bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Prescribing and the Ethical Duty to Do No Harm
Authors: Nicholson Kate M. , Hellman Deborah 
Published: July 2020

Doctors have two ethical duties: to cure disease or ease suffering and, also, to do no harm. The ethical duty to “Do No Harm” has been used to justify two sides of a pendulum swing in the philosophy of opioid prescribing for pain. In the 1990s, it was invoked to expand prescribing, and more recently to justify dramatic reductions in prescription opioid use. In this Article, we explore whether prescribing opioids for pain presents challenges that differ from the ordinary mandate physicians face as they balance the call for action with the imperative to do no harm [DNH].We argue that the treatment of pain differs in three important ways. First, the fact that pain is present and occurrent reduces uncertainty about the need for action, and thus strengthens the reasons to act. Second, while DNH applies to both physicians and policymakers, each has distinct duties: physicians have a duty to the individual patient; policymakers have a duty to society. As a result, harm from drug diversion should weigh little when clinicians decide how to treat individual patients. Public health officials, by contrast, rightly consider societal effects. However, in doing so, they must adopt policies that mitigate the ethical burdens placed on physicians, respect the testimony of patients in pain, and pay particular attention to how policy guidance is likely to be implemented by others. Finally, we address what duties are owed to patients who are currently taking opioid medication, given evidence that they are experiencing significant barriers in receiving healthcare. We argue that once treatment has been initiated, there are special duties to these patients.
Repair of pulmonary artery sling with tracheal and intracardiac defects
Authors: Muthialu Nagarajan , Martens Thomas , Kanakis Meletios , Bezuska Laurynas , Nakao Masakazu , Derrick Graham , Marek Jan , Khambadkone Sachin , Kostolny Martin , Tsang Victor 
Published: July 2020

Background Pulmonary artery sling is commonly associated with tracheal stenosis and intracardiac anomalies. While surgical repair is standardized, coexistent anomalies often determine outcomes. With the paucity of risk stratification, this study aimed to review our experience and stratify risk factors for the surgical outcome of complex pulmonary artery sling repair in the presence of airway or intracardiac lesions. Methods Seventy-nine consecutive children with pulmonary artery sling were evaluated retrospectively following surgical repair. Median age at surgery was 5 months (interquartile range 3–9). Surgical approaches included pulmonary artery sling alone ( n = 10), pulmonary artery sling with tracheoplasty ( n = 41), and pulmonary artery sling with both intracardiac and tracheal surgery ( n = 28). Results There were 7 early (8.8%) deaths. Two patients after left pulmonary artery reimplantation needed revision of the anastomosis. The median intensive care and hospital stay were 11 (interquartile range 9.2–24.8) and 17.9 (interquartile range 4.3–19.8) days, and considerably longer when associated tracheal surgery ( p = 0.002). Follow-up was complete in 66/69 and 3 (3.8%) children died late: 2.7, 10.2, and 17 months after surgery. Univariate analysis showed abnormal lung and coexisting structural heart disease as risk factors. Multivariate analysis revealed total cardiopulmonary bypass time as an independent predictor of overall mortality. Conclusion Complex pulmonary artery sling repair can be performed with a good surgical outcomes even when associated with airway malformations or structural heart diseases. Lung abnormality and longer cardiopulmonary bypass time as a surrogate marker of complex surgery, are possible risk factors.
Sterility and performance of open and closed extracorporeal circuits after long-term dry-wet setups
Authors: Deptula Joseph , McGrath Catrina , Preston Thomas , Miller Hayden , Yen Bianca , Munari Lenny , Setty Shaun P 
Published: July 2020

Background: The timeframe for safely using previously setup dry, crystalloid, and blood-primed extracorporeal circuits has long been debated. This study was undertaken to determine a safe deviation from standardized recommendations. Methods: Open (cardiopulmonary bypass) circuits and closed extracorporeal membrane oxygenation circuits were setup dry for up to 60 days and wet primed for up to 6 weeks with one control inoculated with Escherichia coli. Open circuits were cultured daily, closed circuits weekly. Circuits were primed with blood, albumin, heparin, NaHCO3, and CaCl2. Baseline pCO2, pO2, hemoglobin, lactate dehydrogenase, and plasma free hemoglobin were measured. Circuits were recirculated at a blood flow of 6 Liters/minute with a sweep gas of 1 Liter/minute at 100% FiO2 for 1 minute. Post oxygenator blood gases were collected at 8-, 16-, and 24-hour intervals. Results: There was no observed compromise to the sterility of the circuits and no clinically significant gas exchange abnormalities observed over the duration of the study period. Statistical significance (p < 0.01) was seen in free hemoglobin and lactate dehydrogenase levels, most significant in between the 16- and 24-hour time point in the closed systems intentionally inoculated with E. coli. Conclusion: Open and closed circuits can be safely setup dry for up to 60 days. Open, wet-primed circuits can be used safely up to 5 days. Closed, wet-primed circuits can be used safely up to 6 weeks. Blood-primed circuits can be safely run up to 16 hours prior to patient use but should be validated in a randomized clinical study.
Minor tributary veins of the common femoral vein near the saphenofemoral junction – A postmortem study
Authors: Mühlberger Dominic , Mumme Achim , Stücker Markus , Brenner Erich , Hummel Thomas 
Published: July 2020

Objectives Recurrent varicose veins after surgery are a frequent burden and the saphenofemoral junction is the most common source of reflux. Pre-existing branches of the common femoral vein near the saphenofemoral junction, which may increase due to haemodynamic or other reasons, could play a role in the development of recurrent varices. There exist only a few anatomical data about the prevalence of these minor venous tributaries of the common femoral vein near the saphenofemoral junction. Therefore, this study aimed to elucidate their frequency and distribution. Method A total of 59 veins from 35 anatomical donors were dissected. The common femoral vein with the adherent parts of the profunda femoris vein and the great saphenous vein was exposed and analysed ex situ. The number of minor tributaries to the common femoral vein was counted and their distances to the saphenofemoral junction as well their diameters were measured. Results We could identify up to 10 minor tributaries of the common femoral vein below the level of the great saphenous vein as far as 6 cm distally and up to four veins above the level as far as 5 cm proximally. The mean diameters of these vessels ranged from 0.5 to 11.7 mm. Most of these vessels were located near the saphenofemoral junction and 3 cm distally. Directly opposite to the opening of the great saphenous vein we could find at least one minor tributary of the common femoral vein in 57%. Conclusions There exist a vast number of minor tributaries of the common femoral vein and they are mainly located near the saphenofemoral junction. Nevertheless, their role in the development of recurrent varices is still unclear and further studies are necessary.
Efficacy of high-intensity laser therapy on arthropathy of the hands in patients with systemic lupus erythematosus: a double-blinded, randomized controlled trial
Authors: Abdel-Aal Nabil Mahmoud , Ali Khadra Mohamed , Eladl Hadaya Mosaad 
Published: July 2020

Objective: To determine the efficacy of high-intensity laser therapy (HILT) on arthropathy of the hands in patients with systemic lupus erythematosus. Design: A double-blinded randomized, controlled study. Setting: Outpatient setting Participants: Fifty patients, 30–50-years-old, suffering from arthropathy of the hands were randomly assigned either into the experimental group, received HILT plus the routine physical therapy program or the control group, received sham HILT plus the same routine physical therapy program. Intervention: All treatment interventions were applied at a frequency of three sessions per week for eight weeks. Outcome measures: Handgrip strength, joints swelling counts, joints tenderness counts, visual analog scale (VAS) were measured before and after eight-weeks of interventions. Results: There were statistically significant differences in handgrip strength, joint swelling count, joint tenderness count and VAS in favor of the study group ( P < 0.05). After eight-weeks of intervention, the mean (SD) for handgrip strength, joint swelling counts, joint tenderness count, and pain score was 28.34 ± 8.3 kg, 4.4 ± 2.18, 5 ± 2.1, and 35.6 ± 13.87 mm in the study group, and 22.96 ± 8.76 kg, 7.36 ± 2.14, 9.08 ± 1.63, and 58.8 ± 10.54 mm in the control group, respectively. The MD (95%CI) for handgrip strength, joint swelling counts, joint tenderness count, and pain score was 5.38(0.53,10.23) kg, −2.96(−4.19, −1.73), −4.08(−5.15, −3.01), and −23.2(−30.2, −16.2) mm between groups, respectively. Conclusions: Adding HILT to the routine physical therapy program might be more effective than routine physical therapy program alone in improving handgrip strength, decreasing joint swelling counts, joint tenderness counts, and pain in patients with arthropathy of the hands.
Comparative Evaluation of Cortical Bone Anatomy of Mandibular Buccal Shelf for Mini Implant Placement in Different Facial Divergence: A Cone Beam Computed Tomography Study
Authors: Trivedi Kalyani , Jani Bharvi K , Hirani Sagar , Radia Mansi V 
Published: July 2020

Aim: The purpose of this study was to use measurements from cone beam computed tomography scans to quantify the cortical bone thickness of mandibular buccal shelf region and preferable site for buccal shelf implant placement in 10 hyperdivergent and 10 hypodivergent patients. Method: 20 cone beam computed tomographies were equally divided based on divergence. 6 sites were examined: mesial of first molar (6M), middle of first molar (6Mi), interdental between the first and second molar (Id), mesial of second molar (7M), middle of second molar (7Mi), and distal of second molar (7D). The study quantified the mandibular buccal shelf relative to its angle of slope, the cortical bone thickness measured perpendicular to the bone surface, the amount of cortical bone 30° angle to the bone surface. The cortical bone thickness was measured perpendicular and at a 30° angle at 3, 5, and 7 mm from the alveolar crest. Result: Significant change is seen at the buccal shelf slope at 6M ( P = .001) and further increase in this angle till 7D ( P = .003). Mean amount of cortical bone for hyperdivergent group at 7D is 4.77 ± 0.68 mm and for hypodivergent group is 3.86 ± 0.70 mm. Statistically significant differences were noted at insertion site at 90° and 30° for both groups at 3, 5, and 7 mm from the alveolar crest. Conclusion: Preferable site for buccal shelf implant placement is distal to the mandibular second molar. The maximum amount of cortical bone is found distal to the second molar 7 mm vertically from alveolar crest when the buccal shelf implant is placed at 30° angulation for hyperdivergent group.
What Is Good Advance Care Planning According to Hospitalized Palliative Patients and Their Families? An Explorative Study
Authors: Vanderhaeghen Birgit , Bossuyt Inge , Menten Johan , Rober Peter 
Published: July 2020

Background: Advance care planning is not well implemented in Belgian hospital practice. In order to obtain successful implementation, implementation theory states that the adopters should be involved in the implementation process. This information can serve as a basis for creating better implementation strategies. Aim: For this study, we asked hospitalized palliative patients and their families what they experienced as good advance care planning. Methods: Twenty-nine interviews were taken from patients and families, following the Tape Assisted Recall procedure of Elliot. These interviews were analyzed using content analysis based on grounded theory. To improve reliability, 3 independent external auditors audited the analysis. Results: Results show that hospitalized palliative patients and families want to have advance care planning communication about treatment and care throughout their disease and about different aspects: social, psychological, physical, practical, and medical. They prefer to have these conversations with their supervising physician. They report 4 important goals of advance care planning communication: establishing a trustful relationship with the physician, in which they feel the involvement of the physician; giving and receiving relevant information for the decision process, making a personal decision about which treatment and care are preferred; and finding consensus between the preferred decision of the physician, the patient and the family concerning the treatment and care policy. Conclusion: This study can contribute to advance care planning implementation in hospital practice because it gives in insight into which elements in advance care planning patients and families experience as necessary and when advance care planning is necessary to them.
Evaluation of Cost, Workflow, and Safety of Implementing a Vial Transfer Device for Ready-to-Mix Drugs at an Academic Medical Center
Authors: Tran Lena K. , Anger Kevin E. , Dell’Orfano Heather , Rocchio Megan A. , Szumita Paul M. 
Published: July 2020

Objective: To evaluate the cost, workflow, and safety of implementing a vial transfer device system. Methods: In this retrospective analysis, pharmacy systems and electronic health record reports identified high-volume and high-cost medications prepared by a Vial2Bag® (V2B) system from July 2017 to June 2018. The major outcome was the extrapolated yearly cost avoidance (EYCA) from utilization of a V2B system, calculated by subtracting total costs of the V2B system from total cost of ready-to-use products and locally compounded sterile products. Secondary outcomes included a workflow and safety analysis. Results: Implementing a V2B system led to a total EYCA of $2 295 261. A total of 283 209 potential V2B units were available for dispensing from automated dispensing systems and 41 082 yearly sterile product room units were avoided. A 0.02% safety report incidence per V2B administration was calculated at our institution. Conclusion: Use of a V2B system resulted in a substantial cost avoidance compared to purchasing commercial products and preparing locally compounded sterile products. The V2B system appears to be a safe addition to further optimize workflow but may require further investigation in prospective analyses.
Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus
Authors: Liszka Henryk , Gądek Artur 
Published: July 2020

Background: The objective of the study was evaluation of the clinical and radiologic outcomes and complications following the minimally invasive chevron procedure employing the Akin osteotomy with percutaneous transosseous suture as compared to screw fixation. Methods: Between 2018 and 2019, the authors performed 103 minimally invasive chevron (MIC) with Akin osteotomies. In 54 patients, the Akin osteotomy was performed with screw stabilization (group A), and in 49 with percutaneous transosseous suture (group B). Preoperatively and 1 year later, the authors employed anteroposterior and lateral weightbearing radiographs of the feet to evaluate interphalangeal angle (IPA), distal phalangeal articular angle (DPAA), proximal phalangeal articular angle (PPAA), intermetatarsal angle (IMA), hallux valgus angle (HVA), and functional result using the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. Furthermore, all additional procedures and complications were recorded. Results: Both groups demonstrated a statistically significant decrease of the value of HVA (group A: from 34.1° to 14.0°, group B: from 33.6° to 13.0°), DPAA (group A: from 12.1° to 4.0°, group B: from 11.5° to 3.4°), PPAA (group A: from 4.6° to 1.7°, group B: from 4.3° to 1.5°), IMA (group A: from 15.1° to 8.0°, group B: from 14.7° to 7.5°) and IPA (group A: from 14.1° to 6.3°, group B: from 12.9° to 5.1°). Functional improvement as measured using the AOFAS scale was achieved in both groups (group A: from 42 to 90 points, group B: from 40 to 89 points). No cases of bone nonunion or delayed union and permanent damage to the medial dorsal cutaneous nerve were seen. Two group B patients underwent conversion of the fixation of the Akin osteotomy to screws, 3 patients had their MICA screws and 1 Akin screw removed in the outpatient setting. Conclusion: The minimally invasive chevron osteotomy with transosseous suture stabilization of the Akin osteotomy was a safe method with good functional results that were comparable to the outcomes achieved when using screw fixation. Level of Evidence: Level III, retrospective comparative study.
Real-world evidence of poly ADP-ribose polymerase inhibitors in the treatment of ovarian cancer: A systematic literature review
Authors: Borrelli Eric P , McGladrigan Conor G 
Published: July 2020

Objective The treatment landscape for ovarian cancer has shifted in recent years with the approval of poly ADP-ribose polymerase inhibitors in 2014. Most patients with ovarian cancer have advanced disease at diagnosis. Understanding how treatments for advanced disease work in real-world settings must be assessed to provide care for these patients. Therefore, the objective of this study was to locate and assess real-world studies measuring the safety and effectiveness of poly ADP-ribose polymerase inhibitors and analyze the results. Data sources: A targeted systematic literature review was conducted in April 2020 of PubMed/Medline. Inclusion criteria consisted of observational studies using real-world data of olaparib, rucaparib, or niraparib as an intervention in the treatment of ovarian cancer. In addition, studies needed to assess either clinical effectiveness or safety. Once studies were identified, we aimed to narratively describe the studies’ patient population, intervention effectiveness, and/or safety. Data summary: Our systematic review identified six studies assessing the real-world effectiveness and/or safety of poly ADP-ribose polymerase inhibitors, with five assessing olaparib, one assessing poly ADP-ribose polymerase inhibitors as a composite, and none assessing either niraparib or rucaparib. The median progression free survival in the real-world trials for olaparib ranged from 12.7 to 15.6 months. The median overall survival in the real-world trials for olaparib ranged from 30.9 to 35.4 months. Rates of treatment discontinuation due to adverse events for olaparib ranged from 4.4% to 12.5%. Conclusions The identified studies showed slightly higher, but comparable results for median progression free survival, median overall survival, and discontinuation due to adverse events compared to the respective randomized controlled trials.
Professional identity construction among social work agencies
Authors: Yang Hui , Wang Ruxin , Chen Honglin 
Published: July 2020

Summary Social work agencies in China are encountering issues like lack of social perception, social recognition, and public participation and insufficient competitiveness of their professional services. To discuss solutions to these problems, this study adopts a different perspective than existing studies, focusing on professional identity construction among social work agencies. It provides an effective theoretical framework that includes value, contextual, and symbolic identity construction embedded in the Chinese administrative institution. Findings Positive and negative factors influencing the construction of professional cultural, status, and brand identity among social work agencies and approaches are identified. In the context of government purchasing of public services, the professional cultural identity of Chinese social work agencies can integrate with traditional Chinese culture and Western social work values to enhance the cultural consciousness and introspection of agencies. Professional status identity helps agencies access government resources and establish professional authority. Professional brand identity can increase the identification of the agencies under the political features of party construction. The combination of the three can promote the development of Chinese social work. Applications Professional identity construction offers a new perspective to improve the credibility, competitiveness, and public recognition of social work agencies in China to attract social participation and perform the function of social governance more effectively. Social organizations can improve their professional status and brand identities by refining their professional cultural and promotional systems, fostering the development of institutional credibility, and cultivating professional service projects.
Investigating the causes of patient anxiety at induction of anaesthesia: A mixed methods study
Authors: Lumb Andrew B , Latchford Gary J , Bekker Hilary L , Hetmanski Anna R , Thomas Caroline R , Schofield Claire E 
Published: July 2020

Aim To investigate patient anxiety at anaesthetic induction and whether this is affected by anaesthetic room interventions. Methods A mixed methods study was carried out: pre-induction interventions were directly observed. Patient anxiety was assessed quantitatively with cardiovascular changes, the visual analogue scale and the state-trait anxiety inventory. Interviews allowed qualitative assessment. Results Patient-reported anxiety did not correlate with cardiovascular changes. Anaesthetic room interventions were not predictive of anxiety. Postoperative interviews identified five sources of anxiety, mostly related to preparation for surgery. Staff responses to anxiety were also highlighted. Discussion Patient-reported anxiety and its biological response are not correlated. Pre-induction interventions do not contribute to anxiety. Anxiety levels at induction are similar to or lower than earlier in the preoperative period. Conclusions On induction of anaesthesia, patients have little control over their situation but are actively reassured and distracted by theatre staff. Our data suggest staff are good at this. More could still be done to reduce preoperative sources of anxiety.