bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bucket-Handle Meniscus Repair in a Below-Knee Amputee
Authors: Massey Patrick A. , Miller Benjamin C. , Perry Kevin , McClary Kaylan , Chauvin Brad , Barton R Shane 
Published: August 2020

Case:
We report a case of a right knee lateral bucket-handle meniscal tear repair in a 25-year-old woman bilateral below-knee amputee. At the 4-year follow-up, the patient was ambulatory in a prosthesis with a successful outcome.

Conclusion:
Meniscus repair in below-knee amputees requires careful evaluation and surgical management. Specific consideration should be given to evaluating limb alignment, maintaining the stump integrity, surgical technique, modified bracing, and rehabilitation. This case report demonstrates that bucket-handle meniscus repair can be successful in a below-knee amputee.
Injury to the Popliteal Artery and Vein During Open Fibular Collateral Ligament Reconstruction
Authors: Naylor William M. , Johnson Daniel J. , Welter Jessica M. , Dunn Albert S.M. 
Published: August 2020

Case:
We present a case involving a 26-year-old male who sustained an iatrogenic injury to the right popliteal artery and vein during open fibular collateral ligament reconstruction. The lesions were repaired immediately and required subsequent procedures on postoperative day 1.

Conclusions:
Iatrogenic vascular injuries during knee surgery can be devastating for patients and may lead to increased medical costs, unexpected hospital admissions, and additional surgical procedures. Surgeons should scrutinize preoperative imaging to identify the anatomic location of the popliteal artery and vein, which may be at risk during posterolateral knee reconstruction.
Surgical Treatment for Toe Deformities in Stiff-Person Syndrome
Authors: Takeda Ryutaro , Isawa Kazuya , Matsumoto Takumi , Tanaka Sakae , Yasui Tetsuro 
Published: August 2020

Case:
Stiff-person syndrome is a rare neurological disorder characterized by rigidity and painful spasms of the trunk and limbs, and patients sometimes have difficulty in walking due to rigid toe deformities. This is a case report of a 76-year-old woman suffering from stiff-person syndrome with painful rigid toe deformities regained walking ability after metatarsal osteotomy and cutting of the toe extensors for all toes in the left foot.

Conclusion:
For patients with stiff-person syndrome, surgical intervention is a powerful treatment option when they have developed rigid and painful toe deformities despite adequate pharmacological treatment.
Extensor Pollicis Longus Tendon Rupture After a Pediatric Distal Radius Fracture
Authors: Patel Harshadkumar A. , Lee Mark C. , Chaudhry Sonia 
Published: August 2020

Case:A 16-year-old boy underwent closed reduction and pinning of a Salter-Harris II distal radius fracture (DRF). Extensor pollicis longus (EPL) rupture occurred 6 weeks after the injury. Extensor indicis proprius transfer was performed using wide-awake local anesthesia no tourniquet (WALANT) technique. Active thumb range of motion was restored, and the patient returned to all activities, including sports, after 2 months.Conclusion:Although delayed attritional EPL rupture after DRF is a well-known complication in adults, this is the first reported case in a truly skeletally immature patient. Awareness of this complication prompts monitoring for prodromal signs and symptoms. The WALANT technique is feasible in selected children.
Ethical issues encountered by medical school students during the physical examination of female genitalia
Authors: Özcan Müesser , Yeniceri Emine Neşe , Küçük Mert 
Published: August 2020

Abstract
Background The aim of the study was to identify the ethical issues encountered during the physical examination of the female genitalia, which can be deemed culturally intimate, by medical school students who have practiced genital examination so far on a limited number of models and find out the reasons of such issues. Methods The study was conducted with 120 voluntary medical school students in clinical years who completely filled out and delivered the forms. Results Students stated that while performing genital examinations on real patients during their clinical years, they faced various issues including the importance of taking patient's consent, disclosing their identity and proficiency, fearing to harm the patient due to lack of knowledge and skills, failing to perform genital examination, and having emotional problems. The rate of encountering such problems differed depending on students' gender and grade. Conclusions In clinical education, while they are equipped with self-confidence and proficiency, students should also be integrated in an environment where patient's comfort, ethical principles and values are preserved. This subject should be examined when ethical dilemmas constrain learning. In order to avoid ethical concerns during this process and ensure that the process can be managed positively by both parties, medical schools should put forth official policies and guidelines concerning the practice of genital examination in particular which is considered intimate by patients and share such policies and rules with both parties.
Implementation of a National Electronic Health Information System in Gabon: A Survey of Healthcare Providers’ Perceptions.
Authors: Bagayoko C.O. , Tcheente Jack , Traoré Diakaridia , Moukoumbi Gaetan , Ondzigue Raymond , Koumamba Aimé Patrice , Ondjani Myriam Corille , Ndjeli Olive Lea , Gagnon Marie-Pierre 
Published: August 2020

Abstract
BackgroundThe Health Information System (HIS) is a set of computerized tools for the collection, storage, management, and transmission of health data. The role of such tools in supporting the modernization of health systems, improving access to quality healthcare, and reducing costs in developing countries is unquestionable, but their implementation faces several challenges. In Gabon, a unique national electronic HIS has been launched. It will connect healthcare institutions and providers at all levels in the whole country.ObjectiveThis study aims to explore and identify the factors influencing healthcare providers’ perceptions of the national electronic HIS in Gabon. MethodsA 44-item questionnaire based on the Information System Success Model (ISSM) was administered between February and April 2018 among 2,600 healthcare providers across the country. The questions assessed the different aspects of the HIS that could influence its perceived impact on a 5-level Likert scale (from fully agree to totally disagree). The reliability and construct validity of the questionnaire were checked using Cronbach alpha and congeneric reliability coefficients. A logistic regression was used to identify the factors influencing healthcare providers’ perceptions of the system.ResultsA total of 2,327 questionnaires were completed (i.e. 89.5% response rate). The logistic regression identified five elements that significantly influenced perceived system impact: System Quality (Odds Ratio–OR=1.70), Information Quality (OR=1.69), Actual Use (OR=1.41), Support Quality (OR=1.37), and Useful Functions (OR=1.14). The model explained 30% of the variance in providers’ perception that the national HIS leads to positive impacts. DiscussionThe results show that healthcare providers’ perceptions regarding the positive impact of the national HIS in Gabon are influenced by their previous use of an HIS, the scope of their usage, and the quality of the system, information, and support provided to users. These results could inform the development of strategies to ensure adequate change of management and user experience for the implementation of the national HIS in Gabon, and eventually in other low resource environments.
Consumers’ satisfaction factors mining and sentiment analysis of B2C online pharmacy reviews
Authors: liu jingfang , zhou yingyi , jiang xiaoyan , zhang wei 
Published: August 2020

Abstract
BackgroundIn recent years, online pharmacies have been accepted by increasingly more consumers, and the prospects for online pharmacies are optimistic. This article explores the consumers’ satisfaction factors addressed in Business to Customer (B2C) online pharmacy reviews and analyzes the sentiments expressed in the reviews. The goal of this work is to help B2C online pharmacy enterprises identify consumers’ concerns, continuously improve the health services level.MethodsThis article was based on the Latent Dirichlet Allocation (LDA) topic model. From a third-party platform-based B2C online pharmacy and a proprietary B2C online pharmacy (JD Pharmacy and J1.COM, respectively), 136,630 pieces of over-the-counter (OTC) drug review data posted from January 1, 2015 to December 31, 2018 were selected as samples and used to explore the satisfaction factors of B2C online pharmacy consumers regarding the entire drug purchasing process. Then, the sentiments expressed in the drug reviews were analyzed with SnowNLP.ResultCategorization of the 12 factors identified by LDA showed that 5 factors were related to logistics; these 5 factors, which also included the most drug reviews, made up 38.5% of the reviews. The number of factors related to drug prices was second, with 3 factors, and reviews of drug prices made up 25.5% of the reviews. Customer service and drug effects each had two related factors, and a smaller percentage of these reviews (13.95%) were related to drug effects. Consumers still maintain positive opinions of JD Pharmacy and J1.COM. However, some opinions on logistics and drug prices are expressed.Conclusion The most important task for online pharmacies is to improve logistics. It is better to develop self-built logistics. Both types of B2C online pharmacies can improve consumer viscosity by implementing marketing strategies. With regard to customer service, focusing on improving employees' service attitudes is necessary.
A practice improvement package at scale to improve management of birth asphyxia in Rwanda: A before-after mixed methods evaluation
Authors: Umunyana Jacqueline , Sayinzoga Felix , Ricca Jim , FAVERO RACHEL , Manariyo Marcel , Kayinamura Assumpta , Tayebwa Edwin , Khadka Neena , Molla Yordanos , Kim Young-Mi 
Published: August 2020

Abstract
Background: Helping Babies Breathe (HBB) is a competency-based educational method for an evidence-based protocol to manage birth asphyxia in low resource settings. HBB has been shown to improve health worker skills and neonatal outcomes, but studies have documented problems with skills retention and little evidence of effectiveness at large scale in routine practice. This study examined the effect of complementing provider training with clinical mentorship and quality improvement as outlined in the second edition HBB materials. This “system-oriented” approach was implemented in all public health facilities (n=172) in ten districts in Rwanda from 2015 to 2018. Methods: A before-after mixed methods study assessed changes in provider skills and neonatal outcomes related to birth asphyxia. Mentee knowledge and skills were assessed with HBB objective structured clinical exam (OSCE) B pre and post training and during mentorship visits up to one year afterward. The study team extracted health outcome data across the entirety of intervention districts and conducted interviews to gather perspectives of providers and managers on the approach.Results: Nearly forty percent (n= 772) of health workers in maternity units directly received mentorship. Of the mentees who received two or more visits (n=456), sixty percent demonstrated competence (received > 80% score on OSCE B) on the first mentorship visit, and 100% by the sixth. In a subset of 220 health workers followed for an average of five months after demonstrating competence, 98% maintained or improved their score. Three of the tracked neonatal health outcomes improved across the ten districts and the fourth just missed statistical significance: neonatal admissions due to asphyxia (37% reduction); fresh stillbirths (27% reduction); neonatal deaths due to asphyxia (13% reduction); and death within 30 minutes of birth (19% reduction, p=0.06). Health workers expressed satisfaction with the clinical mentorship approach, noting improvements in confidence, patient flow within the maternity, and data use for decision-making. Conclusions: Framing management of birth asphyxia within a larger quality improvement approach appears to contribute to success at scale. Clinical mentorship emerged as a critical element. The specific effect of individual components of the approach on provider skills and health outcomes requires further investigation.
Potentialities of multi-b-values diffusion-weighted imaging for predicting efficacy of concurrent chemoradiotherapy in cervical cancer patients
Authors: Liu Bing , Ma Wan-Ling , Zhang Guang-Wen , Sun Zhen , Wei Meng-Qi , Hou Wei-Huan , Hou Bing-Xin , Wei Li-Chun , Huan Yi 
Published: August 2020

Abstract
Background: To testify whether multi-b-values diffusion-weighted imaging (DWI) can be used to ultra-early predict treatment response of concurrent chemoradiotherapy (CCRT) in cervical cancer patients and to assess the predictive ability of concerning parameters.Methods: Fifty-three patients with biopsy proved cervical cancer were retrospectively recruited in this study. All patients underwent pelvic multi-b-values DWI before and at the 3rd day during treatment. The apparent diffusion coefficient (ADC), true diffusion coefficient (Dslow), perfusion-related pseudo-diffusion coefficient (Dfast), perfusion fraction (f), distributed diffusion coefficient(DDC) and intravoxel diffusion heterogeneity index(α) were generated by mono-exponential, bi-exponential and stretched exponential models. Treatment response was assessed based on Response Evaluation Criteria in Solid Tumors (RECIST v1.1) at 1 month after the completion of whole CCRT. Parameters were compared using independent t test or Mann-Whitney U test as appropriate. Receiver operating characteristic (ROC) curves was used for statistical evaluations.Results: ADC-T0 (p=0.02), Dslow-T0 (p<0.01), DDC-T0 (p=0.03), ADC-T1 (p<0.01), Dslow-T1 (p<0.01), ΔADC (p=0.04) and Δα (p<0.01) were significant lower in non-CR group patients. ROC analyses showed that ADC-T1 and Δα exhibited high prediction value, with area under the curves of 0.880 and 0.869, respectively. Conclusions: Multi-b-values DWI can be used as a noninvasive technique to assess and predict treatment response in cervical cancer patients at the 3rd day of CCRT. ADC-T1 and Δα can be used to differentiate good responders from poor responders.
Young Medical Doctors’ Perspectives on Professionalism: A Qualitative Study Conducted in Public Hospitals in Pakistan
Authors: Jalil Aisha , Mehmood Qaisar Khalid , Fischer Florian 
Published: August 2020

Abstract
Background: Professionalism is amongst the major dimensions determining the competence of medical doctors. Poor professionalism affects the overall outcome of healthcare services. This study explores the perspectives of young medical doctors on professionalism in Pakistan.Methods: A qualitative study based on in-depth interviews was conducted with 60 young medical doctors, aged less than 40 years, who had studied medicine in Pakistani universities, were Pakistani nationals, and were employed at various hierarchical levels, from house officer to consultant specialist, in public tertiary hospitals in Pakistan. The respondents were identified through a multistage maximum heterogeneity sampling strategy. A semi-structured interview guide was developed based on a previous extensive literature review. Written consent was obtained from the hospitals and study participants. Qualitative thematic analysis was applied to analyse the data. Results: The data analysis revealed that rigidity of opinions, unacceptability of contrasting perspectives, false pride, and perceived superiority over other professions and patients were major components of poor medical professionalism. Most of the young doctors believed that there is no need to include professionalism and humanity course modules in the medical curriculum, because topics related to social sciences are deemed irrelevant to medicine and judged to be common sense. The doctors recognised good professionalism in themselves, while reporting unprofessional behaviour demonstrated by their colleagues and paramedics. Other factors contributing to poor medical professionalism included the use of social media applications during duty hours, ridiculing patients, substance use such as smoking cigarettes in the office, referrals of complicated cases to other hospitals, freeing up beds before holidays, lack of cooperation from paramedical staff, and inadequate role models. Conclusions: Poor medical professionalism among young doctors needs to be addressed by policymakers. There is a need to revisit the medical curriculum to strengthen professionalism. It is essential to develop the qualities of tolerance, teachability, and acceptance in doctors in order to facilitate interprofessional collaborations and avoid medical errors.
Effect of Bone Morphogenetic Protein-2/Hydroxyapatite on Ankle Fusion with Bone Defect in a Rabbit Model: A Pilot Study
Authors: Dang Le Hoang Nam , Lee Kwang-Bok 
Published: August 2020

Abstract
Background: Revision ankle-fusion surgery after a failure of total ankle arthroplasty has a problem with bone-defect management by implant removal. For the reconstruction of bone defects, autogenous bone often causes minor and major complications. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) plays essential roles in bone regeneration strategies and Hydroxyapatite (HA) is beneficial as the rhBMP-2 carrier. In this study, we evaluate whether rhBMP-2/HA can replace autogenous bone in a rabbit ankle-fusion model with distal tibia bone defect. Methods: The bone defect was created in the distal tibia. The ankle fusion was performed by a cannulated screw from lateral malleolus and various treatments on bone defect. Thirty male white New Zealand rabbits were divided into three groups of 10 animals on each group dependent on treatment methods as control group (no treatment into defect), auto-bone group (autogenous bone treatment), and rhBMP-2/HA group (40 μL of 1 μg/mL rhBMP-2/ 100 μL HA). Bone formation on defect and the union of the ankle joint were evaluated by X-ray, micro-CT and histological analysis at 8 weeks and 12 weeks, postoperatively. Results: Radiographic assessment found the control and auto-bone groups still had the bone defect present, but rhBMP-2/HA group showed complete replacement of the defect with newly formed bone at 12 weeks. Micro-CT showed significantly higher new bone formation within the defect in the rhBMP-2/HA group than in the auto-bone and control groups at 8 weeks (p > 0.05 and p < 0.01, respectively) and 12 weeks (p < 0.05, p < 0.001, respectively). Fusion rate (%) analysis of micro-CT showed a higher percentage of union in the rhBMP-2/HA group than in the auto-bone and control groups at 8 weeks (p > 0.05, p < 0.001, respectively) and 12 weeks (p < 0.001 and p < 0.001, respectively). The histological showed the highest osteointegration between distal tibia and talus in the rhBMP-2/HA group at 12 weeks. Conclusions: This study indicated that rhBMP-2/ HA showed much better bone fusion than did the autogenous bone graft and was effective in promoting fusion rate and improving the quality of the ankle joint fusion.
The Multi-biomarker Disease Activity test for assessing response to treatment strategies using methotrexate with or without prednisone in the CAMERA-II Trial
Authors: Jurgens Maud , Safy-Khan Mary , de Hair Maria , Bijlsma Johannes , Welsing Paco , Tekstra Janneke , Lafeber Floris , Sasso Eric , Jacobs Johannes 
Published: August 2020

Abstract
Objectives The CAMERA-II trial compared two tight-control, treat-to-target strategies, initiating methotrexate with prednisone (MTX+pred) or MTX with placebo (MTX+plac), in early RA-patients. The multi-biomarker disease activity (MBDA) blood test objectively measures RA disease activity with a score of 1−100. In CAMERA-II, response profiles of the MBDA score, its individual biomarkers and DAS28 were assessed.Methods We evaluated 92 patients from CAMERA-II of whom clinical data and serum for MBDA testing at baseline and ≥1 timepoint from months 1, 2, 3, 4, 5, 6, 9 or 12 were available. Changes (∆) from baseline for DAS28 and MBDA score and comparisons of ∆DAS28 and ∆MBDA score over time within the MTX+pred versus the MTX+plac strategy, were tested for significance with t-tests. Changes in biomarker concentration from baseline to months 1−5 were tested with Wilcoxon signed rank test and tested for difference between treatment arms by Mann-Whitney U test. Results MBDA and DAS28 showed similar response profiles, with gradual improvement over the first 6 months in the MTX+plac group, and in the MTX+pred group faster improvement during month 1, followed by gradual improvement. The 12 MBDA biomarkers could be grouped into 4 categories of response profiles, with significant responses for 4 biomarkers during the MTX+plac strategy and 9 biomarkers during the MTX+pred strategy.Conclusions MBDA tracked treatment response in CAMERA-II similarly to DAS28. More individual MBDA biomarkers tracked treatment response of MTX+pred than of MTX+plac. Four response profiles could be observed. TRIAL REGISTRATIONCAMERA-II International Standard Randomised Controlled Trial Number: ISRCTN 70365169. Registered 29 March 2006, retrospectively registered.
Validity and reliability of a simplified food frequency questionnaire: A cross sectional study among physical health examination adults in southwest region of China
Authors: Cheng Zhengyan , Shuai Ping , Qiao Qichuan , Li Tingxin 
Published: August 2020

Abstract
Background: In China, many people are suitable for participating in regular physical examination for prevention. Some simplified food frequency questionnaires have been designed and used. However, the accuracy of questionnaire is absent. This study aimed to examine the reliability and validity of simplified food frequency questionnaire (SFFQ) used among physical examination adults in southwest region of China.Methods: This was a cross-sectional study conducted among physical health examination adults in Southwest region of China. A total of 239 participants aged 20-65 were included from February 2019 to June 2019. The performance of SFFQ was evaluated by means of a three-day 24-hour dietary record (3R24). The relative validity and agreement was assessed by Pearson`s correlation and intra-class correlation coefficients (ICC), respectively. Results: The median energy-adjusted ICC of food groups between SFFQ2 and SFFQ1 was 0.59 (range: 0.49-0.73) and the ICC of nutrients was 0.47(range: 0.39-0.76). The Pearson correlation showed a validity between SFFQ1 and 3R24, which ranged from -0.086 to 0.93 for food and 0.21 to 0.71 for nutrition, respectively. The energy-adjustment slightly increased the correlation coefficients.Conclusions: The reliability and validity of SFFQ was acceptable. It could be an appropriate dietary assessment tool for future epidemiological studies among physical health examination adults in southwest China.Trial registration:CHiCTR, ChiCTR1900020934, Registered 22 January 2019, http://www.chictr.org.cn/edit.aspx?pid=35414&htm=4.