bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determining the educational impact of the introduction of practice-based small group learning within an intraprofessional group of doctors
Authors: Willman Antony Sean 
Published: January 2018

IntroductionPractice-Based Small Group Learning (PBSGL) is a system for continuing professional development introduced into Wessex Region Defence Primary Healthcare (DPHC) as the Salisbury Plain PBSGL group in 2012. This is a mixed intraprofessional group comprising general practitioners (GPs), GP trainers, general practice specialist registrars (GPSTs) and general duties medical officers (GDMOs).MethodsAn anonymised online questionnaire and thematic analysis was undertaken to assess the educational impact of PBSGL in such a mixed-role group reflecting military general practice.ResultsA positive effect of PBSGL was demonstrated and further enhanced by the intraprofessional composition. Positive peer support effects were demonstrated for all members of the cohort regardless of role.ConclusionPBSGL is an essential pillar for supporting all doctors working within DPHC. Further qualitative evaluation of cohorts of GDMOs, GPSTs and mixed-role groups as well as the development of standardised questionnaires is recommended.
How good are doctors at introducing themselves? #hellomynameis
Authors: Gillen Peter , Sharifuddin Sue Faye , O’Sullivan Muireann , Gordon Alison , Doherty Eva M 
Published: January 2018

AbstractBackgroundThis explorative study was triggered by the ‘#hellomynameis’ campaign initiated by Dr Kate Granger in the UK. Our objectives were twofold: first, to measure rates of introduction in an Irish hospital setting by both consultant and non-consultant hospital doctors. Second to establish whether such practices were associated with patient perceptions of the doctor/patient interaction.MethodA patient ‘exit’ survey was undertaken following doctor–patient consultations in both acute (surgical and medical assessment units) and elective settings (outpatient clinics). The survey was carried out over a 5-month period by three trained clinical observers.ResultsA total of 353 patients were surveyed. There were 253 outpatients and 100 inpatients surveyed. There were 121 outpatients (47.8%) who attended a surgeon, 73 were medical (28.8%), while 59 (23.3%) were divided between obstetrics, gynaecology and ophthalmology. One hundred acute presentations were surveyed: 52% in the emergency department, 20% to the acute medical assessment unit, 21% attended the acute surgical assessment unit and 7% attended other specialties/departments.ConclusionAccording to the returned forms, 79% of doctors (n=279) introduced themselves to patients. Eleven per cent (39) of doctors did not introduce themselves, and 8.5% of patients (30) were unsure whether the doctor had introduced themselves. Five patients left their response blank.Consultants were significantly more likely (P=0.02) to introduce themselves or shake hands than non-consultant hospital doctors. Gender had no bearing (P=0.43) on introductions or handshakes regardless of grade of doctor.Three hundred and seventeen patients (89.7%) felt that an introduction had made a positive difference to their healthcare visit. Thirty patients (8.5%) felt it did not make a difference and 8 patients (2.2%) were unsure or failed to answer.This study has highlighted the importance of introductions to patients. Definite evidence of an introduction was documented in 79% of patients with 14.5% either not receiving or could not recall whether an introduction had been made on repeat visits. 6.5% stated that they did not receive an introduction.
Does intracranial pressure management hurt more than it helps in traumatic brain injury?
Authors: Adams Charles A , Stein Deborah M , Morrison Jonathan J , Scalea Thomas M 
Published: January 2018

Traumatic brain injury (TBI) is the leading cause of death after traumatic injury. Raised intracranial pressure (ICP) is particularly associated with poor TBI outcomes, prompting clinicians to monitor this parameter, using it to guide therapies aimed at reducing pressures. Despite this approach being recommended by several bodies such as the Brain Trauma Foundation and the American College of Surgeons, the evidence demonstrating that ICP-guided therapy improves outcome is limited. The topic was debated at the 36th Annual Point/Counterpoint Acute Care Surgery Conference and the following article summarizes the discussants points of view along with a summary of the evidence.Level of evidenceLevel III.
Osteoprotegerin Is Associated With Major Bleeding But Not With Cardiovascular Outcomes in Patients With Acute Coronary Syndromes: Insights From the PLATO (Platelet Inhibition and Patient Outcomes) Trial
Authors: Ueland Thor , Åkerblom Axel , Ghukasyan Tatevik , Michelsen Annika E. , Aukrust Pål , Becker Richard C. , Bertilsson Maria , Himmelmann Anders , James Stefan K. , Siegbahn Agneta , Storey Robert F. , Kontny Frederic , Wallentin Lars ,   the PLATO (Platelet Inhibition and Patient Outcomes) Trial Investigators
Published: January 2018

Background
Elevated levels of osteoprotegerin, a secreted tumor necrosis factor–related molecule, might be associated with adverse outcomes in patients with coronary artery disease. We measured plasma osteoprotegerin concentrations on hospital admission, at discharge, and at 1 and 6 months after discharge in a predefined subset (n=5135) of patients with acute coronary syndromes in the PLATO (Platelet Inhibition and Patient Outcomes) trial.

Methods and Results

The associations between osteoprotegerin and the composite end point of cardiovascular death, nonprocedural spontaneous myocardial infarction or stroke, and non–coronary artery bypass grafting major bleeding during 1 year of follow‐up were assessed by Cox proportional hazards models. Event rates of the composite end point per increasing quartile groups at baseline were 5.2%, 7.5%, 9.2%, and 11.9%. A 50% increase in osteoprotegerin level was associated with a hazard ratio (
HR
) of 1.31 (95% confidence interval [CI], 1.21–1.42) for the composite end point but was not significant in adjusted analysis (ie, clinical characteristics and levels of C‐reactive protein, troponin T,
NT
‐pro
BNP
[N‐terminal pro‐B‐type natriuretic peptide], and growth differentiation factor‐15). The corresponding rates of non–coronary artery bypass grafting major bleeding were 2.4%, 2.2%, 3.8%, and 7.2%, with an unadjusted
HR
of 1.52 (95% CI, 1.36–1.69), and a fully adjusted
HR
of 1.26 (95% CI, 1.09–1.46). The multivariable association between the osteoprotegerin concentrations and the primary end point after 1 month resulted in an
HR
of 1.09 (95% CI, 0.89–1.33); for major bleeding after 1 month, the
HR
was 1.33 (95% CI, 0.91–1.96).

Conclusions
In patients with acute coronary syndrome treated with dual antiplatelet therapy, osteoprotegerin was an independent marker of major bleeding but not of ischemic cardiovascular events. Thus, high osteoprotegerin levels may be useful in increasing awareness of increased bleeding risk in patients with acute coronary syndrome receiving antithrombotic therapy.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
00391872.
Race and Socioeconomic Status Independently Affect Risk of Major Amputation in Peripheral Artery Disease
Authors: Arya Shipra , Binney Zachary , Khakharia Anjali , Brewster Luke P. , Goodney Phil , Patzer Rachel , Hockenberry Jason , Wilson Peter W. F. 
Published: January 2018

Background

Black race has been shown to be a risk factor for amputation in peripheral artery disease (PAD); however, race has been argued to be a marker for socioeconomic status (
SES
) rather than true disparity. The aim of this study is to study the impact of race and
SES
on amputation risk in
PAD
patients.

Methods and Results

Patients with incident
PAD
in the national Veterans Affairs Corporate Data Warehouse were identified from 2003 to 2014 (N=155 647). The exposures were race and SES (measured by median income in residential ZIP codes). The outcome was incident major amputation. Black veterans were significantly more likely to live in low‐
SES
neighborhoods and to present with advanced
PAD
. Black patients had a higher amputation risk in each
SES
stratum compared with white patients. In Cox models (adjusting for covariates), black race was associated with a 37% higher amputation risk compared with white race (hazard ratio: 1.37; 95% confidence interval, 1.30–1.45), whereas low
SES
was independently predictive of increased risk of amputation (hazard ratio: 1.12; 95% confidence interval, 1.06–1.17) and showed no evidence of interaction with race. In predicted amputation risk analysis, black race and low
SES
continued to be significant risk factors for amputation regardless of
PAD
presentation.

Conclusions

Black race significantly increases the risk of amputation within the same
SES
stratum compared with white race and has an independent effect on limb loss after controlling for comorbidities, severity of
PAD
at presentation, and use of medications.
Hospital readmissions and the day of the week
Authors: Verma Aman , Rochefort Christian , Powell Guido , Buckeridge David 
Published: January 2018

Objectives Patients discharged from hospitals on a Friday (Friday discharges) are readmitted sooner (a shorter time-to-emergency-readmission) than those discharged on any other day of the week. To evaluate the cost-effectiveness of increasing weekend capacity, the effect estimate of Friday discharge on time-to-emergency-readmission needs to be precise. However, precise effect estimation is complicated by the confounding effect of differing healthcare-seeking behaviour and admission practices, and therefore different admission probability, by day of the week. The objective of this research was to examine how differing admission probability by day of the week influences the effect of discharge day on time-to-emergency-readmission. Methods We used a Markov model to determine how day of the week admission probability would theoretically affect the time-to-emergency-readmission for Friday and Wednesday discharges. We tested this in a cohort of patients who have had a history of respiratory illness, using a Cox proportional hazards model to fit the time-to-emergency-readmission to any Quebec hospital as a function of the day of the week of discharge and admission. We fitted another Cox model with an additional time-varying covariate for the current day of the week, to model differing admission probabilities by day of the week. Results Our Markov model showed that if admission probability is lower on the weekends, Friday discharges will be readmitted later (longer time-to-emergency-readmission) than Wednesday discharges. Using hospital admission data, we found that Friday discharges were readmitted slightly earlier than Wednesday discharges (HR: 1.03, 95% CI: (1.02, 1.05)). After adding a time-varying covariate for the current day of the week, the length of time-to-emergency-readmission for a Friday discharge increased, but it was still earlier than a Wednesday discharge (HR: 1.04, 95% CI: (1.01, 1.07)). Conclusions The lower admission probabilities on the weekend confound the effect of Friday discharge on time-to-emergency-readmission by increasing the time-to-emergency-readmission. This confounding effect causes an underestimate of the effect of Friday discharge on time-to-emergency-readmission.
Manipulating hemoglobin oxygenation using silica nanoparticles: a novel prospect for artificial oxygen carriers
Authors: Devineau Stéphanie , Kiger Laurent , Galacteros Frédéric , Baudin-Creuza Véronique , Marden Michael , Renault Jean Philippe , Pin Serge 
Published: January 2018

Key PointsSilica nanoparticles act as an effector for human native and sickle cell hemoglobin while preserving their tetrameric structure. Manipulating hemoglobin oxygenation using nanoparticles opens the way for the rational design of hemoglobin-based oxygen carriers.
Pharmacologic inhibition of phospholipase C in the brain attenuates early memory formation in the honeybee (Apis melliferaL.)
Authors: Suenami Shota , Iino Shiori , Kubo Takeo 
Published: January 2018

ABSTRACTAlthough the molecular mechanisms involved in learning and memory in insects have been studied intensively, the intracellular signaling mechanisms involved in early memory formation are not fully understood. We previously demonstrated that phospholipase C epsilon (PLCe), whose product is involved in calcium signaling, is almost selectively expressed in the mushroom bodies, a brain structure important for learning and memory in the honeybee. Here, we pharmacologically examined the role of phospholipase C (PLC) in learning and memory in the honeybee. First, we identified four genes for PLC subtypes in the honeybee genome database. Quantitative reverse transcription-polymerase chain reaction revealed that, among these four genes, three, including PLCe, were expressed higher in the brain than in sensory organs in worker honeybees, suggesting their main roles in the brain. Edelfosine and neomycin, pan-PLC inhibitors, significantly decreased PLC activities in homogenates of the brain tissues. These drugs injected into the head of foragers significantly attenuated memory acquisition in comparison with the control groups, whereas memory retention was not affected. These findings suggest that PLC in the brain is involved in early memory formation in the honeybee. To our knowledge, this is the first report of a role for PLC in learning and memory in an insect.
Parathyroid hormone-related protein exhibits antioxidant features in osteoblastic cells through its N-terminal and osteostatin domains
Authors: Portal-Núñez S. , Ardura J. A. , Lozano D. , Martínez de Toda I. , De la Fuente M. , Herrero-Beaumont G. , Largo R. , Esbrit P. 
Published: January 2018

Objectives Oxidative stress plays a major role in the onset and progression of involutional osteoporosis. However, classical antioxidants fail to restore osteoblast function. Interestingly, the bone anabolism of parathyroid hormone (PTH) has been shown to be associated with its ability to counteract oxidative stress in osteoblasts. The PTH counterpart in bone, which is the PTH-related protein (PTHrP), displays osteogenic actions through both its N-terminal PTH-like region and the C-terminal domain. Methods We examined and compared the antioxidant capacity of PTHrP (1-37) with the C-terminal PTHrP domain comprising the 107-111 epitope (osteostatin) in both murine osteoblastic MC3T3-E1 cells and primary human osteoblastic cells. Results We showed that both N- and C-terminal PTHrP peptides at 100 nM decreased reactive oxygen species production and forkhead box protein O activation following hydrogen peroxide (H2O2)-induced oxidation, which was related to decreased lipid oxidative damage and caspase-3 activation in these cells. This was associated with their ability to restore the deleterious effects of H2O2 on cell growth and alkaline phosphatase activity, as well as on the expression of various osteoblast differentiation genes. The addition of Rp-cyclic 3′,5′-hydrogen phosphorothioate adenosine triethylammonium salt (a cyclic 3',5'-adenosine monophosphate antagonist) and calphostin C (a protein kinase C inhibitor), or a PTH type 1 receptor antagonist, abrogated the effects of N-terminal PTHrP, whereas protein phosphatase 1 (an Src kinase activity inhibitor), SU1498 (a vascular endothelial growth factor receptor 2 inhibitor), or an anti osteostatin antiserum, inhibited the effects of C-terminal PTHrP. Conclusion These findings indicate that the antioxidant properties of PTHrP act through its N- and C-terminal domains and provide novel insights into the osteogenic action of PTHrP. Cite this article: S. Portal-Núñez, J. A. Ardura, D. Lozano, I. Martínez de Toda, M. De la Fuente, G. Herrero-Beaumont, R. Largo, P. Esbrit. Parathyroid hormone-related protein exhibits antioxidant features in osteoblastic cells through its N-terminal and osteostatin domains. Bone Joint Res 2018;7:58–68. DOI: 10.1302/2046-3758.71.BJR-2016-0242.R2.
Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable?
Authors: Kleinlugtenbelt Y. V. , Krol R. G. , Bhandari M. , Goslings J. C. , Poolman R. W. , Scholtes V. A. B. 
Published: January 2018

Objectives The patient-rated wrist evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire are patient-reported outcome measures (PROMs) used for clinical and research purposes. Methodological high-quality clinimetric studies that determine the measurement properties of these PROMs when used in patients with a distal radial fracture are lacking. This study aimed to validate the PRWE and DASH in Dutch patients with a displaced distal radial fracture (DRF). Methods The intraclass correlation coefficient (ICC) was used for test-retest reliability, between PROMs completed twice with a two-week interval at six to eight months after DRF. Internal consistency was determined using Cronbach’s α for the dimensions found in the factor analysis. The measurement error was expressed by the smallest detectable change (SDC). A semi-structured interview was conducted between eight and 12 weeks after DRF to assess the content validity. Results A total of 119 patients (mean age 58 years (sd 15)), 74% female, completed PROMs at a mean time of six months (sd 1) post-fracture. One overall meaningful dimension was found for the PRWE and the DASH. Internal consistency was excellent for both PROMs (Cronbach’s α 0.96 (PRWE) and 0.97 (DASH)). Test-retest reliability was good for the PRWE (ICC 0.87) and excellent for the DASH (ICC 0.91). The SDC was 20 for the PRWE and 14 for the DASH. No floor or ceiling effects were found. The content validity was good for both questionnaires. Conclusion The PRWE and DASH are valid and reliable PROMs in assessing function and disability in Dutch patients with a displaced DRF. However, due to the high SDC, the PRWE and DASH are less useful for individual patients with a distal radial fracture in clinical practice. Cite this article: Y. V. Kleinlugtenbelt, R. G. Krol, M. Bhandari, J. C. Goslings, R. W. Poolman, V. A. B. Scholtes. Are the patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaire used in distal radial fractures truly valid and reliable? Bone Joint Res 2018;7:36–45. DOI: 10.1302/2046-3758.71.BJR-2017-0081.R1.
Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion
Authors: Huang H. , Nightingale R. W. , Dang A. B. C. 
Published: January 2018

Objectives Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine. Methods A previously validated FE model of the human body in the driver-occupant position was used to investigate cervical hyperextension injury. The cervical spine was subjected to simulated whiplash exposure in accordance with Euro NCAP (the European New Car Assessment Programme) testing using the whole human FE model. The coupled motions between the cervical spine and lumbar spine were assessed by evaluating the biomechanical effects of simulated cervical fusion and lumbar fusion. Results Peak anterior longitudinal ligament (ALL) strain ranged from 0.106 to 0.382 in a normal spine, and from 0.116 to 0.399 in a fused cervical spine. Strain increased from cranial to caudal levels. The mean strain increase in the motion segment immediately adjacent to the site of fusion from C2-C3 through C5-C6 was 26.1% and 50.8% following single- and two-level cervical fusion, respectively (p = 0.03, unpaired two-way t-test). Peak cervical strains following various lumbar-fusion procedures were 1.0% less than those seen in a healthy spine (p = 0.61, two-way ANOVA). Conclusion Cervical arthrodesis increases peak ALL strain in the adjacent motion segments. C3-4 experiences greater changes in strain than C6-7. Lumbar fusion did not have a significant effect on cervical spine strain. Cite this article: H. Huang, R. W. Nightingale, A. B. C. Dang. Biomechanics of coupled motion in the cervical spine during simulated whiplash in patients with pre-existing cervical or lumbar spinal fusion: A Finite Element Study. Bone Joint Res 2018;7:28–35. DOI: 10.1302/2046-3758.71.BJR-2017-0100.R1.
Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques
Authors: Tsang S. T. J. , McHugh M. P. , Guerendiain D. , Gwynne P. J. , Boyd J. , Simpson A. H. R. W. , Walsh T. S. , Laurenson I. F. , Templeton K. E. 
Published: January 2018

Objectives Nasal carriers of Staphylococcus (S.) aureus (MRSA and MSSA) have an increased risk for healthcare-associated infections. There are currently limited national screening policies for the detection of S. aureus despite the World Health Organization’s recommendations. This study aimed to evaluate the diagnostic performance of molecular and culture techniques in S. aureus screening, determine the cause of any discrepancy between the diagnostic techniques, and model the potential effect of different diagnostic techniques on S. aureus detection in orthopaedic patients. Methods Paired nasal swabs for polymerase chain reaction (PCR) assay and culture of S. aureus were collected from a study population of 273 orthopaedic outpatients due to undergo joint arthroplasty surgery. Results The prevalence of MSSA nasal colonization was found to be between 22.4% to 35.6%. The current standard direct culturing methods for detecting S. aureus significantly underestimated the prevalence (p = 0.005), failing to identify its presence in approximately one-third of patients undergoing joint arthroplasty surgery. Conclusion Modelling these results to national surveillance data, it was estimated that approximately 5000 to 8000 S. aureus surgical site infections could be prevented, and approximately $140 million to $950 million (approximately £110 million to £760 million) saved in treatment costs annually in the United States and United Kingdom combined, by using alternative diagnostic methods to direct culture in preoperative S. aureus screening and eradication programmes. Cite this article: S. T. J. Tsang, M. P. McHugh, D. Guerendiain, P. J. Gwynne, J. Boyd, A. H. R. W. Simpson, T. S. Walsh, I. F. Laurenson, K. E. Templeton. Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed. Bone Joint Res 2018;7:79–84. DOI: 10.1302/2046-3758.71.BJR-2017-0175.R1.