bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chronic limb threatening ischemia and diabetes mellitus: the severity of tibial atherosclerosis and outcome after infrapopliteal revascularization
Authors: Koivunen Veerakaisa , Juonala Markus , Mikkola Kimmo , Hakovirta Harri 
Published: November 2020

Background and objective: Diabetes mellitus associates with poor outcomes in chronic limb threatening ischemia but data on different hypoglycemic regimens and outcomes are lacking. We analyzed insulin-treated diabetes mellitus, non-insulin-treated diabetes mellitus, and patients without diabetes mellitus. Methods: All patients with peripheral artery disease and/or diabetes mellitus and infrapopliteal revascularization in the Department of Vascular Surgery, Turku University Hospital during 2007–2015 were included. Tibial atherosclerosis was categorized into crural index classes of I–IV. Results: Of the 497 patients, 180 were insulin-treated diabetes mellitus, 94 non-insulin-treated diabetes mellitus, and 223 patients without diabetes mellitus groups (diabetes mellitus 55.1%). Insulin-treated diabetes mellitus was the most ill, youngest (insulin-treated diabetes mellitus—median: 72.4, interquartile range: 64.0–79.5 versus non-insulin-treated diabetes mellitus—76.0, interquartile range: 67.9–83.6 versus patients without diabetes mellitus—77.3, interquartile range: 68.5–83.7, p < 0.001), had the highest body mass index (insulin-treated diabetes mellitus—median: 27.7, interquartile range: 24.0–31.8 versus non-insulin-treated diabetes mellitus—26.3, interquartile range: 23.2–30.3 versus patients without diabetes mellitus—23.9, interquartile range: 21.5–26.9, p < 0.001), and Charlson comorbidity index (insulin-treated diabetes mellitus—65.6% versus non-insulin-treated diabetes mellitus—46.8% versus patients without diabetes mellitus—10.8%, p < 0.001). After endovascular revascularization, limb salvage was poorer for insulin-treated diabetes mellitus ( p = 0.046) and non-insulin-treated diabetes mellitus groups ( p = 0.011) compared to surgery, but not for patients without diabetes mellitus ( p = 0.15). Patients with crural index IV in insulin-treated diabetes mellitus ( p = 0.001) and non-insulin-treated diabetes mellitus ( p = 0.013) had higher mortality after revascularization. Crural index IV was a risk factor for limb loss (hazard ratio: 1.37, 95% confidence interval: 1.08–1.74, p = 0.008). Conclusions: Limb salvage after bypass is better for insulin and non-insulin diabetics, compared to the endovascular approach. Extensive tibial atherosclerosis is an independent risk factor for limb loss. It associates with increased mortality in both insulin and non-insulin diabetics.
Healthcare professionals’ perspectives on rehabilitating persons with cognitive impairment
Authors: McGilton Katherine S , Vellani Shirin , Zheng Nancy , Wang Daniel , Yeung Lydia , Escrig-Pinol Astrid 
Published: November 2020

Background and Objectives Despite emerging evidence that persons with cognitive impairment (CI) (including dementia and/or delirium) can be rehabilitated post-hip fracture surgery, there still remains a paucity of research on best practice rehabilitation strategies that help healthcare providers effectively rehabilitate persons with CI. Therefore, this qualitative study explores healthcare professionals’ (HCPs) perspectives who have been successfully providing rehabilitation for people with CI. Research Design and Methods Sixteen HCPs with a specialty in rehabilitating persons with CI from one inpatient rehabilitation facility with various professional backgrounds were purposively sampled using a maximum diversity sampling strategy. Three focus group discussions were conducted to explore their experiences of providing rehabilitation to persons with CI. A hybrid inductive–deductive approach was used to analyze the data. Findings HCPs acknowledged that older adults with CI deserved the opportunity for inpatient rehabilitation and that good outcomes were achievable; however, their knowledge, skills, and attitudes required reframing. The analysis identified three essential components to rehabilitation: (1) staff education and support, (2) tailored rehabilitation approaches, and (3) care partner involvement and support. Discussion and Implications Rehabilitation of persons with CI post-hip fracture surgery is achievable, and HCPs can learn to modify their practices to achieve positive patient outcomes. The attitudes of the healthcare team members had to be shifted to embrace the belief that persons with CI can be rehabilitated. However, it takes a steep learning curve, creativity, ingenuity, and tailored approaches to rehabilitate persons with CI successfully. This involves knowing the individual, maintaining routines, and learning the best ways to engage and motivate the person. As well, care partners’ knowledge and understanding of the individual improved the chances of a successful rehabilitation stay and discharge. Essential to the success of rehabilitation of persons with CI includes a supportive management team to help create the processes to enable their staff to succeed.
Retrospective Matched Case-Control Study on the Use of CO2 Laser for the Treatment of Nonhealing Diabetic Foot Ulcers: The DULCIS-2 (Diabetic ULcer, CO2 Laser, and Infections) Study
Authors: Monami Matteo , Ragghianti Benedetta , Silverii Antonio , Scatena Alessia , Landi Letizia , Cosentino Claudia , Vitale Valentina , Mannucci Edoardo 
Published: November 2020

Purpose Infection, which is one of the possible complications of diabetic foot ulcers (DFUs), makes the treatment of ulcers challenging because of its negative impact on healing processes and the high prevalence of multiresistant germs. This study is aimed at verifying the effect of a surgical CO2 laser (which reduces the bacterial load and allows a more accurate debridement), as compared with the traditional lancets, on the healing rate of DFU. Methods The present case-control retrospective analysis was performed on patients with chronic (>6 months) DFU with Texas grade >1, treated with 80 W surgical CO2 laser (DEKA SmartXide2 C80, El.En. Group) and compared with a matched sample of patients with similar characteristics, who were treated with a traditional surgical approach. The debridement was performed trying to achieve the complete removal of nonviable tissues. The principal endpoint was the proportion of patients healed at 6 months. All analyses were carried out with SPSS 25.0. The study protocol was approved by the local ethical committee. Results This study included 118 patients (59 cases and 59 controls). At 6 months, the proportion of healing patients was 35% and 18% in cases and controls, respectively ( P = .034). The corresponding figure at 1 year was 62% and 38% ( P = .009), whereas no difference was observed at 1, 2, and 3 months. No serious adverse event was observed. Conclusions In this article, we show for the first time that CO2 laser treatment, in comparison with traditional surgical approaches, can be associated with an increased healing rate in patients with DFU.
Sauve-Kapandji Remains a Viable Option for Distal Radioulnar Joint Dysfunction
Authors: Munaretto Nicholas , Aibinder William , Moran Steven , Rizzo Marco 
Published: November 2020

Introduction Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution’s results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations. Methods A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes. Results The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%). Conclusion The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications. Level of Evidence Level IV
Use of Low-Dose Recombinant Factor Ⅶa for Uncontrolled Perioperative Bleeding
Authors: Chang Zhi-gang , Chu Xin , Chen Wen , Hu Jun-hua , Gong Ji-wu , Liu Da-dong , He Qing , Feng Zhe , Xiao Shi-rou , Liu Ya-lin 
Published: November 2020

Background: Recombinant activated factor VIIa (rFVIIa) is a prohemostatic agent initially approved for use in hemophilia patients and has also been used for a diverse range of off-label indications in the context of massive uncontrolled blood loss; however, no convincing evidence exists regarding the optimal dose of rFVIIa to treat uncontrolled bleeding in surgical patients. Aim: To evaluate the effects and safety of a very low dose of rFⅦa in patients with uncontrolled perioperative bleeding in the surgical intensive care unit (ICU). Methods: 55 patients from Beijing Hospital, who received rFⅦa between July 2004 and November 2018 for uncontrolled perioperative bleeding were included. The controls were matched for age, sex, severity, and operation type. The baseline demographics, survival, changes in bleeding and transfusion, coagulation parameters and complications were analyzed. Results: A low dose of rFⅦa (2.0∼3.6 mg, with a median dose of 39.02 μg/kg) appears to be effective in controlling massive hemorrhage (with an effective rate of 74.55%), and can reduce volume of red blood cell transfusion, improve coagulation status, while has a relatively low risk of thromboembolic complications (3.6%). Conclusion: In patients with uncontrolled perioperative bleeding, a low dose of rFⅦa could be used when traditional methods are ineffective.
The role of cholecalciferol deficiency in the pathogenesis of polycystic ovary syndrome
Authors: Safi Aigul , Orazov Mekan , Kalinchenko Svetlana 
Published: November 2020

Objectives: to evaluate and compare clinical presentations, medical history, and laboratory data of patients with polycystic ovary syndrome, including vitamin 25(OH)D3 level. Methods: In total, 81 patients were examined. The patient group included 51 patients with signs of polycystic ovary syndrome. The control group included 30 healthy women without signs of polycystic ovary syndrome, comparable according to gender and age to the patient group. Polycystic ovary syndrome was verified based on the diagnostic Rotterdam and international polycystic ovary syndrome guidelines’ criteria. The levels of cholecalciferol were determined by mass spectrometry (ng/mL). At the second stage of the study, the patient group with polycystic ovary syndrome was divided into two subgroups depending on the waist circumference and compared with each other by the level of insulin, low-density lipoproteins, triglycerides, anti-Mullerian hormone, follicle-stimulating hormone, and luteinizing hormone. Statistical analysis was carried out using the parametric t-test for two-independent samples with equal or different variance. For nominal data—Pearson’s chi-test, when the means are not calculated and a test is carried out for the presence of a relationship between the nominal variables. Results: Patients with polycystic ovary syndrome and without polycystic ovary syndrome did not have a statistically significant difference in 25(OH)D3 level. Statistically significant differences in the level of 25(OH)D3 were found in women with polycystic ovary syndrome with the waist circumference ⩾80 cm. In these subgroups, differences in insulin, low-density lipoprotein, and triglycerides levels were also revealed. Conclusion: The correlation of the 25(OH)D3 level does not differ in the groups of patients with polycystic ovary syndrome and without polycystic ovary syndrome, but significantly correlates with the metabolic profile of patients.
A comparison of the nationally important infection prevention and control documents in NHS England and NHS Scotland
Authors: Curran Evonne T , Burnett Emma , Robinson Jude , Loveday Heather 
Published: November 2020

Background: The devolution of health to Scotland in 1999, led for the first time in the NHS, to different priorities and success indicators for infection prevention and control (IPC). This project sought to understand, compare and evaluate the national IPC priorities and available indicators of success. Aim: To identify the national IPC priorities alongside national indicators of success. Methods: Critical analysis of nationally produced documents and publicly available infection-related data up to March 2018. Findings: For both NHS Scotland and England the local and national IPC priorities are evidenced by: (1) people being cared for in an IPC-safe environment; (2) staff following IPC-safe procedures; and (3) organisations continuously striving not just to attain standards, but to improve on them. If national agencies that produce data were also charged with using a Continuous Quality Improvement (CQI) model, then there would be further opportunities to detect and improve on successes.
Clinical and Epidemiological Characterization of Neurological Consults: When a Neurological Evaluation Is Requested
Authors: Corrêa Karin Mitiyo , de Rezende Filho Flávio Moura , Abrantes Fabiano Ferreira , de Andrade João Brainer Clares , Barsottini Orlando G. P. , Pedroso José Luiz 
Published: November 2020

Background and Objectives: Medical consultation by a specialist physician consists of an evaluation to review diagnosis and management of patients with some neurological conditions referred from other specialty wards. This mode of care delivery has gained relevance in the field of neurology and adequate training on it is valuable, allowing neurologists to provide state-of-the-art management to patients with neurological manifestations. The present study aimed to characterize neurology consults and to discuss the roles of the neurologist within a hospital setting. Methods: A prospective analysis of neurological consultations provided to inpatients of a university hospital in São Paulo, Brazil, was performed from September 2016 to September 2017. These patients were followed by the principal investigator, who was not involved in their care. Results: We evaluated data from 117 female and 106 male inpatients with a mean age of 53.8 ± 2.4. The medical specialties that most frequently requested neurological consultations were Internal Medicine (17%), Cardiology (11.2%) and Pulmonology (9.4%). The main reasons for a neurology consultation request were seizures (15.6%); decreased level of consciousness (8.9%) and confusion (7.1%). The most frequent diagnosis in patients receiving a neurology consult were stroke (10.2%); hypoxic-ischemic encephalopathy (5.3%) and sepsis (2.2%). Conclusion: Our findings show the growing importance of the role of neurologists within hospital settings as many medical conditions present with neurological manifestations and the significance of the neurohospitalist model of care.
Risk factors for 30‐day readmission in adults hospitalized for pulmonary hypertension
Authors: Bhattacharya Priyanka T. , Hameed Asif M. Abdul , Bhattacharya Shubhadeep T. , Chirinos Julio A. , Hwang Wei‐Ting , Birati Edo Y. , Menachem Jonathan N. , Chatterjee Saurav , Giri Jay S. , Kawut Steven M. , Kimmel Stephen E. , Mazurek Jeremy A. 
Published: November 2020

Readmissions for pulmonary hypertension are poorly understood and understudied. We sought to determine national estimates and risk factors for 30‐day readmission after pulmonary hypertension‐related hospitalizations. We utilized the Healthcare Cost and Utilization Project Nationwide Readmission Database, which has weighted estimates of roughly 35 million discharges in the US. Adult patients with primary International Classification of Disease, Ninth Revision, Clinical Modification diagnosis codes of 416.0 and 416.8 for primary and secondary pulmonary hypertension with an index admission between 2012 and 2014 and any readmission within 30 days of the index event were identified. Predictors of 30‐day readmission were identified using multivariable logistic regression with adjustment for covariates. Results showed that the national estimate for Primary Pulmonary Hypertension vs Secondary Pulmonary Hypertension‐related index events between 2012 and 2014 with 30‐day readmission was 247 vs 2550 corresponding to a national readmission risk estimate of 17% vs 18.3%, respectively. The presence of fluid and electrolyte disorders, renal failure, and alcohol abuse were associated with increased risk of readmission in Primary Pulmonary Hypertension, while factors associated with Secondary Pulmonary Hypertension readmissions included anemia, congestive heart failure, lung disease, fluid and electrolyte disorders, renal failure, diabetes, and liver disease. The median cost of Primary Pulmonary Hypertension admissions and readmissions were $46,132 (IQR: $25,384–$85,647) and $41,604.50 (IQR: $22,481.50–$84,420.50), respectively. The median costs of Secondary Pulmonary Hypertension admissions and readmissions were $34,893 (IQR: $19,670–$66,143) and $36,279 (IQR: $19,059–$74,679), respectively. In conclusion, approximately 19% of Primary Pulmonary Hypertension and Secondary Pulmonary Hypertension hospitalizations result in 30‐day readmission, with significant costs accrued during the index hospitalization and readmission. With evolving clinical terminology and diagnostic codes, future study will need to better clarify underlying factors associated with readmissions amongst pulmonary hypertension sub‐types, and identify methods and procedures to minimize readmission risk.
Renal outcomes of treatment with telmisartan in patients with stage 3–4 chronic kidney disease: A prospective, randomized, controlled trial (JINNAGA)
Authors: Kitamura Mineaki , Arai Hideyuki , Abe Shinichi , Ota Yuki , Muta Kumiko , Furusu Akira , Mukae Hiroshi , Kohno Shigeru , Nishino Tomoya 
Published: November 2020

Objectives: Although angiotensin II receptor blockers are effective for patients with chronic kidney disease, dose-dependent renoprotective effects of angiotensin II receptor blockers in patients with moderate to severe chronic kidney disease with non-nephrotic proteinuria are not known. Our aim was to elucidate the dose-dependent renoprotective effects of angiotensin II receptor blockers on such patients. Methods: A multicenter, prospective, randomized trial was conducted from 2009 to 2014. Patients with non-nephrotic stage 3–4 chronic kidney disease were randomized for treatment with either 40 or 80 mg telmisartan and were observed for up to 104 weeks. Overall, 32 and 29 patients were allocated to the 40 and 80 mg telmisartan groups, respectively. The composite primary outcome was renal death, doubling of serum creatinine level, transition to stage 5 chronic kidney disease, and death from any cause. Secondary outcomes included the level of urinary proteins and changes in the estimated glomerular filtration rate. Results: There was no difference in the primary outcome (p = 0.78) and eGFR (p = 0.53) between the two groups; however, after 24 weeks, urinary protein level was significantly lower in the 80 mg group than in the 40 mg group (p < 0.05). No severe adverse events occurred in either group, and the occurrence of adverse events did not significantly differ between them (p = 0.56). Conclusion: Our findings do not demonstrate a direct dose-dependent renoprotective effect of telmisartan. The higher telmisartan dose resulted in a decrease in the amount of urinary protein. Even though high-dose angiotensin II receptor blockers may be preferable for patients with stage 3–4 chronic kidney disease, the clinical importance of the study results may be limited. The study was registered in the UMIN-CTR ( https://www.umin.ac.jp/ctr ) with the registration number UMIN000040875.
What They Learned Won’t Go Away: The Impacts of an International Exchange Program on Chinese Teacher Candidates’ Understanding of and Practice in Science Education
Authors: Zhou (周国强) George , Wang (王佩玉) Peiyu , Liu (刘天) Tian , Zhang (张俊义) Junyi , Li (李远蓉) Yuanrong , Fu (付成茵) Chengyin , Wu (吴淑娥) Shue 
Published: November 2020

Purpose: The Canadian university where this study took place has established an international exchange program in teacher education with a large Chinese university. This study was designed to examine how the international exchange program influenced Chinese science teacher candidates’ understanding of science education and how such learning impacted their teaching in China. Design/Approach/Methods: The study adopted a qualitative research design with interview and reflective journal as the main approaches for data collection. Findings: Participants greatly appreciated the opportunity of exchange. They reported an improved understanding of Canadian school education and its science curriculum and pedagogy, which changed many aspects of their original values about the relationship between the teacher and students, classroom environment, and so on. Although they faced many constraints to implement what they learned from the exchange in Chinese science classrooms, what they learned had never been forgotten. Participants tried to apply them here and there at the level they could control. Originality/Value: There are many reported studies in the literature about Chinese international students on Western campuses. However, research on Chinese students who participate in international exchange programs is very rare. The findings of this study can inform policymakers and education practitioners about student international exchange programs and benefit future exchange participants.