bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported Outcomes and Complications in 18,585 Cases
Authors: Emara Ahmed K. , Grits Daniel , Samuel Linsen T. , Acuña Alexander J. , Rosneck James T. , Kamath Atul F. 
Published: July 2020

Background: Although the negative effects of smoking have been documented for other types of arthroscopic procedures, there is limited information regarding its influence on hip arthroscopy outcomes. Purpose: To examine the effect of smoking on the following outcomes after hip arthroscopy: patient-reported outcomes (PROs), the degree of improvement in PROs relative to baseline, complication rates, and rates of revision arthroscopy and/or conversion to total hip arthroplasty (THA). Study Design: Systematic review. Methods: The PubMed, Embase, and Cochrane Library databases were queried for studies published between January 1, 1985, and January 14, 2020, comparing the outcomes of hip arthroscopy between smokers and nonsmokers. Case reports, basic science studies, and studies investigating pediatric patients or lacking a description of outcomes were excluded. Included outcome tools were the modified Harris Hip Score, the visual analog scale (VAS) for pain and satisfaction, and the Hip Outcome Score (HOS)–Sports Specific and HOS–Activities of Daily Living. Preoperative characteristics and operative indications were also recorded. Results: Postoperative combined means (± SD) were better in nonsmokers versus smokers for the modified Harris Hip Score (75.67 ± 20.88 vs 82.32 ± 15.5; P = .001), the VAS pain (3.13 ± 2.79 vs 2.13 ± 2.21; P < .001), and the HOS–Sports Specific (62.54 ± 25.38 vs 71.7 ± 23.3; P < .001). There was no difference between groups in VAS satisfaction ( P = .23) or HOS–Activities of Daily Living ( P = .13). The extent of PRO score improvement relative to baseline values was similar in smokers and nonsmokers in all PRO measures ( P > .05 for all). Smokers demonstrated higher rates of postoperative thromboembolic ( P = .0177) and infectious ( P = .006) complications. There was no difference between rates of revision arthroscopy ( P = .47) and THA conversion ( P = .31). Conclusion: Smoking adversely affects certain postoperative PROs and is associated with higher postoperative complication rates. Further studies are required investigating the degree of PRO improvement and long-term arthroscopy revision and THA conversion rates.
Dexmedetomidine for Facilitating Mechanical Ventilation Extubation in Difficult-to-Wean ICU Patients: Systematic Review and Meta-Analysis of Clinical Trials
Authors: Buckley Mitchell S. , Smithburger Pamela L. , Wong Adrian , Fraser Gilles L. , Reade Michael C. , Klein-Fedyshin Michele , Ardiles Thomas , Kane-Gill Sandra L. 
Published: July 2020

Background: Agitation and delirium are common in mechanically ventilated adult intensive care unit (ICU) patients and may contribute to delayed extubation times. Difficult-to-wean ICU patients have been associated with an increased risk of longer ICU length of stays and mortality. The purpose of this systematic review and meta-analysis is to evaluate the evidence of dexmedetomidine facilitating successful mechanical ventilation extubation in difficult-to-wean ICU patients and clinical outcomes. Methods: A literature search was conducted using MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Global Health, Cochrane Central Register of Controlled Trials, Clinical Trial Registries, and the Health Technology Assessment Database from inception to December 5, 2019. Randomized controlled trials evaluating dexmedetomidine with the intended purpose to facilitate mechanical ventilation liberation in adult ICU patients (≥18 years) experiencing extubation failure were included. The primary outcome of time to extubation was evaluated using the weighted mean difference (WMD), with a random effects model. Secondary analyses included hospital and ICU length of stay, in-hospital mortality, hypotension, and bradycardia. Results: A total of 6 trials (n = 306 patients) were included. Dexmedetomidine significantly reduced the time to extubation (WMD: −11.61 hours, 95% CI: −16.5 to −6.7, P = .005) and ICU length of stay (WMD: −3.04 days; 95% CI: −4.66 to −1.43). Hypotension risk was increased with dexmedetomidine (risk ratio [RR]: 1.62, 95% CI: 1.05-2.51), but there was no difference in bradycardia risk (RR: 3.98, 95% CI: 0.70-22.78). No differences were observed in mortality rates (RR: 1.30, 95% CI: 0.45-3.75) or hospital length of stay (WMD: −2.67 days; 95% CI: −7.73 to 2.39). Conclusions: Dexmedetomidine was associated with a significant reduction in the time to extubation and shorter ICU stay in difficult-to-wean ICU patients. Although hypotension risk was increased with dexmedetomidine, no differences in other clinical outcomes were observed.
The use of therapeutic untruths by learning disability nursing students
Authors: McKenzie Karen , Taylor Suzanne , Murray George , James Ian 
Published: July 2020

Background: The use of therapeutic untruths raises a number of ethical issues, which have begun to be explored to some extent, particularly in dementia care services, where their use has been found to be high. Little is known, however, about their use by health professionals working in learning disability services. Research question: The study aimed to explore the frequency of use of therapeutic untruths by student learning disability nurses, and by their colleagues; how effective the students perceived them to be as a means of responding to behaviours that challenge; and their level of comfort with using them. Research design: A correlational design was used to gather data from an online version of the Best Interest Scale, adapted for a learning disability context. Participants were 30 learning disability student nurses (female = 28, ages 18–48 years, M = 26.8, standard deviation = 7.3) studying at a university in the North-East of England. Ethical considerations: The study was reviewed and received ethical approval from the first author’s university ethics committee. Findings: Overall, 96% of participants reported using therapeutic untruths. ‘Omission’ was the most frequently used type of therapeutic untruths, the most effective and the type that the students felt most comfortable using. Frequency of use of therapeutic untruths correlated significantly and positively with perceived effectiveness and the level of comfort that the students felt when using them, for all types of therapeutic untruths. Conclusion: The use of therapeutic untruths by the student nurses was consistent with that found in research in dementia care services in the United Kingdom and abroad. Further research to explore the generalisability of the results to the wider context of learning disability services is needed. The study highlights that there may be a need for more formal guidance and educational input to student nurses in the use of therapeutic untruths with people with a learning disability.
Conscience and conscientious objection: The midwife’s role in abortion services
Authors: Ramsayer Beate , Fleming Valerie 
Published: July 2020

Traditionally, the role of midwives has been to be with women throughout the pregnancy continuum, from conception until the end of the postnatal period. Midwives, however, have been named as key providers of abortion services. While freedom of conscience is legally protected within Europe, discrepancies exist between midwifery and conscientious objection to abortion-related services. Midwives are largely ignored within the academic discussion despite the care and support they give to women undergoing abortions. Those discrepancies led to the aim of this article to address this issue by discussing some of the key ethical and legal concepts that are relevant to midwives’ role in the provision of abortion services. This article shows that the decision to provide or object to abortion services remains ethically very complex because arguments exist both for and against its provision. Being with women can be interpreted differently and individual situations of care are multifaceted. Conscientious objection to abortion services is a highly contentious issue that has an overall importance to midwives. Noting that decisions are individual, may change or may be situationally dependant; a definitive position of midwives for or against conscientious objection cannot be assumed. Respecting conscience and acknowledging that there are various arguments for and against conscientious objection promotes widespread understanding. It accommodates both the opportunity for midwives to object on conscience grounds to the provision of abortion services and respect women’s autonomy so that mutual agreement may be reached on issues that may have far reaching consequences.
Nurses’ refusals of patient involvement in their own palliative care
Authors: Glasdam Stinne , Jacobsen Charlotte Bredahl , Boelsbjerg Hanne Bess 
Published: July 2020

Background: Ideas of patient involvement are related to notions of self-determination and autonomy, which are not always in alignment with complex interactions and communication in clinical practice. Aim: To illuminate and discuss patient involvement in routine clinical care situations in nursing practice from an ethical perspective. Method: A case study based on an anthropological field study among patients with advanced cancer in Denmark. Ethical considerations: Followed the principles of the Helsinki Declaration. Findings: Two cases illustrated situations where nurses refused patient involvement in their own case. Discussion: Focus on two ethical issues, namely ‘including patients’ experiences in palliative nursing care’ and ‘relational distribution of power and knowledge’, inspired primarily by Hannah Arendt’s concept of thoughtlessness and a Foucauldian perspective on the medical clinic and power. The article discusses how patients’ palliative care needs and preferences, knowledge and statements become part of the less significant background of nursing practice, when nurses have a predefined agenda for acting with and involvement of patients. Both structurally conditioned ‘thoughtlessness’ of the nurses and distribution of power and knowledge between patients and nurses condition nurses to set the agenda and assess when and at what level it is relevant to take up patients’ invitations to involve them in their own case. Conclusion: The medical and institutional logic of the healthcare service sets the framework for the exchange between professional and patient, which has an embedded risk that ‘thoughtlessness’ appears among nurses. The consequences of neglecting the spontaneous nature of human action and refusing the invitations of the patients to be involved in their life situation call for ethical and practical reflection among nurses. The conditions for interaction with humans as unpredictable and variable challenge nurses’ ways of being ethically attentive to ensure that patients receive good palliative care, despite the structurally conditioned logic of healthcare.
Does a community based recovery service reduce inpatient bed days?
Authors: Isobel Sophie , Thomas Margaret , Boardman Helen , Clenaghan Paul 
Published: July 2020

Objective: Increasing options for the delivery of community-based care may be one way to reduce inpatient bed pressures. This study set out to examine the effect of community-based step up/step down (SUSD) care on hospital usage for service users with multi-service usage. Methods: A retrospective audit was undertaken of the medical records of all individuals admitted to a SUSD unit over a 2-year period, calculating inpatient bed days for the 12 months prior to, and the 12 months after, the SUSD admission. Results: There was a statistically nonsignificant decrease in bed days in the 12 months following admission. Conclusion: It is possible that inpatient bed day reduction may not be an appropriate outcome measure for a service built on principles of personal recovery. How to translate recovery-outcomes to justifiable financial benefits for services requires further consideration and alignment of values with reporting measures.
The efficacy of biofeedback visual rehabilitation therapy in patients with infantile nystagmus syndrome: A retrospective study
Authors: Caputo Roberto , Febbrini del Magro Elena , Amoaku Winfried M , Bacci Giacomo Maria , Marziali Elisa , Morales Marco U 
Published: July 2020

Objective: To report fixation stability changes in patients with different forms of infantile nystagmus syndrome (INS), who have undergone a visual rehabilitation through biofeedback fixation training (BFT) with microperimetry (MP). Design: Retrospective study. Methods: Patients 6 to 12 years-old with INS who performed BFT with MP. Initially 10 once-weekly followed by eight twice-weekly sessions of BFT during a minimum of 6 months period were performed. Visual acuity (VA) and MP fixation stability indices were analyzed, including displacement from fixation point (P1, P2) and percentage of retinal loci used during fixation attempt (BCEA 63% and 95%). Statistical analysis was conducted at baseline (BL), 10 weeks (W10) and 6 months (M6). Results: Twelve patients (mean age 8.9 years.) with INS completed the whole training session. All patients showed significant improvement in the mean BCEA fixation area (deg2): For BCEA@95% BL was 78.0, 46.1 at W10, and 27.4 at M6 ( p-value = 0.004). For BCEA@63% BL was 27.3, 15.4 in W10, and 9.17 at M6 ( p = 0.01). The ANOVA test for the FS indices of P1 and P2, as well as for BCVA showed no significant difference when compared at the same intervals. Conclusion: Fixation stability (FS) indices of BCEAs (63% and 95%) improved at W10 and M6, while P1 and P2 showed significant improvement at W10 but not at M6, probably because BCEA involves a much larger area than P1 and P2. VA did not show significant improvement at any time point.
Early versus late decompressive craniectomy in traumatic brain injury: A retrospective comparative case study
Authors: Fatima Nida , Mujeeb-Ur-Rehman  , Shaukat Samia , Shuaib Ashfaq , Raza Ali , Ayyad Ali , Saqqur Maher 
Published: July 2020

Objectives Decompressive craniectomy is a last-tier therapy in the treatment of raised intracranial pressure after traumatic brain injury. We report the association of demographic, radiographic, and injury characteristics with outcome parameters in early (<24 h) and late (≥24 h) decompressive craniectomy following traumatic brain injury. Methods We retrospectively identified 204 patients (158 (early decompressive craniectomy) and 46 (late decompressive craniectomy)), with a median age of 34 years (range 2–78 years) between 2015 and 2018. The primary endpoint was Glasgow Outcome Scale Extended (GOSE) at 60 days, while secondary endpoints included Glasgow Coma Score (GCS) at discharge, mortality at 30 days, and length of hospital stay. Regression analysis was used to assess the independent predictive variables of functional outcome. Results With a clinical follow-up of 60 days, the good functional outcome (GOSE = 5–8) was 73.5% versus 74.1% (p = 0.75) in early and late decompressive craniectomy, respectively. GCS ≥ 9 at discharge was 82.2% versus 91.3% (p = 0.21), mortality at 30 days was 10.8% versus 8.7% (p = 0.39), and length of stay in the hospital was 21 days versus 28 days (p = 0.20), respectively, in early and late decompressive craniectomy groups. Univariate analysis identified that GCS at admission (0.07 (0.32–0.18; < 0.05)) and indication for decompressive craniectomy (3.7 (1.3–11.01; 0.01)) are significantly associated with good functional outcome. Multivariate regression analysis revealed that GCS at admission (<9/≥9) (0.07 (0.03–0.16; <0.05)) and indication for decompressive craniectomy (extradural alone/ other hematoma) (1.75 (1.09–3.25; 0.02)) were significant independent predictors of good functional outcome irrespective of the timing of surgery. Conclusions Our results corroborate that the timing of surgery does not affect the outcome parameters. Furthermore, GCS ≥ 9 and/or extra dural hematoma are associated with relatively good clinical outcome after decompressive craniectomy.
The Swinging Self: The Costs of Shifting Between Self-Images in Alzheimer’s Disease
Authors: Altintas Emin , Moustafa Ahmed A. , Gallouj Karim , Haj Mohamad El 
Published: July 2020

Background: We investigated the ability of patients with Alzheimer’s disease (AD) to shift between different self-images. Methods: We developed an original task (shifting-self task) in which we invited 28 patients with AD and 30 control participants to generate “who am I” statements that describe 2 alternative self-images (ie, physical-self vs psychological-self). In a control task, participants had to generate 2 blocks of “who am I” statements (ie, physical-self block and psychological-self block). Results: Analyses showed longer completion time in both the shifting-self and control task in patients with AD than in control participants. Completion time on the shifting-self task was longer than that on the control task in patients with AD, suggesting a shifting cost in AD. Conclusion: We propose that one feature of the diminished sense of self in AD is the difficulty of patients to shift between different alternating self-images.
Application of Dexmedetomidine in Cardiopulmonary Bypass Prefilling
Authors: Wang Li , Wang Shaowei , Xing Zhen , Li Fulong , Teng Jinliang , Jia Tong 
Published: July 2020

Objective: The purpose of this study was to explore the application of dexmedetomidine (Dex) in cardiopulmonary bypass. Methods: A total of 60 patients undergoing elective cardiopulmonary bypass were divided into control (C) group and Dex group. In the Dex group, appropriate amount of Dex was added into the membrane lung prefilling solution before anesthesia induction, while those in control group were given normal saline. The levels of mean arterial pressure (MAP) and heart rate (HR) at different times were measured. The levels of cardiac troponin I (CTNI), malondialdehyde (MDA), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α) at different points (T0/T1/T2/T3/T4) in both groups were measured by enzyme-linked immunosorbent assay kits. Results: The intraoperative and postoperative levels of MAP and HR in the 2 groups were significantly lower than those preoperatively ( P < .05). The levels of MAP and HR in the Dex group were significantly lower than those of the C group ( P < .05). The levels of CTNI/MDA/IL-6/TNF-α at different points in both groups were significantly higher than those at T0 ( P < .05). The serum levels of CTNI, MDA, IL-6, and TNF-α in the Dex group at T1/T2/T3/T4 were significantly lower than those in the C group ( P < .05). The rate of arrhythmia in the Dex group was significantly lower than that in the C group ( P < .05). Conclusion: Dexmedetomidine has a stable effect in cardiopulmonary priming solution.
A case series of non-valvular cardiac aspergillosis in critically ill solid organ transplant and non-transplant patients and systematic review
Authors: Navaratnam Annalan MD , Al-Freah Mohammad , Cavazza Anna , Auzinger Georg 
Published: July 2020

Introduction Non-valvular cardiac aspergillosis is a rare infection of the pericardium, myocardium or endocardium and is associated with a high mortality. There is a paucity of reports of non-valvular cardiac aspergillosis in critically ill and solid organ transplant (SOT) patients. The majority of cases have been reported in haemato-oncology patients, some of whom have undergone a bone marrow transplant. Objectives We describe four cases affected by non-valvular cardiac aspergillosis in the intensive care setting including a systematic review of this extremely rare infection which is associated with high mortality. Results All four-patients died but presented with varying clinical, radiological and microbiological evidence of the disease. Three patients presented following complications after solid organ transplantation, two in the context of acute liver failure and emergency liver transplant and one several years after a double lung transplant. The last patient presented with necrotising gall stone pancreatitis, multi-organ failure and subsequently a prolonged intensive care unit (ICU) stay. On review of the literature, January 1955 to July 2019, 45 cases were identified, with different risk factors, clinical and radiological manifestations, treatment regimen and outcome. Conclusion Antemortem diagnosis of cardiac aspergillosis is difficult and rare, with no cases reporting positive blood culture results. Galactomannan serology has poor sensitivity in solid organ transplant patients, further reduced by prophylactic antimicrobial treatment, which is common in the ICU setting especially post-transplant patients. Due to the scarcity of cases, treatment is extrapolated from invasive aspergillosis management, with emphasis on early treatment with combination therapy.
An ulnar parametacarpal perforator flap for volar digital soft tissue reconstruction
Authors: Usami Satoshi , Inami Kohei , Hirase Yuichi , Mori Hiroki 
Published: July 2020

We present outcomes of using a perforator-based ulnar parametacarpal flap in 25 patients for digital pulp defects. These included 17 free transfers to the thumb, index, middle and ring fingers and eight reverse pedicled transfers to the little fingers. This flap includes a dorsal sensory branch of the ulnar nerve, which was sutured to the digital nerve in all transfers. Each flap had one to three reliable perforators (mean 0.44 mm diameter) to the ulnar parametacarpal region and contained at least one perforator within 2 cm proximal to the palmar digital crease. All the 25 flaps survived completely. Twenty-two patients were followed for 15 months (range 12 to 24), and three were lost to follow-up. The mean static and moving two-point discrimination of the flap was 7 mm and 5 mm, respectively. At the donor site, sensory reinnervation was acceptable. We conclude that ulnar parametacarpal perforator flaps offer sensate, thick and glabrous skin for finger pulp repair, all in a single operative field. Level of evidence: IV
Inhaled antibiotics therapy for stable non-cystic fibrosis bronchiectasis: a meta-analysis
Authors: Xu Meng-Jiao , Dai Bing 
Published: July 2020

Background: The optimum antibiotic therapy for non-cystic fibrosis bronchiectasis (NCFB) has yet to be determined. A meta-analysis was conducted to evaluate the efficacy and safety of inhaled antibiotics in adults with stable NCFB. Methods: PubMed, EMBASE, MEDLINE and the Cochrane Central Register of Controlled Trials were searched through November 2019. Results: A total of 16 randomized controlled trials (RCTs), recruiting 2748 NCFB patients, were finally included. Inhaled antibiotics treatment significantly reduced the sputum bacterial load [standard mean difference (SMD) = –0.74, 95% CI: –1.16–0.32, p < 0.001, I2 = 68.1%], prolonged median time [hazard risk (HR) = 0.73, 95% confidence interval (CI): 0.57–0.93, p < 0.001, I2 = 53.6%] and reduced frequency [incidence rate ratio (IRR) = 0.74, 95% CI 0.63–0.87, p < 0.001, I2 = 20.5%] of exacerbations, with good tolerance. However, it failed to improve Pseudomonas aeruginosa eradication, [forced expiratory volume in 1 s (FEV1)] % predicted, quality of life questionnaire (QoL-B) and St. George’s respiratory questionnaire (SGRQ) scores, and may induce higher risk of P. aeruginosa resistance. Subgroup analysis showed Ciprofloxacin was more effective than other antibiotics in reducing bacterial load (SMD = –1.35, 95% CI: –1.85–0.85, I2 = 63.4%, p = 0.042). Conclusion: Inhaled antibiotics therapy holds great promise for stable NCFB as it is effective in reducing sputum bacterial load and the risk of acute attack, delaying disease progression, and is well tolerated. Although this study brings some constructive ideas in the field of clinical medication, further clinical trials should be carried out, particularly in solving drug-resistance and improving health-related quality of life (HRQoL), which we believe will finally provide benefits for patients suffering from bronchiectasis. The reviews of this paper are available via the supplemental material section.