bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spinal Anaesthesia—Early Australian Experience
Authors: Mcbride L. J. 
Published: July 2019

Australia in 1902 was a fledgling colony in its second year of Federation with a population of around 3.7 million. European settlement had been largely confined to the coastal margins of this enormous land mass, although some bold adventurers in search of gold and farmland had struggled their way into the interior. Horsham, situated 300 km northwest of Melbourne in the state of Victoria, was founded in June 1849. By 1902 the town, with a population of around 2500, had grown to boast a hospital, two doctors, a pharmacist and a dentist. It was at the Horsham Hospital on January 7, 1902 that Dr Robert Ritchie performed Australia's first recorded spinal anaesthetic. Ritchie performed a lumbar puncture at the L3–4 level, injected 2 ml of 2% cocaine solution and waited for a total of 20 minutes before realising that the sensation the patient was feeling when he pinched him was pressure, not pain. The 78-year-old man with a gangrenous right leg, prostatic obstruction and congestive cardiac failure was laid supine, and had his right leg amputated through the thigh while being administered brandy and water. Strychnine injections were administered four hourly postoperatively. The adoption of the technique of spinal anaesthesia spread quickly in Australia despite communication difficulties at that time.
Barriers and Enablers That Influence Overweight/Obesity/Obesogenic Behavior in Adolescents From Lower-Middle Income Countries: A Systematic Review
Authors: Leandro Carol Góis , Fonseca Eveline Viana da Silva da , de Lim Cybelle Rolim , Tchamo Mario Eugénio , Ferreira-e-Silva Wylla Tatiana 
Published: July 2019

Background: Overweight/obesity during adolescence in lower-middle income countries has become a public health problem with consequences in adulthood. Inadequate dietary habits, poor diet quality, sedentary behavior, and parental obesity have been reported. Objective: To describe management of obesity-like food habits and behavior of adolescents from lower-middle income countries with respect to what keeps them using this diet (barriers) and what helps them avoid it (enablers). Methods: Systematic review of the literature related to obesity and food intake of adolescents conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results: We classified 11 eligible studies describing the barriers to and enablers of the management of obesity-like food intake and obesity lifestyle. The dual burdens of malnutrition and increased urbanization have been observed. There is preference for processed food, dietary habits, and obesity-like food intake and sedentary behavior. Barriers to managing body weight gain included mostly consumption of fast-food and snack food, less vegetable and fruit intake, skipping meals, and sedentary behavior. Enablers of managing body weight gain included changes in nutritional habits, perception of the consumption of healthy food, physical activity, and engagement in programs to change lifestyle. Conclusion: The globalization of the fast food industry has provided an obesogenic environmental stimulus for adolescents in lower-middle income countries.
Improving service in an emergency department by designing the health production flow
Authors: Barros Oscar , Riffo Rodrigo , Paredes Inti 
Published: July 2019

Background Most emergency departments have overcapacity with poor service measured by length of stay. We hypothesized that a formal design of the emergency department production flows will improve service. Thus, we propose a methodology that was tested in a large hospital, including new flow implementation. Results We implemented new workflows during June to July 2017. A comparison of the patients’ average length of stay from June to September shows a decrease of 26%. Additionally, a comparison with 2016 shows a decrease of 50%. Direct evaluation of the value generated reveals an emergency department admissions increase of 540 monthly, equivalent of a savings of approximately US$250.000 annually. This savings is a very conservative estimate because the most significant value of this work is fast service that diminishes the patients’ risks. Conclusions Production design is an important problem in health services in terms of potential service improvements, executable with a formal, systemic, replicable method founded on several disciplines. Thus, we are replicating the approach at other hospitals with extensions to other services.
Effectiveness of a Volunteer Training Program on the Learning Support of Children in Hospice Palliative Care
Authors: Niinomi Kazuteru , Soejima Masakazu , Hiraga Kentaro , Kodama Shoko , Okazaki Shin , Nakao Shigeki 
Published: July 2019

Background: Volunteers are expected to play a key role in children’s hospice. However, there is a lack of information about how to cultivate effective volunteer training programs. Objective: To verify the effect of a training program on volunteers’ confidence in providing learning support and sharing experiences with children with life-threatening conditions and their families in a children’s hospice. Methods: In this pre–post study, participants were 48 undergraduate and graduate students from 3 universities in Japan. They received 5 lectures on children’s hospice learning support. They evaluated the training program by rating their self-confidence in meeting each of the 15 program goals on a questionnaire. Results: An exploratory factor analysis of the questionnaire yielded 12 goals in 4 factors: understanding of one’s own and others’ mental state, accommodating the learning needs of children with life-threatening conditions, understanding and accommodating the physical state of children with life-threatening conditions, and understanding the significance of children’s hospice. A paired t test revealed that participants’ self-confidence had increased significantly in 3 of these 4 factors after the program. However, the score for accommodating the learning needs of children with life-threatening conditions decreased but not significantly. Conclusion: Although it needs some improvements, the program was effective for improving volunteers’ self-confidence in and understanding of learning support and sharing experiences with children with life-threatening conditions.
Early results of a high friction surface coated uncemented socket in revision hip arthroplasty
Authors: Chacko Vinay , Agrawal Pranshu , Porter Martyn L , Board Tim N 
Published: July 2019

Background: Revision hip arthroplasty with high friction trabecular metal sockets has resulted in good medium-term results. Many manufacturers have therefore introduced higher friction coatings to their implants to meet a growing demand for similar implants. The Pinnacle Gription was introduced in 2007 as an evolution of the standard Pinnacle socket. This study aimed to assess the early results of this socket in a revision setting. Methods: Between August 2009 and December 2016, the Gription socket was used in 146 revision hip replacements. The mean age was 63 (19–88) years. Defects were classified as Paprosky Grade 2 in 71(2A [28], 2B [19], 2C [24]) and grade 3 in 20 (3A [18], 3B [2]). Bearing combinations were ceramic-on-ceramic in 23, metal-on-polyethylene in 71, ceramic-on-polyethylene in 52. Screws were used in 112 cases, impaction bone grafting in 34 and metal augments in 1 case. Radiographs were analysed for progressive radiolucent lines and migration. Results: Mean follow-up was 43.5 (range 25–62) months. There were 6 re-revisions (2 for deep infection, 2 for recurrent dislocation and 2 for aseptic loosening). None of the other cases had evidence of socket migration or progressive radiolucent lines. There were no intraoperative or postoperative periprosthetic fractures. The crude survivorship for all-cause failure was 95.8% and the survivorship for aseptic loosening was 98.6%. at 43.5 months follow-up. Conclusions: This is the largest reported series of Gription socket use in revision arthroplasty and demonstrates encouraging early results. We therefore advocate the continued cautious use of this implant.
Effect of Simple Interrupted Suture Spacing on Aesthetic and Functional Outcomes of Skin Closures
Authors: Stoecker Allison , Blattner Collin M , Howerter Stephanie , Fancher Whitney , Young John , Lear William 
Published: July 2019

Background Dermatologic surgeons are trained in fundamental wound closure techniques that minimize wound tension and tissue ischemia to optimize healing and create discrete scars. These include orienting excisions along resting skin tension lines, handling tissue edges with care, and avoiding strangulation while tying suture. Another variable that may affect wound healing and cosmetic outcomes is the spacing between sutures. Objective This prospective, single-centre, randomized, split-scar comparison trial was designed to explore how suture spacing distance affects wound complication rate and scar cosmesis. Methods Elliptical surgical wounds of the trunk and extremities were repaired with simple interrupted sutures with varying suture spacing. One half of each wound was repaired with high-density suture spacing (approximately 5 mm apart) and the other with low-density suture spacing (approximately 10 mm apart). Wounds were evaluated at 2-week suture removal for complications, and then reevaluated at 3 and 6 months for cosmesis using the Patient and Observer Scar Assessment Scale score. Results Results revealed no significant difference in minor wound complications during the early healing process between high- and low-density suture spacing. At 3 months postoperatively, physicians and patients alike preferred the aesthetics of the low-density suture placement. By 6 months postoperatively, this preference disappeared. Conclusions These results suggest that suture spacing may affect early scar formation. Additionally, placing sutures farther apart results in fewer total puncture wounds, decreases tissue trauma, and saves surgical time while conserving suture material. Therefore, dermatologic surgeons should consider placing fewer percutaneous sutures during wound repair.
The role of open and endovascular treatment of patients with chronic aortoiliac Leriche syndrome
Authors: Kretschmann Tim , Usai Marco V , Taneva Gergana T , Pitoulias Georgios A , Torsello Giovanni , Donas Konstantinos P 
Published: July 2019

Objectives Leriche syndrome, defined as a chronic obliteration of a segment of the infrarenal aorta and the iliac arteries, represents a challenging pathology. Surgical reconstruction represents the standard treatment option. However, the endovascular therapy is gaining ever greater applicability in several vascular territories comparable with the open repair results. The aim of the present study was to evaluate the role of endovascular repair in patients with chronic Leriche syndrome. Methods Between January 2008 and September 2016, 82 patients with Leriche syndrome underwent surgical and endovascular repair at two European vascular centers. After risk stratification, 40 patients were matched based on chronic TASC D obstructive arterial disease with involvement of the aortic bifurcation and bilateral iliac arteries, the age, and the cardiovascular risk factors identifying finally 20 patients who underwent surgical repair (open group) and 20 patients who were treated by deployment of stents/stent-grafts in the aortic and iliac segment (endo group). Kaplan–Meier estimation for patency and freedom from reintervention were calculated and univariate analyses were performed. Results Estimated primary patency rate was 100% vs. 84% at one year for the open group vs. endovascular group, respectively ( p = .05). Freedom from reintervention was 100% vs. 89% at one year for the open group vs. endo group ( p = .09). During the entire follow-up of 34.9 ± 23.1 months, five reinterventions were performed for the endo group vs. two for the open group ( p = .212). Additionally, the major adverse cardiac and cerebrovascular events were 5/20 vs. 2/20 for the endovascular vs. open group, respectively ( p = .212). The postoperative ankle–brachial index improved in 0.66 in the endo group vs. 0.71 in the open group ( p = .624). Conclusions Endovascular techniques for the treatment of complex chronic Leriche lesions seem not to be associated with better early or mid-term outcomes compared to surgical repair.
Blinded Evaluation of Endoscopic Skill and Instructability After Implementation of an Endoscopic Simulation Experience
Authors: Stephenson Elizabeth D. , Farquhar Douglas R. , Masood Maheer M. , Capra Gregory , Kimple Adam , Ebert Charles S. , Thorp Brian D. , Zanation Adam M. 
Published: July 2019

Background Interest in endoscopic simulation is increasing. Past studies have used virtual reality or nonhuman models or residents with varying experience. Our aim was to evaluate the effect of simulation on procedural and psychomotor competence of medical students—surgical novices—performing endoscopic tasks on human cadavers and assess student perceptions. Methods Students (n = 22) completed a baseline sinus model skill evaluation graded by 2 blinded Rhinology fellows. Intervention and control groups with equal baselines were assigned. Intervention students practiced endoscopic tasks on the model for 45 minutes minimum over 2 weeks. All students reviewed sinus anatomy/disease and sinus surgery materials. The final cadaver evaluation was similar to the baseline. Fellows graded students on anatomy identification (sinuses, turbinates), psychomotor (navigation, camera alignment, instrument handling), and timed procedural (sinus object retrieval) skills, confidence, and instructability via fellow-guided frontal balloon placement. Results Participants included 16 males (72.7%) and 6 females (27.3%). Intervention and control groups contained 10 (45.4%) and 12 (54.6%) students, respectively. Intervention group final “Total Psychomotor” scores were higher (10.1/15 vs 7.8/15, P = .0231). “Surgical confidence” was 3.3/5 versus 2.5/5, and “Instructability” was 3.9/5 versus 3.4/5 in intervention versus control groups, respectively ( P < .050). Multivariate regression analysis demonstrated superior psychomotor skills, navigation, and confidence in the intervention group ( P < .036). Activity perception scores were higher in intervention students versus controls, 26.13 versus 18.36/40 ( P = .022). Conclusion In surgical novices, endoscopic simulation leads to superior endoscopic navigation and task performance in cadavers. This simulation presents a novel method for incorporating Otolaryngology simulation in medical student education.
Endoscopic management of 345 small rectal neuroendocrine tumours: A national study from the French group of endocrine tumours (GTE)
Authors: Fine Caroline , Roquin Guillaume , Terrebonne Eric , Lecomte Thierry , Coriat Romain , Do Cao Christine , de Mestier Louis , Coffin Elise , Cadiot Guillaume , Nicolli Patricia , Lepiliez Vincent , Hautefeuille Vincent , Ramos Jeanne , Girot Paul , Dominguez Sophie , Céphise Fritz-Line V , Forestier Julien , Hervieu Valérie , Pioche Mathieu , Walter Thomas 
Published: July 2019

IntroductionSmall rectal neuroendocrine tumours are good candidates for endoscopic resection provided that complete pathological resection (R0) is obtained and their risk of metastatic progression is low. We conducted a large multicentre nationwide study to evaluate the outcomes of the management of non‐metastatic rectal neuroendocrine tumours ≤2 cm diagnosed endoscopically.Patients and methodsThe medical records, the endoscopic and pathological findings of patients with non‐metastatic rectal neuroendocrine tumours ≤2 cm managed from January 2000–June 2018 in 16 French hospitals, were retrospectively analysed. The primary objective was to describe the proportion of R0 endoscopic resections.ResultsA total of 329 patients with 345 rectal neuroendocrine tumours were included, 330 (96%) tumours were managed by local treatments: 287 by endoscopy only and 43 by endoscopy followed by transanal endoscopic microsurgery. The final endoscopic R0 rate was 134/345 (39%), which improved from the first endoscopy (54/225, 24%), to the second (60/100, 60%) and the third endoscopy (20/26, 77%). R0 was associated with endoscopic technique (90% for advanced techniques, 40% for mucosectomy and 17% for polypectomy), but not with tumour or patient characteristics. Twenty patients had metastatic disease, which was associated with tumour size ≥10 mm (odds ratio: 9.1, 95% confidence interval (3.5–23.5)), tumour grade G2–G3 (odds ratio: 4.2, (1.5–11.7)), the presence of muscular (odds ratio: ∞, (11.9–∞)) and lymphovascular invasion (odds ratio: 57.2, (5.6–578.9)).ConclusionsThe resection of small rectal neuroendocrine tumours often requires multiple procedures. Training of endoscopists is necessary in order to better recognise these tumours and to perform the appropriate resection technique.
Possible effects of a free, healthy school meal on overall meal frequency among 10–12-year-olds in Norway: the School Meal Project
Authors: Vik Frøydis N. , Næss Ida K. , Heslien Kaia E. P. , Øverby Nina C. 
Published: July 2019

Abstract
Objective
To evaluate possible effects of intake of a free, healthy school meal on overall meal frequency among 10–12-year-olds in Norway. This was evaluated using a quasi-experimental school-based intervention study assessing children’s meal frequency retrospectively using a questionnaire in two elementary schools in the southern part of Norway in 2014/15. Multiple logistic regression analyses with breakfast, lunch, dinner, supper as dependent variables were used.

Results
A total of 164 children at baseline; 55 children in the intervention group and 109 children in the control group were included. The serving of a free school meal every day for 1 year did not improve the overall meal frequency in the intervention group compared to the control group. However, children in the intervention group had a lower odds of eating breakfast during weekends compared to the control group in crude analyses [odds ratio (OR) = 0.28 (95% confidence interval (CI) 0.09–0.84)] and in adjusted analyses [adjusted for baseline values, gender and socio-economic status) (OR = 0.15 (95% CI 0.03–0.72)]. Studies including larger study samples and therefore more statistical power are needed to further investigate possible effects of school meals on meal frequency.
Trial registration ISRCTN61703361, Date of registration: December 3rd, 2018, Retrospectively registered
Realizing a Closed-Loop (Artificial Pancreas) System for the Treatment of Type 1 Diabetes
Authors: Lal Rayhan A , Ekhlaspour Laya , Hood Korey , Buckingham Bruce 
Published: July 2019

AbstractRecent, rapid changes in the treatment of type 1 diabetes have allowed for commercialization of an “artificial pancreas” that is better described as a closed-loop controller of insulin delivery. This review presents the current state of closed-loop control systems and expected future developments with a discussion of the human factor issues in allowing automation of glucose control. The goal of these systems is to minimize or prevent both short-term and long-term complications from diabetes and to decrease the daily burden of managing diabetes. The closed-loop systems are generally very effective and safe at night, have allowed for improved sleep, and have decreased the burden of diabetes management overnight. However, there are still significant barriers to achieving excellent daytime glucose control while simultaneously decreasing the burden of daytime diabetes management. These systems use a subcutaneous continuous glucose sensor, an algorithm that accounts for the current glucose and rate of change of the glucose, and the amount of insulin that has already been delivered to safely deliver insulin to control hyperglycemia, while minimizing the risk of hypoglycemia. The future challenge will be to allow for full closed-loop control with minimal burden on the patient during the day, alleviating meal announcements, carbohydrate counting, alerts, and maintenance. The human factors involved with interfacing with a closed-loop system and allowing the system to take control of diabetes management are significant. It is important to find a balance between enthusiasm and realistic expectations and experiences with the closed-loop system.
Mifepristone Increases Thyroid Hormone Requirements in Patients With Central Hypothyroidism: A Multicenter Study
Authors: Guarda Francisco J , Findling James , Yuen Kevin C J , Fleseriu Maria , Nachtigall Lisa B 
Published: July 2019

Abstract

Purpose
Mifepristone is a glucocorticoid and progesterone receptor blocker that can be used for patients with hyperglycemia and Cushing syndrome in whom surgery failed to achieve remission or who were ineligible for surgery. We report a case series of patients with Cushing disease (CD) and central hypothyroidism that presented with increased levothyroxine requirements during mifepristone therapy.

Methods
Retrospective longitudinal case series of patients with CD and central hypothyroidism treated with mifepristone in a retrospective database at four pituitary centers in the United States.

Results
Five patients with CD were found, all women, median age 50 (interquartile range 47 to 64.5). They received mifepristone because no adequate response or intolerance to other drugs was observed. Mifepristone initiation was associated with a decrease in free thyroxine levels, mandating a dose increase of a median 1.83 (1.71 to 3.5) times the initial dose of levothyroxine to achieve normal levels. Weight loss was seen in four of five patients, ranging from 3.2 to 42.6 kg in up to 54 months of follow-up.

Conclusions
Although the mechanism behind the decrease in thyroid hormone level is unknown, intestinal malabsorption, decreased residual thyroid function and increased inactivation of T4 via deiodinases are all potential causes. Whereas therapies for hypercortisolism aim to decrease features of hypercortisolemia such as weight gain and depression, hypothyroidism can hamper these goals. This case series raises awareness on the importance of assessment of thyroid status in patients receiving mifepristone to optimize clinical outcomes.