bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of chest compression depth and rate during cardiopulmonary resuscitation with and without a feedback device
Authors: Fronczek-Wojciechowska Magdalena , Kopacz Karolina , Jaźwińska Anna , Padula Gianluca , Gaszyński Tomasz 
Published: February 2018

Background:Many feedback devices have been designed to improve the resuscitation outcomes. None have been implemented as a standard in patient care.Objectives:The aim of this study was to evaluate the chest compression depth and rate during cardiopulmonary resuscitation with and without a feedback device and to evaluate differences regarding the impact of a feedback device based on provider experience.Methods:The study was performed on 20 men divided into two groups: group A (n = 10)—paramedics; group B (n = 10)—non-paramedics, trained to provide resuscitation. Participants were examined during resuscitation with Ambu Megacode manikin and with or without the feedback device—CPRmeter. Depth of compressions was evaluated in the first and fourth minute of resuscitation with a BTS Smart DX7000 motion capture system. For statistical analysis, summary statistics, Shapiro–Wilk Test of normality, dependent samples t-test, Levene test, t-test for independent samples, or Welch’s t-test were used. Accepted level of significance was α = 0.05.Results:Statistically significant greater depth of chest compressions in group A was observed in the first minute of resuscitation with the device versus the first minute without the device. Significant differences in compressions rate between attempts with and without the device were observed in both groups in the first and fourth minute.Conclusion:Only the group of paramedics showed in time some benefits of the device related to the depth, whereas for the group of non-paramedics, the device seemed to have even a deleterious effect. The group of paramedics met the 2015 recommendations related to compressions rate all the time, while the non-paramedics only in the fourth minute of the procedure.
High Burden of Human Papillomavirus Infection in Madagascar: Comparison With Other Sexually Transmitted Infections
Authors: Bigoni Jérôme , Catarino Rosa , Benski Caroline , Viviano Manuela , Munoz Maria , Tilahizandry Honoré , Petignat Patrick , Vassilakos Pierre 
Published: February 2018

Background: In Madagascar, human papillomavirus (HPV), human immunodeficiency virus (HIV), and hepatitis B virus (HBV) infection, as well as syphilis share common risk factors but seem to differ in their prevalence. We measured and compared their prevalence in the country. Methods: The data used in this study came from the Saint Damien Health Centre in Ambanja, Madagascar. The tests used for disease detection were the Alere Determine, Virucheck, rapid plasma reagin, and S-DRY self-HPV samples for HIV infection, HBV infection, syphilis, and HPV infection, respectively. Results: In men and women, respectively, the prevalence was 0.6% and 0.4% for HIV infection, 2.2% and 2.0% for HBV infection, and 0.6% and 0.3% for syphilis. The HPV infection prevalence was 39.3%. Conclusions: Despite common risk factors, the prevalence of HPV infection was high, in contrast to a much lower prevalence of other sexually transmitted infections (STIs) in the same geographical area. Further investigations are required to clarify the status of STIs in the Malagasy population.
Comparison of Doctors', Nurses', Politicians' and Public Attitudes to Health Care Priorities
Authors: Myllykangas Markku , Ryynänen Olli-Pekka , Kinnunen Juha , Takala Jorma 
Published: February 2018

Objectives: The aim of this study was to investigate differences in attitudes concerning prioritisation in health care held by doctors, nurses, local politicians and the general public. Methods: Four groups were established: A population sample of 2000 subjects, aged 18–70 years; a random sample of 1500 doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire contained, among other things, a list of 12 statements concerning ethical decisions regarding prioritisation in health care. Respondents were asked to indicate their level of agreement with each statement. Results: Most respondents in all the groups felt able to express an opinion on the statements. Despite considerable professional and cultural differences between groups, the views were generally similar. On the whole, respondents supported liberal policies in which the community took responsibility for subsidising health care. When differences between groups occurred, it was usually the doctors who held discordant views. Doctors were less inclined to consider a patient's economic status as a determinant of priority for treatment than the other three groups. Both doctors and nurses were less punitive towards patients with self-induced diseases. And doctors and politicians were more likely to feel further cuts in health care expenditure were possible than was true for nurses and the public. Conclusions: While considerable uniformity of opinion exists on ethical issues of prioritisation between the principal interested parties, the views of doctors differ substantially on some matters. If prioritisation was left entirely to doctors, health care provision would not reflect the views of other groups in some important ways.
The Cost and Effectiveness of the London Helicopter Emergency Medical Service
Authors: Brazier John , Nicholl Jon , Snooks Helen 
Published: February 2018

Objectives: To assess the incremental consequences of the London Helicopter Emergency Medical Service (HEMS) for the outcomes of survivors in terms of disability and health status, and cost. Methods: Prospective comparison of outcomes in cohorts of seriously injured patients attended either by the HEMS or by paramedically crewed land ambulances. In survivors, disability was assessed using an 11-point disability scale, and general health status was measured by the six dimensions of the 100-point Nottingham Health Profile (NHP) assessed 6 months after the injury. Costs were estimated for the HEMS and associated facilities at the Royal London Hospital, and the extra admissions attributable to the HEMS. Results: There was no evidence of reduced disability in HEMS survivors (estimate: +0.8 disability grades worse; 95% CI: 0, 1.6), and no evidence of improvement in the six NHP dimension scores or in the mean number of problems with seven aspects of daily living (estimated difference: +0.5; 95% CI: −0.2, 1.2). The incremental costs of HEMS were estimated to be £2.0 million a year. Conclusion: As there is no evidence of any improvement in outcomes overall for the extra cost, the HEMS has not been found to be a cost-effective service.
Geographic Variation in the Utilization and Choice of Procedures for Treating Coronary Artery Disease in New York State
Authors: Hannan Edward L. , Kumar Dinesh ,   The Ischaemic Heart Disease Patient Outcomes Research Team
Published: February 2018

Objectives: To examine geographical variations in rates of coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) in New York State, and to examine variations in the choice between these two procedures. Methods: A retrospective analysis of data from the New York registries for CABG and angioplasty was conducted. Rates were compared for 12 different regions of the state to assess geographic variations. To assess variations in the choice of procedure, frequencies of each procedure by region were compared with expected frequencies obtained by a logistic regression model that related procedure performance to various patient risk factors. Results: There was more than a three-fold variation in age/sex adjusted CABG rates and more than a two-fold variation in age/sex adjusted angioplasty rates among regions. The regional percentages of patients undergoing CABG rather than PTCA ranged from 49% to 70%, and most of the disparity was not related to patient risk factors. Instead, the disparity was largely a result of differences in racial composition and the hospitalization rate for myocardial infarctions. Conclusions: There is considerable regional variation in New York in the tendency to use aggressive cardiac procedures and in the choice of which procedure to use, and these differences are mostly unrelated to patient need.
Organ Transplantation and European Community Law: The Case of Non-Residents
Authors: Haase-Kromwijk Bernadette , Pré Frans du , Cohen Bernard 
Published: February 2018

Objectives: The role of the European Union in influencing health care policies in member states is of increasing importance. The Eurotransplant Foundation is an organization which provides donor organs to the most suitable transplant recipients. It covers a region of five countries (Austria, Belgium, Germany, Luxembourg, The Netherlands). As there is a severe shortage of donor organs within its region, registration of so-called non-resident patients on the waiting lists aggravates this shortage. Could European Community law, especially rules on competition, limit Eurotransplant's freedom to introduce a restrictive policy on non-residents? If so, could participating transplant centres or patients initiate legal action against Eurotransplant to stop the execution of such a policy? Methods: Quantitative descriptive data on organ donation and use by the Eurotransplant Foundation during 1994 and 1995, by residents and non-residents. Analysis on basis of economic and legal framework. Results: Solidarity between potential donors and potential recipients is organized in a different manner in an organization such as Eurotransplant as compared to a national organization under national law. National regulations may introduce a restrictive policy for the acceptance of non-resident patients. Eurotransplant — as a matter of its own policy — has to consider international solidarity. The scope of the non-resident issue is dealt with, and it is explained why it is considered to be a problem. On the basis of a discussion of the economic and the legal framework for a non-resident policy, an answer to the question is suggested. Conclusion: It might be possible for Eurotransplant to introduce a restrictive policy on the admission of non-residents without violating the European Community Treaty.
The Efficiency of Specialist Outreach Clinics in General Practice: Is Further Evaluation Needed?
Authors: Gosden Toby , Black Mary , Mead Nicola , Leese Brenda 
Published: February 2018

Objectives: To assess the need for further evaluation of general practice-based outreach clinics in two specialties using data from a UK pilot study to model their cost-effectiveness. Methods: A pilot study was undertaken comparing one outreach and one outpatient clinic held by three dermatology specialists and three orthopaedic specialists. Information was collected on waiting times, costs to patients, casemix and resource use. Results: Only dermatology outreach clinic patients experienced significantly shorter waiting times for first appointments than their hospital counterparts. Outreach clinic patients incurred lower costs in attending appointments in either specialty but the differences were not statistically significant. Evidence of a difference in casemix between patients attending outreach and outpatient clinics meant that treatment costs incurred in both types of clinic could not be compared. Outreach clinics in both specialties were significantly more costly in terms of staff, staff travel and associated opportunity costs compared with outpatient clinics. Sensitivity analysis showed that outreach and outpatient clinics had the same marginal cost if the number of patients per outreach clinic increased greatly or attendance fell considerably at outpatient clinics. Conclusions: This study has found no evidence that outreach clinics in these two specialties are cost-effective in terms of costs and benefits. A more definitive conclusion could only be made if studies estimated other costs and benefits not accounted for in this study. Further research is required to see whether outreach clinics in other specialties or clinics with different configurations to those studied are efficient.
Physical impairments predict hand dexterity function after distal radius fractures: A 2-year prospective cohort study
Authors: Nazari Goris , Bobos Pavlos , MacDermid Joy C , Lalone Emily A , Grewal Ruby 
Published: February 2018

Introduction The overall aim of this study was to determine whether physical impairments – loss of range of motion and grip strength – could be used to predict hand dexterity functions in patients at 1 and 2 years after distal radius fracture. Methods This was a prospective cohort study. Hand dexterity was assessed at three different levels using the NK hand dexterity test. We used a manual goniometer to measure the active range of motion in the affected hand for wrist flexion and extension movements, and a J-Tech grip strength device to measure patients’ hand grip strength levels. Assessments were performed at 1- and 2-year follow-ups. Separate multivariable regression analyses were performed to determine if range of motion predicts hand dexterity functions at 1 and 2 years after distal radius fracture. Results A total of 160 patients with distal radius fracture were included in this study. Range of motion (flexion and extension) and grip strength were both statistically significant (p < 0.05) independent variables in predicting hand dexterity functions at all three levels among patients after distal radius fracture at 1-year follow-up. Range of motion and strength levels accounted for 31%, 33% and 22% of the variance in patients’ large, medium and small hand dexterity functions, respectively. At 2 years, grip strength remained the only statistically significant (p < 0.001) independent variable in predicting hand dexterity functions at all three levels. Conclusions Physical impairments (loss of range of motion and grip strength) have higher predictive values for large and medium hand dexterity functions, than small hand dexterity functions, in patients after distal radius fracture, at both 1- and 2-year follow-up periods.
Left in limbo – Experiences and needs among postmenopausal women newly diagnosed with osteoporosis without preceding osteoporotic fractures: A qualitative study
Authors: Jakobsen Pernille Ravn , Hermann Anne Pernille , Søndergaard Jens , Wiil Uffe Kock , Dixon Ronald F , Clemensen Jane 
Published: February 2018

Introduction Despite the fact that the first osteoporotic fracture is preventable, osteoporosis is still a major health challenge. The disease is highly prevalent among postmenopausal women. However little is known about how to meet and support women, when they are diagnosed with osteoporosis without preceding fractures. Therefore this study aims at gaining a deeper understanding of how women experience being diagnosed. Furthermore to describe and identify their needs, which should be met in future healthcare services. Methods We conducted a phenomenological qualitative study. We included 17 women aged 52–65 and collected data through semi-structured interviews. We analysed data following Giorgi's methodology. Findings Needs among the women were classified into three main themes: (1) needs of targeted and tailored information about osteoporosis, (2) needs of being prepared for GP visit to participate in treatment decision-making and (3) needs of being able to take care of bone health. Conclusion and implications In general the women experienced as been left ‘in limbo’, and they requested targeted and tailored information about osteoporosis. In particular, they want information about dual-energy X-ray absorptiometry (DXA) scan results and treatment options in advance of the GP visit. This will help them in being prepared and able to participate in treatment decisions. They ask for support in self-management of the disease with less focus on disease and risk of fracture. Instead, they demand more attention on the benefits of detecting early stage osteoporosis. The study highlights the call for new approaches to postmenopausal women newly diagnosed with osteoporosis without preceding fractures.
A comparison of the initial orthotic effects of functional electrical stimulation and ankle-foot orthoses on the speed and oxygen cost of gait in multiple sclerosis
Authors: (Miller) Renfrew Linda , Lord Anna C , McFadyen Angus K , Rafferty Danny , Hunter Rebecca , Bowers Roy , Mattison Paul , Moseley Owen , Paul Lorna 
Published: February 2018

Background Foot drop affects walking in people with multiple sclerosis (pwMS). This study compares the initial orthotic effects of two treatments for foot drop: ankle-foot orthoses (AFO) and functional electrical stimulation (FES), on the speed and oxygen cost of walking in MS. Method and materials Seventy-eight pwMS were randomised to receive AFO or FES (ODFS PACE (OML, Salisbury, UK)). Participants completed the 25-ft walk test (25ftWT) and 5-min self-selected walk test (5minSSWT), from which oxygen cost was determined, with and without their device. Between-, within- and sub-group analyses (based on baseline walking speed of <0.8 m/s (slow) or ≥0.8 m/s (fast)) were undertaken. Results No significant differences between baseline measures were observed. The AFO group walked significantly slower than the FES group (5minSSWT, p = 0.037, 0.11 m/s). The AFO group walked significantly slower with than without AFO (25ftWT, p = 0.037), particularly in the fast-walking group (  p = 0.011). The slow-walking FES group walked significantly faster with FES than without (25ftWT; p = 0.029, 5minSSWT; p = 0.037). There were no differences in the fast-walking FES group or in the oxygen cost for either device. Conclusion AFO reduced walking speed, particularly in fast walkers. FES increased walking speed in slow, but not fast walkers.
The Impact of Workload on the Evolution of Hip Internal and External Rotation in Professional Baseball Players Over the Course of the Season
Authors: Camp Christopher L. , Zajac John M. , Pearson Dave , Wang Dean , Sinatro Alec S. , Ranawat Anil S. , Dines Joshua S. , Coleman Struan H. 
Published: February 2018

Background: Although restricted hip range of motion (ROM) is associated with an increased risk for injuries in baseball players, the evolution of hip ROM over the season remains undefined. Hypothesis: Hip ROM profiles would be symmetric between hips and positions (pitchers vs position players) but would decrease from preseason to postseason. Additionally, it was hypothesized that this decrease in motion would correlate with workload. Study Design: Cohort study; Level of evidence, 2. Methods: Bilateral hip ROM was assessed in 96 professional baseball players (54 pitchers, 42 position players) preseason and postseason. ROM comparisons were made between lead and trailing hips, pitchers and position players, and preseason and postseason measures. The change from preseason to postseason was correlated with player demographics and measures of workload for pitchers and position players. Results: Preseason hip ROM was symmetric between hips; however, pitchers demonstrated increased preseason lead hip internal rotation (IR) ( P = .018) and bilateral hip total ROM (TROM) ( P < .020) compared with position players. From preseason to postseason, position players lost 7° of external rotation (ER) ( P ≤ .005 ). In pitchers, the loss of IR correlated with increased pitches ( P = .016) and innings ( P = .037), while the loss of ER ( P = .005 ) and TROM ( P = .014) correlated with increasing mean fastball velocity. Workload for position players did not correlate with motion loss. Conclusion: Symmetric hip ROM profiles should be anticipated in baseball players; however, pitchers may have increased preseason IR and TROM and postseason ER and TROM relative to position players. Although loss of motion correlated with workload in pitchers, this was not the case for position players. Hip motion should be monitored over the course of the season. This is particularly true for pitchers who lose IR as workload increases, which may place them at a greater risk for injuries.
Single-agent ibrutinib in treatment-naïve and relapsed/refractory chronic lymphocytic leukemia: a 5-year experience
Authors: O’Brien Susan , Furman Richard R. , Coutre Steven , Flinn Ian W. , Burger Jan A. , Blum Kristie , Sharman Jeff , Wierda William , Jones Jeffrey , Zhao Weiqiang , Heerema Nyla A. , Johnson Amy J. , Luan Ying , James Danelle F. , Chu Alvina D. , Byrd John C. 
Published: February 2018

Key Points
Our 5-year experience shows sustained single-agent efficacy of ibrutinib in CLL patients, with complete response rates increasing over time. Long-term ibrutinib was well tolerated with no new safety signals; rates of grade ≥3 cytopenias decreased with continued therapy.
Markers of cardiovascular autonomic dysfunction predict COPD in middle-aged subjects
Authors: Ricci Fabrizio , Wollmer Per , Engström Gunnar , Fedorowski Artur , Hamrefors Viktor 
Published: February 2018

Autonomic dysfunction is commonly observed in chronic obstructive pulmonary disease (COPD) and may relate to the known comorbidity with coronary artery disease (CAD). We hypothesised that clinical markers of cardiovascular autonomic dysfunction predict COPD in the population, independently of CAD.In a population-based cohort of 24 768 subjects (mean age 45 years) without baseline airflow obstruction, we analysed the cross-sectional relationship of one-minute orthostatic systolic blood pressure (SBP) and diastolic blood pressure (DBP) changes and resting heart rate with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). Cox regression models were used to analyse the association of orthostatic SBP and DBP changes (SBP/DBP decrease) and resting heart rate with incident COPD over a 32-year follow-up.Baseline orthostatic SBP decrease (p=0.020) and DBP decrease (p=0.001) were associated with reduced FVC, whereas resting heart rate was associated with reduced FVC and FEV1(p<0.001). After adjustment for smoking and baseline lung function, SBP decrease predicted COPD (hazard ratio (HR) 1.10 per 10 mmHg, 95% CI 1.03–1.18). Resting heart rate predicted COPD among smokers (HR 1.11 per 10 beats-per-minute increase, 95% CI 1.05–1.18). Results were similar in subjects without CAD.Subtle signs of cardiovascular autonomic dysfunction may precede the development of COPD in middle-aged subjects. This association is independent of the relationship between cardiovascular autonomic dysfunction and CAD.
Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis
Authors: van Diermen Linda , van den Ameele Seline , Kamperman Astrid M. , Sabbe Bernard C.G. , Vermeulen Tom , Schrijvers Didier , Birkenhäger Tom K. 
Published: February 2018

BackgroundElectroconvulsive therapy (ECT) is considered to be the most effective treatment in severe major depression. The identification of reliable predictors of ECT response could contribute to a more targeted patient selection and consequently increased ECT response rates.AimsTo investigate the predictive value of age, depression severity, psychotic and melancholic features for ECT response and remission in major depression.MethodA meta-analysis was conducted according to the PRISMA statement. A literature search identified recent studies that reported on at least one of the potential predictors.ResultsOf the 2193 articles screened, 34 have been included for meta-analysis. Presence of psychotic features is a predictor of ECT remission (odds ratio (OR) = 1.47,P= 0.001) and response (OR = 1.69,P< 0.001), as is older age (standardised mean difference (SMD) = 0.26 for remission and 0.35 for response (P< 0.001)). The severity of depression predicts response (SMD = 0.19,P= 0.001), but not remission. Data on melancholic symptoms were inconclusive.ConclusionsECT is particularly effective in patients with depression with psychotic features and in elderly people with depression. More research on both biological and clinical predictors is needed to further evaluate the position of ECT in treatment protocols for major depression.Declaration of interestNone.