bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-directed Learning in Otolaryngology Residents’ Preparation for Surgical Cases
Authors: Jabbour Jad , Bakeman Anna , Robey Thomas , Jabbour Noel 
Published: February 2017

Objectives: To characterize the nature of surgical preparation among otolaryngology residents nationwide, determine the self-rated effectiveness and efficiency of case preparation practices, and identify potential means for educational improvement. Methods: A survey examining the study objectives was developed and distributed to otolaryngology residents nationwide. Survey response data were submitted to descriptive analysis and comparative analyses between junior and senior residents. Literature regarding case preparation among otolaryngology residents was reviewed. Results: Among 108 resident respondents, the most commonly used resources included textbooks (86.1%), surgical education websites (74.1%), and surgical atlases (66.7%). Time was the primary limitation (cited by 84.3%) and convenience the predominant factor influencing resource selection (92.5%). On a 5-point Likert scale, mean scores regarding effectiveness and efficiency of case preparation were 3.53 ± 0.68 and 3.19 ± 0.88, respectively. Senior residents compared to junior residents were more likely to rate their preparation as effective (3.75 ± 0.54 vs 3.40 ± 0.72, P = .008) and efficient (3.45 ± 0.85 vs 3.03 ± 0.86, P = .02). Conclusion: Otolaryngology residents do not consistently rate their case preparation as effective or efficient. While there appears to be progress in self-directed learning throughout residency, room for improvement remains, with potential avenues for such improvement explored here.
Metabolic changes in normal-appearing white matter in patients with neuromyelitis optica and multiple sclerosis: a comparative magnetic resonance spectroscopy study
Authors: Duan Yunyun , Liu Zheng , Liu Yaou , Huang Jing , Ren Zhuoqiong , Sun Zheng , Chen Hai , Dong Huiqing , Ye Jing , Li Kuncheng 
Published: February 2017

BackgroundPrevious studies with a small sample size have not reported metabolic changes in neuromyelitis optica (NMO). Metabolic changes, such as decreased N-acetylaspartate (NAA), are well-established in patients with multiple sclerosis (MS). It remains unknown whether different patterns of metabolic changes occur in NMO and MS.PurposeTo investigate the metabolic changes in normal-appearing white matter (NAWM) in NMO, compared with MS patients and healthy controls (HC), and correlate these changes with clinical disability.Material and MethodsWe recruited 27 patients with NMO, 24 patients with MS, and 24 HC. Each participant underwent chemical shift imaging with a 1H-MR spectroscopy operating in a 1.5 T magnetic resonance imaging (MRI) scanner. The absolute concentrations of NAA, choline (Cho), creatine (Cr) as well as the metabolite ratios of NAA/Cr, Cho/Cr, and NAA/Cho were measured and compared among the groups. The correlations between the metabolic concentrations, disease duration, and clinical disability (Expanded Disability Status Scale, EDSS) were further explored.ResultsCompared with HC, a mild increase of Cho without significant NAA changes was observed in NMO patients, while both a significant reduction of NAA and an increase of Cho were observed in MS patients. The absolute concentration of NAA and NAA/Cho ratio were significantly decreased in MS patients in a direct comparison with NMO patients. In MS patients, the EDSS was correlated with the NAA/Cr and Cho/Cr ratios.ConclusionA reduction of NAA was not observed in NMO, implying axonal or neuronal damage may be absent in NAWM for NMO, which is different from MS. A mild increase in Cho was observed in NAWM of NMO patients, suggesting that subtle metabolic changes occur in NMO.
Incidence and risk factors of postoperative sore throat after endotracheal intubation in Korean patients
Authors: Lee Jin Young , Sim Woo Seog , Kim Eun Sung , Lee Sangmin M , Kim Duk Kyung , Na Yu Ri , Park Dahye , Park Hue Jung 
Published: February 2017

Objective To investigate the incidence of postoperative sore throat (POST) in Korean patients undergoing general anaesthesia with endotracheal intubation and to assess potential risk factors. Methods This prospective study enrolled patients who underwent all types of elective surgical procedures with endotracheal intubation and general anaesthesia. The patients were categorized into group S (those with a POST) or group N (those without a POST). The demographic, clinical and anaesthetic characteristics of each group were compared. Results This study enrolled 207 patients and the overall incidence of POST was 57.5% ( n = 119). Univariate analysis revealed that significantly more patients in group S had a cough at emergence and hoarseness in the postanaesthetic care unit compared with group N. Receiver operating characteristic curve analysis showed that an intracuff pressure ≥17 cmH2O was associated with POST. Multivariate analysis identified an intracuff pressure ≥17 cmH2O and cough at emergence as risk factors for POST. At emergence, as the intracuff pressure over ≥17 cmH2O increased, the incidence of hoarseness increased. Conclusions An intracuff pressure ≥17 cmH2O and a cough at emergence were risk factors for POST in Korean patients. Intracuff monitoring during anaesthesia and a smooth emergence are needed to prevent POST.
Practice of Intubation of the Critically Ill at Mayo Clinic
Authors: Smischney Nathan J. , Seisa Mohamed O. , Heise Katherine J. , Busack Kyle D. , Loftsgard Theodore O. , Schroeder Darrell R. , Diedrich Daniel A. 
Published: February 2017

Objective: To describe the practice of intubation of the critically ill at a single academic institution, Mayo Clinic’s campus in Rochester, Minnesota, and to report the incidence of immediate postintubation complications. Patients and Methods: Critically ill adult (≥18 years) patients admitted to a medical–surgical intensive care unit from January 1, 2013, to December 31, 2014, who required endotracheal intubation included. Results: The final cohort included 420 patients. The mean age at intubation was 62.9 ± 16.3 years, with 58% (244) of the cohort as male. The most common reason for intubation was respiratory failure (282 [67%]). The most common airway device used was video laryngoscopy (204 [49%]). Paralysis was used in 264 (63%) patients, with ketamine as the most common sedative (194 [46%]). The most common complication was hypotension (170 [41%]; 95% confidence interval [CI]: 35.7-45.3) followed by hypoxemia (74 [17.6%]; 95% CI: 14.1-21.6), with difficult intubation occurring in 20 (5%; 95% CI: 2.9-7.3). Conclusion: We found a high success rate of first-pass intubation in critically ill patients (89.8%), despite the procedure being done primarily by trainees 92.6% of the time; video was the preferred method of laryngoscopy (48.6%). Although our difficult intubation (4.8%) and complication rates typically associated with the act of intubation such as aspiration (1.2%; 95% CI: 0.4-2.8) and esophageal intubation (0.2%; 95% CI: 0.01-1.3) are very low compared to other published rates (8.09%), postintubation hypotension (40.5%) and hypoxemia (17.6%) higher.
‘Who Rates the Raters?’ The Regulation of Credit Rating Agencies in the EU
Authors: Oster Jan 
Published: February 2017

Recent regulatory measures in the EU give reason to scrutinize the rules by which credit rating agencies have to abide. The article explains the functioning and the previous regulation of credit rating agencies. Since this regulation has proved to be insufficient in preventing the failure of rating agencies in the financial turmoil, the EU took regulatory measures by adopting Regulation 1060/2009 on credit rating agencies (subsequently referred to as CRA Regulation) and recently proposed amendments, thereby addressing the main failures of the credit rating industry: conflicts of interest, lack of transparency and weaknesses in the methods and models used by credit rating agencies. Despite well-founded criticism concerning details, the article finds that the EU principally took a well-balanced approach by leaving credit rating a private, but regulated, business. However, the Commission should reconsider one aspect of the regulatory concept that seems to be flawed: the instrumentalization of credit ratings for regulatory purposes and the limitation of the scope of the CRA Regulation thereon. Concluding observations illustrate the Regulation's integration in the broader context of the developing European financial market regulation.
China's Public Procurement Regime — Comparative and Theoretic Insights
Authors: Weishaar Stefan 
Published: February 2017

Bid rigging conspiracies have long been recognized as significantly inflating public expenditures. Anecdotal evidence suggesting bid rigging offences and a general dissatisfaction about procurement prices and the contracted quality in China is taken as an indication of a lack of competition in public procurement tenders. Because procuring entities are unable to monitor industrial markets effectively, it is submitted that well designed public procurement regimes can help to prevent bid rigging conspiracies. Since structural market determinants are largely beyond reach of public procurement laws, auction theory is used to address cartel formation and cartel stability. Applying this theory to the Chinese public procurement regime identifies concrete actions for procurement entities to undermine cartel formation and stability. The insights gained are compared to the EU public procurement regime in order to examine in how far other legislators have chosen different solutions. It is found that the Chinese legal regime does facilitate both the formation and stabilization of bid rigging cartels and that the European public procurement regime is also subject to criticism in some respects.
Super Kutler flap: an alternative technique for reconstruction of fingertip defects
Authors: Arpaci E. , Unlu R. E. , Altun S. , Ertas N. M. 
Published: February 2017

The bilateral V-Y flap concept for fingertip reconstruction was first desribed by Kutler. This method has limitations, such as flap size and advancement, therefore larger flap modifications are described to increase the advancement capacity of the flaps. We described a small direct-flow homodigital island flap method, called the ‘super Kutler flap’, for recontruction of finger pulp defects. In addition, neurorrhaphy was performed between the cut ends of the digital nerves to prevent neuroma formation. This method was used in 10 fingers in patients who had undergone pulp tissue reconstruction of fingertip defects from May 2008 to October 2011. The mean defect size was 2.2 × 1.7 cm. The mean static two-point discrimination was 3.5 mm and the mean Semmes–Weinstein monofilament test of the flaps was 2.83 g. The super Kutler flap provides an altenative option for reconstruction of fingertip defects. Level of evidence: IV
The effect of merging two infectious disease units on hand hygiene adherence in Italy
Authors: Petrilli Christopher M. , Mantengoli Elisabetta , Saint Sanjay , Fowler Karen E. , Bartoloni Alessandro 
Published: February 2017

Background: Healthcare-associated infections (HAIs) are common and harmful to patients. Effective hand hygiene can help prevent HAIs, however, suboptimal healthcare worker hand hygiene remains problematic across the globe. This study analyses the impact of organisational changes on hand hygiene. Methods: This observational study assessed hand hygiene by different professions before and after a merger of a recently combined infectious diseases (ID) unit coupled with a qualitative study about barriers to optimal hand hygiene. Direct observations were compared with previous data collected on both units before they merged. We also conducted focus groups with the doctors and nurses about hand hygiene. Results: After two ID units merged in 2013, we observed 681 provider–patient interactions. We compared these with a previous observation period in 2012. Hand hygiene adherence among nurses significantly declined after the merger (from 36% to 24%, P <0.001). However, adherence among doctors increased from 51% to 63% after the merger ( P = 0.004). Data from the focus groups revealed a gap between doctor and nurses perceptions of education and goal adherence rates. Conclusions: Our findings underscore the important role played by effective unit leaders to prevent infection. We found long-term sustainability of hand hygiene practices among doctors. However, adherence among nurses was substantially lower.
Correction of Hallux Valgus Deformity in Association With Underlying Metatarsus Adductus Deformity
Authors: Shibuya Naohiro , Jupiter Daniel C. , Plemmons Britton S. , Martin Lanster , Thorud Jakob C. 
Published: February 2017

Presence of underlying metatarsus deformity is known to negatively affect the outcome of hallux valgus corrective surgery. Yet there are many other factors that also affect final outcomes. In order to address the potential relationships between variables, we attempted to evaluate the association of metatarsus adductus with surgical outcomes, independent of other common factors used in evaluation of hallux valgus deformity. We enrolled 154 patients who had undergone hallux valgus corrective surgery and recorded their pre- and postoperative intermetatarsal (IM12) and hallux valgus (HVA) angles, preoperative Engel’s angle, and type of hallux valgus procedure. Using linear and logistic regression models, we identified variables that were independently (1) associated with the final IM12 and HVA and those (2) independently associated with dichotomized postoperative IM12 and HVA. We found that the only factors that were independently associated were preoperative IM12 with postoperative IM12, and preoperative HVA with postoperative HVA. In the linear model, a discretized Engel’s angle of 21 to 25 was marginally negatively associated with the final IM12. There was no detectable relationship between underlying metatarsus adductus deformity and the final outcome of hallux valgus correction after adjusting for other covariates. Levels of Evidence: Level III: Retrospective, cohort study
End of life care for urological cancer patients
Authors: Hounsome Luke , Verne Julia , Woodhams Simon 
Published: February 2017

Background: Each year around 15,000 men and 2900 women die from a urological cancer. The trajectory at end of life can be long and progressive or punctuated by acute events. Nonetheless those who die from urological cancer share some certain common disease manifestations that necessitate input from secondary care. Methods: All records of people dying from a urological cancer in 2004–2013 were extracted from Office for National Statistics and National Cancer Registration and Analysis Service databases. Records were linked to hospital episode statistics to analyse patterns of admitted patient care, outpatient attendances and emergency department attendances. Results: There has been a progressive decline in the proportion of deaths in hospital, from 47% to 35% of deaths. There has been a notable increase in care home deaths, which have risen from 13% to 19% of deaths and overtaken deaths in a hospice. Despite an only modest rise in total deaths from urological cancers (15,573 per year 2004–2006; 16,921 per year 2011–2013) there has been a much larger increase in secondary care activity in the last year of life. The largest change was for outpatient attendances, where the mean number increased from 3.0 to 13.6 per person. Conclusion: Differences in age at death may account for some of the differences in place of death. Those dying at an older age will be more likely to require care for comorbidities or frailty, and hence be in a care home already. The large increase in outpatient activity could reflect attempts to manage more end of life care without hospital admissions. Yet inpatient activity has increased more quickly than the number of deaths. The increase in outpatient activity may instead be due to developments in treatment for advanced cancer, and prostate cancer in particular, being offered to patients close to the end of life.
Variation in usage of radical prostatectomy and radical radiotherapy for men with locally advanced prostate cancer
Authors: Hounsome Luke , Rowe Ed , Verne Julia , Kockelbergh Roger , Payne Heather 
Published: February 2017

Locally advanced prostate cancer is defined as primary tumours extending outside the prostate gland to the surrounding tissues or seminal vesicles but without spread beyond the pelvic region. With radical treatment there is good prospect of cure. Radiotherapy in combination with hormone therapy is well established, but specific NICE guidelines have only recently been published. The guidelines recommend offering either radical prostatectomy (RP), possibly with adjuvant radiotherapy, or radical radiotherapy (RT) with neo-adjuvant hormone therapy as treatment for men with locally advanced prostate cancer. Given that guidelines on managing locally advanced prostate cancer have recently changed, we wanted to quantify the baseline variation in use of radical treatments for this patient group. Methods: Men with T3/T4 N0 M0 prostate cancer who were diagnosed in 2010–2012 were identified using data from the National Cancer Registration and Analysis Service (NCRAS). Data on age, ethnicity, deprivation, Charlson comorbidity score, Strategic Clinical Network (SCN) of residence, and treatments delivered were extracted. A multivariable logistic regression was undertaken to identify important variables. Results: Overall, 1692 (14%) of men in the cohort had a record of radical prostatectomy. A total of 6212 (52%) had a record of curative RT. In a regression model each decade increase in age yielded odds of 0.39 ( p < 0.001) for receiving radical treatment. Black men were only half as likely as white men to receive radical treatment (OR = 0.54; p < 0.001). Deprivation, comorbidity and SCN of residence had smaller effects. The variation observed in radical treatment between SCNs largely disappeared once the multiple variables were accounted for. Conclusion: Radical treatments vary by 71% to 85% between networks for men aged 60–69 years. Given that men >80 years made up 12% of the study population and only 6% had a Charlson comorbidity score >0, there is a possibility that some men with ‘clinically significant’ disease are undertreated.
The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty
Authors: Cankaya Deniz , Dasar Uygar , Satilmis Ahmet Burak , Basaran Serdar Hakan , Akkaya Mustafa , Bozkurt Murat 
Published: February 2017

Aims: The combined (IV (intravenous) + topical) use of tranexamic acid (TXA) has been shown to be a safe method and more effective than single (IV or topical) application. The optimal administration method of TXA is still being investigated and safety, efficiency and cost are the three main crucial parameters in achieving the best administration method. We aimed to determine whether combined (oral + topical) use of TXA reduced blood loss and transfusion rates more than single (topical) administration in TKA and whether oral + topical use is as safe and efficient as the IV + topical use, in addition to the main advantage of relatively low cost. Methods: In this prospective, randomized study, 100 patients were randomly assigned to either the topical TXA group or the combined (oral + topical) TXA group. There were no significant differences between the groups in age, body mass index or gender. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on post-operative days 0, 1, 2 and 3. The post-operative suction drainage and blood transfusion volumes were also recorded. Results: There were statistically significant differences between the groups in haemoglobin and haematocrit levels on post-operative days 0, 1, 2 and 3 ( p < 0.05) in favour of the combined group. The post-operative drainage amounts ( p = 0.0001), measured blood loss volume ( p = 0.003) and transfusion rates ( p = 0.03) were lower in the combined (oral + topical) group compared to the topical group. Conclusions: Of the different methods of TXA administration, the combined use of oral and topical TXA is a safe, efficient and low-cost method in reducing blood loss and transfusion rates after TKA.
Intimate Partner Violence, Depression, and Quality of Life among Women Living with HIV/AIDS in a Coastal City of South India
Authors: Achchappa Basavaprabhu , Bhandary Mahak , Unnikrishnan Bhaskaran , Ramapuram John T. , Kulkarni Vaman , Rao Satish , Maadi Deepak , Bhat Anish , Priyadarshni Shivani 
Published: February 2017

Background: Intimate partner violence (IPV) is a severe form of abuse prevalent in urban and rural areas of India with its effects on mental and physical health of the person receiving it, leading to a poorer quality of life. Methods: A cross-sectional study was conducted among 99 women living with HIV, and information was collected using abuse assessment scale. The data were entered and analyzed using SPSS version 17.0. Results: The IPV was reported by 19.2% of the respondents, of which psychological (14.1%) was most common followed by physical (4.1%) and sexual abuse (1.0%). The experience of IPV was significantly associated with socioeconomic status, number of children, marital status, and CD4 counts of the participants. Conclusion: The prevalence of IPV in our study was found to be less compared to previous studies, however, there were significant association among factors such as socioeconomic status, CD4 counts, and marital status of the participants.
Patellar Maltracking Persists in Adolescent Females With Patellofemoral Pain
Authors: Carlson Victor R. , Boden Barry P. , Shen Aricia , Jackson Jennifer N. , Alter Katharine E. , Sheehan Frances T. 
Published: February 2017

Background: Patellofemoral pain is one of the most common conditions seen in sports medicine practices, particularly among adolescent females. However, the natural history of the underlying pathology in patellofemoral pain during puberty remains poorly understood. Purpose: The purpose of this longitudinal study is to assess changes in patellar maltracking patterns in subjects with patellofemoral pain as they mature from mid- to late adolescence. Study Design: Cohort study; Level of evidence, 3. Methods: Three-dimensional patellofemoral kinematic data were acquired during active knee extension-flexion using dynamic magnetic resonance imaging in 6 girls (10 knees; mean age, 14.0 years) with clinically diagnosed patellofemoral pain. The subjects then returned as late adolescents (mean age, 18.5 years) for follow-up scanning. Three-dimensional patellofemoral kinematic parameters were evaluated across the range of motion, but comparison between time points was restricted to 10° of flexion. Participation in impact and nonimpact physical activities, pain score based on the visual analog scale, and the anterior knee pain score were also compared across initial and follow-up visits. Results: All subjects reported improved patellofemoral pain symptoms at follow-up, and one subject reported complete resolution. However, relative to the initial visit, no differences were found in patellar maltracking. There was a decrease in hours engaged in impact physical activities for all subjects at follow-up. Conclusion: This study provides insight into the natural history of patellofemoral pain in adolescent females. The relatively unchanged patellofemoral maltracking across subjects suggests that potential anatomic and kinematic abnormalities contributing to patellofemoral pain during mid-adolescence persist during skeletal maturation. Symptom improvement for these subjects did not result from a change in patellofemoral tracking, but rather from other causes.