bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variations in surgical technique for adrenalectomy with caudal vena cava venotomy in 19 dogs
Authors: Knight Rebekah C. , Lamb Christopher R. , Brockman Daniel J. , Lipscomb Victoria J. 
Published: January 2019

AbstractObjectiveTo describe surgical techniques, caval occlusion times, and short‐term outcomes in dogs undergoing adrenalectomy with caval venotomy.Study designRetrospective case series.AnimalsDogs undergoing adrenalectomy with caval venotomy between October 1, 2010 and May 31, 2018.MethodsMedical records of dogs undergoing adrenalectomy with caval venotomy were reviewed for signalment, perioperative management, surgical details, perioperative complications, mortality, and histopathology. Computed tomography images were reviewed to describe tumor morphology and signs of thrombus extension.ResultsNineteen dogs had adrenal tumor thrombi extending into the prehepatic (14 dogs, 74%), hepatic (3 dogs, 16%), and posthepatic (2 dogs, 11%) caudal vena cava. Tumors occurred in left (11) and right (8) adrenal glands. Median caval occlusion was 6.5 minutes (range, 2–25). Two to six vascular tourniquets were used. Venotomy closure was performed under full caval occlusion in 11 dogs and by using a partial occlusion clamp in 8 dogs. Left ureteronephrectomy was performed in 5 dogs. Perioperative mortality rate was 21% (4 dogs).ConclusionExtension of caval tumor thrombus beyond the hepatic hilus did not preclude a good outcome. Longer caval occlusion than has been previously reported was tolerated in some cases. Number of vascular tourniquets used reflected the location of phrenicoabdominal vein insertion on the cava and length of the caval tumor thrombus. Venotomy closure under full occlusion was often required for right adrenal tumors. When required, ureteronephrectomy was left sided.Clinical significanceDogs with adrenal tumors extending beyond the hepatic hilus and those requiring a long caval occlusion time can survive adrenalectomy.
Evaluation of a resorbable self‐locking ligation device for performing peripheral lung biopsies in a caprine cadaveric model
Authors: Nylund Adam M. , Chen Chi‐Ya , Höglund Odd V. , Campbell Bonnie G. , Fransson Boel A. 
Published: January 2019

AbstractObjectiveTo compare airway leak pressures after sealing peripheral lung biopsy sites with a resorbable ligation device (LigaTie) or thoracoabdominal (TA) staples.Study designEx vivo study.AnimalsFour normal caprine cadavers.MethodsTwelve lung lobes were harvested from 4 goats immediately after euthanasia. Each lobe was inflated to 20 cm H2O to test for leaks prior to biopsy. Pressure was then maintained at 10 cm H2O. Biopsy samples were obtained 3 cm from the periphery with a resorbable ligation device or a TA stapler (n = 6 per group). After biopsy, inflation pressure was slowly increased to 40 cm H2O while lungs were submerged in water. The pressure at which bubbles were first seen was recorded as the airway leak pressure. The length, width, volume, and weight were recorded for each biopsy sample.ResultsFive of 6 LigaTie biopsy sites sustained the maximum pressure of 40 cm H2O without leaking. One site leaked at 24 cm H2O. The TA‐stapled sites sustained airway pressure to median 25.5 cm H2O (interquartile range, 23.5–26 cm H2O), and none of them reached the maximum pressure (P = .015). There were no differences in biopsy length, volume, or weight between groups.ConclusionBiopsy sites sealed with LigaTie withstood higher airway pressure without leaking compared with TA‐stapled biopsy sites in normal cadaveric specimens.Clinical significanceThe LigaTie may be an alternative technique for sealing peripheral lung biopsy sites.
Medical students’ experience of a Teddy Bear Hospital as part of a paediatric curriculum
Authors: Nheu Lilly , Uahwatanasakul Wonie , Gray Amy 
Published: January 2019

Introduction: Teddy Bear Hospital is a strategy used to help reduce children’s fears of the healthcare system and teach them about health-related issues. It involves mock consultations where medical students play the role of a “teddy doctor” and children act as the carer of teddy, or another soft toy, requiring consultation. This provides medical students with the opportunity to interact with children and develop communication skills while children are introduced to the medical consultation process. The aim of this study was to evaluate the medical student experience of Teddy Bear Hospital as part of a paediatric curriculum.Methods: We conducted a qualitative observational study using observations and focus group interviews with third-year postgraduate medical students. Strategies for engaging children and medical student behaviours were observed. In focus groups, students discussed their experience and the benefits of involvement they perceive. Inductive content analysis was performed, guided by a phenomenological approach, to identify themes.Results: Three major themes were identified: student discomfort, adapting communication to child temperament and developmental age and how the Teddy Bear Hospital contextimpacts learning. Students experienced discomfort approaching families and through disclosure of medical information. Despite this, students described it as an enjoyable learning experience that taught them to adapt communication to the child. Students also recognised greater challenges in a hospital-based event than one in the community.Conclusions: Participation in Teddy Bear Hospital appears to be a valuable component of the paediatric curriculum for medical students. Through enjoyable experiential learning, students described developing important communication skills with children. While they did experience discomfort in the process, this has potential to deepen learning.
Radiography Student Preferences Regarding Assessments and Feedback
Authors: Oh Audrey , Williams Imelda , Hodgson Yvonne 
Published: January 2019

Introduction: Assessment and feedback are important aspects of higher education. In allied health degrees, including radiography, the successful completion of assessments demonstrates that a graduate meets accreditation standards for clinical practice. Feedback within a degree program provides critical information to students on their attainment of these skills. Using a framework of discourse, emotion and identity, this study investigated the preferences of radiography students regarding the assessments and feedback they experienced during their degree program at an Australian university.Method: A survey was administered to all radiography students. Students were asked to rank the assessment tasks and feedback they experienced during their degree program according to what they liked most and learned the most from. Final-year students were asked an additional question about their perceived readiness to meet professional standards.Results: The survey was completed by 129/264 (48.9%) students. The assessment most liked by students was computer-based image analysis (mean 4.99/6.00) while practical assessment was ranked as the assessment that they learned the most from (mean 4.12/6.00). These types of assessments are strongly related to professional identity. Feedback preferences differed depending on the setting—detailed written comments were most preferred on campus (mean 4.88/6.00) while individual verbal feedback was most preferred in the clinical context (mean 4.54/6.00). Discourse is an important aspect of these types of feedback. Final-year students gave positive ratings of their preparedness to meet professional standards.Conclusion: Our findings provide a greater understanding of radiography student preferences in assessment and feedback, which can guide future curriculum design. Students valued and preferred assessments that related to professional identity and real-life radiography skills. Students’ preferred form of feedback was dependent upon the learning environment.
Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial
Authors: Kortekangas Tero , Haapasalo Heidi , Flinkkilä Tapio , Ohtonen Pasi , Nortunen Simo , Laine Heikki-Jussi , Järvinen Teppo LN , Pakarinen Harri 
Published: January 2019

AbstractObjectiveTo determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks.DesignRandomised, pragmatic, non-inferiority, clinical trial with blinded outcome assessment.SettingTwo major trauma centres in Finland, 22 December 2012 to 6 June 2016.Participants247 skeletally mature patients aged 16 years or older with an isolated Weber B type fibula fracture and congruent ankle mortise in static ankle radiographs.InterventionsParticipants were randomly allocated to conventional six week cast immobilisation (n=84) or three week treatment either in a cast (n=83) or in a simple orthosis (n=80).Main outcome measuresThe primary, non-inferiority, intention-to-treat outcome was the Olerud-Molander Ankle Score at 12 months (OMAS; range 0-100; higher scores indicate better outcomes and fewer symptoms). The predefined non-inferiority margin for the primary outcome was −8.8 points. Secondary outcomes were ankle function, pain, quality of life, ankle motion, and radiographic outcome. Follow-up assessments were performed at 6, 12, and 52 weeks.Results212 of 247 randomised participants (86%) completed the study. At 52 weeks, the mean OMAS was 87.6 (SD 18.3) in the six week cast group, 91.7 (SD 12.9) in the three week cast group, and 89.8 (SD 18.4) in the three week orthosis group. The between group difference at 52 weeks for the three week cast versus six week cast was 3.6 points (95% confidence interval −1.9 to 9.1, P=0.20), and for the three week orthosis versus six week cast was 1.7 points (−4.0 to 7.3, P=0.56). In both comparisons, the confidence intervals did not include the predefined inferiority margin of −8.8 points. The only statistically significant between group differences observed in the secondary outcomes and harms in the two primary comparisons were slight improvement in ankle plantar flexion and incidence of deep vein thrombosis, both in the three week orthosis group versus six week cast group.ConclusionImmobilisation for three weeks with a cast or orthosis was non-inferior to conventional cast immobilisation for six weeks in the treatment of an isolated stable Weber B type fracture.Trial registrationClinicalTrials.govNCT01758835.
Impact and sustainability of centralising acute stroke services in English metropolitan areas: retrospective analysis of hospital episode statistics and stroke national audit data
Authors: Morris Stephen , Ramsay Angus I G , Boaden Ruth J , Hunter Rachael M , McKevitt Christopher , Paley Lizz , Perry Catherine , Rudd Anthony G , Turner Simon J , Tyrrell Pippa J , Wolfe Charles D A , Fulop Naomi J 
Published: January 2019

Abstract

Objectives
To investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained.

Design
Retrospective analyses of patient level data from the Hospital Episode Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP).

Setting
Acute stroke services in Greater Manchester and London, England.

Participants
509 182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218 120 stroke patients in SSNAP between April 2013 and March 2016.

Interventions
Hub and spoke models for acute stroke care.

Main outcome measures
Mortality at 90 days after hospital admission; length of acute hospital stay; treatment in a hyperacute stroke unit; 19 evidence based clinical interventions.

Results
In Greater Manchester, borderline evidence suggested that risk adjusted mortality at 90 days declined overall; a significant decline in mortality was seen among patients treated at a hyperacute stroke unit (difference-in-differences −1.8% (95% confidence interval −3.4 to −0.2)), indicating 69 fewer deaths per year. A significant decline was seen in risk adjusted length of acute hospital stay overall (−1.5 (−2.5 to −0.4) days; P<0.01), indicating 6750 fewer bed days a year. The number of patients treated in a hyperacute stroke unit increased from 39% in 2010-12 to 86% in 2015/16. In London, the 90 day mortality rate was sustained (P>0.05), length of hospital stay declined (P<0.01), and more than 90% of patients were treated in a hyperacute stroke unit. Achievement of evidence based clinical interventions generally remained constant or improved in both areas.

Conclusions
Centralised models of acute stroke care, in which all stroke patients receive hyperacute care, can reduce mortality and length of acute hospital stay and improve provision of evidence based clinical interventions. Effects can be sustained over time.
Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis
Authors: de Groot Rosa , van den Hurk Katja , Schoonmade Linda J , de Kort Wim L A M , Brug Johannes , Lakerveld Jeroen 
Published: January 2019

IntroductionThe built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults.MethodsPubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years). Two reviewers independently screened titles/abstracts and full-texts of papers and appraised the risk of bias of included studies using an adapted version of the Quality Assessment Tool for Quantitative Studies. We performed meta-analyses when five or more studies had sufficient homogeneity in determinant and outcome.ResultsAfter screening 6902 titles/abstracts and 141 potentially relevant full-text articles, we included 50 studies. Forty-seven studies explored associations between urban versus rural areas with blood lipid levels. Meta-analyses on urban versus rural areas included 133 966 subjects from 36 studies in total. Total cholesterol levels were significantly and consistently higher in urban areas as compared with rural areas (mean difference 0.37 mmol/L, 95% CI 0.27 to 0.48). Urban/rural differences in high density lipoprotein cholesterol were inconsistent across studies and the pooled estimate showed no difference (0.00 mmol/L 95% CI −0.03 to 0.04). Low density lipoprotein (LDL) cholesterol and triglyceride levels were higher in urban than in rural areas (mean difference 0.28, 95% CI 0.17 to 0.39 and 0.09, 95% CI 0.03 to 0.14, respectively).ConclusionsTotal and LDL cholesterol levels and triglycerides were consistently higher in residents of urban areas than those of rural areas. These results indicate that residents of urban areas generally have less favourable lipid profiles as compared with residents of rural areas.Prospero registration numberCRD42016043226.
The impact of a cash transfer programme on tuberculosis treatment success rate: a quasi-experimental study in Brazil
Authors: J Carter Daniel , Daniel Rhian , Torrens Ana W , N Sanchez Mauro , Maciel Ethel Leonor N , Bartholomay Patricia , Barreira Draurio C , Rasella Davide , Barreto Mauricio L , Rodrigues Laura C , Boccia Delia 
Published: January 2019

BackgroundEvidence suggests that social protection policies such as Brazil’s Bolsa Família Programme (BFP), a governmental conditional cash transfer, may play a role in tuberculosis (TB) elimination. However, study limitations hamper conclusions. This paper uses a quasi-experimental approach to more rigorously evaluate the effect of BFP on TB treatment success rate.MethodsPropensity scores were estimated from a complete-case logistic regression using covariates from a linked data set, including the Brazil’s TB notification system (SINAN), linked to the national registry of those in poverty (CadUnico) and the BFP payroll.ResultsThe average effect of treatment on the treated was estimated as the difference in TB treatment success rate between matched groups (ie, the control and exposed patients, n=2167). Patients with TB receiving BFP showed a treatment success rate of 10.58 percentage points higher (95% CI 4.39 to 16.77) than patients with TB not receiving BFP. This association was robust to sensitivity analyses.ConclusionsThis study further confirms a positive relationship between the provision of conditional cash transfers and TB treatment success rate. Further research is needed to understand how to enhance access to social protection so to optimise public health impact.
Spatial and temporal projections of the prevalence of active tuberculosis in Cambodia
Authors: Prem Kiesha , Pheng Sok Heng , Teo Alvin Kuo Jing , Evdokimov Konstantin , Nang Ei Ei Khaing , Hsu Li Yang , Saphonn Vonthanak , Tieng Sivanna , Mao Tan Eang , Cook Alex R 
Published: January 2019

IntroductionCambodia is among the 30 highest burden of tuberculosis (TB) countries. Active TB prevalence has been estimated using nationally representative multistage sampling that represents urban, rural and remote parts of the country, but the prevalence in non-sampled communes remains unknown. This study uses geospatial Bayesian statistics to estimate point prevalence across Cambodia, and demographic modelling that accounts for secular trends in fertility, mortality, urbanisation and prevalence rates to project the future burden of active TB.MethodsA Bayesian hierarchical model was developed for the 2011 National Tuberculosis Prevalence survey to estimate the differential effect of age, sex and geographic stratum on active TB prevalence; these estimates were then married with high-resolution geographic information system layers to project prevalence across Cambodia. Future TB projections under alternative scenarios were then derived by interfacing these estimates with an individual-based demographic model.ResultsStrong differences in risk by age and sex, together with geographically varying population structures, yielded the first estimated prevalence map at a 1 km scale. The projected number of active TB cases within the catchment area of each existing government healthcare facility was derived, together with projections to the year 2030 under three scenarios:no future improvement,continualreductionandGDPprojection.ConclusionSynthesis of health and geographic data allows likely disease rates to be mapped at a high resolution to facilitate resource planning, while demographic modelling allows scenarios to be projected, demonstrating the need for the acceleration of control efforts to achieve a substantive impact on the future burden of TB in Cambodia.
Profile of a population-based diabetic macular oedema study: the Liverpool Eye and Diabetes Study (Sydney)
Authors: Liew Gerald , Wong Vincent W , Saw Mercy , Tsang Tania E , Nolan Tim , Ong Stephen , Ho I-Van 
Published: January 2019

PurposeThe population prevalence of diabetic macular oedema (DME) is unclear. Previous estimates have depended on photographic grading of clinically significant macular oedema, which is subjective and has resulted in widely varying estimates. With the advent of optical coherence tomography (OCT), the presence and severity of DME can now be assessed objectively and accurately.MethodsThe Liverpool Eye and Diabetes Study (LEADS) is a cross-sectional population-based study of patients with type 1 and type 2 diabetes in a multi-ethnic region of Sydney, Australia, to determine the population prevalence of OCT-defined DME, how this varies by ethnicity and association with systemic factors. This report describes the rationale, methodology and study aims.ResultsTo date 646 patients out of an expected sample size of 2000 have been recruited. Baseline data are presented for patients with type 1 (n=75, 11.8%) and type 2 (n=562, 88.2%) diabetes recruited to date. Patients with type 1 diabetes were younger (39.5vs60.7 years), with longer duration of diabetes (18.1vs11.7 years), slightly worse glycaemic control (HbA1c 9.0vs8.3), and less likely to have hypertension (30.7vs71.4%), hypercholesterolaemia (33.3vs74.6%) and obesity (31.1vs51.5%, respectively, all p<0.05).ConclusionsThe LEADS will provide objective estimates of the population prevalence of DME, how this varies with ethnicity and associations with systemic disease.
Learning from the transfer of a fellowship programme to support primary care workforce needs in the UK: a qualitative study
Authors: Bryce Carol , Russell Rachel , Dale Jeremy 
Published: January 2019

ObjectivesService redesign, including workforce development, is being championed by UK health service policy. It is allowing new opportunities to enhance the roles of staff and encourage multiprofessional portfolio working. New models of working are emerging, but there has been little research into how innovative programmes are transferred to and taken up by different areas. This study investigates the transferability of a 1-year post-Certification of Completion of Training fellowship in urgent and acute care from a pilot in the West Midlands region of England to London and the South East.DesignA qualitative study using semistructured interviews supplemented by observational data of fellows’ clinical and academic activities. Data were analysed using a thematic framework approach.Setting and participantsTwo cohorts of fellows (15 in total) along with key stakeholders, mentors, tutors and host organisations in London and the South East (LaSE). Fellows had placements in primary and secondary care settings (general practice, emergency department, ambulatory care, urgent care and rapid response teams), together with academic training.ResultsSeventy-six interviews were completed with 50 participants, with observations in eight clinical placements and two academic sessions. The overall structure of the West Midlands programme was retained and the core learning outcomes adopted in LaSE. Three fundamental adaptations were evident: broadening the programme to include multiprofessional fellows, changes to the funding model and the impact that had on clinical placements. These were felt to be key to its adoption and longer-term sustainability.ConclusionThe evaluation demonstrates a model of training that is adaptable and transferable between National Health Service regions, taking account of changing national and regional circumstances, and has the potential to be rolled out widely.