bluuebunny/crossref_metadata_2025_split huggingface dataset:
Return to Play and Long-term Participation in Pivoting Sports After Anterior Cruciate Ligament Reconstruction
Authors: Lindanger Line , Strand Torbjørn , Mølster Anders Odd , Solheim Eirik , Inderhaug Eivind 
Published: October 2019

Background: Rupture of the anterior cruciate ligament (ACL) is a common and feared injury among athletes because of its potential effect on further sports participation. Reported rates of return to pivoting sports after ACL reconstruction (ACLR) vary in the literature, and the long-term consequences of returning have rarely been studied. Purpose: To examine the rate and level of return to pivoting sports after ACLR, the duration of sports participation, and long-term consequences of returning to pivoting sports. Study Design: Cohort study; Level of evidence, 2. Methods: All primary ACLRs with a bone–patellar tendon–bone autograft between 1987 and 1994 (N = 234) in athletes participating in team handball, basketball, or soccer before injury were selected from a single-center quality database. A long-term evaluation (median, 25 years; range, 22-30 years) was performed using a questionnaire focusing on return to pivoting sports, the duration of sports activity after surgery, later contralateral ACL injuries, revision surgery, and knee replacement surgery. Participants were stratified into 2 groups depending on the time between injury and surgery (early, <24 months; late, ≥24 months). Results: A total of 93% of patients (n = 217) responded to the questionnaire. Although 83% of patients returned to pivoting sports after early ACLR, only 53% returned to preinjury level. Similar return-to-sport rates were observed in males and females ( P > .05), but males had longer sports careers (median, 10 years; range, 1-23 years) than females (median, 4 years; range, 1-25 years; P < .001). The incidence of contralateral ACL injuries was 28% among athletes who returned to sports versus 4% among athletes who did not return ( P = .017) after early ACLR. The pooled reinjury rate after return to preinjury level of sports was 41% (30%, contralateral injuries; 11%, revision surgery). The incidence of contralateral ACL injuries was 32% among females versus 23% among males ( P > .05) and, for revision surgery, was 12% among females versus 7% among males ( P > .05) after returning to sports. Having a late ACLR was associated with an increased risk of knee replacement surgery (9% vs 3%; P = .049) when compared with having an early ACLR. Conclusion: ACLR does not necessarily enable a return to preinjury sports participation. By returning to pivoting sports after ACLR, athletes are also facing a high risk of contralateral ACL injuries. Long-term evaluations in risk assessments after ACLR are important, as a significant number of subsequent ACL injuries occur later than the routine follow-up.
Healthcare professionals’ perceptions about the Italian law on advance directives
Authors: Maffoni Marina , Argentero Piergiorgio , Giorgi Ines , Giardini Anna 
Published: October 2019

Background: In the variegated legislative framework on advance directives, the first specific regulation in Italy on this issue came into force only in 2018. Research objective: This qualitative study aimed to investigate the implications of the new Italian law on advance directives in clinical practice from the perspective of those who deal with this delicate ethical issue on an everyday basis, that is, Italian healthcare professionals. Research design: A qualitative research design using semi-structured audio-recorded interviews was adopted. The data collection and analysis were performed according to the Grounded Theory approach. Participants: Nineteen healthcare professionals (16 nurses, 3 physicians) working in a palliative care unit of a research and clinical institute in Italy. Ethical considerations: The study is part of the WeDistress HELL Project (WEllness and DISTRESS in HEalth care professionals dealing with end of Life and bioethicaL issues) approved by the Ethical Committee of ICS Maugeri - Institute of Pavia (Italy). Findings: The authors identified a main overall category, ‘Pros and Cons of the Italian law on advance directives’, composed of six constituent categories: Positive welcome, Self-determination and protection, Prompts for future betterment, Uncertainties, Lack of knowledge, and Neutrality and no suggestions. Discussion: The Italian law n. 219/2017 on advance directives was seen as a legal instrument possessing both strengths and weaknesses, but able to guarantee the patient’s self-determination and support healthcare professionals in providing care according to patients’ wishes. Conclusion: An understanding of the healthcare providers’ perspective may support the discussion on advance directives and bridge the gaps that currently persist in handling ethical issues.
A retrospective study of more than 400 feline nasal biopsy samples in the UK (2006–2013)
Authors: Ferguson Stephanie , Smith Ken C , Welsh Claire E , Dobromylskyj Melanie J 
Published: October 2019

Objectives The main objective of this study was to utilise a large database from a UK-based, commercial veterinary diagnostic laboratory to ascertain the prevalence of different forms of nasal disease within the feline population. Further objectives included using this database to detect any breed, sex or age predilections, or associations between the degree of brachycephalism, and the different conditions diagnosed. Methods Records from the laboratory were searched for feline submissions received between 31 May 2006 and 31 October 2013. For all samples taken from the nasal cavity, the diagnosis was recorded together with the breed, age, sex and neuter status of the cat, whether the clinical presentation was uni- or bilateral and whether a nasal discharge was present. Pedigree breeds were further subclassified according to skull conformation into brachycephalic, mesocephalic and dolichocephalic. Logistic regression models were constructed to assess the adjusted magnitude of association of significant risk factors with each disease, and each disease was also used as a potential independent risk factor for each other disease. Results The most prevalent nasal disease was rhinitis, followed by neoplasia and polyps. The most commonly diagnosed neoplasm was lymphoma, followed by adenocarcinoma and undifferentiated carcinoma, with benign tumours being very uncommon. No significant association was found between skull conformation and nasal diseases. The only statistically significant association was polyps being more likely to arise in younger male cats, with a mesocephalic skull conformation and no nasal discharge. Conclusions and relevance No significant association was found between skull conformation and nasal diseases, contrary to what might be expected. The only significant association found between any of the potential risk factors and various forms of nasal disease was polyps being more likely to arise in younger cats; other identified associations are only likely to be weak.
Viral nucleic acid analysis with PCR in lacrimal tissue and nasal swab samples of primary acquired nasolacrimal duct obstruction cases
Authors: Yanık Özge , Hoşal Banu , Tekeli Alper , Nalcı Hilal 
Published: October 2019

Purpose: To evaluate the role of viral infections in the pathogenesis of primary acquired nasolacrimal duct obstruction. Methods: The study included 48 patients diagnosed with primary acquired nasolacrimal duct obstruction undergoing dacryocystorhinostomy surgery. Prior to dacryocystorhinostomy surgery, nasal swab sample was taken from the inferior meatus at the same side. During dacryocystorhinostomy, tissue biopsy sample (2 × 2 mm) was taken from the junction area of the lacrimal sac and nasolacrimal duct. Following nucleic acid extraction, polymerase chain reaction was performed. Results: The patients consisted of 9 (18.8%) men and 39 (81.2%) women with a mean age of 51.0 ± 14.3 years. Qualitative polymerase chain reaction showed viral genome in the nasal swabs of 10 (20.8%) patients, including coronavirus 229E (three cases), coronavirus HKU1 (two cases), respiratory syncytial virus (two cases), coronavirus OC43 (one case), coronavirus NL63 (one case), and adenovirus (one case). In the dacryocystorhinostomy samples, viral genomes were detected in four (8.3%) cases, including respiratory syncytial virus (two cases), coronavirus HKU1 (one case), and adenovirus (one case). There was a statistically significant agreement between nasal mucosal swab and dacryocystorhinostomy biopsy samples in terms of respiratory syncytial virus positivity (kappa = 1.000, p = 0.001). Conclusion: Although the viral genome was detected in the samples, a direct relationship between viruses and pathogenesis of primary acquired nasolacrimal duct obstruction could not be revealed because of the low number of positive results. However, considering the profibrotic characteristics of specific viruses such as respiratory syncytial virus and adenovirus, viral infections may be one of the many predisposing factors of primary acquired nasolacrimal duct obstruction.
Innovative Use of Google Cardboard in Clinical Examination of Patients of Vertigo
Authors: Yeolekar Aditya M , Shinde Kiran J , Qadri Haris 
Published: October 2019

Background: Vertigo is 1 of the most prominent and frequent neurological symptom. It is estimated that about 30% of all people need medical care once in their life due to this index symptom. The neurological expertise required is usually scarce in underprivileged areas. One has to look for spontaneous nystagmus, and perform Dix–Hallpike maneuver and Head Impulse test specifically to differentiate central from peripheral vertigo. The nystagmus, that is spontaneous, involuntary to-and-fro movement of the eyeball which aids in the diagnosis, can be better elicited by Frenzel glasses, Munich glasses. These devices consist of the combination of magnifying glasses and a lighting system to detect eye movements better than routine examination. Objective: To test usefulness of modified Google cardboard as Frenzel glasses in poor resource setting. Study design: A modified Google cardboard was used in 52 consecutive cases of vertigo and compared with examination with naked eye. The device consists of 2 magnifying lenses, 1 for each eye with power of +24 dioptres. Observation: The tool was found to be better for identifying spontaneous nystagmus, in Dix–Hallpike maneuver and during head impulse test as compared with the naked eye owing to the property of magnification and inhibition of fixation. Being a cheaper alternative and handy, it could be carried by every doctor in any setting.
The importance of external clinical facilitation for a perinatal and infant telemental health service
Authors: Taylor Monica , Kikkawa Naomi , Hoehn Elisabeth , Haydon Helen , Neuhaus Maike , Smith Anthony C , Caffery Liam J 
Published: October 2019

Introduction Clinical facilitation is an established strategy for introducing innovation into clinical practice. The Queensland Centre for Perinatal and Infant Mental Health has used clinical facilitation to establish a telehealth service to support perinatal and infant mental health in regional, rural and remote areas of the Australian state of Queensland. The aim of this study is to explore the role of clinical facilitation in implementing and sustaining the telehealth service. Methods Semi-structured interviews were conducted with 14 remote-site users of the telehealth service. Interviews were analysed using thematic analysis. Results Two dominant themes emerged: unmet need and service visibility. The study confirms the usefulness of telehealth as a way to address unmet need for specialist mental health services in regional, rural and remote areas. The study also provides evidence that a telehealth service with intermittent demand requires a consistent clinical facilitator, to keep the service visible to remote-site clinicians and maintain awareness of the service as a referral option. Conclusion Previous research has identified the importance of clinical facilitation in initial service implementation. This study demonstrates the necessity of clinical facilitation for ongoing service provision. Facilitation is likely to be more important where the telehealth service responds to intermittent or infrequent clinical need, compared with high-volume services where clinics are conducted routinely.
Physician and patient’s insights towards generic prescribing: The scenario in the United Arab Emirates
Authors: Abduelkarem Abduelmula R , Othman Amna M , Elgendy Sara M , Moustafa Raneem E , Al-Areqi Noor M 
Published: October 2019

Objective To assess the perspectives and perceptions of physicians and patients towards generic prescribing in the United Arab Emirates. Founding those views can help in improving medicines prescription to provide the best cost-effective healthcare services in the country. Methods A cross-sectional study targeted physicians and patients across the United Arab Emirates. Two different questionnaires were conducted in 25 clinics, government healthcare centres and private hospitals. Collected data were analysed by descriptive analysis and Chi-square test. Key findings: Around half of 225 patients, agreed that generic medications have the same efficacy as branded medications. However, 54.7% believes that medications have been on the market longer are safer than newer ones. Majority of patients agreed that physicians’ advice would influence their choice when choosing between a generic and brand medication, though only a third of the participants agreed that the pharmacist’s advice would influence their choice. Of the 100 physicians, a preponderance reported that they actively prescribe generic medications. Moreover, they reported that the patient’s financial status would affect their decision when prescribing medications. Additionally, they identify medical representatives (64%) as their main sources of information regarding generic medications in the UAE. Conclusions The results showed somewhat negative views of physicians and patients towards generics prescriptions. Hence, measures should be taken by the Health Regulatory Authorities to clear up the misconceptions. This could be done by providing valid sources of information and assurance to the public about generic medications.
Stroke Patients’ Experiences in an Adaptive Healing Room in a Stroke Rehabilitation Unit
Authors: Arbel Ifah , Ye Bing , Mihailidis Alex 
Published: October 2019

Objectives: This study evaluated the user experiences (UX) of stroke patients residing in the adaptive healing room (AHR) and compared them to the UX of patients residing in standard private rooms (SPRs). Background: Healing environments in healthcare settings can promote patients’ healing processes, outcomes, and psychological well-being. The AHR was designed as a healing environment for stroke patients and has been previously evaluated in laboratory settings. This study was the first to evaluate it in its intended context—a stroke rehabilitation unit. Methods: The UX of 10 patients residing in the AHR and 15 patients residing in SPRs were collected via structured interviews with a set of open-ended questions and analyzed using quantitative and qualitative methods. Results: The AHR design features (orientation screen, skylight, and nature view) were rated positively by most patients. The skylight emerged as the least favorable. Responses to open-ended questions revealed that UX may be further improved if patients have more control over some of the settings (e.g., light intensity and nature views), and if the system allowed for more stimulation for patients at later stages of their recovery. Additionally, the results suggest that patients in the AHR have better UX than patients in the SPRs. Conclusion: The AHR has the potential to improve UX in the stroke rehabilitation unit. Patient feedback can be used to refine the AHR before carrying out clinical trials to assess the effect of the AHR on patient outcomes (e.g., sleep, mood, and length of stay) and stroke recovery.
The Timed Up and Go test and the ageing heart: Findings from a national health screening of 1,084,875 community-dwelling older adults
Authors: Chun Sohyun , Shin Dong Wook , Han Kyungdo , Jung Jin Hyung , Kim Bongseong , Jung Hee-Won , Son Ki Young , Lee Seung-Pyo , Lee Sang Chol 
Published: October 2019

Abstract

Aim
This study aimed to evaluate the relationship between Timed Up and Go test performance and the incidence of older adult heart diseases and mortality.

Methods
This was a retrospective cohort study of 1,084,875 older adults who participated in a national health screening program between 2009–2014 (all aged 66 years old). Participants free of myocardial infarction, congestive heart failure, and atrial fibrillation at baseline were included and were divided into Group 1 (&lt;10 s), Group 2 (10−20 s) and Group 3 (≥20 s) using the Timed Up and Go test scores. The endpoints were incident myocardial infarction, congestive heart failure, atrial fibrillation, and all-cause mortality.

Results
During mean follow-up of 3.6 years (maximum 8.0 years), 8885 myocardial infarctions, 10,617 congestive heart failures, 15,322 atrial fibrillations, and 22,189 deaths occurred. Compared with participants in Group 1, Group 2 and Group 3 participants had higher incidences of myocardial infarction (Group 3: adjusted hazard ratio = 1.40, 95% confidence interval = 1.11–1.77), congestive heart failure (Group 3: adjusted hazard ratio = 1.59, 95% confidence interval = 1.31–1.94) and total mortality (Group 3: adjusted hazard ratio=1.93, 95% confidence interval = 1.69–2.20). The additional risks remained after adjusting for multiple conventional risk factors. For atrial fibrillation, a linear trend of increased risk was observed with slower Timed Up and Go test speed, but was statistically marginal (Group 3: adjusted hazard ratio=1.17, 95% confidence interval=0.96–1.44).

Conclusion
Slower Timed Up and Go test speed is associated with increased risk of developing myocardial infarction, congestive heart failure, and mortality in older adults.
Long-term management of high-grade atrioventricular block using cilostazol in a cat
Authors: Iwasa Naoki , Nishii Naohito , Takashima Satoshi , Kobatake Yui , Nomura Saki , Iwasa Kazuko , Iwasa Tatsuo , Suzuki Tomomi , Machida Noboru , Kitagawa Hitoshi 
Published: October 2019

Case summary A 12-year-old neutered female domestic shorthair cat was admitted for syncope. Clinical signs and electrocardiography revealed high-grade atrioventricular (AV) block. Treatment with cilostazol ameliorated the clinical signs and arrhythmia. However, the high-grade AV block recurred on several occasions. After 640 days, the cat presented again with clinical deterioration owing to reoccurrence of the arrhythmia and it died 11 days later. Histopathological examination revealed a loss of conduction cells within the His bundle. Relevance and novel information To our knowledge, this is the first report of high-grade AV block treated with cilostazol in a cat. Treatment with cilostazol prolonged survival for 650 days without pacemaker implantation. Histological findings suggested that the AV block was related to fibrosis of the impulse conduction system.
A cross-sectional study of physical activity participation among adults with chronic conditions participating in a digital health program
Authors: Smith-Ray Renae L , Nikzad Nima , Singh Tanya , Jiang Jenny Z , Taitel Michael S , Quer Giorgio , Cherry Jean , Steinhubl Steven R 
Published: October 2019

Objective Many American adults are insufficiently active. Digital health programs are designed to motivate this population to engage in regular physical activity and often rely on wearable devices and apps to objectively measure physical activity for a large number of participants. The purpose of this epidemiological study was to analyze the rates of physical activity among participants in a digital health program. Method We conducted a cross-sectional study of participants enrolled in a digital health program between January 2014 and December 2016. All activity data were objectively collected through wearable devices. Results Participants ( n =  241,013) were on average 39.7 years old and 65.7% were female. Participants walked on average 3.72 miles per day. Overall, 5.3% and 21.8% of participants were being treated with diabetes and cardiovascular medications respectively, but these rates varied across young, middle and older adults. Participants of all ages being treated with cardiovascular and/or diabetes medications walked significantly less than those not being treated for these conditions. Conclusion The feasibility of using a large database containing data from consumer-grade activity trackers was demonstrated through this epidemiological study of physical activity rates across age and condition status of participants. The approach and findings described may inform future research as the information age brings about new opportunities to manage and study massive amounts of data generated by connected devices.
A Point-Based Model to Predict Absolute Risk of Revision in Anatomic Shoulder Arthroplasty
Authors: Lapner Peter LC , Rollins Meaghan D , Tuna Meltem G , Netting Caleb , Bader Eddeen Anan , van Walraven Carl 
Published: October 2019

Background Total shoulder arthroplasty (TSA) has demonstrated good long-term survivorship but early implant failure can occur. This study identified factors associated with shoulder arthroplasty revision and constructed a risk score for revision surgery following shoulder arthroplasty. Methods A validated algorithm was used to identify all patients who underwent anatomic TSA between 2002 and 2012 using population-based data. Demographic variables included shoulder implant type, age and sex, Charlson comorbidity score, income quintile, diagnosis, and surgeon arthroplasty volume. The associations of covariates with time to revision were measured while treating death as a competing risk and were expressed in the Shoulder Arthroplasty Revision Risk Score (SARRS). Results During the study period, 4079 patients underwent TSA. Revision risk decreased in a nonlinear fashion as patients aged and in the absence of osteoarthritis with no influence from surgery type or other covariables. The SARRS ranged from −21 points (5-year revision risk 0.75%) to 30 points (risk 11.4%). Score discrimination was relatively weak 0.55 (95% confidence interval: 0.530.61) but calibration was very good with a test statistic of 5.77 ( df = 8, P = .762). Discussion The SARRS model accurately predicted the 5-year revision risk in patients undergoing TSA. Validation studies are required before this score can be used clinically to predict revision risk. Further study is needed to determine if the addition of detailed clinical data including functional outcome measures and the severity of glenohumeral arthrosis increases the model’s discrimination.