bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of surgery using a locking plate for proximal humerus fractures in patients older than 80 years: A retrospective case series
Authors: Shin Won Chul , Kang Suk-Woong , Son Seung Min , Bae Hyuk 
Published: November 2019

Abstract
Background: To evaluate the results of surgical treatment using a locking plate for proximal humeral fractures in patients aged >80 years.

Methods: Between September of 2013 and March of 2016, there were 22 patients who received locking plate fixation from proximal humeral fractures over 80 years-old. Among the 22 cases, Clinical, radiological results were analyzed for 19 patients who were able to follow up more than one year. We analyzed bone union, neck-shaft angle, UCLA score, range of motion compared to opposite side and complication. Clinical, radiological results were investigated for medial comminuted fracture or not.

Results: All the patients achieved bone union. The mean bone union time was 13.7 weeks, and the mean neck-shaft angle was 126.4. The mean University of California, Los Angeles, shoulder score was 22.4, and score was <28 point in 12 patients. The mean forward flexion, abduction, external rotation, and internal rotation angles were 129.2°, 112.3°, 44.2°, and L2. All motions were significantly different from the normal shoulder motion. A significant difference was found in the loss of neck-shaft angle according to the medial comminuted fracture.

Conclusion: In the surgical treatment of proximal humeral fractures in patients aged >80 years, use of a locking plate attained bone union with relatively satisfactory results. However, we considered that prevention of and training for postoperative stiffness are necessary. Other surgical methods should be considered for patients with complex displaced fractures, especially those with medial comminuted fractures.
The prognostic value of postoperative blood glucose in non-diabetic patients with rheumatic heart disease
Authors: Hong Wanzi , Wang Yu , Yu Hongjiao , Wei Xuebiao , Yu Danqing , Zhang Chunxiang , Tan Ning , Jiang Lei 
Published: November 2019

Abstract
Background: Blood glucose (BG) is a risk factor of adverse prognosis in non-diabetic patients in several conditions. However, a limited number of studies were performed to explore the relationship between postoperative BG and adverse outcomes in non-diabetic patients with rheumatic heart disease (RHD).
Methods: We identified 1395 non-diabetic patients who diagnosed with having RHD, and underwent at least one valve replacement and preoperative coronary angiography. BG was measured at admission to the intensive care unit (ICU) after surgery. The association of postoperative BG level with in-hospital and one-year mortality was accordingly analyzed.
Results: Included patients were stratified into four groups according to postoperative BG level’s (mmol/L) quartiles: Q1 (< 9.3 mmol/L, n=348), Q2 (9.3-10.9 mmol/L, n=354), Q3 (10.9-13.2 mmol/L, n=341), and Q4 (≥ 13.2 mmol/L, n=352). The in-hospital death (1.1% vs. 2.3% vs. 1.8% vs. 8.2%, P<0.001) and MACEs (2.0% vs. 3.1% vs. 2.6% vs. 9.7%, P<0.001) were significantly higher in the upper quartiles. Postoperative BG > 13.0 mmol/L was the best threshold for predicting in-hospital death (area under the curve (AUC) = 0.707, 95% confidence interval (CI): 0.634-0.780, P<0.001). Multivariate logistic regression analysis indicated that postoperative BG > 13.0 mmol/L was an independent predictor of in-hospital mortality (adjusted odds ratio (OR) = 3.418, 95% CI: 1.713–6.821, P<0.001). In addition, Kaplan–Meier curve analysis showed that the risk of one-year death was increased for a postoperative BG > 13.2 (log-rank = 32.762, P<0.001).
Conclusion: Postoperative BG, as a routine test, could be served as a risk measure for non-diabetic patients with RHD.
Stress ulcer prophylaxis with proton pump inhibitors or histamine 2 receptor antagonists in critically ill adults - A meta-analysis of randomized controlled trials with trial sequential analysis.
Authors: Zhou Xiaoyang , Fang Hanyuan , Xu Jianfei , Chen Peifu , Hu Xujun , Chen Bixin , Wang Hua , Hu Caibao , Xu Zhaojun 
Published: November 2019

Abstract
Background

Proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) have been widely used as stress ulcer prophylaxis (SUP) in critically ill patients, however, its efficacy and safety remain unclear. This study aimed to assess the effect of SUP on clinical outcomes in critically ill adults.Methods

Literature search was conducted in PubMed, EMBASE, Web of Science, and the Cochrane database of clinical trials for randomized controlled trials (RCTs) that investigated SUP, with PPI or H2RA, versus placebo or no prophylaxis in critically ill patients from database inception through 1 June 2019. Study selection, data extraction and quality assessment were performed in duplicate. The primary outcomes were clinically important gastrointestinal (GI) bleeding and overt GI bleeding. Conventional meta-analysis with random-effects model and trial sequential analysis (TSA) were performed.Results

Twenty-nine RCTs were identified, of which four RCTs were judged as low risk of bias. Overall, SUP could reduce the incident of clinically important GI bleeding [relative risk(RR)= 0.58; 95% confidence intervals (CI): 0.42–0.81] and overt GI bleeding (RR= 0.48; 95% CI: 0.36–0.63), these results were confirmed by the sub-analysis of trials with low risk of bias, TSA indicated a firm evidence on its beneficial effects on the overt GI bleeding (TSA-adjusted CI: 0.31–0.75), but lack of sufficient evidence on the clinically important GI bleeding (TSA-adjusted CI: 0.23–1.51). Among patients who received enteral nutrition (EN), SUP was associated with a decreased risk of clinically important GI bleeding (RR=0.61; 95% CI: 0.44–0.85; TSA-adjusted CI: 0.16–2.38) and overt GI bleeding (RR=0.64; 95% CI: 0.42–0.96; TSA-adjusted CI: 0.12–3.35), but these benefits disappeared after adjustment with TSA. Among patients who did not receive EN, SUP had only benefits in reducing the risk of overt GI bleeding (RR=0.37; 95% CI: 0.25–0.55; TSA-adjusted CI: 0.22–0.63), but not the clinically important GI bleeding (RR=0.27; 95% CI: 0.04–2.09).Conclusions

SUP has benefits on the overt GI bleeding in critically ill patients who did not receive EN, however, its benefits on clinically important GI bleeding still needs more evidence to confirm.
Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update.
Authors: Krastman Patrick , Mathijssen Nina M. , Bierma-Zeinstra Sita M.A. , Kraan Gerald , Runhaar Jos 
Published: November 2019

Abstract
Background The standard diagnostic work-up for hand and wrist fractures consists of history taking, physical examination and imaging if needed, but the supporting evidence for this work-up is limited. The purpose of this study was to systematically examine the diagnostic accuracy of tests for hand and wrist fractures.

Methods A systematic search for relevant studies was performed. Methodological quality was assessed and sensitivity (Se), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted from the eligible studies.

Results Of the 35 eligible studies, two described the diagnostic accuracy of history taking for hand and wrist fractures. Physical examination with or without radiological examination for diagnosing scaphoid fractures (five studies) showed Se, Sp, accuracy, PPV and NPV ranging from 15-100%, 13-98%, 55-73%, 14-73% and 75-100%, respectively. Physical examination with radiological examination for diagnosing other carpal bone fractures (one study) showed a Se of 100%, with the exception of the triquetrum (75%). Physical examination for diagnosing phalangeal and metacarpal fractures (one study) showed Se, Sp, accuracy, PPV and NPV ranging from 26-55%, 13-89%, 45-76%, 41-77% and 63-75%, respectively.
Imaging modalities of scaphoid fractures showed predominantly low values for PPV and the highest values for Sp and NPV (24 studies). Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Ultrasonography (US) and Bone Scintigraphy (BS) were comparable in diagnostic accuracy for diagnosing a scaphoid fracture, with an accuracy ranging from 85-100%, 79-100%, 49-100% and 86-97%, respectively. Imaging for metacarpal and finger fractures showed Se, Sp, accuracy, PPV and NPV ranging from 73-100%, 78-100%, 70-100%, 79-100% and 70-100%, respectively.

Conclusions Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures in the current review. Physical examination was of moderate use for diagnosing a scaphoid fracture and of limited use for diagnosing phalangeal, metacarpal and remaining carpal fractures. MRI, CT and BS were found to be moderately accurate for the definitive diagnosis of clinically suspected carpal fractures.
Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up
Authors: Maldonado David R. , Yelton Mitchell J. , Rosinsky Philip J. , Shapira Jacob , Meghpara Mitchell , Domb Benjamin 
Published: November 2019

Abstract
Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting Patient Reported Outcomes (PROs) and return to play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic surgery and (2) compare outcomes between recreational and competitive tennis players.
Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated.
Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% return to sport rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS.
Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved.
Association between renal function and bone mineral density in healthy postmenopausal Chinese women
Authors: Li Shuang , Zhan Junkun , Wang Yanjiao , Wang Yi , He Jieyu , Huang Wu , Sheng Zhifeng , Liu Youshuo 
Published: November 2019

Abstract
Background: The relationship between renal function and bone mineral density (BMD) is controversial. The aim of this study was to determine the relationship of renal function with BMD and osteoporosis risk in healthy postmenopausal Chinese women. Methods: A cross-sectional study was conducted in 776 healthy postmenopausal Chinese women. Dual-energy X-ray absorptiometry was used to measure BMDs. Clinical, demographic, and biochemical data were obtained at the time of image acquisition. Estimated glomerular filtration rate (eGFR) was calculated using a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Results: Women with eGFR levels of at least 90 ml/min/1.73m2 had a lower prevalence of osteoporosis compared with women with decreased eGFR levels (60 ml/min/1.73 m2 ≤ eGFR < 90.0 ml/min/1.73 m2). BMDs at femoral neck and total hip were significantly lower in the lower eGFR class than the higher class (0.717 ± 0.106 vs 0.744 ± 0.125 g/cm2, P < 0.01; 0.796 ± 0.116 vs 0.823 ± 0.129 g/cm2, P < 0.01, respectively). eGFR was positively correlated with BMDs at femoral neck and total hip in unadjusted analysis (P <0.05). After controlling for age, menopausal duration and body mass index (BMI), decreased eGFR was not associated with osteoporosis risk. Conclusions: After adjustments for age, menopausal duration and BMI, the decline in renal function was not independently associated with osteoporosis risk in healthy postmenopausal Chinese women.
Correlation between 61 risk factors and vancomycin blood concentration reached based on real world data
Authors: Chen Haiqin , Shi Qing-ping , Kong Lingti , Zhu Yulin , Zhu jinxiu 
Published: November 2019

Abstract
Background: Vancomycin (VAN), an antibiotic produced by microbial fermentation, is used to treat gram-positive infections. With extensive broad-spectrum antibiotics use, bacterial resistance to vancomycin continues to increase. In this study, we explored the factors affecting the blood concentration of vancomycin and established a prediction equation for VAN blood concentration, providing a reference for the individual application of vancomycin.
Methods: We used a single-center, retrospective, case-control study design based on real-world data from the Hospital Information System of the First Affiliated Hospital of the Teaching Hospital of Bengbu Medical School from January 1, 2017, to December 31, 2018. Inpatients whose VAN blood concentration (enzyme amplification immunoassay) was monitored were selected. Single-factor and multivariate logistic regression analyses were performed using SPSS 21.0 software to screen factors affecting VAN blood concentration compliance rate. VAN blood concentration was then determined. A receiver operator characteristic (ROC) curve of influencing factors was then used to establish a prediction model.
Results: In total, 168 patients (122 males and 46 females) were enrolled. Eighty-one had their VAN blood concentration monitored, and 87 had concentrations that did not reach the standard. Multivariate logistic model analyses showed that patient drug allergy history, alanine aminotransferase (ALT), aspartate aminotransferase (AST), patient infusion volume, and urine volume influenced VAN blood concentration compliance rate. According to logistic model analysis, a history of drug allergy (95% CI: 1.225-24.850, P<0.05), ALT (95% CI: 0.979-0.999, P<0.05), AST (95% CI: 1.003-1.027, P<0.05), patient infusion volume (95% CI: 0.996-0.998, P<0.05), patient urine volume (95% CI: 1.001-1.003, P<0.05), and combined predictors were used to construct ROC curves. For combined predictive factors, area under the ROC curve (0.829, 95% CI: 0.755-0.902, P<0.005) was greater than that of the five individual indicators and was predicted to be the preferred value.
Conclusions: In clinical practice, the patient’s daily average infusion and urine volumes can be substituted into the joint predictor calculation formula: P=1/[1+e-(0.940-0.004*Xinfusion+0.002*Xurine)]. By calculating the combined predictive factor to predict VAN blood concentration compliance rate, the dosing regimen can be adjusted.
Keywords: Real-world research; Vancomycin; Blood concentration monitoring; Influencing factor; Logistic regression analysis
Predicting patient outcomes in psychiatric hospitals with routine data: a machine learning approach
Authors: Wolff Jan , Gary Alexander , Jung Daniela , Normann Claus , Kaier Klaus , Binder Harald , Domschke Katharina , Klimke Ansgar , Franz Michael 
Published: November 2019

Abstract
Background:A common problem in machine learning applications is availability of data at the point of decision making. The aim of the present study was to use routine data readily available at admission to predict aspects relevant to the organization of psychiatric hospital care. A further aim was to compare the results of a machine learning approach with those obtained through a traditional method and those obtained through a naive baseline classifier.
Methods:The study included consecutively discharged patients between 1stof January 2017 and 31stof December 2018 from nine psychiatric hospitals in Hesse, Germany. We compared the predictive performance achieved by stochastic gradient boosting (GBM) with multiple logistic regression and a naive baseline classifier. We tested the performance of our final models on unseen patients from another calendar year and from different hospitals.
Results: The study included 45,388 inpatient episodes. The models’ performance, as measured by the area under the Receiver Operating Characteristic curve, varied strongly between the predicted outcomes, with relatively high performance in the prediction of coercive treatment (area under the curve: 0.83) and 1:1 observations (0.80) and relatively poor performance in the prediction of short length of stay (0.69) and non-response to treatment (0.65). The GBM performed slightly better than logistic regression. Both approaches were substantially better than a naive prediction based solely on basic diagnostic grouping.
Conclusion:The present study has shown that administrative routine data can be used to predict aspects relevant to the organisation of psychiatric hospital care. Future research should investigate the predictive performance that is necessary to provide effective assistance in clinical practice for the benefit of both staff and patients.
Oral health of children and adolescents with or without attention deficit hyperactivity disorder (ADHD) living in residential care in rural Rhineland-Palatinate, Germany
Authors: Ehlers Vicky , Callaway Angelika , Wantzen Sophia , Patyna Michael , Deschner James , Azrak Birgül 
Published: November 2019

Abstract
Background: Attention deficit hyperactivity disorder (ADHD) is defined as childhood neurobehavioural disorder. Due to short attention span, oral hygiene and dental treatment of such individuals can be challenging. Aim of this study was to evaluate the oral health of children and adolescents with and without ADHD living in residential care in rural Rhineland-Palatinate, Germany.
Methods: Included in the study were 79 participants (male/female:58/21, age 9-15 years) living in residential care: 34 participants with ADHD and 45 participants without ADHD (control). Oral examination included the following parameters decayed, missing, filled teeth in the primary dentition (dmft), decayed, missing, filled surfaces/teeth in the secondary dentition (DMFS/DMFT), approximal plaque index (API), bruxism and orthodontic treatment. Additionally, oral hygiene, last dental visit and treatment performed, and dietary habits were assessed by questionnaire.
Results: There were no significant differences in dmft, API, bruxism and oral hygiene habits between groups. However, participants with ADHD tended to have higher DMFS/DMFT values than the control group. Ongoing orthodontic treatment was found more often in the control group. The ADHD group tended to consume acidic/sugary beverages and sweet snacks more often than the controls. Different treatments (control visit/prophylaxis, dental therapy, orthodontic treatment) were performed at the last dental visit in the two groups.
Conclusions: Within the limitations of this study , oral health was similar in children and adolescents with or without ADHD from the same residential care setting. Parents/guardians need instructions for better supervision of oral hygiene and dietary habits to improve the poor oral health of children with or without ADHD.
Anticipatory Care Planning Intervention for Older Adults at Risk of Functional Decline: Study protocol for a Primary Care Cluster Feasibility Randomised Trial
Authors: Brazil Kevin , Scott David , Wallace Emma , Clarke Mike , Fahey Tom , Gillespie Patrick , O’Halloran Peter , Cardwell Christopher , Carter Gillian , McGlade Kieran , Doyle Frank 
Published: November 2019

Abstract
Background The treatment and management of long-term health conditions is the greatest challenge facing health systems around the world today. Innovative approaches to patient care in the community such as Anticipatory Care Planning (ACP), which seek to help with the provision of high-quality comprehensive care to older adults at risk of functional decline, require evaluation. This study will evaluate one approach that will include primary care as the setting for Anticipatory Care Planning.Methods This study will help to determine the feasibility for a definitive randomised trial to evaluate the implementation and outcomes of an ACP intervention. The intervention will be delivered by specially trained registered nurses in a primary care setting with older adults identified as at risk of functional decline. The intervention will comprise of: a) information collection via patient assessment; b) facilitated informed dialogue between the patient, family carer, general practitioner and other healthcare practitioners; and, c) documentation of the agreed support plan and follow-up review dates. Through a structured consultation with patients and their family carers, the nurses will complete a mutually agreed personalized support plan.Discussion This study will determine the feasibility for a full trial protocol to evaluate the implementation and outcomes of an (ACP) intervention in primary care to assist older adults aged 70 years of age or older and assessed as at risk of functional decline. The study will be implemented in two jurisdictions on the island of Ireland which employ different health systems but which face similar health challenges. This study will allow us to examine important issues, such as the impact of two different healthcare systems on the health of older people and the influence of different legislative interpretations on undertaking cross jurisdictional research in Ireland.