bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of Vascular Surgery Skills During General Surgery Training
Authors: Kwolek Christopher J. , Donnelly Michael B. , Endean Eric D. , Sloan David A. , Schwarcz Thomas H. , Hyde Gordon L. , Schwartz Richard W. 
Published: June 2007

Purpose: We previously have shown that performance on the National Board of Medical Examiners (NBME) part II examination does not reflect clinical skills. Many training programs use the American Board of Surgery In-Service Training Examination (ABSITE) as the only objective measure of clinical knowledge. This study evaluates the utility of the ABSITE and an objective structured clinical examination (OSCE) in measuring vascular clinical skills during general surgery residency training. Methods: Residents' mean scores on the vascular section of an OSCE were compared with their mean overall scores on the OSCE by using a two-way analysis of variance (ANOVA). Residents' performance on each clinical section of the ABSITE (body as a whole; gastrointestinal, cardiovascular, and respiratory systems; genitourinary/head and neck/musculoskeletal, and endocrine) and a vascular subsection (VASC) were evaluated by using ANOVA. Results: Mean vascular scores were significantly lower than mean overall scores for residents at all levels of training (P < 0.0001). Fischer's PLSD (plausible least significant difference) post hoc test revealed that significant improvement occurred between the intern and junior years (P < 0.05), but not between the junior and senior years. In contradistinction, VASC ABSITE scores were better than all other scores for both junior and senior residents, but not for interns (senior: VASC = 96%, other = 79%, P = 0.04; junior: VASC = 84%, other = 64%, P = 0.02; intern: VASC = 63%, other = 50%, P = 0.12). Conclusions: It is assumed that residents completing residency training are competent to perform clinical vascular examinations. Our findings paradoxically showed that although residents scored highest on the clinical vascular section of the ABSITE, they scored lowest on the vascular section of the OSCE. Although both tests found evidence of improvement between the intern and junior years, neither test found a significant improvement in vascular performance between the junior and senior years. These results emphasize that ABSITE scores do not necessarily correlate with clinical competence, and they demonstrate the need for providing more objective measures of clinical performance.
Ambulatory Venous Hypertension: Component Analysis in 373 Limbs
Authors: Raju Seshadri , Neglén Peter N. , Carr-White Paige A. , Fredericks Ruth K. , Devidas Meenakshi 
Published: June 2007

Purpose: We studied factors contributing to ambulatory venous hypertension in patients with symptoms of chronic venous insufficiency in order to delineate the contribution of each to global venous hypertension. Methods: A total of 373 consecutive limbs with ambulatory venous hypertension were studied. Simultaneous ambulatory venous pressure and air plethysmography measurements allowed compliance calculations. With reactive hyperemia, maximal arterial inflow was measured. Air plethysmography provided calf venous pump capacitance and ejection fraction data. Reflux was quantified by a point system based on Duplex, venous filling index on airplethysmography (VFI-90), Valsalva foot venous pressure, and ambulatory venous pressure recovery time (VFT). Multiple regression analysis was used to model ambulatory venous pressure in terms of these variables. Results: Six major causes of ambulatory venous hypertension were identified and quantified: 1. reflux, 2. increased arterial inflow, 3. reduced venous capacitance, 4. poor ejection fraction, 5. poor compliance of the calf venous pump, and 6. a combination of factors. Of the total, 91% of the limbs had at least two of these factors, 57% had three factors, and 24% had four factors contributing to ambulatory venous hypertension. Reflux was present in 97% of limbs but was significant (VFT <15 seconds) in only 57%, suggesting that other factors were dominant in the remainder. Conclusion: Ambulatory venous hypertension is a multifactorial entity. Many of the contributing factors are interrelated in a complex fashion. Regression analysis indicates that even though reflux followed by arterial inflow and capacitance were important as single contributing factors, a combination of factors is more important than any single individual factor in the genesis of ambulatory venous hypertension. VFT was found to be superior to other measurements in quantifying global reflux.
Risk Factors Associated with Recurrent Carotid Artery Stenosis
Authors: Liapis Christos D. , Kakisis John D. , Papavassiliou Vassilios G. , Koumakis Konstantinos M. , Gogas John G. 
Published: June 2007

The aim of this open, perspective study was to determine the impact of risk factors, excluding the type of closure of the arteriotomy, in the development of recurrent carotid stenosis following carotid endarterectomy. One hundred and ninety-eight patients, who underwent a total of 221 carotid endarterectomies, were evaluated postoperatively with duplex scanning 1 month after the operation and every 6 months thereafter for a period of 6-120 months (mean duration of follow-up: 44 months). There were 149 (75.3%) men and 49 (24.7%) women with a mean age of 66.8 years (age range 38-92 years). Diabetes mellitus was present in 62 patients (31.3%), hypertension in 134 (67.7%), coronary artery disease in 130 (65.7%), hypercholesterolemia in 70 (35.4%), and smoking habit in 166 (83.8%). Indications for carotid endarterectomy were asymptomatic carotid stenosis > 70% in 20 (10.1%) patients and symptomatic stenosis > 50% in 178 (89.9%), 129 (65.2%) of whom had a history of transient ischemic attacks and 49 (24.7%) of previous stroke. General anesthesia was used in 197 (89.1%) operations and local anesthesia in 24 (10.9%). Deep endarterectomy with primary closure of the arteriotomy using 5/0 running suture was performed in this group of patients. One patient (0.5%) died during the perioperative period. Five (2.5%) patients had a transient ischemic attack and three (1.5%) a nonfatal stroke in the immediate postoperative period, six (3.0%) a persistent cranial nerve injury, and two a hematoma, and three patients had delayed postoperative recovery. Twenty-six (13.1%) patients were transferred to the Intensive Care Unit postoperatively. Recurrent carotid stenosis > 50% was identified in eight patients (4.0%) and it was asymptomatic in all cases. Mean interval between endarterectomy and development of restenosis was 47.4 months (range 6-118 months). Factors such as clinical presentation, age, sex, diabetes mellitus, hypertension, coronary artery disease, hypercholesterolemia, and smoking habit were not found to be significantly associated with the development of restenosis (Chi-square). Smoking, coronary artery disease, and normal cholesterol levels were connected with a statistically nonsignificant tendency toward higher rates of restenosis. Recurrent carotid stenosis following carotid endarterectomy was not significantly associated with any of the risk factors studied in this series.
Horseshoe Abscesses and Fistulas: How Are We Doing?
Authors: Rosen Seth A. , Colquhoun Patrick , Efron Jonathan , Vernava Anthony M. , Nogueras Juan J. , Wexner Steven D. , Weiss Eric G. 
Published: June 2007

Background:Various surgical treatments exist for horseshoe abscesses and fistulae, including posterior midline sphincterotomy, catheter drainage, cutting and draining setons, and advancement flaps. The aim of this study was to evaluate the long-term results of patients treated for these complex anorectal problems. Methods: A retrospective review was undertaken of patients with a diagnosis of horseshoe abscess, horseshoe fistula, postanal space abscess, or postanal space fistula from 1990 to 2001. Long-term follow-up was accomplished by telephone questionnaire. Results: Thirty-one patients were identified, of whom 17 (54.8%) had a diagnosis of Crohn disease. The diagnosis at presentation included unilateral (ischiorectal) abscess (32.3%), bilateral horseshoe abscess (51.6%), bilateral horseshoe fistula (9.7%), and postanal space abscess (6.4%). Endoanal ultrasonography was used during the preoperative evaluation in 11 patients (35.5%). After referral to our institution, patients underwent a median of four operations (range, 1 to 9). At a mean follow-up of 49.3 months, 60.7% of patients had either healed perineal disease or were asymptomatic with controlled disease. Patients who had a posterior midline sphincterotomy were more likely to be asymptomatic (P = .047). Patients who had a diagnosis of Crohn disease required more operations than those without Crohn disease (3 vs 1.86, P= .02). Only patients who had a diagnosis of Crohn disease had a stoma at their last follow-up (4 of 17, 23.5% vs 0 of 11, 0%; P=.05). Conclusions: Patients with horseshoe abscess or fistulae often require multiple operations for treatment but can expect reasonable rates of long-term success in controlling or curing their disease. Those who undergo posterior midline sphincterotomy seem to benefit with higher rates of improved symptoms. Patients with a diagnosis of Crohn disease may fare less well. The role of endoanal ultrasonography in directing therapy remains to be defined.
Anglicans and Islam in Nigeria: Anglicans Encountering Difference
Authors: Idowu-Fearon Josiah 
Published: June 2007

ABSTRACTNigeria is the most populous nation in Africa. It is also divided on religious grounds with a predominantly Muslim north and a mainly Christian south. Christians make up the majority of the population (52.6 per cent) compared with Muslims (41 per cent). The 17 million Anglicans are the second largest Christian group. With its large and religiously divided population Nigeria is one of the main countries in Africa, and the world, where large numbers of Muslims and Christians live and interact together. In today's world where the ‘Christian’ West and the Islamic world are becoming increasingly polarized, the history of Anglican/Muslim relations in Nigeria provides a key case study with important implications for Anglicans all over the world.
Imperial Nexus and National Anglican Identity: The Australian 1911–12 Legal Nexus Opinions Revisited
Authors: Withycombe Robert S.M. 
Published: June 2007

ABSTRACTThe legal Opinion of eminent English Counsel on the legal nexus of the Australian Anglican colonial dioceses to their Mother Church in England was delivered on 20 June 1911. It provoked a decade of debate in diocesan, provincial and national synods that revealed how leading Australian Anglicans identified themselves before and after World War One. Great diversity appears among the responses of bishops, clergy and laity. Both enthusiasm for change and wariness of it were confined to no one region or diocese. Lay understandings and participation in these debates, along with churchmanship anxieties and long traditions of colonial diocesan independence, were among important factors that governed the Australian Anglicans' long march towards constitutional autonomy in 1962. Lambeth archives, printed Synod Reports, Australian secular and religious press reports are quarried to reconstruct these images of a diverse and uncertain pre-1921 Australian Anglican identity.
The Church in Wales and the State: A Juridical Perspective
Authors: Doe Norman 
Published: June 2007

ABSTRACTIn 1536 Wales (Cymru) and England were formally united by an Act of Union of the English Parliament. At the English Reformation, the established Church of England possessed four dioceses in Wales, part of the Canterbury Province. In 1920 Parliament disestablished the Church of England in Wales. The Welsh Church Act 1914 terminated the royal supremacy and appointment of bishops, the coercive jurisdiction of the church courts, and pre-1920 ecclesiastical law, applicable to the Church of England, ceased to exist as part of public law in Wales. The statute freed the Church in Wales (Yr Eglwys yng Nghymru) to establish its own domestic system of government and law, the latter located in its Constitution, pre-1920 ecclesiastical law (which still applies to the church unless altered by it), elements of the 1603 Canons Ecclesiastical and even pre-Reformation Roman canon law. The Church in Wales is also subject to State law, including that of the National Assembly for Wales. Indeed, civil laws on marriage and burial apply to the church, surviving as vestiges of establishment. Under civil law, the domestic law of the church, a voluntary association, binds its members as a matter of contract enforceable, in prescribed circumstances, in State courts.
A trial of asthma self-management in Beijing schools
Authors: Clark Noreen M. , Gong Molly , Kaciroti Niko , Yu Jimmy , Guixian Wu  , Zhechun Zeng  , Zhaosu Wu  
Published: June 2007

Objectives: This study examined the effectiveness in children in China of an asthma education programme adapted from a model developed in the USA. Methods: Six hundred and thirty-nine children in 21 elementary schools in one agricultural and one industrial area participated in a randomized, controlled trial. Data were collected at baseline and 1 year subsequently. The self-regulation-based programme addressed topics including preventing and managing symptoms, using medicines, and identifying and controlling triggers. Results: Positive effects on treatment children v. control children were noted in school performance (0.21 v. -0.06, p=0.04), absences (-0.55 v . -0.32, p=0.02), and home environment (1.78 v. 4.75, p=0.009). Industrial-area children additionally benefited from fewer hospitalizations (odds ratio=1.96, p=0.05) and asthma-related concerns of parents (-0.63 v. -0.34, p=0.001). Agricultural-area parents showed greater improvement in asthma management (0.93 v. 0.26, p=0.0001), and expressed more negative feelings about asthma (-0.13 v. -0.58, p=0.04) and asthma concerns (-0.31 v. -0.63, p=0.0001). Discussion: The programme provided overall benefits related to school performance, absences, and home environment. In the agricultural area, where fewer resources were available, benefits were fewer and concerns greater. In the industrial area, where education and income were higher, additional benefits related to healthcare use and parents' quality of life were realized.
Women's and doctors' accounts of their experiences of depression in primary care: the influence of social and moral reasoning on patients' and doctors' decisions
Authors: Maxwell Margaret 
Published: June 2007

Background: Little is known about how general practitioners (GPs) manage depression within everyday clinical practice, particularly in relation to the issue of `problem definition'. In addition, there has been relatively little research on the patients' perspective of depression and its management in primary care. Methods: Qualitative interviews explored women's and GPs' experiences of recognizing depression and their experiences of the management of depression. Thirty-seven women and 20 GPs were recruited from practices in four National Health Service Board areas of Scotland. Each participant was interviewed at the start of the study, and 30 women and 19 GPs were revisited approximately 9—12 months later so that the process of care could be reviewed. Results: The findings demonstrate the social and moral reasoning that lies behind women's decisions to seek help and to subsequently accept their GPs' explanation and advice, and that the acceptance of antidepressants created a moral dilemma for the women. For GPs, the diagnosis and management of depression led to contemplating the boundaries of their professional role, and social and moral reasoning was also evident in their decision-making processes. Discussion: The implication is that, for the majority of women, a chronic-disease model for the management for depression in primary care would be likely to increase rather than reduce the moral dilemma. In addition, the management of depression is not solely based on clinical decisions, so the applicability of a chronic-disease model to primary care requires further consideration.
Pastoral relationships and holding work in primary care: affect, subjectivity and chronicity
Authors: Cocksedge Simon , May Carl 
Published: June 2007

Objectives: To understand family doctors' constructs of long-term therapeutic relationships with patients in primary care. Methods: Semi-structured interviews were administered to general practitioners with >5 years of experience ( n=28) working in an English semi-rural district, and the results were subjected to constant comparative qualitative analysis. Results: Participants identified pastoral relationships as long-standing patterns of doctor—patient interaction aimed at providing reliable supportive care indirectly concerned with clinical medicine. Holding work was identified as a technique for structuring and delivering care within pastoral relationships. Pastoral relationships and holding work were seen as valuable in the affective management of people with long-standing chronic illness, especially mild-to-moderate depression and anxiety. Discussion: At a time when primary care is undergoing significant structural change, respondents in this study laid emphasis on personal and continuing relationships with patients who had diffuse needs connected with the experience of complex and chronic problems, and their accounts intimately connected life events with health status. Importantly, these accounts suggest that such relationships are hard to define and therefore hard to measure, but have important therapeutic purposes.
Harnessing the potential of the Internet to promote chronic illness self-management: diabetes as an example of how well we are doing
Authors: Bull Sheana S. , Gaglio Bridget , Mckay H. Garth , Glasgow Russell E. 
Published: June 2007

Objectives: Given the potential for the Internet to be used as a dynamic, interactive medium for providing information, changing attitudes and behaviour and enhancing social support, it is important to consider whether what is currently available online for chronic illness self-management adequately harnesses this potential. The objective of this paper was to review the content of diabetes self-management websites and to identify strengths and limitations of online diabetes self-management. Methods: We reviewed and coded features of 87 publicly available diabetes websites hosted by governmental, health plan, commercial, pharmaceutical, and not-for-profit organizations. We assessed whether each website was using online opportunities in the areas of interactivity, theory-based interventions, social support, and evidence-based care. Results: The majority of sites provided information, essentially using an electronic newspaper or pamphlet format. Few sites offered interactive assessments, social support or problem-solving assistance, although there were some significant differences in these characteristics across the types of site. Discussion: Current diabetes websites fall short of their potential to help consumers. Suggestions are made for ways to improve the helpfulness and interactivity of these resources.
A naturalistic study of ambulatory asthma severity and reported avoidant coping styles
Authors: Nazarian Deborah , Smyth Joshua M. , Sliwinski Martin J. 
Published: June 2007

Objective: To examine how the use of dispositional avoidant coping traits prospectively predicts ambulatory asthma severity in daily life. Methods: An ecological momentary assessment (EMA) design enabled examination of stable coping styles across dynamic daily changes of ambulatory peak expiratory flow rate (PEFR), asthma symptoms and stress in the natural environment of patients with asthma. A community sample of 61 adults with asthma reported their typical use of avoidant coping styles and carried palmtop computers that alerted them to record their stress and symptoms five times per day for 1 week. Results: Some aspects of dispositional avoidant coping predicted more asthma symptoms and worse PEFR. Denial and behavioural disengagement as typical coping styles predicted more symptoms and worse PEFR. Mental disengagement was unrelated to symptoms and PEFR. Discussion: These data suggest that individuals with asthma who report typically utilizing avoidant coping may have worse health parameters in momentary reports when examined in their natural environments. Differences between avoidant coping styles emerged, suggesting the existence of moderating factors of coping effectiveness.
`Walking like John Wayne': open-format diaries of people with knee pain and disability
Authors: Bie Nio Ong  , Jinks Clare 
Published: June 2007

Objective: To describe older people's everyday experience and context of living with knee pain and disability, and to explore the potential of open-format diaries in accessing these experiences. Methods: This was a diary study, embedded in a larger mixed-method study. Ten people who participated in a qualitative interview study volunteered to keep an open-format diary over a period of 1 week. Results: Diaries provided current and historical details about people's lives and their health. The diaries set these experiences within the context of daily life, and combined description with reflection. Themes covered included: causes of pain, symptoms and treatments, consultations, and co-morbidity. Discussion: Open-format diaries allow insights into the complex and contextual experience of pain and disability, and because of the contemporaneous detail, can be helpful to clinicians' holistic understanding of the impact of knee pain on people's quality of life. This method provides descriptive material that complements survey and qualitative interview data.
The relative effect of self-management practices on glycaemic control in type 2 diabetic patients in Mexico
Authors: Garcia Javier E. , Garcia Alba , Dallo Florence J. , Salcedo Rocha Ana L. , Colunga Rodriguez Cecilia , Perez Noe , Baer Roberta D. , Weller Susan C. 
Published: June 2007

Objective: In this study, we examined the relative impact of self-management activities on glycaemic control in a population at high risk for developing complications. Methods: Patients diagnosed with diabetes mellitus of at least 1 year in duration at 30 years of age or older were sampled from the Instituto de Mexico Seguro Social (IMSS) Family Medicine Clinics in Guadalajara, Mexico ( n=800). Demographic, clinical and health behaviour variables were used to predict good/poor glycaemic control, as measured by haemoglobin A1c (A1C). Results: Most (72.24%) patients had poor control (A1C≥7.0). Hyperglycaemia was significantly associated with factors not under patient control, such as having diabetes for a longer time [odds ratio (OR)=2.40, 95% confidence interval (CI) 1.39, 4.14], having a first-degree relative with diabetes (OR=1.52; 95% CI 1.06, 2.19), and being prescribed anti-diabetic medications, e.g. insulin (OR=7.88, 95% CI 2.42, 25.63). After controlling for these variables, the only self-management variable that reduced the likelihood of hyperglycaemia was following a special diet (OR=0.49; 95% CI 0.32, 0.76). Furthermore, depression had an important effect on self-management, as those with lower levels of depressive symptoms were more likely to follow a diet and exercise. Discussion: While patients in this population have little control over many factors associated with glycaemic control, an important exception is diet. However, because of the adverse effect of depression on dieting, both depression management and dietary education are important for this population.