bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful Treatment of Pyoderma Gangrenosum with Intravenous Immunoglobulins during Pregnancy
Authors: Erfurt-Berge Cornelia , Herbst Christine , Schuler Gerold , Bauerschmitz Juergen 
Published: January 2017

Background: Pyoderma gangrenosum is a rare ulcerative skin disease usually starting with a pustular lesion that rapidly progresses to painful ulcers with undermined violaceous borders. Numerous associated disorders have been described, including inflammatory bowel disease, rheumatologic or hematologic disorders, chronic active hepatitis, and malignancies. The occurrence of pyoderma gangrenosum during pregnancy is uncommon. Objective: We report a case of a patient with an aggravation of preknown pyoderma gangrenosum during pregnancy who was successfully treated with intravenous immunoglobulins. Conclusion: Administration of immunoglobulins represents a safe and effective treatment option for this subset of patients, as demonstrated in the present case.
Comparison of Dermatologists' and Nondermatologists' Diagnostic Accuracy for Malignant Melanoma
Authors: Corbo Michael D. , Vender Ronald , Wismer Judy 
Published: January 2017

Background: The incidence of malignant melanoma is increasing annually in Canada and patients present to nondermatologist groups (NDGs) first to have suspicious lesions examined. Objective: To determine the ability of Canadian NDGs in the recognition and management of melanoma. Methods: A survey of 25 malignant and benign skin lesion photographs was distributed to dermatologists and NDGs across Canada. Participants were asked to list whether the lesions were malignant or benign, and could answer ‘uncertain’ if needed. Dermatologists were subsequently asked if they would biopsy the lesion, whereas NDGs were asked if they would biopsy/refer. Results: Dermatologists achieved mean sensitivities, specificities, and diagnostic accuracies of 0.79, 0.77, and 0.71, respectively. They consistently decided to biopsy malignant lesions. NDGs attained mean scores of 0.61, 0.62, and 0.53, respectively, and selected to refer/biopsy the majority of lesions, malignant and benign. Conclusions: NDGs should receive more dermatologic training in the recognition of malignant melanoma.
Effect of Age on Health State Valuations
Authors: Dolan Paul 
Published: January 2017

Objectives: Valuations for health states defined by the EQ-5D measure of health-related quality of life, which were elicited using the time trade-off method, from a large sample of the UK general population have previously been shown to be related to the age of the respondent. This paper presents population valuation tariffs for all EQ-5D health states for those aged 18–59 and those aged 60 and over. Methods: Health state valuations were elicited from a representative sample of over 3000 members of the UK general population using one-to-one interviews. The same regression technique which had previously been used to estimate the EQ-5D tariff for the whole population is used in the current analysis. Additional variables were created which were the product of the original variables and the dummy attached to the age group of the respondent. An earlier qualitative study had suggested that some of the observed differences in valuations might have resulted from more older respondents doubting the plausibility of the ‘worse than dead’ scenario. Therefore, the model was estimated both when the scores of those aged 60 and over were unmodified and when they were modified to account for this possibility. Results: The tariff based on values from those aged 60 and over, was considerably lower than that based on values from those aged 18–59. When changes between health states were calculated, the difference could be as much as 0.15 on a scale between −1 and 1. However, when the scores of older respondents were adjusted, on the assumption that their lower values for states rated as worse than dead were due to an experimental artefact, the differences between the valuation tariffs of the two age groups greatly diminished. Conclusion: These results suggest that whose values are used may have an important effect on health state valuations, and in turn, therefore, on resource allocation decisions, but more research is needed to understand the source of the differences between the values given by different population subgroups.
Why is it so Difficult to Organise an Outpatient Clinic?
Authors: McKee Martin , Waghorn Alison 
Published: January 2017

Objectives: The shift from inpatient to outpatient care in the UK is drawing attention to the role of the outpatient clinic. Yet, outpatient clinics have received less attention than other elements of hospital work. This study sought to identify key problems perceived by staff in the functioning of outpatient clinics and to understand their responses to these problems. Methods: Interviews were conducted with 57 hospital staff in two hospitals (one teaching, one district general) in South-East England. Staff were selected through snowball sampling to provide a cross-section of those working in, and interacting with, the outpatient department. Constant comparison was used to generate hypotheses from the data collected in the first hospital, which were then tested in the second hospital. Results: Four main themes emerged. These were the role of the individual consultant, pressure on time, weaknesses in communication and problems with training. The personality of the consultant — in particular, his or her attitude to risk — was often central to the functioning of the clinic. The actions arising from differing personalities were remarkably resilient to managerial action. Most clinics operated in the face of pervasive pressures on time, which created a service that was seen as meeting no-one's needs adequately. Communication was almost universally poor in all directions and through all media. Training of medical staff was haphazard. Conclusions: Despite its growing importance, the hospital outpatient clinic is often ill-equipped to respond to the new challenges it faces. Overall, there is a need for the system to be managed, rather than simply to respond to whatever comes its way, and to ensure that the growing literature on individual and organisational change is understood and applied.
Computer Simulation to Estimate the Effectiveness of Carotid Endarterectomy
Authors: Lavender Michael , Craig Neil , Kerr Ron , Howel Denise 
Published: January 2017

Objectives: To investigate the benefit of carotid endarterectomy relative to medical treatment, by comparing the outcome for different groups of patients following transient ischaemic attacks. Methods: A Markov model was used to describe the survival and quality of life of patients treated for a transient ischaemic attack. The benefit is measured in terms of quality adjusted life months (QALMs). The outcome was estimated using a computer simulation with parameters based on published studies on the probability of events following treatment. The benefit of carotid endarterectomy was explored using a baseline set of parameters and a sensitivity analysis. Results: The baseline scenario of a 65-year-old male patient with the model factors set at an intermediate level showed a benefit for surgery of 3 QALMs compared with medical treatment alone. The sensitivity analysis showed that the most favourable combination of factors had a benefit of 13.4 QALMs and the least favourable a loss of 2 QALMs. Of all 128 factor combinations, 79.9% showed a benefit for surgery, 5.5% showed equal benefit, and 15.6% showed a benefit for medical treatment. Conclusions: Computer simulations have the potential for deriving estimates of benefit for different patient groups from the results of clinical trials. Combined with reliable information on costs, the technique could also demonstrate variations in cost-effectiveness for these groups. For patients following a transient ischaemic attack, the results from this simulation and limited cost information suggest that carotid endarterectomy is unlikely to be a cost-effective intervention in the UK for many patient groups despite a reduction in the risk of stroke.
The Importance of Laboratory Data for Comparing Outcomes and Detecting ‘outlier’ Wards in the Treatment of Patients with Pneumonia
Authors: Maor Yasmin , Rubin Haya R. , Gabbai Uri , Mozes Benjamin 
Published: January 2017

Objectives: To evaluate whether routine laboratory data can improve the ability to compare risk-adjusted outcomes of different medical wards, and to detect ‘outlier’ wards with significantly better or worse outcome. Methods: Patient data were taken from the Combined Patient Database Systematic Management and Research Tool, a database created by merging different computerized sources at a tertiary care hospital. All patients admitted to internal wards with the diagnosis of pneumonia during the years 1991–1995 were included ( n = 2734). The outcome variable was mortality 30 days post-admission. We used three comorbidity measures based on ICD-9-CM codes as possible predictors of mortality: secondary diagnoses; the Health Care Financing Administration severity index; and the Charlson comorbidity index. Models were created using logistic regression. To each model, laboratory data gathered in the first 48 hours after admission were added. To identify ‘outlier’ services we determined whether the patients' ward was an independent predictor of mortality. The area under the receiver operator curve (ROC) of the models was used for comparisons. Results: The area under the ROC was 0.65–0.72 for the models based on age and comorbid diagnoses. The addition of laboratory data improved markedly the discriminatory ability of each of the models, as reflected by an increase in the area under the ROC to 0.83–0.84. An ‘outlier’ ward with a higher risk-adjusted mortality rate was identified only by the models that included laboratory data. Conclusion: Basic, automated, routinely gathered laboratory data added significantly to the discriminatory power of risk models based on administrative data with abstracted diagnoses. Addition of laboratory data improved the ability to identify providers with possible exceptional quality of care.
A Review of the Use of Health Status Measures in Economic Evaluation
Authors: Brazier John , Deverill Mark , Green Colin 
Published: January 2017

Objective: To review the use of measures of health status in the assessment of benefits in economic evaluation, whether or not the measures were designed for this purpose. Methods: The review was based on a systematic search of the literature. It provides a comprehensive assessment of the evidence where it exists and a balanced overview of opinion otherwise. Results: Over 3000 papers were identified, of which 632 were found to be relevant. The review provides a set of recommendations. These include: a checklist of questions for selecting a measure for use in economic evaluation; a list of circumstances in which non-preference-based measures can be used; and recommendations surrounding the use of health state valuation techniques and multi-attribute utility scales. Conclusion: These recommendations should help to identify poor economic evaluations and hence guard against inefficient conclusions being drawn regarding the provision of health services.
Preoperative Assessment of Small Tumours in Women with Breast Cancer
Authors: Kald B. A. , Boiesen P. , Ronnow K. , Jonsson P. E. , Bisgaard T. 
Published: January 2017

Background and Objectives: In patients with breast cancer, planning of the surgical strategy may rely on preoperative tumour size. The optimal method for assessment of small tumours has not been established. We compared findings from preoperative mammography and ultrasonography with histopathological tumour size in patients treated with breast-conserving surgery. Material and Methods: The study was retrospective and the setting a single institution clinic with free referral of patients. The patients were examined before the operation with mammography, ultrasonography, and findings were compared with postoperative histopathological tumour size. Results: The study included 131 patients (median age was 59) years with grade I, II, and III cancers in 47, 71 and in 13 patients, respectively. The medium histological tumour size was 14 mm, range 4–45 mm. A wide 95 % confidence interval between histopathological tumour size and preoperative mammography (standard deviation 4.8 mm) and ultrasonography (standard deviation 4.8 mm) was found. The combination of mammography and ultrasonography did not improve the results (standard deviation 4.3 mm). Preoperative mammography tended to over estimate the tumour size compared with histological tumour size whereas preoperative ultrasonography tended to underestimate the tumour size. Conclusion: In this retrospective study with preoperative evaluation of small breast cancers by mammography and ultrasonography, wide 95 % confidence intervals for the methods were found and they should therefore be used with caution in the planning of the surgical strategy.
Recurrences after Immediate Reconstruction in Breast Cancer
Authors: Mustonen P. , Kataja V. , Berg M. , Pietiläinen T. , Papp A. 
Published: January 2017

Aim: To determine the incidence of and reasons for recurrences after immediate breast reconstruction in breast cancer patients. Material and Methods: The data of 79 patients undergoing immediate breast reconstruction between 1998 and 2001 in Kuopio University Hospital were re-examined from both the local cancer register and the patient charts at the end of year 2003. Results: There were five local recurrences (6.3 %), one regional recurrence (1.2 %), and three cases (3.8 %) presented bone and/or visceral metastases. All recurrences except one (primary tumor noninvasive) appeared within the first two years after primary therapy. Young age and increasing size of the tumour were risk factors for distant or logoregional metastases. Conclusion: Immediate breast reconstruction is a safe procedure in breast cancer patients, but a multidisciplinary team is needed for careful patient selection.
Fatal Explosion Injuries in Finland: A Twenty-Year Nationwide Survey
Authors: Mäkitie I. , Pihlajamäki H. 
Published: January 2017

Background and Aims: Expanding violence may necessitate treatment of explosion victims, requiring a broadening of existing medical skills and knowlegde of injury mechanisms. The aim of the study was to assess the number, nature and injury pattern of fatal explosion incidents in Finland. Material and Methods: Retrospective analysis of explosion-related deaths from January 1985 to December 2004. Death certificates were obtained and reviewed. Results: Over the 20-year period from 1985 to 2004, only 61 inviduals died in Finland as a result of unintentional or unspecified explosion related events. A homemade bomb assault for unknown motives killed seven people in a suburb in 2002. The incidence was 5.7 cases per 10 000 000 person-years. Suicides using explosives were slightly more common; on average 4 cases per year (6.7 cases per 10 000 000 person-years). A small increase in the fatality trend was noticeable during the last years of the study period. Conclusions: The incidence of fatal explosion injuries is a minor problem, but a small increase can be seen during the last few years. Victims of such injuries required only minimal hospital resources, because in most cases they died at the scene. Our results suggest that efforts to prevent fatalities related to explosives or corresponding devices, or to reduce their number, should focus on prevention of intentions.
Low Maruyama Index Surgery for Gastric Cancer
Authors: Hundahl S. A. 
Published: January 2017

Background: Japanese definitions and treatment guidelines have dominated extent-of-surgery concepts in gastric cancer for over 4 decades, despite the fact that such definitions/guidelines have changed considerably over time, and the fact they have largely failed to improve survival in prospective, randomized clinical trials. Aim: To briefly review lessons from previous surgical trials in gastric cancer, and, more specifically, to review data validating the concept of “low Maruyama Index surgery” as a data-driven guide to surgical treatment. Methods: Review of results from blinded multivariate analyses of two separate, prospective, randomized clinical trials: a) the Macdonald Trial of adjuvant postoperative chemo-radiation, Intergroup 0116, conducted in North America; and b) the Dutch D1-D2 Trial. Results: Blinded univariate and multivariate analysis of both trials establish “Maruyama Index of Unresected Disease” (MI) <5 as a strong independent predictor of better disease-free and overall survival in gastric cancer. Moreover, a strong “dose response” effect for MI versus survival is apparent. Conclusions: In contrast to surgery focused on achievement of a particular Japanese-defined D-level, “low Maruyama Index surgery” is associated with increased disease-free and overall survival. Further, the dose-response effect suggests MI can be used to quantify the adequacy of lymphadenectomy for a given patient. Low MI surgery can be pro-spectively planned by using the Maruyama Computer Program pre-operatively or intra-operatively.
Immunonutrition in Elective Gastrointestinal Surgery Patients
Authors: Helminen H. , Raitanen M. , Kellosalo J. 
Published: January 2017

Background: Previous trials have shown that perioperative immunonutrition could protect patients from infectious complications after gastrointestinal cancer operations. The purpose of this study was to determine whether perioperative immunonutrition decreases postoperative morbidity, especially infection complications, mortality and length of hospital stay in patients undergoing major gastrointestinal tract surgery. Methods: One hundred patients with a planned elective operation for benign or malignant gastrointestinal illness were randomized into two groups: group 1) oral supplementation for five days before and five days after surgery with 900 mL/day of a formula enriched with arginine, gamma-3-fatty acid and RNA + liquid diet ad libitum on one and two postoperative day and then solid food (immunonutrition group; n = 50) or group 2) no artificial nutrition before and after surgery, on one and two postoperative day intravenous solution of 5% glucose and electrolytes and then normal diet (conventional group; n = 50). Results: The groups were comparable for all key baseline and surgical characteristics. There were nine (18%) infectious complications in both groups. Overall complication rates were 28% (n = 14) in the immunonutrition group and 24% (n = 12) in the conventional group. No significant difference between the groups was found in complication rates, mortality or length of hospital stay. Conclusion: Routine perioperative immunonutrition to the patients undergoing major gastrointestinal surgery is not beneficial.
A 19-Year Review of Paediatric Patients with Acute Scrotum
Authors: Mäkelä E. , Lahdes-Vasama T. , Rajakorpi H. , Wikström S. 
Published: January 2017

Background and Aims: The aim of the study was to compare incidence, symptoms and signs of spermatic cord torsion to those of other conditions causing acute scrotum. Material and Methods: Records of 388 consecutive boys under 17 years of age treated for acute scrotum at The Hospital for Children and Adolescents in Helsinki in 1977–1995 were reviewed. During the period studied all patients with acute scrotum underwent urgent surgery to ensure accurate diagnosis and treatment. The duration and characteristics of the symptoms, clinical findings prior to operation and the age of the patients were registered. Results: Scrotal explorations revealed 100 cases (26%) of spermatic cord torsion (SCT), 174 cases (45%) of torsion of the testicular appendage (AT), 38 cases (10%) of epididymitis (ED), 32 cases (8%) of incarcerated inquinal hernias and 44 (11%) other conditions. During the first year of life SCT was the most common cause of acute scrotum, another peak incidence being in adolescence. Almost half of the boys with AT were nine to 12 years of age (median 11). Except for infants, the patients' acute symptoms were pain (SCT 88%, AT 94%, ED 76%). Swelling in the hemiscrotum was found in 44% of SCT, in 39% of AT and in 88% of ED cases. Epididymitis was also accompanied by erythema (37%), but infrequently with fever (in 16%). Erythema was found also in AT (32%), but the “blue dot sign” was found positive in only 17 (10%) of the boys with AT. Three quarters of the boys who were operated on within six hours from onset of symptoms had testicle torsion. All testicles were saved when detorsion was performed within six hours, but salvage was possible in only half of the cases when symptoms had lasted more than six but less than 12 hours. Conclusions: The high probability of SCT among those admitted to an emergency department within six hours from the onset of the symptoms justifies immediate surgical exploration.
Arthroscopic Anterior Cruciate Ligament Reconstruction Using a Hamstring Graft with Interference Screw Fixation
Authors: Moisala A.-S. , Järvelä T. , Honkonen S. , Paakkala A. , Kannus P. , Järvinen M. 
Published: January 2017

Background and Aims: This study assessed the clinical and radiographic results 3 to 8 years after an arthroscopic ACL reconstruction using a hamstring graft with interference screw fxation on femoral and tibial sites. Material and Methods: Seventy-six of 100 patients, who underwent an arthroscopic ACL reconstruction, could be re-examined with a mean follow-up of 5 years. Results: The mean Tegner activity score was 4 (scale: 0 to 10) before surgery, and 5 at the follow-up. Fifty-four patients (78%) achieved a satisfactory result in the IKDC rating. The mean Lysholm score was 85 (scale: 0 to 100), the score being better in patients without meniscal resection than those with (P = 0.04). The mean side-to-side difference in anterior-posterior knee laxity was 1.8 mm, and 62 patients (90%) had good stability. Sixty-four patients (93%) had normal range of motion of the knee. Twelve patients (46 %) with meniscal resection had osteoarthritic changes, compared with only 8 of those (20 %) without meniscal resection (P = 0.03). Conclusions: This medium-term follow-up study showed that good stability and function and normal range of motion of the knee can be achieved in majority of the patients who have undergone an ACL reconstruction with a hamstring graft and interference screw fixation.