bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the working environment for the delivery of safe surgical care in the UK: a qualitative cross-sectional analysis
Authors: Baggaley Alice , Robb Lydia , Paterson-Brown Simon , McGregor Richard J 
Published: January 2019

ObjectivesThe aim of this study was to identify current problems and potential solutions to improve the working environment for the delivery of safe surgical care in the UK.DesignProspective, questionnaire-based cross-sectional study.Setting/participantsFollowing validation, an electronic questionnaire was distributed to postgraduate local education and training board distribution lists, the Royal College of Surgeons of Edinburgh (RCSEd) mailing lists and trainee organisations. This consisted of a single open-ended question inviting five open-ended responses. Throughout the 13-week study period, the survey was also published on a number of social media platforms.ResultsA total of 505 responders completed the survey, of which 35% were consultants, 30% foundation doctors, 17% specialty trainees, 11% specialty doctors, 5% core trainees and <1% surgical nurse practitioners. A total of 2238 free-text answers detailed specific actions to improve the working environment. These responses were individually coded and then grouped into nine categories (staff resources, non-staff resources, support, working conditions, communication and team work, systems improvement, patient centred, training and education, and miscellaneous).ConclusionsThe results of this study have identified a number of key areas that, if addressed, may improve the environment for the delivery of safer surgical care. Common themes that emerged across all grades included: increased front-line staff; a return to a ‘firm’ structure to improve team continuity; greater senior support; and improved hospital facilities to help staff rest and recuperate. While unlimited funding remains unrealistic, many of the suggestions could be implemented in a cost-neutral fashion and include insightful ideas for remodelling or restructuring the workforce to improve the efficiency of the surgical team. The findings of this study formed the basis of a set of recommendations published by the RCSEd as a discussion paper.
Cost-effectiveness of internet-delivered cognitive–behavioural therapy for adolescents with irritable bowel syndrome
Authors: Sampaio Filipa , Bonnert Marianne , Olén Ola , Hedman Erik , Lalouni Maria , Lenhard Fabian , Ljótsson Brjánn , Ssegonja Richard , Serlachius Eva , Feldman Inna 
Published: January 2019

ObjectiveTo assess whether exposure-based internet-delivered cognitive–behavioural therapy (internet-CBT) is a cost-effective treatment for adolescents with irritable bowel syndrome (IBS) compared with a waitlist control, from a societal perspective, based on data from a randomised trial.DesignWithin-trial cost-effectiveness analysis.SettingParticipants were recruited from the whole of Sweden via primary, secondary and tertiary care clinics reached through news media and advertising.ParticipantsAdolescents (aged 13–17) with a diagnosis of IBS.InterventionsParticipants were randomised to either an exposure-based internet-CBT, including 10 weekly modules for adolescents and five modules for parents, or a waitlist.Outcome measuresThe main health outcome was the quality-adjusted life-year (QALY) estimated by mapping Pediatric Quality-of-Life Inventory (PedsQL) scores onto EQ-5D-3L utilities. The secondary outcome was the point improvement on the PedsQL scale. Data on health outcomes and resource use were collected at baseline and 10 weeks post-treatment. Resource use was measured using the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P) . Incremental cost-effectiveness ratios (ICER) were calculated as the difference in average costs by the difference in average outcomes between groups.ResultsThe base-case results showed that internet-CBT costs were on average US$170.24 (95% CI 63.14 to 315.04) more per participant than the waitlist. Adolescents in the internet-CBT group showed small QALY gains (0.0031; 95% CI 0.0003 to 0.0061), and an average improvement of 5.647 points (95% CI 1.82 to 9.46) on the PedsQL compared with the waitlist. Internet-CBT yielded an ICER of $54 916/QALY gained and a probability of cost-effectiveness of 74% given the Swedish willingness-to-pay threshold. The ICER for the outcome PedsQL was US$85.29/point improvement.ConclusionsOffering internet-CBT to adolescents with IBS improves health-related quality of life and generates small QALY gains at a higher cost than a waitlist control. Internet-CBT is thus likely to be cost-effective given the strong efficacy evidence, small QALY gains and low cost.Trial registration numberNCT02306369; Results.
Association between benzodiazepine use and risks of chronic-onset poststroke pneumonia: a population-based cohort study
Authors: Lin Shu-Man , Yang Shih-Hsien , Liang Chung-Chao , Huang Huei-Kai , Loh Ching-Hui 
Published: January 2019

ObjectivesTo investigate the association between benzodiazepine (BZD) use and the risk of chronic-onset poststroke pneumonia.DesignPopulation-based propensity-matched retrospective cohort study.SettingTaiwan’s National Health Insurance Research Database.ParticipantsPatients newly diagnosed with stroke between 2000 and 2012 were identified and, after propensity score matching, 7516 patients were enrolled. Among these, 3758 patients received BZDs after stroke while 3758 did not.Outcome measuresHRs for developing pneumonia over 1 month after stroke according to BZD use were assessed using Cox proportional hazards regression models. Analyses according to cumulative defined daily doses (cDDDs) of BZDs and stratification for age and sex were also performed.ResultsDuring a mean follow-up time of 4.4 years, 1027 patients in the BZD cohort and 478 patients in the non-BZD cohort developed pneumonia over 1 month after stroke. Patients using BZDs after stroke had a higher pneumonia risk than did those not using BZDs (52.2vs32.6 per 1000 person-years, adjusted HR (aHR)=2.21, 95% CI (CI)=1.97 to 2.48, p<0.001). Analyses based on cumulative BZD dose revealed that all BZD user subgroups were associated with a higher risk of pneumonia. The aHRs for patients taking 1–90, 91–365 and >365 cDDDs of BZDs were 2.28 (95% CI=2.01 to 2.58; p<0.001), 2.09 (95% CI=1.77 to 2.47; p<0.001) and 2.08 (95% CI=1.72 to 2.52; p<0.001), respectively. The significant association between BZD use and increased pneumonia risk persisted even after stratifying subgroups by age and sex.ConclusionsBZD use is associated with an increased risk of chronic-onset poststroke pneumonia.
Spatial distribution and temporal trends in social fragmentation in England, 2001−2011: a national study
Authors: Grigoroglou Christos , Munford Luke , Webb Roger T , Kapur Nav , Ashcroft Darren M , Kontopantelis Evangelos 
Published: January 2019

ObjectiveSocial fragmentation is commonly examined in epidemiological studies of mental illness as high levels of social fragmentation are often found in areas with high prevalence of mental illness. In this study, we examine spatial and temporal patterns of social fragmentation and its underlying indicators in England over time.SettingData for social fragmentation and its underlying indicators were analysed over the decennial Censuses (2001–2011) at a small area geographical level (mean of 1500 people). Degrees of social fragmentation and temporal changes were spatially visualised for the whole of England and its 10 administrative regions. Spatial clustering was quantified using Moran’s I; changes in correlations over time were quantified using Spearman’s ranking correlation.ResultsBetween 2001 and 2011, we observed a strong persistence for social fragmentation nationally (Spearman’s r=0.93). At the regional level, modest changes were observed over time, but marked increases were observed for two of the four social fragmentation underlying indicators, namely single people and those in private renting. Results supported our hypothesis of increasing spatial clustering over time. Moderate regional variability was observed in social fragmentation, its underlying indicators and their clustering over time.ConclusionPatterns of social fragmentation and its underlying indicators persisted in England which seem to be driven by the large increases in single people and those in private renting. Policies to improve social cohesion may have an impact on the lives of persons who experience mental illness. The spatial aspect of social fragmentation can inform the targeting of health and social care interventions, particularly in areas with strong social fragmentation clustering.
Trends in road transport collision deaths in the Irish paediatric population: a retrospective review of mortality data, 1991–2015
Authors: McGarvey Cliona , Hamilton Karina , Donnelly Jean , Nicholson Alf J 
Published: January 2019

ObjectiveTo establish the incidence of road transport collision (RTC) fatalities in the Irish paediatric population, examining trends in fatality rates over a period of 25 years, during which several national road safety interventions were implemented.Study designRetrospective review of death registration details of children 0–19 years in Ireland between January 1991 and December 2015. Trends in mortality rates were investigated using average annual per cent change and Poisson regression analysis.ResultsProportionate RTC mortality, the majority of which occurred on public roads (94.1%, n=1432) increased with age; <0.3% (<1 year), 8.3% (1–14 years) and 18.4% (15–19 years) (2011–2015 average). Over time, rates declined significantly in all age groups; reductions of 79.0% (4.0 to 0.84/100 000, 1–14 years) and 68.4% (15.5 to 4.9/100 000, 15–19 years) resulted in 537 (95% CI 515 to 566) fewer child deaths (1–19 years) over the period 1996–2015. This reduction was evident for both road user types, the greatest decline (84.8%) among pedestrians 1–14 years (2.1 to 0.32/100 000) and the lowest (66.5%) among occupants 15–19 years, the majority of whom were male (12.4 to 4.2/100 000). The rate of decline was greatest during periods coinciding with introduction of targeted interventions. Risk of death in children 1–14 years was halved in the period after 2002 (incidence rate ratio (IRR) 0.52) while in children 15–19 years old, a significantly lower RTC fatality risk was evident after 2006 and 2010 (IRR 0.68 and IRR 0.50).ConclusionChild and adolescent mortality from RTCs has declined dramatically in Ireland, in excess of reductions in overall paediatric mortality. However, rates remain higher than in other EU countries and further effort is required to reduce the number of deaths further, particularly among adolescent males.
Disclosing pre‐existing veterinary conditions to insurance companies
Authors: Henderson Kathryn 
Published: January 2019

This series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved.In addition, a possible way forward is suggested; however, there is rarely a cut‐and‐dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Disclosing pre‐existing veterinary conditions to insurance companies’, was submitted and is discussed by Kathryn Henderson. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue.The series is being coordinated by Steven McCulloch, senior lecturer in human animal studies at the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.
Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study
Authors: Kumar Kevin K , Appelboom Geoffrey , Lamsam Layton , Caplan Arthur L , Williams Nolan R , Bhati Mahendra T , Stein Sherman C , Halpern Casey H 
Published: January 2019

BackgroundThe safety and efficacy of neuroablation (ABL) and deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) has not been examined. This study sought to generate a definitive comparative effectiveness model of these therapies.MethodsA EMBASE/PubMed search of English-language, peer-reviewed articles reporting ABL and DBS for OCD was performed in January 2018. Change in quality of life (QOL) was quantified based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the impact of complications on QOL was assessed. Mean response of Y-BOCS was determined using random-effects, inverse-variance weighted meta-analysis of observational data.FindingsAcross 56 studies, totalling 681 cases (367 ABL; 314 DBS), ABL exhibited greater overall utility than DBS. Pooled ability to reduce Y-BOCS scores was 50.4% (±22.7%) for ABL and was 40.9% (±13.7%) for DBS. Meta-regression revealed no significant change in per cent improvement in Y-BOCS scores over the length of follow-up for either ABL or DBS. Adverse events occurred in 43.6% (±4.2%) of ABL cases and 64.6% (±4.1%) of DBS cases (p<0.001). Complications reduced ABL utility by 72.6% (±4.0%) and DBS utility by 71.7% (±4.3%). ABL utility (0.189±0.03) was superior to DBS (0.167±0.04) (p<0.001).InterpretationOverall, ABL utility was greater than DBS, with ABL showing a greater per cent improvement in Y-BOCS than DBS. These findings help guide success thresholds in future clinical trials for treatment refractory OCD.
Comparison of bupivacaine plus intrathecal fentanyl and bupivacaine alone for spinal anesthesia with intravenous dexmedetomidine sedation: a randomized, double-blind, noninferiority trial
Authors: Park Sun-Kyung , Lee Joon Hee , Yoo Seokha , Kim Won Ho , Lim Young-Jin , Bahk Jae-Hyon , Kim Jin-Tae 
Published: January 2019

Background and objectivesFentanyl is widely used as an intrathecal adjuvant to local anesthetics to enhance the duration of spinal anesthesia. Recent evidence suggests that intravenous dexmedetomidine prolongs the duration of spinal anesthesia. This noninferiority study evaluated whether bupivacaine alone could provide a noninferior duration of block compared with bupivacaine and fentanyl when intravenous dexmedetomidine was administered intraoperatively.MethodsFifty-six patients scheduled for total knee arthroplasty under spinal anesthesia were randomly allocated to receive either bupivacaine 13 mg with intrathecal fentanyl 20 µg (Group BF) or bupivacaine 13 mg (Group B). Both groups underwent intravenous dexmedetomidine sedation throughout the surgery (1 µg kg–1for 10 min, followed by 0.5 µg kg–1h–1). The primary outcome was the time to two-segment regression of the sensory block. The noninferiority margin for the mean difference was predefined as −10 min. Secondary outcomes included postoperative pain scores, analgesics consumptions, and the incidences of pruritus, nausea, and vomiting.ResultsThere was no significant difference in the two-segment regression time of sensory block (Group B 109.1±25.0 min vs Group BF 104.3±25.9 min; p=0.484). The mean difference in the two-segment regression time between the 2 groups was 4.8 min (95 % CI −8.9 to 18.6), demonstrating the noninferiority of bupivacaine alone. Secondary outcomes showed no significant differences between the two groups.ConclusionsThe duration of spinal anesthesia with bupivacaine alone is noninferior to that of bupivacaine plus fentanyl in patients receiving intravenous dexmedetomidine intraoperatively. Our results suggest that intrathecal fentanyl may not be required when intravenous dexmedetomidine is administered.Trial registration numberNCT03105115.
Systemic dexmedetomidine is not as efficient as perineural dexmedetomidine in prolonging an ulnar nerve block
Authors: Andersen Jakob Hessel , Jaeger Pia , Grevstad Ulrik , Estrup Stine , Geisler Anja , Vilhelmsen Frederik , Dahl Jorgen B , Laier Gunnar Hellmund , Ilfeld Brian M , Mathiesen Ole 
Published: January 2019

BackgroundWe tested the joint hypotheses that both perineural and systemic dexmedetomidine prolong the duration of an ulnar nerve block (UNB) compared with ropivacaine alone and that systemic dexmedetomidine is noninferior compared with perineural dexmedetomidine in block prolongation.MethodsWe performed bilateral UNBs in 22 healthy volunteers on two separate days. On the first day, each arm was randomized to either 4 mL ropivacaine 5 mg/mL+1 mL dexmedetomidine 100 µg/mL (Perineural) or 4 mL ropivacaine 5 mg/mL+1 mL saline (Systemic). On the subsequent treatment day, each arm was randomized to 1 mL of saline plus 4 mL of ropivacaine at either 7.5 mg/mL(HiRopi) or 5 mg/mL (NoDex). The primary outcome measure was the duration of sensory block assessed by mechanical discrimination.ResultsMean sensory block duration was longer in both the Perineural (14.4 hours, 95% CI 13.1 to 15.6) and Systemic treatments (9.2 hours, 95% CI 8.6 to 9.8) compared with the NoDex treatment (7.1 hours, 95% CI 6.6 to 7.6) (p<0.0001 for both). Systemic dexmedetomidine was inferior (not noninferior) compared with perineural dexmedetomidine, as the 95% CI of the difference (mean difference 5.2 hour, 95% CI 4.2 to 6.1) exceeded the noninferiority limit of 3.6 hour. Onset time did not differ among the groups. The other test modalities demonstrated similar block durations as the primary outcome.ConclusionsAdding dexmedetomidine perineurally to ropivacaine doubles the duration of an UNB. Systemic dexmedetomidine also prolongs the duration of UNB, but has less of an effect compared with the perineural route.Trial registration numberNCT03222323.
The Denominator problem: estimating the size of local populations of men-who-have-sex-with-men and rates of HIV and other STIs in Switzerland
Authors: Schmidt Axel Jeremias , Altpeter Ekkehardt 
Published: January 2019

ObjectivesThere is no estimate of the current number of men who have sex with men (MSM) in Switzerland, or of their geographical distribution. We aimed to (1) estimate MSM concentration factors and population sizes for 83 Swiss postal code areas (PCA), including the nine largest Swiss cities, and (2) calculate MSM-specific local HIV prevalence and yearly rates of diagnosed HIV, hepatitis C virus (HCV), syphilis and gonorrhoea.MethodsWe triangulated data from general population estimates, MSM online surveys, published data on HIV prevalence and Swiss notification data for HIV and STDs. We compared two different formulae for the estimation of local MSM populations and calculated Bayesian 95%-credible-intervals (CrI) for each PCA.ResultsAcross Switzerland, we estimate the MSM population aged 15–64 at roughly 80 000 men (95% CrI 64 000–96 000). (1) MSM in Switzerland were most concentrated in the five largest cities of Zurich, Geneva, Lausanne, Bern and Basel. (2) We estimate that in 2012, 6300 MSM, or 8.0%, were living with HIV, both diagnosed and undiagnosed and 1700 MSM, or 2.2%, had non-suppressed HIV infection. Between 2010 and 2013, average yearly rates of diagnosed HIV, HCV, syphilis and gonorrhoea were 0.3%, 0.02%, 0.4 % and 0.4 %, respectively.ConclusionsCombining general population data, MSM online surveys and notification data allows the calculation of realistic estimates of local MSM populations and thus proportions of MSM with diagnosed HIV and other STIs, with implications for prevention planning, commissioning of health services and counselling MSM on HIV/STI risk. Our methodology for Switzerland is transferable to other countries with similar data sources.
INNOVATING WITH DOMINANT SUPPLIERS: LESSONS FROM THE RACE FOR LASER LIGHT
Authors: GOLDBERG JANINA MILENA , SCHIELE HOLGER 
Published: January 2019

Traditionally, manufacturers could usually choose from several suppliers who would be more than willing to engage in innovation processes with them. However, more often the situation arises that a supplier has a dominant position because of a clear leadership or even exclusivity in a certain technology. How should the buying companies handle such situations when a supplier can choose the customer to collaborate with, rather than cueing in front of the customer’s door? This paper focuses on how a buying company may best handle this situation of innovating with dominant suppliers. The methodology used is a case study that compares, from an original equipment manufacturer’s perspective, two implemented supplier innovations with different expirations — a success case and a failure. Findings lead to three main propositions: First, firms may benefit from carefully analysing and designing the buyer–supplier constellation in innovation processes and not only the quality of the innovation. Drawing back on attractiveness theory grounded in social exchange theory may provide clues on how to do so. Second, in case of a dominant supplier situation, traditional innovation management processes may fail and need to be amended by a dedicated innovation process with a different order of steps. In the case of supplier dominance, it is essential to first analyse the supplier constellation, and then make the decision for the innovation path to follow — and not the other way around. Third, in the fight for getting access to a supplier’s innovation, a speed-up process with the buying company may be a tool for outperforming other buyers competing for the same supplier.