bluuebunny/crossref_metadata_2025_split huggingface dataset:
Operational strategies to manage non-elective orthopaedic surgical flows: a simulation modelling study
Authors: Persson Marie , Hvitfeldt-Forsberg Helena , Unbeck Maria , Sköldenberg Olof Gustaf , Stark Andreas , Kelly-Pettersson Paula , Mazzocato Pamela 
Published: April 2017

ObjectivesTo explore the value of simulation modelling in evaluating the effects of strategies to plan and schedule operating room (OR) resources aimed at reducing time to surgery for non-elective orthopaedic inpatients at a Swedish hospital.MethodsWe applied discrete-event simulation modelling. The model was populated with real world data from a university hospital with a strong focus on reducing waiting time to surgery for patients with hip fracture. The system modelled concerned two patient groups that share the same OR resources: hip-fracture and other non-elective orthopaedic patients in need of surgical treatment. We simulated three scenarios based on the literature and interaction with staff and managers: (1) baseline; (2) reduced turnover time between surgeries by 20 min and (3) one extra OR during the day, Monday to Friday. The outcome variables were waiting time to surgery and the percentage of patients who waited longer than 24 hours for surgery.ResultsThe mean waiting time in hours was significantly reduced from 16.2 hours in scenario 1 (baseline) to 13.3 hours in scenario 2 and 13.6 hours in scenario 3 for hip-fracture surgery and from 26.0 hours in baseline to 18.9 hours in scenario 2 and 18.5 hours in scenario 3 for other non-elective patients. The percentage of patients who were treated within 24 hours significantly increased from 86.4% (baseline) to 96.1% (scenario 2) and 95.1% (scenario 3) for hip-fracture patients and from 60.2% (baseline) to 79.8% (scenario 2) and 79.8% (scenario 3) for patients with other non-elective patients.ConclusionsHealthcare managers who strive to improve the timelines of non-elective orthopaedic surgeries may benefit from using simulation modelling to analyse different strategies to support their decisions. In this specific case, the simulation results showed that the reduction of surgery turnover times could yield the same results as an extra OR.
Diagnosis and repair of perineal injuries: knowledge before and after expert training—a multicentre observational study among Palestinian physicians and midwives
Authors: Zimmo Kaled , Laine Katariina , Vikanes Åse , Fosse Erik , Zimmo Mohammed , Ali Hadil , Thakar Ranee , Sultan Abdul H , Hassan Sahar 
Published: April 2017

ObjectiveTo assess whether a 2 days training with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives and physicians could change their level of knowledge towards the correct diagnosis and treatment.Study designMulticentre observational study.SettingObstetric departments in 6 government Palestinian hospitals.ParticipantsAll physicians and midwives who attended the training.MethodsA questionnaire comprising of 14 questions on the diagnosis and repair of perineal tears was distributed to all participants before the training (n=150; 64 physicians and 86 midwives) and 3 months after the training (n=124, 53 and 71, respectively). Characteristics, differences of the study population and level of knowledge before and after the training were presented as frequencies and percentages. Consistency in responses was tested by estimating the p value of McNemar test.ResultsAmong physicians only 11.4% had accurate knowledge on perineal anatomy before the training compared with 78.85% after the training (p<0.001). For midwives, the corresponding numbers were 9.8% and 54.2%, respectively (p<0.001). Before the training, 5.8% of the physicians were aware that rectal examination is mandatory before and after suturing of episiotomies compared with 45.8% after the training (p<0.001). The corresponding numbers for midwives were 0% and 18% (p<0.001), respectively. Physicians knowledge of best practice of skin repair following episiotomy improved from 36.5% to 64.5% (p=0.008) and among midwives from 26.1% to 50.7% (p<0.001). Physicians knowledge of the overlap technique in the repair of full thickness external anal sphincter tears improved from 28.5% to 42.8% (p=0.05), whereas knowledge of repairing torn internal anal sphincter separately improved from 12.8% to 86.8% (p<0.001).ConclusionsImprovement in the level of knowledge on diagnosis and repair of perineal tears was observed for all physicians and midwives who attended the 2 days' expert training. Regular ongoing training will serve to maintain the newly acquired knowledge.
Learning outcomes for communication skills across the health professions: a systematic literature review and qualitative synthesis
Authors: Denniston Charlotte , Molloy Elizabeth , Nestel Debra , Woodward-Kron Robyn , Keating Jennifer L 
Published: April 2017

ObjectiveThe aim of this study was to identify and analyse communication skills learning outcomes via a systematic review and present results in a synthesised list. Summarised results inform educators and researchers in communication skills teaching and learning across health professions.DesignSystematic review and qualitative synthesis.MethodsA systematic search of five databases (MEDLINE, PsycINFO, ERIC, CINAHL plus and Scopus), from first records until August 2016, identified published learning outcomes for communication skills in health professions education. Extracted data were analysed through an iterative process of qualitative synthesis. This process was guided by principles of person centredness and an a priori decision guide.Results168 papers met the eligibility criteria; 1669 individual learning outcomes were extracted and refined using qualitative synthesis. A final refined set of 205 learning outcomes were constructed and are presented in 4 domains that include: (1) knowledge (eg, describe the importance of communication in healthcare), (2) content skills (eg, explore a healthcare seeker's motivation for seeking healthcare),( 3) process skills (eg, respond promptly to a communication partner's questions) and (4) perceptual skills (eg, reflect on own ways of expressing emotion).ConclusionsThis study provides a list of 205 communication skills learning outcomes that provide a foundation for further research and educational design in communication educationacrossthe health professions. Areas for future investigation include greater patient involvement in communication skills education design and further identification of learning outcomes that target knowledge and perceptual skills. This work may also prompt educators to be cognisant of the quality and scope of the learning outcomes they design and their application as goals for learning.
Admission Glucose and Effect of Intra-Arterial Treatment in Patients With Acute Ischemic Stroke
Authors: Osei Elizabeth , den Hertog Heleen M. , Berkhemer Olvert A. , Fransen Puck S.S. , Roos Yvo B.W.E.M. , Beumer Debbie , van Oostenbrugge Robert J. , Schonewille Wouter J. , Boiten Jelis , Zandbergen Adrienne A.M. , Koudstaal Peter J. , Dippel Diederik W.J. 
Published: April 2017

Background and Purpose—
Hyperglycemia on admission is common after ischemic stroke. It is associated with unfavorable outcome after treatment with intravenous thrombolysis and after intra-arterial treatment. Whether hyperglycemia influences the effect of reperfusion treatment is unknown. We assessed whether increased admission serum glucose modifies the effect of intra-arterial treatment in patients with acute ischemic stroke.

Methods—
We used data from the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Hyperglycemia was defined as admission serum glucose >7.8 mmol/L. The primary outcome measure was the adjusted common odds ratio for a shift in the direction of a better outcome on the modified Rankin Scale at 90 days, estimated with ordinal logistic regression. Secondary outcome variable was symptomatic intracranial hemorrhage. We assessed treatment effect modification of hyperglycemia and admission serum glucose levels with multiplicative interaction factors and adjusted for prognostic variables.

Results—

Four hundred eighty-seven patients were included. Mean admission serum glucose was 7.2 mmol/L (SD, 2.2). Fifty-seven of 226 patients (25%) randomized to intra-arterial treatment were hyperglycemic compared with 61 of 261 patients (23%) in the control group. The interaction of either hyperglycemia or admission serum glucose levels and treatment effect on modified Rankin Scale scores was not significant (
P
=0.67 and
P
=0.87, respectively). The same applied for occurrence of symptomatic hemorrhage (
P
=0.39 for hyperglycemia,
P
=0.39 for admission serum glucose).

Conclusions—
We found no evidence for effect modification of intra-arterial treatment by admission serum glucose in patients with acute ischemic stroke.

Clinical Trial Registration—

URL:
www.isrctn.com
. Unique identifier: ISRCTN10888758.
Nationwide Estimates of 30-Day Readmission in Patients With Ischemic Stroke
Authors: Vahidy Farhaan S. , Donnelly John P. , McCullough Louise D. , Tyson Jon E. , Miller Charles C. , Boehme Amelia K. , Savitz Sean I. , Albright Karen C. 
Published: April 2017

Background and Purpose—
Readmission within 30 days of hospital discharge for ischemic stroke is an important quality of care metric. We aimed to provide nationwide estimates of 30-day readmission in the United States, describe important reasons for readmission, and sought to explore factors associated with 30-day readmission, particularly the association with recanalization therapy.

Methods—

We conducted a weighted analysis of the 2013 Nationwide Readmission Database to represent all US hospitalizations. Adult patients with acute ischemic stroke including those who received intravenous tissue-type plasminogen activator and intra-arterial therapy were identified using
International Classification of Diseases
-Ninth Revision codes. Readmissions were defined as any readmission during the 30-day post-index hospitalization discharge period for the eligible patient population. Proportions and 95% confidence intervals for overall 30-day readmissions and for unplanned and potentially preventable readmissions are reported. Survey design logistic regression models were fit for determining crude and adjusted odds ratios and 95% confidence interval for association between recanalization therapy and 30-day readmission.

Results—
Of the 319 317 patients with acute ischemic stroke, 12.1% (95% confidence interval, 11.9–12.3) were readmitted. Of these, 89.6% were unplanned and 12.9% were potentially preventable. More than 20% of all readmissions were attributable to acute cerebrovascular disease. Readmitted patients were older and had a higher comorbidity burden. After controlling for age, sex, insurance status, and comorbidities, patients who underwent recanalization therapy had significantly lower odds of 30-day readmission (odds ratio, 0.82; 95% confidence interval, 0.77–0.89).

Conclusions—
Up to 12% of patients with ischemic stroke get readmitted within 30 days post-discharge period, and recanalization therapy is associated with 11% to 23% lower odds of 30-day readmission.
Wind-Induced Mixing in the North Pacific
Authors: Inoue Ryuichiro , Watanabe Michio , Osafune Satoshi 
Published: April 2017

AbstractTemporal variability of the winter input of wind energy flux (wind power) and its relationship to internal wave fields were examined in the North Pacific. The dominant long-term variability of the wind power input, estimated from a mixed layer slab model, was inferred from an empirical orthogonal function analysis, and it was found that variability partly corresponded to the strength and movement of the Aleutian low. Responses of the internal wave field to the input of wind power were examined for two winters with a meridional float array along 170°W at a sampling interval of 2 dbar. Time series of the vertical diffusivities inferred from density profiles were enhanced during autumn and winter. After comparing diffusivities inferred from densities sampled at 2- and 20-dbar intervals, Argo floats with a vertical resolution of 20 dbar were used to detect spatial and temporal variability of storm-related mixing between 700 and 1000 dbar in the North Pacific over a period of 10 years. Horizontal maps of inferred seasonal diffusivities suggested that the diffusivities were enhanced in autumn and winter. However, it is unlikely that there is a simple linear relationship between the input of wind power and the inferred mixing.
Stimulating TSH receptor autoantibodies immunoassay: analytical evaluation and clinical performance in Graves’ disease
Authors: Autilio C , Morelli R , Locantore P , Pontecorvi A , Zuppi C , Carrozza C 
Published: April 2017

Background Thyroid-stimulating hormone (TSH) receptor (TSHR) autoantibodies (TRAbs) are a heterogeneous group of antibodies (Abs) with different functionalities. Among all TRAbs, only the stimulating ones (S-TRAbs) are considered as the pathogenetic marker of Graves’ disease (GD). To date, the methods available for TRAbs testing are based on immunoassays (IMAs) which detect total serum TRAbs or bioassays which are not suitable in clinical practice, even though they discern Abs functionality. The aim of our work was to evaluate the analytical and clinical performance of a very recent IMA (Immulite TSI method), supposed to test only the serum concentration of S-TRAbs, in comparison with a current method for total TRAbs (Roche/Elecsys IMA). Methods We evaluated serum samples of 145 subjects: 46 with untreated (GD), 36 with chronic autoimmune thyroiditis, 3 with atrophic thyroiditis, 10 with multinodular non-toxic goiter and 50 healthy subjects. Results The method showed an optimal analytical sensitivity and high precision levels (LoB: 0.04 UI/L, LoD:0.07 UI/L, LoQ:0.14 UI/L, intra-assay CV: 4.2–5.9%, inter-assay: 4.5–7.2%). By receiver operating characteristics curve analysis, we obtained a value of 0.57 (sensitivity: 98.0%, specificity: 99.9%) as the best cut-off to distinguish GD, apart from four cases. Passing Bablok regression and Bland Altman analysis pointed out a good correlation and agreement with Roche method (R2 = 0.98, slope = 1.03, bias = −2.70). Conclusions The new method presents very promising analytical characteristics and could be adopted in clinical practice for GD diagnosis. Moreover, the test allows to accurately detect very low values of analyte with a further clinical utility in detecting earlier possible relapses.
Managing acromio-clavicular joint pain: a scoping review
Authors: Chaudhury Salma , Bavan Luckshman , Rupani Neal , Mouyis Kyriacos , Kulkarni Ro , Rangan Amar , Rees Jonathan 
Published: April 2017

Background Shoulder pain secondary to acromioclavicular joint pain is a common presentation in primary and secondary care but is often poorly managed as a result of uncertainty about optimal treatment strategies. Osteoarthritis is the commonest cause. Although acromioclavicular pain can be treated non-operatively and operatively, there appears to be no consensus on the best practice pathway of care for these patients, with variations in treatment being common place. The present study comprises a scoping review of the current published evidence for the management of isolated acromioclavicular pain (excluding acromioclavicular joint dislocation). Methods A comprehensive search strategy was utilized in multiple medical databases to identify level 1 and 2 randomised controlled trials, nonrandomised controlled trials and systematic reviews for appraisal. Results Four systematic reviews and two randomised controlled trials were identified. No direct studies have compared the benefits or risks of conservative versus surgical management in a controlled environment. Conclusions High-level studies on treatment modalities for acromioclavicular joint pain are limited. As such, there remains little evidence to support one intervention or treatment over another, making it difficult to develop any evidenced-based patient pathways of care for this condition. Level of evidence: 2A
Open Repair of Acute Achilles Tendon Ruptures: Is the Incidence of Clinically Significant Wound Complications Overestimated?
Authors: Bishop Meghan E. , Comer Carly D. , Kane Justin M. , Maltenfort Mitchell G. , Raikin Steven M. 
Published: April 2017

Background: Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures. Operative repair is thought to afford patients a lower risk of rerupture, albeit at a higher overall risk of wound complications. Methods: A retrospective chart review of 369 consecutive patients undergoing open repair of acute Achilles tendon ruptures performed by a single foot and ankle fellowship-trained orthopedic surgeon was undertaken. Healing was classified as no complications, complications without prolonging treatment, complications requiring prolonged local treatment, and complications requiring operative intervention. A statistical analysis comparing the rates of complications in this cohort to that reported in the literature was conducted. Results: There were a total of 33 (8.94%) wound complications. Compared to the rates reported in the literature, no significant difference was detected ( P = .3943; CI 6.24-12.33). However, when the complications not requiring additional treatment or prolonged care were excluded, only 9 wound complications (2.44%) were identified—a significantly lower complication rate than that reported in the literature ( P < .0001; CI 1.12-4.58). There were only 2 (0.54%) major complications requiring operative intervention, also a significantly lower rate than in the literature ( P < .0001; CI 0.067-1.94). Conclusion: In the past, wound-healing complications have been cited as a concern when treating patients operatively. We found that when solely looking at healing complications prolonging the patients’ overall recovery, a significantly lower rate of complications existed compared to that reported in the literature. Level of Evidence: Level IV.
Severe Corneal Complications Associated With Corneal Lubricant Used During Surgery
Authors: Lee Andrew C. , Opremcak E. Mitchel , Hunt Christiane , Astruc Juan A. , Toussaint Brian , Miller David G. , Busquets Miguel A. , Ferrone Philip J. 
Published: April 2017

Purpose: To present a series of cases of corneal chemical burns associated with the use of likely improperly buffered corneal lubricant gel, Goniovisc, during uncomplicated, posterior segment surgery. Methods: Cases of postoperative corneal complications following surgeries in which Goniovisc was used were collected from 6 retina practices across the United States between January and August 2016. The preoperative diagnosis, type of procedure, postoperative day 1 corneal findings, treatment method, and time to resolution of the corneal irregularity were recorded. pH testing of Goniovisc lots from this time period was performed using Hydrion litmus paper. Results: A total of 157 eyes of 156 patients were found to have corneal complications following relatively simple posterior segment surgeries in which Goniovisc was used. Findings included one or more of the following: corneal epithelial defect (84% of cases), Descemet folds (34%), stromal edema (14%), and superficial punctate keratitis (3%). Time to resolution ranged from 2 to 90 days (mean, 12 days; median, 7 days). Treatment methods included artificial tears (37%), bandage contact lens (28%), antibiotic drops (17%), antibiotic ointment (16%), and patching (9%). Two cases were treated with amniotic membrane grafts. One case required a penetrating keratoplasty due to an old laser-assisted in situ keratomileusis (LASIK) flap with a nonhealing epithelial defect that scarred significantly. Litmus testing of Goniovisc lots from this time period revealed a pH of 4 to 5. Conclusion: Chemical burns secondary to improperly buffered corneal lubricant solution should be considered in the differential when corneal injury is encountered following posterior segment surgery.
Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure
Authors: Yao Christopher M. , Ziai Hedyeh , Tsang Gordon , Copeland Andrea , Brown Dale , Irish Jonathan C. , Gilbert Ralph W. , Goldstein David P. , Gullane Patrick J. , de Almeida John R. 
Published: April 2017

Background Plate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure. Methods A retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models. Results Three hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/−13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively). Conclusion Surgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.
Interdependence between the stock market and the bond market in one country: evidence from the subprime crisis and the European debt crisis
Authors: Cheng Ke , Yang Xiaoguang 
Published: April 2017

Abstract
Background
Once a global financial crisis breaks out, the interdependence between different financial markets suddenly increases and leads to a significant contagion.

Methods
With 39 countries used as samples, this paper analyzes the interdependence between the stock market and the government bond market during the crisis periods.

Results
It proves that the investor focuses more on the safety of their portfolio so there is neither a flight from quality nor a positive spillover during a crisis period. When one market is safer than the other market in the same country, a flight to quality occurs between the two markets; however, when the two markets in one country are both risky, negative spillover appears between these two markets.

Conclusions
This means a flight to quality from the stock market to the short-term government bond will occur more frequently than will occur from the stock market to the long-term government bond markets. In addition, a flight to quality always emerges in developed markets, while negative spillovers take place in emerging markets and in the PIIGS countries (Portugal, Italy, Ireland, Greece, and Spain, referred to hereon as “PIIGS”) in the European Debt Crisis.