dialectique nature / culture, avec d’un côté une violence pseudo-primitive et de l’autre une sophistication de codes et de règles. Des recommandations managériales et des perspectives de recherche sont également présentées.
Syntactic awareness skills in English among children who speak Slavic or Chinese languages as a first language and English as a second language
Authors: Lipka Orly 
Published: January 2019

Aims and objectives/purpose/research questions: The purpose of this study was to examine syntactic awareness skills in English, among two groups of children: native Chinese speakers and native Slavic (L1) speakers. Both groups were second language English (L2) speakers. Their syntactic awareness skills were compared to a matched sample of L1 English speakers. Design/methodology/approach: Eighty-six third grade students participated in the study, matched between language groups on the basis of age and gender, as well as academic achievements and word reading levels. Data and analysis: L1 English and L1 Slavic groups performed significantly better on the syntactic awareness task than did the L1 Chinese group. A close examination of specific syntactic constructions revealed that the L1 Chinese group did not perform as well as the other groups on past tense constructions, which do not exist in Chinese but do exist in Slavic languages. However, there were no between-group differences on superlative and comparative constructions, which exist in all three languages. Findings/conclusions: The results contribute to our knowledge about cross-linguistic influences between English, Slavic, and Chinese, showing that L1 Slavic facilitates the learnability of L2 English, while L1 Chinese impedes the learnability of L2 English. Originality: The originality of the study lies in the comparison of children from three different L1 groups, matched with respect to reading level. The examination of languages that are typologically different in their syntax is unique. Significance/implications: The results highlight the importance of taking the specific language backgrounds of L2 learners into consideration. Limitations: The current study did not include an assessment of L1 language proficiency among participants.
Quantifying outcomes for leech therapy in digit revascularization and replantation
Authors: Lee Z-Hye , Cohen Joshua M. , Daar David , Anzai Lavinia , Hacquebord Jacques , Thanik Vishal 
Published: January 2019

We retrospectively reviewed 201 digit replantations or revascularizations that were performed between August 2007 and June 2015. Leeching therapy was used in 48 digits and was more commonly required in replanted digits. In revascularized digits, leeching was used significantly more frequently in avulsion injuries and injuries associated with fractures. Digits that were leeched for more than 4.5 days had significantly higher rates of survival of digits after replantation or revascularization. Leeching was associated with higher incidence of transfusion, higher mean number of transfusions, and longer length of stay. We conclude from this study that leeching is used more frequently after digital replantation than revascularizaion, and in revascularized digits, leeching is used more often in avulsion injury and in patients with fractures. In patients requiring leeching therapy, leaching for more than 4.5 days leads to higher rate of digital survival. Level of evidence: IV