bluuebunny/crossref_metadata_2025_split huggingface dataset:
AB0770 A RARE CASE OF SYNOVIAL METASTASIS REVEALED BY KNEE PAIN
Authors: Yasmine M. , Miladi S. , Fazaa A. , Mariem S. , Ouenniche K. , Souebni L. , Kassab S. , Chekili S. , Ben Abdelghani K. , Laatar A. 
Published: May 2021

Background:Intra-articular masses are not frequently encountered in clinical practice. However, the differential diagnosis can be broad. Synovial metastasis is a rare presentation that carries a poor prognosis with a poor survival rate.Objectives:Here by a case of synovial metastasis of the knee joint in a patient diagnosed with an adenocarcinoma of the lung.Methods:A 60-year-old man with no remarkable past medical history presented to our department of rheumatology with right knee pain. He described a dull ache and swelling in his right knee with a dragging sensation, waking him up at night on a regular basis. The symptoms lasted from 6 months and were partially improved by analgesics and anti-inflammatory drugs. On examination, temperature was normal. The knee was edematous, erythematous, and warm with a range of motion of <90°. Laboratory investigations showed high acute phase reactants, the erythrocyte sedimentation rate was 75 mm. A plain radiograph of the left knee demonstrated a lytic lesion of the upper tibia. A magnetic resonance imaging of the right knee showed diffuse enlargement of the joint space due to a tissue infiltration within the synovium. These structures demonstrated heterogeneously increased T2 signal and intermediate T1 intensity characteristics. Most of the joint space was replaced by hyper enhancing synovium. At that time, differential considerations included severe inflammatory arthritis and synovial chondromatosis rather than unusual metastasis.Results:Biopsy concluded to synovial metastasis from primary adenocarcinoma. Further investigations were necessary. Chest tomography showed a tumor process of left lower lobe associated with mediastinal lymphadenopathy. The patient was treated with palliative external radiotherapy to the right knee. The evolution was marked by the appearance of multiple tracheobronchial fistulas. The patient died 3 months later due to the progression of the disease.Conclusion:We report a rare case of synovial metastasis concomitant to a lung adenocarcinoma. It is important to make a rapid diagnosis as early recognition of malignant infiltration into joints ensure appropriate multidisciplinary management decisions.Disclosure of Interests:None declared
Predicting the 10-year risk of cataract surgery using machine learning techniques on questionnaire data: findings from the 45 and Up Study
Authors: Wang Wei , Han Xiaotong , Zhang Jiaqing , Shang Xianwen , Ha Jason , Liu Zhenzhen , Zhang Lei , Luo Lixia , He Mingguang 
Published: May 2021

Background/aimsTo investigate the feasibility and accuracy of using machine learning (ML) techniques on self-reported questionnaire data to predict the 10-year risk of cataract surgery, and to identify meaningful predictors of cataract surgery in middle-aged and older Australians.MethodsBaseline information regarding demographic, socioeconomic, medical history and family history, lifestyle, dietary and self-rated health status were collected as risk factors. Cataract surgery events were confirmed by the Medicare Benefits Schedule Claims dataset. Three ML algorithms (random forests [RF], gradient boosting machine and deep learning) and one traditional regression algorithm (logistic model) were compared on the accuracy of their predictions for the risk of cataract surgery. The performance was assessed using 10-fold cross-validation. The main outcome measures were areas under the receiver operating characteristic curves (AUCs).ResultsIn total, 207 573 participants, aged 45 years and above without a history of cataract surgery at baseline, were recruited from the 45 and Up Study. The performance of gradient boosting machine (AUC 0.790, 95% CI 0.785 to 0.795), RF (AUC 0.785, 95% CI 0.780 to 0.790) and deep learning (AUC 0.781, 95% CI 0.775 to 61 0.786) were robust and outperformed the traditional logistic regression method (AUC 0.767, 95% CI 0.762 to 0.773, all p<0.05). Age, self-rated eye vision and health insurance were consistently identified as important predictors in all models.ConclusionsThe study demonstrated that ML modelling was able to reasonably accurately predict the 10-year risk of cataract surgery based on questionnaire data alone and was marginally superior to the conventional logistic model.
Genetic associations of central serous chorioretinopathy: a systematic review and meta-analysis
Authors: Chen Zhen Ji , Lu Shi Yao , Rong Shi Song , Ho Mary , Ng Danny Siu-Chun , Chen Haoyu , Gong Bo , Yam Jason C , Young Alvin L , Brelen Marten , Tham Clement C , Pang Chi Pui , Chen Li Jia 
Published: May 2021

AimsTo identify single-nucleotide polymorphisms (SNPs) associated with central serous chorioretinopathy (CSCR) by a systematic review and meta-analysis, and to compare the association profiles between CSCR, neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV).MethodsWe searched the EMBASE, PubMed and Web of Science for genetic studies of CSCR from the starting dates of the databases to 12 September 2020. We then performed meta-analyses on all SNPs reported by more than two studies and calculated the pooled OR and 95% CIs. We also conducted sensitivity analysis and adopted the funnel plot to assess potential publication bias.ResultsTotally 415 publications were reviewed, among them 10 were eligible for meta-analysis. We found 10 SNPs that have been reported at least twice. Meta-analysis and sensitivity analysis confirmed significant associations between CSCR and six SNPs in three genes, namely age-related maculopathy susceptibility 2 (ARMS2) (rs10490924, OR=1.37; p=0.00064), complement factor H (CFH) (rs800292, OR=1.44; p=7.80×10−5; rs1061170, OR=1.34; p=0.0028; rs1329428, OR=1.40; p=0.012; and rs2284664, OR=1.36; p=0.0089) and tumour necrosis factor receptor superfamily, member 10a (TNFRSF10A) (rs13278062, OR=1.34; p=1.44×10−15). Among them, onlyTNFRSF10Ars13278062 showed the same trend of effect on CSCR, nAMD and PCV, while the SNPs inARMS2andCFHshowed opposite trends in the SNP associations.ConclusionsThis study confirmed the associations ofARMS2,CFHandTNFRSF10Awith CSCR, and revealed thatARMS2,CFHandTNFRSF10Amay affect different phenotypic expressions of CSCR, nAMD and PCV.
Optic nerve tortuosity and displacements during horizontal eye movements in healthy and highly myopic subjects
Authors: Wang Xiaofei , Chang Stanley , Grinband Jack , Yannuzzi Lawrence A , Freund K Bailey , Hoang Quan V , Girard Michael JA 
Published: May 2021

Aims(1) To assess the morphology and 3-dimensional (3D) displacements of the eye globe and optic nerve (ON) in adduction/abduction using MRI. (2) To assess differences between healthy emmetropic and highly myopic (HM) subjects.MethodsMRI volumes of both eyes from 18 controls and 20 HM subjects in primary gaze, abduction and adduction (15°) were postprocessed. All ONs were manually segmented and fitted to a 3D curve to assess ON tortuosity. ON displacements were evaluated in four quasicoronal planes which were perpendicular to the ON in primary gaze and were 3 mm apart.ResultsAxial length was higher in the HM group (28.62±2.60 vs 22.84±0.89 mm; p<0.0001). Adjusted ON tortuosities (ie, ON tortuosities estimated before myopia onset) were lower in HM eyes (0.9063±0.0591) versus controls (1.0152±0.02981) in primary gaze, adduction (0.9023±0.05538 vs 1.0137±0.0299) and abduction (0.9100±0.0594 vs 1.0182±0.0316); p<0.0001 for all cases. In all eyes, ON displacements in adduction were significantly different from those in abduction in the naso-temporal direction (p<0.0001 in all planes) but not in the supero-inferior direction. ON displacements in the posterior segments of the ON were smaller in the HM group in both gaze directions and were larger in the anterior-most ON segment in adduction only.ConclusionThe adjusted tortuosity of the ON was significantly lower in HM eyes, suggesting that eyes destined towards HM exhibited higher ON traction forces during eye movements before the onset of myopia. Our ON metrics may be valuable to explore a potential link between eye movements and axial elongation.
Risk factors for ophthalmic artery stenosis and occlusion in patients with retinoblastoma treated with intra-arterial chemotherapy
Authors: Zhou Min , Wen Xuyang , Jia Shichong , Han Yanping , He Xiaoyu , Han Minglei , Xu Wei , Fan Jiayan , Jia Renbing , Fan Xianqun 
Published: May 2021

PurposeTo explore the risk factors for ophthalmic artery (OA) stenosis and occlusion after intra-arterial chemotherapy (IAC) with selective ophthalmic artery catheterisation (OAC) in the treatment of retinoblastoma.DesignRetrospective, single centre case-control study.MethodsThe study was conducted including consecutive patients with unilateral or bilateral intraocular retinoblastoma undergoing IAC between June 2016 and June 2019 with a follow-up time of 4 years. Main outcomes are rate of IAC-induced OA occlusion and OA diameter.Results346 attempted OAC infusions were successful. The total incidence of OA occlusion was 15.89%. The occlusion and control groups were similar in patients’ age, sex and disease stage. Median OA diameter was 0.49 mm in those with OA occlusion, and 0.66 mm in those without occlusion. In the occlusion group, the OA diameter difference was significantly larger between the first IAC and the final IAC (0.22mm vs 0.12mm, p=0.001). In both groups, the median number of IAC treatments was 3. Multivariate Cox regression models included initial OA diameter (OR: 0.005, p=0.001), ratio of OA orifice diameter differences between first and last IAC to the initial OA orifice diameter (OR: 4.661, p=0.003), and number of IAC (OR: 1.538, p=0.042) as clinical features significantly associated with OA occlusion.ConclusionsThe OA diameter at first IAC treatment, the ratio of OA orifice diameter differences between first and last IAC to the initial OA orifice diameter and total number of IAC treatments may be three main clinical predictors for OA occlusion after IAC for retinoblastoma.
Case series of shrinking hydroxyapatite orbital implants
Authors: Han Louis S , Keillor Rodney B , Weatherhead Robert G 
Published: May 2021

BackgroundAn orbital implant is used after enucleation or evisceration surgery to replace the volume lost and to aid in prosthesis fitting and movement. Different materials have been used through the years. The authors noted that with bone-derived hydroxyapatite orbital implants, some patients lose their orbital volume.MethodsThe operating theatre record was searched to find patients who had their hydroxyapatite orbital implant removed at Dunedin Hospital, New Zealand, between 2011 and 2015. The original implant size and size at removal were noted. Histological results were noted. Medical notes were reviewed.ResultsA total of six patients had hydroxyapatite orbital implants removed during this time. Four patients had implants that were smaller than their original sizes. All specimens had fibrovascular infiltration noted, three had chronic inflammatory cells and one had osteoclastic activity.ConclusionsBone-derived hydroxyapatite orbital implants can reduce in size, and this may occur due to osteoclastic activity. The surgeon must consider this scenario when choosing the type of implant to be used after enucleation or evisceration.
Methods, challenges and benefits of a health monitoring programme for Norwegian Olympic and Paralympic athletes: the road from London 2012 to Tokyo 2020
Authors: Clarsen Benjamin , Steffen Kathrin , Berge Hilde Moseby , Bendiksen Fredrik , Fossan Bjørn , Fredriksen Hilde , Gjelsvik Hilde , Haugvad Lars , Kjelsberg Mona , Ronsen Ola , Torgalsen Thomas , Walløe Anders , Bahr Roald 
Published: May 2021

ObjectiveTo describe the implementation of a health monitoring programme for Norwegian Paralympic and Olympic candidates over five consecutive Olympic and Paralympic Games cycles (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020).MethodsAthletes were monitored for 12–18 months preparing for the games using a weekly online questionnaire (OSTRC-H2) with follow-up by physicians and physiotherapists, who provided clinical care and classified reported problems.ResultsBetween 2011 and 2020, 533 Olympic and 95 Paralympic athletes were included in the monitoring programme, with an overall response of 79% to the weekly questionnaire and a total observation period of 30 826 athlete weeks. During this time, 3770 health problems were reported, with a diagnosis rate of 97%. The average prevalence of health problems at any given time was 32% among Olympic athletes and 37% among Paralympic athletes. Acute traumatic injuries represented the greatest burden for Olympic team sport athletes, and illnesses represented the greatest burden for Olympic endurance and Paralympic athletes. On average, Olympic athletes lost 27 days and Paralympic athletes lost 33 days of training per year due to health problems.ConclusionConducting long-term health monitoring of Olympic and Paralympic athletes is challenging, particularly because athletes travel frequently and often relate to many medical providers. This programme has been implemented and improved within Team Norway for five Olympic and Paralympic cycles and during this time we believe it has helped protect our athletes’ health.
Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial
Authors: Nathan Nicole , Hall Alix , McCarthy Nicole , Sutherland Rachel , Wiggers John , Bauman Adrian E , Rissel Chris , Naylor Patt-Jean , Cradock Angie , Lane Cassandra , Hope Kirsty , Elton Benjamin , Shoesmith Adam , Oldmeadow Christopher , Reeves Penny , Gillham Karen , Duggan Bernadette , Boyer James , Lecathelinais Christophe , Wolfenden Luke 
Published: May 2021

ObjectivesTo assess if a multi-strategy intervention effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months and 18 months.MethodsA cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal’s mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October–December 2017), 12-month (October–December 2018) and 18-month (April–June 2019). Data were analysed using linear mixed effects regression models.ResultsOverall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; p<0.001) which remained at 18 months, however, the effect size was smaller at 27.1 min (95% CI 15.5 to 38.6; p≤0.001).ConclusionA multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research should assess the impact of scale-up strategies on the sustainability of PA policy implementation over longer time periods.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12617001265369).
Rehabilitation post-COVID-19: cross-sectional observations using the Stanford Hall remote assessment tool
Authors: O’Sullivan Oliver , Barker-Davies R M , Thompson K , Bahadur S , Gough M , Lewis S , Martin M , Segalini A , Wallace G , Phillip R , Cranley M 
Published: May 2021

IntroductionThe multisystem COVID-19 can cause prolonged symptoms requiring rehabilitation. This study describes the creation of a remote COVID-19 rehabilitation assessment tool to allow timely triage, assessment and management. It hypotheses those with post-COVID-19 syndrome, potentially without laboratory confirmation and irrespective of initial disease severity, will have significant rehabilitation needs.MethodsCross-sectional study of consecutive patients referred by general practitioners (April–November 2020). Primary outcomes were presence/absence of anticipated sequelae. Binary logistic regression was used to test association between acute presentation and post-COVID-19 symptomatology.Results155 patients (n=127 men, n=28 women, median age 39 years, median 13 weeks post-illness) were assessed using the tool. Acute symptoms were most commonly shortness of breath (SOB) (74.2%), fever (73.5%), fatigue (70.3%) and cough (64.5%); and post-acutely, SOB (76.7%), fatigue (70.3%), cough (57.4%) and anxiety/mood disturbance (39.4%). Individuals with a confirmed diagnosis of COVID-19 were 69% and 63% less likely to have anxiety/mood disturbance and pain, respectively, at 3 months.ConclusionsRehabilitation assessment should be offered to all patients suffering post-COVID-19 symptoms, not only those with laboratory confirmation and considered independently from acute illness severity. This tool offers a structure for a remote assessment. Post-COVID-19 programmes should include SOB, fatigue and mood disturbance management.
Value improvement at the point of care: engaging and empowering front-line teams with a new quality improvement methodology
Authors: Gupta Poonam , Chacko Gracy , Mavin Paul , McDonald Ian , El Hassan Mawahib , Omari Emad , Ali Azhar , Siddiqui Raana , Khan Needa , McKenzie Lisa , Bolender Tricia , Andrews William 
Published: May 2021

BackgroundHealthcare organisations require systems to consistently meet the needs of their patients while providing excellent quality of care. The value improvement (VI) approach was developed by the Institute for healthcare improvement and successfully piloted at Raigmore Hospital, Scotland. It showed positive results in improving outcomes and reducing costs. Our multidisciplinary team from a tertiary care cardiac hospital in Doha, Qatar wanted to see if we could improve value in a clinically and geographically distinct context. We sought to understand the effectiveness of this approach as an integrative management philosophy that aims for continuous improvement in the quality of services by increasing efficiency and reducing waste.MethodsThis study evaluates the outcomes achieved from applying the VI methodology. The method is rooted in a framework that emphasises standardisation, continuous process improvement and rightsizing capacity to demand. The main tools include a data box score, a visual management board and weekly communication huddles.ResultsAs a result of the VI methodology, our team achieved improvements across performance, staff capacity and cost domains. Compared with the 4–8 weeks baseline data collection period, these improvements included an increase in discharges before 13:00 hour by 61%, a reduction in the number of blood samples per patient per day by 20%, an increase in nursing time spent in direct patient care by 18%, and an increase in staff satisfaction to 40%.ConclusionsWe found that the VI approach offered a systematic method for continuously improving the quality of care by focusing attention each week on safety, efficiency and patient experience. The team improved numerous processes and outcomes resulting in a positive impact on patients and families and increased the engagement of staff in continuous improvement. In this way, we improved our capacity to undertake and complete quality projects.
Importance of living arrangements and coparenting quality for young children’s mental health after parental divorce: a cross-sectional parental survey
Authors: Bergström Malin , Salari Raziye , Hjern Anders , Hognäs Robin , Bergqvist Kersti , Fransson Emma 
Published: May 2021

BackgroundParental separation has been associated with adverse child mental health outcomes in the literature. For school-aged children, joint physical custody (JPC), that is, spending equal time in both parents’ homes after a divorce, has been associated with better health and well-being than single care arrangements. Preschool children’s well-being in JPC is less studied. The aim of this study was to investigate the association of living arrangements and coparenting quality with mental health in preschool children after parental separation.MethodsThis cross-sectional population-based study includes 12 845 three-year-old children in Sweden. Mental health was measured by parental reports of the Strength and Difficulties Questionnaire and coparenting quality with a four-item scale. The living arrangements of the 642 children in non-intact families were categorised into JPC, living mostly with one parent and living only with one parent.ResultsLinear regression models, adjusted for sociodemographic confounders, showed an association between increased mental health problems and living mostly and only with one parent (B=1.18; 95% CI 0.37 to 2.00, and B=1.20; 95% CI 0.40 to 2.00, respectively), while children in intact families vs JPC did not differ significantly (B=−0.11; 95% CI −0.58 to 0.36). After adjusting the analyses for coparenting quality, differences in child mental health between the post divorce living arrangements were, however, minimal while children in intact families had more mental health problems compared with JPC (B=0.70; 95% CI 0.24 to 1.15). Factorial analysis of covariance revealed that low coparenting quality was more strongly related to mental health problems for children in intact families and JPC compared with children living mostly or only with one parent.ConclusionsThis study suggests that coparenting quality is a key determinant of mental health in preschool children and thus should be targeted in preventive interventions.
Incidence and impact of incivility in paramedicine: a qualitative study
Authors: Credland Nicola Jane , Whitfield Clare 
Published: May 2021

BackgroundIncivility or rudeness is a form of interpersonal aggression. Studies suggest that up to 90% of healthcare staff encounter incivility at work with it being considered ‘part of the job’.MethodsQualitative, in-depth, semistructured interviews (n=14) undertaken between June and December 2019. Purposive sampling was used to identify front-line paramedics working for one NHS Ambulance Trust. Interviews lasted between 16 and 45 min, were audiorecorded, verbatim transcribed and analysed using thematic analysis.ResultsFour themes were identified: paramedics reported a lack of respect displayed both verbally and non-verbally from other professional groups. The general public and interdisciplinary colleagues alike have unrealistic expectations of the role of a paramedic. In order to deal with incivility paramedics often reported taking the path of least resistance which impacts on ways of working and shapes subsequent clinical decision-making, potentially threatening best practice. Finally paramedics report using coping strategies to support well-being at work. They report that a single episode of incivility is easier to deal with but subsequent episodes compound the first.ConclusionsThis study highlights the effect incivility can have on operational paramedics. Incivility from the general public and other health professionals alike can have a cumulative effect impacting on well-being and clinical decision-making.