bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expert Panel Assessment of Appropriateness of Abdominal Aortic Aneurysm Surgery: Global Judgement versus Probability Estimation
Authors: Silverstein Marc D. , Ballard David J. 
Published: January 2017

Objective: To compare an expert panel's global assessment of appropriateness of elective surgery for abdominal aortic aneurysms (AAA) with their assessment of the effect of surgery on the probability of 5-year mortality. Methods: Nine expert panel members rated the appropriateness of 120 scenarios for elective AAA repair on a nine-point scale, and also estimated the 5-year probability of AAA-related death and of non-AAA related death among 30-day survivors of AAA surgery and among patients with unoperated AAA. These probabilities were used to determine differences in 5-year probability of mortality of surgery vs. no surgery for each scenario. Three categories of appropriateness were defined based on these differences: inappropriate (< 0%), equivocal (0-5%), and appropriate (>5%). Results: The distribution of scenarios was inappropriate (39%), equivocal (12%), and appropriate (49%) based on probability estimates and inappropriate (43%), equivocal (22%), and appropriate (36%) based on global assessment. There was poor agreement between the two methods, with a Kappa coefficient=0.28 (95% CI: 0.23 to 0.32). Although a higher proportion of scenarios were rated as appropriate using probability estimation rather than global judgment, the level of agreement among members of the panel was similar, Kappa coefficient= 0.07 (95% CI: — 0.07 to 0.72) Conclusions: Experts disagree about the appropriate indications for elective surgery for AAA. Explicit estimates used in a decision analysis may provide a better assessment of appropriate indications than the global judgment of experts. Global assessment of the appropriateness of AAA surgery based on panel members' review of research evidence for increased survival appears to include implicitly their valuation of outcomes.
Day Case Surgery Trends in England: The Influences of Target Setting and of General Practitioner Fundholding
Authors: Raftery James , Stevens Andrew 
Published: January 2017

Objectives: To describe the trends in the proportion of elective surgery carried out as day cases, and the impact of the setting of targets and the introduction of general practitioner (GP) fundholding on the use of day surgery. Methods: Cross-sectional analysis of Hospital Episode Statistics for England, 1990/1991 to 1994/1995, comparing procedures for which targets were and were not set, and comparing types of purchaser (GP fundholder and health authority). Results: Elective surgical procedures increased from 2.7 million in 1990/1991 to 3.9 million in 1994/1995, a 44% increase. Increased numbers of day cases (up 117%) accounted for almost all of the increased total activity. The proportion of day cases rose from 35% to 53% over the period. Those procedures for which targets were set (over 25% of elective surgery) had a slightly lower day case proportion in 1990/1991 (34% compared to 36%) but slightly higher by 1994/1995 (57% compared to 52%). GP fundholders generally had slightly lower proportions treated as day cases compared to health authorities. Conclusions: Day cases were additional to, rather than a substitute for, inpatient treatments. Setting day case targets may have been associated with growth in use of day surgery, but there was no association with type of purchaser.
Variations in Use of Cardiac Services in England: Perceptions of General Practitioners, General Physicians and Cardiologists
Authors: Chapple Alison , Gatrell Anthony 
Published: January 2017

Objective: To explain why those who live some distance from tertiary cardiac centres make less use of coronary angiography and revascularisation than those who live close by, and why people living in particular wards within certain districts make less use of services than might be expected from their level of need. Method: Semi-structured interviews with 24 general practitioners (GPs) in two English health districts (Morecambe Bay and East Lancashire), five general physicians working in district general hospitals, and four interventional cardiologists working in tertiary centres. Transcripts of audiotape recordings were analysed using the constant comparative method. Results: Those living far from tertiary centres are usually referred to general physicians before they are referred for angiography. The general physicians tend to be more conservative in their approach to treatment than interventional cardiologists. GPs working near tertiary centres are able to refer directly to interventional cardiologists. There are also logistical and economic reasons for inequitable use of services. Some GPs perceived that patients of South Asian descent undergo fewer investigations than might be expected because of communication or other difficulties. Conclusion: Use of cardiac services would be more equitable if there were interventional cardiologists based in district general hospitals who could perform angiograms for their own patients in the tertiary centres. Patients might also benefit if angiograms could be conducted in selected district general hospitals. Further qualitative research, involving both doctors and patients, is needed to explore other reasons for relatively low rates of investigation and revascularisation in certain groups of patients.
The Distribution of Health Care Costs and Their Statistical Analysis for Economic Evaluation
Authors: Briggs Andrew , Gray Alastair 
Published: January 2017

Objective: Where patient level data are available on health care costs, it is natural to use statistical analysis to describe the differences in cost between alternative treatments. Health care costs are, however, commonly considered to be skewed, which could present problems for standard statistical tests. This review examines how authors report the distributional form of health care cost data and how they have analysed their results. Method: A review of cost-effectiveness studies that collected patient-level data on health care costs. To supplement the review, five datasets on health care costs are examined. Consideration is given to the use of parametric methods on the transformed scale and to non-parametric methods of analysing skewed cost data. Results: Since economic analysis requires estimation in monetary units, the usefulness of transformation-based methods is limited by the inability to retransform cost differences to the original scale. Non-parametric rank sum methods were also found to be of limited use for economic analysis, partly due to the focus on hypothesis testing rather than estimation. Overall, the non-parametric approach of bootstrapping was found to offer a useful test of the appropriateness of parametric assumptions and an alternative method of estimation where those assumptions were found not to hold. Conclusions: Guidelines for the analysis of skewed health care cost data are offered.
Can Community Leaders' Preferences be Used to Proxy Those of the Community as a Whole?
Authors: Onwujekwe Obinna , Shu Elvis , Okonkwo Paul 
Published: January 2017

Background: Community-based distribution of ivermectin and other drugs requires people in the endemic communities who are capable of distributing the drug. It is essential also to collect information on local people's views concerning different financing mechanisms and approaches to distributing ivermectin. However, studies at household level are resource-intensive. Eliciting the preferences of the community by interviewing a smaller number of community leaders offers an alternative strategy. Methods: A comparison of information from community leaders and household heads on the financing and distribution of ivermectin through communities was conducted in three communities in Nigeria to determine whether rapidly collected information from key community leaders could represent broad community preferences. Results: The preferences of community leaders and household heads were comparable in relation to the method of collecting payments, managing payments and making payments, who should set the level of payments and the drug distribution mechanisms. However, there were differences between community leaders' views and those of heads of households concerning how the scheme should be supervised. Conclusions: This study has shown that community leaders' views can only be used as a partial substitute for more laborious methods of data collection insofar as they have the attraction of being quicker and less costly to use. However, they should not be assumed to be identical with the views of the community as a whole.
A rhetorical field theory: Background, communication, and change
Authors: Kornprobst Markus , Senn Martin 
Published: January 2017

Develops a rhetorical field theory that conceptualises the relationship between background ideas and foreground communication Distinguishes between two layers of background ideas ( nomos and topoi) that underpin communicative encounters in a field Conceptualises communicative opportunities and moves through which actors change the nomos of a field Illustrates the added value of a rhetorical field theory by inquiring into nomic change in the nuclear-weapons field A burgeoning literature in International Relations draws on Bourdieu’s theory of social fields to address the question of how actors make and unmake order in world politics. Inquiring into deeply seated background ideas constituting order, this literature often neglects how communication reproduces and (de)contests background ideas. Our article seeks to remedy this shortcoming by outlining a rhetorical field theory. This theory puts background ideas and foreground communication on an equal footing and conceptualises their relationship in detail. We distinguish between two layers of background ideas ( nomos and topoi) and address the crucial question of how nomic change becomes possible. We introduce a typology of nomic change (destabilisation, adaption, disorientation, shift) and conceptualise the interplay of rhetorical opportunities and rhetorical moves that bring about particular types of nomic change. We probe this theoretical framework by analysing the recent nomic change in the nuclear-weapons field. This empirical analysis provides evidence for our theoretical framework.
Dupuytren'S Contracture; Increased Cellularity — Proliferation, is There Equality?
Authors: Forsman M. , Kallioinen L. , Kallioinen M. , Ryhänen J. 
Published: January 2017

Background: Dupuytren's disease is a chronic inflammatory process which causes contractures of the fingers by shortening and thickening the palmar fascia. During the proliferative phase, fibroblasts transform into myofibroblasts apparently under the influence of several different factors. The disease usually develops slowly, but in some patients it tends to develop aggressively. The pathogenesis of Dupuytren's disease remains unsolved. In this study, we analyzed some histological characteristics that seem to predict rapid recurrence. Material and Methods: 21 patients were divided into two groups. In 11 patients the disease was classified as aggressive because it had recurred within two years after an operation. In 10 cases it was non-aggressive, as no recurrence had been seen. Five control samples were taken from healthy palmar aponeurosis. The differences in cellularity, collagen, Ki-67, MSA, alpha-SMA and tenascin between the specimens were analyzed using immunohistochemistry. Results: Alpha-SMA and Ki-67 were present more often in the aggressive specimens. Immunohistochemical stainings for macrophages and lymphocytes were negative. Conclusion: There may be differences in the histology and/or immunohistochemical appearance of pathological palmar connective tissue cords in aggressive and normal Dupuytren's disease. Further studies are needed to elucidate the pathogenesis of this disease.
Simultaneous Colorectal and Liver Resections for Synchronous Colorectal Metastases
Authors: Sasanuma H. , Yasuda Y. , Mortensen F. V. , Yamashita K. , Nihei Y. , Houjou N. , Chiba H. , Shimizu A. , Okada M. , Nagai H. 
Published: January 2017

Background: The surgical strategy for the treatment of colorectal cancer and synchronous hepatic metastases remains controversial. Many surgeons fear anastomotic leakage and intraperitoneal abscesses when performing a one-step procedure. They prefer a two-step procedure with a liver resection 2 to 3 months after resection of the colorectal primary lesion. Subjects and Methods: We analysed medical records from April 1994 to April 2002 for a total of 42 patients with colorectal cancer and synchronous liver metastases who underwent simultaneous liver and colorectal resections with a primary anastomosis. Special attention was paid to data on surgical procedures, postoperative morbidity, and mortality. Results: Forty-two patients, 24 men and 18 women, were studied. Median operating time was 6.50 hours (3.75–11.0 hours), and median blood loss was 1522 ml (range 288 to 5650 ml). Postoperative complications included pleural effusion in 4 patients, ileus in 3, anastomotic leakage in 2, intraperitoneal pelvic abscesses in 1, pneumonia in 1, bile leakage in 1, atelectasis in 1, and wound infection in 1. There was no perioperative mortality. Conclusion: Simultaneous colorectal resection with a primary anastomosis and hepatectomy for synchronous liver metastases is considered a safe procedure.
Feasibility of Axillary Ultrasound in the Quality Assessment of Sentinel Node Biopsy in Breast Cancer Surgery
Authors: Paajanen H. , Kilponen V.-M. , Heikkinen J. , Sammalkorpi H. , Helle M. 
Published: January 2017

Background and Aims: The purpose of this study was to evaluate the efficacy of high-resolution axillary ultrasound (AU) in detecting the rate of recurrence after anegative sentinel node (SN) biopsy in patients with breast cancer and without additional axillary dissection. Materials and Methods: The operating oncologic surgeon performed 196 consequent sentinel node biopsies during surgery of breast cancer. The sentinel nodes were identified by using preoperative lymphoscintigraphy, intraoperative gamma probe and Patent Blue® dye. A routine postoperative follow-up of the patients were performed every 3rd month including clinical examinations, blood chemistry and mammography. After 31 months (range 14–49 months), a high-resolution AU was performed for 107 patients with a negative sentinel node during surgery and without axillary dissection, to visualize any abnormal lymph nodes in the axilla. If necessary, large core biopsies were undertaken to obtain histology of abnormal axillary nodes. Results: The SNs were visualized during preoperative lymphoscintigraphy in 167/196 (85%) and found during the surgery in 163/167 (98%) of patients. The mean number of removed SN were 1.7 ±0.8. The SN metastasis were found in 29% (56/196) of patients. During the follow-up, abnormal nodes were identified during AU in only 4/107 patients. Core biopsies confirmed benign histology in three patients and one case of lymphoma was detected. Conclusions: There were no axillary recurrences of breast cancer after a negative SN biopsy during the 2.6 year follow-up. Axillary ultrasound is a useful tool in the quality control of patients with negative SN biopsy and without diagnostic axillary dissection.
Organisation and Early Outcomes of Major Upper Gastrointestinal Cancer Surgery in Denmark 1996–2004
Authors: Jensen L. S. , Bendixen A. , Kehlet H. 
Published: January 2017

Background: To assess the relationship between hospital volume and early postoperative outcome the incidence and early outcome of all esophagectomies, pancreaticoduodenectomies and gastric resections in Denmark from 1996 to 2004 was described. Methods: The National Patient Registry and discharge information from all hospital departments were analysed for all the operations due to a malignant diagnosis. All information was examined for postoperative length of stay and hospital mortality. Results: During the study period 26 departments performed at least one esophageal resection, 13 departments performed at least one Whipple procedure and 37 departments performed at least one gastric resection. Four departments performed more than 20 esophageal resections per year, whereas one department performed more than 20 Whipple procedures and one more than 20 gastric resections per year. The overall mean length of stay was 21.6 days, 24 days and 18 days for esophageal, pancreatic and gastric resections, respectively, with no difference between high and low volume departments. The hospital mortality was 8.6%, 8.9% and 8.2%, respectively. Conclusion: The overall high mortality and long postoperative stay in patients undergoing upper gastrointestinal cancer surgery in Denmark calls for improvement by regionalisation into 3–4 departments and monitoring of results.
FDG-PET Improves Management of Patients with Colorectal Liver Metastases Allocated for Local Treatment: A Consecutive Prospective Study
Authors: Sørensen M. , Mortensen F. V. , Høyer M. , Vilstrup H. , Keiding S. ,   The Liver Tumour Board at Aarhus University Hospital
Published: January 2017

Background and Aim: Colorectal cancer is a common cancer in the Nordic countries and 50% of the patients develop liver metastases. Liver resection may result in long term survival. Proper staging is therefore essential and CT is the standard imaging modality. We examined whether additional FDG-PET improves therapeutic management of patients with colorectal liver metastases. Patients and Methods: Fifty-four consecutive patients were enrolled. Each patient had a treatment plan made based on our standard evaluation. The patients then had a PET scan and the treatment plan was re-evaluated, taking these results into account. Results: In 76% of the cases, PET did not change the treatment plan due to complete concordance with CT. In another 19% of the cases, the plan was altered due to finding of more liver lesions by PET than by CT (four patients), fewer or no liver lesions (three patients), and extrahepatic lesions not visible on CT (three patients). In 5% of the cases, non-concordance between PET and CT did not change the therapeutic plan. Conclusion: Pre-treatment FDG-PET, used supplementary to CT, improved the treatment plan in one fifth of the patients with colorectal liver metastases.
Clinical and MRI Evaluation of Meniscal Tears Repaired with Bioabsorbable Arrows
Authors: Tielinen L. , Lindahl J. , Koskinen S. , Hirvensalo E. 
Published: January 2017

Background and Aims: Excision of meniscal tissue has been shown to increase the risk of degenerative changes of the knee joint. Whenever possible, meniscus repair has become the procedure of choice for treatment of meniscal tears. Materials and Methods: The present retrospective study evaluated the healing results of 77 meniscal ruptures treated with the an all-inside technique (Biofix meniscus arrow). The study group consisted of 73 patients with 77 longitudinal, vertical meniscal ruptures treated at Helsinki University Hospital between the beginning of January 1997 and the end of March 2001. The patients who had not received secondary surgery for failed repair during the follow-up period were examined clinically and with MRI. Results: Fifty-one out of 77 meniscal ruptures (66%) healed clinically. In repairs performed in conjunction with ligament reconstruction the healing rate was higher (79%) than in the isolated tears (56%). The poorest results were seen in the very long vertical tears with luxation of the meniscus (38% healing rate). Conclusions: Bioabsorbable arrows offer a good alternative for treatment of meniscal ruptures, but the arrows alone do not seem to be sufficient to provide a reliable long-lasting result in the repair of very unstable meniscal ruptures.
Incidence of HIP Fractures among the Elderly in Satakunta, Finland
Authors: Jaatinen P. T. , Panula J. , Aarnio P. , Kivelä S.-L. 
Published: January 2017

Background and Aims: The aim was to describe the incidence rate of hip fractures in the elderly in a specific region in Finland and circumstances around them. Material and Methods: Retrospective analysis of 461 women and men aged 65 or older undergoing an operation for hip fracture during a two-year period between 1999 and 2000. 80 variables in all were obtained from the hospital discharge register and patient documents. Results: The age-specific incidence of hip fractures was higher in women than in men (women 6.88/1000 person/y vs. 3.50/1000 person/y). Prior to the fracture, patients were primarily doing well; 63.4% lived at home and 65.1% used no mobility equipment or aids. Altogether 41.9% of hip fractures occurred in institutions. Both women and men more often suffered their injury indoors (91.1% and 75.7% respectively), and only a slight seasonal variation was observed. More than every fourth (26.9%) had experienced a previous fracture. Conclusions: The age-specific incidence of hip fractures was higher in women than in men. The fractures took place mostly indoors and often in institutions. Therefore the measures that impact on indoor safety are particularly important for the elderly.
Evolution of Robot-Assisted Radical Prostatectomy
Authors: Orvieto M. A. , Patel V. R. 
Published: January 2017

Introduction and Objective: Open radical prostatectomy (RRP) is the gold standard and most widespread treatment for clinically localized prostate cancer. However, in recent years robot-assisted laparoscopic prostatectomy (RARP) is rapidly gaining acceptance among urologists worldwide. We sought to outline our surgical technique of robotic radical prostatectomy and provide practical recommendations based on available reports and personal experience. We also critically review the current experience on RARP world-wide and compare the available data with the gold standard open RRP series. Material and Methods: A systematic review of the literature was performed for all published manuscripts between 1997 and 2008 using the keywords — ‘robotic radical prostatectomy, ‘robot-assisted radical prostatectomy’, ‘laparoscopic radical prostatectomy’ and ‘robotic” using the Medline database. Results: A total of 226 original manuscripts on RARP were identified. Manuscripts were selected according to their relevance to the current topic (i.e. original articles, number of patients in the series, prospective data collection) and incorporated into this review. Conclusions: Eight years after the first RARP, multiple series are mature enough to demonstrate safety, efficiency and reproducibility of the procedure, as well as oncologic and functional outcomes comparable to its open counterpart. Further prospective, randomized studies comparing both surgical techniques are necessary in order to draw more definitive conclusions.