bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Publicly Financed Health Insurance Scheme (Rashtriya Swasthya Bima Yojana) from Equity and Efficiency Perspectives
Authors: Sinha Rajesh Kumar 
Published: October 2018

Executive Summary Catastrophic health expenses result in impoverishment of a large number of people every year in India. This often forces the resource-poor households to forego treatment due to lack of affordability. Providing quality health care to all at an affordable cost is a policy commitment for India as it is a signatory of the Alma Ata Declaration. The Government of India is working towards providing universal health coverage through its National Health Policy. As part of universalization of health care, the government had launched a publicly financed health insurance scheme, Rashtriya Swasthya Bima Yojana (RSBY), to provide affordable and quality health services. The present study dealt with understanding the impact of the scheme for improving health care-seeking and reducing burden of health expenditure among resource-poor families through a matched controlled cross-sectional study. The study tried to assess whether RSBY had improved care-seeking and reduced incidences of catastrophic health expenditure (CHE) and health expenditure-induced poverty among the insured population and also tried to explore whether the benefits were equitable. It was conducted in purposively selected two blocks of Ranchi district in Jharkhand with 1,643 households below poverty line (BPL). Both enrolled and non-enrolled households were selected randomly for the study after matching with some key matching criteria. It was found that RSBY neither increased in-facility treatment (hospitalization) nor reduced the likelihood of CHE among the enrolled households. More importantly, it significantly increased the incidence of health expenditure-induced poverty among the households who were above the poverty line before incurring any health expenditure. From equity perspective, care-seeking was much lower among the economically weaker households compared to the better-off households. Similarly, incidences of CHE and health expenditure-induced poverty were also found to be higher among the weaker sections. The study shows that RSBY did not achieve its objective of improving care-seeking and providing financial security to the enrolled households, and more importantly to the economically weaker sections of the society. Other studies have also found that one of the factors for high out-of-pocket expenditure in health is a weak public health delivery system which forces people to seek care from private providers. Hence, it is important for the policymakers to critically evaluate whether such insurance models will actually ensure better financial security for the households from excessive health expenditure and whether strengthening the existing public health delivery system would be a better option.
Extracellular histones indicate the prognosis in patients undergoing extracorporeal membrane oxygenation therapy
Authors: Wen Zongmei , Jin Yang , Jiang Xuemei , Sun Meng , Arman Nazzarena , Wen Tao , Lv Xin 
Published: October 2018

Introduction: Extracellular histones have been recently identified as damage-associated molecular-pattern (DAMP) molecules involved with the pathogenesis of various inflammatory diseases. This study intended to investigate whether extracellular histones can indicate the prognosis in critically ill patients supported by extracorporeal membrane oxygenation (ECMO) therapy. Methods: A total of 56 patients undergoing ECMO were analysed retrospectively. Median concentrations of extracellular histones in patients before ECMO were assessed and used to divide the patients into two groups (Group 1 <48 µg/ml and Group 2 ⩾48 µg/ml). Mortality rate, Sequential Organ Failure Assessment (SOFA) scores and systemic inflammation were compared between the groups. Results: There were relatively higher concentrations of extracellular histones in Group 2 patients (57.78 µg/ml [48.4, 71.3]) than in Group 1 patients (36.76 µg/ml [28.5, 39.3], p<0.0001). The hospital mortality rate was 55.4% for the entire study subjects, with significantly worsened mortality in Group 2 in contrast to Group 1 (58.8% vs. 50%, p=0.031). Moreover, Group 2 patients had significantly higher SOFA scores and more pronounced systemic inflammation than Group 1 patients prior to ECMO initialization. Conclusions: Extracellular histones are known contributors to cell damage and organ injury. Our study showed that extracellular histones have a predictive value in the assessment of outcome of patients undergoing ECMO therapy and may be helpful for risk stratification in clinical settings.
The effect of theta-burst stimulation on unilateral spatial neglect following stroke: a systematic review
Authors: Cotoi Andreea , Mirkowski Magdalena , Iruthayarajah Jerome , Anderson Rachel , Teasell Robert 
Published: October 2018

Objective: To evaluate the effectiveness of theta-burst stimulation for the treatment of stroke-induced unilateral spatial neglect. Data sources: A systematic literature search was conducted from the inception of each database to 30 June 2018 using CINAHL, EMBASE, PubMed, PsycINFO, and Scopus. Review methods: Articles were included if theta-burst stimulation was used to treat neglect following a stroke. The additional a priori inclusion criteria were as follows: (1) ⩾3 adult (⩾18 years) participants, (2) ⩾50% stroke population, and (3) peer-reviewed journal articles published in English. Extracted data included study and treatment characteristics, results, and adverse events. Results: Nine studies met the inclusion criteria, generating a total of 148 participants. Eight studies evaluated a continuous stimulation protocol and one study investigated an intermittent stimulation protocol. Overall, both protocols significantly improved neglect severity when compared against placebo or active controls ( P < 0.05). Adding smooth pursuit training to theta-burst stimulation did not improve neglect relative to when the stimulation was delivered alone ( P > 0.05). There was inconsistent reporting of neglect terminology, outcome measures, and adverse events. The treatment characteristics were heterogeneous among the trials. Conclusion: This systematic review found that theta-burst stimulation seems to improve post-stroke unilateral spatial neglect, but because the evidence is limited to a few small studies with varied and inconsistent protocols and use of terminology, no firm conclusion on effectiveness can be drawn.
What factors affect clinical decision-making about access to stroke rehabilitation? A systematic review
Authors: Longley Verity , Peters Sarah , Swarbrick Caroline , Bowen Audrey 
Published: October 2018

Objectives: To determine the factors affecting clinical decision-making about which patients should receive stroke rehabilitation. Methods: Data sources (MEDLINE, CINAHL, AMED and PsycINFO) were searched systematically from database inception to August 2018. Full-text English-language studies of data from stroke clinicians were included. Studies of patients were excluded. The included studies were any design focussed on clinical decision-making for referral or admission into stroke rehabilitation. Summary factors were compiled from each included study. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Results: After removing duplicates, 1915 papers were identified, of which 13 met the inclusion criteria. Eight included studies were qualitative and one used mixed methods. A total of 292 clinicians were included in the studies. Quality of the included studies was mixed. Patient-level and organizational factors as well as characteristics of individual clinicians contributed to decisions about rehabilitation. The most often described factors were patients’ pre- and poststroke function ( n = 6 studies), presence of dementia ( n = 6), patients’ social/family support ( n = 6), organizational service pressures ( n = 7) and the decision-making clinician’s own knowledge ( n = 5) and emotions ( n = 5). Conclusion: The results highlight a lack of clinical guidance to aid decision-making and reveal that a subjective approach to rehabilitation decision-making influenced by patient-level and organizational factors alongside clinicians’ characteristics occurs across services and countries.
An economic evaluation of the SUNBEAM programme: a falls-prevention randomized controlled trial in residential aged care
Authors: Hewitt Jennifer , Saing Sopany , Goodall Stephen , Henwood Timothy , Clemson Lindy , Refshauge Kathryn 
Published: October 2018

Objective: To estimate the cost-effectiveness of a strength and balance exercise programme (SUNBEAM) which has been shown to be clinically effective in reducing the rate of falls in residents of aged care facilities. Design: An economic evaluation was conducted alongside a pragmatic cluster randomized controlled trial that included 16 residential care facilities and 221 participants. Mean participant age was 86 years, 65% were female and 78% relied on a mobility aide. A cost-effectiveness analysis examined the costs of providing the exercise programme and costs of health service use arising from falls in each arm (intervention and usual care) over 12 months. Main measures: Incremental cost-effectiveness ratios were calculated for the cost per fall avoided. Costs were bootstrapped to obtain adjusted confidence intervals for the incremental cost-effectiveness ratios. Results: Of 63 facilities contacted, 16 met the eligibility criteria and were randomized to the intervention or usual care (1:1). There were 142 falls in the intervention group and 277 in the usual care group. 72 injurious falls occurred in the intervention group versus 157 with usual care. Delivery of the SUNBEAM programme cost $463 per participant. The mean total cost of each fall (regardless of group) was $400.09 and the mean cost of each injurious fall was $708.27. The incremental cost-effectiveness ratio was $22 per fall per person avoided with the mean bootstrapped incremental cost-effectiveness ratio $18 per fall avoided (95% CI: −$380.34 to $417.85). Conclusion: The SUNBEAM programme can be considered cost-effective, relative to other fall-prevention interventions in older adults.
Transcatheter cardiac interventions in neonates with congenital heart disease: A single centre experience
Authors: Melekoglu Asli Nuriye , Baspinar Osman 
Published: October 2018

Objective Percutaneous cardiac catheterization has been used as a diagnostic tool and as a therapeutic option in neonates with congenital heart disease (CHD). This study aimed to evaluate the procedural and short-term follow-up data of newborns who underwent cardiac catheterization procedures. Methods This retrospective study reviewed demographic, diagnostic and clinical data from the medical records of newborns who underwent percutaneous transcatheter interventions to treat CHD. Results Forty-six newborns were included in the study. The median gestational week and weight were 35.0 weeks and 2723 g, respectively. The median time to the procedure was 7.6 days. Aortic and pulmonary balloon valvuloplasty, ductal stenting, atrial balloon/blade septostomy and coronary fistula embolization procedures were used. The overall success rate was 73.9% (34 of 46 patients) with a complication rate of 28.3% (13 of 46 patients). Eleven patients (23.9%) underwent reinterventions after initial catheterization. Five patients (10.9%) died in the first 48 h after their procedures. Conclusions Interventional cardiological procedures applied during the neonatal period provide alternative life-saving methods to surgery, especially in developing countries where surgical outcomes are poor and newborn mortality rates are high.
Metastatic primary urothelial carcinoma of the prostatic urethra: A case report
Authors: Kisa Erdem , Semiz Hüseyin Salih , Küçük Ülkü , İlbey Yusuf Özlem 
Published: October 2018

Introduction: Primary carcinomas of the urethra differ by location and histologic subtype. Primary urethral cancer of the proximal urethra is rare and aggressive tumor with a high propensity for regional and distant metastases. Case description: In this case report, we present primary urothelial carcinoma of the prostatic urethra, diagnosed by transrectal ultrasound-guided biopsy of the prostate and having multiple metastases at the time of diagnosis. Metastatic patients were initiated chemotherapy according to the histological type of urethral cancer. Conclusion: Urothelial carcinomas of the urethra are rarely seen, and therefore there is no standard treatment regimen for early-stage or metastatic disease. Gemcitabine-, platinum-, and taxane-based treatments are used in the metastatic stage.
Retropubic Radical Prostatectomy and Immediate Continence
Authors: Simonato A. , Galli S. , Romagnoli A. , Traverso P. , Pizzorno R. , Corbu C. , Carmignani G. 
Published: October 2018

Aim Temporary urinary incontinence after removing the catheter in patients who have undergone radical prostatectomy is commonly accepted and considered inevitable. Detailed information can be found in literature regarding continence at 3, 6 and 12 months after operation, but few reports mention the immediate results upon removing the catheter. We have collected together data from our patients regarding continence upon removal of the catheter, in order to assess this important aspect. Materials and methods Between November ‘94 and August ‘98, 156 patients underwent retropubic radical prostatectomy for histologically diagnosed prostatic adenocarcinoma (average age 65 years, range 49–74). Out of 156 patients, the bladder neck was removed in 72 (46%) (RCV), in 43 (28%) the bladder neck circular fibres (CCV) were preserved and in 41 (26%) a new technique was used to anatomically dissect the bladder-prostate junction, preserving the mucous of the prostatic urethra (CUP). Continence immediately after removal of the catheter was assessed in all patients in orthostatism and under stress by filling the bladder with 150 cc of saline solution. Results Upon removal of the catheter, 59/130 patients (45.5%) were perfectly continent. Of these 26/72 (36%) had undergone ample removal of the bladder neck, the bladder neck circular fibres were spared in 18/43 (43%), whilst the proximal tract of the prostatic urethra had been preserved in 26/41 (63%). There was infiltration of the bladder neck in 11/156 patients (7%), none of whom had the bladder neck circular fibres or the end section of the prostatic urethra spared. Conclusions Our experience shows that in correctly selected patients, if the bladder neck circular fibres and the proximal tract of the prostatic urethra are preserved, the possibility of immediate continence is high without increasing the oncological risk.
Local-Regional Recurrence of Renal Cell Carcinoma following Nephrectomy. Our Experience
Authors: Fandella A. , Maccatrozzo L. , Merlo F. , Faggiano L. , Checchin P. , Tuccitto G. , Mangano M. , Cicerello E. , Drago-Ferrante G.L. , Anselmo G. 
Published: October 2018

Introduction Locally recurrent renal cell carcinoma (RCC) after nephrectomy is uncommon (1.3% of our cases) and prognosis is poor. There is as yet no standard treatment, but radical surgery is classed by many authors as the best therapeutic approach given the relative ineffectiveness of chemo-immunotherapy and radiotherapy. The surgical approach and follow-up protocol that we adopt are described. Materials and methods Between January 1985 and December 1996, 7 patients (2 M - 5 F; mean age 63 - range 47–72), nephrectomised for RCC, underwent further surgery of the homolateral renal cavity. The stage of the primary neoplasm was pT3G3N0 in 3 patients, pT3G2N0 in 2, pT3G1N0 in 1 and pT2G2N0 in 1. Recurrence appeared on average at 30 months (12–84), with a diameter varying between 14 to 40 mm. Patients were staged again by median laparotomic access; no remote metastases were found. Three patients received adjuvant therapy with biological response modulators. Results Histological results confirmed recurrence of the primitive tumour in all cases and metastatised lymph node tissue was found in just one case. Four patients were still alive (2 disease-free, 2 with lung and multi-organ metastases respectively) after a mean follow-up of 24 months (15–54) following removal of the local recurrence. Two patients died at 13 and 27 months after surgery due to progression of the disease, whilst 1 patient died from uncorrelated pathology after 30 months. Of the above 4 live patients, 3 developed a single metastasis at 5, 8 and 21 months after treatment of the first local recurrence and underwent further radical surgery (2 in the pelvic pouch, 1 vaginal). They also received adjuvant therapy with biological response modulators after the 2nd operation. The disease progressed, however, and only 1 patient is alive with multiple metastasis. Conclusions Surgery of local recurrences of RCC presents no particular difficulties, whilst allowing excellent control of the neoplasm and survival free from advancing diseases. The role that adiuvant therapy (immunomodulators) plays is not yet certain, but could be associated with surgical removal, considering the possible co-existence of micrometastases that cannot clinically be shown.
The Effect of Age of Initiation of Cannabis Use on Psychosis, Depression, and Anxiety among Youth under 25 Years
Authors: Hosseini Shera , Oremus Mark 
Published: October 2018

Objectives: This study was conducted to review the current state of evidence on the association between age of initiation of cannabis use and symptoms of psychosis, depression, or anxiety among youth under 25 years of age. Methods: We conducted a systematic review of articles published prior to March 2018 by searching OVID MEDLINE, PsycINFO, EMBASE, and the references of included studies. We included comparative studies (cohort, case-control, cross-sectional) that reported on cannabis use in persons <25 years of age (exposure) and symptoms of psychosis, depression, or anxiety (outcome). We narratively synthesized the studies according to design (cohort, etc.) and psychiatric outcome. We used the Newcastle-Ottawa Scale to assess risk of bias. Results: Of the 534 citations identified through the literature search, 23 met the eligibility criteria and were included in this review. With psychosis as the outcome, all except one study found that earlier cannabis use was generally associated with higher risks. With depression/anxiety as the outcome, 6 of the 11 included studies reported findings indicating that earlier use of cannabis was linked to higher symptom levels. Conclusion: In persons <25 years old, greater cannabis use is associated with more psychological symptoms, especially among those with a predisposition or existing vulnerability to such outcomes (Oxford Centre for Evidence-Based Medicine level 3 or 4). Policy makers need to consider the adverse effects of cannabis use in youth when planning a public health approach to cannabis legalization.
Aid for Trade and Recipient Countries’ Export Structure: Does Trade Policy Liberalisation Matter?
Authors: Gnangnon Sèna Kimm 
Published: October 2018

This article investigates the effect of aid-for-trade (AfT) inflows on beneficiary-countries’ export structure. It additionally examines whether this effect depends on recipient-countries’ level of trade policy liberalisation. Export structure is measured by the ratio of exports of low-skilled and technology-intensive manufactures to total primary export products (LOW), the ratio of exports of medium-skilled and technology-intensive manufactures to total primary export products (MEDIUM) and the ratio of exports of high-skilled and technology-intensive manufactures to total primary export products (HIGH). The analysis has been carried out using an unbalanced panel data set of 121 countries (of which 41 least-developed countries [LDCs]) over the period 2002–2015. Using the two-step generalised methods of moments (GMM) approach, the empirical results show that AfT inflows exert a positive and significant impact on recipient countries’ export ratios LOW and HIGH, but not on the MEDIUM export ratio. For LDCs, AfT inflows influence positively LOW and negatively MEDIUM and HIGH. Furthermore, for both the full sample and LDCs, there is a strong positive effect of the cumulative AfT inflows on the three export ratios. Finally, the effect of AfT inflows on export ratios appears to be dependent on the degree of trade policy liberalisation. JEL: F13, F14, F35, O24
Long-term survival in six cats with mediastinal cysts
Authors: Camero Corrine M , Neumann Zachary L , Garrett Laura D 
Published: October 2018

Case series summary Mediastinal cysts were diagnosed as incidental findings in six cats evaluated for non-thoracic disease, including staging for historical bladder leiomyosarcoma, flea dermatitis and hairballs, and hyperthyroidism. Radiographically, the cysts appeared as soft tissue opacities cranial to the heart. Ultrasound revealed the masses to be thin-walled, single lumen, anechoic, fluid-filled structures. One cat also had thoracic and abdominal CT performed for cancer staging; the CT revealed a well-defined, fluid-attenuating mass without peripheral contrast enhancement in the cranial mediastinum. Fine-needle aspiration confirmed acellular fluid consistent with a cyst in five cases; in one case the cyst ruptured during aspiration and no fluid was obtained. Post-aspiration, all masses were no longer visible with ultrasound or radiographs. No treatment was recommended for the cysts. Long-term follow-up (2–9 years post-diagnosis) was available in all six cats. The cysts recurred in five cats but were never associated with clinical signs. Relevance and novel information Mediastinal cysts are an important benign differential for cranial mediastinal masses in cats. Treatment for the cysts does not appear to be indicated. This series also includes the first CT description of this clinical entity.
Tools for managing feline problem behaviours: Owner understanding and involvement
Authors: Halls Vicky 
Published: October 2018

Practical relevance: Good communication skills are at the heart of best practice for veterinarians and behaviourists (be they veterinarians/nurses/technicians with specialist behaviour training and qualifications or clinical animal behaviourists). Hence gaining an understanding of how to engage clients to become involved in their pets’ treatment, both medical and behavioural, is relevant to all who work in this field. Clinical challenges: Poor communication skills can be responsible for owners’ lack of compliance regarding both medical treatment and implementation of behavioural protocols. Evidence base: Much of the evidence-based information on effective communication comes from the fields of human psychology and psychotherapy, human medicine and business, with only a limited amount coming from the veterinary field. Therefore, some opinions expressed in this article are based on the author’s experience of treating cases in a cat-specific behaviour referral practice over the past 20 years and her work as a humanistic counsellor. Audience: Any veterinarians, veterinary nurses or technicians who are involved in the diagnosis or treatment of problem feline behaviour in practice would benefit from knowledge of what promotes and also hinders owner understanding and involvement.