bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptions of the quality of generic medicines: implications for trust in public services within the local health system in Tumkur, India
Authors: Aivalli Praveen Kumar , Elias Maya Annie , Pati Manoj Kumar , Bhanuprakash Srinath , Munegowda Chikkagollahalli , Shroff Zubin Cyrus , Srinivas Prashanth N 
Published: January 2018

IntroductionGeneric medicines are an important policy option to reduce out-of-pocket expenditure on medicines. However, negative perceptions of their quality affect utilisation and raise issues of confidence and trust in medicines and health services. The aim of the study was to test the quality of generic and branded medicines and explain negative perceptions towards generic medicines.MethodsThe study was part of a larger study on access to medicines. Information on various quality parameters was collected for branded medicines and branded and unbranded generic versions of the same medicines from government and private pharmacies in Karnataka in Southern India. To assess perceptions related to quality and drivers of preferred point of care (public vs private), focus group discussions were conducted with diabetes and hypertension patients, health workers and private pharmacists. The results of the quality tests were assessed and thematic analysis was conducted on the qualitative data to develop a conceptual framework to explain perceptions of medicine and care quality in the local health system.ResultsThe generic and branded variants of the medicines tested were of comparable quality. Contrary to the quality test results, patients’ and health workers’ perceptions of quality were largely in favour of branded medicines. Negative perceptions of medicine quality along with other drivers contribute towards choosing more expensive medicines in the private sector. Trust in the health system emerged as an underlying central theme that explained and drove choice of medicines and providers within the local health system.ConclusionNegative perceptions of generic medicines and preferential promotion of branded medicines over generics by pharmaceutical companies could influence prescriber behaviour and affect trust in healthcare provided in public services. To succeed, access to medicines programmes need to systematically invest in information on quality of medicines and develop strategies to build trust in healthcare offered in government health services.
Patient pain drawing is a valuable instrument in assessing the causes of exercise-induced leg pain
Authors: Rennerfelt Kajsa , Zhang Qiuxia , Karlsson Jón , Styf Jorma 
Published: January 2018

AimWe validated patientpain drawing (PPD) in establishing the diagnosis of chronic anterior compartment syndrome (CACS) in patients with exercise-induced leg pain.MethodsThe study comprised 477 consecutive patients, all suspected of having CACS. The diagnosis was based on the patient’s history, a thorough clinical examination and measurements of intramuscular pressure (IMP) following an exercise test. Patients completed a PPD before their hospital visit. Two independent orthopaedic surgeons diagnosed the causes of leg pain based only on the PPD at least 1 year after admission. Based on the results of diagnostic tests, the patients were divided into three groups: CACS (n=79), CACS with comorbidity (n=89) and non-CACS (n=306).ResultsThe sensitivity of the PPD to identify CACS correctly was 67% (observer 1) and 75% (observer 2). The specificity was 65% and 54%, respectively. The interobserver agreement (n=477) was 80%, and the kappa value was 0.55. The interobserver agreement was 77%, and the kappa value was 0.48 among 168 CACS patients with or without comorbidity. The interobserver agreement was 85%, and the kappa value was 0.56 in 79 CACS, and CACS was correctly diagnosed in 79% (observer 1) and 82% (observer 2). The test–retest showed the same results for the two observers, with an intraobserver agreement of 84%, while the test–retest reliability coefficient was 0.7. Comorbidity was found in 53% of CACS patients.ConclusionPPD might be a valuable instrument in diagnosing the causes of exercise-induced leg pain. It is useful in identifying CACS with and without comorbidity.
Severity and pattern of injuries caused by Swiss wrestling (Schwingen): first retrospective study at a level I University Emergency Department in Switzerland
Authors: Maliachovas Nikolaos K , Klukowska-Rötzler Jolanta , Sauter Thomas C , Lehmann Beat , Krummrey Gert , Exadaktylos Aristomenis K 
Published: January 2018

BackgroundThis article addresses typical injury patterns related to the traditional Swiss folk wrestling, ‘Schwingen’. This is a fight between two competitors with its own rules, grips and throws. A variety of injuries have been occasionally reported. The aim of this study was to characterise all cases of Schwingen injuries treated in the University Hospital of Bern from January 2006 to July 2016.MethodsTo assess the frequency, type and outcome of Schwingen injuries, database search was performed of all inpatient and outpatient cases related to Schwingen that were admitted to Bern University Hospital from January 2006 to December 2016.ResultsA total of 32 such patients could be identified. Apart from a single woman, all patients were male. 31 of the 32 players were Swiss. One patient was admitted to the intermediate care unit, eight patients underwent surgery, two were hospitalised for further treatment and two were given a plaster. 17 other patients were given medications such as painkillers. One was dismissed without further treatment and another one left the hospital on his own. Typical injury patterns varied from simple lesions to distortions and fractures as well as head injuries and other neurological complications.ConclusionThe majority of injuries caused by Schwingen are not life threatening. Nevertheless, there is always the potential of head injuries and neurological deficits. Apart from the economic loss due to treatment costs and sick leave, these injuries can be disabling for life. It should therefore be obligatory for all players to evaluate preventive measures.
Effects of an 8-week strength training intervention on tibiofemoral joint loading during landing: a cohort study
Authors: Czasche Maike B , Goodwin Jon E , Bull Anthony M J , Cleather Daniel J 
Published: January 2018

ObjectivesTo use a musculoskeletal model of the lower limb to evaluate the effect of a strength training intervention on the muscle and joint contact forces experienced by untrained women during landing.MethodsSixteen untrained women between 18 and 28 years participated in this cohort study, split equally between intervention and control groups. The intervention group trained for 8 weeks targeting improvements in posterior leg strength. The mechanics of bilateral and unilateral drop landings from a 30 cm platform were recorded preintervention and postintervention, as was the isometric strength of the lower limb during a hip extension test. The internal muscle and joint contact forces were calculated using FreeBody, a musculoskeletal model.ResultsThe strength of the intervention group increased by an average of 35% (P<0.05; pre: 133±36 n, post: 180±39 n), whereas the control group showed no change (pre: 152±36 n, post: 157±46 n). There were only small changes from pre-test to post-test in the kinematics and ground reaction forces during landing that were not statistically significant. Both groups exhibited a post-test increase in gluteal muscle force during landing and a lateral to medial shift in tibiofemoral joint loading in both landings. However, the magnitude of the increase in gluteal force and lateral to medial shift was significantly greater in the intervention group.ConclusionStrength training can promote a lateral to medial shift in tibiofemoral force (mediated by an increase in gluteal force) that is consistent with a reduction in valgus loading. This in turn could help prevent injuries that are due to abnormal knee loading such as anterior cruciate ligament ruptures, patellar dislocation and patellofemoral pain.
Is it necessary to adjust current creatine kinase reference ranges to reflect levels found in professional footballers?
Authors: Mahmutyazicioglu Jamie , Nash Julian , Cleves Andrew , Nokes Len 
Published: January 2018

ObjectiveWe aimed to explore the validity of applying current reference ranges of the enzyme creatine kinase (CK) when analysing the medical status of professional footballers and to offer a more functional CK reference range for professional footballers.MethodsA sample of 27 professional male footballers competing in The Football League Championship was analysed. The single sample Wilcoxon signed-rank test was used to compare the CK distribution of the study group with that of a control group of military personnel reported in the literature.ResultsThe median values for study group and the published control group were 284 U/L and 124 U/L, respectively (P<0.001) suggesting that the average CK activity of professional footballers is higher than that of the normal healthy military population.ConclusionEthnicity, sex, age and physical exercise are factors that likely influence CK levels among various populations. From our analysis, we recommend a new 95% reference interval of 64.9 U/L to 1971.7 U/L for professional footballers.
Association between frontal plane knee control and lower extremity injuries: a prospective study on young team sport athletes
Authors: Räisänen Anu M , Pasanen Kati , Krosshaug Tron , Vasankari Tommi , Kannus Pekka , Heinonen Ari , Kujala Urho M , Avela Janne , Perttunen Jarmo , Parkkari Jari 
Published: January 2018

Background/aimPoor frontal plane knee control can manifest as increased dynamic knee valgus during athletic tasks. The purpose of this study was to investigate the association between frontal plane knee control and the risk of acute lower extremity injuries. In addition, we wanted to study if the single-leg squat (SLS) test can be used as a screening tool to identify athletes with an increased injury risk.MethodsA total of 306 basketball and floorball players participated in the baseline SLS test and a 12-month injury registration follow-up. Acute lower extremity time-loss injuries were registered. Frontal plane knee projection angles (FPKPA) during the SLS were calculated using a two-dimensional video analysis.ResultsAthletes displaying a high FPKPA were 2.7 times more likely to sustain a lower extremity injury (adjusted OR 2.67, 95% CI 1.23 to 5.83) and 2.4 times more likely to sustain an ankle injury (OR 2.37, 95% CI 1.13 to 4.98). There was no statistically significant association between FPKPA and knee injury (OR 1.49, 95% CI 0.56 to 3.98). The receiver operating characteristic curve analyses indicated poor combined sensitivity and specificity when FPKPA was used as a screening test for lower extremity injuries (area under the curve of 0.59) and ankle injuries (area under the curve of 0.58).ConclusionsAthletes displaying a large FPKPA in the SLS test had an elevated risk of acute lower extremity and ankle injuries. However, the SLS test is not sensitive and specific enough to be used as a screening tool for future injury risk.
Efficacy, tolerability and acceptability of oxycodone for cancer-related pain in adults: an updated Cochrane systematic review
Authors: Schmidt-Hansen Mia , Bennett Michael I , Arnold Stephanie , Bromham Nathan , Hilgart Jennifer S 
Published: January 2018

ObjectivesTo assess the efficacy, tolerability and acceptability of oxycodone for cancer pain in adultsMethodsWe searched CENTRAL, MEDLINE, MEDLINE In-Process, Embase, SCI, Conference Proceedings Citation Index-Science, BIOSIS, PsycINFO and four trials registries to November 2016.ResultsWe included 23 randomised controlled trials with 2144 patients analysed for efficacy and 2363 for safety. Meta-analyses showed no significant differences between controlled-release (CR) and immediate-release oxycodone in pain intensity or adverse events but did show significantly better pain relief after treatment with CR morphine compared with CR oxycodone. However, sensitivity analysis did not corroborate this result. Meta-analyses of the adverse events showed a significantly lower risk of hallucinations after treatment with CR oxycodone compared with CR morphine, but no other differences. The remaining studies either compared oxycodone in various formulations or compared oxycodone to different alternative opioids. None found any clear superiority or inferiority of oxycodone in pain relief or adverse events. The quality of this evidence base was limited by the high/unclear risk of bias of the studies and the low event rates for many outcomes.ConclusionsOxycodone offers similar levels of pain relief and adverse events to other strong opioids. However, hallucinations occurred less with CR oxycodone than with CR morphine, but the quality of this evidence was very low, so this finding should be treated with utmost caution. Our conclusions are consistent with other reviews and suggest that oxycodone can be used first line as an alternative to morphine. However, because it is cheaper, morphine generally remains the first-line opioid of choice.
Bibliometric analysis of military trauma publications: 2000–2016
Authors: Vickers Mark L , Coorey C P , Milinovich G J , Eriksson L , Assoum M , Reade M C 
Published: January 2018

IntroductionBibliometric tools can be used to identify the authors, topics and research institutions that have made the greatest impact in a field of medicine. The aim of this research was to analyse military trauma publications over the last 16 years of armed conflict in order to highlight the most important lessons that have translated into civilian practice and military doctrine as well as identify emerging areas of importance.MethodsA systematic search of research published between January 2000 and December 2016 was conducted using the Thompson Reuters Web of Science database. Both primary evidence and review publications were included. Results were categorised according to relevance and topic and the 30 most cited publications were reviewed in full. The h-index, impact factors, citation counts and citation analysis were used to evaluate results.ResultsA plateau in the number of annual publications on military trauma was found, as was a shift away from publications on wound and mortality epidemiology to publications on traumatic brain injury (TBI), neurosurgery or blast injury to the head. Extensive collaboration networks exist between highly contributing authors and institutions, but less collaboration between authors from different countries. The USA produced the majority of recent publications, followed by the UK, Germany and Israel.ConclusionsIn recent years, the number of publications on TBI, neurosurgery or blast injury to the head has increased. It is likely that the lessons of recent conflicts will continue to influence civilian medical practice, particularly regarding the long-term effects of blast-related TBI.
Construction of an evaluation index system for determining the academic impact of military medical scholars
Authors: Li Xuan , Hao J Y 
Published: January 2018

IntroductionAcademic papers are an essential manner for describing new ideas and consolidating existing concepts in the field of military medicine. The academic impact of military medical publications reflects the extent and depth of recognition, acceptance and utilisation of the concepts transmitted in these publications. The aim of this research was to construct an evaluation index system suitable for evaluating the academic influence of scholars in the field of military medicine.MethodsUsing the Delphi consensus methodology, 30 experts from the field of military medicine, military medical information and library and information science were asked during three rounds of questioning to score the feasibility and importance of indicators that could be used to determine academic impact. An analytic hierarchy process method was used to calculate the relative weighting of each indicator in determining the final level of academic impact.ResultsEight evaluation indicators were agreed on to potentially determine academic impact. These comprised: ‘Web of Science documents’, ‘Citation impact’, ‘h-index’, ‘Percentage of international collaborations’, ‘Percentage of the top 10% of the cited frequency’, ‘Category normalised citation impact’, ‘Percentage of documents cited’ and ‘The number of F1000 Recommended papers’.ConclusionsThe evaluation index system determined from this study combines the advantages of both qualitative and quantitative recognised evaluation indicators, which are subsequently weighted according to their importance in the field of military medicine. It is hoped that this framework will provide a manner in the future for comparing the potential academic impact of military medical scholars.
Preliminary programme evaluation of the Scottish Clinical Leadership Fellowship
Authors: Pearson Andrew , Ryan Christina , MacVicar Ronald 
Published: January 2018

BackgroundThe Scottish Clinical Leadership Fellowship (SCLF) is a 1-year programme to help medical and dental specialty trainees develop as future clinical leaders for the National Health Service (NHS) in Scotland. This preliminary programme evaluation combines qualitative and quantitative data from the 2016/2017 SCLF cohort. It will lay the foundation for a future more detailed evaluation study.MethodsData from written reflections were combined with accounts from a residential day and results of an anonymous survey. The survey considered the various personal development activities of the SCLF and how fellows’ perspectives had changed over the year. Results were thematically analysed.ResultsThe 2016/2017 cohort comprised 12 doctors. Fellows were left with highly positive views of the SCLF and their ability to influence their NHS organisation on return to practice. Personal reflections were assessed in six different themes, while the lessons fellows identified felt would shape their future clinical careers centred around personal behaviour, how fellows interacted with teams and their organisation, and improved leadership skills in general.ConclusionThis preliminary programme evaluation is the first such exercise completed on the SCLF. The highly positive findings have helped shape the programme for the subsequent cohort and will inform a future more detailed evaluation study.
Associations between type I interferon and antiphospholipid antibody status differ between ancestral backgrounds
Authors: Iwamoto Taro , Dorschner Jessica , Jolly Meenakshi , Huang Xiangyang , Niewold Timothy B 
Published: January 2018

ObjectiveThe type I interferon pathway is activated in many patients with systemic lupus erythematosus (SLE), and anti-double-stranded DNA (dsDNA) and anti-RNA binding protein autoantibodies are correlated with high interferon-α (IFNα) activity. We studied whether antiphospholipid (APL) antibodies, which should not stimulate Toll-like receptors, are also associated with high levels of IFNα activity.MethodsSerum IFNα activity was measured in patients with SLE using the WISH cell bioassay. IgG APL, anti-RBP and anti-dsDNA antibodies were measured in the clinical laboratory, and standard clinical cut-offs were used to define the positive results.ResultsHigh IFNα activity was associated with anti-RBP and anti-dsDNA antibodies in all three ancestral backgrounds. Strikingly, African-American subjects with a positive APL antibody test had higher IFNα activity than those without IgG APL antibodies. This was not shared with other ancestral backgrounds. This finding was independent of other autoantibody profiles, and clinical features did not differ between IgG APL antibody positive versus negative African-American patients.ConclusionThe difference in association between IFNα activity and IgG APL status between ancestral backgrounds supports differences in molecular pathogenesis. This may suggest B cell hyperactivity in the setting of type I IFN in African-Americans and could suggest ways to individualise therapy.
LVIS Blue as a low porosity stent and coil adjuvant
Authors: Koch Matthew J , Stapleton Christopher J , Raymond Scott B , Williams Susan , Leslie-Mazwi Thabele M , Rabinov James David , Patel Aman B 
Published: January 2018

IntroductionThe LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms.MethodsWe performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond–Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome.ResultsSixteen aneurysms were treated with the LVIS Blue device in conjunction with coil embolization with 6-month angiographic follow-up. Aneurysms were treated throughout the intracranial circulation: five proximal internal carotid artery (ICA) (ophthalmic or communicating segments), two superior cerebellar artery, two ICA terminus, two anterior communicating artery, two distal middle cerebral artery, one posterior inferior cerebellar artery, and two basilar tip aneurysms. Post-procedurally, there was one mRRC 1 closure, five mRRC 2 closures, and 10 mRRC 3a or 3b occlusion. At follow-up, all the mRRC 1 and mRRC 3a closures, 85% of the mRRC 3b closures and 75% of the mRRC 2 closures were stable or improved to an mRRC 1 or 2 at follow-up.ConclusionsThe LVIS Blue represents a safe option as a coil adjunct for endovascular embolization within both the proximal and distal anterior and posterior circulation.
SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis
Authors: Hodges Gethin W , Bang Casper N , Eugen-Olsen Jesper , Olsen Michael H , Boman Kurt , Ray Simon , Kesäniemi Antero Y , Jeppesen Jørgen L , Wachtell Kristian 
Published: January 2018

BackgroundWe evaluated whether early measurement of soluble urokinase plasminogen activator receptor (suPAR) could predict future risk of postoperative complications in initially asymptomatic patients with mild-moderate aortic stenosis (AS) undergoing aortic valve replacement (AVR) surgery.MethodsBaseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox analyses were used to evaluate suPAR in relation to all-cause mortality and the composite endpoint of postoperative complications (all-cause mortality, congestive heart failure, stroke and renal impairment) occurring in the 30-day postoperative period.ResultsPatients with initially higher levels of suPAR were at increased risk of postoperative mortality with a HR of 3.5 (95% CI 1.4 to 9.0, P=0.008) and postoperative complications with a HR of 2.7 (95% CI 1.5 to 5.1, P=0.002), per doubling in suPAR. After adjusting for the European System for Cardiac Operative Risk Evaluation or Society of Thoracic Surgeons risk score, suPAR remained associated with postoperative mortality with a HR 3.2 (95% CI 1.2 to 8.6, P=0.025) and 2.7 (95% CI 1.0 to 7.8, P=0.061); and postoperative complications with a HR of 2.5 (95% CI 1.3 to 5.0, P=0.007) and 2.4 (95% CI 1.2 to 4.8, P=0.011), respectively.ConclusionHigher baseline suPAR levels are associated with an increased risk for postoperative complications and mortality in patients with mild-moderate, asymptomatic AS undergoing later AVR surgery. Further validation in other subsets of AS individuals are warranted.Trial registration numberNCT00092677; Post-results.