bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical analysis of an anchor nail combined with a titanium cable in the treatment of lower patella fractures
Authors: Dong Zhijun , Liu Fuyao , Pan Yuan , Wu Shengzhong , Luo Chunshan 
Published: December 2019

Objective This study was performed to evaluate the clinical effect of an anchor nail and titanium cable for lower patella fractures and identify an effective treatment. Methods Thirty-five patients with lower patella fractures were treated using anchor nail and titanium cable technology. The anchor was fixed to the main part of the patella; the lower patella was then fixed. A bone tunnel was created, and the titanium cable was fixed. The fracture was allowed to heal without tension. Postoperative radiographs were obtained at regular follow-up evaluations. The Böstman function scores were used to assess postoperative complications. Results All patients were followed for an average of 15 months. The fracture healing time ranged from 12 to 24 weeks. The postoperative Böstman function scores were as follows: average, 28.6 points; excellent and good scores in 28 and 7 patients, respectively (100% rate of excellent and good scores). At 6 and 12 months postoperatively, the maximum degree of active extension of the affected knee joint was comparable with that of the healthy contralateral joint. Conclusion The combination of an anchor nail and titanium cable for lower patella fractures is simple and clinically satisfactory, restores knee function well, and is a worthy orthopedic method.
The joint prediction model of pBMI and eFBG in predicting gestational diabetes mellitus
Authors: Pan Ying , Hu Ji , Zhong Shao 
Published: December 2019

Objective To explore the predictive value of prepregnancy body mass index (pBMI) and early gestational fasting blood glucose (eFBG) in gestational diabetes mellitus (GDM). Methods This case–control study enrolled pregnant women at 6 to 16 weeks of gestation. The pBMI, eFBG and glycosylated haemoglobin (HbA1c) was recorded in the first trimester of pregnancy. Receiver-operating characteristic (ROC) curve analysis was used to measure the efficacy of factors that predict GDM. Results A total of 2119 pregnant women were enrolled in this study. Of these, 386 were diagnosed with GDM and 1733 did not have GDM. The age (odds ratio [OR] 1.16; 95% confidence interval [CI] 1.13, 1.20), pBMI (OR 1.12; 95% CI 1.07, 1.17) and eFBG (OR 5.37; 95% CI 3.93, 7.34) were independent risk factors for GDM occurrence. The areas under the ROC curve of eFBG, pBMI and eFBG + pBMI were 0.68 (95% credibility interval 0.65, 0.71), 0.66 (95% credibility interval 0.63, 0.69) and 0.71 (95% credibility interval 0.69, 0.74), respectively. The area under the curve of eFBG + pBMI was significantly higher than that of eFBG or pBMI alone. Conclusion The combination of eFBG and pBMI had a high predictive value for GDM.
Efficacy of the bispectral index and Observer’s Assessment of Alertness/Sedation Scale in monitoring sedation during spinal anesthesia: A randomized clinical trial
Authors: Lim Tae Wan , Choi Yi Hwa , Kim Jong Yeop , Choi Jong Bum , Lee Soo Kyung , Youn Eun Ji , Lee Jun Suck 
Published: December 2019

Objective The bispectral index (BIS) has been used to monitor sedation during spinal anesthesia. We evaluated the correlation between BIS and the Observer’s Assessment of Alertness/Sedation Scale (OAA/S) in patients sedated with dexmedetomidine, propofol, or midazolam. Methods This prospective, randomized study included 46 patients scheduled for knee arthroplasty under spinal anesthesia with sedation. The patients were randomized to receive sedation with dexmedetomidine (n = 15), propofol (n = 15), or midazolam (n = 16). Correlation between BIS and OAA/S was assessed during sedation in the three groups. Results A linear correlation was observed between BIS and OAA/S, and there was no significant difference in BIS score between the groups during mild to moderate sedation status (OAA/S 3–5). During deep sedation (OAA/S 1–2), the BIS score in the midazolam group was significantly higher than that in the propofol and dexmedetomidine groups (74.4 ± 11.9 vs 67.7 ±  9.5 vs 62.6 ± 12.2). Conclusions BIS values differed at the same level of sedation between different sedative agents. Objective sedation scores should therefore be used in combination with BIS values for the assessment of sedation levels during spinal anesthesia.
Spinopelvic Characteristics in Acetabular Retroversion: Does Pelvic Tilt Change After Periacetabular Osteotomy?
Authors: Grammatopoulos George , Salih Saif , Beaule Paul E. , Witt Johan 
Published: December 2019

Background: Acetabular retroversion may lead to impingement and pain, which can be treated with an anteverting periacetabular osteotomy (aPAO). Pelvic tilt influences acetabular orientation; as pelvic tilt angle reduces, acetabular version reduces. Thus, acetabular retroversion may be a deformity secondary to abnormal pelvic tilt (functional retroversion) or an anatomic deformity of the acetabulum and the innominate bone (pelvic ring). Purpose: To (1) measure the spinopelvic morphology in patients with acetabular retroversion and (2) assess whether pelvic tilt changes after successful anteverting PAO (aPAO), thus testing whether preoperative pelvic tilt was compensatory. Study Design: Case series; Level of evidence, 4. Methods: A consecutive cohort of 48 hips (42 patients; 30 ± 7 years [mean ± SD]) with acetabular retroversion that underwent successful aPAO was studied. Spinopelvic morphology (pelvic tilt, pelvic incidence, anterior pelvic plane, and sacral slope) was measured from computed tomography scans including the sacral end plate in 21 patients, with adequate images. In addition, the change in pelvic tilt with aPAO was measured via the sacrofemoral-pubic angle with supine pelvic radiographs at an interval of 2.5 ± 2 years. Results: The spinopelvic characteristics included a pelvic tilt of 4° ± 4°, a sacral slope of 39° ± 9°, an anterior pelvic plane angle of 11° ± 5°, and a pelvic incidence of 42° ± 10°. Preoperative pelvic tilt was 4° ± 4° and did not change postoperatively (4° ± 4°) ( P = .676). Conclusion: Pelvic tilt in acetabular retroversion was within normal parameters, illustrating “normal” sagittal pelvic balance and values similar to those reported in the literature in healthy subjects. In addition, it did not change after aPAO. Thus, acetabular retroversion was not secondary to a maladaptive pelvic tilt (functional retroversion). Further work is required to assess whether retroversion is a reflection of a pelvic morphological abnormality rather than an isolated acetabular abnormality. Treatment of acetabular retroversion should focus on correcting the deformity rather than attempting to change the functional pelvic position.
Employee Perceptions of Wellness Programs and Incentives
Authors: Fink Jennifer , Zabawa Barbara , Chopp Sara 
Published: December 2019

Purpose: To explore, by income level, employee perceptions of an employer offered wellness incentive program. Design: Qualitative and quantitative study that includes a survey with close-ended and open-ended questions. Setting: The study setting was a hospital in Wisconsin. Participants: Participants (n = 105). Measures and Analysis: Quantitative responses were analyzed using descriptive statistics in Qualtrics and logistic regression in Statistical Analysis System. Results: Sixty-three percent participated in the wellness incentivized program because their employer offers them a reward; 52% said they would participate without a reward; 48% feel like they must participate in this year’s program; and 34% feel like they would have to disclose information about their health at or below the current reward level. Conclusion: Income does not have a significant effect on whether employees feel they must participate or disclose health information. However, income has a significant effect on employee’s beliefs about whether or not employers should play an active role in improving the health of their employees.
Racial and Ethnic Differences in Response to Anticoagulation: A Review of the Literature
Authors: Gibson Caitlin M. , Yuet Wei C. 
Published: December 2019

Introduction: Anticoagulants are among the most frequently prescribed medications in the United States. Racial and ethnic disparities in incidence and outcomes of thrombotic disorders are well-documented, but differences in response to anticoagulation are incompletely understood. Objective: The objective of this review is to describe the impact of race and ethnicity on surrogate and clinical end points related to anticoagulation and discuss racial or ethnic considerations for prescribing anticoagulants. Methods: A PubMed and MEDLINE search of clinical trials published between 1950 and May 2018 was conducted using search terms related to anticoagulation, specific anticoagulant drugs, race, and ethnicity. References of identified studies were also reviewed. English-language human studies on safety or efficacy of anticoagulants reporting data for different races or ethnicities were eligible for inclusion. Results: Seventeen relevant studies were identified. The majority of major trials reviewed for inclusion either did not include representative populations or did not report on the racial breakdown of participants. Racial differences in pharmacokinetics, dosing requirements, drug response, and/or safety end points were identified for unfractionated heparin, enoxaparin, argatroban, warfarin, rivaroxaban, and edoxaban. Conclusions: Race appears to influence drug concentrations, dosing, or safety for some but not all direct oral anticoagulants. This information should be considered when selecting anticoagulant therapy for nonwhite individuals.
Cannulation of the superficial femoral vein at mid-thigh when catheterization of the superior vena cava system is contraindicated
Authors: Zhao Linfang , Cao Xiuzhu , Wang Yapping 
Published: December 2019

Purpose: Patients needing medium- to long-term infusion therapy with limited catheterization via the superior vena cava system is a challenging condition. The conventional catheterization via the femoral vein in the groin has a high complication rate, discomfort, and short indwelling time. Since changing the insertion site can avoid the disadvantage of conventional catheterization via the femoral vein in the groin, the present study aimed to investigate the effects of femoral inserted central catheters insertion via the superficial femoral vein at the mid-thigh to resolve the issue of limited superior vena cava system catheterization. Methods: Based on the symptoms and signs, enhanced computed tomography findings, and insertion history, in 121 patients, limited catheterization via the superior vena cava system was identified. Subsequently, the femoral inserted central catheters were inserted via the superficial femoral vein at the mid-thigh under the guidance of ultrasound, and the tip of femoral inserted central catheters was in the inferior vena cava. Results: A total of 121 patients underwent femoral inserted central catheters insertion via a superficial femoral vein at the mid-thigh from August 2017 to December 2018. The success rate of insertion was 100%, and the indwelling time was 3–472 days. The complications of femoral inserted central catheters in the thigh were similar to that of peripherally inserted central catheters in the arm. The incidence of primary malposition was 1.65%, the incidence of catheter-related thrombosis was 0.83%, and the central line associated bloodstream infection rate was 0.83%. Subsequently, 116 lines (95.87%) were removed at the end of the treatment, one line (0.83%) was accidentally removed by the patient, and four lines (3.31%) were unplanned removed due to complications. Conclusion: The technique of femoral inserted central catheters insertion via the superficial femoral vein at the mid-thigh has a high success rate, low complication rate, and less impact on activities, and is easy to maintain. This phenomenon resolves the patient’s needs of medium- to long-term infusion therapy with limited catheterization of superior vena cava system.
Minimally Invasive Aortic Valve Replacement with Sutureless Valves: Results From an International Prospective Registry
Authors: Glauber Mattia , Di Bacco Lorenzo , Cuenca Jose , Di Bartolomeo Roberto , Baghai Max , Zakova Daniela , Fischlein Theodor , Troise Giovanni , Viganò Giorgio , Solinas Marco 
Published: December 2019

Objective To report the early and mid-term results of patients who underwent minimally invasive aortic valve replacement (MI-AVR) with a sutureless prosthesis from an international prospective registry. Methods Between March 2011 and September 2018, among 957 patients included in the prospective observational SURE-AVR (Sorin Universal REgistry on Aortic Valve Replacement) registry, 480 patients underwent MI-AVR with self-expandable Perceval aortic bioprosthesis (LivaNova PLC, London, UK) in 29 international institutions through either minithoracotomy ( n = 266) or ministernotomy ( n = 214). Postoperative, follow-up, and echocardiographic outcomes were analyzed for all patients. Results Patient age was 76.1 ± 7.1 years; 64.4% were female. Median EuroSCORE I was 7.9% (interquartile range [IQR], 4.8 to 10.9). Median cardiopulmonary bypass and cross-clamp times were 81 minutes (IQR 64 to 100) and 51 minutes (IQR 40 to 63). First successful implantation was achieved in 97.9% of cases. Two in-hospital deaths occurred, 1 for noncardiovascular causes and 1 following a disabling stroke. In the early (≤30 days) period, stroke rate was 1.4%. Three early explants were reported: 2 due to nonstructural valve dysfunction (NSVD) and 1 for malpositioning. One mild and 1 moderate paravalvular leak were reported. In 16 patients (3.3%) pacemaker implantation was needed. Mean follow-up was 2.4 years (maximum = 7 years). During follow-up 5 explants were reported, 3 due to endocarditis and 2 due to NSVD. Follow-up stroke rate was 2.5%. Three structural valve deteriorations not requiring reintervention were reported. Five-year survival was 91.45%. Conclusions In this large prospective international registry, MI-AVR with Perceval valve confirmed to be safe, reproducible, and effective in an intermediate-risk population, providing excellent clinical recovery both in early and mid-term follow-up.
Quantitative Evaluation of Hormesis in Breast Cancer Using Histoculture Drug Response Assay
Authors: Aoishi Yuka , Yoshimasu Tatsuya , Oura Shoji , Kawago Mitsumasa , Hirai Yoshimitsu , Miyasaka Miwako , Ohashi Takuya , Nishimura Yoshiharu 
Published: December 2019

Purpose: Hormesis is a phenomenon of growth stimulation at low doses and inhibition at higher doses. In cancer treatment, little is known about how hormesis affects cancer cell proliferation. We evaluated the hormetic dose–response relationship of paclitaxel using surgically resected breast cancer specimens on the basis of histoculture drug response assay (HDRA). Methods: We used surgically resected fresh tumor specimens from 22 patients with breast cancer: 17 invasive ductal, 3 mucinous, and 2 other “special-type” cancers. All patients were female, ranging in age between 40 and 86 (median 60) years. Small pieces of viable cancer tissue were placed on collagen gel and cultured for 7 days with paclitaxel. Inhibition rates of paclitaxel at several concentrations were measured and fitted to a sigmoid dose–response curve. Results: Hormesis was observed in 9 of the 22 cases; ED50 of cytotoxic effect was significantly higher ( P = .0036) in hormesis (H) group (44.6 ± 4.2 µg/mL) than in nonhormesis (N) group (26.7 ± 3.5 μg/mL). Conclusion: We evaluated hormesis in breast cancer tissue using HDRA for the first time although previously confirmed in cultured cells. Hormesis seems to occur in patients undergoing treatment with anticancer agents, especially in a metastatic setting. Meanwhile, tumor growth may be stimulated in patients who are resistant to paclitaxel.
Comparison of managerial competence of Indonesian first-line nurse managers: a two-generational analysis
Authors: Gunawan Joko , Aungsuroch Yupin , Fisher Mary L , McDaniel Anna M 
Published: December 2019

Background Much research provides evidence that four age groups or generations of nurse managers exist, and it is assumed that they work and act differently according to each generation’s characteristics and attitudes, which may influence their managerial competence. Aims To compare first-line nurse managers’ managerial competence according to generational analysis across public hospitals in Indonesia. Methods This study employed a cross-sectional survey in 18 public hospitals in Indonesia with 254 first-line nurse managers selected using simple random sampling. The Indonesian First-Line Nurse Managers Managerial Competence Scale (IFLNMMCS) was used to measure managerial competence. Data were analysed using descriptive analyses using means, standard deviations and independent t-test. Results There was no significant difference in the total score of managerial competence of Generation X and Millennial first-line nurse managers ( p = 0.077). Of five dimensions of managerial competence, only applying quality care improvement ( p = 0.028) and financial management ( p = 0.013) were significantly different, while leadership ( p = 0.142), facilitating spiritual nursing care ( p = 0.353), self-management ( p = 0.130), staffing and professional development ( p = 0.068) and utilizing informatics ( p = 0.304) were not significantly different. Conclusion This study serves as a foundation for better human resource management, education and professional development for first-line nurse managers among public hospitals in Indonesia.
Health Care Provider Knowledge and Perceptions of FDA-Approved and Do-It-Yourself Automated Insulin Delivery
Authors: Murray James A. , Clayton Margaret F. , Litchman Michelle L. 
Published: December 2019

Background: Automated insulin delivery (AID) technology may reduce variability in blood glucose, resulting in lower risk for hypoglycemia and associated complications, and by extension improve quality of life. While clinical trials, research, and patient experience have consistently demonstrated the value of AID, this technology is still inaccessible to many patients. Patient-driven innovation has resulted in alternative do-it-yourself (DIY) solutions to available off-the-shelf AID devices. Method: This two-phase cross-sectional observational study addressed health care provider (HCP) perceptions of AID as well as the perceived need for, development of, and evaluation of an AID fact sheet comparing the most commonly used Federal Drug Administration approved AID and DIY AID devices. Results: Negative attitudes toward the use of DIY AID were low. The majority of HCPs saw their lack of knowledge about how DIY AID work to be the greatest barrier to answering patient questions about what is available (74.4%). Additionally, the majority of HCPs (64.5%) indicated they were either “likely” or “very likely” to use the fact sheet when answering patient questions about AID options. Conclusion: Increased awareness and utilization of AID technology offer hope to further reduce the burden of diabetes, but there is a need to bridge the knowledge gap about DIY AID. A fact sheet provides a way to facilitate discussions of this emerging technology between HCPs and patients. Next steps could investigate additional ways to put needed information in the hands of HCPs.
Magnitude Matters: Art Image Size and Waiting Time Impact Perceived Quality of Care
Authors: Devlin Ann Sloan , Anderson Alaina , Hession-Kunz Sarah , Kelly Margaret , Noble Lilly , Zou Amy 
Published: December 2019

Objective: The study fills a gap in the literature by examining the size of the art displayed and waiting time in an exam office on patients’ judgments of the quality of care they are likely to receive. Background: A body of research shows that the content of art in healthcare settings has an impact on patients’ well-being, yet no work has empirically systematically examined the size of the art displayed on perceived healthcare outcomes. Method: A fully crossed 4 ×2 between-subjects experimental design examined the impact of exposure to images in an outpatient exam room that varied in the size of what was displayed (a landscape scene: small, medium, large, and control—blank wall) crossed by the time waiting for the physician (10 vs. 45 min). The Dependent Variables were the reported anxiety and various measures of satisfaction with the healthcare visit. Results: The size of the art had a significant effect on the majority of the dependent variables; specifically, the large image had a more positive impact than the other sizes; longer waits were also negatively evaluated by patients and affected anxiety and judgments of room spaciousness. Conclusions: Identifying the recommended content of art displayed is necessary but not sufficient; the size of the art in its context has the potential to impact a range of important perceptions related to healthcare. When the size does not match the available wall space (i.e., the canonical size was not utilized), a variety of ratings of the healthcare environment (including the practitioner) were negatively affected.
Outcome after treatment of osteoarthritis with open-wedge high-tibial osteotomy with a plate: 2-year results of a Japanese cohort study
Authors: Sawaguchi Takeshi , Takeuchi Ryohei , Nakamura Ryuichi , Yonekura Akihiko , Akiyama Takenori , Kerstan Marta , Goldhahn Sabine 
Published: December 2019

Purpose: This prospective multicenter study evaluated patient reported outcomes (PROs) in individuals undergoing medial open-wedge high-tibial osteotomy (OWHTO) with plate stabilization compared to conservative care or no treatment. Methods: One hundred eighteen of 148 patients older than 40 years were elected for OWHTO with plate treatment. Thirty patients declined surgery and were followed as a conservative group. The primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 2 years. Secondary measures included Oxford knee score, Western Ontario and McMaster Universities osteoarthritis index, range of motion (ROM), joint space width (JSW), femorotibial angle (FTA), and weight-bearing line ratio (WBLR). Results: Patient enrollment and baseline characteristics were heterogeneously distributed and led to group characteristics that were not comparable. Therefore, the comparison of the KOOS between the groups showing no differences must be treated with caution. In the OWHTO plate group, all PROs and the ROM significantly improved between baseline and 2-year follow-up. JSW remained stable in the OWHTO group. The FTA and WBLR significantly changed from a mean of 179.3 (95% confidence interval (CI): 178.7, 179.9) to 169.8 (95% CI: 169.2, 170.5) and from 23.1 (95% CI: 20.7, 25.5) to 62.4 (95% CI 59.0, 65.8), respectively. Treatment failure with conversion to total knee arthroplasty occurred in 1% of the OWHTO group; and in the conservative group, 10% converted to HTO or knee arthroplasty. Conclusions: OWHTO with plate leads to significant improvement of PROs and function 2 years after intervention and demonstrates reliable mechanical axis correction with subsequent shift of weight-bearing.