bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation capacity in the European Commission
Authors: van Voorst Stijn
Published: January 2017

Ex-post evaluations are a potential tool to improve regulatory interventions and to hold rule-makers accountable. For these reasons the European Commission has promised to systematically evaluate its legislation, but it remains unclear if actual evaluation capacity is being built up in the Commission’s Directorates-General. This article describes and explains the variation in evaluation capacity between the Directorates-Generals by applying a theoretical model of evaluation capacity developed by Nielsen et al. to the European context. To gain an in-depth understanding of the Directorates-Generals’ evaluation capacity, 20 Commission officials were interviewed. The results show that there is much variation in the extent to which Directorates-Generals prioritize evaluation as well as in the amount of human and technological capital that they invest in evaluation. Further analysis using fuzzy-set Qualitative Comparative Analysis reveals that part of this variation can be explained by the Directorates-Generals’ total budgets, suggesting that Directorates-Generals with a tradition of evaluating spending programmes also attach more importance to legislative evaluations.
Towards rigorous practice: A framework for assessing naturalistic evaluations in the development sector
Authors: Phillips Tracey , de Wet Jacques P.
Published: January 2017

This article reflects on the design and application of a framework for assessing the rigour of naturalistic evaluations in the development sector. The framework was employed in a review of a naturalistic evaluation ‘model’. It focused on the quality of evaluation results generated by the application of this model to outcome and impact assessments of development programmes. Naturalistic evaluation research is frequently portrayed as lacking in rigour, so we wanted to know whether the outcomes of development interventions could be assessed with an appropriate level of rigour when a naturalistic evaluation approach is used. The assessment entailed a meta-evaluation of five outcome/impact evaluations; these were undertaken by a Cape Town-based development consultancy over a four-year period. Using Lincoln and Guba’s trustworthiness criteria as the foundation for a meta-evaluation framework, we demonstrated that hallmarks of rigorous practice could be developed and applied to evaluations that employ a naturalistic evaluation model.
Quality of Life in Patients with Intermittent Claudication: Relationship with Laboratory Exercise Performance
Authors: Barletta Giuseppe , Perna Sergio , Sabba Carlo , Catalano Annalisa , O'Boyle Cyaran , Brevetti Gregorio
Published: January 2017

In patients with peripheral arterial disease, limitation of exercise capacity will reduce the level of everyday physical activity and affect the quality of life. This study was designed (1) to examine the health-related quality of life of patients with intermittent claudication, and (2) to verify whether treadmill performance is related to the patient's perceived ability to function in the community. In 251 patients with intermittent claudication and 89 matched normal subjects, quality of life was assessed by a general health index questionnaire, the McMaster Health Index Questionnaire (MHIQ), which covers three dimensions of life (physical, social and emotional function). The maximal walking capacity of intermittent claudication patients was measured by the treadmill test. When controls were compared to intermittent claudication patients using the MHIQ, it was found that intermittent claudication patients showed a significant ( p<0.01) impairment of ‘general health’ and lower scores for physical (0.90±0.17 vs 0.65±0.17; p<0.01), social (0.71±0.11 vs 0.63±0.12; p<0.01) and emotional (0.75±0.17 vs 0.65±0.15; p<0.01) function. Age, gender and work status had a significant impact upon health scores in several areas. Treadmill performance did not correlate with social or emotional function, whereas there was a small but significant relationship between maximal walking capacity and physical function scores ( r=0.197; p<0.01). This study suggests that impairment in quality of life experience by patients with intermittent claudication poorly correlates with the reduced exercised capacity assessed by the treadmill test. Therefore, the evaluation of medical and surgical treatment of intermittent claudication should include the administration of a questionnaire for quality of life assessment.
New Antithrombotics for the Treatment of Acute and Chronic Arterial Ischemia
Authors: Hirsh Jack
Published: January 2017

The established antithrombotic agents are effective but they have limitations which have provided opportunities for the development of new antithrombotic compounds. Of these new agents, the antithrombin III-independent thrombin inhibitors and the platelet GPllb/llla receptor antagonists are the most advanced in their development. Other new antithrombotic agents include the antithrombin III-independent factor Xa inhibitors, activated protein C, soluble thrombomodulin and tissue factor pathway inhibitor. Of the GPIIb/IIIa antagonists, the humanized 7E3 antibody and integrin have been evaluated in phase III studies. The 7E3 antibody was effective in preventing both short-term and longer-term complications of coronary angioplasty. The antithrombin III-independent thrombin inhibitors hirudin and hirulog have also been evaluated in phase III studies. The studies with hirudin as an adjuvant to coronary thrombolysis had to be terminated and restarted at lower dosages because of an unacceptable incidence at intracranial hemorrhage and the study with hirulog produced equivocal results.
Preliminary support for the role of alcohol cues in food cravings and attentional biases
Authors: Karyadi Kenny A , Cyders Melissa A
Published: January 2017

This study examined whether alcohol odors, in isolation or when combined with pictures, would influence food attentional biases and cravings. Participants’ cravings and attentional biases to food and alcohol pictures were assessed after exposure to alcohol or water odors ( n = 77; mean age = 30.84 years, 51.9% female, 83.1% Caucasian). Food attentional biases were increased by alcohol odors, but food cravings were increased only by a combination of alcohol odors and food pictures. These effects were related with self-reported problematic food consumption. These findings support a research program for further examining the effect of alcohol cues on problematic food consumption.
Is a general or specific exercise recommendation more effective for promoting physical activity among postpartum mothers?
Authors: Mailey Emily L , Hsu Wei-Wen
Published: January 2017

This comparative effectiveness trial examined the effects of a behavior change intervention supplemented by a general or specific exercise recommendation on physical activity among postpartum mothers. Participants ( N = 49) attended three workshop sessions that provided the exercise recommendation and taught self-regulatory skills. Physical activity, self-efficacy, planning, and barriers were assessed at baseline, post-intervention, and 6-month follow-up. Self-reported physical activity increased significantly in both groups ( p < .001), but the increase was larger in the general condition ( p = .03). Both groups reported increased planning and decreased barriers. Postpartum mothers may benefit from interventions that teach strategies for overcoming barriers while allowing them to choose preferred activities.
“Free butterflies will come out of these deep wounds”: A grounded theory of how endometriosis affects women’s psychological health
Authors: Facchin Federica , Saita Emanuela , Barbara Giussy , Dridi Dhouha , Vercellini Paolo
Published: January 2017

This study aimed to develop a grounded theory of how endometriosis affects psychological health. Open interviews were conducted with 74 patients. The Hospital Anxiety and Depression Scale was administered to all women, who were divided into distressed versus non-distressed. At the core of our grounded theory was the notion of disruption due to the common features of living with endometriosis. Experiencing disruption (vs restoring continuity) involved higher distress and was associated with a long pathway to diagnosis, bad doctor–patient relationships, poor physical health, lack of support, negative sense of female identity, and identification of life with endometriosis.
Governing health equity in Scandinavian municipalities: The inter-sectorial challenge
Authors: Scheele Christian Elling , Little Ingvild , Diderichsen Finn
Published: January 2017

Aims: Local governments in the Scandinavian countries are increasingly committed to reduce health inequity through ‘health equity in all policies’ (HEiAP) governance. There exists, however, only very sporadic implementation evidence concerning municipal HEiAP governance, which is the focus of this study. Methods: Data are based on qualitative thematic network analysis of 20 interviews conducted from 2014 to 2015 with Scandinavian political and administrative practitioners. Results: We identify 24 factors located within three categories; political processes, where insufficient political commitment to health equity goals outside of the health sector and inadequate economic prioritization budget curbs implementation. Concerning evidence, there is a lack of epidemiological data, detailed evidence of health equity interventions as well as indicators relevant for monitoring implementation. Concerted administrative action relates to a lack of vertical support and alignment from the national and the regional level to the local level. Horizontally within the municipality, insufficient coordination across policy sectors inhibits effective health equity governance. Conclusions: A shift away from ‘health in all policies’ based on a narrow health concept towards ‘health equity for all policies’ based on a broader concept such as ‘sustainability’ can improve ownership of health equity policy goals across municipal sectors.
Ignorance is not bliss: The effect of systematic information on immigrants’ knowledge of and satisfaction with the Danish healthcare system
Authors: Smith Jervelund Signe , Maltesen Thomas , Wimmelmann Camilla Lawaetz , Petersen Jørgen Holm , Krasnik Allan
Published: January 2017

Aims: Suboptimal healthcare utilisation and lower satisfaction with the patient–doctor encounter among immigrants has been documented. Immigrants’ lack of familiarity with the healthcare system has been proposed as an explanation for this. This study investigated whether a systematic delivery of information affected immigrants’ knowledge of and satisfaction with the Danish healthcare system. Methods: A prospective, randomised intervention study of 1158 adult immigrants attending two language schools in Copenhagen was conducted. Two intervention groups received written information or a 12-hour course on the Danish healthcare system, while a control group received nothing. Survey data included self-assessed knowledge, true/false questions on access and questions relating to satisfaction with the healthcare system. Data were linked to socioeconomic registry data. Logistic regression analyses were performed. Results: The course improved knowledge of who to contact in the event of an accident (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.56–4.59) but not in the event of illness. Further, it positively affected correct answers for nine out of 11 questions on the healthcare system (varying from OR = 1.87, 95% CI = 1.08–3.24 to OR = 3.11, 95% CI = 1.58–6.11). Written information positively affected correct answers for three out of 11 questions, but negatively affected one out of 11 compared with the control group. Neither intervention affected immigrants’ satisfaction with the healthcare system. Conclusions: Knowledge of the healthcare system is necessary for optimal healthcare-seeking behaviour. The results may form the basis of national and international changes in immigrant reception and optimise immigrants’ contact with the healthcare system.
Cultural competence in medical education: A questionnaire study of Danish medical teachers’ perceptions of and preparedness to teach cultural competence
Authors: Sorensen Janne , Smith Jervelund Signe , Norredam Marie , Kristiansen Maria , Krasnik Allan
Published: January 2017

Aims: The cultural competence training of healthcare professionals is a key element in ensuring the quality of both the access and delivery of healthcare to increasingly ethnically diverse populations. The aim of this study is to investigate Danish medical teachers’ opinions about cultural competence, their willingness to receive training and preparedness to teach cultural competence topics. Methods: The survey was sent to medical teachers, clinical teachers and external lecturers who teach in the medical programme at the University of Copenhagen. A total of 1400 medical teachers received the survey, and 199 responded. The response rate is 14%. Data were analysed through descriptive calculations, and answers to open-ended questions were coded using content analysis. Results: Results showed that 82.4% of the informants agreed or strongly agreed that the medical education programme should include training on cultural issues, and 60.3% agreed or strongly agreed that students should be assessed on their cultural competence skills. Regarding preparedness to teach a diverse classroom, 88.4% felt somewhat or very prepared to engage and motivate all students. About 70% were interested in receiving training on cultural competence. Conclusions: Generally, there is interest in and acknowledgement of the importance of cultural competence in Danish medical education among teachers at the University of Copenhagen. This creates an opportunity to implement cultural competence in the medical curriculum, training of teachers and strengthening the diversity sensitivity of the organisation. However, support for this programme by management and the allocation of an appropriate level of resources is a prerequisite to the success of the programme.
Assessment of turbulence models and air supply opening models for CFD modelling of airflow and gaseous contaminant distributions in aircraft cabins
Authors: Li Mengxi , Yan Yihuan , Zhao Bin , Tu Jiyuan , Liu Junjie , Li Fei , Wang Congcong
Published: January 2017

Computational fluid dynamics (CFD) is an important and effective tool to study the airflow field and contaminant distribution in aircraft cabins. The accuracy of numerical simulation using the CFD approach could be significantly affected by configurations of the inlet boundary conditions, turbulence model, etc. The core of this study was to assess whether conclusions achieved in simulation of airflow on usual surfaces in buildings like in commercial offices could be applicable to aircraft cabins. Comparative studies involving turbulence models or air supply opening models in aircraft cabin environment are still absent in the literature. Therefore, in this study, two turbulence models (the renormalization group (RNG) k-ɛ model and Reynolds-stress model) and three types of air supply opening models (simple open model, basic model and momentum model) were applied to simulate the airflow and contaminant concentration fields in a mockup seven-row cabin section. Our simulation results were compared with the experimental data. Six indexes based on different criteria were used to quantitatively evaluate the agreement between measurements and modelled results given by turbulence models and air supply opening models. The results show that the RNG k-ɛ and RSM turbulence models have similar accuracy in airflow and contaminant fields in the mockup cabin, and the momentum model has the best accuracy among the three air supply opening models for the aircraft cabin environment.
Postoperative Physical Training following Colorectal Surgery: A Randomised, Placebo-Controlled Study
Authors: Houborg K. B. , Jensen M. B. , Rasmussen P. , Gandrup P. , Schroll M. , Laurberg S.
Published: January 2017

Background and Aims:

Major surgery is often followed by fatigue and reduced physical function. We wished to study if postoperative physical training reduced fatigue and improved physical function.

Material and Methods:

Randomised, placebo-controlled, single-blinded study. Participants were unselected patients ≥ 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease. Group A trained muscular strength and work capacity. Group B performed relaxation exercises and received hot wrappings and massage. Main outcome measures were: fatigue (visual analogue scale), muscular strength, walking speed, physical performance test, and physical function questions (SF-36).

Results:

Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively, more in B than A, but by day 30 and 90 there were no significant differences between groups. All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function. Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups.

Conclusion:

Postoperative training did not improve physical function, but reduced fatigue in hospital.
Stoma Care Problems after Stoma Surgery in Northern Finland
Authors: Mäkelä J. T. , Niskasaari M.
Published: January 2017

Background and Aims:

Stoma-related complications and problems in stoma care are common after gastrointestinal surgery requiring the construction of a stoma. The frequency and types of such complications and problems were evaluated in a patient cohort operated on in Oulu University Hospital.

Material and Methods:

A detailed questionnaire concerning clinical problems and stoma care was mailed to 163 stoma patients operated on during the years from 1995 to 2001 in Oulu University Hospital. One hundred and nineteen patients (70 percent) answered the questions adequately. The clinical variables concerning stoma complications and the patients' symptoms, problems with stoma care and adaptation to the situation were recorded. Special attention was paid to the patients' general wellbeing and social problems.

Results:

Thirty-five patients (30%) had stoma complications, most commonly parastomal hernias (18 cases). Patients with an ileostomy had more difficulties with stoma handling more often than the patients with a colostomy. Seventy-eight patients (66%) were well adapted to their stoma, including 49 (72%) of the patients with a colostomy and 25 (56%) of the patients with an ileostomy. Of the 41 non-adapted patients, 12 did not accept their altered body image, ten had problems in social life and nine had difficulties because of faecal leakage. The quality of life analysis of 114 patients showed that their physical condition was better than before the operation in 55 cases (48%), unchanged in 16 (14%) and worse in 43 (38%). General mental health was better than before the operation in 52 cases (46%), unchanged in 23 (20%) and worse in 39 (34%) patients. Social functioning had improved after stoma surgery in 38 cases (34%), remained unchanged in 27 (24%) and deteriorated in 46 (42%) patients after stoma surgery. Patients with a colostomy reported worse subjective physical condition, mental health and social functioning than the patients with an ileostomy.

Conclusions:

Two-thirds of the patients had adapted to their stoma. The patients with an ileostomy had difficulties in stoma handling and the patients with a colostomy reported their physical, mental and social wellbeing to be affected.
Red Blood Cell Transfusions in Patients Undergoing Lower Extremity Artery Bypass Surgery
Authors: Niemi T. T. , Kuitunen A. H. , Haukka J. , Lepäntalo M.
Published: January 2017

Background and Aims:

The purpose of this study was to search predictors of red blood cell transfusions in peripheral vascular surgical patients.

Material and Methods:

All the patients who undergone infrainguinal bypass surgery at Helsinki University Hospital in the year 2000 were included. Of 266 records 261 (98%) were available for data review. Multiple stepwise regression model was created to identify independent predictors of blood use.

Results and Conclusions:

174 (67%) of the patients received red blood cell transfusion. The lowest measured mean (SD) haemoglobin was 94 (11) g/l intraoperatively and 92 (± 10) g/l on the first two postoperative days. The median (range) number of units was 3 (1–19). Multivariate analysis showed that high age (p = 0.019), small body surface area (p = 0.017), low preoperative haemoglobin (p<0.001), blood loss (p<0.001), long lasting surgery (p<0.001), reoperation (p = 0.018), femoro-distal reconstruction (p = 0.048) and chronic obstructive pulmonary disease (p = 0.023) increased the risk to receive red blood cell transfusion. The frequent use of antithrombotic medication (72% of the patients) did not significantly increase red blood cell administration. The generous use of red blood cells despite relative safe haemoglobin levels indicates a need for a standardized multidisciplinary transfusion strategy in this patient population. Otherwise, most of the predictors for red blood cell administration were nonmodifiable.
Low Local Recurrence Rates after Rectal Cancer Resection with Limited Use of Preoperative Radiotherapy
Authors: Wasmuth H. H. , Nestvold T. , Røkke O.
Published: January 2017

Background:

Local recurrence rates after curative rectal resection for rectal cancer have decreased after introduction of TME. In order to achieve even further reduction in local recurrence rates, several hospitals increase the use of preoperative radiotherapy. Thus, radiotherapy-related side effects will increase. The aim of the study was to evaluate the results of the TME-technique with minimal use of radiotherapy.

Materials and Methods:

A prospective observational study from 1993 to 2000 of 137 consecutive patients treated for rectal cancer at the Department of Surgery, Nordland Hospital HF, Bodø, Norway.

Results:

115 patients underwent curative resections (84%). Eight patients (6.4 %) received peri-operative radiotherapy: three preoperatively (2.4%) because of clinically fixed tumours and five patients (4%) postoperatively; four with pR1-resections and one patient after perforation of the rectum. The local recurrence rate was 3.4 % with an observation time of 5 years. The total survival rate was 74% in curative group. In 22 patients the treatment was palliative. Only one of these patient survived 5 years.

Conclusion:

With TME-technique it is possible to achieve low recurrence rates and high survival rates with a high curative rate with minimal use of additional radiotherapy.
Local Staging of Rectal Cancer Using the Black Lumen Magnetic Resonance Imaging Technique
Authors: Piippo U. , Pääkkö E. , Mäkinen M. , Mäkelä J.
Published: January 2017

Background and Aims:

The treatment of rectal cancer is comprised of surgery and possible adjuvant therapy depending on the stage of the tumour. This prospective study evaluates the accuracy of magnetic resonance imaging (MRI) in the preoperative staging of rectal cancer using an endorectal and intravenous contrast.

Materials and Methods:

37 consecutive patients with rectal cancer were imaged using a mixture of ferumoxsil and methylcellulose endorectally, and a gadolinium contrast intravenously. 33 tumours were resected and 4 tumours were considered unresectable during operation. The images were reviewed for local staging of the tumours. A tumour confined to the rectal wall was classified as a negative finding and a tumour invading through muscularis propria as a positive finding. The results were correlated with the histopathologic T stage (n = 33), or the clinical status (n = 4).

Results and Conclusions:

Of 37 cases, 20 (51 %) were true positive, and 11 (28%) were true negative. There were 3 false negative and 3 false positive cases. The sensitivity was 87%, specificity 79%, and diagnostic accuracy 84%. For the non-contrast images the figures were 78%, 79% and 78%, respectively. We consider black lumen magnetic resonance imaging to be a useful method for preoperative local staging of rectal cancer.
Elective Laparoscopic Cholecystectomy without Routine Intraoperative Cholangiography: A Retrospective Analysis of 1101 Consecutive Cases
Authors: Lill S. , Rantala A. , Pekkala E. , Sarparanta H. , Huhtinen H. , Rautava P. , Grönroos J. M.
Published: January 2017

Background:

Laparoscopic cholecystectomy (LC) is today the operation of choice for symptomatic gallstone disease. Before the laparoscopic era intraoperative cholangiography (IOC) was generally considered as a fundamental step in cholecystectomy while nowadays the role of IOC is controversial: is there a need for IOC to specify anatomy of biliary tree in order to avoid bile duct injuries (BDI) and to detect possible common bile duct (CBD) stones or not?

Patients and Methods:

We studied retrospectively all the elective LCs done in Turku City Hospital for Surgery during the ten years (1992–2001). Cholecystectomy was performed to 1101 patients, 874 (79%) female and 227 (21%) male patients, mean age 53y (range 15–89). LC was possible in 1022 (93%) cases while 79 (7%) had to be converted to open procedure. The number and severity of bile duct injuries were recorded. The cases with endoscopic retrograde cholangiopancreatography (ERCP) and/or magnetic resonance cholangiopancreatography (MRCP) during the follow-up and the findings in ERCP and MRCP were recorded from patient records and radiological database.

Results:

IOC was performed in 32 operations (20 in LC and 12 after conversion) and CBD stones were found in seven patients. There were four primary BDIs: two CBD injuries and two minor bile leaks. During a mean follow-up of 72 months (range 36–144) ERCP was performed in 16 and MRCP in three patients. Three patients underwent both MRCP and ERCP. CBD stones were detected in ten patients and a postoperative late CBD stricture was found in one case.

Conclusions:

According to our data, both the incidence of BDIs (0.5%) and symptomatic postoperative CBD stones (0.9%) remain low without the routine use of IOC.
Characteristics of the Serum Pepsinogen (PG) Test, and the Relationship between PG Test Results and Gastric Cancer Outcomes
Authors: Ubukata H. , Konishi S. , Nakachi T. , Motohashi G. , Goto Y. , Watanabe Y. , Nakada I. , Tabuchi T.
Published: January 2017

Background and Aims:

The serum pepsinogen (Pg) test is considered to be a high-risk marker for gastric cancer, so that it is intended that it will be gradually adopted for mass surveys in Japan. This manuscript examines the characteristics of the preoperative Pg test and the relationship between its results and the postoperative outcomes of gastric cancer cases in relation to the neutrophil/lymphocyte ratio (NLR) as a prognostic marker.

Materials and Methods:

Peripheral blood samples were taken within 1 week before gastrectomy for the Pg test and NLR.

Results:

The Pg test identified 128 (+) cases (59.0%) and 89 (–) cases (41.0%). In three of all cases, cancer had not been detected by an upper gastrointestinal series (UGI) in the previous year (every case showed Pg (+)). Five-year survival was 80.5% in the Pg (+) group, 60.7% in the Pg (–) group, 85.6% in the NLR (< 5.0) group, and 29.9% in the NLR (≥ 5.0) group, but 14.3% in the NLR (≥ 5.0) plus Pg (–) group, and 89.5% in the NLR (< 5.0) plus Pg (+) group. The differences in the 5-year survivals were statistically significant.

Conclusions:

A mass survey using the Pg test alone is inadequate, but the Pg test may be an important adjunct to the conventional methods. Gastric cancer with Pg (–) may have a higher potential for malignancy than cancer with Pg (+).
Clinical Presentation of Pseudomyxoma Peritonei
Authors: Järvinen P. , Lepistö A.
Published: January 2017

Background and Aims:

We analysed the clinical symptoms and signs of pseudomyxoma peritonei (PMP), a rare syndrome affecting one to two persons per million annually. Presumably, patients with PMP would benefit from early diagnosis. This study was conducted to further characterise the manifestations of PMP.

Material and Methods:

We performed a retrospective chart review of a consecutive series of 82 PMP cases at the Helsinki University Central Hospital from June 1984 to September 2009. We then analysed the patients' characteristics, clinical manifestations, indications for surgery and preoperative radiological investigations.

Results:

The study involved 53 women (65%) and 29 men (35%). The preponderance of women was statistically significant (p = 0.008). Abdominal pain was the most common chief complaint in the initial evaluation with 23% of the cases. The subsequent more common chief complaints were acute abdomen with 21%, increased abdominal girth with 17%, coincidental diagnosis with 13%, other reasons with 13% and newly onset hernia with 12% of the cases. Suspected ovarian tumour was the most common cause for surgery overall, with 26 of 82 initial operations (32%). Of the 82 initial operations, 23 (28%) were performed with a suspicion or diagnosis of PMP. Computed tomography had a sensitivity of 51% in recognising PMP.

Conclusions:

While only 28% of patients underwent initial surgery for presumed PMP, the accuracy of preoperative diagnostics was modest. Diagnostics of PMP is challenging due to the mimicking nature of the disease. In case of indistinct intra-abdominal tumour, we recommend, careful patient examination prior to the initial surgery, when possible.
Up to 10 Years Follow up of the Use of 71 Cortical Allografts (Strut-Grafts) for the Treatment of Periprosthetic Fractures
Authors: Virolainen P. , Mokka J. , Seppänen M. , Mäkelä K.
Published: January 2017

Backround and Aims:

Periprosthetic fractures are often located in areas of poor bone quality. There are multiple strategies to manage these fractures. Stable fixation in areas of low bone quality may require the use of cortical bone strut allografts.

Material and Methods:

Cortical allograft struts were used in the treatment of 71 patients with periprosthetic fractures between a 10 year period from 1/1999 untill 12/2008. 18 patients had a periprosthetic fracture around the knee implant, 52 around the hip implant and 1 in between the hip and knee prosthesis. The average follow-up time was 943 days ranging from 90 days to 3428 days.

Results and Conclusions:

The overall union rate was 91%. 20 patients died during the follow-up, 6 of them during the first six month after operation. 8 patients (12%) had an diagnosed infection during the follow-up time. The specific strategy chosen to periprostehetic fracture treatment should depend on the quality of the remaining bone stock, type of the implant, location and classification of the fracture and on patients related factors, such age age and comorbidities. Use of cortical bone struts is a good option in fractures associated with poor bone quality. Use of allograft strut combined with a nonlocking plate, which offers the highest stiffness known, may provide superior biomechanical stability compared with other methods in some situations.
Mid-Term Results for Three Contemporary Total Knee Replacement Designs — A Comparative Study of 104 Patients with Primary Osteoarthritis
Authors: Koskinen E. , Paavolainen P. , Ylinen P. , Eskelinen A. , Harilainen A. , Sandelin J. , Tallroth K. , Remes V.
Published: January 2017

Aims:

The purpose of this study was to compare retrospectively the mid-term clinical and radiological results of three contemporary knee designs in cohorts operated on in the same hospital during the same time period.

Materials and Methods:

We evaluated mid-term clinical and radiographic outcome of three contemporary total knee designs (the AGC V2, the Duracon and the Nexgen) in 104 consecutive patients (129 knees) operate on for primary knee osteoarthritis at our hospital. The mean indexed age at the time of the operation was 69.2 years (range, 49.3 to 81.1 years). The mean follow-up time was 6.0 years (range, 0.2 to 7.9). All patients were followed for at least three years or until the first revision. In the survival analyses, the end point was defined as, revision for any reason.

Results:

The Kaplan-Meier survival analysis showed a 98% (95% CI 94–100) survival rate for the NexGen, a 98% (95% CI 93–100) for the AGC and a 90% (95% CI 81–99) for the Duracon design at six years. Both the mean KSS for pain, KSS for function and the mean clinical knee score improved significantly in all three groups. There was no difference between the three designs in mid-term survivorship.

Conclusions:

Most of the revisions could be directly linked to perioperative surgical errors. In conclusion, the most recently introduced knee replacements of the present study (Duracon and Nexgen) did not show any clinically significant benefit over the older design (AGC) in the mid-term.
Communities of interest as a lens to explore the advantage of collaborative behaviour for developing economies
Authors: Davies Paul , Mason-Jones Rachel
Published: January 2017

This article introduces the concept of communities of interest (CoIs) as a lens to explore the developing collaborative practice. A shared philosophy between companies offers a means of understanding the behaviour of individuals within a community context. This context is an important element within a developing economy, because this shared experience enables organizations to develop and learn together. The article draws on a study within the Welsh organic food sector to illustrate the way that the CoI concept provides an informative framework to explore interaction. The concept of a shared philosophy providing a distinct community identity is one that can be transposed to a number of sectors and offers a creative lens for developing economies as network connections are seen as integral aspects of how companies are able to grow.
‘I’ll sue you if you publish my wife’s interview’: ethical dilemmas in qualitative research based on life stories
Authors: Sabar Galia , Sabar Ben-Yehoshua Naama
Published: January 2017

This article addresses ethical dilemmas linked to using in-depth interviews while researching blended families in Israel, mainly during the analysis phase and while getting interviewees’ final written approval, prior to publication. Amongst the dilemmas presented are: should we publish statements that we thought might harm the interviewee even though we got their approval? Or those including pejorative statements on members of the interviewee’s extended family who weren’t asked for consent as they weren’t interviewed? We bring several types of changes our interviewees requested and demonstrate how we responded, not always successfully. Finally, we re-think dilemmas related to the complex issues of confidentiality and consent and raise questions – still open – these dilemmas generate. We discuss our own frustrations vis-à-vis the power vested with our interviewees that might affect the quality of any research when too many requests for substantial changes are done as a precondition for a written approval.
A sociogram is worth a thousand words: proposing a method for the visual analysis of narrative data
Authors: Contandriopoulos Damien , Larouche Catherine , Breton Mylaine , Brousselle Astrid
Published: January 2017

This article proposes an innovative method for the visual analysis of narrative data that involves three steps: transforming narrative data into relational data, creating two-mode networks displayed with graph optimization algorithms derived from social network analysis (SNA), and visually analyzing sociograms. We argue that understanding how actors and their opinions constitute a network-like structure opens up promising avenues for interpreting data. This approach provides powerful data visualization that facilitates inductive identification of the underlying structure of narrative data. It also reveals the complexities of the links between differently positioned actors in a structure that a personal attribute-based analytical method might overlook. Lastly, it can be productively combined with other quantitative and qualitative methods to make sense of narrative data.
Some Fallacies and Truths Concerning the Image in Old and New Media
Authors: Lechte John
Published: January 2017

Despite differences in approach most conceptions of the image fall prey to what Jean-Paul Sartre calls the ‘illusion of immanence’ – treating the image as a separate reality, as a thing. This article provides an explication of the ‘illusion of immanence’, then proceeds to evaluate Sartre’s theory in the context of digital versions of the image. The question is: does the ‘illusion of immanence’ still pertain when the digital image is involved? In this regard, consideration is given to Paul Crowther’s ontology of the digital image in art, where the issue of the manipulation of the digital is highlighted, along with the work of Lev Manovich on cinema and that of Mark B.N. Hansen on the body in relation to immersion in new media. A call is made for a new theory of the image which takes on Sartre’s insights – insights which are seen to be of particular relevance to immersion and interactivity in VR (virtual reality).
Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease
Authors: Aboussouan LS
Published: January 2017

Indications for exercise and pulmonary rehabilitation extend to neuromuscular diseases tough these conditions pose particular challenges given the associated skeletal muscle impairment and respiratory muscle dysfunction. These challenges are compounded by the variety of exercise prescriptions (aerobic, muscle strengthening, and respiratory muscle training) and the variety of neuromuscular disorders (muscular, motor neuron, motor nerve root, and neuromuscular transmission disorders). Studies support a level II evidence of effectiveness (i.e., likely to be effective) for a combination of aerobic exercise and strengthening exercises in muscular disorders, and for strengthening exercises in amyotrophic lateral sclerosis. The potential deleterious effects of work overload in the dystrophinopathies have not been confirmed in Becker muscular dystrophy. Adjunctive pharmacologic interventions (e.g., theophylline, steroids, PDE5 inhibitors, creatine), training recommendations (e.g., interval or lower intensity training) and supportive techniques (e.g., noninvasive ventilation, neuromuscular electrical stimulation, and diaphragm pacing) may result in more effective training but require more study before formal recommendations can be made. The exercise prescription should include avoidance of inspiratory muscle training in hypercapnia or low vital capacity, and should match the desired outcome (e.g., extremity training for task-specific performance, exercise training to enhance exercise performance, respiratory muscle training where respiratory muscle involvement contributes to the impairment).
PatientsLikeMe the case for a data-centered patient community and how ALS patients use the community to inform treatment decisions and manage pulmonary health
Authors: Frost J. , Massagli M.
Published: January 2017

What happens when patients go online to not only discuss health and daily living but to share detailed health data? PatientsLikeMe© is an online platform where patients with life-altering conditions share structured information about symptoms, treatments, and outcomes, view individual and aggregated reports of these data, and discuss health and garner support on forums and through private messages. In this case study, we describe the components of this platform and how people with Amyotrophic lateral sclerosis have used the site to manage and improve pulmonary health. A qualitative analysis of forum content containing preset terms reveals patterns in use. As in other online communities, members of PatientsLikeMe offer one another support based on their own personal experience and advise each other on both medical issues and how to improve day-to-day life. Unique to this patient platform, members tailor questions and consults by referencing concrete data displayed for each patient member. PatientsLikeMe adds data into patient investigations on how to improve daily life and long term health outcomes.
How African Americans Express Their Intentions to Be Organ Donors
Authors: Korda Holly , Wagstaff David A. , McCleary Karl J.
Published: January 2017

Context

As part of an organ sharing network's outreach, African American adults were interviewed to assess their awareness of the network's efforts and willingness to donate their organs after death.

Objective

To describe (1) the proportion who expressed their intentions to be an organ donor, (2) the means they had used, and (3) sociodemographic characteristics of the participants who used a particular means.

Design

A repeated, cross-sectional, random-digit dialing telephone interview was conducted from July 2005 (start of wave 1) to April 2006 (end of wave 3). Each interview averaged 7 minutes and consisted of 60 items.

Setting

Trained interviewers placed telephone calls to the residences of African Americans who resided in 1 of 4 New Jersey locales: East Orange/Orange, Irvington, Jersey City/Newark, and Trenton.

Participants

One thousand five hundred sixty-seven African Americans, aged 18 to 95 years.

Main Outcome Measures

Five Yes/No items were used to determine if participants had declared their intention to be an organ donor via driver's license application, donor card, donor registry, will/healthcare directive, or discussion with a family member.

Results

Twenty-seven percent of the participants had expressed their intentions to be an organ donor with an organ donor card, driver's license, donor registry, or will/healthcare directive. The participants who had used one or more of these formal means were 14.4 times more likely to have discussed their intention to be an organ donor with a family member than were the participants who had not.
Family and Staff Responses to a Scripted Introduction to Tissue Donation for Hospice Inpatients on Admission
Authors: Niday Patricia , Painter Caitlyn , Peak Joyce , Bennett Eileen , Wiley Mandy , McCartt Lee , Teixeira Otto H. P.
Published: January 2017

Purpose

To implement and evaluate a change in practice regarding the timing of introducing donation for inpatient hospice staff and families whereby scripted information about tissue/organ donation was given by the nurse upon admission as part of the normal admission process and then repeated at the time of death per usual protocol.

Methods

Data were collected from staff for 6 months (January to June 2006). The hospice staff agreed to complete a donor services comment log at the admission and at the death of each patient to relay any concerns with the change in practice rather than just writing down complaints as was the previous practice. Data were supplemented with staff input during regular meetings. Donation rates were compiled as usual for 6 months and compared with the preceding 6 months.

Results

Data were analyzed from the written interactions. Trends identified were limited by the small sample size. The results confirmed that both nursing staff and potential donor families supported the change in practice. No families or staff called the organ procurement organization with complaints during the 6-month period. Corneal donations increased from 2 to 7, a 250% increment for the 6-month period.

Conclusion

The assumption that discussing donation when hospice patients are admitted will lead to a decrease in donation is not supported by the results of this study. The findings suggest the need for a methodologically rigorous, theoretically driven examination of hospice donor families' reactions to the introduction of donation at admission and the subsequent decrease in stress and increase in donation rates.
Collaboration to Improve Education after Liver Transplant: The Experience at Portland Veterans Affairs Medical Center
Authors: Perez Cynthia , Busch Ann , Oyama Katie , Jackson Nicole
Published: January 2017

Education after a liver transplant can be an overwhelming experience for transplant recipients. Clinical nurse specialist graduate students with the assistance of the liver transplant clinical nurse specialist at the Portland Veterans Affairs Medical Center developed a multidisciplinary tool for documenting posttransplant education. By creating 1 central document in which all disciplines provide evidence of post-transplant education, all members of the healthcare team are afforded an efficient system for tracking progress in patients' education and for eliminating duplicative teaching.
Community-Based Weight Management in Long-Term Heart Transplant Recipients: A Pilot Study
Authors: Salyer Jeanne , Flattery Maureen , Joyner Pamela , Friend Jennifer , Elswick R. K.
Published: January 2017

Background

Heart transplant recipients often suffer from obesity, dyslipidemia, and hypertension thought to be related to triple-drug immunosuppression and poor adherence to diet and exercise. A lifestyle intervention that allows recipients to attend a community-based weight management program may improve health outcomes.

Objective

To determine (1) the effects of attending a community-based weight management program on weight, systolic and diastolic blood pressure, and the lipid profile; and (2) the feasibility of a community-based program for weight management.

Methods

Twenty-one patients (81% male; age 57 years, 99.7 months since transplantation) participated in a randomized clinical trial and received either weight management counseling (control) or a 6-month scholarship to a structured commercial program (treatment). Using simple analysis of covariance models, group differences were assessed and reported as marginal means.

Results

At baseline, there were no demographic differences between groups. There were no differences in outcome variables except weight (control, 102.1 kg vs treatment, 98.3 kg; P = .05). After 6 months, significant differences were found in weight (control, 100.5 kg vs treatment, 95.6 kg; P = .047) and high-density lipoprotein cholesterol (control, 40.6 mg/dL vs treatment, 49.1 mg/dL; P = .044). A marginally significant difference was found in systolic blood pressure (control, 138 mm Hg vs treatment, 121 mm Hg; P=.07). A decrease in diastolic blood pressure (6 mm Hg) was attributed to treatment effect ( P = .16). No differences were noted in total cholesterol, triglycerides, or low-density lipoprotein cholesterol.

Conclusions

The structured commercial program appears to be an effective, feasible alternative to usual care. Findings need to be confirmed in future research with a larger sample.