bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring the Connotative Meanings of Foods
Authors: Fewster W. Jean , Bostian Lloyd R. , Powers Richard D. 
Published: January 2008

Foods have many meanings, nutritive value being only one. Knowing some of the connotative or implied meanings that people associate with foods can help nutritionists define communication goals and plan educational programs.This exploratory study sought to determine if certain connotative or implied meanings of foods can be measured and if common underlying dimensions of meaning can be identified. Other hypotheses related to the discriminating power, validity, and reliability of the instrument developed for the study.The instrument, composed of a number of adjectival scales, was adapted from a behavioral science research technique, the semantic differential. Performance of the instrument was demonstrated by having homemakers in high‐ and low‐income groups use it to judge a number of foods and food groups. The selection of foods and populations was based on results of recent food consumption surveys in the United States.Multivariate and univariate analyses of these data attested to the validity and reliability of the instrument. These analyses showed that the instrument measured differences between income groups and foods, both food groups and single foods. Major dimensions of meaning were identified by factor analysis. On the basis of the statistical tests, scales were selected for retention in the instrument for use in further testing with other foods and populations.
Methodological issues in therapeutic trials of COPD
Authors: Suissa S. , Ernst P. , Vandemheen K. L. , Aaron S. D. 
Published: January 2008

The recent Towards a Revolution in COPD Health (TORCH) randomised trial replicated the findings of previous trials in chronic obstructive pulmonary disease (COPD) on the apparent effectiveness of inhaled corticosteroids (ICS) in reducing exacerbation rates, but not so for mortality.In the present article, the authors review methodological issues in the TORCH and previous trials, such as patients already receiving ICS before randomisation and the absence of follow-up after study drug discontinuation, using data from two trials.First, among previous ICS users in the Canadian Optimal Therapy of COPD Trial, the hazard ratio of the first exacerbation with ICS relative to bronchodilators was 0.71 (95% confidence interval (CI) 0.53–0.96), while among those not using ICS prior to randomisation, it was 1.11 (95% CI 0.69–1.79). Secondly, the rate ratio of exacerbations with ICS was 0.78 (95% CI 0.61–0.99) prior to drug discontinuation during follow-up and 1.23 (95% CI 0.78–1.95) thereafter. Finally, a 2×2 factorial analysis of the TORCH data found a rate ratio of mortality for the salmeterol component to be 0.83 (95% CI 0.74–0.95), while for the fluticasone component it was 1.00 (95% CI 0.89–1.13).In conclusion, after proper consideration of the various methodological shortcomings in the design and analysis of randomised trials, the effectiveness of inhaled corticosteroids in treating chronic obstructive pulmonary disease remains doubtful, while the benefit observed with combination therapy may be due exclusively to the beneficial effects of the long-acting bronchodilator alone.
Budesonide/formoterol maintenance and reliever therapy: impact on airway inflammation in asthma
Authors: Sears M. R. , Boulet L-P. , Laviolette M. , Fitzgerald J. M. , Bai T. R. , Kaplan A. , Smiljanic-Georgijev N. , Lee J. S-M. 
Published: January 2008

The aim of the present study was to compare the effectiveness, safety and health economics of budesonide/formoterol maintenance and a novel reliever therapy with conventional best practice in patients with persistent asthma in Canada.After 2 weeks of usual therapy, 1,538 patients were randomised for 6 months to open-label budesonide/formoterol maintenance and reliever therapy 160/4.5 μg twice daily and as needed, or to guideline-based conventional best practice. Severe asthma exacerbations, reliever medication use and total inhaled corticosteroid dose were analysed in all patients and airway inflammation was assessed in a sub-study of 115 patients.No differences were seen in time to first severe exacerbation and severe asthma exacerbation rate. There were numerically fewer emergency room visits or hospitalisations with budesonide/formoterol maintenance and reliever therapy (4.4versus7.5 events per 100 patients·yr−1, 41% reduction); however, this did not reach statistical significance. Mean total inhaled corticosteroid dose, reliever use, asthma medication costs and total annual costs per patient were all significantly lower with budesonide/formoterol maintenance and reliever therapy. Mean sputum eosinophil cell counts remained in the range for controlled inflammation in both groups.In conclusion, budesonide/formoterol maintenance and reliever therapy achieved similar or improved clinical control compared with conventional best practice, with significantly lower total inhaled corticosteroid dose and lower cost, while maintaining similar control of eosinophilic inflammation.
Outcome Scores Collected by Touchscreen: Medical Audit as it Should be in the 21st Century?
Authors: Dixon Sean , Bunker Timothy , Chan Daniel 
Published: January 2008

INTRODUCTION Collecting outcome scores in paper form is fraught with difficulty. We have assessed the feasibility of, and patient's attitude towards, entering scores using a touchscreen. PATIENTS AND METHODS A touchscreen was installed in the orthopaedic out-patient clinic. If relevant, patients were asked to complete either an Oswestry Disability Index (ODI) or Oxford Shoulder Score (OSS) using the screen. Patients were given written instructions and their hospital number by the receptionist who had no further input. Scores were completed with two identifiers. A paper questionnaire was used to assess computer experience and attitude towards the touchscreen. RESULTS A total of 1348 patients, average age 50 years, successfully completed a score in the first 12 months. One-third were over 60 years. Overall, 91% correctly entered their hospital number and date of birth, falling to 84% in patients over 70 years. All patients were identifiable. The average time to complete the scores was 4.7 min rising with age. Of 170 patients completing the paper assessment of the touchscreen, one-third had little or no experience of computers and a third were over 60 years. Of patients, 93% were willing to repeat the score using the touchscreen to monitor progress. Two-thirds found it easier to use than expected. Only 10% would prefer a paper score. These results were maintained among patients over 60 years. Only two were unable to complete the score and 80% of those potentially eligible did so. The remainder were called to clinic before the touchscreen was free. CONCLUSIONS Orthopaedic outcome scores can be collected in very large volumes using a touchscreen. Data are then in an immediately usable form. The method is acceptable to patients, independent of age and computer experience. Even in the oldest patients, the accuracy is higher than for paper versions of the score. Combined with operative data, this simple method has the potential to provide a very powerful audit tool indeed.
Vascular Surgery within General Surgery: An Analysis of Workload 1989–2005
Authors: Ashraf SQ , Bajwa A , Magee TR , Galland RB 
Published: January 2008

INTRODUCTION There is considerable debate as to whether vascular surgery should be a subspecialty separate from general surgery. This study examines the changing relationship between general and vascular surgery in a district general surgical unit over 16 years. PATIENTS AND METHODS A detailed survey of referrals, admissions and operations to one unit was carried out over 3 months in 003. This was compared with similar surveys in 1989, 1990 and 1995. In addition a 3-month audit of operations performed was carried out in 2005 following a decision by the Primary Care Trust (PCT) to reduce varicose vein referrals. RESULTS There was a significant increase in the number of varicose vein and arterial referrals 1989–2003 (P = 0.0001 and P < 0.0001, respectively). This was reflected in increased number of vascular admissions (P < 0.0001). In 1989, 14% of the arterial cases were admitted as emergencies. This figure rose to 52% in 2003 (P < 0.0001). There was a significant increase in the number of arterial operations performed between 1989 and 1995; however, from 1995 to 2003 this number fell P < 0.0001). The number of varicose vein procedures increased significantly 1989–2003 (P < 0.0001), with a significant fall after the PCT decision (P < 0.0001). However, the number of operations carried out in 2005 increased slightly with the proportion of general surgical cases, mostly hernia repairs and laparoscopic cholecystectomies, increasing. CONCLUSIONS With increasing specialisation comes the risk that reduction in any aspect of a particular specialty may result in that unit becoming unsustainable. In vascular surgery this will inevitably lead to centralisation of services. In a large district general hospital having two general surgeons with a vascular interest, the general surgical component has maintained the workload of the unit following reduction in varicose vein referrals.
Surgery in Malawi – A National Survey of Activity in Rural and Urban Hospitals
Authors: Lavy Chris , Tindall Alistair , Steinlechner Colin , Mkandawire Nyengo , Chimangeni Sandy 
Published: January 2008

INTRODUCTION Malawi is a poor country with few doctors. It has 21 district hospitals all of which have operating theatres but none of which has a permanent surgeon. It also has 4 central hospitals, each with one or more surgeons. Most district hospitals are manned by a single doctor and two or more paramedical clinical officers. PATIENTS AND METHODS All district and central hospitals were visited, and theatre logbooks analysed. All cases performed in 2003 were recorded. RESULTS In 2003, a total of 48,696 surgical operations were recorded, of which 25,053 were performed in 21 district hospitals and 23,643 in 4 central hospitals. Caesarean section is the commonest major surgical procedure in district hospitals and is performed in approximately 2.8% of all births, compared to 22% in the UK. Very few major general surgical or orthopaedic procedures are carried out in district hospitals. CONCLUSION This study underlines Malawi's need for more surgeons to be trained and retained.
Using Marker Pens on Patients: a Potential Source of Cross Infection with MRSA
Authors: Tadiparthi S , Shokrollahi K , Juma A , Croall J 
Published: January 2008

INTRODUCTION Marker pens are widely used in surgery but pre-operative marking of patients may be a cause of bacterial cross-infection. PATIENTS AND METHODS Two experiments were performed to assess whether marking pens can be cause of cross-infection: (i) 26 indelible marker pens were collected from surgical wards for analysis; and (ii) ‘fresh’ as well as ‘dry’ (artificially dried by removing cap and exposing tip for 2 h) new permanent marker pens, and whiteboard marker pens were inoculated by dipping the tips into various concentrations of methicillin-resistant Staphylococcus aureus (MRSA). Each pen was inoculated onto 2 blood agar plates at 0 (immediately after inoculation) to 30 min at various intervals, 4 h and 24 h. The plates were incubated for 18 h at 35°C in an incubator. RESULTS Of 26 pens collected from the wards, 2 cultured Micrococci spp. (skin commensals). The constituents of new ‘fresh’ pen tips rapidly kill MRSA – in all cases by 4 h, but usually within minutes. At high inoculum concentrations, MRSA is not killed immediately. Dry marker pens harbour MRSA for at least 30 min and probably longer. CONCLUSIONS Marker pens can act as fomites for nosocomial infection. The ethanol-based ink in permanent marker pens has a bactericidal action against MRSA that starts within seconds, and they are likely to be safe to use with a gap of at least 2 min between patients. Usually, harmless skin commensals are not pathogenic except in immunocompromised patients. Old or dried-out marker pens can harbour pathogens and should be discarded before attempted use on patients. We recommend disposable markers for the immunocompromised and patients with a known positive MRSA status.
Impact of Surgeon-Specific Data Reporting on Surgical Training
Authors: Khan Omar A , Iyengar Srikanth , Pontefract David E , Rogers Vanessa , Ohri Sunil K , Livesey Steven A 
Published: January 2008

INTRODUCTION Since April 2002, collection and publication of surgeon-specific data in adult cardiac surgery has become mandatory in the UK. It has been suggested that this may discourage consultants from allowing trainees to perform cases. The aim of this study was to attempt to analyse the effect of the introduction of surgeon-specific data (SSD) on surgical training in a large cardiac surgical centre. PATIENTS AND METHODS A retrospective analysis was performed on 2111 consecutive patients undergoing elective coronary artery bypass surgery, aortic and mitral valve surgery at Southampton General Hospital between April 2000 and April 2004. Results were analysed and compared over a 2-year period prior to and a 2-year period following the introduction of SSD. RESULTS There were no changes in the overall mortality rate following the introduction of SSD. SSD was associated with a reduction in the overall proportion of cases performed by trainees (49% versus 42.8%; P = 0.004) and, in particular, a reduction in the proportion of aortic and mitral valve procedures performed by trainees. In addition, the proportion of cases performed by the trainees without consultant supervision declined significantly following SSD (18.7% versus 10.4%; P < 0.001). CONCLUSIONS Publication of surgeon-specific data has coincided with a decrease in both the proportion and variety of cases performed by trainees.
Reduction in Varicose Vein Services: Impact on Operative Training
Authors: Bajwa A , Magee TR , Galland RB 
Published: January 2008

INTRODUCTION This study examines the impact of rationing varicose vein operations on operative training on a general surgical unit with a vascular interest. PATIENTS AND METHODS Log-books of middle-grade surgeons were analysed for 3-month periods before and after a decision by the local Primary Care Trust to ration varicose vein referrals. Number, intermediate equivalents and type of operations were recorded, whether they were general or vascular cases and whether the trainee had carried out or assisted with the operation. RESULTS There was a slight fall in the total number of operations in which the middle-grade surgeons were involved (208 to 186). There was a significant increase in general surgical cases with the fall in number of varicose vein operations (P < 0.0001).The fall in case-load and work-load operative training in vascular surgery was compensated by an increase in general surgical cases (P = 0.0003). This was largely due to increased number of hernia repairs (P = 0.0035). CONCLUSIONS From the point of operative training, a vascular unit in a district general hospital would not be sustainable following withdrawal of varicose vein services. However, this can be off-set by increasing general surgical case-load to fill the gap created.
Managing the 2-Week Wait for Breast Patients
Authors: Singhal Rishi , Marudanayagam Ravi , Balasubramanian B , Paterson IS 
Published: January 2008

INTRODUCTION Published data suggest that the 2-week wait system and triple assessment at one fast-track clinic visit is an out-dated method of capturing disease from a referral population. These studies report up to 32% of breast cancer coming from routine referrals. It has been recommended, therefore, that all breast referrals should be seen within 2 weeks. The sheer volume of referrals are likely to prevent this target being achieved. The aim of this study was to analyse the performance of our fast-track system. PATIENTS AND METHODS The Birmingham Heartlands and Solihull fast-track clinics were set up in 1999 with a prospective audit system. The data from this audit were retrospectively analysed and cross-referenced with the cancer data base to determine the referral origin of breast cancers from November 1999 to February 2005. RESULTS A total of 14,303 (fast-track, n = 6678; routine referral, n = 7625) patients were seen over a 5-year period. Overall, 1095 cancers (91.8% of the total) came from the fast-track clinics which had a pick-up rate of 16.4% compared with 98 cancers (8.2% of the total) and a pick-up rate of 1.3% for routine referrals (P < 0.001). The appropriateness of fast-track referral was also analysed which showed that 14.4% of cancers were detected if the referral criteria were met compared to 0.55% if they were inappropriate (P < 0.001). CONCLUSIONS The traditional fast-track, triple assessment breast clinic is an efficient and well-structured way of diagnosing disease. We recommend that the two system referral pattern should continue.
Assessment of Pre-Operative Delays in the Management of Elective Abdominal Aortic Aneurysms
Authors: Sadat U , Hayes PD , Gaunt ME , Varty K , Boyle JR 
Published: January 2008

INTRODUCTION Successful endovascular aneurysm repair (EVAR) requires detailed pre-operative imaging to allow device planning. This process may delay surgery and some aneurysms may rupture prior to intervention. The aim of this study was to quantify these delays. PATIENTS AND METHODS Data were collected prospectively on all patients presenting with non-ruptured abdominal aortic aneurysms (AAAs) between January 2003 and October 2005. The delay between referral, the first out-patient visit, CT-scan, follow-up appointment and surgery were quantified in all patients and compared between two groups undergoing open repair and EVAR. RESULTS A total of 146 patients underwent AAA repair during the study (48 EVAR versus 98 open repair). There was no significant differences in the wait for CT scans between the groups (median 42 days for EVAR versus 47 days for open repairs [P = 0.48]) or the median interval between decision to operate and surgery (56 days versus 42 days [P = 0.075]). However, the median delay between referral and surgery was significantly longer in those patients undergoing EVAR at 129 days versus 77 days for open repair (P = 0.02). CONCLUSIONS Patients presenting electively with AAAs experienced significant delay from referral to surgery. This delay was significantly greater in those patients undergoing endovascular repair. Inevitably, some patients will rupture whilst waiting and strategies aimed at reducing delay should be pursued.
Pre-Hospital and In-Hospital Thoracostomy: Indications and Complications
Authors: Aylwin Christopher J , Brohi Karim , Davies Gareth D , Walsh Michael S 
Published: January 2008

INTRODUCTION Pleural drainage with chest tube insertion for thoracic trauma is a common and often life-saving technique. Although considered a simple procedure, complication rates have been reported to be 2–25%. We conducted a prospective cohort observational study of emergency pleural drainage procedures to validate the indications for pre-hospital thoracostomy and to identify complications from both pre- and in-hospital thoracostomies. PATIENTS AND METHODS Data were collected over a 7-month period on all patients receiving either pre-hospital thoracostomy or emergency department tube thoracostomy. Outcome measures were appropriate indications, errors in tube placement and subsequent complications. RESULTS Ninety-one chest tubes were placed into 52 patients. Sixty-five thoracostomies were performed in the field without chest tube placement. Twenty-six procedures were performed following emergency department identification of thoracic injury. Of the 65 pre-hospital thoracostomies, 40 (61%) were for appropriate indications of suspected tension pneumothorax or a low output state. The overall complication rate was 14% of which 9% were classified as major and three patients required surgical intervention. Twenty-eight (31%) chest tubes were poorly positioned and 15 (17%) of these required repositioning. CONCLUSIONS Pleural drainage techniques may be complicated and have the potential to cause life-threatening injury. Pre-hospital thoracostomies have the same potential risks as in-hospital procedures and attention must be paid to insertion techniques under difficult scene conditions. In-hospital chest tube placement complication rates remain uncomfortably high, and attention must be placed on training and assessment of staff in this basic procedure.
A Survey to Investigate Shortfalls in the Dental Care Professional (DCP) Workforce in South Yorkshire in 2004
Authors: Jackson Rachel J , Baird Wendy O , Worthington Lee S , Robinson Peter G 
Published: January 2008

AimTo determine the composition of the dental care professional (DCP) workforce in South Yorkshire, the existence of any training requirements, and future intentions and motivations relating to the provision of National Health Service (NHS) dental care.MethodsThe study used mixed methods and incorporated a cross-sectional postal questionnaire and focus groups. The questionnaire was sent to all NHS dental practices in South Yorkshire (n=201) for completion by a principal general dental practitioner (GDP). Focus groups were held with GDPs in these practices.ResultsResponses were received from principal GDPs at 156 practices (78%). A total of 624 dental nurses, 65 dental hygienists and 24 dental therapists were employed in the responding General Dental Services (GDS) practices, representing whole-time equivalents (WTEs) of 458.5, 18.5 and 10.1, respectively. Many practices had current vacancies for DCPs, with 24.9 WTE available for dental nurses, 3.7 WTE for dental hygienists, and 5.0 WTE for dental therapists. Workforce shortages were evident among dental nurses (5.2%), dental hygienists (16.7%), and dental therapists (33.0%). Principal GDPs suggested that improved terms and conditions of employment for DCPs, particularly dental nurses, might aid recruitment and retention in NHS practice.ConclusionsRespondents perceived that there were shortages in the DCP workforce in South Yorkshire. Initiatives are required to address these shortages.
An Investigation of Trainers’ and VDPs’ Views in the Mersey Deanery of the FGDP(UK) Key Skills in Primary Dental Care and Assessment of Vocational Training
Authors: Palmer Nikolaus OA , Grieveson Brian 
Published: January 2008

Objective To investigate the views of vocational dental practitioners (VDPs) and trainers in the Mersey Deanery on the Faculty of General Dental Practice (UK) Key Skills in Primary Dental Care and other means of assessing satisfactory completion of vocational training (VT). Design An anonymous four-part questionnaire survey was delivered to all 48 dental vocational trainers and VDPs at the final day of the educational day-release programme in the Mersey Deanery. Results There was a 100% response rate from VDPs and a 91% response rate from their trainers. Overall the VDPs and trainers thought the FGDP(UK) Key Skills were a good idea but the VDPs felt completion of all the key skills during the VT year was time-consuming. Eighty-one per cent of trainers but only 52% of VDPs felt there should be a formal assessment of the VT year. Neither group unanimously agreed that completion of key skills alone was a marker of successful completion of the VT year. For assessment of clinical performance the only areas of agreement were direct observation of performance, review of patients following treatment, and tutorial sessions. Conclusions The FGDP(UK) Key Skills have an important role in assessing competence in a number of important areas for VDPs. However, satisfactory completion of the key skills alone fails to assess clinical performance. Other methods of assessment of completion of VT will need to be considered in the light of the principles of assessment as laid down by the Postgraduate Medical Education and Training Board (PMETB).