bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arthroscopic Soft Tissue Stabilization With Selective Augmentations for Traumatic Anterior Shoulder Instability in Competitive Collision Athletes
Authors: Hoshika Shota , Sugaya Hiroyuki , Takahashi Norimasa , Matsuki Keisuke , Tokai Morihito , Morioka Takeshi , Ueda Yusuke , Hamada Hiroshige , Takeuchi Yasutaka 
Published: April 2021

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes. Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability Study Design: Case series; Level of evidence, 4. Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated. Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002). Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.
Evaluation of a Pharmacist-Led Diabetes Collaborative Drug Therapy Management Service
Authors: Bald Elizabeth M. , Triplett Chad , Beranek Randi , Kennelty Korey 
Published: April 2021

Objective: To evaluate the pharmacist-led diabetes collaborative drug therapy management services in a family medicine and internal medicine clinic. Design: Mixed methods of evaluation based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Results: Reach: 71.3% of patients who were independently consulted (n = 184/258) and 1.6% (n = 11/680) of patients who triggered a best practice advisory (BPA) were enrolled. Effectiveness: 27.7% of patients (n = 54/195) enrolled were lost to follow-up. Adoption: 55% of eligible providers (n = 77/140) have placed a consult. Implementation: Providers independently choose to refer patients and are also prompted to place consults by a BPA that triggers for patients with an HbA1c ≥ 9%. Common reasons providers did not place a consult include: alignment with workflow, patient refusal, and patients followed by other services. Regarding patient perceptions, patients valued the service. Patients reported increased accountability with disease state maintenance and increased self-efficacy. Regarding how to improve the service, patients wanted more information on expectations before engaging with the pharmacist. Patients suggested to replicate this service for pain, cancer, and blood pressure management. Maintenance: 96.7% of providers (n = 30/31) reported they were very likely/likely to place a consult in the future and 60% of providers (n = 18/30) reported they were very likely/likely to place a consult when prompted by the BPA. Conclusion: These results can be utilized to make improvements to the pharmacist-led diabetes collaborative drug therapy management service to ensure sustainability. This study also provides lessons learned and strategies for future adoption, implementation, and maintenance of similar services for other disease states.
Madness, virtue, and ecology: A classical Indian approach to psychiatric disturbance
Authors: Ram-Prasad Chakravarthi 
Published: April 2021

The Caraka Saṃhitā (ca. first century BCE–third century CE), the first classical Indian medical compendium, covers a wide variety of pharmacological and therapeutic treatment, while also sketching out a philosophical anthropology of the human subject who is the patient of the physicians for whom this text was composed. In this article, I outline some of the relevant aspects of this anthropology – in particular, its understanding of ‘mind’ and other elements that constitute the subject – before exploring two ways in which it approaches ‘psychiatric’ disorder: one as ‘mental illness’ ( mānasa-roga), the other as ‘madness’ ( unmāda). I focus on two aspects of this approach. One concerns the moral relationship between the virtuous and the well life, or the moral and the medical dimensions of a patient’s subjectivity. The other is about the phenomenological relationship between the patient and the ecology within which the patient’s disturbance occurs. The aetiology of and responses to such disturbances helps us think more carefully about the very contours of subjectivity, about who we are and how we should understand ourselves. I locate this interpretation within a larger programme on the interpretation of the whole human being, which I have elsewhere called ‘ecological phenomenology’.
The presence of lupus nephritis additionally increases the risk of preeclampsia among pregnant women with systemic lupus erythematosus
Authors: Bremme Katarina , Honkanen Sonja , Gunnarsson Iva , Chaireti Roza 
Published: April 2021

Introduction Pregnant women with systematic lupus erythematosus (SLE) have an increased risk of obstetric complications, such as preeclampsia and premature births. Previous studies have suggested that renal involvement could further increase the risk for adverse obstetric outcomes. Aims: The aim of this study was to compare the obstetric outcomes in a Swedish cohort of patients with SLE with and without lupus nephritis (LN). Patients and methods The study was conducted as a retrospective observational study on 103 women with SLE, who gave birth at the Karolinska University Hospital between the years 2000-2017. Thirty-five women had previous or active LN and 68 women had non-renal lupus. Data was collected from digital medical records. The outcomes that were analysed included infants born small for gestational age (SGA), premature birth, preeclampsia, SLE- or nephritis flare and caesarean section. Results Women with LN, both with previous and with renal flare during pregnancy suffered from pre-eclampsia more often compared to women with non-renal lupus (25.7% vs 2.9%, p = 0.001) and this complication was associated with premature birth (p = 0.021) and caesarean section (p = 0.035). Conclusions Lupus nephritis is a significant risk factor for adverse obstetric outcomes in women with SLE, including preeclampsia. Those patients could benefit from more frequent antenatal controls and more vigorous follow-up.
Fatty acid binding protein 4 (FABP4) and metabolic-related parameters in systemic lupus erythematosus active and non-active episode
Authors: Hamijoyo Laniyati , Putri Mirasari , Alita Vilya Rizkiyanti , Atik Nur , Syamsunarno Mas Rizky AA 
Published: April 2021

Objective To assess serum FABP4 and other metabolic-related parameters in Systemic Lupus Erythematosus (SLE) active and non-active episode. Methods Fifty-four SLE patients in Hasan Sadikin General Hospital, Bandung, Indonesia in 2018–2019 were recruited and serum samples were collected in their active and non-active episode status. Serum was analyzed for FABP4, leptin, glucose, and triglycerides. The clinical characteristics were analyzed from medical records. Disease activity was assessed with the SLEDAI-2K (≥4 defined as an active; <4 as non-active episode). Results Significantly correlation of Systolic Blood Pressure (SBP) (p = 0.001, r = 0.59) and C3 (p = 0.04, r = 0.47) between active and non-active episode. In non-active episode, there was significant correlation of FABP4 with Diastolic Blood Pressure (DBP) (p = 0.04, r = 0.26) and blood glucose (p = 0.01, r = −0.39). In active episode, there was significant correlation FABP4 with SBP (p = 0.04, r = −0.28) and triglyceride (p = 0.002, r = 0.55). Conclusion FABP4 correlates with high DBP in the non-active and high triglyceride serum in the active episode.
Prescribing unapproved medical devices? The case of DIY artificial pancreas systems
Authors: Roberts Joseph T.F. , Moore Victoria , Quigley Muireann 
Published: April 2021

In response to slow progress regarding technological innovations to manage type 1 diabetes, some patients have created unregulated do-it-yourself artificial pancreas systems (DIY APS). Yet both in the United Kingdom (UK) and internationally, there is an almost complete lack of specific guidance – legal, regulatory, or ethical – for clinicians caring for DIY APS users. Uncertainty regarding their professional obligations has led to them being cautious about discussing DIY APS with patients, let alone recommending or prescribing them. In this article, we argue that this approach threatens to undermine trust and transparency. Analysing the professional guidance from the UK regulator – the General Medical Council – we demonstrate that nothing within it ought to be interpreted as precluding clinicians from initiating discussions about DIY APS. Moreover, in some circumstances, it may require that clinicians do so. We also argue that the guidance does not preclude clinicians from prescribing such unapproved medical devices.
Effect of Nature Experience on Fronto-Parietal Correlates of Neurocognitive Processes Involved in Directed Attention: An ERP Study
Authors: Sahni Pooja , Kumar Jyoti 
Published: April 2021

Background: Several studies have demonstrated that brief interactions with natural environments can improve cognitive functioning. However, the neurocognitive processes that are affected by natural surroundings are not yet fully understood. It is argued that the “elements” in natural environment evoke “effortless” involuntary attention and may affect the neural mechanisms underlying inhibition control central to directed attention. Methods: The present study used electroencephalography (EEG) to investigate the effects of nature experience on neurocognitive processes involved in directed attention. During EEG recordings, participants ( n = 53) were presented nature audio/video as stimuli to evoke nature experience, and flanker task was administered both before and after nature experience. An open eye rest condition was included randomly in either before or after nature experience cognitive task as a control condition. Results: The event-related potential analysis demonstrated a significant improvement in the response time after the nature experience. The analysis also demonstrated a significant difference for the inhibitory control process in fronto-parietal N2 ( P < .01) and P3 ( P < .05) for incongruent trials subsequent to nature experience. The spectral analysis also found an increase in alpha in all five brain regions (all Ps < .01) and fronto-central theta power ( P < .01). Conclusion: The findings suggest that improved inhibitory control processes could be one of the aspects of enhanced directed attention after nature experience. Increased alpha along with theta indicates a relaxed yet alert state of mind after nature experience.
Impact of anti-cancer drugs shortages in oncology and hematology departments in a Moroccan hospital
Authors: Cherif Chefchaouni Ali , Moutaouakkil Youssef , Adouani Badr , Tadlaoui Yasmina , Lamsaouri Jamal , Bousliman Yassir 
Published: April 2021

Introduction Drug shortages have been a growing global problem in recent years. Some of them are of vital necessity and importance for the patient, such as those used to treat pathologies in clinical hematology and oncology departments. The objectives of this study are to determine the impact of anti-cancer drugs shortages on both: treatment and patient in the hematology and oncology departments, to describe the actions that have been put in place to manage the shortages and to survey patients about their perspectives and experiences. Materials and methods It was a prospective, observational study, it took place in the oncology and hematology departments. It was carried out with the help of an operating sheet, which contained two parts: patient and treatment data. This sheet was filled out after the interview with the patient and on the basis of the medical file. Results Of the 101 patients interviewed, 67.3% were impacted by the shortage of drugs. The treated pathology that was most impacted by the rupture was Non-Hodgkin lymphoma (55.8%), vincristine was the drug most responsible for the shortages (34%). Most patients (51.4%) went to a non-local pharmacy to buy the medicine that was in short supply in the hospital. Delayed care was the main impact of the drug shortage (42.6%). As a result of these shortages, the majority of patients (45.6%) were frustrated and anxious about the situation. Conclusion Drug shortages have a profound impact on patient safety, clinical outcomes, quality of treatment, hospital management and other important factors. In-depth collaboration between different health actors and timely communication strategies are essential elements of an effective drug shortage management plan.
Using qualitative content analysis to understand the active ingredients of a parent-mediated naturalistic developmental behavioral intervention
Authors: Frost Kyle M , Russell Kaylin , Ingersoll Brooke 
Published: April 2021

Although naturalistic developmental behavioral interventions have a sizable and growing evidence base for supporting the development of children on the autism spectrum, their active ingredients and mechanisms of change are not well understood. This study used qualitative content analysis to better understand the intervention process of a parent-mediated naturalistic developmental behavioral intervention. Caregivers completed weekly written reflection responses as they learned each intervention technique. These responses were coded, and code co-occurrences were examined to understand the relationship between implementation of specific intervention techniques and potential mechanisms of change according to caregiver observations. The responses were subsequently compared to a theoretical causal model derived from the intervention manual. Many responses were consistent with the intervention theory; however, some theoretical outcomes were not reported by caregivers, and caregivers described some potential mechanisms that were not explicitly stated in the intervention theory. Importantly, we found that individual techniques were associated with various mechanisms, suggesting that global measures of social communication may be insufficient for measuring context-dependent responses to individual intervention techniques. Our findings point to specific observable behaviors that may be useful targets of measurement in future experimental studies, and as indicators of treatment response in clinical settings. Overall, qualitative methods may be useful for understanding complex intervention processes. Lay abstract Although naturalistic developmental behavioral interventions are supported by research for supporting the development of children on the autism spectrum, how they work is not well understood. This study reviewed parent reflection comments in a systematic way to better how one such treatment worked, when delivered by caregivers. Caregivers completed weekly written reflection responses as they learned how to use the treatment techniques. We studied these responses to understand caregiver perspectives on how their children responded to the techniques. The responses were then compared to a theory of how the treatment works. Many responses were consistent with the treatment theory; however, others were not. We found that individual techniques were associated with different child responses, suggesting that general measures of social communication may not measure these specific short-term changes. Our findings point to specific behaviors that may be useful to measure in future research, or useful as indicators of treatment response in clinical practice settings. Overall, qualitative methods may be useful for understanding complex treatment processes.
Between facts and ambiguity: Discourses on medical cannabis in Swedish newspapers
Authors: Abalo Ernesto 
Published: April 2021

Aim: This study examines the discursive construction of medical cannabis in Swedish newspapers, with the aim of understanding how the news media recontextualise the medical potential of cannabis. Design: The study is centred on the concept of recontextualisation, which focuses on how discourses are reinterpreted and reshaped when moving from one context to another, with a special focus on recontextualisation in relation to the media. Methodologically, the study uses critical discourse analysis to qualitatively analyse 134 articles of different subgenres, published in four Swedish newspapers between 2015 and 2020. Results: The study shows that medical cannabis is constructed around myriad topics and contexts, ranging from news that focuses on the medical potential of cannabis to articles where medical cannabis is mentioned in passing and constructed in a more abstract form. The media have difficulties retaining a conceptual boundary between medical and recreational cannabis. Moreover, the study shows that the medical potential of cannabis is discursively constructed using three different discourses: patient discourse, strong science discourse, and weak science discourse. Conclusions: The study suggests that there is a widening of the debate on cannabis in the Swedish public sphere, giving more recognition to the potential medical use of cannabis. The media, however, show difficulties in refining discourses on medical cannabis, which results in an altering between constructions that are strongly connected to science, and those that are not.
Patient Self-Assessment and Acoustic Voice Analysis in Screening of Postoperative Vocal Fold Paresis and Paralysis
Authors: Heikkinen Maria , Penttilä Elina , Qvarnström Mari , Mäkinen Kimmo , Löppönen Heikki , Kärkkäinen Jussi M 
Published: April 2021

Background and objective: The aim of this study was to evaluate the utility of two items in vocal fold paresis and paralysis screening after thyroid and parathyroid surgery: patient self-assessment of voice using the Voice Handicap Index and computer-based acoustic voice analysis using the Multi-Dimensional Voice Program. Methods: This was a prospective study of 181 patients who underwent thyroid or parathyroid surgery over a 1-year study period (2017). Preoperatively, all patients underwent laryngoscopic vocal fold inspection and acoustic voice analysis, and they completed the Voice Handicap Index questionnaire. Postoperatively, all patients underwent laryngoscopy prior to hospital discharge; 2 weeks after the surgery, they completed the Voice Handicap Index questionnaire a second time. Two weeks postoperatively, patients with vocal fold paresis or paralysis and 20 randomly selected controls without vocal fold paresis or paralysis underwent a follow-up acoustic voice analysis. Results: Fourteen patients had a new postoperative vocal fold paresis or paralysis. Postoperatively, the total Voice Handicap Index score was significantly higher (p = 0.040) and the change between preoperative and postoperative scores was greater (p = 0.028) in vocal fold paresis or paralysis patients. A total postoperative Voice Handicap Index score > 30 had 55% sensitivity, and 90% specificity, for vocal fold paresis or paralysis. In the postoperative Multi-Dimensional Voice Program analysis, vocal fold paresis or paralysis patients had significantly more jitter (p = 0.044). Postoperative jitter > 1.33 corresponded to 55% sensitivity, and 95% specificity, for vocal fold paresis or paralysis. Conclusions: In identifying postoperative vocal fold paresis or paralysis, patient self-assessment and jitter in acoustic voice analysis have high specificity but poor sensitivity. Without routine laryngoscopy, approximately half of the patients with postoperative vocal fold paresis or paralysis could be overlooked. However, if the patient has no complaints of voice disturbance 2 weeks after thyroid or parathyroid surgery, the likelihood of vocal fold paresis or paralysis is low.
World’s First Experience Treating TASC II C and D Tibial Occlusive Disease Using the Selution SLR Sirolimus-Eluting Balloon: Six-Month Results From the PRESTIGE Study
Authors: Tang Tjun Yip , Yap Charyl , Soon Shereen Xue Yun , Chan Sze Ling , Lee QingWei Shaun , Yap Hao Yun , Tay Hsien Ts’ung Luke , Chong Tze Tec 
Published: April 2021

Purpose: The performance of sirolimus-coated devices has not been studied in patients with chronic limb-threatening ischemia patients. PRESTIGE aims to investigate the 6-month efficacy and safety profile of the Selution Sustained Limus Release (SLR) sirolimus-eluting balloon for treatment of TASC II C and D tibial occlusive lesions in patients with CLTI. Materials and Methods: PRESTIGE is a pilot prospective, nonrandomized, single-arm, multi-investigator, single-center clinical study. Endpoints were adverse event-free survival at 1 month, technical success rate, primary tibial patency at 6 months, limb salvage success, target lesion revascularization (TLR), and amputation free survival (AFS). Results: A total of 25 patients were included. There were 17 (68.0%) males; mean age, 63.7±9.73 years. CLTI severity was based on the Rutherford scale (R5=25/25; 100.0%). Significant comorbidities included diabetes mellitus (n=22; 88.0%) and end-stage renal failure (n=11; 44.0%). A total of 33 atherosclerotic lesions were treated (TASC II D=15 (45.5%)). Mean lesion length treated was 191±111 mm. Technical success was 100%. Primary tibial patency at 6 months was 22/27 (81.5%) and freedom from clinically driven TLR was 25/30 (83.3%). AFS was 21/25 (84.0%; 3 deaths and 1 major lower extremity amputation). Mean Rutherford score improved from 5.00 at baseline to 1.14±2.10 (p<0.05) at 6 months. There was a wound healing rate of 13/22 (59.1%) and 17/21 (81.0%) at 3 and 6 months respectively. Conclusions: Selution SLR drug-eluting balloon is a safe and efficacious modality in treating complex tibial arterial occlusive lesions in what is an otherwise frail cohort of CLTI patients, with a high prevalence of diabetes and end-stage renal failure. Technical and clinical success rates are high and 6-month target lesion patency and AFS are more than satisfactory.