bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study
Authors: Luckraz Heyman , Manga Na’ngono , Senanayake Eshan L , Abdelaziz Mahmoud , Gopal Shameer , Charman Susan C , Giri Ramesh , Oppong Raymond , Andronis Lazaros 
Published: November 2017

Background Ventilator-associated pneumonia is associated with significant morbidity, mortality and healthcare costs. Most of the cost data that are available relate to general intensive care patients in privately remunerated institutions. This study assessed the cost of managing ventilator-associated pneumonia in a cardiac intensive care unit in the National Health Service in the United Kingdom. Methods Propensity-matched study of prospectively collected data from the cardiac surgical database between April 2011 and December 2014 in all patients undergoing cardiac surgery (n = 3416). Patients who were diagnosed as developing ventilator-associated pneumonia, as per the surveillance definition for ventilator-associated pneumonia (n = 338), were propensity score matched with those who did not (n = 338). Costs of treating post-op cardiac surgery patients in intensive care and cost difference if ventilator-associated pneumonia occurred based on Healthcare Resource Group categories were assessed. Secondary outcomes included differences in morbidity, mortality and cardiac intensive care unit and in-hospital length of stay. Results There were no significant differences in the pre-operative characteristics or procedures between the groups. Ventilator-associated pneumonia developed in 10% of post-cardiac surgery patients. Post-operatively, the ventilator-associated pneumonia group required longer ventilation (p < 0.01), more respiratory support, longer cardiac intensive care unit (8 vs 3, p < 0.001) and in-hospital stay (16 vs 9) days. The overall cost for post-operative recovery after cardiac surgery for ventilator-associated pneumonia patients was £15,124 compared to £6295 for non-ventilator-associated pneumonia (p < 0.01). The additional cost of treating patients with ventilator-associated pneumonia was £8829. Conclusion Ventilator-associated pneumonia was associated with significant morbidity to the patients, generating significant costs. This cost was nearer to the lower end for the cost for general intensive care unit patients in privately reimbursed systems.
Sickness certification in Singapore’s public primary healthcare system: A cross-sectional analysis
Authors: Ng David Chee Chin , Lew Yii Jen , Koh Eileen Yi Ling , Nguyen Van Hai , Wong Hwee Bee , James Lyn , Tan Ngiap Chuan 
Published: November 2017

Objectives: Sickness absenteeism has been rising in Singapore with sickness certification commonly performed by primary care physicians. The Primary Care Survey 2014 reported increased primary care demand driven by a rapidly ageing population and the prevalence of chronic disease. This article aims to determine the magnitude of outpatient sickness certification in all the polyclinics in Singapore and identify the demographic characteristics and factors influencing the taking of sick leave by the local multi-ethnic Asian patients. Design: A one-week, cross-sectional survey using computer-assisted interviews with age-stratified, systematically sampled patients was conducted at all 18 polyclinics in 2014. Sick leave data was then extracted from each polyclinic’s administrative system. Data was analysed with logistic regression to determine statistically significant factors. Results: The sickness certification rate was 22.6% during the study period with a weighted average duration of 1.42 days. Sickness certification was most associated with the younger age group (17–20 years; adjusted odd ratio (AOR) = 9.51), an acute condition (AOR = 24.8) and those living in 1–2 room public housing (AOR = 4.72). Among employees, those working in manufacturing industries had the most association with sickness certification while the finance and insurance industry had the least. An acute upper respiratory tract infection was the most frequent diagnosis for those who obtained medical certificates (38.7%). Conclusion: A medical certificate was issued in almost one-quarter of consultations in Singapore polyclinics. Sickness certification was predominated by short-term absence for acute conditions. Characterisation of sickness absenteeism among employees serves as a benchmark for future studies. Mitigation measures were discussed while exclusion of private primary care clinics probably led to an underestimation of the magnitude of sickness certification.
Does service timing matter for psychological outcomes in cardiac rehabilitation? Insights from the National Audit of Cardiac Rehabilitation
Authors: Sumner Jennifer , Böhnke Jan R , Doherty Patrick 
Published: November 2017

Background The presence of mental health conditions in cardiac rehabilitation (CR) patients such as anxiety and depression can lead to reduced programme adherence, increased mortality and increased re-occurrence of cardiovascular events undermining the aims and benefit of CR. Earlier research has identified a relationship between delayed commencement of CR and poorer physical activity outcomes. This study wished to explore whether a similar relationship between CR wait time and mental health outcomes can be found and to what degree participation in CR varies by mental health status. Methods Data from the UK National Audit of Cardiac Rehabilitation, a dataset that captures information on routine CR practice and patient outcomes, was extracted between 2012 and 2016. Logistic and multinomial regression models were used to explore the relationship between timing of CR and mental health outcomes measured on the hospital anxiety and depression scale. Results The results of this study showed participation in CR varied by mental health status, particularly in relation to completion of CR, with a higher proportion of non-completers with symptoms of anxiety (5% higher) and symptoms of depression (8% higher). Regression analyses also revealed that delays to CR commencement significantly impact mental health outcomes post-CR. Conclusion In these analyses CR wait time has been shown to predict the outcome of anxiety and depression status to the extent that delays in starting CR are detrimental. Programmes falling outside the 4-week window for commencement of CR following referral must strive to reduce wait times to avoid negative impacts to patient outcome.
Serum levels of Growth Arrest-Specific 6 protein and soluble AXL in patients with ST-segment elevation myocardial infarction
Authors: Caldentey Guillem , García De Frutos Pablo , Cristóbal Helena , Garabito Manel , Berruezo Antonio , Bosch Xavier , San Antonio Rodolfo , Flores-Umanzor Eduardo , Perea Rosario J , De Caralt Teresa M , Rodríguez Jany , Ortiz-Pérez José T 
Published: November 2017

Background:Serum soluble AXL (sAXL) and its ligand, Growth Arrest-Specific 6 protein (GAS6), intervene in tissue repair processes. AXL is increased in end-stage heart failure, but the role of GAS6 and sAXL in ST-segment elevation myocardial infarction (STEMI) is unknown.Objectives:To study the association of sAXL and GAS6 acutely and six months following STEMI with heart failure and left ventricular remodelling.Methods:GAS6 and sAXL were measured by enzyme-linked immunosorbent assay at one day, seven days and six months in 227 STEMI patients and 20 controls. Contrast-enhanced magnetic resonance was performed during admission and at six months to measure infarct size and left ventricular function.Results:GAS6, but not sAXL, levels during admission were significantly lower in STEMI than in controls. AXL increased progressively over time ( p<0.01), while GAS6 increased only from day 7. GAS6 or sAXL did not correlate with brain natriuretic peptide or infarct size. However, patients with heart failure (Killip >1) had higher values of sAXL at day 1 (48.9±11.9 vs. 44.0±10.7 ng/ml; p<0.05) and at six months (63.3±15.4 vs. 55.9±13.7 ng/ml; p<0.05). GAS6 levels were not different among subjects with heart failure or left ventricular remodelling. By multivariate analysis including infarct size, Killip class and sAXL at seven days, only the last two were independent predictors of left ventricular remodelling (odds ratio 2.24 (95% confidence interval: 1.08–4.63) and odds ratio 1.04 (95% confidence interval: 1.00–1.08) respectively).Conclusion:sAXL levels increased following STEMI. Patients with heart failure and left ventricular remodelling have higher sAXL levels acutely and at six month follow-up. These findings suggest a potential role of the GAS6–AXL system in the pathophysiology of left ventricular remodelling following STEMI.
New holosystolic murmur after acute myocardial infarction
Authors: Flores-Umanzor Eduardo , Caldentey Guillem , San Antonio Rodolfo 
Published: November 2017

Abstract
In the era of primary percutaneous coronary intervention, mechanical complications after acute myocardial infarction are extremely rare, with an incidence of less than 0.5%. Rupture of the ventricular septum is the least frequent occurrence. Nevertheless, current mortality remains high and a prompt diagnosis and treatment are imperative to increase survival. Despite early surgical repair, mortality still remains high.
Risk stratification of colorectal polyps for predicting residual or recurring adenoma using the Size/Morphology/Site/Access score
Authors: Barosa Rita , Mohammed Noor , Rembacken Bjorn 
Published: November 2017

Background and AimsEndoscopic mucosal resection is an effective and safe procedure to manage large non‐pedunculated colonic polyps for which residual/recurrent adenoma is the main drawback. Size/Morphology/Site/Access score determines polypectomy difficulty. We aimed to describe residual/recurrent adenoma rate according to Size/Morphology/Site/Access and to select the ize/Morphology/Site/Access cut‐off to predict low residual/recurrent adenoma.MethodsThis was a retrospective cohort study of endoscopic mucosal resection for large non‐pedunculated colonic polyps performed in a tertiary centre.ResultsThree hundred and sixteen procedures were included. The mean size of lesions was 34.5 ± 17.1 mm, 59.5% were sessile, 60.4% were in the right colon and in 17.7% (n = 56) the access was difficult. Of the lesions, 83.6% were Size/Morphology/Site/Access 3–4. Residual/recurrent adenoma at first and second follow‐up was significantly lower in Size/Morphology/Site/Access 2 (1.9% and 0.0%, respectively) when compared to Size/Morphology/Site/Access 3 (18.2%, p = 0.004 and 6.7%, p = 0.049) and Size/Morphology/Site/Access 4 (30.8%, p < 0.001 and 22.7%, p = 0.030). The negative predictive value of Size/Morphology/Site/Access 2 for residual/recurrent adenoma at second follow‐up was 86.1%. On multivariate analyses, Size/Morphology/Site/Access 3–4 predicted residual/recurrent adenoma at first (odds ratio 11.96, 95% confidence interval 1.57–91.13) and second follow‐up (odds ratio 2.47, 95% confidence interval 1.51–4.22) and had higher cumulative incidence of residual/recurrent adenoma compared to Size/Morphology/Site/Access 2 (p ≤ 0.003).ConclusionUse of the Size/Morphology/Site/Access score allows cases to be identified with a low risk of residual/recurrent adenoma.
Patient-centred outcomes research: perspectives of patient stakeholders
Authors: Chhatre Sumedha , Gallo Joseph J , Wittink Marsha , Schwartz J Sanford , Jayadevappa Ravishankar 
Published: November 2017

Objective To elicit patient stakeholders’ experience and perspectives about patient-centred care. Design Qualitative. Setting A large urban healthcare system. Participants Four patient stakeholders who are prostate cancer survivors. Main outcome measures Experience and perspectives of patient stakeholders regarding patient-centred care and treatment decisions. Results Our patient stakeholders represented a diverse socio-demographic group. The patient stakeholders identified engagement and dialogue with physicians as crucial elements of patient-centred care model. The degree of patient-centred care was observed to be dependent on the situations. High severity conditions warranted a higher level of patient involvement, compared to mild conditions. They agreed that patient-centred care should not mean that patients can demand inappropriate treatments. Conclusions An important attribute of patient-centred outcomes research model is the involvement of stakeholders. However, we have limited knowledge about the experience of patient stakeholders in patient-centred outcomes research. Our study indicates that patient stakeholders offer a unique perspective as researchers and policy-makers aim to precisely define patient-centred research and care.
Determining the Most Important Factors Involved in Ranking Orthopaedic Sports Medicine Fellowship Applicants
Authors: Baweja Rishi , Kraeutler Matthew J. , Mulcahey Mary K. , McCarty Eric C. 
Published: November 2017

Background: Orthopaedic surgery residencies and certain fellowships are becoming increasingly competitive. Several studies have identified important factors to be taken into account when selecting medical students for residency interviews. Similar information for selecting orthopaedic sports medicine fellows does not exist. Purpose: To determine the most important factors that orthopaedic sports medicine fellowship program directors (PDs) take into account when ranking applicants. Study Design: Cross-sectional study. Methods: A brief survey was distributed electronically to PDs of the 92 orthopaedic sports medicine fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). Each PD was asked to rank, in order, the 5 most important factors taken into account when ranking applicants based on a total list of 13 factors: the interview, the applicant’s residency program, letters of recommendation (LORs), personal connections made through the applicant, research experience, an applicant’s geographical ties to the city/town of the fellowship program, United States Medical Licensing Examination (USMLE) scores, Orthopaedic In-Training Examination (OITE) scores, history of being a competitive athlete in college, extracurricular activities/hobbies, volunteer experience, interest in a career in academics, and publications/research/posters. Factors were scored from 1 to 5, with a score of 5 representing the most important factor and 1 representing the fifth-most important factor. Results: Of the 92 PDs contacted, 57 (62%) responded. Thirty-four PDs (37%) listed the interview as the most important factor in ranking fellowship applicants (overall score, 233). LORs (overall score, 196), an applicant’s residency program (overall score, 133), publications/research/posters (overall score, 115), and personal connections (overall score, 90) were reported as the second- through fifth-most important factors, respectively. Conclusion: According to orthopaedic sports medicine fellowship PDs, the fellowship interview is the most important factor in determining how an applicant will be ranked. Other factors, including LORs, the applicant’s residency program, research production, and personal connections, were also considered to be important. This information provides orthopaedic sports medicine fellowship applicants with a better understanding of which areas to focus on when preparing for the fellowship interview and matching process.
Twin–Twin Transfusion Syndrome and Maternal Symptomatology—An Exploratory Analysis of Patient Experiences When Reporting Complaints
Authors: Nicholas Lauren , Fischbein Rebecca , Falletta Lynn , Baughman Kristin 
Published: November 2017

Objective: The aim of this study was to assess patient experiences when reporting symptoms of twin–twin transfusion syndrome (TTTS) to their health-care providers. Methodology: The study utilized an online, retrospective survey of women, over the age of 18, who were living in the United States at the time of their pregnancy and had completed a TTTS pregnancy. Results: Three hundred sixty-seven cases were included for analysis. Nearly half of the respondents (45.2%) reported experiencing maternal symptoms prior to TTTS diagnosis. The average number of symptoms experienced was 2.85. The average gestational week of symptom onset was 18.2. A total of 76.2% of respondents experiencing symptoms shared these concerns with their health-care provider; however, slightly more than half (51.2%) believed that the provider dismissed their complaints. Conclusions: Results suggest a disconnect between patients’ reporting TTTS symptoms and health-care providers responding attentively, as perceived by the patient. It would be advantageous for health-care providers to inform women pregnant with a monochorionic–diamniotic pregnancy to immediately report the presence of any symptom described in the present research, which may be associated with any number of twin pregnancy–related complications.
FOXP1 expression is a prognostic biomarker in follicular lymphoma treated with rituximab and chemotherapy
Authors: Mottok Anja , Jurinovic Vindi , Farinha Pedro , Rosenwald Andreas , Leich Ellen , Ott German , Horn Heike , Klapper Wolfram , Boesl Michael , Hiddemann Wolfgang , Steidl Christian , Connors Joseph M. , Sehn Laurie H. , Gascoyne Randy D. , Hoster Eva , Weigert Oliver , Kridel Robert 
Published: November 2017

Key PointsHigh expression of FOXP1 predicts adverse FFS in patients with FL treated with immunochemotherapy. FOXP1 high and low expressors differ in specific gene mutations and gene expression changes.
RETRACTED ARTICLE: Effect of rosuvastatin on fasting and postprandial endothelial biomarker levels and microvascular reactivity in patients with type 2 diabetes and dyslipidemia: a preliminary report
Authors: Kim Kyoung Min , Jung Kyong Yeun , Yun Han Mi , Lee Seo Young , Oh Tae Jung , Jang Hak Chul , Lim Soo 
Published: November 2017

Abstract
Background
The cardiovascular benefits of statins have been proven, but their effect on circulation in small vessels has not been examined fully. We investigated the effect of 20 mg rosuvastatin on biomarkers, including paraoxonase-1 (PON-1) and asymmetric dimethylarginine (ADMA), and on microvascular reactivity.

Method
We enrolled 20 dyslipidemic patients with type 2 diabetes and 20 age- and body mass index (BMI)-matched healthy controls. Rosuvastatin (20 mg/day) was given to the patient group for 12 weeks. Biochemical parameters, including PON-1 and ADMA, were compared between the patient and control groups, and before and after rosuvastatin treatment in the patient group. Fasting and 2 h postprandial levels of PON-1 and ADMA after mixed-meal challenge were also compared. Microvascular reactivity in a peripheral artery was examined using laser Doppler flowmetry.

Results
The respective mean ± standard deviation of age and BMI were 50.1 ± 3.8 year and 25.8 ± 3.7 kg/m2 in the patients and 50.2 ± 3.2 year and 25.4 ± 3.4 kg/m2 in the controls. The patient group had worse profiles of cardiometabolic biomarkers, including PON-1 and ADMA, than the controls. In the patients treated with 20 mg rosuvastatin, low-density lipoprotein (LDL)-cholesterol decreased from 147.2 ± 26.5 to 68.3 ± 24.5 mg/dL and high-density lipoprotein (HDL)-cholesterol increased from 42.4 ± 5.2 to 44.7 ± 6.2 mg/dL (both P < 0.05). Both fasting and 2 h postprandial levels of PON-1 increased and those of ADMA decreased after treatment with rosuvastatin for 12 weeks. The changes in postprandial levels of both biomarkers were greater than those after fasting. Microcirculation assessed as reactive hyperemia in the patients after an ischemic challenge increased significantly from 335.3 ± 123.4 to 402.7 ± 133.4% after rosuvastatin treatment. The postprandial changes in the biomarkers were significantly associated with improvement of microvascular reactivity.

Conclusions
Rosuvastatin treatment for 12 weeks improved microvascular reactivity with concomitant beneficial changes in the postprandial levels of PON-1 and ADMA. These results suggest that rosuvastatin improves the postprandial cardiometabolic milieu in type 2 diabetes.
Trial registration ClinicalTrials.gov: NCT02185963 (July 7, 2014)
‘Fast cast’ and ‘needle Tenotomy’ protocols with the Ponseti method to improve clubfoot management in Bangladesh
Authors: Evans Angela , Chowdhury Mamun , Rana Sohel , Rahman Shariar , Mahboob Abu Hena 
Published: November 2017

AbstractBackgroundThe management of congenital talipes equino varus (clubfoot deformity) has been transformed in the last 20 years as surgical correction has been replaced by the non‐surgical Ponseti method. The Ponseti method, consists of corrective serial casting followed by maintenance bracing, and has been repeatedly demonstrated to give best results ‐ regarded as the ‘gold standard’ treatment for paediatric clubfoot.MethodsTo develop the study protocol Level 2 evidence was used to modify the corrective casting phase of the Ponseti method in children aged up to 12 months. Using Level 4 evidence, the percutaneous Achilles tenotomy (PAT) was performed using a 19‐gauge needle instead of a scalpel blade, a technique found to reduce bleeding and scarring.ResultsA total of 123 children participated in this study; 88 male, 35 female. Both feet were affected in 67 cases, left only in 22 cases, right only in 34 cases. Typical clubfeet were found in 112/123 cases, six atypical, five syndromic. The average age at first cast was 51 days (13–240 days).The average number of casts applied was five (2–10 casts). The average number of days between the first cast and brace was 37.8 days (10–122 days), including 21 days in a post‐PAT cast. Hence, average time of corrective casts was 17 days.Parents preferred the reduced casting time, and were less concerned about unseen skin wounds.PAT was performed in 103/123 cases, using the needle technique. All post tenotomy casts were in situ for three weeks. Minor complications occurred in seven cases ‐ four cases had skin lesions, three cases disrupted casting phase. At another site, 452 PAT were performed using the needle technique.ConclusionsThe ‘fast cast’ protocol Ponseti casting was successfully used in infants aged less than 8 months. Extended manual manipulation of two minutes was the essential modification. Parents preferred the faster treatment phase, and ability to closer observe the foot and skin. The treating physiotherapists preferred the ‘fast cast’ protocol, achieving better correction with less complication. The needle technique for PAT is a further improvement for the Ponseti method.