bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pedicle frozen autograft-prosthesis composite reconstructions for malignant bone tumors of the proximal femur
Authors: xu gang , Miwa Shinji , Yamamoto Norio , Hayashi Katsuhiro , Takeuchi Akihiko , Igarashi Kentaro , Taniguchi Yuta , Araki Yoshihiro , Yonezawa Hirotaka , Morinaga Sei , Tsuchiya Hiroyuki 
Published: November 2019

Abstract
Background
Limb salvage surgery is becoming increasingly popular after tumor resection in the lower extremity. Biological reconstruction and use of megaprosthesis are main methods for malignant bone tumors of the proximal femur, which remain controversial due to short- and long-term complication in the proximal femur. Tumor-bearing bone treated by liquid nitrogen is one of biological reconstruction. This study aimed to evaluate the mid- and long-term functional outcomes and complications in patients treated with frozen autograft–prosthesis composite (FAPC) reconstructions in the proximal femur.
Methods
This retrospective study included 19 patients (10 women, 9 men) with malignant tumors of the proximal femur who underwent tumor-wide resection and FAPC reconstruction (mean age, 46 years; range, 9-77 years). The mean follow-up period of 66 months (range, 9-179 months). Functional outcomes, oncological outcome and complications were evaluated by Musculoskeletal Tumor Society score, clinical and radiological examinations.
Results The overall survival rate was 68.4%, and the mean Musculoskeletal Tumor Society functional score was 26.4 points (88%). FAPC survival rates were 100% and 50% at 5 and 10 years, respectively. Five of the 19 patients (26%) had complications: 2 required prosthesis removal and 2 developed a deep infection around acetabular. Wear of the acetabulum occurred in 2 cases, while disease recurrence was occurred in 1 case. There were no cases of greater trochanter avulsion, obvious absorption around frozen bone, prosthesis loosening or leg length discrepancy. Conclusions Due to without femoral osteotomy, ease of soft-tissue attachment and preservation of bone matrix, FAPC reconstruction provide early limb stability and satisfactory functional outcome after malignant bone tumor resection in the proximal femur.
Principal Surrogates in Context of High Vaccine Efficacy
Authors: Callegaro Andrea , Fabian Tibaldi , Follmann Dean 
Published: November 2019

Abstract
Background: The use of correlates of protection (CoPs) in vaccination trials offers significant advantages as useful clinical endpoint substitutes. Vaccines with very high vaccine efficacy (VE) are documented in the literature (95% or above). Callegaro and Tibaldi, (2019) showed that the rare infections observed in thevaccinated groups of these trials poses challenges when applying conventionally-used statistical methods for CoP assessment such as the Prentice criteria and meta-analysis.Methods: In this paper, we extended Callegaro and Tibaldi, (2019) simulation study by evaluating the impact of high VE on the Principal stratification approach.Results: Similarly to the Prentice framework, we showed that the power decreases when the VE grows. It follows that it can be challenging to validate a principal surrogate (and a statistical surrogate) when rare infections are observed in the vaccinated groups.
Association Between Charlson Comorbidity Index and Complications of Endoscopic Resection of Gastric Neoplasms in Elderly Patients
Authors: Kim Sunmin , Kim Dong Hyun , Park Seon-Young , Park Chang Hwan , Kim Hyun Soo , Choi Sung Kyu , Rew Jong Sun 
Published: November 2019

Abstract
Background Although endoscopic resection is safe and effective for gastric epithelial neoplasms, information is limited on its efficacy and safety in extremely elderly patients who have various comorbidities. Further, the relationship between comorbidities and complications of endoscopic resection is not well established. Therefore, we aimed to evaluate the efficacy and safety of endoscopic resection of gastric epithelial neoplasms in extremely elderly patients. Methods From October 2008 to December 2017, 4475 consecutive patients underwent endoscopic resection of gastric epithelial neoplasms. Among them, 242 were 75 years or older. We assessed Charlson comorbidity index (CCI) scores, procedural outcomes, and procedure- and sedation-related complications related to endoscopic resection. Results Mean patient age was 78 (range, 75–88) years. Of the 242 patients, 124 (51.2%) had low-grade dysplasia and 112 (46.3%) had high-grade dysplasia or adenocarcinoma. The most common comorbidity was hypertension (55.4%), followed by diabetes (23.1%). The mean CCI score was 5.0 ± 1.5. Eighty patients (33.1%) had a CCI score ≥ 6. During the procedure, 10 (4.1%) patients had desaturation that recovered by flumazenil use with mask (n=2) or Ambu bag (n=3) ventilation. During subsequent admission, in addition to abdominal pain (35.1%), atelectasis and pneumonia occurred in 45 (18.6%) patients, hypotension in 27 (11.2%), and post-procedural bleeding in 12 (5.0%). Respiratory complications were more common in patients with a CCI score ≥ 6 (23/80, 28.7%) than in those with a CCI score < 6 (22/162, 13.6%, P=0.001). Conclusions CCI score is related to respiratory complications of endoscopic resection in elderly patients. Endoscopic resection must be performed cautiously, particularly in elderly patients with a high CCI score, to prevent respiratory complications.
The construction of a framework explaining the relation between barriers to change in nursing homes: a qualitative study
Authors: Teunenbroek Charlotte Frederike van , Verhagen Kim , Smalbrugge Martin , Persoon Anke , Zuidema Sytse U. , Gerritsen Debby L. 
Published: November 2019

Abstract
Background Many studies have tried to achieve change in the treatment of neuropsychiatric symptoms in nursing homes, however only few of them succeeded. Numerous barriers to change were identified, yet only one conceptual model is known to study the relationships between these barriers in healthcare. Unfortunately, this model does not discuss specific barriers encountered in nursing home practice. The aim of this study is to explore perceived barriers to change in nursing home organizations and to construct a framework providing insight into the relative importance of and the relationships between these barriers with regard to improving quality of care.Methods In order to explore the barriers to change in nursing home care, four focus groups were conducted in different dementia special care units of one nursing home in the Netherlands, with a specific focus on NPS and psychotropic drug use. Participants were either nursing staff, treatment staff or relatives of residents. Qualitative thematic analysis was conducted according to the five phases constructed by Braun & Clarke. Finally, a conceptual framework showing the interrelations of themes was defined using text fragments of the focus groups.Results We constructed a framework consisting of eight themes of barriers explaining the extent to which change can be achieved: 'organizational barriers', 'personal barriers', 'deficiency of knowledge', 'suboptimal communication', 'inadequate (multidisciplinary) collaboration', 'disorganization of processes', 'reactive coping' and 'differences in perception'. Addressing 'organizational barriers' and a 'deficiency of knowledge' is a precondition for change. 'Suboptimal communication' and 'inadequate (multidisciplinary) collaboration' play a key role in the extent of change achieved via the themes 'differences in perception' and 'disorganization of processes'. Furthermore, 'personal barriers' influence all themes - except 'organizational barriers' - and influence the extent of change. 'Personal barriers' can cause 'reactive coping', which in turn may lead to 'difficulties t structure processes'.Conclusions A framework was created explaining the relationships between barriers towards achieving change in nursing homes, focused on improving quality of care. This framework can be used to study the interrelatedness of barriers to change, and to determine the importance of addressing it in order to achieve change in the provided care.
Gait, cognition and falls over 5 years, and Motoric Cognitive Risk in New Zealand octogenarians: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS
Authors: Lord Sue , Moyes Simon , Teh Ruth , Port Waiora , Muru-Lanning Marama , Bacon Catherine , Wilkinson Tim , Kerse Ngaire 
Published: November 2019

Abstract
Introduction Understanding falls risk in advanced age is critical with people over 80 a rapidly growing demographic. Slow gait and cognitive complaint are established risk factors and together comprise the Motoric Cognitive Risk Syndrome (MCR).Objectives To examine trajectories of gait and cognition, and associations with falls over 5 years, and to document MCR in Māori and non-Māori of advanced age living in New Zealand.Method Falls frequency was ascertained retrospectively at annual assessments. Gait speed (3m), cognition (3MS) and MCR were reported. Gait and cognition trajectories were modelled and clusters identified from Latent Class Analysis. GEE examined association between changes in gait, cognition, MCR and falls.Results At baseline, 138 of 408 Māori (34%) and 205 of 512 non-Māori (40%) had fallen. Mean (SD) gait speed (m/s) for Māori was 0.66 (0.29) and 0.82 (0.26) for non-Māori. Respective 3MS scores were 86.2 (15.6) and 91.6 (10.4). Ten (4.3%) Maori participants met MCR criteria, compared with 7 (1.9%) non-Māori participants. Māori men were more likely to fall (OR 1.56; 95% CI 1.0 – 2.43 ( P = 0.04) whilst for non-Māori slow gait increased falls risk (OR 0.40; 95% CI 0.24 – 0.68( P <0.001). Non-Māori with MCR were more than twice as likely to fall than those without MCR (OR 2.45; 95% CI 1.06 – 5.68 ( P = 0.03).Conclusions Māori and non-Māori of advanced age show a mostly stable pattern of gait and cognition over time. Risk factors for falls differ for Māori, and do not include gait and cognition.
Abnormal Cisatracurium Pharmacodynamics and Pharmacokinetics among Patients with Severe Aortic Regurgitation during Anesthetic Induction
Authors: Huang Xiaocong , Chen Lei , Cai Yujing , Wei Jinfeng , Lin Lina , Sun Jie , Peng Xuemei , Wang Sheng 
Published: November 2019

Abstract
Purpose This study was designed to examine whether severe aortic regurgitation (AR) will affect the pharmacodynamics (PD) and pharmacokinetics (PK) of cisatracurium during anesthetic induction.
Method s A total of 32 patients were divided into two groups: the AR group (n=16) and the control group (n=16). Arterial blood samples were drawn before and at 1, 2, 4, 6, 8, 10, 16 and 20 minutes after intravenous injection of 0.15mg/kg cisatracurium. TOF tests were applied to determine the onset time of maximal muscle relaxation. The concentration of cisatracurium in plasma was determined by high-performance liquid chromatography.
Results The time to maximal neuromuscular block was prolonged from 2.07(0.32) minutes to 4.03(0.56) minutes, which indicated that the PD responses to cisatracurium were significantly delayed in the AR group (P<0.01) compared to the control group.
A conventional two-compartment PK model showed a higher plasma concentration of cisatracurium among the AR group with markedly reduced intercompartment transfer rate (K 12 = 0.19(0.02) and K 21 = 0.11(0.01) in the AR group vs. K 12= 0.26(0.01) and K 21 = 0.19(0.01) in the control group, P<0.01) compared to the control group.
Conclusion Backward blood flow during diastole in severe AR impaired distribution of cisatracurium from the central compartment to the peripheral compartment, which accounted for the lagged PD responses.
Findings from this study may provide useful guidance for safe administration of cisatracurium and reasonable prediction of PD responses during anaesthetic induction among patients with severe AR.
Randomized controlled clinical trial evaluating the efficacy of hyperbaric oxygen therapy in facilitating the healing of chronic foot ulcers in diabetic patients: the study protocol
Authors: Lopes Jocefabia Reika Alves , Dias Mariza D’Agostino , Correa João Antonio , Batalha Maria Alice Bragagnolo , Guerra Luanda Karla Dantas 
Published: November 2019

Abstract
Background: Diabetic limb ulcers are highly prevalent and contribute to a significant increase in cost for the treatment of these patients in health services. However, healing of these wounds is a major health problem and may even lead to amputation. The aim of the current study is to evaluate the efficacy of hyperbaric oxygen therapy (HBOT) in facilitating the healing of diabetic foot ulcers and reducing the number of amputations in these patients.Methods : The study will be conducted in the city of Imperatriz, Maranhão from 2019 to 2020, in diabetic patients with chronic foot ulcers (classified as Wagner grade 2, 3, and 4, persisting for more than one month). The outpatient follow-up for diabetic foot patients will be done at the SUS (Unified Health System), with a sample size of 120 patients (60 patients for each arm). Half of the patients will receive standard treatment, i.e. dressings, debridement, antibiotics, and load relief, along with HBOT (HBOT group), and the other half will receive only standard treatment (control group). The patients of the HBOT group will be evaluated upon admission, after 10, 20, 30 and 35 HBOT sessions, and after six months. The patients of the control group will also be evaluated at equivalent periods. The progression of the wounds and specific treatment, such as appropriate bandage, antibiotic therapy, or need of some surgical intervention will be evaluated on a weekly basis. The SF-36 quality of life questionnaire will be filled upon admission and after three months of follow-up in both groups. Upon admission, the patients of both groups will undergo arterial Doppler ultrasound, and laboratory tests–complete blood count, erythrocyte sedimentation rate, C-reactive protein, creatinine, fasting blood glucose, and glycosylated haemoglobin.Discussion : Diabetic foot ulcers are a highly prevalent complication of diabetes with serious consequences. A study to assess the efficacy of HBOT in healing the ulcers and reducing the rate of amputations in diabetic patients is justified, which will eventually aid in the development of guidelines for treating these ulcers.
Adjunctive Subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: A systematic review and meta-analysis
Authors: Zhao Han , Hu Jingchao , Zhao Li 
Published: November 2019

Abstract
Background Subgingival applications of chlorhexidine (CHX) gel are commonly used as an adjunct in nonsurgical periodontal treatment (NSPT) for chronic periodontitis (CP). However, there is lack of data supporting the effects of adjunctive CHX gel on clinical outcomes. The objective of this meta-analysis was to evaluate the efficacy of adjunctive subgingival administration of CHX gel in NSPT compared to NSPT alone for CP.Methods An electronic search of four databases and a manual search of four journals were conducted up to August 2019. Only randomized controlled trials reporting on the clinical outcomes of subgingival use of CHX gel adjunct to scaling and root planing (SRP), as compared to SRP alone or with placebo, for at least 3 months were included. Primary outcomes were probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at 3 and 6 months, when data on at least three studies were obtained.Results 17 studies were included for qualitative analysis and seven studies for quantitative analysis (four studies for the application of CHX gel adjunct to SRP at selected sites with at least pocket depth≥4mm and three studies for comparison of full-mouth disinfection (FMD) with subgingival use of CHX gel and full-mouth scaling and root planing (FMSRP). For subgroups, the clinical outcomes between adjunctive use of Xanthan-based CHX gel (XAN-CHX gel) and CHX gel were analyzed. Results indicated a significant improvement of PPD reduction following local adjunctive administration of XAN-CHX gel for SRP at selected sites (MD: 0.15mm). However, no difference was found in CAL gain. Moreover, no significant difference was observed in PPD and CAL at both 3 and 6 months post-treatment between FMD and FMSRP.Conclusion Adjunctive subgingival administration of XAN-CHX gel at individual selected sites appears to provide slight benefits in PPD reduction. Due to the lack of high-quality studies, further studies with larger sample sizes and strict standards are needed to confirm the conclusions.
The relationship between endothelial progenitor cells and pulmonary hypertension in children with congenital heart disease
Authors: Sun Hong-Xiao , Li Guo-Ju , Du Zhan-Hui , Bing Zhen , Ji Zhi-Xian , Luo Gang , Pan Silin 
Published: November 2019

Abstract
Background: To assess the relationship between endothelial progenitor cells (EPCs) in peripheral blood and pulmonary hypertension (PH) in children with congenital heart disease (CHD) and explore the possibility of applying EPCs to treatment of PH in children with CHD. Methods: In this study, a total of 173 cases with CHD (from 0 to 6 years old) were collected. According to the right heart catheterization of mean pulmonary arterial pressure (mPAP) results, these cases were divided into PH groups (including high PH group, n=32, and the middle PH group, n=30) and non-PH group (n=111). We took their peripheral blood for flow cytometry, and counted the number of EPCs(CD133+/KDR+ cells). The number of EPCs /μL of peripheral blood was calculated using the following formula: EPCs /μL =WBC /L × lymphocytes % × EPCs % × 10-6. Results: The median EPCs of the non-PH group, middle PH group and high PH group are 1.86/μL, 1.30 /μL and 0.98/μL, respectively. The mPAP decreases steadily as the level of EPCs increases (P<0.05). After adjustment of gender, age and BMI, the EPCs was significantly associated with a decreased risk of high PH (OR=0.37, 95%CI: 0.16-0.87, P<0.05). However, EPCs was not significantly associated with middle PH (P>0.05). Conclusion: The findings revealed that the EPCs and high PH in CHD patients correlate significantly and EPCs may become an effective treatment for PH in CHD patients.EPCs may be a protective factor of high PH for children with CHD.
Integrated Care Search: Development and validation of a PubMed search filter for retrieving the integrated care research evidence
Authors: Damarell Raechel A. , Lewis Suzanne , Trenerry Camilla , Tieman Jennifer J. 
Published: November 2019

Abstract
Background Integrated care is an increasingly important principle for organising healthcare. Integrated care models show promise in reducing resource wastage and service fragmentation whilst improving the accessibility, patient-centredness and quality of care for patients. Those needing reliable access to the growing research evidence base for integrated care can be frustrated by search challenges reflective of the topic's complexity. The aim of this study is to report the empirical development and validation of two search filters for rapid and effective retrieval of integrated care evidence in PubMed. One filter is optimised for recall and the other for precision.Methods An Expert Advisory Group comprising international integrated care experts guided the study. A gold standard test set of citations was formed from screening Handbook Integrated Care chapter references for relevance. This set was divided into a Term Identification Set (20%) for determining candidate terms using frequency analysis; a Filter Development Set (40%) for testing performance of term combinations; and a Filter Validation Set (40%) reserved for confirming final filter performance. In developing the high recall filter, recall was steadily increased while maintaining precision at ≥ 50%. Similarly, the high precision filter sought to maximise precision while keeping recall ≥ 50%. For each term combination tested, an approximation of precision was obtained by reviewing the first 100 citations retrieved in Medline for relevance.Results The gold standard set comprised 534 citations. The search filter optimised for recall ('Broad Integrated Care Search') achieved 86.0%-88.3% recall with corresponding low precision (47%-53%). The search filter optimised for precise searching ('Narrow Integrated Care Search') demonstrated precision of 73%-95% with recall reduced to between 55.9% and 59.8%. These filters are now available as one-click URL hyperlinks in the website of International Foundation for Integrated Care.Conclusions The Broad and Narrow Integrated Care Search filters provide potential users, such as policy makers and researchers, seamless, reliable and ongoing access to integrated care evidence for decision making. These filters were developed according to a rigorous and transparent methodology designed to circumvent the challenges of information retrieval posed by this complex, multifaceted topic.
Power and complexity in obstetric teamwork: an observational study.
Authors: Neuhaus Christopher , Lutnaes Dag Erik , Bergström Johan 
Published: November 2019

Abstract
Background In recent years, increasing attention has been paid to team processes in peripartum care settings with the aim to improve fetomaternal outcomes. However, we have yet to understand how the perception of teamwork in peripartum care is shaped in a complex, multi-disciplinary environment.Methods The aim of this study was to approach the question using a qualitative social-scientific methodology. The theoretical foundation of the study was that obstetric teamwork is the result of a balancing act in which multiple goal conflicts are continuously negotiated and managed right at the boundary of acceptable performance in a complex adaptive system. We explored this theory by gathering lived experiences, from multiple perspectives, of successful management of peripartum emergencies in the setting of a German university hospital. Based on our analysis we generated an understanding of teamwork as a phenomenon emerging from interpersonal relationships, complex relations of power, and the enactment of current quality management practices.Results Caregivers often define teamwork through the quality of their collaboration, defined by respect and appreciation, open communication, role distribution, and shared experiences. However, teamwork also becomes the framework for negotiation of many conflicts that originated elsewhere. Power, in various forms, was the core theme that emerged in the analysis of our participants’ narratives, which is in stark contrast to the otherwise promoted egalitarian rhetoric of team training. While our participants generally reverted to explanations based on their professional identities, traditions or cultures, interesting dynamics become visible when work is viewed through the power lens.Conclusions Our study paints the convoluted picture of a work environment with all its intricacies, constraints, interpersonal relations and hierarchical struggles that are much more representative of a complex system rather than the easily tractable environment that so many stakeholders would like healthcare practitioners to believe in. The issue of power emerged as a decisive factor in the social dynamics at the workplace, revealing hidden agendas in the teamwork discourse.