bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Length of Questionnaire Matter? A Randomised Trial of Response Rates to a Mailed Questionnaire
Authors: Iglesias Cynthia , Torgerson David 
Published: January 2017

Objective: To assess whether length of questionnaire affects response rates. Methods: A quasi-randomised trial of women aged 70 years and over in a general practice in England. Three questionnaires of different lengths: a clinical questionnaire (four pages); the same questionnaire plus the EuroQol (five pages); the same questionnaire plus the SF-12 (seven pages). The impact of length on the proportion of returned questionnaires and item completion rates was assessed. Results: In total, 847 questionnaires were mailed; response rates were 49%, 49% and 40% to the short, medium and long questionnaires, respectively. This difference was statistically significant when the short questionnaire was compared against the longest instrument (9% difference; 95% confidence interval (CI) of difference=0.3% to 16.6%). Item completion rates for the clinical questionnaire did not differ. Respondents did not differ in age or self-reported health status between the three groups. Conclusions: Increasing the length of a questionnaire from five to seven pages reduces response rates from women aged 70 years and over. However, lengthening a questionnaire does not seem to affect the quality of responses to questions near the front of the questionnaire.
Do Managers Pay Their Way? The Impact of Management Input on Hospital Productivity in the NHS Internal Market
Authors: Söderlund Neil 
Published: January 2017

Introduction: Levels of management staffing in the UK National Health Service (NHS) have received considerable political and media attention in the last four years or so. Both the previous and current governments committed themselves to reducing management expenditure in the health service, and significant cuts appear to have been made in this area in the last year or so. Few systematic evaluations have been undertaken of the value of general management input, however, and policy changes appear to have been largely determined by popular opinion. This study attempts to quantify the effect of management input on hospital productivity for the first three years of the NHS internal market (1991/2–1993/4). Methods: An average cost function was used to model the effect of management inputs on hospital costs after adjustment for the levels of outputs produced, input costs, and internal and external exogenous constraints on hospital functioning. Two measures of management input were used: the proportion of total spending consumed by top level management, and the proportion consumed by all administrative activities. Cross-sectional and longitudinal models with contemporaneous and lagged management input effects were estimated. Results: Higher spending on top level management was associated with poorer productivity levels in most instances. Total administrative inputs had a weaker, but still generally negative, association with productivity. Conclusions: No evidence was found that increasing management inputs was associated with improved productivity. On the contrary, spending more on top level managers appeared in fact to be associated with lower productivity levels. Results would thus appear to be in line with decisions to reduce the level of expenditure on management in NHS hospitals. Quality differences could not be measured, however, and it is possible that management input is associated with quality improvements which might reduce or reverse observed productivity losses.
Effect of Japanese Government Policy on Hospital Pharmaceutical Profit Levels
Authors: Oliver Adam James , Ikegami Naoki , Ikeda Shunya 
Published: January 2017

Objectives: Our main objective is to examine whether the Japanese government's pharmaceutical price reduction policy has reduced the size of pharmaceutical profit traditionally enjoyed by health care providers. We discuss alternative measures that the government could introduce in an attempt to control drug costs. Methods: We review Japan's pharmaceutical reimbursement system. We then analyse published and unpublished data in an attempt to reach our main objective. Calculations are made from raw data, provided by the National Hospital Federation of Japan, in order to discover the extent to which hospitals are experiencing financial difficulties. Results: Due to pharmaceutical product shifting by hospitals from older, less profitable drugs to newer, more profitable ones, drug profit margins may not have fallen to the extent that is often reported in the Japanese press. Furthermore, increased prescribing, possibly due to the ageing of the population, may have maintained the total drug profits of hospitals, to a large extent, despite any reduction in profit margins. Conclusions: Although drug price reduction policy has had some success in controlling pharmaceutical expenditure, there is little evidence to suggest that total pharmaceutical profits for the provider units have been seriously undermined, despite the prevalence of this notion among hospital administrators. Nevertheless, in order to promote the more efficient and effective manufacture and utilization of pharmaceuticals, the government should seriously consider alternative methods for controlling pharmaceutical costs.
Postoperative Wound Complications after Internal Fixation of Closed Calcaneal Fractures: A Retrospective Analysis of 126 Consecutive Patients with 148 Fractures
Authors: Koski A. , Kuokkanen H. , Tukiainen E. 
Published: January 2017

Aim: The aim of the study was to analyse the number of soft-tissue complications after internal fixation of calcaneal fractures and to evaluate risk factors leading to these complications. Material: A retrospective analysis of 126 consecutive patients with 148 operatively treated calcaneal fractures was performed. Only primarily closed fractures were included in the study. Results: Wound healing was problematic in 35 cases (24 per cent). The wound was infected in 23 cases (16 per cent) and a wound edge necrosis was observed in 12 cases (8 per cent). The soft tissue complication needed operative treatment in 20 cases (14 per cent). The complications did not lead to amputations in any case. In the end of the follow up all wounds had healed. Conclusions: The statistical analysis identified a longer delay in surgery and longer operation time to be positive risk factors for wound complications.
The Durability of Evar — What are the Evidence and Implications on Follow-Up?
Authors: Lange C. , Aasland J. K. , Ødegård A. , Myhre H. O. 
Published: January 2017

Background and Aims: To investigate the durability of EVAR and to explore the evidence for follow-up investigations. Furthermore, to study the patients' impressions of follow-up investigations, and how complications and secondary procedures influence cost-effectiveness. Material and Methods: 263 patients were treated by EVAR from february 1995-february 2007. The series is divided into two groups with the year 2000 as a cut-off point since a new generation of stent grafts was then introduced. Early and late complications and secondary procedures were recorded. A questionnaire study was performed to investigate the patients' views on the follow-up program. Results: There was a significant reduction of complications from period I to period II, which was also reflected in the reduction of secondary procedures. Freedom from secondary procedures were 47% and 93% at 5 years follow-up in the two periods, respectively. In phase II, 7.5% of the patients needed a secondary procedure. Limb extension and femoro-femoral bypass were the most common procedures. Since late complications still occur, and can be unpredictable, a follow-up program is necessary. The vast majority of the patients tolerated the follow-up program well. Conclusions: Although the number of complications following EVAR has decreased significantly over the years, a thorough follow-up program is still necessary. This follow-up regime is well tolerated by the patients. Reduction of secondary procedures is important to improve the cost-effectiveness of EVAR.
Cholecystectomy for Acute Gallstone Pancreatitis: Early Vs Delayed Approach
Authors: Wilson C. T. , de Moya M. A. 
Published: January 2017

Background and Aims: The management of gallstone pancreatitis, in particular timing of cholecystectomy, has evolved substantially over the last decade. The trend has been toward earlier cholecystectomy. We review current literature regarding the timing of cholecystectomy in the context of gallstone pancreatitis. Materials and Methods: The authors performed a literature search in PubMed for relevant articles in the English language with greatest weight given to prospective trials compared to observational studies and previous reviews. Results: The literature search yielded 59 articles discussing cholecystectomy in the context of gallstone pancreatitis. Most were retrospective studies or reviews, but there were nine prospective observational studies and two randomized control trials. For mild gallstone pancreatitis, laparoscopic cholecystectomy within 48 hours of presentation (without normalization of pancreatic enzymes or absence of abdominal pain) has been shown to shorten hospital stay without increased morbidity or mortality. Routine preoperative ERCP is unnecessary for patients with mild disease. For more severe disease, timing of cholecystectomy is governed by clinical status. Interval cholecystectomy (>2 weeks after index admission) can be safely done with low risk of recurrence if the patient has had ERCP and sphincterotomy at index admission. Conclusion: Patients with mild gallstone pancreatitis should have cholecystectomy during index admission within 48 hours of arrival, but patients with more severe disease will require cholecystectomy at a later time, depending on the clinical circumstances. Sphincterotomy should be done as soon as possible if cholecystectomy is not feasible early in course.
A Clinical Study on the Resection of Breast Fibroadenoma Using Two Types of Incision
Authors: Liu X.-F. , Zhang J.-X. , Zhou Q. , Chen F. , Shao Z.-M. , Lu C. 
Published: January 2017

Background and Aims: Breast fibroadenoma (FA) is traditionally managed by FA excision through an overlying incision (FETOI). FA excision through a periareolar incision (FETPI) has been developed, paying special attention to incision location to preserve cosmesis. The purpose of this article is to discuss the FETPI technique. Methods: The clinical data of 76 patients who underwent FETPI (98 FAs, group A) and 82 patients who underwent FETOI (122 FAs, group B) were retrospectively analyzed in this non-randomized study. Early postoperative complications, nipple sensation loss, and cosmetic results were compared between the two groups. The techniques, indications, and special considerations of the FETPI technique were described and identified. Results: The FETPI technique was associated with more early postoperative complications (7/76 vs. 2/82, p = 0.067) and more nipple sensation losses (15/76 vs. 7/82, p = 0.042) than those of the FETOI technique. Cosmetic assessment at 6 months demonstrated statistically more excellent/good results in group A than in group B (62/76 vs. 50/82, p = 0.004). Conclusion: The FETPI technique yields superior cosmetic results with minor postoperative complications.
Results of a Surgical Resection for Patients with Thymic Carcinoma
Authors: Yasuda M. , Hanagiri T. , Oka S. , Uramoto H. , Takenoyama M. , Yasumoto K. 
Published: January 2017

Objectives: This study investigated the clinical features of patients with complete resection of thymic carcinoma. Patients and Methods: The clinical records from 11 patients who underwent a complete resection of thymic carcinoma were retrospectively reviewed. Results: Twelve of 22 patients underwent a resection (a complete resection in 11 and an incomplete in 1). Six of the 11 patients with complete had confirmed recurrent tumors. The 5-year survival rate was 45.4%, and the median survival time was 50.6 months. The patients who underwent complete resection showed significantly better prognosis than cases with incomplete resection and inoperable cases ( p = 0.048). Three of the 6 patients had a recurrence within 1 year. Frequent sites of recurrence were the pleura, pericardium, and lung. Conclusions: A complete resection improved the prognosis of thymic carcinoma. Further prospective studies regarding postoperative adjuvant therapy are necessary to prevent local recurrence after a surgical resection for thymic carcinoma.
Latissimus Dorsi Free Flap Harvesting May Affect the Shoulder Joint in Long Run
Authors: Giordano S. , Kääriäinen M. , Alavaikko J. , Kaistila T. , Kuokkanen H. 
Published: January 2017

Background: The latissimus dorsi (LD) muscle or myocutaneous flap is one of the most commonly used flaps and is believed to result in minimal donor-side morbidity. The impact on shoulder function from LD removal is important due to the common nature of this procedure. Previous studies have been performed after relatively short follow-up time and mostly after breast reconstruction. The purpose of this study was to objectively evaluate shoulder function years after latissimus dorsi muscle free flap operation. Methods: Between 1998 and 2004, eight patients who underwent LD-free flap for lower limb (7) or head and neck (1) soft tissue reconstruction were enrolled in this study. Scar, shoulder pain, function, mobility, stability and strength were evaluated and measured by using the Patient Scar Assessment Questionnaire (PSAQ), the Scar Evaluation Scale (SES) score, the American Shoulder and Elbow Surgeons (ASES) form, goniometer and isokinetic tests. Measurements of the operated sides were compared to the non-operated sides. Results: Mean age was 54 ± 21 years and mean follow-up was 92.5 ± 36 months after surgery. Mean PSAQ was 73 (65%), mean SES score was 2 ± 1. When comparing the operated sides to the unoperated sides, ASES score was significantly lower in the operated side (76 versus 93, p = 0.008); The range of motion in active and passive endorotation, active extrarotation and active forward elevation were significantly reduced after surgery. Operated side revealed a significant joint instability (3.6 versus 1.2, p = 0.007) using the ASES form. Isokinetic tests revealed that only intra-rotation strength was significantly reduced (35.74 Newton-metre versus 42.7 Newton-metre, p = 0.03) in the operated side. Conclusion: LD harvesting can affect the function of the shoulder joint in the long run. Reduced mobility, instability and weakness could be obtained with objective measurements. However, the results should be interpreted with caution because of the small sample size, internal controls and retrospective nature of this study.
Incomplete Event Documentation in Medical Records of Lung Transplant Recipients
Authors: Troiani John S. , Finkelstein Stanley M. , Hertz Marshall I. 
Published: January 2017

Context The medical record is frequently used in clinical studies as a source of information on illness events experienced by patients; however, it may be incomplete. Objective To estimate the extent of incompletely documented acute bronchopulmonary events in a transplant clinic medical record at a single university medical center, using home monitoring data. Design, Setting, and Subjects Trends in daily home monitoring data were compared to contemporaneous medical record documentation at 150 different times in 30 lung transplant recipients over 45 subject-years. Outcome Measure Proportion of acute bronchopulmonary illness events documented in clinic medical record. Results By using home monitoring data in a new way, we found that 40% of events actually suffered by lung recipients could not be ascertained to have occurred from the clinic medical record alone. All missed encounters occurred away from the transplant clinic, and involved hospitalizations and telephone prescriptions. Conclusions Using the clinic medical record alone to identify acute bronchopulmonary events in lung transplant recipients may result in missing 40% of events. This has important ramifications for studies relying on the medical record for acute event ascertainment in lung transplantation and possibly other chronic diseases.
Leading the Flock: Organ Donation Feelings, Beliefs, and Intentions among African American Clergy and Community Residents
Authors: Davis Kimberly , Holtzman Samuel , Durand Roger , Decker Phillip J. , Zucha Bryanne , Atkins Lamon 
Published: January 2017

Context Despite a considerable potential role in organ donation for African American clergy, there has been little investigation to date of the beliefs, attitudes, and personal intentions of such clergy regarding donation. Objective To compare the beliefs, attitudes, and behavioral intentions regarding organ donation among African American clergy to those of African American residents of the same large US city. Design Focus groups and 3 cross-sectional surveys. Setting Greater Houston, Tex, metropolitan area. Participants A total of 761 randomly selected African American community residents and 311 African American clergy. Main Outcomes Measures Beliefs about the importance of organ donation; how comfortable one is in thinking about donation; whether one believes that organ donation is against one's religion; trust in healthcare professionals regarding death declaration; concerns that donation leads to body mutilation; and the likelihood that one will donate one's own organs upon death. Results Compared to general African American residents, African American clergy in the Houston area were found more often to believe in the importance of donation; to be more comfortable with thinking about donation; to feel more certain that donation was not against their religion; to believe that they could trust healthcare professionals regarding death declaration; to feel less often that donation leads to mutilation of the body; and to indicate a greater likelihood of donating their own organs upon death. The same was found to be true among clergy and congregants of the largest religious denomination in Houston, the Baptists.
Hand-Assisted Laparoscopic Donor Nephrectomy: A Low Rate of Complications
Authors: Sharma Ajay K. , Meier Scott , Larmeu Louis , Florman Sander , Slakey Douglas P. 
Published: January 2017

Background Laparoscopic donor nephrectomy is associated with a higher incidence of ureteral complications. Hand-assisted dissection minimizes the use of instruments for intraoperative retraction and handling of periureteric tissue, and may reduce posttransplant complications. Objective To assess the outcome of hand-assisted laparoscopic donor nephrectomy, in particular ureteral complications. Methods Records of 143 kidney transplant recipients who received allografts removed using the hand-assisted laparoscopic technique were retrospectively studied. Results Total operating time was 2.0±0.55 (range 1.08–4) hours. Warm ischemia time was 1.45±0.60 (range 0.58–3.00) minutes. Length of artery, vein, and ureter was 2.4±0.5 cm, 3.0±0.5 cm, and 10.3±2.1 cm, respectively. Estimated blood loss averaged 86.3±55.6 mL. Intraoperative suction was not needed in 65% of patients. Two donors developed incisional hernias and 1 had a postoperative ileus. Four of 143 (2.8%) recipients developed ureteral complications: reoperations for ureteral necrosis (1), stenting for ureteral stenosis (2), and urethral catheterization for ureterovesical leak (1). Graft loss in the first year after transplantation occurred because of renal vein thrombosis, thrombosis of revised arterial anastomosis, arterial thrombosis due to myocardial infarction, vasculitis, focal segmental glomerulosclerosis, and chronic rejection. Delayed graft function developed in 3 recipients. The acute rejection rate was 14.6%. Mean serum creatinine levels at 1 and 3 years were 134±61 μmol/L (1.52±0.69 mg/dL) and 121±35 μmol/L (1.37±0.40 mg/dL), respectively. Conclusions Hand-assisted laparoscopic donor nephrectomy is associated with a low incidence of ureteral complications; may reduce the technical difficulty of the operation and minimize retraction with instruments, resulting in fewer complications for donors and recipients; and minimizes donor blood loss.
An Exploratory Study of the Cognitive, Academic, and Behavioral Functioning of Pediatric Cardiothoracic Transplant Recipients
Authors: Brosig Cheryl , Hintermeyer Mary , Zlotocha Jane , Behrens Darcia , Mao Jingnan 
Published: January 2017

Context Limited information is available regarding the cognitive, academic, and behavioral outcomes of pediatric cardiothoracic transplant recipients. Objective To examine the cognitive, behavioral, and academic functioning of a group of children who have received heart, heart/lung, or lung transplants. Design, Participants, and Setting An exploratory cross-sectional outcomes study of surviving pediatric cardiothoracic transplant recipients at a Midwestern pediatric hospital. Main Outcome Measures Transplant recipients completed measures of cognitive and academic functioning. Parents and teachers completed measures of behavioral functioning. Parents and transplant recipients also provided qualitative data regarding their main concerns after transplantation. Results On measures of cognitive functioning, 46% showed significant delays (>2 SD below the normative population). Of those eligible for academic testing, 78% fell within the average range (within 1 SD of the normative population) for reading and spelling, and 57% fell within the average range for math. Twenty-seven percent of mothers, 11% of fathers, and 17% of teachers rated subjects as having significant behavioral concerns. Results highlight the need for close contact between transplant teams and school personnel to optimize outcomes. In addition, patients and families may benefit from psychological intervention after transplantation as there are ongoing concerns regarding life expectancy and quality of life.
Implementation of an Intervention Plan Designed to Optimize Donor Referral in a Donor Hospital Network
Authors: Van Gelder Frank , Van Hees Dirk , de Roey Joachim , Monbaliu Diethard , Aerts Raymond , Coosemans Willy , Daenen Willem , Pirenne Jacques 
Published: January 2017

Context The shortage of donor organs remains the most important factor of waiting list mortality in organ transplantation worldwide. Donor detection is influenced by the legal system, family refusal, and underreporting caused by erroneous knowledge of donation criteria and lack of familiarity with the procedure. Objective To identify possible key factors of donor referral patterns within an existing cooperation with donor hospitals and donor units across the Dutch-speaking part of Belgium, an area of approximately 3 million inhabitants. An intervention plan to optimize the cooperation and procedure quality and efficiency was designed. Design The intervention plan was based on 3 essential principles in donor referral by donor reporters, information on donor criteria, facilitation of the donor procedure, and communication between donor reporters and the transplant center. The interventions were structured to optimize all 3 of these principles. Two successive periods of 4 years were retrospectively compared. Participants Data were collected retrospectively on donor referral behavior from a total of 37 donor hospitals and donor units over an 8-year period. Main Outcome Measures The referrals were reviewed for potential donors, effective donors, percentage of effective donors, refusal rate of relatives, number of tissue donors, impact on local and national transplant programs, and national donor numbers. Results Data showed a significant positive impact on donor referrals and donor referral behavior (+27% potential donors, +30% effective donors, +172.7% tissue donors, −7% family refusals rates, +9.63% national donors). The results stress the importance of reduced workload and optimization of communication and information availability in an existing donor hospital network.